Katz Adjustment Scale Research Articles

In search of parsimony: reliability and validity of the Functional Performance Inventory-Short Form.

Purpose:The 65-item Functional Performance Inventory (FPI), developed to quantify functional performance in patients with chronic obstructive pulmonary disease (COPD), has been shown to be reliable and valid. The purpose of this study was to create a shorter version of the FPI while preserving the integrity and psychometric properties of the original.Patients and methods:Secondary analyses were performed on qualitative and quantitative data used to develop and validate the FPI long form. Seventeen men and women with COPD participated in the qualitative work, while 154 took part in the mail survey; 54 completed 2-week reproducibility assessment, and 40 relatives contributed validation data. Following a systematic process of item reduction, performance properties of the 32-item short form (FPI-SF) were examined.Results:The FPI-SF was internally consistent (total scale α = 0.93; subscales: 0.76–0.89) and reproducible (r = 0.88; subscales: 0.69–0.86). Validity was maintained, with significant (P < 0.001) correlations between the FPI-SF and the Functional Status Questionnaire (activities of daily living, r = 0.71; instrumental activities of daily living, r = 0.73), Duke Activity Status Index (r = 0.65), Bronchitis-Emphysema Symptom Checklist (r = −0.61), Basic Need Satisfaction Inventory (r = 0.61) and Cantril’s Ladder of Life Satisfaction (r = 0.63), and Katz Adjustment Scale for Relatives (socially expected activities, r = 0.51; free-time activities, r = −0.49, P < 0.01). The FPI-SF differentiated patients with an FEVl% predicted greater than and less than 50% (t = 4.26, P < 0.001), and those with severe and moderate levels of perceived severity and activity limitation (t = 9.91, P < 0.001).Conclusion:Results suggest the FPI-SF is a viable alternative to the FPI for situations in which a shorter instrument is desired. Further assessment of the instrument’s performance properties in new samples of patients with COPD is warranted.

Assessing Social Skills in People With Very Severe Traumatic Brain Injury: Validity of the Social Performance Survey Schedule (SPSS)

AbstractThe current study was designed to determine whether the Social Performance Survey Schedule (SPSS; Lowe &amp; Cautela, 1978) is a useful measure of social skills in people with traumatic brain injuries (TBI). Forty-nine adults with TBI were compared on the SPSS to 190 adults without injuries. The validity of the SPSS was also investigated in relation to another measure of social performance, the first scale of the Katz Adjustment Scale (KAS-R1; Katz &amp; Lyerly, 1963) and a broad measure of social function (the SPRS; Tate, Hodgkinson, Veerabangsa, &amp; Maggiotto, 1999). Individuals with TBI had significantly lower scores on the positive scale of the SPSS than nonbrain-injured individuals. They did not have lower scores on the SPSS negative scale relative to the normative sample. Significant correlations with the KAS-R1 and SPRS provided evidence for the construct and criterion validity of SPSS within this population. In conclusion, this study suggests that where an appropriate normative sample is used, the positive subscale of the SPSS is a sound measure for detecting the extent and nature of deficits in prosocial behaviour seen in TBI, but raises the question as to how we define negative behaviours in the 21st century on scales such as the SPSS.

Social Skills Treatment for People With Severe, Chronic Acquired Brain Injuries: A Multicenter Trial

McDonald S, Tate R, Togher L, Bornhofen C, Long E, Gertler P, Bowen R. Social skills treatment for people with severe, chronic acquired brain injuries: a multicenter trial. Objective To determine whether social skills deficits including unskilled, inappropriate behavior, problems reading social cues (social perception), and mood disturbances (such as depression and anxiety) could be remediated after severe traumatic brain injuries. Design Randomized controlled trial comparing a social skills program with social activity alone or with waitlist control. Several participants were reassigned after randomization. Setting Hospital outpatient and community facilities. Participants Fifty-one outpatients from 3 brain injury units in Sydney, Australia, with severe, chronic acquired brain injuries were recruited. A total of 39 people (13 in skills training, 13 in social activity, 13 in waitlist) completed all phases of the study. Intervention Twelve-week social skills treatment program encompassing weekly 3-hour group sessions focused on shaping social behavior and remediating social perception and 1-hour individual sessions to address psychologic issues with mood, self-esteem, etc. Main Outcome Measures Primary outcomes were: (1) social behavior during encounters with a confederate as rated on the Behaviorally Referenced Rating System of Intermediary Social Skills−Revised (BRISS-R), (2) social perception as measured by The Awareness of Social Inference Test, and (3) depression and anxiety as measured by the Depression, Anxiety and Stress Scale. Secondary outcomes were: relative report on social behavior and participation using: the Katz Adjustment Scale−R1; the Social Performance Survey Schedule; the La Trobe Communication Questionnaire; and the Sydney Psychosocial Reintegration Scale (both relative and self-report). Results Repeated-measures analysis of variance indicated that social activity alone did not lead to improved performance relative to waitlist (placebo effect) on any outcome variable. On the other hand, the skills training group improved differentially on the Partner Directed Behavior Scale of the BRISS-R, specifically the self-centered behavior and partner involvement behavior subscales. No treatment effects were found for the remaining primary outcomes (social perception, emotional adjustment) or for secondary outcome variables (relative and self-report measures of social function). Conclusions This study suggested that treatment effects after social skills training in people with severe, chronic brain injuries are modest and are limited to direct measures of social behavior.

Residential program for long‐term hospitalized persons with mental illness in Japan: Randomized controlled trial

Research on the merits of long-term group residences is inconclusive. The purpose of the present paper was to investigate the effects of supported group residence on the symptoms, social function, quality of life, general health quality, and the medical/psychiatric cost in Japan of a large number of psychiatric beds and long average length of stay. Patients were assessed every 6 months for 2 years using Positive and Negative Syndrome Scale, Katz Adjustment Scale, World Health Organization Quality of Life (WHO-QOL) and General Health Questionnaire 12-item version. Patients discharged to the supported group residence (SGR) significantly improved with regard to positive symptoms, the level of socially expected activities and free-time activities. The QOL physical domain of the inpatients was significantly more deteriorated compared to the SGR group. The total psychiatric/medical cost of the SGR group was approximately one-third that of the inpatient group, while the cost of the SGR to treat physical comorbidity was much higher. The present findings indicate that SGR has advantages for mental and social function but not for physical health. A major limitation of the present study was the high mean age (>60 years) of the subjects who had been hospitalized for a long period (mean, 24 years).

Community Integration Status 4 Years After Traumatic Brain Injury

To measure the level of agreement on community integration outcomes 4 years after traumatic brain injury (TBI) in relation to injury severity, proxy-participant relationship, and type of question. Thirty-one survivors of TBI (14 with mild TBI and 17 with moderate-severe TBI) and 31 significant other proxies. General and leisure activity scales of the Katz Adjustment Scale (KAS). Agreement was highest between proxies and participants with mild versus moderate-severe TBIs, between spouse proxies and TBI participants compared to nonspouse proxies and on the more objective subscales (frequency of participation) compared to the expectation and satisfaction scales regardless of injury severity or proxy-participant relationship. For research purposes, proxy data are acceptable but clinicians should assess outcomes and set goals with input from both persons with TBIs and their proxies.

Coping with spinal cord injury: personal and marital adjustment in the Hong Kong Chinese setting.

A cross-sectional retrospective study was carried out with structured questionnaires and semi-structured interviews on 66 persons with spinal cord injury (SCI) and 40 spouses. The study aimed to explore the psychosocial adjustment of Hong Kong Chinese couples at the post SCI stage. An important study interest was the impact of care-giving in spouses of persons with SCI. Three major regional rehabilitation centres and one community resource centre in Hong Kong. A set of psychometric measures tapping different aspects of psychological functioning was included. These were locus of control (Levenson's Internality, Powerful Others, and Chance Scale), perceived social support (Provision of Social Relationship), coping strategies (Ways of Coping Checklist), marital adjustment (Dyadic Adjustment Scale), caregiving burden (Caregiver Burden Inventory), depression (Beck Depression Inventory), life satisfaction (Satisfaction with Life Situation), and social role adjustment (Katz Adjustment Scale - Relative Form). Persons with SCI with pre-injury marriage were more depressed (P<0.05) as compared with those with post-injury marriage. However, the two groups did not differ in terms of satisfaction with life situation and social role dissatisfaction. The spouses in the preinjury marriage reported a significantly higher score in time-dependent burden than those in the post-injury marriage (P<0.05). Care-giving burden was associated with locus of control, social support, and modes of coping (P<0.05). The impact of SCI is a long-lasting effect not limited to the patients but also extending to their spouses. Findings from the adjustment outcomes and coping styles of persons with SCI and their spouses indicate that they are not passive victims. A similar injury may produce different outcomes in different individuals. Rehabilitation professionals should thus be alert to both the couple's differing needs and idiosyncrasies in their helping process.

Emotional and behavioral adjustment after traumatic brain injury

Objectives: To examine emotional and behavioral adjustment and recovery over 1 year after traumatic brain injury (TBI), and to determine whether the difficulties, if present, are due to neurologic insult. Design: Longitudinal evaluation of adjustment from 1 month to 1 year after injury. Setting: Level I trauma center at a university hospital. Patients: One hundred fifty-seven consecutively hospitalized adults with TBI and 125 trauma controls with other system injuries evaluated at 1 and 12 months after injury. Main Outcome Measures: Katz Adjustment Scale (KAS). Results: The TBI group at 1 year follow-up demonstrated significant emotional and behavioral maladjustment, but such difficulties did not appear to be mediated by the brain injury, since the KAS scores for the TBI and trauma control groups were not significantly different. Those with moderate TBI reported greater difficulties than those with mild or severe injuries. Changes in adjustment over 1 year were common for both groups. Within the TBI group there was differential recovery: improvement in cognitive clarity, dysphoric mood, and emotional stability, but increased difficulties with anger management, antisocial behaviors, and self-monitoring. Conclusions: These results raise questions about commonly held beliefs that those with mild TBI report greater distress, and clarify some misconceptions regarding change in emotional and behavioral functioning over time.

Psychometric properties of the functional performance inventory in patients with chronic obstructive pulmonary disease.

The Functional Performance Inventory (FPI) is a subjective measure of the performance dimension of functional status, based on an explicit analytical framework and the experiences of patients themselves. To describe the conceptual foundation of the instrument, the procedures used to maximize content validity, and the results of the initial psychometric testing of the FPI in patients with chronic obstructive pulmonary disease (COPD). Items and response structure for the instrument were drawn from the literature and qualitative interviews with 12 men and women with COPD. Twenty-four clinical and scientific experts participated in content validation. To assess the FPI's psychometric characteristics, 154 patients participated in a cross-sectional mail survey; 54 took part in a 2-week reproducibility assessment. Forty relatives were also included in validity testing. The instrument was internally consistent (alpha = .96) and reproducible (ICC = .85). Validity was evident in the significant (p < .001) correlations found between the FPI total score and the Functional Status Questionnaire (activities of daily living, r = .68; instrumental activities of daily living, r = .68), Duke Activity Status Index (r = .61), Bronchitis-Emphysema Symptom Checklist (r = -.59), Basic Need Satisfaction Inventory (r = .61), and Cantril's Ladder of Life Satisfaction (r = .63). The relationship between patient FPI score and relative perception of functioning, using the Katz Adjustment Scale for Relatives, was also significant (socially expected activities, r = .53; free-time activities, r = .49, p < .01). The instrument discriminated between patients with severe and moderate levels of perceived severity and activity limitation (t = 8.52, p <.001) and patients with FEV1 greater than and less than 1.0 liter (t = 4.25, p < .001). Results suggest that the FPI is a useful measure of functional performance in patients with COPD. Further development of the spiritual activities and work and school domains is in order, as is additional study of the instrument's responsiveness to change.

Carbamazepine in agitation and aggressive behaviour following severe closed-head injury: results of an open trial

Ten patients presenting agitation and anger outbursts at various stages following a severe closed head injury, were treated in a prospective open trial with carbamazepine, with doses ranging from 400 to 800 mg per day, during 8 weeks. Group analysis demonstrated astatistically significant improvement of a score made up from six target items from the neurobehavioural rating scale. Improvement mainly concerned irritability and disinhibition. A statistically significant improvement was also found with the Agitated Behaviour Scale. Social functioning, as assessed by family or staff ratings of the Katz Adjustment Scale, also significantly improved. No modification of global cognitive functioning was found with the Mini Mental Status Examination. Individual analysis demonstrated that the beneficial effect was important in five cases, moderate in three patientsand negligible in two cases. It is concluded that carbamazepine might help to reduce agitated behaviour in brain-injured patients. However, response to treatment demonstrated an important inter-individual variability.

The validity of the Katz Adjustment Scale among people with traumatic brain injury.

The validity of the Katz Adjustment Scale among people with traumatic brain injury.

The validity of the Katz Adjustment Scale among people with traumatic brain injury.

The validity of the Katz Adjustment Scale among people with traumatic brain injury.

Family expectation, social adjustment and gender differences in a sample of schizophrenic patients.

A case series to study factors related to family expectation regarding schizophrenic patients was conducted in an out-patient setting in the city of S. Paulo, Brazil. Patients diagnosed as presenting schizophrenia by the ICD 9th Edition and having had the disease for more than four years were included in the study. Family Expectation was measured by the difference between the Katz Adjustment Scale (R2 and R3) scores based on the relative's expectation and the socially expected activities of the patient (Discrepancy Score), and social adjustment was given by the DSM-III-R Global Assessment Scale (GAS). Outcome assessments were made independently, and 44 patients comprised the sample (25 males and 19 females). The Discrepancy mean score was twice as high for males as for females (p < 0.02), and there was an inverse relationship between the discrepancy score and social adjustment (r = -0.46, p < 0.001). Moreover, sex and social adjustment exerted independent effects on the discrepancy score when age, age at onset and number of psychiatric admissions were controlled by means of a multiple regression technique. There was an interaction between sex and social adjustment, the inverse relationship between social adjustment and discrepancy score being more pronounced for males. These findings are discussed in the light of the potential association between the family environment, gender and social adjustment of schizophrenic patients, and the need for further research, i.e. ethnographic accounts of interactions between patient and relatives sharing households particularly in less developed countries.

Adjustment and social behaviour in older adults with chronic obstructive pulmonary disease: the family's perspective.

This study employed secondary data analysis to explore family perceptions of adjustment and social behaviour in older adults (n = 51) with chronic obstructive pulmonary disease (COPD) and their relationship to published norms and patient self-report. According to the Katz Adjustment Scale for Relatives, these COPD patients had significantly higher levels of belligerence, negativism, helplessness, withdrawal, psychopathology, nervousness and confusion than reports from relatives of older adults from the general population. No differences were found in performance, expectation or dissatisfaction with socially expected activities, or performance of free-time activities. However, family members of COPD patients were significantly more dissatisfied with their relative's free-time activities. Although family perceptions of socially expected activities corresponded to patient descriptions of general and physical functioning (Sickness Impact Profile), patient perceptions of psychosocial functioning were independent of the family's. The results supported the tenet that older adults with COPD have difficulties with adjustment that may adversely affect social relationships, but were not consistent with the belief that the performance of socially expected or free-time activities is more impaired than in others of this age group. The data also suggested there may be some perceptual discrepancy between family and patient views of social behaviour.

Symptoms and social adjustment of schizophrenic patients as evaluated by family members.

The purpose of this study is to reveal the relationship between family expressed emotion (EE) and family evaluation for symptoms and social adjustment of schizophrenic patients. Chronic schizophrenic outpatients in offshore islands under stationary therapeutic conditions were studied. For evaluation, the Five Minute Speech Sample (FMSS) for EE and the Katz Adjustment Scale (KAS) for family evaluation of patients were used. EE level was high among relatives who thought the patient was belligerent, negativistic, unstable or helpless. High-EE relatives tended to evaluate their patients' performance of social activities rather low and showed strong dissatisfaction with the patient's leisure activities. Moreover, a high emotional overinvolvement (EOI) value is more common in Japan than in other countries. A subgroup of the FMSS-EOI, the emotional display, was seen where many mothers began to cry while speaking.

The scaling of the Katz Adjustment Scale in a traumatic brain injury rehabilitation sample.

Based on the KAS-R1 ratings completed by 88 relatives of clients who had enrolled in a post-acute rehabilitation programme, the 10 component groups discerned by Fabiano and Goran [1] were submitted to a classical analysis of tests. Seventy-nine items were found to contribute to the internal consistency of their respective component groups, resulting in alpha values ranging from 0.75 to 0.93 for the component groups. Intercorrelations between components suggested that while some degree of overlap existed between groups, they represented discrete categories of neurobehavioural functioning. Second-order components, as determined by principal-component analysis, discern two significant component groups. These two components correlated moderately, yielding a value of 0.49. The findings indicate that the revised KAS-R1 exhibits considerable potential for clinical utility. Further research is needed to investigate the validity of this instrument in accurately depicting behavioural manifestations of those who have incurred traumatic brain injury.

A principal component analysis of the Katz Adjustment Scale in a traumatic brain injury rehabilitation sample.

A principal component analysis of the Katz Adjustment Scale in a traumatic brain injury rehabilitation sample.

A principal component analysis of the Katz Adjustment Scale in a traumatic brain injury rehabilitation sample.

A principal component analysis of the Katz Adjustment Scale in a traumatic brain injury rehabilitation sample.

The Katz Adjustment Scale: modification for use with victims of traumatic brain and spinal injury

Although the assessment of the social, emotional and personality sequelae of traumatic injury is of central clinical and medico-legal importance, no satisfactory standard assessment device for this purpose has yet been developed. A multicentered study of a mixed group of head and spinally injured patients is reported. Factor analysis of a modified version of the relatives' form of the Katz Social Adjustment Scale (KAS-R) yielded 30 first-order factors under three main domains of emotional/psychosocial, physical/intellectual and psychiatric changes, together with seven second-order factors which were readily identifiable in terms of syndromes accompanying traumatic injury. Discriminant function analyses indicated that prediction of patient group using KAS-R data was most accurate using the current study's first-order factors as compared with the original factor structure proposed by Katz and Lyerly or the second-order factors from the current analyses. The modified KAS-R shows considerable promise as an instrument for measuring the complex social, emotional and personality changes following traumatic injury, with special significance for assessing brain-injury victims. The representativeness of the current patient sample and implications for future development of the method are discussed.

A principal component analysis of the Katz Adjustment Scale in a traumatic brain injury rehabilitation sample.

A principal component analysis of the Katz Adjustment Scale in a traumatic brain injury rehabilitation sample.

Social role functioning following spinal cord injury

The Katz Adjustment Scale--Relatives Form was completed by the wives of 27 hospital-discharged spinal cord injured (SCI) patients. Their ratings of the spouses' social adjustment and behaviour were compared to available community and psychiatric norms. Overall, spouses rated their SCI husbands as performing significantly more socially inappropriate behaviours compared to ratings of 'normals' but as engaging in significantly less socially inappropriate behaviours compared to the ratings of psychiatric patients. SCI patients were perceived as performing the same levels of social activities as 'normals', but engaging in less free-time activities compared to both 'normals' and psychiatric patients. These results mirror similar analyses comparing moderate and severe head injury victims with normal and psychiatric norms. The implications for rehabilitation and counselling of families of traumatically disabled patients are discussed.