ADMISSIONS TASK

Questions: Is there a relationship between physical handicap and psychological outcomes? Abstract 1: Green, 2003 In order to explore the relationship between levels of physical impairment and psychological distress, 100 adults who had experienced upper and/or lower limb amputation/s within the last 10 years and had varying levels of physical handicap were recruited via rehabilitation services. Participants were rated on their levels of physical handicap on clinician-report standardised measures. The participants then completed self-report measures on a number of standardised indices of psychological distress, including depression, anxiety and stress. Significant positive relationships emerged between physical handicap and all measures of distress (all p<.05). However, these relationships appeared stronger for those participants who had been more recently injured and those who were younger. This study confirms the frequently reported findings of psychological distress resulting from physical trauma. Abstract 2: Romano et al., 2004 The relative impact of a range of demographic, physical and psychosocial variables upon quality of life levels was assessed in 90 adults who were born with a physical disability. Validated self-report measures indicated that variables such as age and gender, physical variables such as level of perceived impairment and psychosocial variables were all correlated with self-reported quality of life. Correlations which were significant at p<.01 were entered into a regression model. The final model explained 49% of the variance; however, only demographic and psychosocial variables emerged as significant independent predictors. In particular, higher self-esteem ( =.322), more perceived social support ( =. 297) and higher perceived control ( = .342) emerged as important psychosocial predictors. Contrary to many other studies findings, this study suggests that self-report assessments of physical impairment do not seem to influence quality of life, at least when compared to other demographic and psychological predictors.

Abstract 3: Carter, 2006 This qualitative study aimed to explore concepts of psychological well-being and distress in eight adult wheelchair users. While previous quantitative research has provided mixed results on the relationship between physical impairment and control and psychological functioning, some of the complexities around the concept of disability have not been explored. In this study four themes emerged: 1) Its the health care system that gets you down: the fight for appropriate services; 2) They all think that because I am in a wheelchair I should hate myself and I dont : dealing with the beliefs of others; 3) I am not disabled; they disable me: understanding wider systemic influences on the individual; 4) Being in a wheelchair does not define who I am, not to me anyway: challenging inherent assumptions of non wheelchair users. The findings of this study highlight the limitations of overly medicalised paradigms in our investigations of distress and physical difference.

Abstract 4: Ross et al., 2007 This review paper argues that social models of disability have been ignored for too long within the psychological sciences and, in particular, within clinical psychology. It is proposed in this review that the medical approach to disability, which seeks to measure physical ability according to prescribed norms and locate any deficit or shortfall at an individual level, is inappropriate as both a research and therapeutic approach. Instead, social models of disability, which aim to understand individual difference in a much wider social context and which argue that society can actively hinder people with different physical abilities from full inclusion, should be preferred. In making this argument, we draw selectively from a wide range of studies and papers. We make no claim to be systematic in our choice of papers included but would urge our overall arguments to be judged on their own merits. Abstract 5: Benton, 2010 Psychological well-being and distress were compared in four different groups of adults with physical impairments. The four groups who completed the self report measures were: 1) individuals who had within the last five years experienced a serious physical trauma (e.g., motorcycle accident) resulting in at least loss of limb, but who had preserved cognitive function (n = 51); 2) individuals who were born with at least one limb missing (n = 50); 3) individuals who had experienced neurological problems (e.g., stroke) within the last five years resulting in loss of functioning in at least one limb, but with preserved cognitive functioning; 4) a control group of participants with no reported limitations in physical functioning (n=48). It was hypothesised that group 2) would report more distress and less well-being than the other groups owing to the more chronic nature of the disability and that group 1) would report more distress and less well-being than group 3) owing to the more traumatic aetiology. All three physically impaired groups were matched on a self-report measure of their perceived physical functional abilities and all four groups were matched on a neurocognitive battery. Contrary to the hypotheses, no differences emerged between the three groups with physical impairments although their scores were significantly different [less well-being, more distress] from the control groups scores. It is concluded that attempting to group participants according to reason for physical impairment is not useful in predicting levels of distress. Questions 1. What does refer to in abstract 2? (1 mark) 2. Discuss the appropriateness of the p value explicitly mentioned in abstract 1. (1 mark) 3. What qualitative approach do you think might have been used in abstract 3? Please justify your answer. (2 marks) 4. Abstract 4 describes a review paper. What type of review paper do you think it was? Please justify. (2 marks) 5. What statistical analysis do you think was used in abstract 5 to compare the four different groups on measures of well-being and distress. Please explain your answer. (2 marks)