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Background: The McGill Quality of Life Questionnaire-Revised (MQoL-R) is the gold standard for assessing QoL in end-of-life, chronic patients; however, an Italian standardization is lacking., Objective: This study aimed at assessing the psychometric properties of the Italian MQoL-R in patients with chronic neurological/oncological conditions., Methods: 177 inpatients with life-threatening, chronic neurological/oncological conditions were consecutively recruited in 8 clinics in Northern/Southern Italy were administered the MQoL-R and the Karnofsky Performance Status (KPS). Factorial structure (Confirmatory Factor Analysis, CFA), reliability (Cronbach's α) and construct validity against the KPS (Pearson's coefficients) were examined., Results: The four-factor model (Physical, Psychological, Existential and Social subscales) was met (comparative fit index = .93; root mean square error of approximation = .07), with all items significantly loading on respective subscales. Internal consistency was good for both the whole scale (Cronbach's α = .83) and subscales ( range  = .6-.85). The KPS was unrelated to MQoL-R measures, except for the Physical subscale ( r  = .24)., Conclusions: The Italian MQoL-R is a valid and reliable tool to assess QoL in end-of-life, both neoplastic and neurological, chronic inpatients undergoing palliative care, whose adoption is thus encouraged in both clinical practice and research addressed to such populations.

Objectives: The aim of this study was to develop and validate a questionnaire designed to measure the impact of sleep impairment on emotional distress in patients with various sleep disorders., Methods: Five experts created an item data-bank pertaining to sleep-related psychological symptoms and somatic perceptions. Fifty patients in two focus groups examined each item for: a) word clarity (indicating any ambiguity of interpretation) and b) appropriateness for the target population. This process permitted to identify 36 appropriate items. Classical Test Theory and Rasch Analysis were used to further refine the questionnaire, yielding the final 17-item set. Concurrent validation of the new scale was tested with the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, and the Anxiety and Depression questionnaires., Results: Starting from the initial item data-bank, a 17-item questionnaire, the Maugeri Sleep Quality and Distress Inventory (MaSQuDI-17), was produced. Parallel Analysis on the MaSQuDI-17 confirmed the presence of a single dimension; exploratory factor analysis showed salient loading for each item, explaining 58.7% of total variance. Item-remainder correlation ranged from 0.72 to 0.39 and Cronbach alpha was 0.896. Rasch analysis revealed satisfactory psychometric properties of the new scale: the rating structure performed according to expectations, model fit was good and no item dependencies emerged. The scale presented good convergent validity and scores significantly distinguished healthy subjects from OSAS or Insomnia or BSD (p < 0.001)., Conclusions: MaSQuDI -17 shows good psychometric qualities, and can be used to assess the impact of sleep disorders such as Insomnia, OSAS, Central Hypersomnia and BSD on emotional stress.

Guidelines in stroke rehabilitation recommend the use of a multidisciplinary approach. Different approaches and techniques with music are used in the stroke rehabilitation to improve motor and cognitive functions but also psychological outcomes. In this randomized controlled pilot trial, relational active music therapy approaches were tested in the post-acute phase of disease. Thirty-eight hospitalized patients with ischemic and hemorrhagic stroke were recruited and allocated in two groups. The experimental group underwent the standard of care (physiotherapy and occupational therapy daily sessions) and relational active music therapy treatments. The control group underwent the standard of care only. Motor functions and psychological aspects were assessed before and after treatments. Music therapy process was also evaluated using a specific rating scale. All groups showed a positive trend in quality of life, functional and disability levels, and gross mobility. The experimental group showed a decrease of anxiety and, in particular, of depression (p = 0.016). In addition, the strength of non-dominant hand (grip) significantly increased in the experimental group (p = 0.041). Music therapy assessment showed a significant improvement over time of non-verbal and sonorous-music relationships. Future studies, including a greater number of patients and follow-up evaluations, are needed to confirm promising results of this study.

Aims and Objectives: The aims of this study were to: (1) identify the role of organisational and personal factors in predicting work engagement in healthcare workers and (2) compare work engagement and occupational stress perceptions of healthcare professional categories., Background: Healthcare professionals, with particular regard to nurses, are exposed to several job stressors that can adversely affect both their mental and physical health and also decrease work engagement. Work engagement can be considered as the positive opposite of burnout, and it is characterised by energy, involvement and professional efficacy., Design: A cross-sectional survey research was conducted with self-report questionnaires., Methods: The Maslach Burnout Inventory-General Survey, the Areas of Worklife Scale and four scales from the Occupational Stress Indicator were administered to a sample of 198 hospital staff (registered nurses, nurse aides, physicians and physiotherapists), of which 110 participated in the study., Results: The most significant predictors of energy were workload, mental health and job satisfaction; the best predictors of involvement were community, workload, mental health and job satisfaction; professional efficacy was best predicted by values and job satisfaction. In relation to the second aim, physiotherapists had the highest levels of occupational stress and disengagement from their work, while nurse aides were the most work-engaged and job-satisfied professional category, with positive perceptions of the work environment., Conclusions: Both organisational and personal factors were found to be significantly associated with work engagement. In this study, physiotherapists were the category with the highest risk of work-related psychological problems, whereas nurse aides had the lowest risk., Relevance to Clinical Practice: Interventions aimed at improving clinical practice and psychological health of nurses and hospital staff should focus on workload, workers' personal expectations and job satisfaction., (© 2013 Blackwell Publishing Ltd.)

Background: Occupational stress and job dissatisfaction are recognized risk factors for healthcare professionals and can lead to a decrease in work performance and in the quality of care offered, and to poorer health of workers. Research in the rehabilitation care setting is very limited and needs to be explored., Objectives: To investigate occupational stress, job satisfaction and their relationships with organizational factors among healthcare staff in rehabilitation units., Methods: A cross-sectional study of healthcare staff working in two rehabilitation units was conducted. They were sent two self-administered questionnaires, the Occupational Stress Indicator (OSI) and the Areas of Work life Scale (AWS), in order to assess occupational stress and job satisfaction. One-way ANOVA was used to explore work stress among two groups of workers, characterized by high and low job satisfaction levels. Stepwise multiple linear regression analysis was conducted to assess the association between job satisfaction and organizational risk factors., Results: A total of 90 questionnaires were returned (response rate 53%). The main sources of stress were unfairness, conflict between personal and organizational values, lack of reward and workload Workers with low job satisfaction significantly scored higher in work-related stress in regard to various aspects of work, and in lower job control. Regression analysis showed that the most important predictors of job satisfaction were fairness and workload., Conclusions: The results of this study showed that job dissatisfaction is strongly associated with work stress and certain organizational risk factors. This study suggests the importance of focusing on the psychosocial factors in the work environment and job satisfaction in order to improve the well-being of rehabilitation healthcare staff.

Objective: Different social norms influence the type and amount of information transmitted to palliative care patients. In Italy disclosure rate is low and medical decisions are often mediated by the family since communication of diagnosis and prognosis is viewed as harmful and brutal. Aims of our study were to assess palliative care patients' knowledge about their diagnosis and prognosis and expectations; and to evaluate possible differences between palliative care patients with and without cancer., Method: 232 palliative care in-patients participated to the study and were interviewed about their knowledge about his/her diagnosis and prognosis, and about cure and disease expectations, perceived family/social support., Results: Overall, 45.4% of the patients knew their diagnosis and 35.3% had partial knowledge of it; 39.2% knew their prognosis. When the prognosis was fatal, only few patients explicitly referred to it (22.0%). Expectations during admission to the palliative care unit were: return back home after symptom management (61.6%), increase personal autonomy (51.3%), and pain relief (45.2%). Family/social support was frequently perceived as good (84.0%). Patients with cancer less frequently knew their diagnosis (44.7% vs. 52.9%) and prognosis (37.7% vs. 64.7%) compared to patients with a non-cancer diagnosis., Conclusions: About half of our patients were unaware of their diagnosis, although, in reality, about one-third of the patients had some knowledge, albeit partial, of their diagnostic and therapeutic course. What to tell or not to tell in palliative care is still controversial and stems from a tailored intervention involving the patient, his/her family and professionals and silence may be more effective than intrusive communication in helping a patient to approach death with tolerable knowledge and dignity.

Introduction: Quality of life is a dynamic concept that can undergo change with time and/or disease progression. The aim of this study was to test the reliability and validity of the Italian version of the McGill Quality of Life Questionnaire (MQOL-It), that we consider useful for assessing quality of life in Palliative Care., Methods: The MQOL-It was administered by interview to 175 patients (M 108; F 67) admitted to a Unit of Palliative Care. All patients were suffering from advanced disease: cancer, amyotrophic lateral sclerosis, chronic heart failure. Statistical analysis was performed to assess the psychometric properties of the questionnaire., Results: Factor analysis (VARIMAX) revealed four domains of quality of life, though the item composition differed, at composition analysis, from the original MQOL version. "Achieved goals" and "control over life", items classified in the English version as part of the existential domain, in the Italian version fitted the psychological domain; the item "well-being" was grouped into the physical domain and did not load clearly with other factors. Cronbach's alpha for the whole questionnaire was 0.85, with a good internal consistency for the four subscales (Cronbach's alpha > or = 0.65). All MQOL-It subscales were significantly correlated (Spearman correlation) with the Single Item rating Scale (SIS); comparison between the MQOL-It and the Nottingham Health Profile (NHP)-part I showed the instrument's concurrent validity., Conclusions: MQOL shows robust psychometric properties and appears suitable for evaluating quality of life in palliative care in Italy.

Unlabelled: Many studies have focused on the importance of the informal care provided by caregivers and on its impact in terms of worsening quality of life and increased burden. The aim of the present study is to analyze the psychometric validity and reliability of the Caregiver Needs Assessment (CNA) questionnaire, which has been built to investigate the needs (related to assistance) perceived by caregivers of severely impaired patients, particularly in the first stages of their illness., Methods: The CNA was administered to 226 family caregivers (24.3% males) of 197 patients (50.8% males) hospitalized for neuromotor rehabilitation after a stroke, head injury, Lateral Amyotrophic Sclerosis, Parkinson or other severely impairing diseases., Results: The instrument was tested on a large sample (KMO = 0.83) of heterogeneous caregivers. Explorative and confirmatory factor analysis, performed on a two subgroup random subdivision of the sample, showed the presence of two factors with good internal consistency: the factor "needs of emotional and social support" (alpha = 0.765) and the factor "needs of information and communication" (alpha = 0.742). The structural equation modeling confirms the goodness of fit of the 2-factor structure (RMSEA = 0.073; SRMR = 0.1; CFI = 0.96). We observed a positive correlation (p < 0.01) between the factor "needs of emotional and social support" of the CNA and other questionnaires aimed at assessing psychological wellbeing, and between the factor "needs of information and communication" and the factor "needs for knowledge about the disease" of the Family Strain Questionnaire, showing good convergent validity. We also observed high Pearson correlation coefficients (0.942 and 0.965) between test-retest measurements of both factors in the CNA., Conclusion: The statistical analysis confirms the good psychometric properties of the CNA questionnaire. For its brevity and ease in compilation the CNA is promising practical tool aimed at assessing caregivers' needs in order to personalize a programme of psychological support, to measure it's outcome and to provide comparison of the different needs in different diseases.

The sense or meaning (constructed meaning) that a person attributes to their own illness is one of the factors involved in the process of adaptation. The Constructed Meaning Scale (CMS), originally developed in the United States by Fife in 1995, is a brief 8-item survey investigating the subjective meaning that patients associate with their disease. The purpose of this study was to validate an Italian version of the CMS in a sample of patients with chronic disabling disease. The validation process consisted of 4 steps: (1) creation of an Italian version (translation and back translation); (2) administration of the translated version to a small sample of patients affected by different types of disease to verify its comprehensibility; (3) administration of the final version to a sample of 122 patients affected by chronic disabling conditions; (4) statistical analysis. The Italian version of the CMS was found to have the following psychometric properties: range of total-item correlation = .30 to .64; Cronbach's Alpha = .79; correlation with CBA 2.0 Depression Scale = -.44. We isolated two factors through VARIMAX factor analysis, which we defined as "disease as permanent damage" and "process of adaptation". The Italian version of the CMS is easy to understand and minimizes possible cultural biases. The psychometric properties of the scale are satisfactory.

This paper presents a questionnaire designed to assess the aspecific treatment efficacy and subjective perceived efficacy of group therapy. A preliminary version of the instrument was administered to a sample of 151 subjects undergoing group therapy. The psychometric properties of the instrument were evaluated by means of the Rasch model, and showed a good score range, good reproducibility and adequate coherence. The hierarchy of difficulty of the items remained stable among the respective categories of sex, age and professional level.

Background: The primary endpoint of this study was to assess the association of health-related quality of life (QoL) and the presence of psychopathology. The association of other patients' characteristics and of Cognitive Behavioral Assessment (CBA) scales with quality of life (QoL) was also evaluated., Methods: 100 consecutive obese patients (WHO grade 2 and 3 obesity), addressed for psychological advice before either invasive or non-invasive treatment of obesity, were investigated. The instruments used were the SF-36 questionnaire (physical and mental component summaries, PCS and MCS), the CBA scales and psychological counselling. The association of PCS and MCS with the presence of psychopathology (Marked or DSM IV discomfort) was assessed by means of logistic regression., Results: SF-36 PCS was 39.5 (95% CI 37.7-41.3) and MCS 49.8 (95% CI 47.7-51.9). PCS only was significantly lower than the average for the reference normal population. The mean PCS score was similar in the No-Moderate (39.6 (SD 7.6)) and Marked-DSM IV (39.1 (SD 7.6)) groups, with an adjusted odds ratios (OR) of 1.07 (95% CI 0.74-1.55), P=0.706, for 5 points increase in PCS. The mean MCS score was 51.7 (SD 10.3) in the No-Moderate group and 42 (SD 8.1) in the Marked-DSM IV group, with an adjusted OR for 5 points increase in score of 0.63 (95% CI 0.43-0.95), P=0.003., Conclusions: SF-36, and particularly the MCS component, is a simple tool of easy use that could be utilized for identifying patients needing a specific psychological intervention in severely obese subjects applying for a weight reduction program.

The development and the role of cardiac rehabilitation in healthcare programs related to cardiovascular diseases has led to the growth of knowledge, experience and specific technical, scientific, organizational and cultural skills on the part of the different health professionals engaged with the cardiologist in the management of rehabilitation programs. The need to define the characteristics of the psychological intervention in cardiac rehabilitation programs on the basis of scientific evidence encouraged the Board of the Italian Group of Cardiac Rehabilitation and Prevention [Gruppo Italiano di Cardiologia Riabilitativa e Preventiva (GICR)] to set up a working group (WG), composed of psychologists chosen on the basis of their proven specific experience in clinical research, with the task of defining the state-of-the-art of the psychological intervention in cardiac rehabilitation on the basis of documented efficacy, as a first step to formulating Guidelines on Psychological Intervention in Cardiac Rehabilitation. The methodology adopted by the WG was in line with the recommendations of the National Guidelines Program of the Italian Ministry of Health; the WG chose, in addition, to exploit a detailed critical review of clinical psychology practice in order to provide systematic evidence for recommendations and clinical approaches at present supported only by expert opinion. The document, which represents the basis upon which the Guidelines on the psychological activity in cardiac rehabilitation will be drawn up, is subdivided into three parts: an introduction, the main body of the text, and some appendices. In the introduction, the theme and context of the Guidelines are defined, preceded by a series of notes and user instructions; also defined in this section are the intended audience. The main body of the document is structured on the basis of the steps that characterize the interactions between the patient suffering from heart disease and the psychologist, through a qualitative analysis of the intervention offered by the psychologist. The phases of this process have been schematized as follows: selection, entry, evaluation, intervention, follow-up. For each of these phases, the evidence is given in support of the evaluative and therapeutic tools at the psychologist's disposition in the context of cardiac rehabilitation. The appendices to the document contain syntheses of the scientific information, some tables, a glossary and a section providing more in-depth information on specific topics. The recommendations contained in the document elaborated by the WG were formulated on the basis of a systematic review of the evidence available in the Italian and international literature, codified according to the National Guidelines Program. Also included is a series of recommendations or working instructions based on the shared clinical experience of the members of the WG. The state of progress of the work of formulating the Guidelines, the objectives, the methodological premises and the deadlines set for the phases of development, diffusion and implementation were presented at the VI National Congress of the GICR which was held in Cosenza, 3-5 October 2002. The base-draft of the document was submitted to the Scientific Committee of Reviewers. In October 2002 the Executive Committee of the GICR announced to the National Guidelines Program of the Ministry of Health, in the persons of the Presidents of the Advanced Institute of Health and of the Regional Health Services Agency, the planning and the timetable for the formulation of the Guidelines. In the course of the first 4 months of 2003 the document produced will be discussed and reviewed jointly by the WG, the Cardiologic Scientific Board instituted by the GICR enlarged to include a delegate of the patient and volunteer no-profit worker associations. The following phases will include the publication by mid 2003 of a position-paper. The final draft of the Guidelines on Psychological Intervention in Cardiac Rehabilitation will be submitted to the Commission of the National Guidelines Program.