Validation of an eight-item resilience scale for inpatients with spinal cord injuries in a rehabilitation hospital: exploratory factor analyses and item response theory

PURPOSE

People with spinal cord injury (PwSCI) can experience life changes, including impacts on their physical and mental health. PwSCI often report less life satisfaction and lower subjective well-being than peers without SCI. These challenges and adversities increase the demand on them to be more resilient. Healthcare providers need quick and valid instruments to assess adult patients' resilience in clinical settings. We aimed to validate the factor validity and discrimination ability of a resilience scale, CD-RISC-10, for clinical usage in adults with SCI during hospitalization.

MATERIALS AND METHODS

93 adults with SCI responded to the self-reported survey, including CD-RISC-10, the Patient Health Questionnaire-9 Scale (PHQ-9), the Satisfaction with Life Scale (SWLS), and the Intrinsic Spirituality Scale. We conducted descriptive statistics, exploratory factor analysis (EFA), and item response theory (IRT).

RESULTS

Two items were deleted from CD-RISC-10 after EFA, forming CD-RISC-8. The item discriminations of the remaining eight items from the unconstrained IRT model ranged from a high of 3.071 to a relatively low 1.433. CD-RISC-8 is significantly related to PHQ-9 and SWLS.

CONCLUSIONS

The factor validity of the CD-RISC-8 was improved. Significantly, the CD-RISC-8 has excellent potential for clinical usage due to its discriminant ability between low and intermediate resilience.

Enriching the lives of children with acquired brain injury and their caregivers: experiences from peer mentorship sports camps

Peer-based community interventions have shown promise in improving health management and fostering coping skills and psychosocial functioning among individuals with a disability. Active Rehabilitation camps are examples of peer-based community interventions that provide structured, time-limited peer mentorship in conjunction with sports and leisure activities. These camps hold potential benefits for individuals with acquired neurological injury. However, the specific impact of Active Rehabilitation camps on children or individuals with acquired brain injury remains unexplored. In this longitudinal, qualitative study, we explored children with an acquired brain injury and their caregivers' experiences with an Active Rehabilitation camp in Norway through observations and interviews with nine children and ten caregivers. Using an abductive thematic analysis, we identified an overarching theme: Active Rehabilitation peer mentorship camps enrich the lives of children with acquired brain injury and their caregivers. The theme contains three sub-themes: (1) Interacting with peers made me wiser, (2) Nudging from peer mentors made me feel better, and (3) A sense of companionship through meeting peers. Peer mentorship, sports and leisure activities, and the safe camp atmosphere benefitted children with acquired brain injury and their caregivers. The children gained knowledge, motivation, and self-worth, and their caregivers had greater impetus to prioritize their children's independence. Meeting peers and peer mentors led to friendships and sustained social connections. The Self-Determination Theory was of assistance in explaining the informants' experiences. Active Rehabilitation camps provide children with acquired brain injury and their caregivers with an opportunity to develop better coping skills, improve psychological functioning, and build more robust social networks.

Peer mentoring for people with acquired brain injury - a systematic review

INTRODUCTION

Over 100 million people worldwide live with disabilities resulting from an acquired brain injury (ABI). ABI survivors experience cognitive and physical problems and require support to resume an active life. They can benefit from support from someone who has been through the same issues (i.e. peer mentor). This review investigated the effectiveness of peer mentoring for ABI survivors.

METHOD

Eleven databases, two trial registers, and PROSPERO were searched for published studies. Two reviewers independently screened all titles, abstracts, and full texts, extracted data, and assessed quality. The PRISMA 2020 guidelines were followed to improve transparency in the reporting of the review.

RESULTS

The search returned 4,094 results; 2,557 records remained after the removal of duplicates and 2,419 were excluded based on titles and abstracts. Of the remaining 138, 12 studies met the inclusion criteria. Five were conducted in the United States, three in Canada, three in the UK, and one in New Zealand. Meta-analysis was inappropriate due to the heterogeneity of study designs. Therefore, a narrative synthesis of the data was undertaken.

CONCLUSION

Although peer mentoring has the potential to positively influence activity and participation among ABI survivors, further research is needed to understand the extent of the benefits.

Understanding the experiences, needs, and strengths of people with incomplete spinal cord injury who can ambulate

PURPOSE

To identify the experiences, needs, and strengths of people with incomplete spinal cord injury who can ambulate and to explore and discuss potential supports, services, and programs that would best assist them in the community.

MATERIAL AND METHODS

In this qualitative descriptive study, interviews were the primary means of data collection. These were supplemented with descriptive standardized measures of function and life satisfaction. Qualitative data were analyzed thematically.

RESULTS

Twenty-four participants were interviewed, their average age was 55 years and 46% were female. We identified three themes: 'I really couldn't go there', described the physical and social barriers experienced by participants, 'It'd be really nice to let the public know there are people out there like me' expressed the desire for greater social understanding of incomplete spinal cord injury, and 'I just don't quit', displayed the perseverance that participants demonstrated following their injury.

CONCLUSION

Findings indicate service providers to improve the inclusion of ambulatory individuals with incomplete spinal cord injury in their programs. Suggestions include designing programs (community, healthcare, return to work, peer support), environments using the principles of universal design for people with incomplete spinal cord injury who ambulate, and increasing consideration of their perspectives.Implication for rehabilitation:People with incomplete spinal cord injury who can ambulate live with invisible impairments, which are often not acknowledged by family, friends, health professionals, and people with complete spinal cord injuryThey may feel excluded from activities (organized by spinal cord injury associations) that were originally designed for people with complete spinal cord injuryGreater awareness among health professionals, friends, family, and people with complete spinal cord injury of the needs of people with incomplete spinal cord injury who can ambulate is needed to increase their inclusion.

"Teaching somebody else makes you a better person:" A phenomenological exploration of the importance of informal peer support for individuals with spinal cord injury

BACKGROUND

Peer support is widely recognized as an important aspect of health promotion for individuals with spinal cord injury (SCI). Reports indicate positive effects for the recipients of either informal and formal peer support. The experience can also be meaningful to the person(s) providing support, although the value to providers is not well studied.

OBJECTIVE

This study examines the experience of provision of and receipt of informal peer support for individuals with SCI through semi-structured interviews.

METHODS

Data were analysed using a qualitative phenomenological approach. 16 participants with SCI participated in the study.

RESULTS

Three main themes were developed, each describing different benefits of peer support from the perspective of both members of the peer support dyad. First, participants found personal satisfaction from using their own experiences to help others adjust to their disability. Participants also noted that they learned how to complete activities of daily living as well as how to be autonomous in travel from others with SCI. Finally, participants spoke of the intrinsic benefit in teaching others with SCI.

CONCLUSIONS

This study provides a novel understanding of the importance of informal peer support for individuals with SCI. Practitioners should provide opportunities for individuals with SCI to develop informal peer relationships with others who have sustained SCI.

Peer support for traumatic injury survivors: a scoping review

PURPOSE

Peers are uniquely able to draw on their lived experiences to support trauma survivors' recovery. By understanding the functions and outcomes of peer support and the factors that impact implementation, evidence can be mobilized to enhance its application and uptake into standard practice. As such, we aimed to review the literature on peer support for trauma survivors to: examine the role of peer support in recovery; describe the nature and extent of peer support; Examine the influence of peer support on health and well-being; and identify the barriers and facilitators to developing and implementing peer support.

METHODS

Scoping review methodology as outlined by Arksey and O'Malley.

RESULTS

Ninety-three articles were reviewed. Peer support was highlighted as an important component of care for trauma survivors and provided hope and guidance for the future post-injury. Most peer support programs were offered in the community and provided one-on-one support from peer mentors using various modalities. Interventions were successful when they involved knowledgeable peer mentors and maintained participant engagement. Prior negative experiences and stigma/privacy concerns deterred trauma survivors from participating.

CONCLUSIONS

Peer support fulfills several functions throughout trauma survivors' recovery that may not otherwise be met within existing health care systems. Implications for rehabilitationBy understanding the functions and outcomes and the factors that impact implementation of peer support, evidence can be mobilized to enhance its application and uptake into standard practice.Peers provide trauma survivors with socioemotional support as well as assistance in daily management and life navigation post-injury.Peer support provided hope and guidance for the future after injury and improved self-efficacy amongst trauma survivors.Peer support programs are most likely to be successful when they involve knowledgeable peer mentors, are flexibly delivered, align with organizations' values and priorities, and have adequate resources and funding to support their implementation.

Exploring a peer-based physical activity program in the community for adults with moderate-to-severe traumatic brain injury

PRIMARY OBJECTIVE

To explore the experiences of program mentors, participants, and employees involved in a peer-based physical activity (PA) program for adults with moderate-to-severe TBI, being piloted by a community fitness center, to develop the program as a measurable intervention.

RESEARCH DESIGN

We adopted an exploratory case study approach through an interpretivist paradigm, which focused on discovering realities about the peer-based PA program across the study participants' views, backgrounds, and experiences.

METHODS AND PROCEDURES

Semi-structured focus groups and individual interviews were conducted with nine adult program participants (3 peer mentors, 6 participants), and three program employees. Inductive content analysis was used to develop themes about their perceived experiences.

MAIN OUTCOMES AND RESULTS

44 open-codes were grouped into 10 subthemes and three final themes: 1) program impacts identified the importance of the program in daily life and resulting psychological, physical, and social outcomes; 2) program characteristics highlighted program leaders, accessibility, and social inclusion; 3) program sustainability included program adherence, benefits for the center, and the program's future.

CONCLUSIONS

Perceptions of program experiences and outcomes identified how peer-based PA for adults with moderate-to-severe TBI can lead to meaningful activities, functioning better, and buy-in from all parties. Implications for research and practice related to supporting health-related behaviors after TBI through group-based, autonomy-supporting approaches are discussed.

Investigating the peer Mentor-Mentee relationship: characterizing peer mentorship conversations between people with spinal cord injury

PURPOSE

This study aimed to: (1) develop a coding manual to characterize topics discussed and conversation techniques used during peer mentorship conversations between people with spinal cord injury (SCI); (2) assess the reliability of the manual; and (3) apply the manual to characterize conversations.

MATERIALS/METHODS

The study was conducted in partnership with three Canadian provincial SCI organizations. Twenty-five phone conversations between SCI peer mentors and mentees were audio-recorded and transcribed verbatim. Ten transcripts were inductively analyzed to develop a coding manual identifying topics and techniques used during the conversations. Inductive technique codes were combined and deductively linked to motivational interviewing and behaviour change techniques. Two coders independently applied the coding manual to all transcripts. Code frequencies were calculated.

RESULTS

The coding manual included 14 topics and 31 techniques. The most frequently coded topics were personal information, recreational programs, and chronic health services for mentors and mentees. The most frequently coded techniques were giving personal information, social smoothers, and closed question for mentors; and giving personal information, social smoothers, and sharing perspective for mentees.

CONCLUSION

This research provides insights into topics and techniques used during real-world peer mentorship conversations. Findings may be valuable for understanding and improving SCI peer mentorship programs.Implications for RehabilitationSCI peer mentorship conversations address a wide range of rehabilitation topics ranging from acute care to living in the community.Identification of the topics discussed, and techniques used in SCI peer mentorship conversations can help to inform formalized efforts to train and educate acute and community-based rehabilitation professionals.Identifying commonly discussed topics in SCI peer mentorship conversation may help to ensure that peer mentors are equipped with the necessary knowledge and resources, or the development of those resources be prioritized.Developing a method to characterize the topics discussed and techniques used during SCI peer mentorship conversations may aid in designing methods to evaluate how rehabilitation professionals provide support to people with SCI.

Randomised pragmatic waitlist trial with process evaluation investigating the effectiveness of peer support after brain injury: protocol

INTRODUCTION

Traumatic brain injury (TBI) is an important global health problem. Formal service provision fails to address the ongoing needs of people with TBI and their family in the context of a social and relational process of learning to live with and adapt to life after TBI. Our feasibility study reported peer support after TBI is acceptable to both mentors and mentees with reported benefits indicating a high potential for effectiveness and likelihood of improving outcomes for both mentees and their mentors.

OBJECTIVES

To (a) test the effectiveness of a peer support intervention for improving participation, health and well-being outcomes after TBI and (b) determine key process variables relating to intervention, context and implementation to underpin an evidence-based framework for ongoing service provision.

METHODS AND ANALYSIS

A randomised pragmatic waitlist trial with process evaluation. Mentee participants (n=46) will be included if they have moderate or severe TBI and are no more than 18 months post-injury. Mentor participants (n=18) will be people with TBI up to 6 years after injury, who were discharged from inpatient rehabilitation at least 1 year prior. The primary outcome will be mentee participation, measured using the Impact on Participation and Autonomy questionnaire after 22 weeks. Primary analysis of the continuous variables will be analysis of covariance with baseline measurement as a covariate and randomised treatment as the main explanatory predictor variable at 22 weeks. Process evaluation will include analysis of intervention-related data and qualitative data collected from mentors and service coordinators. Data synthesis will inform the development of a service framework for future implementation.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from the New Zealand Health and Disability Ethics Committee (19/NTB/82) and Auckland University of Technology Ethics Committee (19/345). Dissemination of findings will be via traditional academic routes including publication in internationally recognised peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ACTRN12619001002178.

An exploration of the roles and experiences of SCI peer mentors using creative non-fiction

PURPOSE

Spinal cord injury (SCI) peer mentors are individuals who, through their lived experiences, offer emotional support and empathetic understanding to others living with SCI to foster positive health, independence, and well-being. This study explored SCI peer mentors' perceptions of their roles and experiences.

MATERIALS AND METHODS

Six paid or volunteer peer mentors participated in semi-structured interviews. We first explored the data using thematic narrative analysis to identify patterns, themes, and narrative types. Next, we analyzed the narrative types using creative analytical practices to construct and refine the stories.

RESULTS

Based on our analysis, we developed two stories from a storyteller perspective to present a snapshot of SCI peer mentors' experiences. The first story focuses on a "discovery" narrative from the point of view of Casey who adopted a person-centered approach to mentoring, focusing their attention on the needs of the mentee. The second story focuses on Taylor's experiences with the "dark" side of peer mentorship, which focuses on the psychological toll of being a SCI peer mentor, from discussions about suicidal thoughts with clients to struggling with burnout.

CONCLUSIONS

Results provided insights for support services regarding the importance of supporting the mental health of mentors to ensure they continue delivering high quality mentorship.Implications for rehabilitationPeer mentors need to be educated on the significance of their role in the rehabilitation process and how their interpersonal behaviours can influence their mentees, both positively and negatively.Peer mentors should receive formalized and accessible training to ensure they are equipped with effective mentoring skills, but also providing them with tools to cope with physical, mental, and emotional stressors they may encounter as mentors.There is a need to continue diversifying and improving the types of services provided to SCI peer mentors in addition to one-on-one counselling, such as interactive educational workshops, for peer mentors to learn and practice coping skills, including mindfulness, meditation, and action-planning.As with other paid employees, SCI peer mentors should be trained to recognize when they are feeling depleted and be supported in seeking appropriate care from a health professional to provide quality psychosocial services to others.

Barriers and facilitators to changing bowel care practices after spinal cord injury: a Theoretical Domains Framework approach

BACKGROUND

Improvement to autonomic processes such as bladder, bowel and sexual function are prioritised by individuals with spinal cord injury (SCI). Bowel care is associated with high levels of dissatisfaction and decreased quality of life. Despite dissatisfaction, 71% of individuals have not changed their bowel care routine for at least 5 years, highlighting a disconnect between dissatisfaction with bowel care and changing routines to optimise bowel care.

OBJECTIVE

Using an integrated knowledge translation approach, we aimed to explore the barriers and facilitators to making changes to bowel care in individuals with SCI.

METHODS

Our approach was guided by the Behaviour Change Wheel and used the Theoretical Domains Framework (TDF). Semi-structured interviews were conducted with individuals with SCI (n = 13, mean age 48.6 ± 13.1 years) and transcribed verbatim (duration 31.9 ± 7.1 min). Barriers and facilitators were extracted, deductively coded using TDF domains and inductively analysed for themes within domains.

RESULTS

Changing bowel care after SCI was heavily influenced by four TDF domains: environmental context and resources (workplace flexibility, opportunity or circumstance, and access to resources); beliefs about consequences; social influences (perceived support and peer mentorship); and knowledge (knowledge of physiological processes and bowel care options). All intervention functions and policy categories were considered viable intervention options, with human (61%) and digital (33%) platforms preferred.

CONCLUSIONS

Modifying bowel care is a multi-factorial behaviour. These findings will support the systematic development and implementation of future interventions to both enable individuals with SCI to change their bowel care and to facilitate the optimisation of bowel care approaches.

Pathways to loneliness: a mediation analysis investigating the social gradient of loneliness in persons with disabilities in Switzerland

Background

The experience of loneliness can have drastic consequences for health and quality of life. Given that loneliness is highly prevalent in persons with physical disabilities and that loneliness more profoundly affects persons of low socioeconomic status, more evidence is required in order to understand the mechanisms determining loneliness in this population. The objective of this study is therefore to investigate the potential pathways through which socioeconomic status influences loneliness in persons with spinal cord injury.

Methods

Mediation analysis utilising structural equation models and bias corrected and accelerated confidence intervals were used in order to test the mediation effects of health status, functioning, participation, social support and self-efficacy on the association between socioeconomic status and loneliness in persons with spinal cord injury. A latent construct was created for socioeconomic status with the indicators education, household income, financial hardship, subjective social status and engagement in paid work.

Results

This study found evidence to support the mediating role of psychosocial resources and of secondary health conditions in the association between socioeconomic status and loneliness. The study demonstrated robust associations between socioeconomic status and all potential mediators, whereby higher socioeconomic status was associated with better health, participation and psychosocial resources, however, not all potential mediators were associated with loneliness. The serial mediation model explained the interplay between socioeconomic status, mediators on different levels, and loneliness. For example, emotional support and self-efficacy were both positively associated with fewer restrictions to participation (0.08 (CI: 0.05, 0.12); 0.29 (CI: 0.24, 0.36) respectively), and fewer restrictions to participation were found to be a result of improved functional independence and fewer secondary health conditions (0.23 (CI: 0.15, 0.39); − 0.29 (CI: − 0.36, − 0.20) respectively).

Conclusions

Our findings highlight the vulnerability of persons with low socioeconomic status to loneliness in persons with spinal cord injury and identified potential mediating factors, such as health, functioning, participation and psychosocial resources, in the association between socioeconomic status and loneliness. This population-based evidence suggests potential targets of interventions on the pathway to loneliness, through which socioeconomic status influences loneliness. The complexity of the model shows the need for comprehensive interprofessional rehabilitation to identify and support people with lower socioeconomic status and concomitant risk factors for loneliness.

A Pilot Feasibility Randomized Controlled Trial on the Ontario Brain Injury Association Peer Support Program

Background: The long-term consequences of traumatic brain injury can create major barriers to community integration. Peer support represents a sustainable model of support across this transition. The objective of the current study was to determine the feasibility of conducting a randomized controlled trial on the Ontario Brain Injury Association Peer Support Program and the preliminary effectiveness of the program on community integration, mood, health-related quality of life, and self-efficacy; Methods: A pilot feasibility randomized controlled trial with an embedded qualitative component was conducted. Mentees with moderate-to-severe traumatic brain injury (n = 13) were randomized to a weekly intervention or waitlist control group. Interviews were conducted with a subset of mentees and peer mentors (n = 10). Integration of the quantitative and qualitative data was completed using a joint display approach; Results: No statistically significant results were found for community integration, mood, or self-efficacy; however, changes in these outcomes were accompanied by moderate-to-large effect sizes. Within health-related quality of life, the mean pain score of the intervention group was significantly lower than that of the control group at the two-month timepoint but not at completion. Interviews revealed proximal improvements in knowledge, skills, and goals, and identified two domains related to trial acceptability: (1) environmental context and resources, and (2) reinforcement; Conclusions: Given the conceivable importance of proximal improvements in domains such as knowledge, skills, and/or goals for the attainment of more distal outcomes, modifications to the existing Peer Support Program may be warranted. The introduction of program recommendations which promote discussion around particular domains may help facilitate long-term improvements in health outcomes.

Peer mentoring reduces unplanned readmissions and improves self-efficacy following inpatient rehabilitation for individuals with spinal cord injury

OBJECTIVE

Evaluate effectiveness of peer interventions on self-efficacy, unplanned hospital readmissions, and quality of life for patients with spinal cord injury (SCI) undergoing inpatient rehabilitation.

DESIGN

Interrupted time-series analysis (ITSA) examined effects of peer interventions on unplanned readmissions. Intervention variables added to ITSA regression examined relationships with exposure to peer interventions. Heterogeneity of treatment effects (HTE) analysis examined differences in intervention effectiveness for patients with quadriplegia and paraplegia.

SETTING

Rehabilitation hospital specializing in SCI and brain injury.

PARTICIPANTS

SCI inpatients (n = 1117) admitted for rehabilitation whose discharge location was home (77% male, 71% Caucasian, mean age 38.2 (SD 16.8)). A subsample of 799 patients participated in secondary analyses examining relationship between peer interventions, readmissions, changes in patient-reported outcomes, and HTE.

INTERVENTIONS

One-to-one mentoring and participation in peer-led self-management classes.

MAIN OUTCOME MEASURES

Unplanned readmissions, general self-efficacy (GSE), and depressive symptoms 30, 90, and 180 days post discharge; satisfaction with life at 180 days.

RESULTS

After implementing the peer interventions, we observed a significant decrease in both level and slope of number of patients readmitted, and level only of unplanned hospital days 30-days post-discharge. Reduction in the number of patients and unplanned hospital days was associated with number of peer visits but not peer-led education classes attended. Higher self-efficacy (GSE) was associated with greater exposure to peer mentoring, and a significant relationship between improvement in GSE and reduced hospital readmissions was observed.

CONCLUSIONS

One-to-one peer mentoring improves self-efficacy and reduces unplanned hospital readmissions following inpatient rehabilitation for persons with SCI.

Identifying the outcomes of participating in peer mentorship for adults living with spinal cord injury: a qualitative meta-synthesis

OBJECTIVE

Peer mentorship is a flagship program utilized by Canadian community-based spinal cord injury (SCI) organizations. Through connecting trained SCI peer mentors with fellow adults with SCI, these programs help adults adapt and thrive following their injury. The objective of this meta-synthesis was to work with SCI community organizations and to identify outcomes of participating in community- or rehabilitation-based peer mentorship programs using an integrated knowledge translation approach.

DESIGN

A meta-synthesis of 21 qualitative peer-reviewed studies and 66 community documents was conducted.

MAIN OUTCOME MEASURES

A total of 87 outcomes of peer mentorship were identified.

RESULTS

The outcomes of peer mentorship were grouped according to six higher-order themes: 1) Independence: enhanced self-sufficiency; 2) Personal growth: positive psychological changes; 3) Activities and participation: greater participation in activities and events; 4) Adaptation: adapting to life with disability; 5) Knowledge: obtaining new information, resources, and opportunities; and 6) Connection: developing and maintaining social relationship.

CONCLUSION

The positive nature of the identified outcomes suggests that participating in peer mentorship can promote improved health and quality of life for adults with SCI. Furthermore, the integrated knowledge translation approach helped identify outcomes that were previously not examined within SCI peer mentorship research, thus providing important insight for future research.

Resilient Coping Types in People With Spinal Cord Injury: Latent Class Analysis

Resilience is central to living well with a spinal cord injury (SCI). To provide a timely, targeted, and individualized intervention supporting resilience, it is necessary to assess an individual’s resilience level and characteristics of resilience on an ongoing basis. We aimed to validate the different types of resilient coping among people with SCI (PwSCI), using the Connor–Davidson resilience scale, and to identify the relationships between resilience and other psychosocial factors among the types of resilient coping. We recruited 93 PwSCI, who took the self-report measures of resilience, depression, life satisfaction, and spirituality. Using latent class analysis, we found three types: (a) goal-pursuing, bouncing-back, and persevering, named GP; (b) uncertainty about coping with setbacks, named UC; and (c) loss of resilient coping, named LOSS. The multivariate tests indicated that the three types differed on a linear combination of resilience, depression, and life satisfaction, with a large effect size. We discussed the three types of resilient coping and the implications for psychosocial interventions. We also recommended that rehabilitation clinicians examine PwSCI’s resilience levels and types of resilience during initial and follow-up visits. In doing so, PwSCI will have timely, targeted supports for developing and/or re-building their resilience.

Implementation Evaluation of an Online Peer-Mentor Training Program for Individuals With Spinal Cord Injury

Background: Community-based spinal cord injury (SCI) associations play a critical role in successful community integration of individuals having experienced an SCI, with knowledge translation being increasingly important for the process. The implementation of a new online peer-mentor training program was perceived as being useful in improving and standardizing training practices for peer mentors across Canada. It was also seen as an opportunity to explore the context, process, and influence of a formal implementation process in SCI community-based associations that are corporate members of SCI Canada with a view to informing future implementation efforts. Objectives: The objectives of this study were to (a) explore the context in which the implementation process will be conducted, (b) identify barriers and facilitators that influence the implementation process, and (c) measure the influence of the implementation process on service delivery. Methods: A sequential cross-sectional design was used with SCI Canada provincial member associations. SCI Canada's purpose is to support collaboration among provincial corporate members. SCI Canada enlisted the participation of several employees from the provincial associations to assess the implementation context using the Evidence-Based Practice Attitude Scale and the Organizational Readiness to Change Assessment and to identify barriers to and facilitators of the implementation of an evidence-based practice through an open-ended questionnaire based on the Consolidated Framework for Implementation Research. A pre-post design was used to evaluate the influence of the implementation process on peer-mentors using the Determinants of Implementation Behavior Questionnaire. Results: Participants reported an overall positive attitude toward evidence-based practice and a positive perception of the organizational readiness to change. The relevance of the practice chosen was a facilitator because peer support is central to the mission of SCI Canada and this type of practice is in line with the organization' culture and values. Equally important, but as an obstacle, is the scarcity of existing resources within the association in general and specifically resources devoted to the implementation of the program. Finally, the implementation process seems to influence half of the implementation determinant types on potential peer mentors. Conclusion: Community-based organizations, such as the provincial association members of SCI Canada, show positive context for the implementation of evidence-based practices. However, successful implementation of online peer-mentor training will require specific consideration of financial and human resources.

Relationship Between Substance Use and the Onset of Spinal Cord Injuries: A Medical Chart Review

Background: Opioid misuse is a leading health care concern within the United States. In many cases, opioid misuse and opioid use disorder are associated with pain, a secondary health condition affecting individuals with spinal cord injury (SCI). Further, substance use is a known risk factor for SCI, resulting in the potential for a substance-related risk trajectory running from pre- to post-SCI. However, little research has examined substance use prior to SCI since the opioid epidemic began, and so the relative risk of opioids to patients with SCI is unclear. Objective: To determine whether individuals with SCI tested positive for substance use at the time of injury and identify the primary substances used at the time of injury. Methods: This study retrospectively reviewed all medical charts of individuals ages 18 and older who had sustained an SCI during an identified 18-month period and received medical care at a selected level 1 trauma center in the Midwest. Results: Data revealed an 80% combined positive toxicology and/or self-report of substance use immediately prior to the onset of the SCI. Twenty-five percent of males were positive for more than one substance at time of injury. Substances used prior to injury, listed most to least prevalent, were opioids (37.5%), alcohol (25%), marijuana (25%), methamphetamines (12.5%), benzodiazepines (12.5%), followed by cocaine (6.25%) and synthetic cathinone (6.25%). Conclusion: Although opioids were the most common substance used prior to SCI, none of the individuals positive for opioids at the time of injury were identified by the reviewing medical professional as having pain as a secondary health condition either prior to or after injury. However, pain is commonly listed as the primary health concern among individuals living with SCI, and the possibility of opioid use prior to injury likely warrants pain management planning that includes careful pharmacological and nonpharmacological interventions.

Experiences of peer counselling during inpatient rehabilitation of patients with spinal cord injuries

Study design

Qualitative study.

Objectives

The aim of this study was to evaluate peer counselling during inpatient rehabilitation of patients with spinal cord injuries (SCI). This article describes the experience with peer counselling from the perspective of patients with SCI as well as from the perspective of the peer counsellors.

Setting

Inpatient rehabilitation of SCI in the Swiss Paraplegic Centre.

Methods

Six interviews with patients and one focus group interview with professional peer counsellors have been evaluated using qualitative content analysis.

Results

Patients experienced the peer counselling sessions as solution-oriented, practical, motivating and especially appreciated the authentic, open demeanor of the peer counsellors. Conversations about recreational activities, hobbies and interests supported the development of interpersonal relationships. Peer counsellors experienced the initial visits with patients with high level quadriplegia as a special challenge. The regular presence of all peer counsellors in the hospital facilitated an easier exchange with the patients.

Conclusion

Patients feel empowered by peer counselling. Special attention should be placed on the timing of the initial visit. Unplanned meetings between patient and peers seem to be essential and highly valued. Peer counsellors are confronted with stressful situations in their work, therefore the need for support and training of peer counsellors should be further investigated.

Making sense of recovery after traumatic brain injury through a peer mentoring intervention: a qualitative exploration

OBJECTIVE

To explore the acceptability of peer mentoring for people with a traumatic brain injury (TBI) in New Zealand.

DESIGN

This is a qualitative descriptive study exploring the experiences reported by mentees and mentors taking part in a feasibility study of peer mentoring. Interviews with five mentees and six mentors were carried out. Data were analysed using conventional content analysis.

SETTING

The first mentoring session took place predischarge from the rehabilitation unit. The remaining five sessions took place in mentees' homes or community as preferred.

PARTICIPANTS

Twelve people with TBI took part: six mentees (with moderate to severe TBI; aged 18-46) paired with six mentors (moderate to severe TBI >12 months previously; aged 21-59). Pairing occurred before mentee discharge from postacute inpatient brain injury rehabilitation. Mentors had been discharged from rehabilitation following a TBI between 1 and 5 years previously.

INTERVENTION

The peer mentoring programme consisted of up to six face-to-face sessions between a mentee and a mentor over a 6-month period. The sessions focused on building rapport, exploring hopes for and supporting participation after discharge through further meetings and supported community activities.

RESULTS

Data were synthesised into one overarching theme: making sense of recovery. This occurred through the sharing of experiences and stories; was pivotal to the mentoring relationship; and appeared to benefit both mentees and mentors. Mentors were perceived as valued experts because of their personal experience of injury and recovery, and could provide support in ways that were different from that provided by clinicians or family members. Mentors required support to manage the uncertainties inherent in the role.

CONCLUSIONS

The insight mentors developed through their own lived experience established them as a trusted and credible source of hope and support for people re-engaging in the community post-TBI. These findings indicate the potential for mentoring to result in positive outcomes.

Peer mentorship for adults with spinal cord injury: a static group comparison between mentees and non-mentees' reported coping strategies

STUDY DESIGN

Cross-sectional study OBJECTIVES: Determine whether participating in peer mentorship is related to differences in reported use of coping strategies (acceptance of injury and fighting spirit) for adults with spinal cord injury.

SETTING

Quebec, Canada METHODS: A static group comparison design was used to retrospectively compare mentees (n = 68) and non-mentees (n = 63) on their reported coping strategies. Moderation analyses examined differences on coping strategies, while controlling for years since injury (significant covariate).

RESULTS

A significant interaction was found between years since injury and peer mentorship for acceptance of injury and fighting spirit, where mentees living with their injury for longer (~30 years) reported more use of the acceptance of injury and fighting spirit coping strategies.

CONCLUSION

Peer mentorship programs could serve as a means for promoting positive coping strategies for adults with SCI. To better understand the role of peer mentorship, follow-up studies using more rigorous research methodologies such as cohort or randomized controlled trial study designs should be conducted.

Hope and self-efficacy are associated with better satisfaction with life in people with ALS

The psychological phenotype in amyotrophic lateral sclerosis (ALS) is less negative than in other neurodegenerative diseases, manifested by a lower prevalence of psychopathology, such as anxiety and major depression, and a higher perceived quality of life by patients, irrespective of physical impairment. We hypothesized that positive psychological factors such as hope, optimism, and self-efficacy in people with ALS (PALS) were key determinants of satisfaction with life (SWL), despite physical impairment, and were protective against psychopathology. Forty PALS, at different functional levels, completed objective questionnaires to evaluate psychological factors of hope, optimism, self-efficacy, and SWL. Approximately 41% of the variance in SWL was accounted for by the Agency factor of hope. The results indicated that SWL was significantly correlated to specific positive psychological factors of hope and self-efficacy. Physical impairment was not correlated with positive psychological factors or SWL. These results support the role of hope and self-efficacy in maintaining satisfaction with life in PALS and consideration of these potentially modifiable factors could improve palliative therapy.

Pilot study of a training program to enhance transformational leadership in Spinal Cord Injury Peer Mentors

Study design

Experimental, pragmatic design.

Objectives

(1) To determine the effects of a transformational leadership (TFL) training program on spinal cord injury (SCI) peer mentors and their mentees; (2) To document characteristics of mentorship within a community-based SCI peer mentor program.

Methods

In total 23 SCI peer mentors (70% male; M age = 47.4 ± 12.1) were randomly allocated to an Experimental or Control condition. Experimental condition mentors received a half-day TFL workshop and bi-weekly emailed information on using TFL in SCI peer mentorship. Sixteen SCI mentees (50% male; M age = 49.1 ± 12.9) enrolled in the study and 9 completed measures of self-efficacy and their mentors' use of TFL and supportiveness at 3 and 6-months. Mentors completed monthly reports of mentorship activities.

Setting

Community-based peer mentorship program in British Columbia, Canada.

Results

There were no between-groups differences in mentee self-efficacy, mentor use of TFL or mentor supportiveness. In the Experimental condition only, total mentorship time and sessions were positively correlated with mentors' use of TFL and supportiveness. Mentorship occurred in-person, by phone, text, and email and mentors discussed an average of 11 topics.

Conclusions

The intervention did not increase SCI peer mentors' use of TFL relative to a Control condition. Nevertheless, there may be merit in coaching SCI peer mentors to use TFL given the positive correlations between mentorship time and sessions, TFL use, and perceived supportiveness of the mentor. Although inherently challenging, research involving community-based SCI peer mentorship programs provides opportunities for scientists and community organizations to extend knowledge of peer mentorship beyond the context of hospital-based programs.

Sponsorship

Research supported by a SSHRC Partnership Development Grant.

Volunteer peer support and befriending for carers of people living with dementia: An exploration of volunteers' experiences

With ageing populations and greater reliance on the voluntary sector, the number of volunteer-led peer support and befriending services for carers of people with dementia in England is set to increase. However, little is known about the experiences of the volunteers who deliver these interventions, many of whom are former carers. Using in-depth semi-structured interviews with 10 volunteer peer supporters and befrienders, this exploratory study investigated volunteers' experiences of delivering the support, the types of relationships they form with carers and their perceptions of its impact upon them and on carers. Data were analysed using framework analysis. Findings showed that volunteers benefitted from their role due to the 'two-way' flow of support. Experiential similarity and having common interests with carers were considered important to the development of mutually beneficial relationships. Volunteers perceived that carers gained emotional and social support, which in turn improved the carers' coping ability. Being able to see positive changes to carers' lives was important for volunteers to gain enjoyment and satisfaction from their role. However, volunteers also identified challenges with their role, such as dealing with carers' emotions. Future research should investigate ways of reducing potential burden on volunteers and explore the impact of volunteering specifically on former carers of people with dementia.

SCI peer health coach influence on self-management with peers: a qualitative analysis

STUDY DESIGN

A process evaluation of a clinical trial.

OBJECTIVES

To describe the roles fulfilled by peer health coaches (PHCs) with spinal cord injury (SCI) during a randomized controlled trial research study called 'My Care My Call', a novel telephone-based, peer-led self-management intervention for adults with chronic SCI 1+ years after injury.

SETTING

Connecticut and Greater Boston Area, MA, USA.

METHODS

Directed content analysis was used to qualitatively examine information from 504 tele-coaching calls, conducted with 42 participants with SCI, by two trained SCI PHCs. Self-management was the focus of each 6-month PHC-peer relationship. PHCs documented how and when they used the communication tools (CTs) and information delivery strategies (IDSs) they developed for the intervention. Interaction data were coded and analyzed to determine PHC roles in relation to CT and IDS utilization and application.

RESULTS

PHCs performed three principal roles: Role Model, Supporter, and Advisor. Role Model interactions included CTs and IDSs that allowed PHCs to share personal experiences of managing and living with an SCI, including sharing their opinions and advice when appropriate. As Supporters, PHCs used CTs and IDSs to build credible relationships based on dependability and reassuring encouragement. PHCs fulfilled the unique role of Advisor using CTs and IDSs to teach and strategize with peers about SCI self-management.

CONCLUSION

The SCI PHC performs a powerful, flexible role in promoting SCI self-management among peers. Analysis of PHC roles can inform the design of peer-led interventions and highlights the importance for the provision of peer mentor training.

Life satisfaction and inflammation in couples: an actor-partner analysis

Life satisfaction has been linked to lower cardiovascular disease mortality. However, much less is known about the biological mechanisms linking life satisfaction to physical health. In addition, the dyadic context of life satisfaction has not been considered despite increasing evidence that partners influence each other in health-relevant ways. These questions were addressed with 94 married couples who completed measures of life satisfaction and had their blood drawn for determination of interleukin-6 (IL-6) and C-reactive protein (CRP). Actor-partner models showed that higher actor levels of life satisfaction predicted lower levels of IL-6 and CRP (p's < .05), whereas partner levels of life satisfaction did not predict any measure of inflammation. The actor results were not mediated by marital satisfaction or health behaviors. Finally, no actor × partner interactions were significant and these links were not moderated by marital satisfaction. These data highlight inflammation as a potentially important biological mechanism linking actor reports of life satisfaction to lower cardiovascular mortality.

Effects of Peer Mentoring on Self-Efficacy and Hospital Readmission After Inpatient Rehabilitation of Individuals With Spinal Cord Injury: A Randomized Controlled Trial

OBJECTIVE

To investigate the effect of intensive peer mentoring on patient-reported outcomes of self-efficacy and unplanned hospital readmissions for persons with spinal cord injury/disease (SCI/D) within the first 6 months after discharge from inpatient rehabilitation.

DESIGN

Randomized controlled trial.

SETTING

Nonprofit inpatient rehabilitation hospital specializing in care of persons with SCI/D and brain injury.

PARTICIPANTS

Patients (N=158) admitted to the SCI/D rehabilitation program whose discharge location was a community setting. Participants (51% with paraplegia and 49% with tetraplegia) were 73% white and 77% men, with a mean age of 38 years.

INTERVENTIONS

Participants in the experimental group received initial consult/introduction with a peer support program liaison and were assigned a peer mentor, who met with the participant weekly throughout the inpatient stay and made weekly contact by phone, e-mail, or in person for 90 days postdischarge. Participants also were encouraged to participate in regularly scheduled peer support activities. Nonexperimental group participants were introduced to peer support and provided services only on request.

MAIN OUTCOME MEASURES

General Self-efficacy Scale (adapted to SCI/D), project-developed community integration self-efficacy scale, and patient-reported unplanned rehospitalizations.

RESULTS

Growth rate for self-efficacy in the first 6 months postdischarge was significantly higher for experimental group participants than nonexperimental group participants. Experimental group participants also had significantly fewer unplanned hospital days.

CONCLUSIONS

This study provides evidence that individuals receiving intensive peer mentoring during and after rehabilitation for SCI/D demonstrate greater gains in self-efficacy over time and have fewer days of unplanned rehospitalization in the first 180 days postdischarge. More research is needed to examine the long-term effects of this intervention on health care utilization and the relation between improved health and patient-reported quality of life outcomes.

Peer support need fulfillment among adults with spinal cord injury: relationships with participation, life satisfaction and individual characteristics

PURPOSE

To test the hypothesis among people with spinal cord injury (SCI) that greater fulfillment of peer support needs to be associated with greater participation and life satisfaction. A secondary objective was to identify characteristics of people in great need of SCI peer support.

METHOD

The participants consisted of a population-based sample of 1549 adults with SCI. The participants completed a survey with questions on peer support, participation, life satisfaction and provided demographic and SCI-related information. A secondary analysis of cross-sectional survey data was conducted. A set of regression analyses tested the primary purpose and a partition analysis was conducted to examine the secondary objective.

RESULTS

In regression analyses, peer support need fulfillment was positively associated with autonomous-outdoors participation (p < 0.05), health participation (p < 0.05), and work/education participation (p < 0.05), as well as life satisfaction (p < 0.001) after controlling demographic and SCI-related variables. However, peer support need fulfillment was not related with overall participation or other subdomains of participation: autonomy indoors, social relationships and family role. The number of unmet SCI-related needs, injury characteristics and education were associated with fulfillment of SCI peer support needs.

CONCLUSIONS

The results provide some evidence that SCI peer support plays an important role in promoting participation and life satisfaction. Individuals with many SCI-related unmet needs are most likely to report a need for peer support.

IMPLICATIONS FOR REHABILITATION

The receipt of peer support after a spinal cord injury (SCI) is positively related to aspects of social participation and life satisfaction. Provision of peer support can play an important role in the SCI rehabilitation process. Education, injury-related characteristics, and the number of other unmet needs are factors that rehabilitation professionals can use to identify those in particular need of peer support. Rehabilitation professionals should encourage patients who have sustained an SCI, to participate in peer support programs.

Effects of concomitant spinal cord injury and brain injury on medical and functional outcomes and community participation

BACKGROUND

There are limited data on the interactions between concomitant spinal cord injury (SCI) and traumatic brain injury (TBI) in terms of medical, psychological, functional, and community outcomes.

OBJECTIVE

To investigate the hypothesis that in addition to SCI-associated sensory-motor impairments, people with dual diagnosis would experience additional TBI-associated cognitive impairments that would have a negative impact on community reintegration.

METHODS

Cross-sectional, case-matched study comparing a consecutive sample of participants with dual diagnosis (n = 30) to an SCI group (n = 30) and TBI group (n = 30). Participants who were on average 3.6 years postrehabilitation discharge were interviewed using a battery of standardized outcome measures.

RESULTS

Length of rehabilitation stay was significantly longer in SCI and dual diagnosis participants. Fatigue, pain, sexual dysfunction, depression, and sleep disturbances were frequently reported by all groups. Similar levels of anxiety and depression were reported by participants in all groups, however TBI participants reported higher stress levels. All groups achieved mean FIM scores > 100. The dual diagnosis and SCI groups received more daily care and support than TBI participants. Similar levels of community reintegration were achieved by all groups with a high level of productive engagement in work, study, or volunteer activities.

CONCLUSIONS

The findings of this study do not support the hypotheses. Postrehabilitation functioning was better than anticipated in adults with dual diagnosis. The contribution of rehabilitation factors, such as longer admission time to develop compensatory techniques and strategies for adaptation in the community, may have contributed to these positive findings.

Biographical disruption and the experience of loss following a spinal cord injury: an interpretative phenomenological analysis

Individual in-depth interviews with eight people who had experienced a total spinal cord injury were conducted, focussing on the experience of living with a spinal cord injury. The interviews were transcribed verbatim and were analysed for recurrent themes using Interpretative Phenomenological Analysis (IPA). Here we present three inter-related recurrent themes: 'Loss of control'; 'Loss of independence' and 'Loss of identity'. Participants reported an ongoing sense of loss, characterised largely by a diminishing sense of personal control. This loss of personal control manifested itself in incontinence, emotion and loss of movement. Helplessness and embarrassment were common responses. A loss of independence was associated with incontinence but also with a loss of spontaneity. A loss of identity ensued and participants reported feeling 'invisible'. The findings are discussed in relation to both extant spinal cord literature and chronic health literature. Recommendations for future research are suggested.

The impact of volunteer mentoring schemes on carers of people with dementia and volunteer mentors: a systematic review

This systematic review aims to examine the differences and similarities between the various types of volunteer mentoring (befriending, mentoring and peer support) and to identify the benefits for carers and volunteers. Literature searching was performed using 8 electronic databases, gray literature, and reference list searching of relevant systematic reviews. Searches were carried out in January 2013. Four studies fitted the inclusion criteria, with 3 investigating peer support and 1 befriending for carers. Quantitative findings highlighted a weak but statistically significant (P =.04) reduction in depression after 6 months of befriending. Qualitative findings highlighted the value carers placed on the volunteer mentors' experiential similarity. Matching was not essential for the development of successful volunteer mentoring relationships. In conclusion, the lack of need for matching and the importance of experiential similarity deserve further investigation. However, this review highlights a lack of demonstrated efficacy of volunteer mentoring for carers of people with dementia.

Peer support for carers: a qualitative investigation of the experiences of carers and peer volunteers

Being a carer of someone with dementia can be rewarding and also challenging. Volunteer peer support schemes for carers are being introduced, little is known about either their impact on carers and volunteers or about volunteers' and carers' experiences. This study investigated peer volunteer and carer recipient experiences of a peer support service. Thematic analysis of 13 in-depth interviews with 9 carers and 4 peer volunteers revealed that peer support helped both carers and peer volunteers through the realization that they were "not alone" in their experiences and emotions. Additional carer benefits included opportunities to talk freely about difficult experiences and learning how others cope. Volunteers found their role rewarding, describing satisfaction from putting their own experiences to good use. These findings highlight the isolation and exclusion experienced by current and former carers of people with dementia and draw attention to the benefits of peer support for both the groups.

Marital formation in individuals with work-related permanent impairment

BACKGROUND

Prior studies on the impact of disabling work injury have neglected social support as a key mediating factor. This study investigates how permanent impairment from a work injury affects marital formation, an indicator of social support and integration with the potential to affect psychosocial adjustment and the resumption of productive social roles following work injury.

HYPOTHESES

Adjusting for socio-demographic and economic factors associated with marriage ability, we expect that individuals with a work-related permanent impairment will have a lower rate of marital formation compared to their non-injured counterparts.

METHODS

Drawing on a linkage of workers' compensation claims data with income tax information, we undertake a duration modeling analysis comparing workers who have sustained a workplace injury with a matched sample of non-injured controls to examine time to marital formation in each group.

RESULTS

Women who suffered a disabling work injury were 17% less likely to marry relative to controls. High levels of physical impairment reduced the rate of marriage in women by 22%. We did not find an effect of impairment on marriage probability in models adjusted for income in men.

CONCLUSIONS

Our findings underscore the importance of examining the social and interpersonal consequences of work injury, factors not currently addressed by the occupational rehabilitation system.

Randomized controlled trial of peer mentoring for individuals with traumatic brain injury and their significant others

OBJECTIVES

To examine the efficacy of a peer-mentoring program for persons with traumatic brain injury (TBI) and their significant others, and to determine the relationship of this mentoring program to 3 main outcomes: (1) emotional well-being; (2) post-TBI quality of life; and (3) community integration.

DESIGN

Randomized controlled trial.

SETTING

Midwestern rehabilitation hospital.

PARTICIPANTS

Persons with TBI (n=96) and significant others/caregivers (n=62).

INTERVENTIONS

Persons with TBI and friends/caregivers who knew the person prior to their injury were randomly assigned to a treatment (mentored) or no-treatment (no mentoring) control group immediately prior to discharge from the rehabilitation unit and were mentored for up to 2 years.

MAIN OUTCOME MEASURES

Peer Mentoring Questionnaire; Brief Symptom Inventory-18; Family Assessment Device; Coping Inventory for Stressful Situations; Short Michigan Alcohol Screening Test; Medical Outcomes Study 12-Item Short-Form Health Survey; and Community Integration Measure.

RESULTS

Eighty-eight percent of individuals who were involved in the mentoring program reported positive experiences. t tests revealed that among persons with TBI, individuals who received mentoring had significantly better behavioral control and less chaos in the living environment (P=.04), lower alcohol use (P=.01), less emotion-focused (P=.04) and avoidance coping (P=.03), and good physical quality of life (P=.04) compared with those who did not receive mentoring. Among significant others, mentored individuals demonstrated greater community integration (P=.03) than the nonmentored control group.

CONCLUSIONS

Mentoring can be an effective way to benefit mood and healthy coping after TBI, and it can help to prevent maladaptive behaviors, such as substance abuse and behavioral dyscontrol, in the living situation.

Using peer mentoring for people with spinal cord injury to enhance self-efficacy beliefs and prevent medical complications

AIMS AND OBJECTIVES

Individuals with spinal cord injury/disease are faced with a myriad of psychosocial adjustment challenges. This article describes the implementation of a peer-mentoring programme designed to support this adjustment process for people with SCI/disease and the programme's believed impact on self-efficacy and prevention of medical complications.

BACKGROUND

With shorter length of stay in acute inpatient rehabilitation after spinal cord injury/disease, peer mentor programmes are becoming an important component to assist with education and community re-integration.

DESIGN

Quasi-experimental non-controlled pretest/post-test.

METHOD

Patients with newly acquired spinal cord injury/disease participated in a one-year spinal cord injury peer-mentoring programme. Peer mentors met with their assigned participants regularly during inpatient care and on discharge to track medical complications and assist with adjusting to life after spinal cord injury/disease.

RESULTS

In all, of 37 mentees enrolled, 24 successfully completed the programme. Sixty-seven per cent showed improved self-efficacy score between the two time points. Medical complications and doctor visits all decreased significantly between 0-6 months and 7-12 months. Our findings indicate that the older an individual is, the lower the likelihood of having a urinary tract infection (p = 0.006). The programme was well received by all mentees who felt they could connect well with their peer mentor.

CONCLUSION

Peer mentoring in a rehabilitation setting enhances the understanding of challenges that patients and medical staff deal with on a day-to-day basis. Our findings suggest it is important to monitor and educate individuals with spinal cord injury/disease at the acute stage to improve medical outcomes. Caution is advised in the interpretation of these results as they were obtained in a small non-random sample using self-report data.

RELEVANCE TO CLINICAL PRACTICE

Peer mentors play an increasingly important role in nurse-delivered education in the spinal cord injury/disease population.

Men's adjustment to spinal cord injury: the unique contributions of conformity to masculine gender norms

Men constitute 82% of the approximately 250,000 people in the United States living with a spinal cord injury. Unfortunately, however, little is known about the impact of men's adherence to gender norms on their adjustment to such injuries. The present investigation examined the utility of masculine norms in explaining variance in depression beyond that accounted for by commonly identified predictors of men's adjustment following spinal cord injury. As hypothesized, results suggested that men's adherence to masculine norms accounted for unique variance in their depression scores beyond that contributed by social support, environmental barriers/access, and erectile functioning. Respondents who adhered to norms stressing the primacy of men's work demonstrated lower rates of depression, whereas those who conformed to norms for self-reliance demonstrated higher depression scores. The authors discuss future research directions and potential psychotherapeutic strategies for working with men with spinal cord injuries.