Cognitions and emotions as predictors of recovery in conditions involving physical disability

摘要

Patients with conditions involving physical disability varyudconsiderably in the course of their recovery. Initial severityudas judged by clinical examination is the usual baseline for predictingudeventual outcome but considerable variability has beenudobserved in the process of recovery in patients with conditionsudof similar initial severity. Recognizing the many potential influencesudon the process of recovery, medical, personal, environmentaludand social, this study investigated psychological factors as predictorsudof different aspects of recovery. The hypotheses tested wereudthat cognitions, such as the patients' perceptions of their conditionudand its implications for them, their perceptions about theirudcontrol over their own recovery, the attributions made about theirudcondition and events in their recovery, the ways in which they copedudwith the problems imposed by their condition and their emotionaludresponses, would be more reliable predictors of different aspects ofudrecovery from physical disability than initial clinical severity.udPhysical disability was conceptualized at two levels, as restrictionudin the performance of movements and restriction in the performanceudof functions and activities.udThe investigation was undertaken in four stages. Early exploratoryudwork of the first two stages studied over 100 patients withudphysical disability during the process of their recovery, by observation,udsemi-structured interviews and videorecording. In the thirdudstage methods of measurement of clinical indices of the selected conditionsudwere developed and tested with the study population. Psychometricudmethods were also tested and where necessary developed.udIn the fourth stage hypotheses about the relationships between clinicaludindices and psychological factors were tested with 40 subjects withudphysical disability, 20 with stroke, 20 with a wrist fracture. There was considerable support for the overall hypothesisudthat psychological factors would be reliable predictors of differentudaspects of recovery. Initial clinical severity was a poor predictorudof outcome in terms of performance of movements and functions, andudindividual perceptions of severity of condition showed little relationshipudto objective measurements of severity. Perceptions of personaludcontrol over recovery were associated with more effective recovery inudterms of performance, and general level of raised emotional responseudwith some less effective levels of performance. These results needudto be re-examined using larger groups of subjects, and including thoseudwith other conditions involving physical disability to find if resultsudcan be generalized. The results provide information about factorsudinfluencing the process of recovery from conditions involving physicaluddisability.