Vocational Profiles of Individuals With Disabilities: A Latent Profile Analysis Using the Work Rehabilitation Questionnaire (WORQ).

Using Latent Profile Analysis and Related Approaches in Adolescent Health Research

Whileevidence-based practice (EBP)is recognized as integral to vocational rehabilitation (VR) and rehabilitation counseling, the literature in these fields is marked by inconsistencies and lacks clear definitions, with little exploration of how EBP was adapted from its roots in medicine. This literature review traces the conceptual evolution of EBP in VR and rehabilitation counseling. The goal is to identify the origins, key milestones, and contributions that led to the adoption and development of EBP within VR and rehabilitation counseling. A comprehensive literature review was conducted, analyzing the progression of EBP from its foundation in evidence-based medicine (EBM) in the 1970s to its integration into VR and rehabilitation counseling. The review included an examination of key publications and the development of an Evolutionary Model of Evidence-Based Practice in Vocational Rehabilitation and Rehabilitation Counseling. The review identified that EBP in VR and rehabilitation counseling evolved through a gradual, multifaceted process influenced by developments in related domains, such as mental health, nursing administration, and general rehabilitation. Contrary to the notion of an EBP movement in VR, the integration of EBP was driven by the adoption of concepts and practices from EBM and their adaptation to the specific needs of VR and rehabilitation counseling. The Evolutionary Model of Evidence-Based Practice in Vocational Rehabilitation and Rehabilitation Counseling illustrates the progression of EBP within these fields. This model provides a framework for understanding the historical and theoretical underpinnings of EBP in VR and offers insights into its ongoing development. The findings suggest that the integration of EBP in these fields was a gradual process that was shaped by interdisciplinary influences rather than a singular movement.

This study examined empirically derived symptom cluster profiles among patients who present with insomnia using clinical data and polysomnography. Latent profile analysis was used to identify symptom cluster profiles of 175 individuals (63% female) with insomnia disorder based on total scores on validated self-report instruments of daytime and nighttime symptoms (Insomnia Severity Index, Glasgow Sleep Effort Scale, Fatigue Severity Scale, Beliefs and Attitudes about Sleep, Epworth Sleepiness Scale, Pre-Sleep Arousal Scale), mean values from a 7-day sleep diary (sleep onset latency, wake after sleep onset, and sleep efficiency), and total sleep time derived from an in-laboratory PSG. The best-fitting model had three symptom cluster profiles: "High Subjective Wakefulness" (HSW), "Mild Insomnia" (MI) and "Insomnia-Related Distress" (IRD). The HSW symptom cluster profile (26.3% of the sample) reported high wake after sleep onset, high sleep onset latency, and low sleep efficiency. Despite relatively comparable PSG-derived total sleep time, they reported greater levels of daytime sleepiness. The MI symptom cluster profile (45.1%) reported the least disturbance in the sleep diary and questionnaires and had the highest sleep efficiency. The IRD symptom cluster profile (28.6%) reported the highest mean scores on the insomnia-related distress measures (eg, sleep effort and arousal) and waking correlates (fatigue). Covariates associated with symptom cluster membership were older age for the HSW profile, greater obstructive sleep apnea severity for the MI profile, and, when adjusting for obstructive sleep apnea severity, being overweight/obese for the IRD profile. The heterogeneous nature of insomnia disorder is captured by this data-driven approach to identify symptom cluster profiles. The adaptation of a symptom cluster-based approach could guide tailored patient-centered management of patients presenting with insomnia, and enhance patient care.

Purpose (1) To perform a cross-cultural adaptation of Work Rehabilitation Questionnaire to Russian (WORQ-R); (2) to report the psychometric properties of WORQ-R in patients with traumatic spinal cord injury (TSCI). Materials and methods WORQ is designed to evaluate the work functioning of individuals who are engaged in vocational rehabilitation. We performed a formal cross-cultural adaptation of WORQ from English to Russian utilizing a standardized 3-step approach. We examined the psychometric properties of WORQ-R in terms of its reliability and construct validity through the use of classical and modern test theory in the TSCI population. Results The adaptation process achieved equivalence between Russian and English versions of WORQ. WORQ-R proved to cover major issues concerning functioning in vocational rehabilitation and was simple to understand. The internal consistency of WORQ-R was good (Cronbach’s Alpha = 0.83). Rasch analysis confirmed the unidimensionality of the WORQ-scale and high reliability (PSI = 0.97) based on a testlet solution. WORQ-R score showed a strong negative correlation with the Functional Independence Measure, moderate negative correlation with the Spinal Cord Independence Measure Version III and the SF-36, moderate positive correlation with the Spinal Cord Injury Secondary Conditions Scale. Conclusions WORQ-R showed good validity and reliability in persons with TSCI allowing vocational professionals to have comprehensive information on vocational functioning. IMPLICATIONS FOR REHABILITATION SCI is a disabling condition that causes impairments in body structure and function leading to activity limitations and participation restrictions. WORQ is a generic tool that allows for an assessment of work-related aspects of functioning in different populations of persons with disabilities. This study demonstrates the psychometric properties of the Russian version of WORQ in the SCI population. WORQ-R is recommended as a tool to describe the biopsychosocial and related vocational background to gain a better understanding of needs among SCI persons in terms of vocational rehabilitation.

The International Classification of Functioning, Disability and Health (ICF) has proven to be a valuable framework for vocational rehabilitation (VR). No reliable and valid ICF-based instruments to capture work functioning is known, hence, the aims of this study were: (1) to outline the process for developing an ICF-based questionnaire, the Work Rehabilitation Questionnaire (WORQ) to assess functioning in VR and (2) to report preliminary psychometric evidence. ICF categories were selected from the ICF Core Sets for VR using explorative Rasch-analysis and VR literature review. Questions were worded to assess identified ICF categories. WORQ was translated from English to German. Psychometrics for the German version of WORQ was examined in one VR centre in Switzerland. 44 ICF categories were selected which resulted in 36 questions related to functioning. The psychometric evaluation of WORQ showed high test-retest reliability (Spearman correlation 0.79) (n = 53) and good internal consistency (Cronbachs Alpha 0.88) (n = 74) WORQ showed moderate correlation with Beck Depression Inventory II (Spearman correlation 0.511) and low correlation (Spearman correlation -0.353) with SF-36. WORQ appears to be a reliable, ICF-based questionnaire to evaluate functioning in VR, easy to administer by health or vocational professionals. The additional information gained when using WORQ would contribute to improving interdisciplinary understanding of the patient's situation and therefore support the integrative planning of the return-to-work process or engagement in gainful employment. However, further studies are needed to further examine its use in clinical practice and research, when validated in other patient populations and settings.

Derive latent profiles of accelerometry-measured moderate-vigorous physical activity (MVPA) for Hispanic/Latino adults, examine associations between latent MVPA profiles and neurocognition, and describe profiles via self-reported MVPA. Complex survey design methods were applied to cross-sectional data from 7,672 adults ages 45-74 years in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL; 2008-2011). MVPA was measured via hip-worn accelerometers. Latent profile analysis was applied to derive latent MVPA profiles (minutes/day of week). Neurocognition was assessed with the Brief-Spanish English Verbal Learning Test (B-SEVLT) Sum, B-SEVLT Recall, Controlled Oral Word Association Test (word fluency), and Digit Symbol Substitution (DSS) test. All tests were z-scored, and a global neurocognition score was generated by averaging across scores. Survey linear regression models were used to examine associations between latent MVPA profiles and neurocognitive measures. Self-reported MVPA domains were estimated (occupational, transportation, and recreational) for each latent profile. Four latent MVPA profiles from the overall adult target population (18-74 years) were derived and putatively labeled: No MVPA, low, moderate, and high. Only the high MVPA profile (compared to moderate) was associated with lower global neurocognition. Sensitivity analyses using latent MVPA profiles with only participants aged 45-74 years showed similar profiles, but no associations between latent MVPA profiles and neurocognition. The occupational MVPA domain led in all latent MVPA profiles. We found no consistent evidence to link accelerometry-measured MVPA profiles to neurocognitive function. Research to better characterize the role of high occupational MVPA in relation to neurocognition among Hispanic/Latino adults are needed.

Cross-cultural translation to French and psychometric evaluation of the self-administered version of the WOrk Rehabilitation Questionnaire (WORQ)

Traumatic brain injury (TBI) produces broad-reaching and often persistent challenges that impact an individual’s ability to engage in vocational productivity. Return to work (RTW) rates after TBI are markedly poor and the efficacy of current TBI vocational rehabilitation (VR) practices is unclear. Positive psychology, the practice of fostering positive emotions and traits, offers novel approaches that might enhance the effectiveness of existing TBI VR practices. This article assesses the potential relevance of positive psychology principles and practices to VR for clients recovering from TBI. A literature search was conducted using the database resources of a large university hospital, including PubMed, ProQuest, PsycINFO, and Web of Science. Content from this search was reviewed and synthesized, including literature on VR for TBI, vocational applications of positive psychology, and general rehabilitation applications of positive psychology. Ten guiding principles for positively-informed TBI VR are proposed. Specific positive psychology measures and interventions for improving emotional, social, and cognitive functioning are identified and discussed as they might be applied to TBI VR. Theoretically, positive psychology principles and practices appear to be well suited to improving VR outcomes for individuals with TBI. In addition to examining the feasibility of incorporating positive psychology techniques, future research should examine the impact of positive psychology interventions on RTW rates, job satisfaction, job stability, and other vocational outcomes. With additional investigation, positive psychology measures and interventions may prove to be a beneficial compliment to existing VR practices.

This chapter will introduce the reader to an example on how an assessment instrument, based on the International Classification of Functioning, Disability, and Health can be developed. It lines out the reasoning behind the development of the new instrument as well as the methodology that was used. The instrument is a questionnaire designed to evaluate functioning in vocational rehabilitation – the Work Rehabilitation Questionnaire (WORQ). In a further step the strengths and weaknesses of a generic instrument as the WORQ and the need for disease-specific or symptom-specific instruments and their respective roles in the vocational rehabilitation process will be discussed. In this context we also reflect on the role of environmental and personal factors when evaluating functioning in vocational rehabilitation.

Latent profile analysis (LPA) has become a popular statistical method for modeling unobserved population heterogeneity in cross-sectionally sampled data, but very few empirical studies have examined the question of how well enumeration indexes accurately identify the correct number of latent profiles present. This Monte Carlo simulation study examined the ability of several classes of enumeration indexes to correctly identify the number of latent population profiles present under 3 different research design conditions: sample size, the number of observed variables used for LPA, and the separation distance among the latent profiles measured in Mahalanobis D units. Results showed that, for the homogeneous population (i.e., the population has k = 1 latent profile) conditions, many of the enumeration indexes used in LPA were able to correctly identify the single latent profile if variances and covariances were freely estimated. However, for a heterogeneous population (i.e., the population has k = 3 distinct latent profiles), the correct identification rate for the enumeration indexes in the k = 3 latent profile conditions was typically very low. These results are compared with the previous cross-sectional mixture modeling studies, and the limitations of this study, as well as future cross-sectional mixture modeling and enumeration index research possibilities, are discussed.

Working on activation : analyses of stories about vocational rehabilitation of people with disabilities in the Netherlands

Background: Employment rates among people with spinal cord injury or spinal cord disease (SCI/D) show considerable variation across countries. One factor to explain this variation is differences in vocational rehabilitation (VR) systems. International comparative studies on VR however are nonexistent. Objectives: To describe and compare VR systems and practices and barriers for return to work in the rehabilitation of persons with SCI/D in multiple countries. Methods: A survey including clinical case examples was developed and completed by medical and VR experts from SCI/D rehabilitation centers in seven countries between April and August 2017. Results: Location (rehabilitation center vs community), timing (around admission, toward discharge, or after discharge from clinical rehabilitation), and funding (eg, insurance, rehabilitation center, employer, or community) of VR practices differ. Social security services vary greatly. The age and preinjury occupation of the patient influences the content of VR in some countries. Barriers encountered during VR were similar. No participant mentioned lack of interest in VR among team members as a barrier, but all mentioned lack of education of the team on VR as a barrier. Other frequently mentioned barriers were fatigue of the patient (86%), lack of confidence of the patient in his/her ability to work (86%), a gap in the team's knowledge of business/legal aspects (86%), and inadequate transportation/accessibility (86%). Conclusion: VR systems and practices, but not barriers, differ among centers. The variability in VR systems and social security services should be considered when comparing VR study results.

Evidence-based practices are utilized in vocational rehabilitation and rehabilitation counseling when providing services. This study aims to articulate practices related to evidence-based practice and present literature-based definitions for these practices in the field. The research explored evidence-based and related practices, definitions presented, and a model to represent their relationships. A scoping review, conducted as a metasynthesis, was used to identify primary sources defining evidence-based and related practices in these fields. Results revealed that evidence-based practice, first associated with vocational rehabilitation in 1998, originated from evidence-based medicine and mental health disciplines. Since then, nine additional nonevidence-based practices have emerged, including unestablished, strengths-based, best, evidence-based best, research-based, emerging, promising, and value-based practices. The review found that the best practices are the most common, though many lack empirical validation. A hierarchical model was developed to illustrate the relationships among these practices. The study concluded that the literature lacks consistent definitions of evidence-based and related practices, which undermines the empirical integrity of vocational rehabilitation and rehabilitation counseling. The dominance of loosely defined best practices highlights the need for future research to validate individual practices through rigorous experimental methods.

The Comprehensive ICF Core Set for vocational rehabilitation (VR) is a list of essential categories on functioning based on the World Health Organization (WHO) International Classification of Functioning, Disability and Health (ICF), which describes a standard for interdisciplinary assessment, documentation, and communication in VR. The aim of this study was to examine the content validity of the Comprehensive ICF Core Set for VR from the perspective of physical therapists. A 3-round email survey was performed using the Delphi method. A convenience sample of international physical therapists working in VR with work experience of ≥2 years were asked to identify aspects they consider as relevant when evaluating or treating clients in VR. Responses were linked to the ICF categories and compared with the Comprehensive ICF Core Set for VR. Sixty-two physical therapists from all 6 WHO world regions responded with 3,917 statements that were subsequently linked to 338 ICF categories. Fifteen (17%) of the 90 categories in the Comprehensive ICF Core Set for VR were confirmed by the physical therapists in the sample. Twenty-two additional ICF categories were identified that were not included in the Comprehensive ICF Core Set for VR. Vocational rehabilitation in physical therapy is not well defined in every country and might have resulted in the small sample size. Therefore, the results cannot be generalized to all physical therapists practicing in VR. The content validity of the ICF Core Set for VR is insufficient from solely a physical therapist perspective. The results of this study could be used to define a physical therapy-specific set of ICF categories to develop and guide physical therapist clinical practice in VR.

Introduction: Cardio-metabolic disease (CMetD) is a prevalent health issue among healthcare professionals, and suboptimal management of metabolic disorders places a burden on the healthcare system. Methods: The present study aimed to cluster the participants based on risk factors for the CMetDs using Latent Profile Analysis (LPA). This study was conducted on 500 healthcare providers, aged 18 to 75 years at Tabriz University of Medical Sciences, Tabriz, Iran. LPA was used to explore the latent risk profiles based on age, blood pressure (BP), lipid profile, insulin, body mass index (BMI), and waist circumference. Results: The individuals were classified into three LPA-driven profiles: low (42.4%), intermediate (21.8%), and high (35.8%). The high-risk profile found in older age and higher BMI, insulin, fasting blood glucose (FBS), as well as higher levels of high-density lipoprotein (HDL) cholesterol, low-density lipoprotein (LDL) cholesterol, total cholesterol, and triglyceride. Furthermore, in the intermediate risk profile, elevated levels of systolic/diastolic BP and waist circumference were associated with higher levels of risk. Haemoglobin and hematocrit levels were significant predictors of low and intermediate latent profiles. Higher levels of hemoglobin and hematocrit were associated with lower odds of being in low and intermediate latent profiles, compared to the high-risk profile (all P<0.05). Conclusion: LPA-derived latent profiles and the specific predictors of profiles help find control and prevention measures in CMetDs; older individuals with poorer lipid profiles, and, elevated insulin, triglyceride, FBS, BP, and BMI levels should be screened more carefully.