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Neuropsychological Prediction of Learning and Adherence in Cardiac Rehabilitation

Kelly, Mary Ann (2005) Neuropsychological Prediction of Learning and Adherence in Cardiac Rehabilitation. Doctoral Dissertation, University of Pittsburgh.

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    Abstract

    The relationship between specific aspects of cognition and adherence is examined in a group of individuals participating in the Dr. Dean Ornish Program for Reversing Heart Disease, an intensive lifestyle modification program. This research was guided by a hypothesis of supply and demand - the information-processing skills in highest demand for adherence may be in short supply due to how the cardiovascular disease process impacts the brain. This hypothesis was evaluated by using results of neuropsychological testing administered to participants before they began the Ornish program to predict specific learning and adherence outcomes. Hierarchical regression was used to evaluate the contribution made by neuropsychological and non-neuropsychological variables (disease, demography, amount of Ornish lifestyle knowledge at the time of program entry and self-reported emotional status, psychosocial adjustment, and quality of life) to the prediction of adherence and program-specific learning. Nine outcomes were examined including behavioral adherence (diet, exercise, group support, and stress management), in-program learning (knowledge acquisition and procedural learning), staff perceptions of participant learning, and the level of program intensity required at the end of twelve weeks (Phase II Stratification). Neuropsychological variables made the most significant and unique contributions to the majority of predictive models. Measures of working memory and executive control were strongly represented in the adherence models. Explicit verbal memory and working memory were, respectively, significant facilitators of in-program knowledge acquisition and improvements in the accuracy of food diaries. Also, working memory was an important predictor of the level of program intensity participants needed at the end of twelve weeks. In summary, most aspects of the neuropsychological supply - information-processing demand (NIP) model were supported. By carefully selecting neuropsychological measures that capture vulnerable areas of cognitive processing in individuals with cardiovascular disease, the importance of cognitive information-processing capacity to adherence and adherence-based learning is demonstrated. Moreover, the research validates previous studies showing that critical cognitive moderators of adherence and learning cannot be discerned by health care professionals delivering clinical care, even when this contact involves intensive educational interventions. Only through the administration of a broad-based neuropsychological assessment battery are these essential cognitive facilitators of learning and adherence identified.


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    Item Type: University of Pittsburgh ETD
    Creators/Authors:
    CreatorsEmailORCID
    Kelly, Mary Annkellus@hotmail.com
    ETD Committee:
    ETD Committee TypeCommittee MemberEmailORCID
    Committee ChairKlein, Roger Drklein@pitt.edu
    Committee MemberRyan, Christopher Mryancm@msx.upmc.edu
    Committee MemberPingel, Louis Apingel@pitt.edu
    Committee MemberElman, Nancy Selman@pitt.edu
    Title: Neuropsychological Prediction of Learning and Adherence in Cardiac Rehabilitation
    Status: Unpublished
    Abstract: The relationship between specific aspects of cognition and adherence is examined in a group of individuals participating in the Dr. Dean Ornish Program for Reversing Heart Disease, an intensive lifestyle modification program. This research was guided by a hypothesis of supply and demand - the information-processing skills in highest demand for adherence may be in short supply due to how the cardiovascular disease process impacts the brain. This hypothesis was evaluated by using results of neuropsychological testing administered to participants before they began the Ornish program to predict specific learning and adherence outcomes. Hierarchical regression was used to evaluate the contribution made by neuropsychological and non-neuropsychological variables (disease, demography, amount of Ornish lifestyle knowledge at the time of program entry and self-reported emotional status, psychosocial adjustment, and quality of life) to the prediction of adherence and program-specific learning. Nine outcomes were examined including behavioral adherence (diet, exercise, group support, and stress management), in-program learning (knowledge acquisition and procedural learning), staff perceptions of participant learning, and the level of program intensity required at the end of twelve weeks (Phase II Stratification). Neuropsychological variables made the most significant and unique contributions to the majority of predictive models. Measures of working memory and executive control were strongly represented in the adherence models. Explicit verbal memory and working memory were, respectively, significant facilitators of in-program knowledge acquisition and improvements in the accuracy of food diaries. Also, working memory was an important predictor of the level of program intensity participants needed at the end of twelve weeks. In summary, most aspects of the neuropsychological supply - information-processing demand (NIP) model were supported. By carefully selecting neuropsychological measures that capture vulnerable areas of cognitive processing in individuals with cardiovascular disease, the importance of cognitive information-processing capacity to adherence and adherence-based learning is demonstrated. Moreover, the research validates previous studies showing that critical cognitive moderators of adherence and learning cannot be discerned by health care professionals delivering clinical care, even when this contact involves intensive educational interventions. Only through the administration of a broad-based neuropsychological assessment battery are these essential cognitive facilitators of learning and adherence identified.
    Date: 20 June 2005
    Date Type: Completion
    Defense Date: 17 May 2005
    Approval Date: 20 June 2005
    Submission Date: 15 June 2005
    Access Restriction: No restriction; The work is available for access worldwide immediately.
    Patent pending: No
    Institution: University of Pittsburgh
    Thesis Type: Doctoral Dissertation
    Refereed: Yes
    Degree: PhD - Doctor of Philosophy
    URN: etd-06152005-192755
    Uncontrolled Keywords: Ornish Knowledge Test; Wisconsin Card Sorting Test; Four-Word Short Term Memory Test; Martin and Park Environmental Demands
    Schools and Programs: School of Education > Psychology in Education
    Date Deposited: 10 Nov 2011 14:47
    Last Modified: 19 Jun 2012 09:48
    Other ID: http://etd.library.pitt.edu/ETD/available/etd-06152005-192755/, etd-06152005-192755

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