JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
type. 7-9 Also, the following health risk factors were observed as they were commonly noted by the surgeons prior to surgery: histories of diabetes, heart disease, and smoking. Psychological resilience. The measure under psychometric focus was the 4-item Brief Resilient Coping Scale (BRCS). 4 Content related to creativity to address adversity; locus of control regarding reaction to adversity; personal growth post-adversity; and replacement of loss. The measure contained a 4-point Likert response format ranging from strongly disagree to strongly agree in belief of aforementioned items. Possible global scores in this study ranged from 4-16, with higher scores indicating greater psychological resilience. Psychometric properties were reported as adequate-to-strong in the original evaluation among a sample of rheumatoid arthritis patients. 4 Coping . For validity testing with the BRCS, three specific coping strategy measures were included in the study. These coping scales came from the Proactive Coping Inventory (PCI). 10 Each coping strategy scale contains a 4-point Likert response format ranging from 1 – not at all true to 4 – completely true ; higher global scores represent greater likelihood to utilize the specific coping strategy during adversity. All coping scales have been previously reported as having, at minimum, satisfactory psychometric properties. 10 A brief description of each coping strategy scale is shown below: 10 • proaction . The 14-item Proactive Coping Scale assesses likelihood to cope via goal setting with thoughts and behaviors geared toward self-regulated attainment. Possible global scores range from 14-56. • reflection . The 11-item Reflective Coping Scale assesses likelihood to cope via contemplation of possible alternatives, imaginingeffectiveness, andcreatingplansof actionaccordingly. Possible global scores range from 11-44. • avoidance . The 3-item Avoidance Coping Scale assesses one’s likelihood to cope via delaying or eluding action. Possible global scores range from 3-12. Back functioning . A physical health measure relating to back functioningwas included, again for validity testingwith theBRCS. The Oswestry Disability Index (ODI) 11 based on its popularity and repeatedly proven, robust psychometrics, is considered the gold standard of low back pain and functionality assessment. The ODI evaluates ability to manage everyday activities in 10 general areas (e.g., sitting, standing, walking, sleeping) in light of back pain and related leg pain. Item scores from each area were summed to obtain global scores, potentially ranging from 0-50. Lower ODI scores reflect greater level of back functioning. Analytic Plan. Descriptive statistics were examined on all measures. Principal components analysis identified the underlying BRCS factor structure. Factor analysis was initially rotated to a varimax solution with no limitation on number of factors. Identification of a factor was based on the customary, minimum eigenvalue of 1.0. Minimum factor loading threshold for scale item retention was set at 0.40 with the minimum
Sample Characterisitics
Variable Age Gender Female Male Ethnicity
Valid % Mean (SD, range) n
65.0 (10.25, 36-89)
36.4 64.5
31 54
Caucasian/White African American/Black American Indian
84.7 14.1 1.2
72 12 1
Marital Status Married Divorced Widowed
76.5 15.3
65 13
3.5 2.4 2.4
3 2 2
Common Health Risks Never married Cohabitating Payment/Insurance Type Private Medicare Worker’s Comp. Attorney Other
60.0 20.0 16.5
51 17 14
2.4 1.2
2 1
Back functioning (ODI) ODI: Oswestry Disability Index Diabetes history (no) Heart disease history (no) Smoking history (no)
78.8. 92.9 70.6
67 79 60
26.0 (6.32, 10-43)
Table 1: ODI: Oswestry Disability Index
loading value identified as follows: 0.32 as poor ; 0.45 as fair ; 0.55 as good ; 0.63 as very good ; or 0.71 as excellent . 12 Reliability on the BRCS was observed via Cronbach’s alpha and Guttman coefficients. For Guttman, the split-half coefficients (lambda-4 [λ-4]) and the highest of the lower bound lambdas (if not λ-4) were noted as the reliability estimate. Inter-item correlations also were observed for internal consistency. Validity of the BRCS was observed via Pearson’s r correlations, and directions of such, with each of its theoretically linked measures. Previous literature has shown psychological resilience to be positively (i.e., directly) linked with goal formulation and corresponding plans of action. 13 Accordingly, the BRCS was expected to demonstrate convergent validity as follows: (a) significantly and positively correlate with the Proactive Coping Scale and the Reflective Coping Scale; and (b) significantly but negatively (i.e., inversely) correlate with the Avoidance Coping
J La State Med Soc VOL 170 JANUARY/FEBRUARY 2018 3
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