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Dwyer K, Mulligan H. The experiences of individuals with a spinal cord injury following discharge from inpatient rehabilitation. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2017. [DOI: 10.12968/ijtr.2017.24.8.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kathryn Dwyer
- Postgraduate student School of Physiotherapy, University of Otago, New Zealand; Physiotherapist, Home Action Team (Division of Laura Fergusson Trust), Christchurch, New Zealand
| | - Hilda Mulligan
- Senior Lecturer, School of Physiotherapy, University of Otago, New Zealand
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Is the Routine Use of a Functional Electrical Stimulation Cycle for Lower Limb Movement Standard of Care for Acute Spinal Cord Injury Rehabilitation? PM R 2017; 9:521-528. [DOI: 10.1016/j.pmrj.2017.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 03/18/2017] [Indexed: 11/20/2022]
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Braaf SC, Lennox A, Nunn A, Gabbe BJ. Experiences of hospital readmission and receiving formal carer services following spinal cord injury: a qualitative study to identify needs. Disabil Rehabil 2017; 40:1893-1899. [DOI: 10.1080/09638288.2017.1313910] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sandra C. Braaf
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alyse Lennox
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Hospital, Heidelberg, Victoria, Australia
| | - Belinda J. Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The Farr Institute, Swansea University Medical School, Swansea University, Singleton Park, Swansea, United Kingdom
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Houlihan BV, Brody M, Everhart-Skeels S, Pernigotti D, Burnett S, Zazula J, Green C, Hasiotis S, Belliveau T, Seetharama S, Rosenblum D, Jette A. Randomized Trial of a Peer-Led, Telephone-Based Empowerment Intervention for Persons With Chronic Spinal Cord Injury Improves Health Self-Management. Arch Phys Med Rehabil 2017; 98:1067-1076.e1. [PMID: 28284835 DOI: 10.1016/j.apmr.2017.02.005] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Revised: 01/24/2017] [Accepted: 02/01/2017] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To evaluate the impact of "My Care My Call" (MCMC), a peer-led, telephone-based health self-management intervention in adults with chronic spinal cord injury (SCI). DESIGN Single-blinded randomized controlled trial. SETTING General community. PARTICIPANTS Convenience sample of adults with SCI (N=84; mean time post-SCI, 9.9y; mean age, 46y; 73.8% men; 44% with paraplegia; 58% white). INTERVENTIONS Trained peer health coaches applied the person-centered health self-management intervention with 42 experimental subjects over 6 months on a tapered call schedule. The 42 control subjects received usual care. Both groups received the MCMC Resource Guide. MAIN OUTCOME MEASURES Primary outcome-health self-management as measured by the Patient Activation Measure (PAM). Secondary outcomes-global ratings of service/resource use, health-related quality of life, and quality of primary care. RESULTS Intervention participants averaged 12 calls over 6 months (averaging 21.8min each), with distinct variation. At 6 months, intervention participants reported a significantly greater change in PAM scores (6mo: estimate, 7.029; 95% confidence interval, .1018-13.956; P=.0468) compared with controls, with a trend toward significance at 4 months. At 6 months, intervention participants reported a significantly greater decrease in social/role activity limitations (estimate, -.443; P=.0389), greater life satisfaction (estimate, 1.0091; P=.0522), greater services/resources awareness (estimate, 1.678; P=.0253), greater overall service use (estimate, 1.069; P=.0240), and a greater number of services used (estimate, 1.542; P=.0077). Subgroups most impacted by MCMC on PAM change scores included the following: high social support, white persons, men, 1 to 6 years postinjury, and tetraplegic. CONCLUSIONS This trial demonstrates that the MCMC peer-led, health self-management intervention achieved a positive impact on self-management to prevent secondary conditions in adults with SCI. These results warrant a larger, multisite trial of its efficacy and cost-effectiveness.
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Affiliation(s)
- Bethlyn Vergo Houlihan
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA.
| | - Miriam Brody
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA
| | - Sarah Everhart-Skeels
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA
| | - Diana Pernigotti
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Rehabilitation Services and Outpatient Services, Spinal Cord Injury Program, Gaylord Hospital, Wallingford, CT
| | - Sam Burnett
- Centre for Collaboration, Motivation and Innovation, Hope, British Columbia, Canada
| | - Judi Zazula
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA
| | - Christa Green
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Hospital for Special Care, New Britain, CT
| | - Stathis Hasiotis
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Rehabilitation Services and Outpatient Services, Spinal Cord Injury Program, Gaylord Hospital, Wallingford, CT
| | - Timothy Belliveau
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Hospital for Special Care, New Britain, CT
| | - Subramani Seetharama
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Hartford Hospital, Hartford, CT
| | - David Rosenblum
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; Rehabilitation Services and Outpatient Services, Spinal Cord Injury Program, Gaylord Hospital, Wallingford, CT
| | - Alan Jette
- New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA; The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA
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Social activity and relationship changes experienced by people with bowel and bladder dysfunction following spinal cord injury. Spinal Cord 2017; 55:679-686. [PMID: 28244500 DOI: 10.1038/sc.2017.19] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 12/04/2016] [Accepted: 01/22/2017] [Indexed: 01/13/2023]
Abstract
STUDY DESIGN Exploratory qualitative. OBJECTIVES The aim of this study was to describe the experiences of bowel and bladder dysfunction on social activities and relationships in people with spinal cord injury living in the community. SETTING People living with spinal cord injury experiencing bowel and bladder dysfunction. METHODS Participants were recruited through the Australian Quadriplegic Association Victoria. Semi-structured in-depth interviews were undertaken with purposively selected participants to ensure representation of age, gender, spinal cord injury level and compensation status. A thematic analysis was performed to interpret patient experiences. RESULTS Twenty-two participants took part in the study. Bladder and bowel dysfunction altered relationships because of issues with intimacy, strained partner relationships and role changes for family and friends. A lack of understanding from friends about bladder and bowel dysfunction caused frustration, as this impairment was often responsible for variable attendance at social activities. Issues with the number, location, access and cleanliness of bathrooms in public areas and in private residences negatively affected social engagement. Social activities were moderated by illness, such as urinary tract infections, rigid and unreliable bowel routines, stress and anxiety about incontinence and managing the public environment, and due to continuous changes in plans related to bowel and bladder issues. Social support and adaptation fostered participation in social activities. CONCLUSION Tension exists between managing bowel and bladder dysfunction and the desire to participate in social activities. Multiple intersecting factors negatively affected the social relationships and activities of people with spinal cord injury and bowel and bladder dysfunction.
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Accelerated Arterial Stiffening Change in Early Years of Spinal Cord Injury. Am J Phys Med Rehabil 2017; 96:120-123. [DOI: 10.1097/phm.0000000000000565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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57
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A cross-sectional study on self-management of pressure ulcer prevention in paraplegic patients. J Tissue Viability 2017; 26:69-74. [DOI: 10.1016/j.jtv.2016.08.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Revised: 07/08/2016] [Accepted: 08/22/2016] [Indexed: 11/20/2022]
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58
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Empowering Adults With Chronic Spinal Cord Injury to Prevent Secondary Conditions. Arch Phys Med Rehabil 2016; 97:1687-1695.e5. [DOI: 10.1016/j.apmr.2016.04.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 03/29/2016] [Accepted: 04/04/2016] [Indexed: 11/21/2022]
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Self-management interventions to improve skin care for pressure ulcer prevention in people with spinal cord injuries: a systematic review protocol. Syst Rev 2016; 5:150. [PMID: 27600153 PMCID: PMC5011862 DOI: 10.1186/s13643-016-0323-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2016] [Accepted: 08/22/2016] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pressure ulcers are a serious, common, lifelong, and costly secondary complication of spinal cord injury (SCI). Community-dwelling people with a SCI can prevent them with appropriate skin care (i.e. pressure relieving activities, skin checks). Adherence to skin care remains suboptimal however, and self-management interventions that focus on improving this have been designed. Little is known on their content, effectiveness, or theoretical basis. The aim of the proposed systematic review is to synthesize the literature on self-management interventions to improve skin care in people with a SCI. Specific objectives are to describe these interventions in relation to their content, effectiveness, theory base, and adherence to reporting guidelines for intervention description. METHODS The search strategy will combine an electronic search of nine bibliographic databases (MEDLINE, Embase, PsycInfo, CENTRAL, CINAHL, Rehabdata, CIRRIE, PEDro, ERIC) and two trial registers with a manual search of relevant reference lists. Predefined eligibility criteria will be applied in a two-phase selection process involving title and abstract screening, followed by full-text screening. A data extraction spreadsheet will be applied to included papers. Intervention content will be coded using two taxonomies (behaviour change taxonomy; PRISMS self-management support taxonomy). A validated tool (Theory Coding Scheme) and the Template for Intervention Description and Replication (TIDieR) will be used to examine theoretical basis and assess adherence to reporting guidelines for intervention description. A small number of heterogeneous studies are likely to be included in this review therefore a narrative synthesis is planned. DISCUSSION This systematic review will help identify the gaps and priorities to guide future research activities in this area. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42016033191.
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Florio J, Arnet U, Gemperli A, Hinrichs T. Need and use of assistive devices for personal mobility by individuals with spinal cord injury. J Spinal Cord Med 2016; 39:461-70. [PMID: 26666510 PMCID: PMC5102298 DOI: 10.1080/10790268.2015.1114228] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To investigate the provision, use, and unmet need of assistive devices for personal mobility in the Swiss population with spinal cord injury (SCI). DESIGN Community survey 2012 of the Swiss Spinal Cord Injury Cohort Study. PARTICIPANTS Individuals aged 16 or older with traumatic or non-traumatic SCI residing in Switzerland. INTERVENTIONS Not applicable. OUTCOME MEASURES Provision, frequency of use, and unmet need (i.e. perceiving the need of a device but it not being provided) of 11 mobility devices were assessed by self-report and analyzed descriptively. Provision of devices was further analyzed by sex, age, SCI etiology, SCI severity, and time since SCI. RESULTS Devices reported highest for provision (N = 492; mean age 55.3 ± 15.1 years; 28.9% female) were adapted cars (78.2%) and manual wheelchairs (69.9%). Provision of various devices markedly varied with age and SCI severity (e.g. 34.6% of those aged 76+ had a walking frame compared to 3.1% of those aged 31-45; 50.0% of participants with complete tetraplegia had a power wheelchair compared to 7.6% of those with complete paraplegia). Many devices were mostly used daily (e.g. manual wheelchair) while others were mostly used less frequently (e.g. handbikes). Unmet need was highest for arm braces (53.2% of those in need) and power assisted wheelchairs (47.3%), and lowest for crutches (11.4%) and manual wheelchairs (4.8%). CONCLUSION The devices individuals have or use is largely dependent on their age and SCI severity. While most participants have access to basic mobility devices, there is still a considerable degree of unmet need for certain devices.
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Affiliation(s)
- Jordanne Florio
- Swiss Paraplegic Research, Nottwil, Switzerland,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Ursina Arnet
- Swiss Paraplegic Research, Nottwil, Switzerland,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Armin Gemperli
- Swiss Paraplegic Research, Nottwil, Switzerland,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Timo Hinrichs
- Swiss Paraplegic Research, Nottwil, Switzerland,Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, University of Basel, Basel, Switzerland,Correspondence to: Timo Hinrichs, Department of Sport, Exercise and Health, University of Basel, Birsstr. 320 B, CH-4052 Basel, Switzerland.
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Hinrichs T, Lay V, Arnet U, Eriks-Hoogland I, Koch HG, Rantanen T, Reinhardt JD, Brinkhof MWG. Age-related variation in mobility independence among wheelchair users with spinal cord injury: A cross-sectional study. J Spinal Cord Med 2016; 39:180-9. [PMID: 25832471 PMCID: PMC5072494 DOI: 10.1179/2045772315y.0000000008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To evaluate age-related variation in mobility independence among community-living wheelchair users with spinal cord injury (SCI). DESIGN Community Survey (2011-2013) as part of the Swiss Spinal Cord Injury Cohort Study. SETTING Community. PARTICIPANTS Individuals aged 16 years or older with traumatic or non-traumatic SCI permanently residing in Switzerland and using a wheelchair for moving around moderate distances (10-100 m). INTERVENTIONS Not applicable. OUTCOME MEASURES Mobility-related items of the Spinal Cord Independence Measure-Self Report were matched to the three principal domains "changing basic body position," "transferring oneself" and "moving around." Binary outcomes ("independence" vs. "no independence") were created for every domain and analyzed using multivariable logistic regression (adjusted for sex, socioeconomic factors, SCI characteristics, and health conditions). RESULTS Regression analyses (N = 949; 27% women; median age 51, interquartile range 41-61) showed a decline in the odds of independence (odds ratio; 95% confidence interval) with increasing age for "changing basic body position" (age 16-30 (reference), 31-45 (0.99; 0.53-1.83), 46-60 (0.64; 0.33-1.21), 61-75 (0.45; 0.22-0.92), 76+ (0.18; 0.07-0.44); P < 0.001), "transferring oneself" (age 16-30 (reference), 31-45 (0.77; 0.37-1.61), 46-60 (0.39; 0.18-0.84), 61+ (0.05; 0.02-0.14); P < 0.001), and "moving around" (age 16-30 (reference), 31-45 (0.79; 0.42-1.48), 46-60 (0.49; 0.26-0.94), 61-75 (0.49; 0.24-1.01), 75+ (0.11; 0.04-0.30); P < 0.001). CONCLUSIONS Mobility independence was negatively associated with age in wheelchair users with SCI. Future longitudinal analyses are required to gain further insights into the causal factors for the age-related decline.
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Affiliation(s)
- Timo Hinrichs
- Swiss Paraplegic Research, Nottwil, Switzerland,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland,Correspondence to: Timo Hinrichs, Swiss Paraplegic Research, Guido A. Zäch-Strasse 4, CH-6207 Nottwil, Switzerland.
| | | | - Ursina Arnet
- Swiss Paraplegic Research, Nottwil, Switzerland,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Inge Eriks-Hoogland
- Swiss Paraplegic Research, Nottwil, Switzerland,Swiss Paraplegic Center, Nottwil, Switzerland
| | | | - Taina Rantanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jan D. Reinhardt
- Swiss Paraplegic Research, Nottwil, Switzerland,Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, People’s Republic of China,Hong Kong Polytechnic University, Hong Kong, People’s Republic of China
| | - Martin W. G. Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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Munce SEP, Webster F, Fehlings MG, Straus SE, Jang E, Jaglal SB. Meaning of self-management from the perspective of individuals with traumatic spinal cord injury, their caregivers, and acute care and rehabilitation managers: an opportunity for improved care delivery. BMC Neurol 2016; 16:11. [PMID: 26801243 PMCID: PMC4724136 DOI: 10.1186/s12883-016-0534-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Accepted: 01/16/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The trend of decreasing length of stay in rehabilitation facilities has led to individuals with spinal cord injury (SCI) entering the community with unmet needs and fewer self-care skills to prevent secondary complications. The implementation of a self-management program for individuals with SCI for the management of these complex needs, including secondary complications, may be one option to fill these care gaps. A greater understanding of the meaning of self-management may facilitate the development of a tailored self-management program in this population. Thus, the current research aims to understand the meaning of self-management in traumatic SCI from the perspectives of individuals with traumatic SCI and their caregivers as well as acute care/trauma and rehabilitation managers. METHODS A descriptive qualitative approach was used. Semi-structured telephone interviews were conducted with 26 individuals with traumatic SCI, their family members/caregivers, and managers from acute care/trauma and rehabilitation centres. Inductive thematic analysis was applied. RESULTS The meaning of self-management in SCI related to two overarching themes of internal and external responsibility attribution and revealed differences between the meaning of self-management in SCI among individuals with traumatic SCI and their caregivers versus managers. Overall, the meaning of self-management among the SCI and caregiver participants related principally to internal responsibility attribution. For the manager participants, the meaning of self-management was much narrower and the overarching theme of internal responsibility attribution that was observed among the SCI-caregiver dyads was not as widely expressed by this group. CONCLUSIONS Interventions that are co-created by users and health care professionals are associated with positive physical and mental health outcomes. Thus, the understanding of self-management from these varying perspectives could be applied to the development of a tailored self-management program that is relevant to individuals with traumatic SCI and their caregivers. This may involve the development of a program that uses some of the structure of traditional chronic disease self-management programs, in accordance with the beliefs held by the managers, but also incorporates elements of wellness/health promotion interventions, in accordance with the beliefs held by the SCI and caregiver participants.
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Affiliation(s)
- Sarah E P Munce
- Institute of Health, Policy, Management and Evaluation, University of Toronto, Rehabilitation Sciences Building, 160-500 University Ave., Toronto, M5G 1 V7, ON, Canada.
| | - Fiona Webster
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - Eunice Jang
- Department of Applied Psychology & Human Development, Ontario Institute for Studies in Education, Toronto, Ontario, Canada
| | - Susan B Jaglal
- Institute of Health, Policy, Management and Evaluation, University of Toronto, Rehabilitation Sciences Building, 160-500 University Ave., Toronto, M5G 1 V7, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada.,Toronto Rehabilitation Institute, Toronto, Canada
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63
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Houlihan B, Brody M, Plant A, Skeels SE, Zazula J, Pernigotti D, Green C, Hasiotis S, Jette A. Health Care Self-Advocacy Strategies for Negotiating Health Care Environments: Analysis of Recommendations by Satisfied Consumers with SCI and SCI Practitioners. Top Spinal Cord Inj Rehabil 2016; 22:13-26. [PMID: 29398890 PMCID: PMC5790025 DOI: 10.1310/sci2201-13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Bethlyn Houlihan
- Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Health & Disability Research Institute, Boston, Massachusetts
| | - Miriam Brody
- Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Health & Disability Research Institute, Boston, Massachusetts
| | - Andrea Plant
- The Life Care Center of America, Plymouth, Massachusetts
| | - Sarah Everhart Skeels
- Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Health & Disability Research Institute, Boston, Massachusetts
| | - Judi Zazula
- Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Health & Disability Research Institute, Boston, Massachusetts
| | | | | | | | - Alan Jette
- Boston University School of Public Health, New England Regional Spinal Cord Injury Center, Health & Disability Research Institute, Boston, Massachusetts
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Munce SEP, Straus SE, Fehlings MG, Voth J, Nugaeva N, Jang E, Webster F, Jaglal SB. Impact of psychological characteristics in self-management in individuals with traumatic spinal cord injury. Spinal Cord 2015; 54:29-33. [PMID: 26055818 PMCID: PMC5399135 DOI: 10.1038/sc.2015.91] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 04/12/2015] [Accepted: 04/23/2015] [Indexed: 11/09/2022]
Abstract
Study design: Cross-sectional survey. Objective: To examine the association between psychological characteristics in self-management and probable depression status in individuals with a traumatic spinal cord injury (SCI). Setting: Community-dwelling individuals with traumatic SCI living across Canada. Methods: Individuals with SCI were recruited by email via the Rick Hansen Institute as well as an outpatient hospital spinal clinic. Data were collected by self-report using an online survey. Standardized questionnaires were embedded within a larger survey and included the Hospital Anxiety and Depression Scale (HADS), the short version of the Patient Activation Measure (PAM), the Moorong Self-Efficacy Scale (MSES) and the Pearlin-Schooler Mastery Scale (PMS). Results: Individuals with probable depression (n=25) had lower self-efficacy (67.9 vs 94.2, P<0.0001), mastery (18.9 vs 22.9, P<0.0001) and patient activation (60.4 vs 71.6, P<0.0001) as well as higher anxiety (9.0 vs 5.5, P<0.0001), compared with their non-depressed counterparts (n=75). A logistic regression determined that lower self-efficacy and mastery scores as well as less time since injury were associated with depression status (P=0.002; P=0.02 and P=0.02, respectively). Individuals with higher anxiety scores were almost 1.5 times more likely to be depressed, while older age was positively associated with depression status (P=0.016 and P=0.024, respectively). Conclusion: Interventions for depression in SCI, including a self-management program, should target factors such as self-efficacy and mastery, which could improve secondary medical complications and overall quality of life.
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Affiliation(s)
- S E P Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - S E Straus
- Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario, Canada
| | - M G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - J Voth
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - N Nugaeva
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - E Jang
- Department of Applied Psychology and Human Development, Ontario Institute for Studies in Education, Toronto, Ontario, Canada
| | - F Webster
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - S B Jaglal
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto, Canada
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65
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Evaluation of a community reintegration outpatient program service for community-dwelling persons with spinal cord injury. Rehabil Res Pract 2014; 2014:989025. [PMID: 25574397 PMCID: PMC4276116 DOI: 10.1155/2014/989025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Revised: 10/26/2014] [Accepted: 11/20/2014] [Indexed: 11/17/2022] Open
Abstract
Objective. To evaluate the effectiveness of a community reintegration outpatient (CROP) service for promoting well-being and
community participation following spinal cord injury (SCI).
Participants. Community-dwelling adults (N = 14) with traumatic and nontraumatic SCI. Interventions. The CROP service is a 12-week (1 × week; 120 minutes) interprofessional closed therapeutic education service. Main Outcome Measure(s). Moorong Self-Efficacy Scale (MSES); Impact on Participation and Autonomy (IPA); Positive Affect and Negative Affect Scale (PANAS); Coping Inventory of Stressful Situations (CISS); World Health Organization Quality of Life (WHOQOL-BREF); semistructured qualitative interviews. Methods. Twenty-one participants were recruited from two subsequent CROP services, with only 14 persons completing all data assessments.
Data were collected at baseline (week 0), at exit (week 12), and at a three-month follow-up. Semistructured interviews were conducted at exit. Results. Self-efficacy (MSES) and positive affect (PANAS) improved from baseline to exit (P < .05), but the changes were not maintained at follow-up. Qualitative analysis identified four major themes related to therapeutic benefits: (1) role of self; (2) knowledge acquisition; (3) skill application; and (4) group processes. Conclusions. Participation in a therapeutic education service has the potential to improve well-being in persons with SCI, but there is a need to identify strategies to maintain long-term gains.
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Munce SE, Fehlings MG, Straus SE, Nugaeva N, Jang E, Webster F, Jaglal SB. Views of people with traumatic spinal cord injury about the components of self-management programs and program delivery: a Canadian pilot study. BMC Neurol 2014; 14:209. [PMID: 25327610 PMCID: PMC4210500 DOI: 10.1186/s12883-014-0209-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 10/10/2014] [Indexed: 11/10/2022] Open
Abstract
Background Given the increasing emphasis on the community management of spinal cord injury (SCI), strategies that could be developed and implemented in order to empower and engage individuals with SCI in promoting their health and minimizing the risk of health conditions are required. A self-management program could be one approach to address these complex needs, including secondary complications. Thus, the objective of this study was to determine the importance attributed to the components of a self-management program by individuals with traumatic SCI and explore their views/opinions about the delivery of such a program. Methods Individuals with SCI were recruited by email via the Rick Hansen Institute (Vancouver, British Columbia, Canada) as well as an outpatient hospital spinal clinic. Data were collected by self-report using an on-line survey. Results The final sample size was 99 individuals with traumatic SCI. The components of a self-management program that were rated as “very important” by the greatest proportion of participants included: exercise (n= 53; 53.5%), nutrition (n= 51; 51.5%), pain management (n= 44; 44.4%), information/education on aging with a SCI (n= 42; 42.4%), communicating with health care professionals (n= 40; 40.4%), problem solving (n= 40; 40.4%), transitioning from rehabilitation to the community (n= 40; 40.4%), and confidence (n= 40; 40.4%). Overall, 74.7% (n= 74) of the sample rated the overall importance of the development of a self-management program for individuals with traumatic SCI as “very important” or “important”. Almost 40% (n= 39) of the sample indicated that an internet-based self-management program would be the best delivery format. The highest proportion of participants indicated that the program should have individuals of a similar level of injury (n= 74; 74.7%); having individuals of a similar age (n= 40; 40.4%) was also noted. Over one-quarter of the sample (n= 24) had a depression score consistent with significant symptoms of depression. Conclusions Future research is needed to further evaluate how the views of people with traumatic SCI change over time. Our findings could be used to develop and pilot test a self-management program for individuals with traumatic SCI. Electronic supplementary material The online version of this article (doi:10.1186/s12883-014-0209-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sarah Ep Munce
- Institute of Health, Policy, Management and Evaluation, University of Toronto, 160-500 University Ave, Toronto M5G 1 V7, Ontario, Canada.
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