Cognitions and emotions as predictors of recovery in conditions involving physical disability
Patients with conditions involving physical disability vary considerably in the course of their recovery. Initial severity as judged by clinical examination is the usual baseline for predicting eventual outcome but considerable variability has been observed in the process of recovery in patients with conditions of similar initial severity. Recognizing the many potential influences on the process of recovery, medical, personal, environmental and social, this study investigated psychological factors as predictors of different aspects of recovery. The hypotheses tested were that cognitions, such as the patients' perceptions of their condition and its implications for them, their perceptions about their control over their own recovery, the attributions made about their condition and events in their recovery, the ways in which they coped with the problems imposed by their condition and their emotional responses, would be more reliable predictors of different aspects of recovery from physical disability than initial clinical severity. Physical disability was conceptualized at two levels, as restriction in the performance of movements and restriction in the performance of functions and activities. The investigation was undertaken in four stages. Early exploratory work of the first two stages studied over 100 patients with physical disability during the process of their recovery, by observation, semi-structured interviews and videorecording. In the third stage methods of measurement of clinical indices of the selected conditions were developed and tested with the study population. Psychometric methods were also tested and where necessary developed. In the fourth stage hypotheses about the relationships between clinical indices and psychological factors were tested with 40 subjects with physical disability, 20 with stroke, 20 with a wrist fracture. There was considerable support for the overall hypothesis that psychological factors would be reliable predictors of different aspects of recovery. Initial clinical severity was a poor predictor of outcome in terms of performance of movements and functions, and individual perceptions of severity of condition showed little relationship to objective measurements of severity. Perceptions of personal control over recovery were associated with more effective recovery in terms of performance, and general level of raised emotional response with some less effective levels of performance. These results need to be re-examined using larger groups of subjects, and including those with other conditions involving physical disability to find if results can be generalized. The results provide information about factors influencing the process of recovery from conditions involving physical disability.