Appraisals, coping and adjustment pre and post SCI rehabilitation: a 2-year follow-up study

Adversity Interpreted: A Scoping Review of Adversity Appraisal Measurement

Although evidence suggests that individuals' appraisals (i.e., subjective interpretations) of adverse or traumatic life events may serve as a mechanism accounting for differences in adversity exposure and psychological adjustment, understanding this mechanism is contingent on our ability to reliably and consistently measure appraisals. However, measures have varied widely between studies, making conclusions about how best to measure appraisal a challenge for the field. To address this issue, the present study reviewed 88 articles from three research databases, assessing adults' appraisals of adversity. To be included in the scoping review, articles had to meet the following criteria: (1) published no earlier than 1999, (2) available in English, (3) published as a primary source manuscript, and (4) included a measure assessing for adults' (over the age of 18) subjective primary and/or secondary interpretations of adversity. Each article was thoroughly reviewed and coded based on the following information: study demographics, appraisal measurement tool(s), category of appraisal, appraisal dimensions (e.g., self-blame, impact, and threat), and the tool's reliability and validity. Further, information was coded according to the type of adversity appraised, the time in which the appraised event occurred, and which outcomes were assessed in relation to appraisal. Results highlight the importance of continued examination of adversity appraisals and reveal which appraisal tools, categories, and dimensions are most commonly assessed for. These results provide guidance to researchers in how to examine adversity appraisals and what gaps among the measurement of adversity appraisal which need to be addressed in the future research.

A Narrative Review of Research on Adjustment to Spinal Cord Injury and Mental Health: Gaps, Future Directions, and Practice Recommendations

Spinal cord injury (SCI) results in autonomic, motor, and sensory impairments that can compromise mental health. Guidelines directing the management of mental health following SCI presently address clinical anxiety, depression, post-traumatic stress, substance use disorders, and suicide. However, evidence suggests that perhaps as many as 70% of individuals with SCI do not develop a clinically diagnosable mental health disorder. Therefore, the authors contend that understanding non-clinical cognitive and psychological aspects of adjustment post-SCI is paramount and that the application of this knowledge to the formulation of adjustment-enhancing interventions is crucial. To assist with this endeavour, we examine existing mental health guidelines targeting SCI, and present a narrative review of research on the under-represented topics of adjustment, coping, grief, and resilience. We include mild cognitive impairment, which reflects a common factor that can compromise adjustment. Loss and stress trigger processes of adjustment, coping, grief, and resilience. SCI involves loss and stress triggering these processes, arguably without exception. Our study applied a narrative review methodology searching Google Scholar and PsychInfo databases for terms adjustment, coping, grief, resilience, and cognitive impairment. Qualitative studies and quantitative studies were selected to capture bottom-up and top-down perspectives. Reference lists of retrieved papers were searched as appropriate. Reviewed literature suggested that existing guidelines concerning mental health following SCI neglect positive processes of adjustment and suggest this neglect contributes to a deficits-based view of mental health following SCI. Research into "positive" or adjustment-enhancing processes is mostly cross-sectional, heterogenous, and poorly positioned to inform future guideline-development. Researchers should achieve consensus over the operationalisation of essential processes and overcome a fixation with "outcomes" to better inform management of mental health after SCI.

Cognitive behaviour therapy in adults with spinal cord injury: A scoping review

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.

Cognitive appraisals of disability in persons with traumatic spinal cord injury: a scoping review

STUDY DESIGN

Scoping review.

OBJECTIVES

To describe the meaning of cognitive appraisals, their relation with outcome. measures, and adapted appraisal scales after Spinal Cord Injury (SCI) in the existing literature.

METHODS

This review was performed according to the Arksey and O'Malley (2005) framework that consisted of five steps: setting the review question, searching the literature, selecting and classifying the studies, charting the data, and summarizing the results. Published articles from 1990 to 16 May 2020 related to cognitive appraisal, persons with traumatic SCI (TSCI), and persons older than 18 years were identified by searching by key terms in four databases (PubMed, Web of Science, Scopus, and Embase).

RESULTS

The included studies (n = 26) were categorized into three categories. Categories focused on the meanings of cognitive appraisals following TSCI (i.e., appraisals being complex and context-related, or in general definition how persons with TSCI interpret their disability and how they evaluate the resources available to respond to it), the relationship between cognitive appraisals and physical/psychological/social/ outcomes, and appraisals of disability (including the use of appraisals as a predictor of subsequent positive or negative consequences).

CONCLUSIONS

The results demonstrated that a cognitive appraisal of TSCI is critical to longer-term rehabilitation outcomes. A combination of physical and psychological-based interventions can help to modify negative or dysfunctional appraisals. Cognitive appraisal in TSCI seems to vary from person to person. To predict it and develop a rehabilitation plan, future research needs to focus on the relationship between cognitive appraisal and person-related factors, including demographic characteristics.

Appraisals of disability and psychological adjustment in veterans with spinal cord injuries

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.

Psychosocial Adaptation to Chronic Illness and Disability: An Updated and Expanded Conceptual Framework

The article revisits and updates an earlier model (Livneh, 2001) that examined the building blocks that constitute the dynamics of psychosocial adaptation to chronic illness and disability (CID). In the revised tripartite model, the author reconstructs and refines the earlier model based on recent theoretical formulations, clinical reviews and research findings. In the revised model, the author discusses three overarching components, namely, antecedents (causes of medical conditions, background variables), processes (the dynamically unfolding course of post-CID events), and outcomes (anticipated exit indicators that serve, as snapshot end products, to assess the individual’s experienced and reported quality of life following onset of CID). The article concludes with a brief review of the model’s practical and research implications.

Does being psychologically resilient assist in optimising physical outcomes from a spinal cord injury? Findings from a systematic scoping review

PURPOSE

To systematically search for current research on the role of resilience in the physical rehabilitation of SCI and describe the research to date.

MATERIALS AND METHODS

The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) approach was used. Five databases were searched for papers published up to March 2020. The sample included adults who have sustained an SCI; outcomes included a physical rehabilitation outcome and a measure of psychological or personal resilience/resilience training.

RESULTS

The initial search found 2074 studies. 12 studies were included. Six suggest positive effects of resilience on physical functioning/recovery, six report resilience as not affecting physical functioning/recovery.

CONCLUSIONS

Resilience may positively affect physical outcomes; however, the relationship is under-researched and contrasting findings may be due to measurements and methods employed by research. Future research may distinguish between two sources of resilience following an SCI: prior resilient experiences, and resilience as a product of the injury. Individuals' past events that triggered resilient behaviour may be able to promote a resilient response to an SCI. Focussing on emotional coping may result in poorer outcomes than building a sense of control. Resilience training may affect psychosocial rehabilitation; it is difficult to establish if it would affect physical outcomes. A negative approach to an injury can have negative effects on functioning; when identifying patients for psychoeducational training, those with the presence of negative appraisals of their injury are most in need.IMPLICATIONS FOR REHABILITATIONResilience may positively affect physical outcomes; however, the relationship is under-researched.Individuals' past events that triggered resilient behaviour may be able to promote a resilient response to an SCI.Focussing on emotional coping may result in poorer outcomes than building a sense of control.When identifying patients for psychoeducational training, it may be those with the presence of negative appraisals of their injury that are most in need.

Regaining A Sense Of Me: a single case study of SCI adjustment, applying the appraisal model and coping effectiveness training

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.

Forgiveness and acceptance of disability in people with traumatic spinal cord injury-the mediating role of disability appraisal. A cross-sectional study

STUDY DESIGN

This is a cross-sectional study using questionnaires.

OBJECTIVES

This paper investigates the correlation between forgiveness and acceptance of disability and mediation effects of appraisal of disability in people with traumatic spinal cord injury (T-SCI).

SETTING

Community-dwelling people with T-SCI in Poland.

METHODS

The study assessed forgiveness, appraisal of disability, and acceptance of disability. The association between all the variables was examined by Pearson correlation analysis, and multiple mediation macro Preacher and Hayes' (Behav Res Methods 40:879-91, 2008)-model 4, including appraisals of disability as a mediator on the relationship between forgiveness and acceptance of disability.

RESULTS

Participants were 163 adults with T-SCI (63 females and 100 males, the average age of the sample was 39.6, SD = 9.38). Forgiveness showed a significant relationship with all dimensions of acceptance of disability. In addition, appraisal of disability, especially determined resolve, overwhelming disbelief, and negative perceptions of disability were mediators between forgiveness and all dimensions of acceptance of disability. In case of acceptance of disability as a subordinating physique relative to other values, full mediation was observed.

CONCLUSIONS

Forgiveness along with appraisal of disability is important for explaining disability acceptance. Promoting forgiveness and positive assessments of disability at the same time weakening negative assessments of disability can be favorable for making necessary changes in values, and as a result, for strengthened mental health and successful psychosocial adaptation in individuals with T-SCI.

The use of generic avoidant coping scales for psychosocial adaptation to chronic illness and disability: A systematic review

This systematic review examined the validity of generic coping-with-stress measures in the relationships between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Major data bases were searched for studies on the association between avoidance-type coping and psychosocial adaptation to chronic illness and disability. Findings indicated that reliance upon avoidance-type coping is linked to reports of poorer psychosocial adaptation. The veracity of these findings must be treated cautiously owing to conceptual, structural, psychometric, and other issues. Users of generic coping measures should consider these concerns prior to empirically investigating the link between generic avoidance-type coping measures and psychosocial adaptation among people with chronic illness and disability.

The associations of acceptance with quality of life and mental health following spinal cord injury: a systematic review

STUDY DESIGN

Systematic review.

OBJECTIVES

To identify, critically appraise, and synthesize research findings on the associations between acceptance, quality of life (QOL), and mental health outcomes in individuals living with spinal cord injury (SCI).

METHODS

Five databases (PubMed, PsycINFO, Embase, Web of Science, and Scopus) were systematically searched. Studies were included if they provided findings on the association between acceptance and QOL, mental health outcomes, or both in an SCI population aged 16 years or older. Only peer-reviewed original quantitative and qualitative studies were included. Screening, quality assessment, and data extraction were conducted independently by two researchers. Findings were tabulated and synthesized by outcome.

RESULTS

Forty-one studies were included. Greater acceptance was consistently associated with greater global and psychological QOL, life satisfaction, sense of well-being, mental health, and with lower levels of depression and anxiety. Inconsistent evidence was found with regards to social QOL and post-traumatic stress disorder. Acceptance was generally not associated with adjustment outcomes further than 2 years into the future. Study quality of the quantitative studies was mostly fair (n = 17) followed by good (n = 13), and poor (n = 9).

CONCLUSION

Health-care professionals may regard acceptance as a psychological resource they can aim to support in improving QOL and mental health following SCI. A range of methodological and conceptual limitations were present in the research. Future studies should prioritize longitudinal designs, consider dyadic effects, explore subjective meaning(s) of acceptance, and investigate the effectiveness of therapeutic approaches that stimulate the acceptance process.

Sense of coherence is linked to post-traumatic growth after critical incidents in Austrian ambulance personnel

BACKGROUND

Ambulance personnel, as well as other emergency services like fire-fighters or the police force, are regularly confronted with experiences of extreme psychological distress and potentially traumatizing events in the line of their daily duties. As a consequence, this occupational group is exposed to an elevated risk of developing symptoms of Post-Traumatic Stress (PTSS). Subsequently, symptoms of Post-Traumatic Stress have been observed as potentially co-occurring with Post-Traumatic Growth (PTG) in ambulance personnel as well. Therefore, in this study we hypothesized that Sense of Coherence (SOC) might play an important role as an underlying feature in enabling growth after stressful experiences in Austrian ambulance personnel.

METHODS

In this study, voluntary and full-time ambulance personnel (n = 266) of the Austrian Red Cross ambulance service completed an online survey including the Sense of Coherence Scale (SOC-29), the Post-Traumatic Growth Inventory (PTGI) and the Impact of Event Scale Revised (IES-R) for the assessment of PTSS. In line with theoretical considerations, a two-step cluster analysis limited to four clusters and further ANOVAs were conducted.

RESULTS

Four clusters were confirmed and labelled PTSS-low/PTG-low, PTSS-low/PTG-high, PTSS-high/PTG-high and PTSS-high/PTG-low. Further ANOVAs revealed substantial cluster differences in SOC, with higher SOC-levels in PTSS-high/PTG-high than in PTSS-high/PTG-low (p < .01), in PTSS-low/PTG-high than in PTSS-low/PTG-low (p < .01) and in PTSS-low/PTG-high than in PTSS-high/PTG-low (p < .01).

CONCLUSIONS

Our findings point to a significant association between SOC and the development of PTG in ambulance personnel. Furthermore, the results suggest that growth and stress after critical incidents are independent from each other and can co-exist. Therefore, promoting SOC (e.g., meaningfulness) in ambulance personnel - e.g., through psychological interventions - might preserve and enhance psychological health after critical incidents.

Diferencias de sexo en el uso de estrategias de afrontamiento en personas con lesión medular

Objetivo: profundizar en la experiencia de afrontamiento en personas con lesión medular (LM), teniendo en cuenta tanto el afron- tamiento actual como el afrontamiento durante momentos iniciales tras sufrir la LM. Materiales y métodos: estudio transversal de encuesta. Participaron 127 personas con LM de larga evolución, 95 hombres y 32 mujeres. Los datos fueron recogidos por medio de un cuestionario online con información sociodemográfica y el Cuestionario de Afrontamiento del Estrés (CAE). Se han realizado análisis descriptivos, pruebas t de Student y análisis multivariados de la varianza (Manovas) Resultados: las comparaciones intrasujetos muestran que la estrategia de focalización en solución de problemas se usa más en el afrontamiento actual. La autofocalización negativa es más utilizada en el afrontamiento pasado, en los momentos iniciales tras sufrir la LM. Los resultados de los Manovas muestran que no existen diferencias en función del sexo en el afrontamiento rememorado ni en el actual. Los Anova de seguimiento para el afrontamiento actual evidencian que las mujeres utilizan más las estrategias de búsqueda de apoyo social y expresión emocional abierta. Conclusiones: no hay diferencias de sexo en el uso de las estrategias de afrontamiento en la LM. Se sugiere seguir investigando cómo el género puede actuar en este proceso.

The influence of clarification and threats on life situation: patients' experiences 1 year after TSCI

INTRODUCTION

The study was conducted at the Spinal Cord Injury Centre of Western Denmark (VCR). The aim of the study was to explore patients' experiences following traumatic spinal cord injury and to identify characteristics of positive versus negative life situation 1 year post discharge from hospital rehabilitation. This was a qualitative study conducted using inductive content analysis.

CASE PRESENTATION

In this qualitative study seven patients were interviewed one year after discharge from initial rehabilitation at the VCR. The interviews were analysed using inductive content analysis.

DISCUSSION

We found that two categories condensed the patients' experiences of their life situation 1 year post discharge: 'clarification in relation to overall life situation' and 'threat to core competences'. The transversal analysis across the derived categories identified different combinations of clarification and threats to core competences explaining the patients' experiences: high degree of clarification combined with low degree of threat to core competences was indicative of positive life situation. Also, positive life situation was seen when a high degree of clarification compensated for high degree of threats on core competencies. In contrast, an overall stressful and negative life situation was influenced by poor clarification combined with a high degree of threat to core competences. However, when core competences can be transformed into new skills, threats were manageable. This study revealed that clarification related to overall life situation in combination with threat to core competences may explain traumatic spinal cord injury patients' overall life situation 1 year post discharge. An appropriate balance characterises a positive life situation. There might be a need to pay attention to patients who are challenged by low degree of clarification and high degree of threats on core competencies 1 year post discharge as this may influence the life situation negatively.

Effectiveness of a Wellness Program for Individuals With Spina Bifida and Spinal Cord Injury Within an Integrated Delivery System

OBJECTIVE

To determine whether an evidence-based wellness program for individuals with spina bifida and spinal cord injury would improve health outcomes and patient experience of care, result in a positive return on investment (ROI), and provide evidence for scalability.

DESIGN

Nonrandomized, noncontrolled cohort study; 2 years of enrollment.

SETTING

Academic hospital-based outpatient physiatry clinic partnered with an insurance division within an integrated health care delivery and financing system.

PARTICIPANTS

Individuals (N=69) with spina bifida and spinal cord injury were consented; 4 were excluded (5.7%), and the remaining 65 (94.2%) participated in the intervention.

INTERVENTIONS

Evidence-based wellness program consisting of care coordination from a mobile nurse, patient education, and patient incentives.

MAIN OUTCOME MEASURES

Validated measures of function, mood, quality of life, and perception of care delivery; knowledge of preventable conditions; self-rating of health; and utilization and cost.

RESULTS

Improvements in all main outcome measures were seen after 2 years of enrollment. Although cost in year 1 of enrollment increased because of hospitalizations and the overall ROI was negative, a small positive ROI was seen in year 2 of enrollment.

CONCLUSIONS

Participation in an evidence-based wellness program was associated with improved health and experience of care. Scaling the program to larger numbers may result in an overall positive ROI.

Perceived functional impairment and spirituality/religiosity as predictors of depression in a Sri Lankan spinal cord injury patient population

STUDY DESIGN

Cross-sectional, questionnaire-based study.

OBJECTIVES

To test the hypothesis that self-perceived functional impairment and religiosity/spirituality (S/R) predict depression among traumatic spinal cord injury (SCI) patients in Sri Lanka.

SETTING

Ragama Rheumatology and Rehabilitation Hospital, Ragama, Sri Lanka.

METHODS

The Spinal Cord Independence Measure, Benefit Through Spirituality/Religiosity Scale, Sheehan Disability Inventory and Beck Depression Inventory-II (BDI-II) were administered to 61 consenting in-patients with traumatic SCI between June and July 2014. A linear regression model on BDI-II score was developed to examine the impact of self-perceived functional impairment and S/R activities on psychiatric outcomes in context of various sociodemographic variables.

RESULTS

Psychiatric consequences of SCI were reflected in a 41% prevalence of depression. Thirty-six percent (R²=0.36) of the variance in BDI-II scores (F(5, 55)=6.07, P<0.001) was explained by the regression model. Functional impairment (β=0.54, t(55)=4.73, P<0.001) and perceived benefit through S/R activities (β=-0.31, t(55)=-2.55, P<0.05) emerged as the strongest predictors for depression severity.

CONCLUSIONS

Perceived functional impairment in work, social and family domains predicted depressive symptomatology among SCI inpatients in Sri Lanka, while perceived benefit through S/R protected against depression. The findings emphasize the need for rehabilitative programming to support patients' S/R activities and mental wellbeing, promoting reintegration into their community roles.

Posttraumatic growth in people with traumatic long-term spinal cord injury: predictive role of basic hope and coping

STUDY DESIGN

Participants with spinal cord injury (SCI) sustained at least 15 years before the study completed questionnaires measuring posttraumatic growth (PTG), basic hope and coping strategies.

OBJECTIVES

To determine contribution of basic hope and coping strategies to accounting for PTG variability in participants with traumatic long-term SCI.

SETTING

Polish rehabilitation centres, foundations and associations implementing social inclusion and professional activation programmes. Participants were enrolled based on their medical history by trained rehabilitation specialists and psychologists.

METHODS

The set of questionnaires included the following: The Post-traumatic Growth Inventory; The Coping Orientations to Problems Experienced (COPE); and Basic Hope Inventory.

RESULTS

A study of 169 individuals with paraplegia in the range of PTG showed the highest degree of positive changes in appreciation of life (AL) and the lowest in self-perception. Regression analysis showed that coping strategies such as religion (REL), focus on the problem, humour, alcohol/drug use ideation and basic hope jointly account for 60% of variance of PTG. The highest contribution to accounting for this variability had REL. Also, it was found that coping strategies and basic hope allow to predict variance of individual growth aspects. Age at trauma exposure positively correlated with changes in AL and spiritual change. No significant relationship between growth and age of participants was confirmed.

CONCLUSION

PTG occurring in people with long-term traumatic SCI is primarily manifested in increased AL. Specific coping strategies and basic hope have a significant role in fostering positive changes.

Understanding post-traumatic growth following pediatric-onset spinal cord injury: the critical role of coping strategies for facilitating positive psychological outcomes

AIM

The aim of this study was to explore positive psychological growth in individuals who had sustained spinal cord injuries (SCIs) in childhood, and to identify factors correlating with such growth.

METHOD

Data were drawn from ongoing research aimed at assessing the long-term outcomes of pediatric-onset SCIs in adults. Participants were assessed using measures of demographics, coping ability, post-traumatic growth, life satisfaction, happiness, and mental health. The study sample included 161 adults with a mean age of 33 years and 2 months (SD 7y 3mo, range 19-50y). The participants had sustained SCIs between the ages of 7 years and 18 years (mean 14y 10mo, SD 2y 6mo) and were injured for an average of 17 years and 9 months (SD 7y 7mo, range 1-36y). Sixty-four percent of participants were male, 81% were white, 63% had tetraplegia, and 70% had complete injuries.

RESULTS

The vast majority of participants (99%) recognized that at least one positive change had occurred in their life as a result of their SCI. Post-traumatic growth was significantly associated with behavioral (r=0.29, p<0.001) and cognitive (r=0.39, p<0.001) coping strategies, as well as with increased life satisfaction (r=0.18, p=0.024) and happiness (r=0.27, p=0.001), but was unrelated to psychological distress. Additional analyses indicated that post-traumatic growth mediated effects of cognitive coping on happiness, but not on life satisfaction.

INTERPRETATION

The majority of individuals with pediatric-onset SCIs experienced positive psychological growth. Coping strategies are crucial to this growth process.

Return-to-work intentions during spinal cord injury rehabilitation: an audit of employment outcomes

STUDY DESIGN

Single-centre, retrospective cohort study.

OBJECTIVES

To analyse the return-to-work intentions during spinal cord injury (SCI) rehabilitation.

SETTING

Tertiary care, spinal cord injury rehabilitation unit, National Spinal Injuries Centre, Stoke Mandeville Hospital, Ayelsbury, UK.

METHODS

Employment outcomes were obtained from the Needs Assessment Checklist (NAC), for all patients admitted to the unit between February 2008 and October 2014. NAC1 is completed within 4 weeks post-mobilisation and NAC2 upon the patient moving to the pre-discharge ward. Data from 362 participants were analysed for return-to-work intentions, by gender, age and injury severity.

RESULTS

Seventy-six percent of the sample population was employed at the time of their injury. At NAC1, 22.4% of individuals had made plans to return to work, whereas 44.2% had not; at NAC2, 34.3% had made plans to return to work and 31.2% had not. This difference was found to be statistically significant. There were significant differences in return-to-work intentions by injury severity at NAC1 but not NAC2, and by age group at NAC2 but not NAC1.

CONCLUSION

Less than half of those employed at the time of their injury had made plans to return to work before their discharge from the unit. The low proportion of individuals with SCI returning to work--just one in three--is concerning in view of the lost health and psychosocial benefits, and requires greater prominence during rehabilitation. Future research into effective employment interventions to improve employment outcomes in this population is required.

Quality of Life and Coping With Chronic Illness and Disability

Quality of life (QOL) has been one of the most commonly used constructs in the field of rehabilitation. More specifically, it has been viewed and studied as a process, measure, goal, and outcome in the domain of psychosocial adaptation to chronic illness and disability (CID). However, it has seldom been discussed in the contexts of community-level clinical interventive strategies or personal-level coping strategies. This article seeks to provide the reader with a better appreciation and understanding of (a) the temporal nature of QOL within both the community-level and personal-level contexts of interventions, (b) the temporal-oriented parallel nature of managing life stresses as viewed from both community- and personal-level perspectives, (c) the intricate nature of anticipating, managing, and coping with CID as viewed from three distinct temporal vantage points, and (d) the psychosocial benefits accrued from future-oriented, positively valenced, post-CID coping efforts and their salutary influence on QOL among people with CID. The article concludes with a brief review of several theoretical, clinical, and research implications, informed by the temporal nature of coping strategies and their effect on psychosocial adaptation to CID.

Evaluation of a community reintegration outpatient program service for community-dwelling persons with spinal cord injury

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.

Quality of life in and after spinal cord injury rehabilitation: a longitudinal multicenter study

PURPOSE

To investigate the changes in quality of life (QOL) in persons with spinal cord injury (SCI) and their close persons during the first 2 years post injury.

METHOD

Longitudinal multiple sample multiple wave panel design. Data included 292 patients recruited from Austrian British German Irish and Swiss specialist SCI rehabilitation centers and 55 of their close persons. Questionnaire booklets were administered at 6 weeks 12 weeks 1 year and 2 years after injury to both samples.

RESULTS

Study 1 investigated the WHOQOL-BREF domains in individuals with SCI and found differences mostly in the physical domain indicating that QOL increases for persons with SCI from onset. An effect of the culture was observed in the psychological and environmental domains with higher QOL scores in the German-speaking sample. Study 2 compared individuals with SCI to their close persons and found differences in the physical environmental and social domains over time. The scores on the psychological dimension did not significantly differ between the persons with SCI and their close persons over time.

CONCLUSION

QOL measured by the WHOQOL-BREF shows that QOL changes during rehabilitation and after discharge. Apart from the physical dimension the persons with SCI and their close persons seem to experience a similar change in QOL. Further longitudinal research is suggested to clarify the mutual adjustment process of people with SCI and their close persons and to explore cultural differences in QOL between English-and German-speaking countries.

Perceived facilitators and barriers to self-management in individuals with traumatic spinal cord injury: a qualitative descriptive study

Background

Current evidence has suggested the need for increased self-management support efforts in spinal cord injury (SCI) to reduce secondary complications. However, current self-management programs may not be suitable for the unique needs of individuals with SCI, including reduced mobility and the importance of attendant care. There is a need for greater understanding of the self-management strategies adopted by individuals with SCI and the potential need for a tailored self-management program. Thus, the purpose of the current study was to understand the perceived facilitators and barriers to self-management to prevent secondary complications.

Methods

A descriptive qualitative approach was used and involved telephone interviews. Semi-structured interviews were conducted with individuals with traumatic SCI, their family members/caregivers, and managers from acute care/trauma and rehabilitation centres. Participants were recruited between September 2011 and May 2012. Analysis was conducted using inductive thematic analysis to understand the perceived facilitators and barriers to self-management to prevent secondary complications.

Results

A total of 26 interviews were conducted and they included 7 individuals with traumatic SCI, 7 family/caregivers (i.e., 7 SCI-caregiver dyads), and 12 acute care/rehabilitation managers from across the province of Ontario. The following five facilitators to self-management were identified: physical support from the caregiver, emotional support from the caregiver, peer support and feedback, importance of positive outlook and acceptance, and maintaining independence/control over care. The following five barriers to self-management were identified: caregiver burnout, funding and funding policies, lack of accessibility, physical limitations and secondary complications, and difficulties achieving positive outlook or mood.

Conclusions

This study demonstrated that the caregiver and the individual’s own mood/outlook, among other facilitators and barriers, make significant contributions to the self-management of individuals with traumatic SCI. The issues of timing/readiness and comorbidities and aging were observed across many of these themes. As such, the development of a tailored self-management program for individuals with traumatic SCI and their caregivers should incorporate these considerations.

Perceptions of gain following spinal cord injury: a qualitative analysis

BACKGROUND

Significant research has focused on psychological difficulties following spinal cord injury (SCI), and there is a small prevalence of individuals who experience distress after injury. However, the converse is that many adjust well to injury and rate their quality of life highly. Despite this, there has been a comparative dearth of research investigating positive psychological outcomes after SCI, perceived by individuals living with this disability.

OBJECTIVE

To explore individuals' perceptions of gain following the experience of SCI.

METHODS

Participants, who had sustained an SCI between the ages 16 and 83, responded to an open-ended written question: "What do you think you have gained from the experience of spinal cord injury?" This was administered at 4 time points post injury: 6 weeks, 12 weeks, 1 year, and 2 years.

RESULTS

Participants' responses were analyzed qualitatively using the framework of thematic analysis. Thirteen themes were identified: relationships, appreciation of relationships, perspective and appreciation of life, new goals or priorities, understanding of SCI or disability, appreciation of health or health care, changed personality, opportunity or challenge, knowledge of SCI or body, newly acquired skills, spirituality, acceptance, and nothing. Descriptive statistics were incorporated in the presentation of the data.

CONCLUSIONS

This study provides evidence that a broad range of positive as well as negative psychological outcomes are possible following SCI. More research is needed to better understand the process through which these outcomes arise and to inform how such outcomes may be communicated to persons experiencing this type of injury.

The influence of depression on physical complications in spinal cord injury: behavioral mechanisms and health-care implications

STUDY DESIGN

This study is a literature review and a proposed conceptual model.

OBJECTIVES

The objective of this study is to develop a conceptual model to explore the relationship between the presence of depressive symptoms and secondary physical complications such as pressure ulcers, urinary tract infections and autonomic dysreflexia in spinal cord injury (SCI).

SETTING

Community setting for individuals with SCI.

METHODS

A conceptual model explaining the mechanism underlying the relationship between depression and secondary physical SCI complications was developed based on the International Classification of Functioning, Disability and Health (ICF). A literature review was conducted to develop the model and to identify potential mechanisms responsible for the association.

RESULTS

A conceptual model based on ICF was created, informed by the literature discussing the link between depression and secondary physical SCI complications. Evidence in the literature was located that supports both a causal connection between depression and increased physical complications and/or the potential mechanisms mediating that connection.

CONCLUSION

The proposed model can be utilized to encourage further research on the influence of depression on SCI outcomes and the importance of prompt and effective identification and treatment of depressive symptoms. Additional research is needed to assess the relationship between depression and secondary physical SCI complications, and to test the validity of the model.