The Self-Regulation Assessment (SeRA) questionnaire: development and exploratory analyses of a new patient-reported outcome measure for rehabilitation

Figures & data

Table 1. Characteristics of the respondents (N = 563).

Characteristic	n (missing)	% or mean (SD)
Age [mean (SD)]	539 (24)	56.7 (12.7)
Male (%)	252	44.8
Ethnicity (%)
Native Dutch	493	87.6
Migration background*	70	12.4
Education (%)
No education/lower education	311	55.2
Higher education	252	44.8
Current marital status (%)
Living alone	133	23.6
Married/living together without children	235	41.7
Married/living together with children	151	26.8
Living alone with children	31	5.5
Other	13	2.3
Diagnose (%)	(1)
Brain injury	125	22.2
Chronic pain disorder	110	19.5
Spinal cord injury	79	14
Neurological and neuromuscular disorder	87	15.6
Musculoskeletal disorder (incl. amputation)	83	14.8
Other (incl. oncology, organs).	78	13.9
Time since last rehabilitation treatment in years [mean (SD)]	561 (2)	3.31 (2.30)
Time since diagnosis (%)
1–2 years ago	87	15.5
3–5 years ago	286	50.8
6–10 years ago	80	14.2
Longer than 10 years ago	110	19.5
Type of last rehabilitation treatment (%)
Inpatient	241	42.8
Outpatient	322	57.2
Reached via (%)
University Medical Centres	184	32.7
General Hospital	32	5.7
Rehabilitation Centres	221	39.3
Private Rehabilitation Clinic	126	22.3

*Dutch speaking.

Table 2. The 22 items of the SeRA and the distribution of the item scores.

	Mean*	(SD)	1. Totally disagree (%)	2. Disagree (%)	3. Neutral (%)	4. Agree (%)	5. Totally agree (%)
1. I understand my condition.	4.35	0.83	1.1	2.7	8.8	35.2	52.1
3. I understand the physical impact of my condition.	4.26	0.78	0.7	2.7	8.1	46.8	41.5
4. I understand the emotional impact of my condition.	4.14	0.78	0.4	2.8	13.8	48.6	34.3
2. I recognize what my body is telling me.	4.11	0.77	0.7	3.7	8.8	57.1	29.5
5. I am aware of what I can do.	4.07	0.85	0.4	5.5	14.5	46.3	33.2
20. I determine how I make use of my options.	4.06	0.77	0.2	2.8	17.7	48.9	29.5
14. I know who to ask for help.	4.05	0.79	0.9	3.2	13.6	54.6	27.6
10. I decide what I do.	4.04	0.83	0	4.4	19.5	43.6	32.3
21. I do what I think is important.	4.04	0.78	0.5	2.5	17.8	50.9	28.3
6. I am aware of my capabilities.	4.02	0.85	0.5	5.3	15.5	48.9	29.5
19. I trust the choices I make.	3.99	0.84	0.7	3.4	20.8	45.6	29.5
15. I know how to get help.	3.97	0.79	0.7	3.7	17.3	54.2	23.9
22. If I want something, I know how to go about it.	3.96	0.79	0.2	3.2	22.8	48.1	25.8
16. I indicate how I want to be helped.	3.95	0.83	0.2	4.9	21.2	47.3	26.1
11. I know how to cope with my impairment(s).	3.93	0.81	0.7	4.1	20.3	51.2	23.7
17. I trust my (own) thoughts.	3.93	0.86	0.5	6.4	18.6	48.9	25.6
12. I know when I need help from others.	3.90	0.78	0.7	4.4	18.4	56.9	19.4
7. I can explain the consequences of my condition clearly to others.	3.83	1.00	1.9	9.0	21.6	39.4	27.9
9. I dare to indicate my limits to others.	3.70	0.98	1.8	12.4	20.8	44.3	20.5
13. I ask others for help when I think I need it.	3.63	0.98	2.1	11.5	25.8	42.0	18.4
8. I know my limits.	3.61	0.99	2.1	12.7	25.3	41.9	17.8
18. I trust my body.	3.37	1.07	3.5	20.1	26.3	35.5	14.5

*Items are ranked from highest (less difficult) to lowest (most difficult) mean scores.

Table 3. Exploratory factor analysis: 4-factor solution for the SeRA (all loadings shown of ≥0.30): pattern matrix after oblimin rotation.

		4-Factor solution			Item classified in which theme prior to the analyses	Item classified in which factor after analyses
	3	1	4	2
1. I understand my condition.		0.84			1	1
2. I recognize what my body is telling me.		0.74			1	1
3. I understand the physical impact of my condition.		0.90			1	1
4. I understand the emotional impact of my condition.		0.78			1	1
5. I am aware of what I can do.		0.36		−0.57	1	2
6. I am aware of my capabilities.		0.38		−0.51	1	2
7. I can explain the consequences of my condition clearly to others.				−0.67	2	2
8. I know my limits.				−0.77	2	2
9. I dare to indicate my limits to others.				−0.62	2	2
10. I decide what I do.	0.70				2	3
11. I know how to cope with my impairment(s).	0.35	0.36			2	3
12. I know when I need help from others.			0.40	−0.45	4	2
13. I ask others for help when I think I need it.			0.69	−0.39	4	4
14. I know who to ask for help.			0.84		4	4
15. I know how to get help.			0.85		4	4
16. I indicate how I want to be helped.			0.61		4	4
17. I trust my (own) thoughts.	0.74				2	3
18. I trust my body.	0.48				2	3
19. I trust the choices I make.	0.85				2	3
20. I determine how I make use of my options.	0.86				3	3
21. I do what I think is important.	0.85				3	3
22. If I want something, I know how to go about it.	0.76				3	3
Eigenvalues	9.66	2.08	1.58	1.10
% of variance explained	43.89	9.45	7.16	4.98

Factor loadings: these are the regression coefficients of the variable on the factor with the highest factor loading.

Table 4. Outcome scores of the SeRA, the SeRA subscales and the UW-SES-6.

	N of items	α	Range	% Floor	% Ceiling	Mean* (SD)	Median (IQR)	Skewness
Total 22-item scale	22	0.93	28.4–100	0.2	3.9	73.8 (14.1)	73.9 (64.8–83.2)	−0.16
Subscale 1: insight in own health condition.	4	0.86	0–100	0.4	22.2	80.4 (16.6)	81.3 (75–93.8)	−1.05
Subscale 2: insight in own capabilities.	6	0.86	12.5–100	0.4	9.4	71.3 (17.5)	70.8 (62.5–83.3)	−0.35
Subscale 3: trust in self and apply self-regulation.	8	0.89	9.4–100	0.2	6.9	72.9 (16)	75 (62.5–84.4)	−0.35
Subscale 4: organisation of help.	4	0.85	6.3–100	0.4	11.9	72.5 (17.7)	75 (62.5–82.8)	−0.47
UW-SES-6	6	0.91	20–68.9	0.7	4.1	44.3 (9.9)	42.6 (36.4–50.2)	0.41

*The higher the score, the better self-regulation (SeRA) or self-efficacy (UW-SES-6).

Table 5. Spearman correlation between the SeRA, the SeRA subscales and the UW-SES-6.

	Total 22-item list	Subscale 1	Subscale 2	Subscale 3	Subscale 4
Subscale 1: insight in own health condition	0.73
Subscale 2: insight in own capabilities	0.91	0.63
Subscale 3: trust on self and apply self-regulation	0.88	0.53	0.71
Subscale 4: organisation of help	0.75	0.43	0.64	0.58
UW-SES-6	0.36	0.26	0.28	0.41	0.20