Work-related stress and the Demand-Control-Support framework: implications for the P x E fit model.
Understanding the relationship between stress and distress can allow vocational personnel to work with consumers in finding positions that maximize productivity and minimize the experience of distress (Steinfeld & Danford, 1999). In supporting vocational choices by consumers, rehabilitation counselors need to work with consumers to develop an understanding of the aspects of different career choices. In particular, rehabilitation counselors need to provide information regarding the level of activity involved with a certain position, the work environment, and other factors involved in stress development and metamorphosis into distress (Beehr, 1995). The transformation of stress into distress may not be adequately captured in prevailing rehabilitation counseling approaches such as the Person x Environment fit model. Rather, the experience of stress and the development of distress may be better understood via the Demand-Control-Support model (DCS; Karasek & Theorell, 1990).
The focus of this article is to raise awareness about the benefits of utilizing the DCS model, which describes the development of stress within work environments, in connection with the Person x Environment fit model. To facilitate appreciation for utilizing the DCS model in determining the best job-match for individuals with disabilities, several areas will be explored. First, given the various conceptualizations of stress and distress, definitions of these constructs, for the purpose of comparison, need to be presented. Second, the authors provide a brief overview of the Demand-Control-Support model (Karasek & Theorell, 1990) as a method of understanding the development of distress in a detrimental person-environment match. Next, a review of the Person x Environment fit model will be presented, including limitations of this model to explain the development of distress. A discussion of disabilities, individuals, and environments within the context of the DCS model is also provided. Finally, the authors summarize how rehabilitation counselors can use this information to develop interventions to minimize stress, thereby helping prevent distress and improving job maintenance of persons with disabilities.
The Concepts of Work, Stress, Environment, and Disability
At the core of the DCS model is the recognition of how the unique combination and interaction of work, stress, environment, and disability is crucial to the development of proactive vocational services. Although multiple definitions of each concept abound, more broadly accepted definitions will be used to describe work, stress, and the environment.
Stress versus Distress
Stress, a concept that often is associated with work (Brodwin, Sauer, Hallberg, & Goldfarb, 1996), has been defined as "... bodily or mental tension resulting from factors that tend to alter an existent equilibrium"(Merriam Webster's Collegiate Dictionary, 1995; p.1164). Stress, previously identified as a tool to increase work productivity, does so through the altering of a person's psychological state (Seyle, 1975). By increasing an individual's level of arousal it is possible to increase work productivity, thus maximizing efficiency of both the individual and the workforce. However, increasing stress beyond and individual's ability to cope causes the experience of distress, and consequently, a decrease in performance (Seyle, 1975).
Distress, which has been conceptualized as the overload of stressful events or stimuli, is "pain or suffering affecting the body, a bodily part, or the mind" (Merriam Webster's Collegiate Dictionary, 1995, p.338). Distress can be viewed as the overloading of a person's capacity to handle his/her current stress load. The experience of distress has been linked to lower levels of job satisfaction and perceptions of limited social support (Kaplan, 1990). In addition, the experience of distress has been linked to lower productivity and poor work performance (Seyle, 1975).
The link between stress and distress is not abstract, but rather it is one that has been theorized for some time. For example, persons accessing rehabilitation counseling services may be at an increased risk of developing distress due to the stress related to the combination of work environment, changing career patterns, and coping with a disability (Szymanski, 1999). Persons with disabilities are not alone in the potential to develop distress. Rehabilitation counselors are also at risk, particularly when organizational commitment is a concern (Biggs, Flett, Voges, & Alpass, 1995). Although a connection can be made between stress and distress, current literature indicates that, "stress does not reside in any one variable, but is a product of many interacting person and environment antecedents" (Gruen et al., 1988, p. 744).
Stress metamorphosis into distress. One model which has attempted to explain the reaction to stress, and ultimately the development of distress, is the General Adaptation Syndrome model (GAS; Seyle, 1975). The GAS views the stress response by an individual in terms of the physical reactions of a person placed in a "hostile" environment. GAS consists of three stages: (a) alarm, (b) resistance, and (c) exhaustion. With the incursion of stress, a person develops an awareness of the stress and begins rallying defenses to deal with the stressful event. The person resists developing distress for a period of time, depending on both the complexity of his/her defenses and the levels of stress being faced (Seyle, 1975). Eventually the person's resources to deal with stress are exhausted and the individual begins to experience distress. This model refines stress reaction and distress development at a basic level. However, it does not address critical information about how a person's strengths and vulnerabilities to cope due to the level of psychological defenses and past experiences, influence stress reaction and distress development. In addition, while this model provides an explanation for how stress can develop into distress, it does not explain the role of the environment as a potential immunity or vulnerability to stress, and thus, distress.
Work Environments and the Experience of Stress by People with Disabilities
Work is a fundamental aspect of human existence (Szymanski, Ryan, Merz, Trevino, & Johnston-Rodriguez, 1996). Work has been described as, "a sustained physical or mental effort to overcome obstacles and achieve an objective or result" (Merriam Webster's Collegiate Dictionary, 1995, p.1363). The objectives, with varying weights and timelines for actualization, are set up by the employer. Work and mastery of the tasks associated with the employer's objectives, contribute to job satisfaction, as well as reduce the barriers associated with work environments (Roessler & Rumrill, 1998). The role of accommodations in reducing barriers appears to be useful in increasing job mastery, in turn improving a worker's perception of job mastery (Roessler & Rumrill, 1995). Although positive perceptions of job mastery is one aspect of maintaining employment, other factors such as stress associated with work, the work environment, and the interaction of the individual's disability also may have significant roles.
The environment can be considered the, "... aggregate of social and cultural conditions that influence the life of an individual or community" (Merriam Webster's Collegiate Dictionary, 1995; p.452). Therefore, the environment in which work and stress are actualized incorporates a variety of factors. It incorporates the physical, social, and cultural conditions that influence the individual and his/her ability to work and cope with stress. The environment is a dynamic force that affects what an individual's work will be, how he/she will do it, and the repercussions for success and failure (Power, 2000). For example, recent literature has been concerned with how changes in the "typical" work environment may be associated with increased job stress for workers with disabilities (Szymanski, 1999). The globalization of economies, the changing nature of workplace technology, and demands placed on organizations from outside sources require employers to continually alter their workforce to meet the burgeoning obligations. Furthermore, these changes in the work environment are linked with increased potential for the development of distress in individuals with disabilities, creating placement and retention difficulties for rehabilitation counselors and the clients they serve (Szymanski). Disability becomes an important determinant in whether an interaction between person and the environment is considered stressful, based on the understanding that experience of stress under such circumstances, "... depends on the meaning or significance of that encounter, which in turn is based on personal agendas and coping resources ..." (Gruen et al., 1988, p. 744).
Definitions of disability tend to vary across programs and government agencies. For example, Webster's Dictionary (1995) defines disability as, "the inability to pursue an occupation because of physical or mental impairment" (p. 329). The Social Security Administration (SSA) has adopted a similar, yet more stringent definition of a person being unable do work that he or she did before and is viewed as being unable to adjust to other work because of a medical condition (SSA, 2003). While SSA defines disability as the inability to currently work or benefit from rehabilitation counseling services, providers of vocational rehabilitation services adopt a different paradigm. For example, the Rehabilitation Services Administration (RSA) utilizes the definition of disability provided in the Rehabilitation Act Amendments of 1998, defines a person with a disability as any individual meeting the following criteria, "has a physical or mental impairment which for such individual constitutes or results in a substantial impediment to employment; and; and 2) can benefit in terms of an employment outcome from vocational rehabilitation services provided pursuant to title I, III, or VI" (Rehabilitation Act Amendments of 1998, Section 7:21). The RSA definition and state vocational rehabilitation services with similar definitions underscore the importance of rehabilitation services and the role of the rehabilitation counselor in assisting persons with disabilities in employment acquisition and maintenance. Therefore, it is essential that rehabilitation counselors understand how disability may impact the way the person, the environment, and the job interact to prevent or facilitate the development of stress and potentially distress (Turner & McLean, 1989). The potential for developing distress may distinguish between persons who fit the SSA definition versus those who meet the RSA definition. In fact, it may be the development of distress, due to limitations posed by the environment and a disability, that have given rise to the experience of mental health issues such as depression among persons with disabilities (Turner & McLean). Therefore, interaction between individuals and their environments as well as the relative degree of "fit" may provide information regarding whether they meet the SSA or RSA definition and corresponding services provided under those definitions.
The DCS model (Karasek & Theorell, 1990) is a multidimensional model that examines the relationship between person and environment with a particular focus on this interaction in employment settings. The DCS model utilizes three dimensions or constructs that focus on explaining the development of stress for the individual at work. The individual, the central figure in this model, has his or her perceptions of work experience ultimately shaped by these factors. The three factors, also collectively referred to as the model for the psychosocial work environment, are: (a) demand, (b) control, and (c) support (Karasek & Theorell, 1990).
Demand and Stress
Demand refers to the amount of workload or responsibilities placed on an individual. For purposes of this discussion, the authors will focus only on those tasks assigned to individuals within a work setting, not the demands individuals place on themselves (i.e., need fur perfection, view of success, etc.). The demands placed on individuals have long been thought of as one of the main reasons for the development of distress (Karasek & Theorell, 1990). As demands increase, stress also increases. If the level of stress increases beyond an individual's ability to cope, the person will likely develop distress. Likewise, having too little work demands can also develop distress, dependent on an individual's need for stimulation and responsibility. For example, too few demands lead to boredom, which in turn can lead the individual to feel overqualified or under-appreciated in their current job (Karasek & Theorell).
Control and Autonomy
Control of job duties and how they are completed is another factor closely linked to the development of distress (Kompier & Levi, 1993). Control, a concept equated with autonomy (Beehr, 1995), allows an individual to control what duties to respond to first and how to go about completing them. This factor, although seemingly trivial, can be a major issue depending on a person's self-esteem (Koslowsky, 1998), locus of control (Cox, 1988), and work goals (Steil & Hay, 1997). Persons who perceive that they have insufficient control in their employment may feel less valued. Conversely, persons who feel they are required to have more control than they would like may feel overloaded and overworked (Karasek & Theorell, 1990). Perceptions regarding the amount of control in work settings and whether those perceptions meet individual needs for a certain degrees of autonomy has an immediate affect on the experience of stress (Lazarus, 1999). As perceptions of control begin to differ with individual expectations, personal agendas increase the likelihood that minimal issues (i.e., daily hassles) become viewed as significant stressful events (Gruen et al., 1988). These significant stressful events are then likely to surpass an individual's coping ability, thus resulting in a loss in performance and the experience of distress.
Perceptions of Support
Support, the last dimension of the model, looks at the level and type of assistance given by management or the supervisor to the worker. Support and control are, "almost inseparable strategies (Karasek & Theorell, 1990, p.69)," in that changes in level of control are almost always accompanied by inverse affects on support. Perceived support by an individual can often be the catalyst that prevents or promotes the development of unhealthy stress (Leather, Lawrence, Beale, Cox, & Dickson, 1998). Individuals that feel supported by their supervisors feel valued and important, have increased self-concept, and develop an internal perspective of being part of a larger group (Storey & Certo, 1996). Developing this internal focus is inherent in the individual's ability to deal with conflicts that do arise in the work place and the stress associated with those conflicts (Aitken & Schloss, 1994).
Persons who feel a lack of support from coworkers and employers often feel less valued and may have lower levels of productivity than those persons who feel more supported (Karasek & Theorell, 1990). Unfortunately, as the level of support increases, the amount of control a person has usually decreases, generating concerns of whether the individual's current position provided him or her with enough autonomy. The interactions among the different dimensions of the model are both the benefit and boon of the DCS model. Reviewing employment opportunities for trade-offs between various dimensions and finding the position that best matches the individual's needs is essential for developing a favorable job match (Karasek & Theorell).
Interactions between Dimensions
The interactions between these dimensions can develop work situations that are more or less stressful depending on the individual. The combination of demand, support, and control factors can lead to lowered work performance, poor response to supervision, and eventual departure from the workplace. For instance, people who are in jobs with high demand, low control, and low support are considered to be a high-risk group for developing stress (Karasek & Theorell, 1990). People in this group are often characterized as having high strain while at the same time feeling isolated from others (Karasek & Theorell). For example, positions historically reflecting these types of dimensions are those in the "fast-food" service occupations, an employment sector known for its high turnover rates of employees and historical use as a vocational placement outcome for persons with disabilities (Schalock, McGaughey, & Kieman, 1989). "Fast-food" settings are associated with high demand, low control, and potentially low support. Although this combination of DCS factors may work for an individual that desires employment with high demands, low control, and low support, for others this is a formula for burnout, which is associated with decreased job satisfaction and difficulties with job maintenance (Schalock et al.). The formula for success, then, relies heavily on finding the best interaction between what individuals need from work (i.e., demands, control, support), what the work environment offers, and the reciprocal effect between person and environment.
Person x Environment Fit Model
The Person x Environment (P x E) fit model is a modernized form of the trait-factor approach to vocational rehabilitation (Kosciulek, 1993). Building on the almost 100-year exploration of trait-factor approaches to assist persons with disabilities to securing employment, the P x E fit model evolved from this first major theory of vocational counseling. Although the trait-factor approach did facilitate successful placements for some individuals with disabilities, it was found to have several limitations. For instance, the trait-factor approach was found to be unable to compensate for persons with limited life experiences, such as those individuals with congenital disabilities (Kosciulek). Furthermore, the trait-factor approach was limited in its ability to provide interventions to facilitate job maintenance by persons with disabilities.
Instead of viewing the person and environment as static forces, the P x E fit approach describes the matching of people and environments as a dynamic interaction, in which individuals have the capacity to shape environments (Kosciulek, 1993). Similar to the trait-factor approach, the P x E approach incorporates the following assumptions: a) people have the capacity to make rational decisions, b) individuals and environments vary in reliable ways, and c) chances for vocational success increase as congruence between individual traits and environments increases (Kosciulek). While these assumptions are the same as those hypothesized in the trait-factor approach, the P x E fit approach stresses the importance of, "... the reciprocal process with individuals shaping the environment and the environment influencing individuals (p. 13)."
The reciprocal process between person and environment, then, provides a method through which rehabilitation counselors can develop person-based and environmental based interventions (Kosciulek, 1993). However, P x E fit approaches, as described in the literature (Dobren, 1994; Hershenson, 1998; Parker, Szymanski, & Hanley-Maxwell, 1989; Szymanski, Dunn, & Parker, 1989; Szymanski & Parker, 1989), usually require the use of supported employment or situation assessment methods to adequately gauge the dynamic interaction between individuals and their work environments. Although the use of ecological assessment methods is recommended whenever possible, the use of these methods is not always possible, given the time, monetary, and caseload constraints of vocational rehabilitation service providers (Thomas, 1999). One alternative rehabilitation counselors may utilize in understanding the dynamic interaction of the person and the environment and the potential for developing distress, without the benefit of having an ecological assessment, is to view the interaction of individual and environment in terms of the Demand-Control-Support (DCS) model (Karasek & Theorell, 1990).
DCS Model Applied to the P x E Fit Model
In applying the DCS model to the P x E fit model, several factors need to be explored, such as the interaction of a disability, understanding individual needs based on the DCS model, and environment considerations posed by the DCS model. Through exploring these factors, a link can be developed regarding the reciprocal relationship between person and environment.
A disability can have a profound effect upon an individual's ability to cope with stress (Turner & McLean, 1989). Moving past the experience of the disability and the stress involved, the impact it can have on the person's physical and psychological defense mechanisms is profound. The definition of disability given earlier denotes a person having either a physical or mental deficiency. It seems logical to assume, then, that individuals with disabilities may be at a higher risk to having impaired physical or psychological defenses to contend with stressful.
The individual's psychological defenses, in response to stress, are an important factor in whether or not he/she will experience distress (Simon, 1971). Defenses mechanisms, either taught or learned via experience, affect the physical response to stress. Understanding the nature of a person's psychological defense mechanisms, their complexity, and the individual's ability to apply them to novel situations is crucial to understanding how the person will react when confronted with a stressful stimulus (Williams & Anderson, 1997).
Psychological defenses or coping ability can help prevent individuals from experiencing distress by giving them the resources to handle stressful events (Steptoe & Wardle, 1994). Defense mechanisms have been researched since the beginning of formal psychology by writers such as Freud (Koocher, Norcross, & Hill, 1998; Levit, 1993; Vaillant, Bond, & Vaillant, 1986). Coping strategies, whether they are passive or active, simple or complex, all work toward easing the physical response to stress. Coping strategies, both effective and ineffective, allow an individual to avoid developing distress (Brown, Nicassio, & Wallston, 1989). Coping strategies are necessary for individuals to adjust to disabilities (Cairns & Baker, 1993; Livneh, 2000), and the degree that persons adjust to disabilities facilitates how well the P x E fit model will enable them in their employment goals.
Interaction Between Disability and P x E fit Model
The level of adjustment and acceptance of a disability has a direct influence on the P x E fit model. For instance, individuals still in the process of adjusting to their disabilities may experience changes in perceptions of needs (Livneh, 2001; McNulty, 2002). As those perceptions change, the environment will also have to change to accommodate those changes. In cases where the environment is unable to reciprocate these changing perceptions, the level of fit may decrease, ultimately developing into a poor match. Coping with a disability may also limit an individual's ability to change with the environment (Millington, Reid, & Leierer, 1997). For example, if the environment begins to vary and individuals are unable to adjust to the changes, the degree of fit is also likely to diminish. In either case, disability can have a profound affect on the P X E fit model. The DCS model, although not exempt from the interaction affects of a disability, does have benefits in understanding and explaining how a sound match can be arrived between individual needs and environmental requirements.
DCS and the Person
Demand, control, and support are all issues that persons with disabilities struggle with on a daily basis, not just in the workplace (Koslowsky, 1998). Understanding how the DCS model complements understanding the needs of persons with disabilities may allow rehabilitation counselors to understand factors related to an individual's difficulty maintaining employment.
Demand and the person. The demand that the disability alone can place on an individual can overwhelm the psychological defenses of the person (Turner & McLean, 1989). The demands of work can mask the strain of coping with a disability (Matheson, 1988), or add to the stress that the person must overcome (Feuerstein, Carosella, Burrell, Marshall, & DeCaro, 1997). In either case, gauging an individual's current demands (i.e., coping demands, issues with activities of daily living), and obtaining an understanding of what type of demands the person is looking for in a work environment may help the rehabilitation counselor guide the individual toward matching occupations.
Control and the person. The onset of a disability can also cause a loss in the sense of control a person has over his/her life (Ericksson & Carlsson, 1991). Dealing with control issues at work can compound the feelings of loss of control in one's life, further lowering a person's sense of control and self-concept. As a result, gathering information from persons with disabilities as to the level of autonomy or control they require in employment settings can facilitate placement efforts. For instance, for persons who wish to have a high level of control of their work environment, placement in a vocational setting in which there is very little control may create maintenance difficulties for the individual. Likewise, although positions are available that allow for more autonomy than others, such as those that allow a person to work from home, the concern with the amount of support these positions afford may create difficulties as well.
Support and the person. The cliche, "It's lonely at the top," reflects the support issues inherent in some occupations that are high in control. Support, an important aspect in facilitating open communication in any work setting (Koslowsky, 1998), is especially important to persons with disabilities, who are responsible for communicating their accommodation needs. Poor support may diminish a person's ability or desire to express those concerns, especially if the supervisor is not viewed as being very supportive (Bahniuk, Dobos, & Hill, 1990). Therefore, although the potential for home-based employment has been viewed as a potential employment outcome for persons with severe disabilities (Shane & Roberts, 1989), rehabilitation counselors should exercise caution promoting it as a vocational option.
DCS and the Environment
The environment is as integral to the development of the distress as the individual (Piltch, Walsh, Mangione, & Jennings, 1994). Furthermore, the environment can serve as either an immunity or vulnerability, enhancing the person's strengths or limitations. An environment may serve as an immunity against the development of distress by reducing the experience of "daily hassles" (Lazarus, 1999; Lazarus & Folkman, 1984). Daily hassles, those, "... seemingly little things that irritate and upset people ..." (Lazarus, p. 56), singularly do not present difficulties for most individuals. Consequently, environments which present few daily hassles for individuals are likely to be perceived as less stressful. However, as the number and chronicity of daily hassles increases, the environment itself becomes a potential vulnerability, particularly when such hassles are associated with harmful work conditions (Gruen et al., 1988). The DCS model provides some insight into various aspects of the environment and the potential experience of daily hassles.
Understanding environmental demands on persons with disabilities. The environment demands placed on individuals with disabilities generally fall into two categories- structural and interpersonal (Renwick & Krywonis, 1992). Structural demands are those conditions that are intrinsic to the specific workplace, such as accessibility of the worksite (i.e., temperature of the work site, hazards, entrance, and stairs or steps) and the accommodations necessary to meet the essential functions of the job (Roessler & Rumrill, 1995). The inability to enter the worksite or failure to meet the essential functions due to ineffective accommodation represents a significant daily hassle that can be resolved in a relatively short period of time, but has the potential to overload an individual's ability to cope if not addressed.
Interpersonal demands, which are primarily comprised of the stigmatized views of employers and coworkers, represent an environmental demand may not have a simple or quick solution, even with federal legislation aimed at reducing this very demand (Schall, 1998). Interventions such as the development of natural supports have helped in reducing the extent of interpersonal demands. However, people with disabilities are still discriminated against, despite the best efforts of lawmakers and rehabilitation counselors. Attitudinal change has occurred in the last several decades (Loo, 2002; Williams, 1972), but there is still a need to work with employers and coworkers on limiting interpersonal demands.
Control within work environments. Perceptions of a lack of control in the work environments by individuals with disabilities can result in increased experience of stress (Renwick & Krywonis, 1992). In particular, factors such as the ability to restructure job tasks and share essential functions, the clarity of definitions regarding acceptable work performance, and the extent that work roles are determined by extraneous variables (i.e., weather/season, traffic flow; (Newton, Elliot, & Meyer, 1988), may limit perceptions of control by individuals with disabilities.
Rehabilitation professionals can help improve perceptions of control by working with employers on accommodations and job restructuring prior to the start of employment. Furthermore, developing concrete work goals, job descriptions, and task analyses may facilitate comprehension of acceptable performance, thus increasing feelings of control. Finally, rehabilitation professionals, in developing rehabilitation plans, should realize the potential of extraneous variables to affect feelings of control and develop employment goals in settings which minimize the importance of these variables.
Supporting persons with disabilities in work environments. Because of the interpersonal demands inherent in work environments for persons with disabilities, the need to establish support mechanisms is crucial for vocational success. The development of natural supports such as building in overlapping or intersecting work tasks, providing flexibility in job duties, and incorporating social times into work schedules can all work toward augmenting personal relationships between persons with disabilities and their coworkers (Hagner & Rogan, 1992). Understanding the culture of work environments, such as the, "... set of shared beliefs, customs, meanings, and tradition" (Hagner & Rogan, p. 32), can facilitate the preparation of the work environment and the individual with a disability for each other.
For persons with disabilities, a long-used strategy in job placement was to match the person's abilities and interests to those matching people in a certain occupations (Szymanski, Hershenson, Enright, & Ettinger, 1996). This P x E fit strategy, a logical connection of people to careers, should also consider the person's ability to deal with stress and the work environment. Understanding the demand, support, and control factors of occupations may allow for long-term vocational stability and positive health outcomes for individuals with disabilities (Roether, 1984). Rehabilitation counselors should appraise the individual and the work environment in terms of the DCS model and provide career counseling to individuals based on this knowledge.
Persons with disabilities, in addition to being made aware of the work environment and its stresses, should also be encouraged to explore their ability to deal with both physical and psychological stress to insure that they will be ready for the challenges posed to them by work. Individuals who express that they may not be ready to cope effectively with a certain environment due to their current ability to cope and manage stress should receive training in areas such as coping and social skills, as well as stress inoculation therapy. This additional training may provide individuals with the tools necessary to handle the day-to-day stress of working and the stress associated with living with a disability and with the work environment.
Although the focus of this article was the use of the DCS model in vocational placement, this model is not limited to pre-employment concerns. Due to the dynamic nature of individuals, work, and the environment, rehabilitation professionals must often reevaluate placements of individuals with disabilities. As work roles are altered, coworkers come and go, and natural supports fluctuate (Szymanski, 1999), the DCS model provides a means for assessing an individual's current capacity to meet the perceived demands of the work environment.
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Timothy N. Tansey
Utah State University
San Francisco State University
James M. Ferrin
University of South Carolina
Molly K. Tschopp
Ball State University
Florida Atlantic Unviversity
Timothy N. Tansey, Ph.D., Utah State University Department of Special Education & Rehabilitation, 2865 Old Main Hill Education Building, Room 313, Logan, UT 84322-2865.
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|Publication:||The Journal of Rehabilitation|
|Date:||Jul 1, 2004|
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