A comprehensive look at the psychoneuroimmunoendocrinology of spinal cord injury and its progression: mechanisms and clinical opportunities

Spinal cord injury (SCI) is a devastating and disabling medical condition generally caused by a traumatic event (primary injury). This initial trauma is accompanied by a set of biological mechanisms directed to ameliorate neural damage but also exacerbate initial damage (secondary injury). The alterations that occur in the spinal cord have not only local but also systemic consequences and virtually all organs and tissues of the body incur important changes after SCI, explaining the progression and detrimental consequences related to this condition. Psychoneuroimmunoendocrinology (PNIE) is a growing area of research aiming to integrate and explore the interactions among the different systems that compose the human organism, considering the mind and the body as a whole. The initial traumatic event and the consequent neurological disruption trigger immune, endocrine, and multisystem dysfunction, which in turn affect the patient's psyche and well-being. In the present review, we will explore the most important local and systemic consequences of SCI from a PNIE perspective, defining the changes occurring in each system and how all these mechanisms are interconnected. Finally, potential clinical approaches derived from this knowledge will also be collectively presented with the aim to develop integrative therapies to maximize the clinical management of these patients.

Mental Health and Spinal Cord Injury: Clinical Considerations for Rehabilitation Providers

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.

The impact of employment on quality of life for adults with brain injury

BACKGROUND: Employment is associated with greater quality of life (QOL) for people with disabilities. Yet, for individuals with traumatic brain injury (TBI), the benefits of work are not often realized given high rates of unemployment. OBJECTIVE: This study examined the unique impact of psychosocial variables and employment status (working vs. not working) on self-reported QOL among adults with TBI. METHODS: Participants included 116 adults with TBI between the ages of 18-65, recruited through state brain injury associations in the United States to complete an anonymous online survey. Hierarchical regression analysis was used to examine the incremental impact of psychosocial variables (sense of community, social support, social network, and problem-solving confidence) and employment status on QOL controlling for age and symptom severity. RESULTS: In the final model, employment status, informal and formal support network ties, problem-solving confidence, sense of community, and emotional support explained 59% of the variance in QOL, which is considered a large effect size. Employment status uniquely explained 5% of the variance in QOL. CONCLUSIONS: Findings support the positive benefits of work for adults with TBI. Rehabilitation services that emphasize vocational considerations and employment supports are needed to impact work status and ultimately QOL for individuals with TBI.

Sustained Attention and Working Memory Predict the Number of Days on Health-Related Benefits in the Year Following Occupational Rehabilitation

Purpose The objective of this study was to investigate the association between cognitive and emotional functioning and the number of days on health-related benefits such as sick leave, work assessment allowance and disability pension. We investigated whether cognitive and emotional functioning at the start of rehabilitation and the change from the start to the end of rehabilitation predicted the number of days on health-related benefits in the year after occupational rehabilitation. Methods A sample of 317 individuals (age 19-67 years), mainly diagnosed with a musculoskeletal or mental and behavioural ICD-10 disorder, participated. The sample was stratified depending on the benefit status in the year before rehabilitation. Those receiving health-related benefits for the full year comprised the work assessment allowance and disability pension (WAA) group and those receiving benefits for less than a year comprised the sick leave (SL) group. The participants were administered cognitive and emotional computerised tests and work and health questionnaires at the beginning and end of rehabilitation. The cumulative number of days on health-related benefits during 12 months after rehabilitation was the primary outcome variable and age, gender, educational level, subjective health complaints, anxiety, and depression were controlled for in multiple regression analyses. Results The WAA group (n = 179) was significantly impaired at baseline compared to the SL group (n = 135) in focused attention and executive function, and they also scored worse on work and health related variables. Higher baseline scores and change scores from the start to the end of rehabilitation, for sustained attention, were associated with fewer number of health-related benefit days in the WAA group, while higher baseline scores for working memory were associated with fewer number of health-related benefit days in the SL group. Conclusions New knowledge about attention and memory and return to work in individuals with different benefit status may pave the way for more targeted programme interventions. Rehabilitation programmes could benefit from designing interventions that respectively improve sustain attention and working memory related to working life in individuals on sick leave or work assessment allowance and disability pension.

Development and Validation of the Satisfaction With Labor Market Participation Survey

Employment is often assumed to be the universally desirable outcome in vocational counseling and research; however, many personal and environmental factors affect individual decisions about the costs and benefits of work and the amount of work that is desired. The objective of this study was to validate an instrument capturing satisfaction with labor market participation regardless of one’s employment status. The Satisfaction with Labor Market Participation Survey (SLMP) was administered at two points in time to adults with disabilities. Analyses included a combination of exploratory and confirmatory factor analysis. A nine-item, two-factor scale emerged from the exploratory factor analysis and was supported by confirmatory factor analysis. All correlations were in the expected direction, and regression analysis with both the SLMP and employment status showed the SLMP significantly predicting satisfaction with life while employment status did not after controlling for the SLMP. Preliminary data support the SLMP as a reliable and valid tool for assessing satisfaction with labor market participation for use with people with disabilities in vocational counseling and employment research.

Motivational Interviewing and Return to Work for People with Musculoskeletal Disorders: A Systematic Mapping Review

Purpose There is limited knowledge about motivational interviewing (MI) for people on sick leave with musculoskeletal disorders. Hence, our objective was to investigate what research on MI as a method to facilitate return to work for individuals who are on sick leave due to musculoskeletal disorders exists, and what are the results of the research? Methods We systematically searched MEDLINE, PsycINFO, EMBASE, Cochrane Library, CINAHL, Web of Science, Sociological Abstracts, Epistemonikos, SveMed + and DARE & HTA (covering 1983 to August 2019). We also searched the MINT bulletin and relevant web pages. Eligibility criteria: empirical studies investigating MI and return to work for people with musculoskeletal disorders. Two authors independently screened the records, critically appraised the studies and charted the data using a data extraction form. Results The searches identified 1264 records of which two studies were included. One randomized controlled trial (RCT) found no effect of MI on return to work for disability pensioner with back pain (n = 89, high risk of bias), while a cluster RCT found that MI increased return to work for claimants with chronic musculoskeletal disorders (n = 728, low risk of bias). Conclusions This mapping review identified a huge gap in research on MI to increase return to work for individuals with musculoskeletal disorders. Registration Current Research Information System in Norway, project id: 635823 ( https://app.cristin.no/projects/show.jsf?id=635823 ).

Effectiveness of Motivational Interviewing in Regard to Activities of Daily Living and Motivation for Rehabilitation among Stroke Patients

Background: Stroke patients urgently need rehabilitation to enhance activities of daily living. This study aims to determine whether motivational interviewing (MI) improves the performance of activities of daily living and enhances motivation for rehabilitation among first-stroke patients. Methods: A quasi-experimental design was used in this study. The study recruited 65 patients between March and October 2016. Before the intervention, all patients received routine care. The experimental group (n = 33) received weekly sessions of MI for 6 weeks, whereas the control group (n = 32) received individual attention from a research nurse weekly for 6 weeks. Structured questionnaires were used to collect data, including demographic data, activities of daily living data (Barthel index {BI} and instrumental activities of daily living {IADLs} scale), and rehabilitation motivation data. Results: The BI and IADLs scores significantly improved with time in both the experimental and control groups. The generalized estimating equation approach showed that at 6 weeks and 3 months after the intervention, the rehabilitation motivation scores in the experimental group were respectively 3.10 and 2.54 points higher than those in the control group, with significant differences. Conclusions: MI could effectively enhance motivation for rehabilitation among stroke patients.

Introducing Motivational Interviewing in a Sickness Insurance Context: Translation and Implementation Challenges

Purpose Motivational interviewing (MI) is a conversational method to support clients in need of behavioral change. In an organizational reform, most Swedish sickness insurance officials were trained in MI to promote clients' return to work (RTW) after sick leave. The aim of this article is to investigate experiences of introducing MI as a tool to promote clients' RTW within a sickness insurance context, with special focus on the translation and implementation of the method. Methods A qualitative approach, comprising 69 interviews with officials, managers, and regional coordinators on two occasions. The material was analyzed through qualitative content analysis. Results Officials were positive about MI, but the application was limited to using certain tools with extensive individual variation. Officials struggled with translating MI into a sickness insurance context, where the implementation strategy largely failed to offer adequate support, due to low managerial priority, competing initiatives, and a high workload. Results of the educational intervention could therefore be seen on an individual but not an organizational level. Conclusions In order to translate MI into a sickness insurance context, training needs to be supported by organizational approaches that promote collective learning and sharing of experiences among officials. The results also illustrate how a method cannot be assumed to be implemented simply because training has been provided. Consequently, the application of the method needs to be carefully monitored in studies of interventions where MI is claimed to be used, in order to measure its effectiveness.

Efficacy of Group Motivational Interviewing in the Degree of Drug Craving in the Addicts Under the Methadone Maintenance Treatment (MMT) in South East of Iran

BACKGROUND

Craving is one of the important factors having an effective role in the addiction relapse. As an important factor in the therapy failure, this clinical phenomenon has to be diagnosed and treated.

OBJECTIVE

The present research aimed at determining the efficacy of group motivational interviewing in the degree of drug craving in the addicts under the Methadone Maintenance Treatment (MMT).

METHOD

This is a quasi-experimental study carried out on 100 addicted men (aged 18-50 years), who were under the MMT in a drug abstinence clinic affiliated with University of Medical Sciences (Iran) in the second half of 2014. The research sample was selected by the availability criteria based on the inclusion and exclusion criteria, and upon matching, it was divided randomly into two groups of 50 (control and treatment). The treatment group first received 5 sessions of group motivational counseling; then it entered the therapy process. The control group received the usual treatment of the drug abstinence clinic. To assess the drug craving degree (in the pretest, 2, 6 and 12 months after the abstinence), the Visual Cue-induced Craving Task, scored 0 to 100, was used. The data were analyzed by the descriptive statistics through independent t-test, and repeated measures analysis of variance.

RESULTS

The means of craving degrees in the control group, 2, 6 and 12 months after the abstinence (73.28 ± 7.52, 65.83 ± 6.69 and 61.25±5.17, respectively) were significantly (p=0.0001) higher than those in the treatment group (68.94 ± 10.53, 40.48 ± 11.78 and 32.51 ± 9.00). Moreover, the mean of retention in the treatment was 9.24 ± 2.45 months in the treatment group that was significantly (p=0.001) higher than the 4.88 ± 3.65 months of retention in the control group.

CONCLUSION

The research results support the fact that motivational interviewing decreases the degree of drug craving, and increases the probability of the addicts' retention in long-term therapeutic abstinence programs. Therefore, the use of such an approach as a pretreatment and a complementary therapy in changing health behaviors is recommended.

Assessing Self-Determined Work Motivation in People with Severe Mental Illness: A Factor-Analytic Approach

Background: Self-determination theory (SDT) has increasingly been used as a theoretical framework for evaluating key elements of the recovery paradigm in rehabilitation and mental health services research and policy-making for people living with severe mental illnesses.Purpose: The purpose of this study was to validate the Behavioral Regulation in Work Questionnaire (BRWQ), an adaptation of the Behavioral Regulation in Exercise Questionnaire-2, as a measure of self-determined work motivation for use in psychiatric rehabilitation settings.Methods: One hundred and twenty-four individuals with severe mental illness were recruited from eight Clubhouse programmes in Hawaii. Factorial validity of the BRWQ was evaluated using exploratory factor analysis.Findings: Principal components analysis of the BRWQ yielded four factors (amotivation, external regulation, introjection and autonomous motivation). The autonomous motivation factor was found to be significantly related to other SDT constructs, including competency, relatedness, outcome expectancy and vocational rehabilitation engagement.Conclusions: The BRWQ is a psychometrically sound SDT measure for assessing self-determined work motivation and could contribute to the use of self-determination as a paradigm for improving recovery and employment outcomes of people with severe mental illness in rehabilitation settings.

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.

Patients, persons or partners? Involving those with chronic disease in their care

Self-care management is essential for effective chronic disease management. Yet prevailing approaches of healthcare practitioners often undermine the efforts of those who require on-going medical attention for chronic conditions, emphasizing their status as patients, failing to consider their larger life experience as people, and most importantly, failing to consider them as people with the potential to be partners in their care. This article explores two approaches for professional-patient interaction in chronic disease management, namely, patient-centred care and empowering partnering, illuminating how professionals might better interact with chronically ill individuals who seek their care. The opportunities, challenges, theory and research evidence associated with each approach are explored. The advantages of moving beyond patient-centred care to the empowering partnering approach are elaborated. For people with chronic disease, having the opportunity to engage in the social construction of their own health as a resource for everyday living, the opportunity to experience interdependence rather than dependence/independence throughout on-going healthcare, and the opportunity to optimize their potential for self-care management of chronic disease are important justifications for being involved in an empowering partnering approach to their chronic disease management.

An exploration of the usefulness of motivational interviewing in facilitating secondary prevention gains in cardiac rehabilitation

Motivational interviewing is a client-centered, directive counseling approach aimed at promoting motivation in clients to change certain behaviors. Its effect is to reduce defensiveness and promote disclosure, engagement, and participation, thereby motivating the client to make behavioral changes. Motivational interviewing marries well with the principles of cardiac rehabilitation (CR) in terms of increasing motivation among CR clients, promoting a client-centered approach and in the cost- and time-effective practices of CR. Very little research has been conducted examining the effectiveness of motivational interviewing in enhancing CR outcomes. This article discusses research that has been conducted in motivational interviewing that relates to the components of CR, provides examples of how motivational interviewing can be applied to CR, and recommends further exploration, development, and investigation of the usefulness of motivational interviewing in the field of CR.