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Li J, Li Y, Mei X, He H, Yu L, Ho GWK, Chan EA. Effectiveness of Cognitive-Based Interventions on Psychological Distress in Adolescents With Physical Disabilities: A Systematic Review and Meta-Analysis. Int J Ment Health Nurs 2024. [PMID: 39010290 DOI: 10.1111/inm.13391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 06/14/2024] [Accepted: 06/29/2024] [Indexed: 07/17/2024]
Abstract
Adolescents with physical disabilities experience common psychological distress that interacts with impaired physical function. While cognitive-based interventions have been implemented for adolescents with physical disabilities, their effects on enhancing psychological health remain uncertain. This systematic review aimed to synthesise the effects of cognitive-based interventions on the psychological distress of this population and identify optimal components for evidence-based interventions. Following the PRISMA guideline, nine databases were searched to identify eligible randomised controlled trials examining the effects of cognitive-based interventions for adolescents with physical disabilities from inception to October 2023. Data syntheses were performed using the R software, employing random-effects models. Twelve trials involving 1201 participants were identified. The pooled results revealed that cognitive-based interventions did not yield noticeable effects in reducing anxiety (g = -0.43 for postintervention; -0.14 for medium term; -0.37 for long term), depression (g = -0.05 for postintervention; -0.02 for medium term; -0.15 for long term) and stress levels (g = -0.15) over time. The secondary outcome (physical function) improved significantly in the long term compared to the control groups (g = 0.31). Furthermore, this review identified variations in the effectiveness of CBIs among different recipients, durations and modes of delivery. Given the limited number and overall low quality of identified studies for each outcome, conducting high-quality randomised controlled trials is recommended to validate the effectiveness of cognitive-based interventions in reducing psychological distress among adolescents with physical disabilities.
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Affiliation(s)
- Jiaying Li
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Yan Li
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Xiaoxiao Mei
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Honggu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Lu Yu
- Department of Applied Social Sciences, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Grace Wing Ka Ho
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
| | - Engle Angela Chan
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong
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Cotter R, Burns J, Kaufman K, Kudla A, Ehrlich-Jones L, Wafford QE, Heinemann AW. Effectiveness of Behavioral and Pharmacologic Interventions for Depressive Symptoms After Spinal Cord Injury: Findings From a Systematic Review. Arch Phys Med Rehabil 2024:S0003-9993(24)00037-6. [PMID: 38266762 DOI: 10.1016/j.apmr.2024.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/10/2023] [Accepted: 01/05/2024] [Indexed: 01/26/2024]
Abstract
OBJECTIVE To summarize and evaluate evidence regarding the efficacy of interventions for depressive symptoms in adults living with spinal cord injury (SCI) and comorbid major depressive disorder or significant depressive symptoms to inform the development of clinical practice guidelines. DATA SOURCES Articles published since 2013 and available in Medline, The Cochrane Library, Embase, Scopus, CINAHL, or PsycINFO. Databases were searched in June 2022 and updated November 2023. STUDY SELECTION Inclusion criteria: age 18 years or older, traumatic SCI, and clinically significant depression (Population), mental health interventions including behavioral, pharmacologic, and complementary and alternative medicine (Intervention), inclusion of a control group (Comparator), with a primary outcome of depression symptom reduction (Outcome). Criteria were applied by multiple reviewers and disagreements were reconciled via unanimous decision among the entire research team. Eight articles of 2780 screened met the selection criteria. DATA EXTRACTION Data were extracted independently by multiple reviewers. Two reviewers independently assigned a quality score using the guidelines described by Hawker and associates and independently evaluated the risk of bias of each article using version 2 of the Cochrane risk-of-bias tool. DATA SYNTHESIS All studies assessed depressive symptoms during participant recruitment, screening, and/or at a baseline assessment stage. Pharmacotherapy with venlafaxine XR and several behavioral interventions appear promising, including an online mindfulness course and eye movement desensitization and reprocessing therapy. Remote interventions may be effective in reaching individuals who are unable to travel to in-person therapy sessions. CONCLUSIONS This systematic review provides valuable information for clinicians who treat individuals with SCI and comorbid major depressive disorder or significant depressive symptoms. It highlights the importance of considering a variety of interventions and individualizing treatment to meet individuals' needs and preferences. Future research should aim to identify effective interventions for treating depressive symptoms in individuals with SCI and optimal delivery methods for these interventions.
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Affiliation(s)
- Robert Cotter
- Shirley Ryan AbilityLab, Chicago, IL; Yale University School of Medicine, New Haven, CT.
| | | | | | | | - Linda Ehrlich-Jones
- Shirley Ryan AbilityLab, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Q Eileen Wafford
- Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL; Northwestern University Feinberg School of Medicine, Chicago, IL
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Widuch-Spodyniuk A, Tarnacka B, Korczyński B, Wiśniowska J. Impact of Robotic-Assisted Gait Therapy on Depression and Anxiety Symptoms in Patients with Subacute Spinal Cord Injuries (SCIs)-A Prospective Clinical Study. J Clin Med 2023; 12:7153. [PMID: 38002765 PMCID: PMC10672092 DOI: 10.3390/jcm12227153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/10/2023] [Accepted: 11/10/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND Mood disorders, especially depression, and emotional difficulties such as anxiety are very common problems among patients with spinal cord injuries (SCIs). The lack of physical training may deteriorate their mental state, which, in turn, has a significant impact on their improvement in functioning. The aim of the present study was to examine the influence of innovative rehabilitation approaches involving robotic-assisted gait therapy (RAGT) on the depression and anxiety symptoms in patients with SCI. METHODS A total of 110 participants with subacute SCIs were enrolled in this single-center, single-blinded, single-arm, prospective study; patients were divided into experimental (robotic-assisted gait therapy (RAGT)) and control (conventional gait therapy with dynamic parapodium (DPT)) groups. They received five training sessions per week over 7 weeks. At the beginning and end of therapy, the severity of depression was assessed via the Depression Assessment Questionnaire (KPD), and that of anxiety symptoms was assessed via the State-Trait Anxiety Inventory (STAI X-1). RESULTS SCI patients in both groups experienced significantly lower levels of anxiety- and depression-related symptoms after completing the seven-week rehabilitation program (KPD: Z = 6.35, p < 0.001, r = 0.43; STAI X-1: Z = -6.20, p < 0.001, r = 0.42). In the RAGT group, post-rehabilitation measurements also indicated an improvement in psychological functioning (i.e., decreases in depression and anxiety and an increase in self-regulation (SR)). Significant results were noted for each variable (STAI X-1: Z = -4.93; KPD: Z = -5.26; SR: Z = -3.21). In the control group, there were also decreases in the effects on depression and state anxiety and an increase in self-regulation ability (STAI X-1: Z = -4.01; KPD: Z = -3.65; SR: Z = -2.83). The rehabilitation modality did not appear to have a statistically significant relationship with the magnitude of improvement in the Depression Assessment Questionnaire (KPD) (including self-regulation) and State-Trait Anxiety Inventory (STAI) scores. However, there were some significant differences when comparing the groups by the extent and depth of the injury and type of paralysis. Moreover, the study did not find any significant relationships between improvements in physical aspects and changes in psychological factors. CONCLUSIONS Subjects in the robotic-assisted gait therapy (RAGD) and dynamic parapodium training (DPT) groups experienced decreases in anxiety and depression after a 7-week rehabilitation program. However, the rehabilitation modality (DPT vs. RAGT) did not differentiate between the patients with spinal cord injuries in terms of the magnitude of this change. Our results suggest that individuals with severe neurological conditions and complete spinal cord injuries (AIS A, according to the Abbreviated Injury Scale classification) may experience greater benefits in terms of changes in the psychological parameters after rehabilitation with RAGT.
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Affiliation(s)
- Alicja Widuch-Spodyniuk
- Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury in Kamien Pomorski, Health Resort Kamien Pomorski, 72-400 Kamień Pomorski, Poland; (A.W.-S.)
| | - Beata Tarnacka
- Department of Rehabilitation, Medical University of Warsaw, 02-091 Warsaw, Poland
| | - Bogumił Korczyński
- Research Institute for Innovative Methods of Rehabilitation of Patients with Spinal Cord Injury in Kamien Pomorski, Health Resort Kamien Pomorski, 72-400 Kamień Pomorski, Poland; (A.W.-S.)
| | - Justyna Wiśniowska
- Department of Rehabilitation, Eleonora Reicher National Institute of Geriatrics, Rheumatology and Rehabilitation, 02-637 Warsaw, Poland;
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Khong CM, Chan J, Pasipanodya E, Dirlikov B, Shem K. Risk Factors Associated With Suicidal Ideation in Individuals With Spinal Cord Injury. Arch Rehabil Res Clin Transl 2023; 5:100284. [PMID: 37744203 PMCID: PMC10517356 DOI: 10.1016/j.arrct.2023.100284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Objective To assess the frequency of suicidal ideation (SI) among individuals with chronic spinal cord injury (SCI) and to identify risk factors associated with SI. Design Cross-sectional. Setting Community setting. Participants Two hundred and forty-six individuals with chronic SCI participating in the Spinal Cord Injury Model Systems at a Level 1 Trauma center. Interventions Not applicable. Main Outcome Measure SI, as assessed by question 9 of the Patient Health Questionnaire-9. Results Twenty-seven (11.0%) participants endorsed SI; 6 (22.2%) of whom endorsed active SI with a plan of self-harm. Participants who endorsed SI had significantly higher depressive symptoms, lower resilience, and lower satisfaction with life (all Ps<.001). They also had lower perceived health (P<.001), Craig Handicap Assessment & Reporting Technique Short Form (CHART-SF) physical independence (P=.013), and Spinal Cord Injury - Functional Index with Assistive Technology domains of basic mobility (P=.003), self-care (P=.042), and fine motor skills (P=.035). However, participants who endorsed SI were not significantly different in re-hospitalization rates and in other domains of CHART-SF and SCI-AT. Logistic regression, with a forward selection procedure, was used to identify significant predictors of endorsing SI in the context of multiple associated variables. Depressive symptoms (odds ratio [OR]=1.18, P=.020), resilience (OR=0.85, P=.003), and physical independence (OR=0.98, P=.019) remained significant predictors of SI. Conclusion Study findings suggest higher levels of SI among people with SCI, a substantial proportion of whom have active SI. Individuals with SCI who endorse SI have greater burden of poor physical and mental health, as well as poorer functional status and adaptation. Interventions targeting multiple dimensions of quality of life may help reduce risk of SI and suicide among individuals with SCI.
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Affiliation(s)
- Cria-May Khong
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA
| | - John Chan
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA
| | | | - Benjamin Dirlikov
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA
| | - Kazuko Shem
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, CA
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, CA
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Dorenkamp MA, Waldron-Perrine B, Hanks R. Influence of Acceptance and Commitment Therapy Core Processes on Anxiety and Stress in Persons With Spinal Cord Injury: A Cross-sectional Study. Arch Phys Med Rehabil 2022; 104:612-618. [PMID: 36481262 DOI: 10.1016/j.apmr.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 09/29/2022] [Accepted: 11/14/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To explore the relationship between the core Acceptance and Commitment Therapy (ACT) processes (mindfulness, self as context, acceptance, defusion, values, and committed action) and anxiety and stress in a sample of individuals with spinal cord injury (SCI). DESIGN Variance accounted for by ACT on anxiety and stress as outcome variables was examined using multiple linear regression. SETTING Study measures were completed via online survey. PARTICIPANTS 159 participants with a SCI completed self-report study measures relevant to the ACT core processes as well as measures of depression, anxiety, and perceived stress. MAIN OUTCOME MEASURES Outcome measures included the Spinal Cord Injury-Quality of Life Anxiety subdomain and the Perceived Stress Scale. RESULTS Higher reported engagement with acceptance (β=0.238, P=.004), pursuit of values (β=0.187, P<.008), and defusion (β=0.351, P<.001) related to less anxious distress. Perceived stress was predicted by depression (β = 0.230, P=.038) and the ACT core processes as a whole (P<.001). CONCLUSIONS The results of our study indicate that considerable variance in anxiety and stress in individuals with SCI is accounted for by the core processes of ACT. Lower levels of anxiety and stress were predicted by the ACT components as a whole. Anxiety was uniquely predicted by pursuit of values, acceptance, and defusion, indicating these 3 components of ACT may be particularly beneficial in the treatment of anxiety in SCI. These results may provide targeted treatment opportunities via tailored ACT-based interventions.
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Affiliation(s)
- Megan A Dorenkamp
- Department of Rehabilitation Psychology and Neuropsychology, Rehabilitation Institute of Michigan, Detroit, MI
| | - Brigid Waldron-Perrine
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
| | - Robin Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI
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Pasipanodya E, Khong CM, Dirlikov B, Prutton M, Held M, Shem K. Telepsychology for Individuals With Spinal Cord Injury: Protocol for a Randomized Control Study of Video-Based Cognitive Behavioral Therapy. Top Spinal Cord Inj Rehabil 2022; 28:56-67. [PMID: 36457360 PMCID: PMC9678220 DOI: 10.46292/sci22-00010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background A substantial proportion of individuals with spinal cord injury (SCI) experience depression, which has been negatively associated with recovery and community participation after injury. Despite significant barriers to seeking and receiving in-person mental health care, little research has focused on the efficacy of telepsychology among individuals with SCI. Objectives To describe the design and implementation of an ongoing single-center, randomized controlled, video-based cognitive behavioral therapy (CBT) intervention among individuals with SCI. Methods Participants within 1 year of SCI will be randomized 1:1 to intervention or usual care in a 24-week study. Intervention participants will engage in 10 sessions of CBT over 12 weeks with a licensed clinical psychologist, using iPads via Apple FaceTime. Primary outcomes are depressive symptomatology, anxiety, and life satisfaction (as measured by the Patient Health Questionnaire-9, Generalized Anxiety Disorder-7 and Satisfaction with Life Scale, respectively) measured at three time points (baseline, 12 weeks, and 24 weeks). These and other measures are also assessed during monthly telephone surveys conducted between primary timepoints. Results Recruitment is ongoing. Forty-six participants have been enrolled thus far. Conclusion Telepsychology is a convenient, flexible, and effective alternative to traditional in-person services. We anticipate that intervention participants will experience improvements in depressive and anxiety symptoms and will have greater life satisfaction. Telepsychology interventions among individuals with SCI are tasked to maintain participant privacy, provide assistive technology and/or engage caregivers to minimize mobility limitations, and manage risk remotely. Challenges encountered include recruitment during the COVID-19 pandemic. Early intervention on symptoms of psychological morbidity using telepsychology may facilitate greater adaptation following SCI.
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Affiliation(s)
- Elizabeth Pasipanodya
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California
| | - Cria-May Khong
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California
| | - Benjamin Dirlikov
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California
| | - Michael Prutton
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California
| | - Mark Held
- Department of Psychiatry, Santa Clara Valley Medical Center, San Jose, California
| | - Kazuko Shem
- Rehabilitation Research Center, Santa Clara Valley Medical Center, San Jose, California
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, San Jose, California
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7
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Yang SH, Mu PF, Huang WC. Cognitive behaviour therapy in adults with spinal cord injury: A scoping review. Int J Nurs Pract 2022:e13078. [PMID: 35770855 DOI: 10.1111/ijn.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/13/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study is to report on the extent and range of the research evaluating cognitive behaviour therapy (CBT) in adults with spinal cord injury. BACKGROUND Spinal cord injury is a devastating event that can lead to permanent neurologic deficit. Compared with the average person, spinal cord injury (SCI) patients are at twice the risk of developing mood disorders, highlighting vulnerability of SCI patients' mental states which can be easily hurt. CBT is the most commonly used psychosocial intervention. DESIGN This was a scoping review. REVIEW METHOD Five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO and Airiti Library) were searched for articles published between 1990 and 2021. Google Scholar was utilized to search additional articles listed in the reference lists of included articles. RESULTS Overall, 16 articles met the inclusion criteria, with the majority reporting on CBT, that focused on psychological distress and neuropathic pain. The core concept of intervention included disease identification, cognitive distortion/modification and coping strategies. CONCLUSIONS There were significant knowledge gaps on the interventions' content and effectiveness for psychological distress of persons with SCI. Development of multifaceted cognitive behaviour interventions, especially to strengthen self-identity and to inspire patients' hope, is needed. Further research is required to investigate the long-term effectiveness of CBT.
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Affiliation(s)
- Shu-Hua Yang
- Department of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Fan Mu
- Department of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Taiwan Evidence Based Practice Center: A JBI Centre of Excellence, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Cheng Huang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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Schultz KR, Mona LR, Cameron RP. Mental Health and Spinal Cord Injury: Clinical Considerations for Rehabilitation Providers. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022; 10:131-139. [PMID: 35502271 PMCID: PMC9046713 DOI: 10.1007/s40141-022-00349-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2022] [Indexed: 10/25/2022]
Abstract
Purpose of Review Assessing and addressing the mental and behavioral health concerns of individuals with SCI during rehabilitation is crucial, as untreated mental health distress can lead to reduced gains in rehabilitation and poor overall health. This review provides an overview of the latest research on prevalence rates of common mental and behavioral health concerns in the SCI population, highlighting disability-specific factors that may impact traditional assessment and treatment of mental health concerns. Recent Findings While those with SCI are at a heightened risk for experiencing mental health distress, overall, the majority of those with SCI adapt well, and live a full and meaningful life. Summary Rehabilitation psychologists are a vital aspect of rehabilitation teams, as they can address behavioral health and mental health concerns that may impede patients achieving their rehabilitation goals.
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Affiliation(s)
- Katlin R Schultz
- VA Long Beach Healthcare System, SCI/D Service (07/128) 5901 E 7th Street, Long Beach, CA 90822 USA
| | - Linda R Mona
- VA Long Beach Healthcare System, SCI/D Service (07/128) 5901 E 7th Street, Long Beach, CA 90822 USA
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9
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Byra S, Gabryś A. Coping Strategies of Women With Long-Term Spinal Cord Injury: The Role of Beliefs About the World, Self-Efficacy, and Disability. REHABILITATION COUNSELING BULLETIN 2022. [DOI: 10.1177/00343552211063649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The present study aimed to investigate the indirect effect of appraisal of disability on the relationship between basic hope and coping strategies in women with long-term spinal cord injury (SCI), taking into account the moderating role of general self-efficacy. A cross-sectional study with 187 women with paraplegia was conducted. Main outcome measures, the Coping Orientations to Problems Experienced (COPE), the Basic Hope Inventory (BHI), Appraisals of Disability Primary and Secondary Scale (ADAPSS), and General Self-Efficacy Scale (GSES), were used. Our study showed that the strategies most commonly used by participants are seeking emotional support, religion, and acceptance. More than 45% of the respondents reveal average levels of basic hope, 58.82% reveal high levels of general self-efficacy, and most of them assessed their disability as determined resilience while noticing its negative aspects. The indirect effect of disability appraisal on the relationship between basic hope and coping strategies (denial, focus on emotions, seeking emotional support, religion, and acceptance) was confirmed. The moderating role of general self-efficacy in this analysis of mediating was also confirmed. General self-efficacy plays a significant role in explaining the relationship between basic hope and coping strategies mediated by appraisals of disability in women with long-term SCI.
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Blackport D, Shao R, Ahrens J, Sequeira K, Teasell R, Hadjistavropoulos H, Loh E, Mehta S. Online psychosocial intervention for persons with spinal cord injury: A meta-analysis. J Spinal Cord Med 2021:1-12. [PMID: 34935600 DOI: 10.1080/10790268.2021.2009675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND Delivery of psychosocial interventions via the Internet has the potential to overcome barriers and increase access; however, effectiveness is yet to be established among those with spinal cord injury (SCI). METHODS The objective of this meta-analysis is to evaluate the efficacy of Internet-based psychosocial interventions on the symptoms of anxiety, depression, and pain amongst those with SCI. The databases Medline, PsycInfo, and EMBASE were used to locate studies published between 1990 and December 2020. A study was included if (1) the study involved the application of an online psychosocial intervention; (2) adults with SCI; and (3) reported outcomes on depression and/or anxiety. From each study, participant characteristics and study details were extracted. A standardized mean difference (SMD) ± standard error and 95% confidence interval (CI) was calculated for each outcome of interest and the results were pooled using a fixed-effects model. RESULTS The search yielded 920 studies, of which five were included in the final meta-analysis; It was revealed that Internet-based psychosocial interventions had a small effect on reducing overall anxiety (SMD: 0.42 ± 0.09, p < 0.001) and depression (SMD: 0.41 ± 0.09, p < 0.001) symptoms at the end of the study period. Online psychosocial interventions also had a moderate effect in maintaining reduction of anxiety (SMD: 0.50 ± 0.1, p < 0.001) and depressive (SMD: 0.64 ± 0.10, p < 0.001) symptoms at 3-month follow-up. CONCLUSION The results of this meta-analysis provide evidence for the use of internet-based psychosocial interventions to manage anxiety and depression symptoms among those with spinal cord injuries.
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Affiliation(s)
- Daymon Blackport
- Parkwood Institute Research, Parkwood Institute, London, Ontario, Canada.,St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
| | - Richard Shao
- Parkwood Institute Research, Parkwood Institute, London, Ontario, Canada.,St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
| | - Jessica Ahrens
- Parkwood Institute Research, Parkwood Institute, London, Ontario, Canada.,St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada
| | - Keith Sequeira
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
| | - Robert Teasell
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
| | | | - Eldon Loh
- St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
| | - Swati Mehta
- Parkwood Institute Research, Parkwood Institute, London, Ontario, Canada.,St. Joseph's Health Care, Parkwood Institute, London, Ontario, Canada.,Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, Ontario, Canada
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Russell M, Ames H, Dunn C, Beckwith S, Holmes SA. Appraisals of disability and psychological adjustment in veterans with spinal cord injuries. J Spinal Cord Med 2021; 44:958-965. [PMID: 32406809 PMCID: PMC8725773 DOI: 10.1080/10790268.2020.1754650] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Context/Objective: Following a spinal cord injury or disability (SCI/D), cognitive appraisals are a marker of psychological adjustment. The present study evaluated the clinical utility and discriminant validity of the Appraisals of DisAbility Primary and Secondary Scale - Short Form (ADAPSS-sf). The ADAPSS-sf was evaluated on 1. identification of individuals experiencing poor psychological adjustment and 2. prediction of life satisfaction beyond measures of emotional distress.Design: A retrospective study was completed using ROC analyses and odds ratios to identify the clinical utility of the ADAPSS-sf. In addition, blocked hierarchical regression explored the ADAPSS-sf predictive characteristics for satisfaction with life beyond measures of emotional distress.Setting: Veteran's Health Administration SCI Center.Participants: Ninety outpatient veterans with SCI/Ds.Outcome Measures: Measures of psychological adjustment post-SCI/D included the PHQ-9, GAD-7, PC-PTSD, and the Diener Satisfaction with Life Scale (SWLS). The ADAPSS-sf was used as a measure of cognitive appraisals.Results: Results indicated the ADAPSS-sf is effective in identification of poor psychological adjustment, P < .001. Diagnostic odds ratios and ADAPSS-sf cut scores were selected to prioritize sensitivity (7.17, ≤ 11), specificity (68.25, ≥ 22), or a balance of the two (16.32, ≤ 19). Hierarchical regression indicated the ADAPSS-sf accounted for unique variance in life satisfaction beyond measures of emotional distress, (ΔR2 = .20, β = -.66, t(89) = 6.54, P < .001).Conclusion: Results indicated SCI/D specific appraisals are predictive of concurrent poor psychological adjustment and provide insight into satisfaction with life beyond measures of emotional distress.
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Affiliation(s)
- Matthew Russell
- Spinal Cord Injury Care Line, Michael E. DeBakey VA Medical Center, HoustonTexas, USA,Department of Psychiatry, Baylor College of Medicine, HoustonTexas, USA
| | - Herb Ames
- Spinal Cord Injury Care Line, Michael E. DeBakey VA Medical Center, HoustonTexas, USA,Physical Medicine and Rehabilitation, Baylor College of Medicine, HoustonTexas, USA,Correspondence to: Herb Ames, Michael E. DeBakey VA Medical Center, 2002 Holcombe Blvd, Houston, TX77030, USA; Ph: (713) 794-7044.
| | - Callie Dunn
- Behavioral Health Service Line, WellStar Medical Group Psychological Services, Marietta, Georgia, USA
| | - Sarah Beckwith
- Spinal Cord Injury Care Line, Michael E. DeBakey VA Medical Center, HoustonTexas, USA
| | - Sally A. Holmes
- Spinal Cord Injury Care Line, Michael E. DeBakey VA Medical Center, HoustonTexas, USA,Physical Medicine and Rehabilitation, Baylor College of Medicine, HoustonTexas, USA
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Plys E, Morrow CD, Portz JD, Jones CD, Piper C, Boxer RS. Psychological interventions with older adults during inpatient postacute rehabilitation: A systematic review. Rehabil Psychol 2021; 66:233-247. [PMID: 34472922 PMCID: PMC8622202 DOI: 10.1037/rep0000383] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Objective: Older adults in inpatient postacute care settings report high rates of depression and anxiety. Psychological interventions address these symptoms through educational, cognitive, behavioral, relaxation, and/or psychosocial approaches. The purpose of this study was to systematically evaluate the quality of existing literature on psychological interventions for depression and/or anxiety among older adults during an inpatient postacute care stay. Method: Medline, Embase, Cochrane Library, CINAHL, PsycINFO, and Google Scholar were searched for key concepts. Studies were included that (a) sampled skilled nursing facility or inpatient rehabilitation facility patients, (b) evaluated a psychological intervention, (c) measured depression and/or anxiety symptoms before and after interventions, and (d) had a mean or median age of 65+. Two raters assessed articles for inclusion and risk of bias. Results: Search strategies identified 7,506 articles for screening; nine met inclusion criteria. Included studies varied by study design, intervention type, and methodological quality. Only one study had low overall risk of bias. Four studies demonstrated preliminary treatment benefits for depression symptoms; none reported benefits for anxiety symptoms. Conclusions: Most of the included studies were limited by small sample size and high risk of bias. Thus, currently, there is insufficient evidence to support the effectiveness of psychological interventions for depression or anxiety among older adults during an inpatient postacute care stay. The authors offer a detailed discussion of methodological limitations, empirical gaps, and future directions to develop this body of literature. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Evan Plys
- Department of Psychiatry, University of Colorado School of Medicine
| | - Cynthia D Morrow
- Health Systems Management and Policy, Colorado School of Public Health
| | - Jennifer D Portz
- Division of General Internal Medicine, University of Colorado School of Medicine
| | - Christine D Jones
- Denver/Seattle Center of Innovation for Veteran-Centered and Value Driven Care, VHA Eastern Colorado Healthcare System
| | - Christi Piper
- Strauss Health Sciences Library, University of Colorado Anschutz Medical Campus
| | - Rebecca S Boxer
- Institute for Health Research, Kaiser Permanente of Colorado
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Regaining A Sense Of Me: a single case study of SCI adjustment, applying the appraisal model and coping effectiveness training. Spinal Cord Ser Cases 2021; 7:11. [PMID: 33574230 PMCID: PMC7878027 DOI: 10.1038/s41394-020-00349-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/09/2020] [Accepted: 10/12/2020] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Sustaining a spinal cord injury (SCI) has been shown to impose a significant physical and psychological challenge with threat to quality of life (QOL). Duff & Kennedy provide a SCI explanation of appraisals and the two-stage process of an individual's primary assessment of their experience, and their secondary appraisal of their perceived coping resource being key facilitators of adjustment and fundamental to longer term adaptation. King & Kennedy designed a group coping effectiveness training (CET) intervention with a framework of coping strategy selection fit to reduce use of threat appraisals/avoidance coping, and to promote development of challenge appraisals with consequent stress reduction and adjustment. CASE PRESENTATION This CET approach was applied within individual psychological therapy with a 74-year old woman who presented with symptoms of anxiety, reactivated PTSD, mood disturbance and difficulty adjusting after sustaining SCI. Psychological adjustment treatment enabled resolution of post-trauma symptoms, re-evaluation of appraisals and perceived loss of identity, and development of positive coping strategies, and promoted a new conceptualisation of independence. DISCUSSION Case studies of psychological treatment are rare within the SCI literature. This paper provides a detailed application of primary appraisals and coping strategy selection fit in individual therapy. Attention is drawn to the important impact appraisals have on long-term rehabilitation outcomes and the necessity of a multi-disciplinary team (MDT) approach to achieve optimal psychological and physical adjustment following SCI. Finally, the paper highlights the need for community education to reduce negative perceptions/taboo of disability.
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14
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Sobreira M, Almeida MP, Gomes A, Lucas M, Oliveira A, Marques A. Minimal Clinically Important Differences for Measures of Pain, Lung Function, Fatigue, and Functionality in Spinal Cord Injury. Phys Ther 2021; 101:6039321. [PMID: 33336700 DOI: 10.1093/ptj/pzaa210] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 07/26/2020] [Accepted: 10/29/2020] [Indexed: 11/13/2022]
Abstract
OBJECTIVE The objective of this study was to determine the minimal clinically important differences (MCIDs) for the numerical pain rating scale (NPRS), peak cough flow (PCF), peak expiratory flow (PEF), fatigue severity scale (FSS), and London chest activities of daily living scale (LCADL) in patients with spinal cord injuries (SCIs) after rehabilitation. METHODS Inpatients with SCI from 2 rehabilitation centers participating in a daily rehabilitation program were recruited. The NPRS, PCF, PEF, FSS, and LCADL were collected at baseline and discharge. The global rating of change scale was performed at discharge. MCIDs were calculated using anchor (linear regression, mean change, and receiver operating characteristic curves) and distribution-based methods (0.5 times the baseline SD, standard error of measurement, 1.96 times standard error of measurement, and minimal detectable change) and pooled using arithmetic weighted mean. RESULTS Sixty inpatients with SCI (36 males; 54.5 [15.9] years) participated. On average their rehabilitation program lasted 7.3 (1.7) weeks. Pooled MCID estimates were 1.6 points for the NPRS, 69.8 L/min for the PCF, 77.4 L/min for the PEF, 1.1 points for the FSS, and 1.4 points for the LCADL. CONCLUSION Established MCIDs for NPRS, PCF, PEF, FSS, and LCADL will help health professionals to interpret results and guide rehabilitation interventions in patients with SCI. IMPACT Health professionals and researchers may now use -1.6 points for the NPRS, 69.8 L/min for the PCF, 77.4 L/min for the PEF, 1.1 points for the FSS, and 1.4 points for the LCADL to interpret if changes in pain, cough intensity, expiratory flow, fatigue and activities of daily living after rehabilitation of patients with SCI have been clinically relevant.
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Affiliation(s)
- Margarida Sobreira
- Medicine and Rehabilitation Centre of Alcoitão, Santa Casa da Misericórdia de Lisboa, Lisbon, Portugal
| | - Miguel P Almeida
- Rehabilitation Centre of the North, Centro Hospitalar de Vila Nova de Gaia-Espinho, Porto, Portugal.,Institute of Biomedicine, Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Ana Gomes
- Rehabilitation Centre of the North, Centro Hospitalar de Vila Nova de Gaia-Espinho, Porto, Portugal
| | - Marlene Lucas
- Medicine and Rehabilitation Centre of Alcoitão, Santa Casa da Misericórdia de Lisboa, Lisbon, Portugal
| | - Ana Oliveira
- Institute of Biomedicine, Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Aveiro, Portugal.,School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada.,West Park Healthcare Centre, Toronto, Ontario, Canada
| | - Alda Marques
- Lab3R-Respiratory Research and Rehabilitation Laboratory, School of Health Sciences, University of Aveiro, Campus Universitário de Santiago, Agras do Crasto, Building 30, 3810-193, Aveiro, Portugal
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15
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Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury. J Spinal Cord Med 2021; 44:102-162. [PMID: 33630722 PMCID: PMC7993020 DOI: 10.1080/10790268.2021.1863738] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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16
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Bombardier CH, Azuero CB, Fann JR, Kautz DD, Richards JS, Sabharwal S. Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Top Spinal Cord Inj Rehabil 2021; 27:152-224. [PMID: 34108836 PMCID: PMC8152173 DOI: 10.46292/sci2702-152] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
| | - Casey B. Azuero
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jesse R. Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Donald D. Kautz
- School of Nursing, University of North Carolina Greensboro, Greensboro, NC, USA
| | - J. Scott Richards
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Sunil Sabharwal
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
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17
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The effects of neck muscle vibration on postural orientation and spatial perception: A systematic review. Neurophysiol Clin 2020; 50:227-267. [DOI: 10.1016/j.neucli.2019.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 10/06/2019] [Accepted: 10/06/2019] [Indexed: 11/17/2022] Open
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18
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Hearn JH, Cross A. Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: a systematic review. BMC Neurol 2020; 20:32. [PMID: 31964353 PMCID: PMC6971852 DOI: 10.1186/s12883-020-1619-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Accepted: 01/16/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Populations with reduced sensory and motor function, such as spinal cord injury (SCI) are at increased risk of depression, anxiety, pain, and poorer quality of life (QoL). Mindfulness-Based Interventions (MBIs) have been developed with the aim of improving outcomes for people with SCI. To understand the value of MBIs, a systematic review was conducted pertaining to the use of MBIs, and interventions including elements of mindfulness, with people with SCI. METHODS Databases were reviewed from 1996 to October 2018 (updated January 2020). Eligibility criteria included the assessment of at least one of the common secondary consequences of SCI (i.e. risk of depression, anxiety, pain, and QoL), describe the use of mindfulness training as a component part of an intervention, or as the whole intervention. The Cochrane Collaboration Risk of Bias and The Effective Public Health Practice Project Quality Assessment Tools were utilised for quality appraisals. Two assessors appraised the studies and demonstrated good agreement (Cohen's k = .848, p < .001). RESULTS Five papers met the inclusion criteria, and demonstrated a range of results of interventions delivered individually, in a group format, in person, and online. Only one study reported significant reductions in pain-related outcomes (with moderate effect sizes), with the remaining studies (n = 4) demonstrating no change. Four studies described reductions in depressive symptoms and three reported reductions in anxiety. Despite the importance of good QoL as a goal for people with SCI, few studies (n = 2) assessed this as an outcome with no improvements reported. Study quality ranged from high to low/weak. CONCLUSIONS The findings in this review provide mixed support for the use of mindfulness to improve outcomes after SCI. In particular, findings indicate that mindfulness may be particularly effective for improving symptoms of depression and anxiety. This review highlights the requirement for more rigorous, high-quality research, particularly larger randomised-controlled trials with long-term follow-up, in this area. The small number of studies included in the present review mean that conclusions drawn are preliminary and thus reflects the paucity of the research in the area to date.
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Affiliation(s)
- Jasmine Heath Hearn
- Department of Psychology, Manchester Metropolitan University, 53 Bonsall Street, Manchester, M15 6GX UK
| | - Ainslea Cross
- Department of Psychology, University of Derby, Kedleston Road, Derby, DE22 1GB UK
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19
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Mehta S, Hadjistavropoulos H, Nugent M, Karin E, Titov N, Dear BF. Guided internet-delivered cognitive-behaviour therapy for persons with spinal cord injury: a feasibility trial. Spinal Cord 2020; 58:544-552. [DOI: 10.1038/s41393-019-0398-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 10/22/2019] [Accepted: 11/14/2019] [Indexed: 11/09/2022]
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20
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Hitzig SL, Titman R, Orenczuk S, Clarke T, Flett H, Noonan VK, Bain P, Mills S, Farahani F, Wiest MJ, Jeyathevan G, Alavinia SM, Craven BC. Development of Emotional Well-Being indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2019; 42:85-98. [PMID: 31573461 PMCID: PMC6783797 DOI: 10.1080/10790268.2019.1605750] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Context: Emotional Well-Being (EWB) post-spinal cord injury or disease (SCI/D) is a critical aspect of adjustment to disability. Advancing care and assuring equity in care delivery within this rehabilitation care domain is essential. Herein, we describe the selection of EWB structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. Methods: A pan-Canadian Working Group completed the following tasks: (1) defined the EWB construct; (2) conducted a systematic review of available outcomes and their psychometric properties; (3) constructed a Driver diagram summarizing available evidence associated with EWB; and, (4) prepared a process map. Facilitated meetings allowed selection and review of feedback following rapid-cycle evaluations of proposed structure, process and outcome indicators. Results: The structure indicator is the proportion of staff with appropriate education and training in EWB and access to experts and resources. The process indicator is the proportion of SCI/D patients who were screened for depression and anxiety symptoms at rehabilitation admission and rehabilitation discharge. The intermediary outcome is the proportion of SCI/D patients at risk for depression or anxiety at rehabilitation discharge based on screening symptom scores. The final outcomes are: (a) proportion of individuals at risk for depression or anxiety based on screening symptom scores; and (b) proportion of individuals who received referral for EWB services or intervention. Conclusion: The proposed indicators have a low administrative burden and will ensure feasibility of screening for depression and anxiety at important transition points for individuals with SCI/D. We anticipate that the current structures have inadequate resources for at-risk individuals identified during the screening process.
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Affiliation(s)
- Sander L. Hitzig
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada,Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Rebecca Titman
- Division of Physical Therapy and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Steven Orenczuk
- Parkwood Institute Research, St. Joseph’s Health Care, London, ON, Canada,Spinal Cord Injury Alberta, Edmonton, Canada
| | | | - Heather Flett
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada,Department of Physical Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vanessa K. Noonan
- Rick Hansen Institute, Vancouver, BC, Canada,Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Patricia Bain
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
| | - Sandra Mills
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
| | - Farnoosh Farahani
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
| | - Matheus Joner Wiest
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
| | - Gaya Jeyathevan
- KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
| | - S. Mohammad Alavinia
- Division of Physical Therapy and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada,KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada
| | - B. Catharine Craven
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, ON, Canada,Division of Physical Therapy and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada,KITE, Toronto Rehabilitation Institute – University Health Network, Toronto, ON, Canada,Correspondence to: B. Catharine Craven, Neural Engineering & Therapeutic Team, Toronto Rehabilitation Institute- University Health Network, Lyndhurst Centre, 520 Sutherland Drive, Toronto, ON M4G 3V9, Canada.
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21
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Brakel K, Hook MA. SCI and depression: Does inflammation commandeer the brain? Exp Neurol 2019; 320:112977. [PMID: 31203113 DOI: 10.1016/j.expneurol.2019.112977] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/29/2019] [Accepted: 06/12/2019] [Indexed: 12/11/2022]
Abstract
The incidence of depression is almost twice as high in the spinally injured population compared to the general population. While this incidence has long been attributed to the psychological, economic, and social burdens that accompany spinal cord injury (SCI), data from animal studies indicate that the biology of SCI may play an important role in the development of depression. Inflammation has been shown to impact stress response in rodents and humans, and inflammatory cytokines have been associated with depression for decades. The inflammation inherent to SCI may disrupt necessary mechanisms of mental homeostasis, such as serotonin production, dopamine production, and the hypothalamic pituitary adrenal axis. Additionally, gut dysbiosis that occurs after SCI can exacerbate inflammation and may cause further mood and behavior changes. These mediators combined may significantly contribute to the rise in depression seen after SCI. Currently, there are no therapies specific to depression after SCI. Elucidation of the molecular pathways that contribute to SCI-specific depression is crucial for the understanding of this disease and its potential treatments.
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Affiliation(s)
- Kiralyn Brakel
- School of Medicine, Department of Neuroscience and Experimental Therapeutics, Texas A&M University, Medical Research and Education Building, Ste. 1005, 8447 Riverside Pkwy, Bryan, TX 77807, United States; Texas A&M Institute of Neuroscience, Texas A&M University, Interdisciplinary Life Sciences Building, Rm 3148, 3474 College Station, TAMU, TX, United States.
| | - Michelle A Hook
- School of Medicine, Department of Neuroscience and Experimental Therapeutics, Texas A&M University, Medical Research and Education Building, Ste. 1005, 8447 Riverside Pkwy, Bryan, TX 77807, United States; Texas A&M Institute of Neuroscience, Texas A&M University, Interdisciplinary Life Sciences Building, Rm 3148, 3474 College Station, TAMU, TX, United States
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22
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Gupta S, Jaiswal A, Norman K, DePaul V. Heterogeneity and Its Impact on Rehabilitation Outcomes and Interventions for Community Reintegration in People With Spinal Cord Injuries: An Integrative Review. Top Spinal Cord Inj Rehabil 2019; 25:164-185. [PMID: 31068748 DOI: 10.1310/sci2502-164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background: Various injury characteristics such as cause, level, severity, and time since injury divide individuals with spinal cord injury (SCI) into many subgroups. The heterogeneity among individuals' injuries and personal characteristics has significant implications for SCI rehabilitation practice, specifically directed toward community reintegration, which is a key goal of rehabilitation interventions for people with disabilities. Purpose: This study aims to summarize the evidence on attributes that make the SCI population heterogeneous, the impact of these attributes on community reintegration, and the implications of heterogeneity for rehabilitation interventions directed toward optimizing community reintegration. Methods: We used an integrative review approach to conduct this study. MEDLINE, PubMed, CINAHL, EMBASE, Google Scholar, and PsycINFO were searched from inception until May 2017. Out of 670 articles retrieved, 49 provided evidence on the impact of various attributes that make SCI heterogeneous on rehabilitation outcomes related to community reintegration. Results: An array of injury-related, personal, social, and environmental factors are associated with various rehabilitation outcomes that affect community reintegration of people with SCI. There is level 1 evidence that social support, self-efficacy, and self-esteem facilitate community reintegration among people with SCI while there is level 5 evidence that presence of psychological or medical complications decreases it. There is lack of clarity on the impact of injury-related factors on community reintegration. Conclusion: This integrative review found that social support and individuals' self-efficacy can improve community reintegration of people with SCI. However, evidence regarding the impact of injury characteristics on community reintegration is still underdeveloped. Approaches directed at community reintegration should involve components of psychosocial, physical, and vocational rehabilitation while considering personal and societal aspects of an individual's life.
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Affiliation(s)
- Shikha Gupta
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Atul Jaiswal
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Kathleen Norman
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Vincent DePaul
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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23
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Sankari A, Badr MS, Martin JL, Ayas NT, Berlowitz DJ. Impact Of Spinal Cord Injury On Sleep: Current Perspectives. Nat Sci Sleep 2019; 11:219-229. [PMID: 31686935 PMCID: PMC6800545 DOI: 10.2147/nss.s197375] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2019] [Accepted: 09/20/2019] [Indexed: 12/22/2022] Open
Abstract
Sleep disorders are commonly encountered in people living with spinal cord injury (SCI). Primary sleep disorders such as sleep-disordered breathing (SDB), sleep-related movement disorders, circadian rhythm sleep-wake disorders, and insomnia disorder are common conditions after SCI but remain under-recognized, underdiagnosed and therefore remain untreated for a majority of patients. Sleep disturbances in people living with SCI are associated with significant impairments of daytime function and quality of life. Previous reviews have described findings related mainly to SDB but have not examined the relationship between other sleep disorders and SCI. This narrative review examines various sleep abnormalities and related functional and physical impairments in people living with SCI. It discusses new evidence pertaining to management, highlights existing limitations in the literature and recommends future directions for research.
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Affiliation(s)
- Abdulghani Sankari
- Department of Internal Medicine, John D. Dingell VA Medical Center, Detroit, MI, USA.,Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - M Safwan Badr
- Department of Internal Medicine, John D. Dingell VA Medical Center, Detroit, MI, USA.,Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | - Jennifer L Martin
- Geriatric Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, North Hills, CA, USA.,Geriatric Research, Education and Clinical Center, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA
| | - Najib T Ayas
- Department of Medicine, The University of British Columbia, Vancouver, BC, Canada
| | - David J Berlowitz
- Department of Physiotherapy, University of Melbourne, Melbourne, Australia.,Department of Physiotherapy, Austin Health, Melbourne, Australia.,Institute for Breathing and Sleep, Austin Health, Melbourne, Australia
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24
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Coker J, Cuthbert J, Ketchum JM, Holicky R, Huston T, Charlifue S. Re-inventing yourself after spinal cord injury: a site-specific randomized clinical trial. Spinal Cord 2018; 57:282-292. [PMID: 30573769 PMCID: PMC6451659 DOI: 10.1038/s41393-018-0230-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 11/27/2018] [Indexed: 01/07/2023]
Abstract
Study Design: Parallel-arm randomized controlled trial comparing an interactive group format versus a no-intervention control. Objective: To evaluate the efficacy of a replicable group treatment program for improving self-efficacy after spinal cord injury (SCI) in a single center cohort of adults. Setting: Regional SCI center. Methods: Participants included 81 individuals with SCI who were at least 4 weeks post-discharge from initial rehabilitation. Those randomized to treatment participated in six interactive learning sessions (2 hours each, one session per week) with structured and facilitated group interactions to improve self-efficacy. A wait-list control group was followed at matching time points for all outcome measures. The primary outcome measure was the Moorong Self-Efficacy Scale (MSES); secondary outcomes were the Generalized Self-Efficacy Scale (GSES); Diener Satisfaction with Life Scale (SWLS); Participation Assessment with Recombined Tools – Objective (PART-O); Patient Health Questionnaire – 9 (PHQ-9); and General Anxiety Disorder 7-item (GAD-7). Results: Individuals in the Treatment group had greater increases in MSES scores from baseline to immediately post-intervention (6 weeks) than the Control group, but that difference did not remain significant after controlling for multiple comparisons. However the improvement in the treatment group relative to the control group was not maintained through follow-up at 30 weeks. There was no evidence of an immediate or sustained treatment effect on any of the secondary outcomes. Conclusions: Self-efficacy improved for participants with SCI in the Treatment group, however, this improvement was not significant or maintained on follow-up.
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25
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Byra S. Basic hope and posttraumatic growth in people with traumatic paraplegia- the mediating effect of acceptance of disability. Spinal Cord 2018; 57:301-307. [PMID: 30374064 DOI: 10.1038/s41393-018-0215-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 09/14/2018] [Accepted: 09/17/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES Investigating the correlations between basic hope, acceptance of disability, and posttraumatic growth (PTG) in people with traumatic paraplegia, exploring the mediating effect of acceptance of disability. SETTING Community-dwelling people with traumatic paraplegia in Poland. METHODS Data were obtained from 281 individuals with paraplegia. The set of questionnaires included: The Posttraumatic Growth Inventory (PTGI); Basic Hope Inventory (BHI); and The Multidimensional Acceptance of Loss Scale. Four dimensions of disability acceptance were measured: subordinating physique relative to other values, enlarging the scope of values, transforming comparative-status values into asset values, and containing the effects of disability. Mediation was tested with the Baron and Kenny's approach. RESULTS A positive and statistically significant correlation between basic hope, acceptance of disability, and posttraumatic growth was found. Using a hierarchical regression analysis, a mediating effect of acceptance of disability was found for explaining the relationship between basic hope and posttraumatic growth in people with paraplegia. Only two dimensions of disability acceptance, subordinating physique relative to other values and transforming comparative-status values into asset values, were found to play a mediating role. CONCLUSION Beliefs about the world and the transformation of values that constitute acceptance of disability are important for explaining PTG in people with paraplegia. Correlations between these variables are complex. The correlation between basic hope and posttraumatic growth in individuals with paraplegia may be understood better by taking into account the mediating role of acceptance of disability.
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Affiliation(s)
- Stanisława Byra
- Faculty of Education and Psychology, Institute of Pedagogy, Maria Curie-Skłodowska University, Lublin, Poland, Narutowicza 12, 20-004, Lublin, Poland.
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26
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Hearn JH, Cotter I, Finlay KA. Efficacy of Internet-Delivered Mindfulness for Improving Depression in Caregivers of People With Spinal Cord Injuries and Chronic Neuropathic Pain: A Randomized Controlled Feasibility Trial. Arch Phys Med Rehabil 2018; 100:17-25. [PMID: 30268806 DOI: 10.1016/j.apmr.2018.08.182] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Revised: 08/13/2018] [Accepted: 08/15/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES To explore the feasibility and efficacy of web-based mindfulness training for carers of people with spinal cord injury (SCI). DESIGN Randomized controlled feasibility study with 3-month follow-up. SETTING Community setting. PARTICIPANTS Spouses or family caregivers (N=55) of people with SCI and chronic neuropathic pain were recruited via the direct care team and advertisements. Participants were older than 18 years (no upper age limit), with Internet access for the duration of the study. Participants were randomly allocated to an 8-week online mindfulness training intervention (n=28), or to receive 8 weeks of psychoeducational materials on SCI and chronic pain (n=27). INTERVENTIONS An established web-based, mindfulness training course was delivered over 8 weeks. Participants completed 10 minutes of mindfulness practices, twice per day, 6 days per week, totaling 960 minutes. The control group received a weekly e-mail with psychoeducational materials (based on the established elements) on SCI and pain for 8 weeks. MAIN OUTCOME MEASURE Depression severity. RESULTS Mindfulness reduced depression severity more than psychoeducation at T2 (mean difference= -.891; 95% confidence interval,-1.48 to -.30) and T3 (mean difference=-1.96; 95% confidence interval, -2.94 to -.97). Mindfulness training also reduced anxiety at T2 (mean difference=-.888; 95% confidence interval, -1.40 to -.38) and T3 (mean difference=-2.44; 95% confidence interval, -3.20 to -1.69). CONCLUSIONS Results indicate that Internet-delivered mindfulness training offers unique benefits and is viable for caregivers of people with SCI and chronic neuropathic pain. Further work should explore the feasibility of combined education and mindfulness training incorporating both patient and caregiver, for optimum benefit.
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Affiliation(s)
| | - Imogen Cotter
- Department of Clinical Psychology, The National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, United Kingdom
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Rapidi CA, Tederko P, Moslavac S, Popa D, Branco CA, Kiekens C, Varela Donoso E, Christodoulou N. Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for persons with spinal cord injury. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2018; 54:797-807. [PMID: 29952157 DOI: 10.23736/s1973-9087.18.05374-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Spinal cord injury (SCI) is a devastating condition and a challenge for every health system and every society. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians for people with SCI. The aim of the paper was to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for persons with SCI in order to improve their functionality, social and community reintegration, and to overcome activity limitations and/or participation restrictions. EVIDENCE ACQUISITION A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. EVIDENCE SYNTHESIS The systematic literature review is reported together with thirty-eight recommendations resulting from the Delphi procedure. CONCLUSIONS The professional role of PRM physicians who have expertise in the rehabilitation of SCI is to run rehabilitation programmes in multi-professional teams, working in an interdisciplinary way in a variety of settings to improve the functioning of people with SCI.
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Affiliation(s)
| | - Piotr Tederko
- Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Sasa Moslavac
- Department of Physical and Rehabilitation Medicine, Special Hospital for Medical Rehabilitation, Varaždinske Toplice, Croatia
| | - Daiana Popa
- Clinical Rehabilitation Hospital Felix-Spa Bihor County, Oradea, Romania
| | - Catarina A Branco
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar de Entre o Douro e Vouga E.P.E, Porto, Portugal
| | - Carlotte Kiekens
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Enrique Varela Donoso
- Physical and Rehabilitation Medicine Department, Complutense University School of Medicine, Madrid, Spain
| | - Nicolas Christodoulou
- Medical School, European University Cyprus, Nicosia, Cyprus.,UEMS PRM Section, Brussels, Belgium
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van Diemen T, Crul T, van Nes I, Geertzen JH, Post MW. Associations Between Self-Efficacy and Secondary Health Conditions in People Living With Spinal Cord Injury: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2017; 98:2566-2577. [DOI: 10.1016/j.apmr.2017.03.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/23/2017] [Accepted: 03/30/2017] [Indexed: 01/13/2023]
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Landmann G, Chang EC, Dumat W, Lutz A, Müller R, Scheel-Sailer A, Schwerzmann K, Sigajew N, Ljutow A. [Pain in patients with paraplegia]. Schmerz 2017; 31:527-545. [PMID: 28940094 DOI: 10.1007/s00482-017-0250-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chronic pain is one of the most reported health problems in patients suffering from spinal cord injuries and is described by the patients as one of the most burdensome sequelae of paraplegia. Various types of pain, such as nociceptive, neuropathic and other types of pain can occur. In addition, multiple pathophysiological mechanisms based on the biopsychosocial pain model play a role in the origins of the pain. These aspects necessitate a multimodal pain management approach in this patient group. This article presents an overview of the occurrence, importance and pathophysiology of chronic pain following spinal cord injury as well as diagnostic and therapeutic approaches.
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Affiliation(s)
- G Landmann
- Zentrum für Schmerzmedizin, Schweizer Paraplegiker-Zentrum, 6207, Nottwil, Guido-A.-Zäch-Str. 1, Schweiz.
| | - E-C Chang
- Zentrum für Schmerzmedizin, Schweizer Paraplegiker-Zentrum, 6207, Nottwil, Guido-A.-Zäch-Str. 1, Schweiz
| | - W Dumat
- Wenckebach-Klinikum, Klinik für Psychiatrie, Psychotherapie und Psychosomatik, Berlin, Deutschland
| | - A Lutz
- Ergotherapie, Schweizer Paraplegiker-Zentrum, Nottwil, Schweiz
| | - R Müller
- Schweizer Paraplegiker-Forschung, Nottwil, Schweiz.,Department Gesundheitswissenschaften und Gesundheitspolitik, Universität Luzern, Luzern, Schweiz
| | - A Scheel-Sailer
- Department Gesundheitswissenschaften und Gesundheitspolitik, Universität Luzern, Luzern, Schweiz.,Forschung Rehabilitation Qualitätsmanagement, Schweizer Paraplegiker-Zentrum, Nottwil, Schweiz
| | - K Schwerzmann
- Zentrum für Schmerzmedizin, Schweizer Paraplegiker-Zentrum, 6207, Nottwil, Guido-A.-Zäch-Str. 1, Schweiz
| | - N Sigajew
- Zentrum für Schmerzmedizin, Schweizer Paraplegiker-Zentrum, 6207, Nottwil, Guido-A.-Zäch-Str. 1, Schweiz
| | - A Ljutow
- Zentrum für Schmerzmedizin, Schweizer Paraplegiker-Zentrum, 6207, Nottwil, Guido-A.-Zäch-Str. 1, Schweiz
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Li Y, Bressington D, Chien WT. Systematic Review of Psychosocial Interventions for People With Spinal Cord Injury During Inpatient Rehabilitation: Implications for Evidence-Based Practice. Worldviews Evid Based Nurs 2017; 14:499-506. [DOI: 10.1111/wvn.12238] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Yan Li
- Doctoral candidate, School of Nursing; the Hong Kong Polytechnic University; Hong Kong SAR China
| | - Daniel Bressington
- Assistant Professor, School of Nursing; the Hong Kong Polytechnic University; Hong Kong SAR China
| | - Wai Tong Chien
- Professor and Associate Head, School of Nursing; the Hong Kong Polytechnic University; Hong Kong SAR China
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Mehta S, Janzen S, McIntyre A, Iruthayarajah J, Loh E, Teasell R. Are Comorbid Pain and Depressive Symptoms Associated with Rehabilitation of Individuals with Spinal Cord Injury? Top Spinal Cord Inj Rehabil 2017; 24:37-43. [PMID: 29434459 DOI: 10.1310/sci16-00027] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To examine the difference in functional outcomes and therapy intensity among individuals with spinal cord injury (SCI) with comorbid depression and pain symptoms compared to those without these symptoms. Methods: A retrospective chart review was conducted of 100 patients admitted to a specialized SCI inpatient rehabilitation unit. Standard demographic factors were collected. Patients were divided into 2 groups: those with comorbid depression and pain symptoms and those without. Outcomes were compared between the 2 groups using analysis of covariance (ANCOVA). Age, gender, level of injury, severity of injury, and FIM® admission were included in the model as covariates. Main outcomes included FIM® discharge, length of stay (LOS), intensity of therapy (total physical therapy time [PTt] and total occupational therapy time [OTt]), living arrangement, and vocational status. Results: No significant difference was seen between the 2 groups in FIM® discharge or OTt; however, those in the comorbidity group required significantly greater PTt than those without (p = .002). Those in the comorbid group also spent longer in inpatient rehabilitation (p = .005). The groups did not differ in postdischarge living arrangements or vocational status. Conclusion: Inpatient rehabilitation physical therapy and LOS differ substantially among individuals with comorbid depression and pain symptoms. This comorbidity may have a negative impact on functional recovery such that individuals may require more physical therapy time and longer LOS. This may also point to the increased resources required to manage individuals with SCI and comorbid depression and pain symptoms.
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Affiliation(s)
| | | | | | | | - Eldon Loh
- Parkwood Institute, London, Ontario, Canada
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Saurí J, Chamarro A, Gilabert A, Gifre M, Rodriguez N, Lopez-Blazquez R, Curcoll L, Benito-Penalva J, Soler D. Depression in Individuals With Traumatic and Nontraumatic Spinal Cord Injury Living in the Community. Arch Phys Med Rehabil 2017; 98:1165-1173. [DOI: 10.1016/j.apmr.2016.11.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 11/09/2016] [Accepted: 11/11/2016] [Indexed: 11/27/2022]
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Pollock K, Dorstyn D, Butt L, Prentice S. Posttraumatic stress following spinal cord injury: a systematic review of risk and vulnerability factors. Spinal Cord 2017; 55:800-811. [PMID: 28485385 DOI: 10.1038/sc.2017.45] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2017] [Revised: 03/22/2017] [Accepted: 03/23/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVES To summarise quantitatively the available evidence relating to pretraumatic, peritraumatic and posttraumatic characteristics that may increase or decrease the risk of developing posttraumatic stress disorder (PTSD) following spinal cord injury (SCI). STUDY DESIGN Systematic review. METHODS Seventeen studies were identified from the PubMed, PsycInfo, Embase, Scopus, CINAHL, Web of Science and PILOTS databases. Effect size estimates (r) with associated 95% confidence intervals (CIs), P-values and fail-safe Ns were calculated. RESULTS Individual studies reported medium-to-large associations between factors that occurred before (psychiatric history r=0.48 (95% CI, 0.23-0.79) P=0.01) or at the time of injury (tetraplegia r=-0.36 (95% CI, -0.50 to -0.19) P<0.01). Postinjury factors had the strongest pooled effects: depressed mood (rw=0.64, (95% CI, 0.54-0.72)), negative appraisals (rw=0.63 (95% CI, 0.52-0.72)), distress (rw=0.57 (95% CI, 0.50-0.62)), anxiety (rw=0.56 (95% CI, 0.49-0.61)) and pain severity (rw=0.35 (95% CI, 0.27-0.43)) were consistently related to worsening PTSD symptoms (P<0.01). Level of injury significantly correlated with current PTSD severity for veteran populations (QB (1)=18.25, P<0.001), although this was based on limited data. CONCLUSION Combinations of peri- and post-injury factors appear to be influential in the development of PTSD among persons with SCI. Further studies are needed to extrapolate these findings to the broader spinal cord-injured population. More longitudinal research, driven by multicausal models of causation such as the diathesis-stress model, is also needed to determine the temporality of PTSD risk factors.
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Affiliation(s)
- K Pollock
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - D Dorstyn
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
| | - L Butt
- Craig Hospital, Englewood, CO, USA
| | - S Prentice
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia
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Depressive mood in adults with spinal cord injury as they transition from an inpatient to a community setting: secondary analyses from a clinical trial. Spinal Cord 2017; 55:926-934. [PMID: 28462933 DOI: 10.1038/sc.2017.41] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2016] [Revised: 03/16/2017] [Accepted: 03/21/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective cohort controlled trial design. OBJECTIVES (i) To investigate mood benefits of adding group cognitive behaviour therapy (group-CBT) to standard spinal cord injury (SCI) inpatient rehabilitation (SR) that included access to antidepressant medication and individually delivered CBT on demand. (ii) To determine whether those with elevated depressive mood during inpatient rehabilitation significantly improve. SETTING SCI rehabilitation and community settings in New South Wales, Australia. METHODS Participants included 50 adults with SCI who completed SCI rehabilitation that included group-CBT compared with 38 participants who also completed SCI rehabilitation that did not contain group-CBT. Comprehensive assessment occurred after admission, within 2 weeks of discharge and 12 months post-injury. Multivariate repeated measures analyses were conducted to examine differences between groups and over time. RESULTS The addition of group-CBT to SR did not result in significant improvement in mood. However, participants with clinically elevated depressive mood assessed during inpatient rehabilitation experienced significant reductions in depressive mood when assessed in the community regardless of CBT dosage. Anxiety correlated with mood while no sociodemographic/injury factors correlated with mood at any time period except education level. CONCLUSION There were no mood advantages over time of adding group-CBT to inpatient SCI rehabilitation that contains individually delivered CBT on demand and access to antidepressant medication. However, findings showed those with elevated depressive mood during inpatient rehabilitation significantly improved when assessed in the community; however, their levels of depressive mood remain high. Future research should investigate the efficacy of providing individual preferences for managing depression in people with SCI.
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Tellier SA, Calleja NG. Renegotiating Sexuality Following an Acquired Disability: Best Practices for Counselors. ADULTSPAN JOURNAL 2017. [DOI: 10.1002/adsp.12033] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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Perrin PB, Paredes AM, Olivera SL, Lozano JE, Leal WT, Ahmad UF, Arango-Lasprilla JC. Multiple mediation path model of pain's cascading influence on physical disability in individuals with SCI from Colombia, South America. NeuroRehabilitation 2017; 40:553-560. [PMID: 28211825 DOI: 10.3233/nre-171442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research has begun to document the bivariate connections between pain in individuals with spinal cord injury (SCI) and various aspects of health related quality of life (HRQOL), such as fatigue, social functioning, mental health, and physical functioning. OBJECTIVE The purpose of this study was to construct and test a theoretical path model illuminating the stage-wise and sequential (cascading) HRQOL pathways through which pain increases physical disability in individuals with SCI in a sample from Colombia, South America. It was hypothesized that increased pain would lead to decreased energy, which would lead to decreased mental health and social functioning, which both would lead to emotional role limitations, which finally would lead to physical role limitations. METHODS A cross-sectional study assessed individuals with SCI (n = 40) in Neiva, Colombia. Participants completed a measure indexing various aspects of HRQOL. RESULTS The path model overall showed excellent fit indices, and each individual path within the model was statistically significant. Pain exerted significant indirect effects through all possible mediators in the model, ultimately suggesting that energy, mental health, social functioning, and role limitations-emotional were likely pathways through which pain exerted its effects on physical disability in individuals with SCI. CONCLUSIONS These findings uncover several potential nodes for clinical intervention which if targeted in the context of rehabilitation or outpatient services, could result in salubrious direct and indirect effects reverberating down the theoretical causal chain and ultimately reducing physical disability in individuals with SCI.
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Affiliation(s)
- Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Juan Esteban Lozano
- Grupo de Investigación Carlos Finlay, Surcolombiana University, Neiva, Colombia
| | - Wendy Tatiana Leal
- Grupo de Investigación Carlos Finlay, Surcolombiana University, Neiva, Colombia
| | - Usman F Ahmad
- Carolina Pain & Rehabilitation Specialists, Charlotte, NC, USA
| | - Juan Carlos Arango-Lasprilla
- BioCruces Health Research Institute, Cruces University Hospital Barakaldo, Bizkaia, Spain.,IKERBASQUE, Basque Foundation for Science, Bilbao, Spain
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Read DJ, Hill AP, Jowett GE, Astill SL. The relationship between perfectionistic self-presentation and reactions to impairment and disability following spinal cord injury. J Health Psychol 2016; 24:362-375. [PMID: 27784778 DOI: 10.1177/1359105316674268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Univariate and multivariate relationships between perfectionistic self-presentation and reactions to impairment and disability following spinal cord injury were examined. A total of 144 adults with spinal cord injury ( M = 48.18 years old, SD = 15.96) completed self-report measures. Analyses revealed that, after controlling for time since injury and gender, perfectionistic self-presentation predicted six of eight reactions, shock, depression and internalised anger particularly strongly. In addition, at multivariate level, perfectionistic self-presentation was positively related to non-adaptive reactions and negatively related to adaptive reactions. The findings suggest that perfectionistic self-presentation may contribute to poorer psychosocial adaptation to spinal cord injury.
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Effects of a Tailored Positive Psychology Intervention on Well-Being and Pain in Individuals With Chronic Pain and a Physical Disability: A Feasibility Trial. Clin J Pain 2016; 32:32-44. [PMID: 25724020 DOI: 10.1097/ajp.0000000000000225] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To determine the feasibility, acceptability, and efficacy of a computer-based positive psychology intervention in individuals with a physical disability and chronic pain. METHODS Individuals with spinal cord injury, multiple sclerosis, neuromuscular disease, or postpolio syndrome and chronic pain were randomly assigned to a positive psychology or a control condition. Participants in the intervention group were instructed to practice 4 personalized positive psychology exercises. Participants in the control group were instructed to write about life details for 8 weeks. Participants completed online well-being and pain-related questionnaires at baseline, posttreatment, and at the 2.5-month follow-up, and rated treatment satisfaction at posttreatment. RESULTS Ninety-six participants were randomized and 68 (70%) completed follow-up assessments. Participants in the positive psychology intervention group reported significant pretreatment to posttreatment improvements in pain intensity, pain control, pain catastrophizing, pain interference, life satisfaction, positive affect, and depression. Improvements in life satisfaction, depression, pain intensity, pain interference, and pain control were maintained to the 2.5-month follow-up. Participants in the control group reported significant pretreatment to posttreatment improvements in life satisfaction, and pretreatment to follow-up improvements in pain intensity and pain control. Significant between-group differences, favoring the treatment group, emerged for pretreatment to posttreatment improvements in pain intensity and pain control. Participants were similarly satisfied with both treatments. DISCUSSION/CONCLUSIONS The results support the feasibility, acceptability, and potential efficacy of a computer-based positive psychology intervention for improving well-being and pain-related outcomes in individuals with physical disabilities and chronic pain, and indicate that a full trial of the intervention is warranted.
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Happiness, Pain Intensity, Pain Interference, and Distress in Individuals with Physical Disabilities. Am J Phys Med Rehabil 2015; 94:1041-51. [DOI: 10.1097/phm.0000000000000294] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Affiliation(s)
- Timothy R. Elliott
- Correspondence to: Timothy R. Elliott, Professor, Department of Educational Psychology, Texas A&M University, 4225 TAMU, College Station, TX 77845, USA.
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Watt MH, Wilson SM, Sikkema KJ, Velloza J, Mosha MV, Masenga GG, Bangser M, Browning A, Nyindo PM. Development of an intervention to improve mental health for obstetric fistula patients in Tanzania. EVALUATION AND PROGRAM PLANNING 2015; 50:1-9. [PMID: 25710896 PMCID: PMC4395537 DOI: 10.1016/j.evalprogplan.2015.01.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/26/2015] [Accepted: 01/31/2015] [Indexed: 06/04/2023]
Abstract
Obstetric fistula is a debilitating childbirth injury that has been associated with high rates of psychological distress. Global efforts have helped to link women to surgical repair, but thus far no evidence-based interventions exist to address the psychological needs of these women during the hospital stay. In this paper, we describe the development of a psychological intervention for women in Tanzania who are receiving surgical care for an obstetric fistula. The intervention was developed based on theories of cognitive behavioral therapy and coping models. Content and delivery were informed by qualitative data collection with a range of stakeholders including women with fistula, and input from a study advisory board. The resulting intervention was six individual sessions, delivered by a trained community health nurse. The session topics were (1) recounting the fistula story; (2) creating a new story about the fistula; (3) loss, grief and shame; (4) specific strategies for coping; (5) social relationships; and (6) planning for the future. A trial run of the intervention revealed that the intervention could be delivered with fidelity and was acceptable to patients. A future randomized control trial will evaluate the efficacy of this intervention to address the mental health symptoms of this population.
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Affiliation(s)
| | - Sarah M Wilson
- Duke Global Health Institute, Durham, NC, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | - Kathleen J Sikkema
- Duke Global Health Institute, Durham, NC, USA; Department of Psychology and Neuroscience, Duke University, Durham, NC, USA
| | | | - Mary V Mosha
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | - Gileard G Masenga
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
| | | | - Andrew Browning
- Maternity Africa, Arusha, Tanzania; Selian Lutheran Hospital, Arusha, Tanzania
| | - Pilli M Nyindo
- Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Centre, Moshi, Tanzania
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Kressler J, Cowan RE, Bigford GE, Nash MS. Reducing cardiometabolic disease in spinal cord injury. Phys Med Rehabil Clin N Am 2015; 25:573-604, viii. [PMID: 25064789 DOI: 10.1016/j.pmr.2014.04.006] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Accelerated cardiometabolic disease is a serious health hazard after spinal cord injuries (SCI). Lifestyle intervention with diet and exercise remains the cornerstone of effective cardiometabolic syndrome treatment. Behavioral approaches enhance compliance and benefits derived from both diet and exercise interventions and are necessary to assure that persons with SCI profit from intervention. Multitherapy strategies will likely be needed to control challenging component risks, such as gain in body mass, which has far reaching implications for maintenance of daily function as well as health.
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Affiliation(s)
- Jochen Kressler
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, 1475 North West 12th Avenue, Miami, FL 33136, USA; The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, 1095 North West 14th Terrace, Lois Pope LIFE Center, Miami, FL 33136, USA
| | - Rachel E Cowan
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, 1475 North West 12th Avenue, Miami, FL 33136, USA; The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, 1095 North West 14th Terrace, Lois Pope LIFE Center, Miami, FL 33136, USA
| | - Gregory E Bigford
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, 1475 North West 12th Avenue, Miami, FL 33136, USA; The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, 1095 North West 14th Terrace, Lois Pope LIFE Center, Miami, FL 33136, USA
| | - Mark S Nash
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, 1475 North West 12th Avenue, Miami, FL 33136, USA; The Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, 1095 North West 14th Terrace, Lois Pope LIFE Center, Miami, FL 33136, USA; Department of Rehabilitation Medicine, Miller School of Medicine, University of Miami, 1500 North West 12th Avenue, Suite 1409, Miami, FL 33136, USA.
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Eisenberg NW, Andreski SR, Mona LR. Sexuality and Physical Disability: A Disability-Affirmative Approach to Assessment and Intervention Within Health Care. CURRENT SEXUAL HEALTH REPORTS 2015. [DOI: 10.1007/s11930-014-0037-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Harper LA, Coleman JA, Perrin PB, Olivera SL, Perdomo JL, Arango JA, Arango-Lasprilla JC. Comparison of mental health between individuals with spinal cord injury and able-bodied controls in Neiva, Colombia. ACTA ACUST UNITED AC 2015; 51:127-36. [PMID: 24805899 DOI: 10.1682/jrrd.2013.04.0086] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Revised: 07/09/2013] [Indexed: 11/05/2022]
Abstract
Although research has investigated the mental health of individuals with spinal cord injury (SCI), an overwhelming majority of this research has been conducted in the United States, Western Europe, and other developed countries. The purpose of this study was to compare the mental health of individuals with SCI with able-bodied controls in Neiva, Colombia, South America. Subjects included 40 Colombians with SCI and 42 age- and sex-matched controls (N = 82). The groups did not differ based on age, sex, years of education, or socioeconomic status. However, controls were twice as likely to be married. Four measures assessed mental health, including satisfaction with life (Satisfaction with Life Scale), depressive symptoms (Patient Health Questionnaire-9), self-esteem (Rosenberg Self-Esteem Scale), and anxiety (State-Trait Anxiety Inventory). In comparison with able-bodied controls, individuals with SCI reported significantly lower mental health on both depressive symptoms and satisfaction with life. These effect sizes were medium and large, respectively. The groups did not differ significantly on measures of self-esteem or anxiety. Mental health of individuals with SCI should be considered a central part of SCI rehabilitation interventions, particularly in Latin America.
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Affiliation(s)
- Leia A Harper
- Department of Psychology, Virginia Commonwealth University, Richmond, VA
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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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Coleman JA, Harper LA, Perrin PB, Olivera SL, Perdomo JL, Arango JA, Arango-Lasprilla JC. The relationship between physical and mental health variables in individuals with spinal cord injury from Latin America. PM R 2014; 7:9-16. [PMID: 25091569 DOI: 10.1016/j.pmrj.2014.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 07/10/2014] [Accepted: 07/13/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND Previous research has examined the health-related quality of life (HRQOL) and mental health of persons with spinal cord injury (SCI), but the majority of the research has taken place in the United States, Western Europe, and other developed countries. Limited research has been conducted with persons with SCI in Latin America. OBJECTIVE To examine the relationship between HRQOL and mental health in persons with SCI from Neiva, Colombia. DESIGN Cross-sectional. SETTING Participants were recruited from the Foundation for the Integral Development of People with Disabilities, a nonprofit community organization for persons with disabilities. PARTICIPANTS Forty persons with SCI from Neiva, Colombia. METHODS Caregivers completed the Spanish versions of questionnaires. MAIN OUTCOME MEASURES Participants completed self-report measures of HRQOL (SF-36 Health Questionnaire) and mental health (Satisfaction with Life Scale, Patient Health Questionnaire-9, and State Trait Anxiety Inventory). RESULTS The hypothesis that higher HRQOL would be related to better mental health found robust support, as the canonical correlation between these 2 sets of variables uncovered that 50.4% of the variance was shared, such that persons with lower HRQOL had reduced mental health. Within this canonical correlation, anxiety, fatigue, and general health loaded most highly, suggesting that persons with SCI who experienced lower energy and reduced general health tended to have high anxiety. Additionally, 9 out of the 18 bivariate correlations between these 2 variable sets were statistically significant. CONCLUSIONS In Latin America, SCI rehabilitation services are extremely sparse and rarely include interventions that target postinjury mental health. The current study suggests that mental health issues in patients with reduced HRQOL warrant attention in SCI rehabilitation services, especially in this region.
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Affiliation(s)
- Jennifer A Coleman
- Department of Psychology, Virginia Commonwealth University, Richmond, VA(∗)
| | - Leia A Harper
- Department of Psychology, Virginia Commonwealth University, Richmond, VA(†)
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA(‡)
| | | | - Jose Libardo Perdomo
- Department of Psychology, Universidad Cooperativa de Colombia, Neiva, Colombia(¶)
| | - Jose Anselmo Arango
- Department of Psychology, Universidad Cooperativa de Colombia, Neiva, Colombia(#)
| | - Juan Carlos Arango-Lasprilla
- Department of Psychology, University of Deusto, IKERBASQUE, Basque Foundation for Science, Bilbao 48007, Spain(∗∗).
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Rodrigues D, Tran Y, Wijesuriya N, Guest R, Middleton J, Craig A. Pain intensity and its association with negative mood States in patients with spinal cord injury. Pain Ther 2013; 2:113-9. [PMID: 25135149 PMCID: PMC4107910 DOI: 10.1007/s40122-013-0017-8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Indexed: 11/25/2022] Open
Abstract
Introduction Chronic and persistent pain is a prevalent and debilitating secondary condition in patients with a neurological injury such as spinal cord injury (SCI). Patients with SCI have an increased risk of developing other co-morbid conditions such as elevated negative mood states. Arguably, the presence of chronic pain would act to intensify the chances of developing negative mood states as opposed to resilient mental states. The objective of this research was to investigate the association between pain intensity and levels of negative mood states in adult patients with SCI. Methods Participants included 107 adults with SCI living in the community who completed an assessment regimen in a relaxed environment. Mean pain intensity over a period of 1 week and the Profile of Mood States, a validated psychometric measure of mood states (anxiety, depressed mood, anger, vigor, fatigue, confusion and total negative mood score) were used to determine associations between pain intensity and mood states. The sample was divided into a low pain intensity sub-group (<4 where 0 = no pain; 10 = worst pain imaginable) and a clinically significant or high pain intensity sub-group (≥4), allowing negative mood to be compared between the sub-groups. Results Mean age was 47.1 years, and 87% of the sample was male. Clinically significant pain intensity over the week prior to assessment was found in 52% of the 107 participants. The high pain intensity sub-group was found to have significantly elevated anxiety, depressed mood, anger, fatigue, confusion and significantly reduced vigor. Conclusion These results provide further evidence that patients with SCI experience clinically elevated negative mood states if they have intense levels of pain over extended periods of time. In contrast, patients without intense pain have mood states similar to those in the able-bodied community. Implications for the treatment of SCI are discussed.
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Affiliation(s)
- Dianah Rodrigues
- Rehabilitation Studies Unit, Sydney Medical School-Northern, The University of Sydney, PO Box 6, Ryde, NSW, 1680, Australia
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Min JA, Lee CU, Hwang SI, Shin JI, Lee BS, Han SH, Ju HI, Lee CY, Lee C, Chae JH. The moderation of resilience on the negative effect of pain on depression and post-traumatic growth in individuals with spinal cord injury. Disabil Rehabil 2013; 36:1196-202. [DOI: 10.3109/09638288.2013.834985] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Perkes SJ, Bowman J, Penkala S. Psychological therapies for the management of co-morbid depression following a spinal cord injury: a systematic review. J Health Psychol 2013; 19:1597-612. [PMID: 23988680 DOI: 10.1177/1359105313496445] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The evidence about psychological therapies used to manage co-morbid depression after a spinal cord injury is presented here. A comprehensive search of five electronic databases identified nine studies (participants, n = 591) meeting inclusion criteria. Pooled statistical analyses were conducted in combination with narrative synthesis. Overall, multimodal cognitive behavioural therapy was found to be moderately effective (standardised mean difference = -0.52; 95% confidence interval = -0.85, -0.19). Activity scheduling, psychoeducation, problem solving and cognitive therapy may be particularly beneficial therapies within cognitive behavioural therapy. Further high-quality randomised controlled trials are needed to better substantiate these findings.
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Fortmann AL, Rutledge T, Corey McCulloch R, Shivpuri S, Nisenzon AN, Muse J. Satisfaction with life among veterans with spinal cord injuries completing multidisciplinary rehabilitation. Spinal Cord 2013; 51:482-6. [DOI: 10.1038/sc.2012.172] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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