Testing integrated behavioural and biomedical models of activity and activity limitations in a population-based sample

Diane Dixon, Marie Johnston, Alison Elliott, Phil Hannaford

Research output: Contribution to journalArticlepeer-review

16 Citations (Scopus)


Purpose: The predictive utility of an integrated model of disability is tested. The integrated model incorporates an impairment based model (International Classification of Functioning, Disability and Health (ICF)) and the behavioural models. Methods: Community dwelling adults (n = 628) completed a postal questionnaire measuring the integrated model. The ability of the model to predict disability in the form of activity limitations (ALs) and walking, in the full community sample and in respondents reporting chronic pain was tested. Results: In both the community and chronic pain samples each version of the integrated model explained a majority (55%–67%) of the variance in ALs but only 11%–29% of the variance in walking behaviour (WB). Impairment directly predicted ALs but did not directly predict WB. Control related cognitions were direct predictors, and mediators, of the relationship between bodily impairment and both ALs and WB. In addition, intentions and outcome expectancies predicted WB. Self-efficacy (SE) was the most consistent predictor of both ALs and WB. Conclusions: An integrated model which combines psychological constructs and impairment is required for an adequate understanding of ALs. By contrast, behavioural models, but not degree of impairment, are necessary to explain activity levels.

Implications for Rehabilitation
Activity limitations are typically predicted by impairment based models, whereas activity is typically predicted by cognition based models of behaviour.

This study examines whether a theoretical model that incorporated both cognition and impairment factors could predict the activity of walking and activity limitations in a community sample of people with and without chronic pain.

An adequate understanding of activity limitations required a model that incorporated impairment and cognitions, whereas impairment factors were not required for an understanding of walking behaviour.

Interventions to reduce or manage activity limitations might usefully incorporate techniques to change cognitions, especially self-efficacy perceptions.
Original languageEnglish
Pages (from-to)1157-1166
Number of pages10
JournalDisability & Rehabilitation
Issue number14
Publication statusPublished - Jul 2012


  • chronic pain
  • disability
  • ICF
  • social cognitive theory
  • theory of planned behaviour
  • walking


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