A longitudinal analysis of emotional impact, coping strategies and post-traumatic psychological growth following spinal cord injury: A 10-year review

OBJECTIVES

To review emotional impact, psychological growth and coping strategies in a sample of traumatic spinal cord injured people from 12 weeks post-injury to 10 years post-hospital discharge.

DESIGN

Longitudinal, multiple wave panel design.

METHODS

Eighty-seven people with traumatically acquired spinal cord injuries were assessed at 12 weeks post-injury and followed up 10 years later (43% of the original sample responded). The Beck Depression Inventory, the State Anxiety Inventory, the COPE Scale, the Functional Independence Measure and the Social Support Inventory were completed on both occasions.

RESULTS

Rates of anxiety and depression had changed little over the 10-year period. Two-thirds of the sample showed no signs or symptoms of depression. Coping strategies remained relatively stable over time, statistically significant regression models (coping strategies at week 12 post-injury) predicted one-third of the variance in depression at year 10. Rates of post-traumatic psychological growth were associated with higher levels of psychological distress.

CONCLUSIONS

These results suggest that many people living with spinal cord injury manage the consequences of their disability without significant levels of psychopathology. However, the coping strategies they employ remain critical in accounting for this adjustment. The relationship between post-traumatic growth and psychological well-being was found to be complex, raising many questions for future research.

Factors predictive of distress in people awaiting a lower gastro-intestinal endoscopy

Lower gastro-intestinal endoscopy is a common investigative procedure which can be distressing. The extent of this distress is not known, nor have the predictive factors been identified. The aim of the present study was to identify to what extent it is distressing, what factors might predict distress in this population and to identify coping strategies that may mediate such distress. Service implications are also explored. Three hundred and one patients awaiting a lower gastro-intestinal endoscopy during a 9-month period from two separate hospitals were sampled using a cross-sectional survey design. Participants completed a battery of questionnaires comprising demographic and health information, the Hospital Anxiety Depression Scale, the Brief COPE, the Social Provisions Scale, the Life Orientation Test Revised and two Appraisal Scales. Patients were found to be significantly more anxious than the general population but not more depressed. Coping strategies of self-blame and self-distraction, threat appraisals of endoscopy procedure and control appraisals of results, low optimism, presence of symptoms, low social support, and gender were found to account for 56.3% variance in anxiety. Longer times on the waiting list increased the degree to which the procedure was appraised as a threat. High levels of distress are evident in this population. There is a clear need for better identification of distressed patients and the appropriate provision of psychological support.

Cognitive appraisals, coping and quality of life outcomes: a multi-centre study of spinal cord injury rehabilitation

STUDY DESIGN

Longitudinal, multiple wave panel design.

OBJECTIVES

To investigate the degree to which current thinking in terms of early appraisals and coping predicts adjustment and quality of life outcomes after spinal cord injury, and to what degree social and demographic variables are involved.

SETTING

Data were analysed from 266 patients recruited as part of an ongoing study from specialist units in selected British, Swiss, German and Irish spinal centres.

METHOD

Questionnaire booklets were administered as soon as possible after injury onset and after 12 weeks to patients with newly acquired spinal cord injuries. Individuals included had sustained their injury between the ages of 16 and 83.

RESULTS

Significant improvements in outcome measures were found across the data set within the first 12 weeks after spinal cord injury and changes observed in the appraisals and coping strategies employed. Significant differences were found between participating centres on both outcome measures and in the coping and appraisal processes used. Coping and appraisal processes at 6 weeks after injury were found to contribute significantly to the variation in psychological well-being at 12 weeks after injury.

CONCLUSION

This study shows the process of adjustment to spinal cord injury to begin in the early stages of rehabilitation, and initial appraisals are important to how an individual will cope with their injury and to their psychological well-being. Support is also given to the importance of psychological factors to functional outcomes.

The severe burns patient with tracheostomy: implications for management of dysphagia, dysphonia and laryngotracheal pathology

INTRODUCTION

Insertion of a tracheostomy for a severe burn patient is not uncommon. The method of decannulation, effects of the tracheostomy on voice and swallowing and subsequent complications have not been described in the literature specifically for this population. The aim of this study was to investigate the risk of dysphagia, dysphonia and laryngotracheal pathology in severe burn patients with tracheostomy and following decannulation.

METHOD

A retrospective chart review was conducted for severe burn patients admitted from January 2000 to December 2007 that received tracheostomy as part of their treatment.

RESULTS

Two hundred and thirty patients were admitted during the study period, 26 of whom underwent tracheostomy. Significant positive correlations were identified between tracheostomy duration and %TBSA burn, days to commence oral intake and days to commence pre-morbid oral diet. Several dysphagic features were identified within the oral and pharyngeal phases of swallowing and dysphonia was frequently demonstrated on perceptual voice assessment with the tracheostomy in situ and following decannulation. Laryngotracheal pathology was diagnosed in 12 of the 26 patients (46.2%) whilst the tracheostomy was in place; 2 with laryngeal granulation tissue, 2 with tracheal granulation tissue, 2 with supraglottic oedema and erythema and 6 with reduced vocal mobility.

CONCLUSION

Severe burn patients that have prolonged tracheostomy are likely to have a larger size burn, take longer to commence oral intake and achieve pre-morbid oral diet. These patients are also at risk for dysphagia, dysphonia and laryngotracheal pathology.

The psychometric analysis of a brief and sensitive measure of perceived manageability

This study was conducted to determine the psychometric properties of the newly developed Perceived Manageability Scale (PMnac). The study was retrospective in design. Two hundred sixty-one inpatients with a spinal cord injury were recruited from The National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, UK, as part of a convenience sample. The PMnac was developed to measure an individual's perceived manageability of their situation. The Mood Questionnaire is used to assess an individual's current mood. Both scales are part of the Needs Assessment Checklist; a psychometrically valid and reliable outcome tool and vital part of the rehabilitation pathway at the NSIC. Results indicated that out of the six items in the scale, five were found to load onto one factor. The remaining item (item number five) did not load onto this factor structure and was consequently removed from subsequent analyses. With the removal of this item, the PMnac was found to yield high internal validity correlations, internal consistency coefficients and significant sensitivity to change. The PMnac is a psychometrically reliable and valid clinical measure of an individual's perceived manageability of their situation.

Sense of coherence and psychological outcomes in people with spinal cord injury: appraisals and behavioural responses

STUDY DESIGN

Longitudinal, multi-wave design.

OBJECTIVES

To investigate the contribution of sense of coherence (SOC), appraisals, and behavioural responses when predicting psychological outcomes to spinal cord injury (SCI).

METHOD

Patients (N=237) sustaining a SCI aged 17 or above were recruited from specialist spinal injuries centres across six European countries. Measures of SOC, appraisals, coping strategies, and psychological well-being were administered at 6 and 12 weeks post-injury and at a 1 year follow-up.

RESULTS

People scoring high on SOC at 6 weeks post-injury showed significantly better psychological outcomes at 1 year post-injury and SOC showed significant relationships with appraisals at 12 weeks post-injury and coping strategies 1 year post-injury. Significant relationships were found between appraisals at 12 weeks post-injury and psychological outcomes, adaptive coping strategies were significantly related to psychological well-being at 1 year post-injury. Regression analyses found SOC, appraisals, and coping behaviours to explain 61.8% of the variance in psychological quality of life, 66.5% of the variance in depression, and 37.7% of the variance in anxiety at 1 year post-injury.

CONCLUSION

This study provides further evidence in support of previous findings which suggest SOC to have a primary role in long-term psychological well-being. The relationship described here - from SOC to the appraisal of injury and subsequent behavioural responses - suggests SOC to be an influential factor in the long-term adjustment of people with SCI.

Spinal cord injury, coping and psychological adjustment: a literature review

OBJECTIVES

This paper reviews the literature concerning psychological adjustment to spinal cord injury, focusing on the recent methodological developments and new directions in research.

METHOD

Several literature reviews using the search terms Spinal Cord Injury, Paraplegia, Coping and Adjustment were undertaken using the databases in Pubmed, Medline and Embase. The papers that were published from 2001 onwards, written in English and used a sample of adults were included.

RESULTS

The literature reviewed lends further support to the importance of appraisals and coping strategies in the adjustment to spinal cord injury. Methodological issues highlighted in earlier reviews are addressed in conjunction with further theoretical explorations.

CONCLUSIONS

Although many of the methodological criticisms have been addressed, there remains a need for longitudinal research into the process of adjustment to spinal cord injury and the contributory role of appraisals and coping strategies. Measurement tools designed specifically for use within the spinal cord injured population should be utilized in the prevention of maladaptive adjustment issues, whereas able-bodied comparison groups would allow identification of coping strategies unique to the spinal cord injured population.

Use of mobile phone cameras for after-hours triage in primary care

Mobile phone images might be useful in after-hours triage of primary care. We conducted a study to identify population access to mobile phone cameras and to assess the clinical usefulness of mobile phone cameras. The survey was conducted among 480 patients attending two rural New Zealand practices. There were significantly more Maori owners compared to non-Maori (P = 0.002). Age was a significant factor influencing the ownership of mobile phones. We also conducted a clinical quiz among health professionals to assess how the provision of images on a mobile phone and on CD-ROM (to simulate the image that would be seen if email was used to transmit the images) influenced diagnostic confidence. Ten photographable clinical conditions were used to quiz 30 health professionals who were randomized into three groups of 10 each on diagnostic confidence. Images were found to significantly increase diagnostic confidence in all cases except one. It appears that mobile phone cameras are generally acceptable to patients and likely to be of practical use to rural practitioners in a range of clinical scenarios.

Changes in serum procalcitonin and C-reactive protein following antimicrobial therapy as a guide to antibiotic duration in the critically ill: a prospective evaluation

Serial procalcitonin is reported to be useful to titrate duration of antibiotic therapy in the non critically ill patient with pneumonia. The aim of this study was to examine the relationship between antibiotic therapy and serial serum procalcitonin concentrations in a cohort of critically ill septic patients and examine for any differences between culture positive (CP) and culture negative (CN) sepsis. Seventy-five critically ill patients with suspected sepsis were enrolled in this prospective observational study. Serial procalcitonin and C-reactive protein assays were measured on days one, three, five, seven, 10 and 14. The mean duration of antibiotic therapy was similar in the two groups (10.4 +/- 5.1 (CP) vs. 8.4 +/- 5.1 (CN) days, P = 0.09). Serum procalcitonin concentrations were significantly higher at baseline in the CP than the CN group (14.9 +/- 22.9 vs. 6.8 +/- 21.5 ng/ml, P = 0.04). During the study period, serum concentrations of procalcitonin and C-reactive protein declined in both groups. Serum procalcitonin consistently remained higher in the CP group (P < 0.05) and did not return to normal values. In the CN group, procalcitonin concentrations fell below 0.5 only on day 10. There was no significant difference in C-reactive protein profile between the two groups. Four patients in the CP group (11%) had relapse of sepsis. The mean procalcitonins in the relapsed subgroup were lower than those in the remission subgroup (P = 0.02). Therapy for proven or presumed infections was associated with declining serum procalcitonin and C-reactive protein in critically ill septic patients. The marked variability and overlap in plasma profile of these markers between CP and CN sepsis makes it difficult to define a nadir plasma concentration at which one can recommend discontinuation of antibiotic therapy.

Redetermination of cis-diaqua-diglycolato-zinc(II)

The title complex, [Zn(C₂H₃O₃)₂(H₂O)₂], was prepared and the crystal structure determined as part of a ⁶⁷Zn solid state nuclear magnetic resonance study. In the title complex, the Zn atom has a disorted octa­hedral coordination comprising two bidentate glycolate ligands and two water mol­ecules. The water mol­ecules are cis to each other; one is trans to a carboxyl­ate O atom and the other trans to an alcohol O atom. The crystal structure has an extensive O—H⋯O hydrogen-bond network.