Health-related Functioning Research Articles

Inference Procedures to Quantify the Efficiency-Equality Trade-Off in Health from Stated Preferences: A Case Study in Portugal.

This article develops two inference procedures to calculate the inequality aversion and alpha parameters of a health-related social welfare function with constant elasticity (CES-HRSWF) using stated preferences. Based on the relative concept of inequality, a range of values were proposed for the trade-offs between improving total population health and reducing health inequalities. A self-administered questionnaire was used to collect data from a sample of 422 college students in Portugal. Respondents faced three hypothetical allocation scenarios where they needed to decide between two health programmes that assign different health gains to two anonymous sub-groups of the population and to two sub-groups identified by socioeconomic class. Combinations of the median response to these three questions were used to estimate the parameters of the CES-HRSWF. Findings suggest that the quantification of the efficiency-equality trade-off is not independent of the inference procedure used. Plausible values for the inequality aversion and for the alpha parameters were obtained ranging from 2.24 to 4.85 and from 0.5 to 0.58, respectively. Respondents revealed some aversion to health inequality. However, the extent of this aversion seems to be sensitive to (1) the identification of the groups by occupation status, (2) the size of the health gain, and (3) the inference procedure used.

Finding meaning in suffering?-Meaning making and psychological adjustment over the course of a breast cancer disease.

This study aimed to explore individual meaning systems in the course of a breast cancer disease to test the assumed positive relation between meaning and well-being and to investigate the relationship between post-traumatic growth and well-being. A total of 65 patients with breast cancer were examined 1year after initial treatment and another year follow-up. Questionnaires addressed meaning in life (MLQ), anxiety and depression (HADS), satisfaction with life (SWLS), health-related quality of life (EQ-5D, EORTC) and post-traumatic growth (PTGI). Personal meaning systems were assessed using a qualitative method. In the personal meaning systems with well-being and relationships as the most frequently named meaning categories, the experienced gains far outweigh the losses sustained as a result of the disease. A stronger sense of meaning was related to lower levels of anxiety and depression, a higher level of satisfaction with life and better health-related functioning. Well-being and post-traumatic growth were mostly independent. Reported losses were strongly related to a poorer well-being. Cancer can induce a process of personal growth, and a strong sense of purpose could facilitate psychological adjustment. The often claimed correlation of post-traumatic growth and a better psychological adjustment is still lacking clear evidence, whereas losses proofed to be crucial.

Carotenoid coloration and health status of urban Eurasian kestrels (Falco tinnunculus).

As the world experiences rapid urban expansion, natural landscapes are being transformed into cities at an alarming rate. Consequently, urbanization is identified as one of the biggest environmental challenges of our time, yet we lack a clear understanding of how urbanization affects free-living organisms. Urbanization leads to habitat fragmentation and increased impervious surfaces affecting for example availability and quality of food. Urbanization is also associated with increased pollution levels that can affect organisms directly, via ecophysiological constraints and indirectly by disrupting trophic interactions in multi-species networks. Birds are highly mobile, while an individual is not necessarily exposed to urban stressors around the clock, but nestlings of altricial birds are. Such a city-dwelling species with a long nestling phase is the Eurasian kestrel (Falco tinnunculus) in Vienna, Austria, which forage on a diverse diet differing in composition from rural habitats. Furthermore, prey items vary in nutritional value and contents of micronutrients like carotenoids, which might impact the nestlings’ health. Carotenoids are pigments that are incorporated into integument tissues but also have antioxidant and immunostimulatory capacity, resulting in a trade-off between these functions. In nestlings these pigments function in parent-offspring communication or sibling competition by advertising an individual’s physical or physiological condition. Anthropogenic disturbance and pollutants could have disruptive effects on the coloration of these traits. In this study, we measured carotenoid based coloration and other indicators of individual health (body condition and susceptibility to the ectoparasite Carnus hemapterus) of 154 nestling kestrels (n = 91 nests) along an urban gradient from 2010 to 2015. We found skin yellowness of nestlings from nest-sites in the city-center to be least pronounced. This result might indicate that inner-city nestlings are strongly affected by urban stressors and depleted their stores of dietary carotenoids for health-related functions rather than coloration. In addition, skin yellowness intensified with age and was stronger pronounced in earlier nests. Since the immune system of nestlings is still developing, younger chicks might need more antioxidants to combat environmental stress. Additionally, parasite infection intensity was highest in nestlings with less intense skin yellowness (paler or less yellow pigmented integuments) and in earlier nests of the season. In combination with results from previous studies, our findings provide further support for the low quality of the inner-city habitat, both in terms of productivity and individual health.

Association between Work Related Stress and Health Related Quality of Life: The Impact of Socio-Demographic Variables. A Cross Sectional Study in a Region of Central Italy.

The aim of this work is investigate relationship between health-related quality of life and work-related stress and the impact of gender, education level, and age on this relationship. A cross-sectional study was conducted among workers of various setting in Rome and Frosinone. Work-related stress was measured with a demand–control questionnaire and health-related functioning by SF (short form)-12 health survey. There were 611 participants. Men reported high mental composite summary (MCS) and physical composite summary (PCS). In multivariate analysis age, gender (p < 0.001) and job demand (0.045) predicted low PCS. Low MCS predicted poor PCS. Job demand and educational level resulted negatively associated with MCS. In an analysis stratified for age, gender, and educational level, gender and age resulted effect modifier for MCS, gender and education level for PCS. In women increase of decision latitude predict (p = 0.001) an increase in MCS; a low job demand predict high MCS in male (p ≤ 0.001). In younger workers, a lower level of job demand predicted high MCS (<0.001). For PCS, gender and education level resulted effect modifier. In women, high decision latitude predicted higher PCS (p = 0.001) and lower level of job demand results in higher PCS (p ≤ 0.001). Higher educational level resulted predictor of low PCS. Management of risk about work-related stress should consider socio-demographic factors.

Indirect health-related social control and psychological functioning in Singaporeans with diabetes

We examined indirect health-related social control and the underlying mechanisms of its association with psychological functioning in patients with type 2 diabetes. Singaporean late middle-aged and older adults (N = 199) completed questionnaires measuring indirect social control, self-efficacy, internal diabetes locus of control, and psychological functioning. We used a bootstrapping approach and structural equation modeling to analyze the data. Results showed that indirect social control was associated with diabetes-related emotional distress and depressive symptoms via the mediator of internal diabetes locus of control, but self-efficacy did not mediate this relationship. More specifically, indirect social control was positively associated with higher internal diabetes locus of control, which, in turn, had a negative impact on diabetes-related emotional distress and depressive symptoms.

ICF-Checklist to Evaluate Inclusion of Elderlies with Intellectual Disability - Psychometric Properties

An instrument should have been developed to measure participation as one possible criterion to evaluate inclusion of elderly people with intellectual disability. The ICF was utilized, because participation is one part of health related functioning, respectively disability. Furthermore ICF includes environmental factors (contextual factors) and attaches them an essentially influence on health related functioning, in particular on participation. Thus ICF Checklist additionally identifies environmental barriers for elimination. A linking process with VINELAND-II yielded 138 ICF items for the Checklist. The sample consists of 50 persons with a light or moderate intellectual disability. Two-thirds are female and the average age is 68. They were directly asked about their perceived quality of life. Additionally, proxy interviews were carried out with responsible staff members concerning necessary support and behavioral deviances. The ICF Checklist was administered twice, once (t2) the current staff member should rate health related functioning at the given time and in addition, a staff member who knows the person at least 10 years before (t1) should rate the former functioning. Content validity was investigated with factor analysis and criterion validity with correlational analysis related to supports need, behavioral deviances and perceived quality of life. Quantitative analysis was validated by qualitative content analysis of patient documentation. Factor analysis shows logical variable clusters across the extracted factors but neither interpretable factors. The Checklist is reliable, valid related to the chosen criterions and shows the expected age-related shifts. Qualitative analysis corresponds with quantitative data. ICF Checklist is appropriate to manage and evaluate patient-centered care.

Diagnostic Accuracy of Screening Tests and Treatment for Post-Acute Coronary Syndrome Depression: A Systematic Review.

Patients who have had an acute coronary syndrome (ACS) event have an increased risk for depression. To evaluate the diagnostic accuracy of depression screening instruments and to compare safety and effectiveness of depression treatments in adults within 3 months of an ACS event. MEDLINE, EMBASE, PsycINFO, CINAHL, and Cochrane Database of Systematic Reviews from January 2003 to August 2017, and a manual search of citations from key primary and review articles. English-language studies of post-ACS patients that evaluated the diagnostic accuracy of depression screening tools or compared the safety and effectiveness of a broad range of pharmacologic and nonpharmacologic depression treatments. 2 investigators independently screened each article for inclusion; abstracted the data; and rated the quality, applicability, and strength of evidence. Evidence from 6 of the 10 included studies showed that a range of depression screening instruments produces acceptable levels of diagnostic sensitivity, specificity, and negative predictive values (70% to 100%) but low positive predictive values (below 50%). The Beck Depression Inventory-II was the most studied tool. A large study found that a combination of cognitive behavioral therapy (CBT) and antidepressant medication improved depression symptoms, mental health-related function, and overall life satisfaction more than usual care. Few studies, no evaluation of the influence of screening on clinical outcomes, and no studies addressing several clinical interventions of interest. Depression screening instruments produce diagnostic accuracy metrics that are similar in post-ACS patients and other clinical populations. Depression interventions have an uncertain effect on cardiovascular outcomes, but CBT combined with antidepressant medication produces modest improvement in psychosocial outcomes. Agency for Healthcare Research and Quality (PROSPERO: CRD42016047032).

Identifying content gaps in health status measures for intermittent claudication using the International Classification of Functioning, Disability and Health

ObjectiveThe Walking Impairment Questionnaire (WIQ) and Intermittent Claudication Questionnaire (ICQ) are commonly used patient-reported functional outcome measures for intermittent claudication, but their functional representation has not been characterized. The World Health Organization's International Classification of Functioning, Disability and Health (ICF) framework comprehensively describes health-related function and has been used to evaluate health status and quality of life (QOL) measures. We applied a content analysis technique commonly used in functional rehabilitation research to evaluate ICF domains represented by WIQ and ICQ to characterize their health status and functional representation. MethodsThe overall perspective of each question was assigned as health status–function, health status–disability, Environment–facilitator, Environment–barrier, or QOL. All meaningful concepts in each question were identified and linked to the most appropriate and precise ICF code from the hierarchy of component, chapter, or category using the validated technique. A 20% random sample of questions was secondarily coded with disagreements resolved by discussion. ResultsCodability was agreed upon for 87% of questions; agreement was 100% on component and chapter and 88% on category. WIQ contains 18 concepts among 14 questions (1.3 concepts per question); all questions are from the health status–disability perspective. All WIQ concepts are from the “Activities/Participation-d” ICF component, “Mobility-d4” chapter. “Walking long distances” (d4501, >1 km) is omitted. ICQ contains 37 codable concepts among 16 questions (2.3 concepts per question). Thirteen questions are from health status-disability perspective, three from QOL. Sox of the nine chapters of the “Activities/Participation-d” ICF component are represented by 20 of 37 concepts; 11 of 20 in the “Mobility-d4” chapter. The other “Activities/Participation-d” chapters and categories in ICQ are “Learning/applying knowledge” (“thinking-d163”), “General tasks/demands” (“carrying out daily routine-d230”), “Domestic life” (“shopping-d6200,” “doing housework-d640”), “Major life areas” (“Maintaining a job-d8451”), and “Community life” (“socializing-d9205,” “hobbies-d9204”). “Body Functions-b” ICF component is represented 11 times, covering pain, numbness, emotion, mood, and cardiovascular functions. “Body Structures-s” is represented three times as lower extremity. Neither WIQ nor ICQ specifically addresses “Walking on different surfaces,” (64,502) “Walking around obstacles” (d4503), or “Moving around using equipment” (d465), which includes assistive devices. Walking on an incline is not addressed in WIQ, ICQ, or the ICF. ConclusionsApplying this ICF-based content assessment methodology to patient-reported vascular disease outcome measures is feasible, representing a novel method of assessing such instruments. WIQ's scope is limited; it does not address functional capacity and covers only health status pertaining to walking disability. The ICQ is more inclusive, but concept density may obscure meaning. Neither instrument is functionally comprehensive and both have significant omissions that should be considered for inclusion.

Mental and physical well-being in oncology-hematology–unit personnel

ABSTRACTHealth care workers (HCWs) in university hematology units (UHUs) face high job demand that can have adverse health effects. This cross-sectional study investigated the relationship between some job stressors and health-related quality of life among HCWs of 3 UHUs in Rome. Work-related stress was measured with the Demand–Control Questionnaire; health-related functioning with the mental component score (MCS) and physical component score (PCS) of the Short Form 12 Survey; positivity with the Positivity Scale. Data of 201 respondents were analyzed. Job demand was inversely associated with MCS (p = .05) and PCS (p = .049); job control was directly associated with PCS (p < .001) and MCS (p = .024). A high positivity scale score and high decision latitude score predicted high MCS and PCS. High job demand score predicted low MCS and PCS scores. Reduced job stressors and enhanced positive attitudes can improve HCWs’ health-related quality of life.

Mental Health Integration Past, Present and Future: National Survey into Mental Health Integration in England

Mental health services have undergone radical transformation in the past 30 years. A community based care model has largely replaced the acute and long term care provided in large institutions. This research seeks to examine the transformation of mental health services in England and the relevance to current policy with particular emphasis on the integration of health and social care within mental health services. Through the use of a comprehensive survey of a range of professionals, and interviews with local and national leaders across England involved in both mental health provision and social care, along with a review of published literature, this paper seeks to explore the context and factors that are affecting integration between health and social care in mental health. In 1999, the Government launched a major programme of change and modernisation in mental health services within England with the NSF for Mental Health. What has followed was an expansion of mental health services and an increasing focus on both service user experience and quality of provision. Through numerous iterations of public policy in the subsequent 15 years, there has been a coming together of health and social care provision within mental health firstly facilitated by section 31 of the 1999 Health Act and subsequently by section 75 of the National Health Service Act 2006. Combined, both Acts facilitated the transfer or secondment of social care staff to NHS bodies and the transfer of health related functions of local authorities to NHS bodies that are 'likely to lead to an improvement in the way in which those functions are exercised‟. Throughout England services have generally moved closer together through various levels of integration, ranging from co-location, shared management and information systems without formal s75 agreements to full integration with formal s75 agreements and governance. The objective was to deliver enhanced service experience to service users, improving the quality of care and reducing isolated or silo working. The experience of integration has been as varied as the numerous locations affected. Over the past decade new statutory duties of local authorities have emerged along with changing policy: Mental Capacity Act 2005 followed by the Deprivation of Liberty Safeguards, policies relating to adult safeguarding subsequently enshrined into duties within the 2014 Care Act and the drive to personalisation, prevention and recovery. All these are against a background of significant cuts to local authority budgets. Within mental health services there has been the emergence of Payment by Results (PbR), of enhanced patient safety and quality measures centred on Care Programme Approach, of an increasingly competitive environment between providers and an approximate 8% cut to NHS mental health funding (BBC News March 2015). This changing policy and economic environment has placed significant tensions on local working arrangements between the NHS and local authorities in mental health services, leading to numerous revisions of arrangements, with uncertain outcomes.

Patient-reported outcomes in Takayasu's arteritis

Patient-reported outcomes (PROs) are assessment tools coming directly from patients about their feelings, perceptions, health-related functions, and treatment effects without interpretation by health-care providers. There is a global interest for more "patient-centered care" and PROs in rheumatology. Assessment of disease impact through patient-reported outcome (PRO) measures is a key element for clinical care and clinical research in Takayasu's arteritis (TAK). Currently there are no disease-specific PRO measures to assess quality of life for patients with TAK. Impaired health-related quality of life (HRQoL), functional status, increased anxiety, and depression were shown in patients with TAK in a few studies with generic PRO instruments such as the Short Form-36. However, it is difficult to capture disease-specific effects on patients' daily life and quality of life with these generic tools. There are ongoing efforts of Outcome Measures in Rheumatology (OMERACT) Vasculitis Working Group to develop disease-specific outcome measures in TAK.

Consequences of maternal morbidity on health-related functioning: a systematic scoping review

ObjectivesTo assess the scope of the published literature on the consequences of maternal morbidity on health-related functioning at the global level and identify key substantive findings as well as research...

Health-Related Lifestyle Factors and Sexual Functioning and Behavior in Older Adults

ABSTRACTThis study explored associations between health-related lifestyle factors and sexual functioning and behavior in 6,916 adults aged 50 and over. Results showed that an active lifestyle was associated with a higher sex drive, more sexual activity, and lower levels of sexual dysfunction (with stronger associations among men). Poor sleep was associated with less sexual activity, higher levels of sexual dissatisfaction, and higher levels of sexual dysfunction. A healthier diet and a higher alcohol intake were associated with more sexual activity and a higher sex drive. Taken together, these findings demonstrate that health-related lifestyle factors are important for sexual functioning and behavior in older adulthood.

Life satisfaction of women of working age shortly after breast cancer surgery

PurposeTo explore, among women of working age, satisfaction with life as a whole and with different life domains, and its associations with social and health variables, shortly after breast cancer surgery.MethodsThis cross-sectional study included 605 women, aged 20–63 years, who had had breast cancer surgery with no distant metastasis, pre-surgical chemotherapy, or previous breast cancer. Associations between LiSat-11 and demographic and social factors as well as health- and treatment-related variables were analysed by multivariable logistic regression.ResultsCompared with Swedish reference levels, the women were, after breast cancer surgery, less satisfied with life, particularly sexual life. Women working shortly after breast cancer surgery were more often satisfied with life in provision domains compared with the reference population. Although most included variables showed associations with satisfaction, after adjustment for all significantly associated variables, only six variables—having children, being in work, having emotional and informational social support, and having good physical and emotional functioning—were positively associated with satisfaction with life as a whole. The odds ratios for satisfaction were higher in most life domains if the woman had social support and good emotional and cognitive functioning.ConclusionsOne month after breast cancer surgery, satisfaction with different life domains was associated primarily with social support and health-related functioning. However, this soon after surgery, treatment-related variables showed no significant associations with life satisfaction. These results are useful for planning interventions to enhance e.g. social support and emotional as well as cognitive functioning.

Information tailoring and framing in wearable health communication

Wearable devices, including smartwatches, smart glasses, and fitness trackers, are becoming increasingly popular, and greater emphasis is being placed on their health-related functions. In light of this new development, this study explores the role of smartwatches as mobile health communication tools and proposes information tailoring (personalization vs. customization) and regulatory framing (promotion vs. prevention-framed) as potential strategies for promoting the tendency for self-preservation. Results from a between-subjects experiment (N = 100) revealed that a customized as opposed to a personalized health message was more effective in promoting self-preservation and inducing positive attitudes toward and representativeness of the message. Meanwhile, regulatory framing was found to have no effects on the outcome. Theoretical and design implications of the key findings are discussed.

Positive effect of dietary lutein and cholesterol on the undirected song activity of an opportunistic breeder.

Song is a sexually selected trait that is thought to be an honest signal of the health condition of an individual in many bird species. For species that breed opportunistically, the quantity of food may be a determinant of singing activity. However, it is not yet known whether the quality of food plays an important role in this respect. The aim of the present study was to experimentally investigate the role of two calorie-free nutrients (lutein and cholesterol) in determining the expression of a sexually selected behavior (song rate) and other behaviors (locomotor activity, self-maintenance activity, eating and resting) in male zebra finches (Taeniopygia guttata). We predicted that males supplemented with lutein and cholesterol would sing at higher rates than controls because both lutein and cholesterol have important health-related physiological functions in birds and birdsong mirrors individual condition. To control for testosterone secretion that may upregulate birdsong, birds were exposed to a decreasing photoperiod. Our results showed that control males down-regulated testosterone in response to a decreasing photoperiod, while birds treated with lutein or cholesterol maintained a constant singing activity. Both lutein- and cholesterol-supplemented groups sang more than control groups by the end of the experiment, indicating that the quality of food can affect undirected song irrespective of circulating testosterone concentrations. None of the other measured behaviors were affected by the treatment, suggesting that, when individuals have full availability of food, sexually selected song traits are more sensitive to the effect of food quality than other behavioral traits. Overall the results support our prediction that undirected song produced by male zebra finches signals access to high-quality food.

Functioning Among Youth with Comorbid Mood Disorder and Chronic Physical Illness in Public Sector Care.

The current study examines parent/caregiver and youth report of psychosocial and health-related functioning among youth served in public systems of care, with mood disorder only, comorbid mood disorder and chronic physical illness, and chronic physical illness only. Participants were 539 youths (ages, 11-18; 64% male) with a mood disorder and/or chronic physical illness enrolled in a study of public sector care. Presence of mood disorder was based on youth report on the Diagnostic Interview Schedule for Children-IV. Parents reported whether they had been told by a school or health professional that their child had 1 of 8 categories of chronic physical illnesses. Psychosocial functioning was assessed with the Child Behavior Checklist and Youth Self Report. Parent and child versions of the Child Health Questionnaire assessed health-related functioning. Covariates included demographic variables, substance use, mental health service utilization, disruptive behavior disorders, and anxiety disorders. Multivariate analysis of covariances assessed differences on outcome measures among the 3 groups. Parents and youths reported significantly worse psychosocial and health-related functioning for youth with comorbid mood and physical illnesses. Generally, parents reported lower functioning in youth with a physical illness compared with mood disorder, and youth with mood disorders reported lower functioning than those with physical illness. Youth with comorbid mood disorder and chronic physical illness experience high levels of impairment. Increased screening of mood disorders in pediatric health settings is warranted. Health systems, clinics, and clinicians should focus on integrating mental and physical health diagnosis and treatment.

When is an image a health claim? A false-recollection method to detect implicit inferences about products' health benefits.

Images on food and dietary supplement packaging might lead people to infer (appropriately or inappropriately) certain health benefits of those products. Research on this issue largely involves direct questions, which could (a) elicit inferences that would not be made unprompted, and (b) fail to capture inferences made implicitly. Using a novel memory-based method, in the present research, we explored whether packaging imagery elicits health inferences without prompting, and the extent to which these inferences are made implicitly. In 3 experiments, participants saw fictional product packages accompanied by written claims. Some packages contained an image that implied a health-related function (e.g., a brain), and some contained no image. Participants studied these packages and claims, and subsequently their memory for seen and unseen claims were tested. When a health image was featured on a package, participants often subsequently recognized health claims that-despite being implied by the image-were not truly presented. In Experiment 2, these recognition errors persisted despite an explicit warning against treating the images as informative. In Experiment 3, these findings were replicated in a large consumer sample from 5 European countries, and with a cued-recall test. These findings confirm that images can act as health claims, by leading people to infer health benefits without prompting. These inferences appear often to be implicit, and could therefore be highly pervasive. The data underscore the importance of regulating imagery on product packaging; memory-based methods represent innovative ways to measure how leading (or misleading) specific images can be. (PsycINFO Database Record

Effects of a Community-Based Multimodal Exercise Program on Health-Related Physical Fitness and Physical Function in Breast Cancer Survivors: A Pilot Study.

Purpose. Breast cancer and oncological treatment can result in significant acute and late localized and systemic negative effects on health-related physical fitness and physical function. The aim of this single-arm study was to examine the effects of a 12-week community-based multimodal exercise program on health-related physical fitness and physical function in breast cancer survivors. Methods. A total of 52 female breast cancer survivors (mean age = 59.7 ± 10.4 years) completed supervised exercise training consisting of (1) aerobic conditioning, (2) resistance training, and (3) balance and flexibility training, for 30 minutes each, totaling 90 minutes twice weekly for 12 weeks. Pretreatment and posttreatment outcome measures—mobility: (1) Timed Up and Go (TUG) and (2) 6-minute walk test (6MWT); muscular strength: (3) leg press strength and (4) chest press strength; upper-extremity flexibility: (5) back scratch test; and balance: (6) functional reach (FR) and (7) single-leg stance time—were assessed and compared. Results. Postintervention assessment measures given as percentage improvement and effect size (ES) for mobility, TUG (18%, 0.59), and 6MWT (14%, 0.74) were significantly (P < .001) improved. Outcome measures of muscular strength, leg press strength (32%, 0.58) and chest press strength (40%, 0.61), both significantly (P < .001) improved. Postintervention assessment measure of upper-extremity flexibility (42%, 0.41) showed significant (P < .001) improvements. Outcome measures for balance, FR (18%, 0.75) and single leg stance time (24%, 0.30), showed significant (P < .001) improvements. Conclusions. Outcome measures showed moderate to large ES improvements after participants completed the 12-week multimodal exercise program for breast cancer survivors.

Examining Committed Action in Chronic Pain: Further Validation and Clinical Utility of the Committed Action Questionnaire.

Psychosocial treatments for chronic pain conditions, such as Acceptance and Commitment Therapy, have highlighted minimizing pain avoidance behaviors and increasing engagement in valued activities as key treatment targets. In terms of salient processes within Acceptance and Commitment Therapy, committed action is considered essential to the pursuit of a meaningful life, as it entails a flexible persistence over time in living consistently with one's values. To date, however, only 1 study has examined the association between measures of committed action and important aspects of pain-related functioning. The purpose of the present study was to analyze the reliability of the Committed Action Questionnaire (CAQ) in a sample of 149 chronic pain patients, perform a confirmatory analysis of its factor structure, and examine how CAQ scores uniquely account for variance infunctioning. Confirmatory factor analyses provided support for a 2-factor model, and regression analyses, which examined the cross-sectional direct effects of the 2 subscales on health-related functioning, indicated that the CAQ accounted for significant variance in functioning after controlling for relevant covariates. Overall, these findings provide further support for the CAQ as a measure of adaptive functioning in those with longstanding pain. This article presents additional evidence for the reliability and validity of the CAQ with chronic pain patients. Confirmatory factor analyses provided support for the 2-factor model, with both subscales demonstrating significant associations with multiple facets of health- and pain-related functioning.