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Peiffer JW, Philippus A, Kanaster K, Monden KR. Understanding the association between perceived injustice, depression symptoms, and stigma in individuals with traumatic spinal cord injury. Spinal Cord 2024; 62:440-445. [PMID: 38871826 DOI: 10.1038/s41393-024-01007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/31/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
STUDY DESIGN This is a secondary analysis of data from a cross-sectional, observational study. OBJECTIVES The study aimed to determine whether stigma mediates the relationship between preceived injustice and depression symptoms among individuals with spinal cord injuries. SETTING Secondary analysis of participants enrolled in the Spinal Cord Injury Model System at a specialty rehabilitation hospital in the Western United States. METHODS A sample of 225 participants completed the questionnaires; eight participants were removed due to incomplete data, resulting in a final sample size of 217 participants (79% male; 21% female). Participants were, on average, 53 years old and were predominantly male, white, and 20 years post-injury. A bootstrapping mediation analysis was conducted to evaluate the stigma-mediated relationship between injustice appraisals and depression symptoms. Injustice appraisals were assessed using the Injustice Experience Questionnaire, stigma with the Spinal Cord Injury Quality of Life Stigma-Short Form, and depression symptoms with the Patient Health Questionnaire-9. RESULTS Stigma was found to mediate the relationship between injustice appraisals and depression, with an estimated proportion mediated of 80.9% (p ≤ 0.0001). CONCLUSIONS This study provides a novel finding that the relationship between injustice appraisals and depression symptoms is mediated by stigma. Consistent with previous research, injustice appraisals were associated with greater severity of depression symptoms. Results provide further evidence for the role of injustice appraisals after spinal cord injury and a potential mechanism (i.e., stigma) by which it may exert its effect on depression symptoms.
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Affiliation(s)
- Joshua W Peiffer
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Angela Philippus
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Karen Kanaster
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kimberley R Monden
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
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Ownsworth T, Mols H, O'Loghlen J, Xie Y, Kendall M, Nielsen M, Mitchell J, Jones R, Geraghty T. Stigma following acquired brain injury and spinal cord injury: relationship to psychological distress and community integration in the first-year post-discharge. Disabil Rehabil 2024; 46:1796-1806. [PMID: 37128900 DOI: 10.1080/09638288.2023.2205173] [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: 11/07/2022] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE This study aimed to compare stigma levels after acquired brain injury (ABI) and spinal cord injury (SCI) during the first 12-months post-discharge and investigate relationships between stigma, psychological distress and community integration. METHODS 110 adults with ABI (55%) or SCI (45%) were recruited from brain and spinal cord injury inpatient rehabilitation units of a tertiary healthcare facility. They were administered Neuro-QOL Stigma subscale and Depression Anxiety and Stress Scales (DASS-21) at discharge, 3-months and 12-months post-discharge, and Community Integration Measure at 12-months post-discharge. RESULTS Stigma levels did not significantly differ between individuals with ABI and SCI. However, stigma significantly decreased between discharge and 12-months post-discharge for the total sample. Stigma was positively associated with psychological distress at discharge and 3-months post-discharge, but not at 12-months post-discharge. Lower functional status and power wheelchair use were associated with higher stigma at 12-months post-discharge. Stigma at 3-months post-discharge predicted community integration at 12-months post-discharge, controlling for psychological distress and functional status. CONCLUSION Experience of stigma in the first few months post-discharge may negatively impact individuals' community reintegration. The early post-discharge period may be a pivotal time for supporting individuals to explore disability and injury-related appraisals and enhance connection to their community.
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Affiliation(s)
- Tamara Ownsworth
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Helen Mols
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jessica O'Loghlen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Yanfei Xie
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - Melissa Kendall
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Mandy Nielsen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Jessie Mitchell
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Rachel Jones
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
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Abou L, Martinez-Navarro O, Kratz A. Satisfaction with social roles and activities across mobility status among persons with spinal cord injury. Spinal Cord 2024; 62:264-269. [PMID: 38519562 DOI: 10.1038/s41393-024-00984-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Revised: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/25/2024]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To examine the differences in satisfaction with social roles and activities among ambulatory individuals, manual wheelchair users, and power wheelchair users with spinal cord injuries (SCIs). SETTING Community setting. METHODS Participants completed surveys of their demographics and clinical data as well as the Spinal Cord Injury - Quality of Life Satisfaction with Social Roles and Activities- Short Form. Participants' mobility status was categorized into (1) ambulatory individuals, (2) independent manual wheelchair users, and (3) power wheelchair/scooter users. One-way ANOVA and ANCOVA were used, respectively, to examine unadjusted and adjusted differences in satisfaction with social roles and activities across mobility status. Adjustment covariates included age, sex, time since SCI, and SCI injury level. RESULTS A total of 129 participants (mean age = 47.4 ± 13.6 years, 73% male) were included in the analyses. Unadjusted (F = 3.8, p = 0.03) and adjusted models (F = 3.4, p = 0.04) evidenced significant differences in satisfaction with social roles and activities according to mobility status. Pairwise Bonferroni Post-Hoc analysis indicated that manual wheelchair users were more satisfied with their social roles and activities when compared to ambulatory individuals (mean difference = 2.8, p < 0.05). CONCLUSIONS Due to the current challenges associated with walking recovery after SCIs, clinicians may want to discuss the use of wheelchairs with individuals with limited walking ability when the goal is to improve participation and quality of life. Emphasizing alternative means of mobility may enhance satisfaction with social roles and activities.
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Affiliation(s)
- Libak Abou
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Oriol Martinez-Navarro
- Department of Nursing and Physiotherapy, University of Lleida, Lleida, Spain
- Healthcare Research Group, IRB Lleida, Institute for Biomedical Research Dr. Pifarre Foundation, Lleida, Spain
| | - Anna Kratz
- Department of Physical Medicine & Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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Leung T, Toatley S, Rodgers MD, Qanungo S, Mueller M, Denny B, Rodriguez A. Feasibility of a Community-Based, Online, Peer-Supported Spinal Cord Injury Self-management Intervention: Protocol for a Pilot Wait-Listed Randomized Trial. JMIR Res Protoc 2023; 12:e42688. [PMID: 36749612 PMCID: PMC9944143 DOI: 10.2196/42688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND People with spinal cord injury (SCI) report feeling unprepared to manage their disability upon discharge to the community. This situation is exacerbated when they return to settings where self-management support and resources are sparse, thus increasing the risk of costly secondary conditions and rehospitalizations. These factors make a compelling case for implementing innovative community-based SCI self-management programs that empower and engage individuals with SCI. Using a community-engaged research (CEnR) approach, we developed a peer-supported SCI self-management intervention, known as PHOENIX (Peer-supported Health Outreach, Education, and Information Exchange), which integrates online educational content and support from peer navigators (PNs) through telehealth, to promote health and community participation after SCI. OBJECTIVE The objective of this pilot study is to evaluate the feasibility and acceptability of PHOENIX and the study design, and to obtain estimates of the variability of relevant outcome measures. METHODS We conducted a pilot randomized waitlist-controlled trial (n=30) in collaboration with the South Carolina Spinal Cord Injury Association (SCSCIA), our long-standing community-based nonprofit organization research partner. We recruited 4 PNs through our SCSCIA collaboration using its existing network of trained peer mentors. Our study design supported comparison of the following 2 randomly assigned groups: PHOENIX intervention group and waitlist enhanced usual care (EUC) group. The PHOENIX intervention was administered online by PNs over 16 weeks through scheduled "video visits." The EUC group participated in the study for 16 weeks with usual community services and no navigation, and received 4 monthly newsletters from the SCSCIA on a variety of SCI-relevant topics. At the end of the waitlist period, the waitlist EUC group received the full PHOENIX intervention. Measures of feasibility included PN and participant recruitment and retention, PN workload, protocol adherence, and incidence of technical issues. We conducted qualitative interviews with participants and PNs to evaluate the acceptability of PHOENIX and the study design. Outcome measures, including community participation, quality of life, and the occurrence and subjective impact of medically serious secondary conditions and rehospitalizations, were assessed at baseline after randomization and at subsequent time points to allow between-group comparisons. RESULTS PN hiring and training were completed in August 2018. Recruitment began in November 2018. A total of 30 participants were recruited across South Carolina, and 28 participants completed follow-up by August 2020. An analysis of the results is being finalized, and the results are expected to be published in 2023. CONCLUSIONS This study will provide valuable information to guide future research seeking to address unmet self-management needs and improve outcomes in individuals with SCI. Feasibility findings of this study will provide evidence from CEnR guided by people with SCI and SCI service providers to inform further development, testing, and dissemination of effective and scalable self-management strategies for people with SCI. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/42688.
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Affiliation(s)
| | - Sherwood Toatley
- South Carolina Spinal Cord Injury Association, Columbia, SC, United States
| | - Marka Danielle Rodgers
- Center for Spinal Cord Injury, Roper Rehabilitation Hospital, Charleston, SC, United States
| | - Suparna Qanungo
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Brian Denny
- South Carolina Spinal Cord Injury Association, Columbia, SC, United States
| | - Angela Rodriguez
- South Carolina Spinal Cord Injury Association, Columbia, SC, United States
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Khazem LR, Pearlstien JG, Anestis MD, Gratz KL, Tull MT, Bryan CJ. Differences in suicide risk correlates and history of suicide ideation and attempts as a function of disability type. J Clin Psychol 2023; 79:466-476. [PMID: 35909343 PMCID: PMC10087921 DOI: 10.1002/jclp.23419] [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: 11/29/2021] [Revised: 05/31/2022] [Accepted: 07/10/2022] [Indexed: 01/19/2023]
Abstract
BACKGROUND Disability status is associated with correlates of suicide risk (perceived burdensomeness, thwarted belongingness, negative future disposition, felt stigma, suicidal ideation, and suicide attempts). AIMS This study aimed to examine whether suicide-related correlates differ significantly as a function of disability type. METHODS Individuals with mobility and vision disabilities (N = 102) completed semistructured interviews and online-based questionnaires. Analysis of variance/analysis of covaiance and Fisher's exact tests were conducted to examine whether mean levels of suicide-related correlates differed significantly between individuals with blindness/low vision (n = 63) versus mobility-related (n = 39) disabilities. RESULTS No significant between-group differences were observed for most outcomes; however, individuals with vision disabilities reported higher mean levels of felt stigma and positive future disposition than those with mobility-related disabilities. LIMITATIONS The limited representation of disabilities among participants precludes generalization to individuals with other forms of disability and the cross-sectional design prevents inference about causality. CONCLUSIONS Interventions targeting cognitive processes that underlie suicide risk may be applicable to people with mobility and vision disabilities.
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Affiliation(s)
- Lauren R Khazem
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Jennifer G Pearlstien
- Department of Psychology, University of California, Berkeley, Berkeley, California, USA
| | | | - Kim L Gratz
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Matthew T Tull
- Department of Psychology, University of Toledo, Toledo, Ohio, USA
| | - Craig J Bryan
- Department of Psychiatry and Behavioral Health, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Tyner CE, Slotkin J, Kisala PA, Levin LS, Tintle SM, Tulsky DS. Assessment of quality of life after upper extremity transplantation: Framework for patient-reported outcome scale domains. Front Psychol 2023; 13:989593. [PMID: 36760917 PMCID: PMC9902934 DOI: 10.3389/fpsyg.2022.989593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2022] [Accepted: 08/31/2022] [Indexed: 01/26/2023] Open
Abstract
Upper extremity transplantation offers the promise of restored function and regained quality of life (QOL) for individuals who have sustained hand or arm amputation. However, a major challenge for this procedure becoming an accessible treatment option for patients is the lack of standard measures to document benefits to QOL. Patient-reported outcomes (PRO) measures are well-suited for this kind of intervention, where the perspective of the patient is central to defining treatment success. To date, qualitative work with experts, clinicians, and patients has been used to identify the most important domains of QOL for PRO item development. Specifically, our group's qualitative work has identified several domains of QOL that are unique to individuals who have received upper extremity transplants, which are distinct from topics covered by existing PRO measures. These include emotional and social aspects of upper extremity transplant, such as Expectations and Perceived Outcomes, Integration and Assimilation of Transplant, Fitting in, and Post-Surgical Challenges and Complications. The broad topic of Satisfaction with Transplant was subdivided into three subtopics: Function, Sensation, and Aesthetics. Satisfaction with Sensation was also identified as a unique domain not evaluated by existing PRO measures. This report operationalizes these eight QOL domains by presenting scoping definitions. This manuscript describes the work that has been completed for domain characterization as an early step toward developing standardized PRO measures to evaluate these important outcomes specific to upper extremity transplantation.
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Affiliation(s)
- Callie E. Tyner
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States,*Correspondence: Callie E. Tyner,
| | - Jerry Slotkin
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States
| | - Pamela A. Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States
| | - L. Scott Levin
- Department of Orthopedic Surgery, Penn Medicine, Philadelphia, PA, United States,Department of Surgery, Division of Plastic Surgery, Penn Medicine, Philadelphia, PA, United States
| | - Scott M. Tintle
- Department of Orthopedic Surgery, Walter Reed National Military Medical Center, Bethesda, MD, United States,Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, United States
| | - David S. Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, United States,Department of Physical Therapy, University of Delaware, Newark, DE, United States,Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
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Kuzu D, Perrin PB, Pugh M. The Affiliate Stigma Scale: Psychometric refinement and validation of a short form in Turkish spinal cord injury/disorder caregivers. NeuroRehabilitation 2023; 52:83-91. [PMID: 36617754 DOI: 10.3233/nre-210127] [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: 01/09/2023]
Abstract
BACKGROUND Despite the widespread international use of the Affiliate Stigma Scale in the context of disability, much research on its psychometric properties has taken dubious statistical approaches. OBJECTIVE The aim of this study was to examine the psychometric properties of the Affiliate Stigma Scale in a sample of Turkish spinal cord injury/disorder (SCI/D) caregivers. METHODS Participants completed the Affiliate Stigma Scale, Zarit Burden Interview, and Generalized Anxiety Disorder-7. This study conducted a series of confirmatory factor analyses (CFAs) of the Turkish Affiliate Stigma Scale using its originally theorized 3-factor structure and a 1-factor structure, as well as an exploratory factor analysis (EFA) to refine the scale items to create a short form, with a final CFA of the items in the short form. RESULTS The 3-factor and 1-factor CFAs of the 22 items from the Affiliate Stigma Scale suggested poor fit to the data across every fit index. An EFA yielded four factors, although the patterns of item loading onto the factors did not map in any discernible way to the original subscales theorized by the scale creators. A 1-factor CFA with the six items loading onto factor 1 of the EFA showed much better fit indices, with most achieving good or adequate fit. CONCLUSION The current study supports a 1-factor solution with a short form comprised of six items, at least in Turkish and with SCI/D caregivers.
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Affiliation(s)
- Duygu Kuzu
- University of Michigan, Ann Arbor, MI, USA
| | | | - Mickeal Pugh
- Virginia Commonwealth University, Richmond, VA, USA
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Budd MA, Gater DR, Channell I. Psychosocial Consequences of Spinal Cord Injury: A Narrative Review. J Pers Med 2022; 12:jpm12071178. [PMID: 35887675 PMCID: PMC9320050 DOI: 10.3390/jpm12071178] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
Consequences of a spinal cord injury (SCI) entail much more than damage to the spinal cord. The lives of people with SCI, along with those around them, experience profound long-lasting changes in nearly every life domain. SCI is a physical (biological) injury that is inextricably combined with various psychological and social consequences. The objective of this review is to present psychosocial challenges following SCI through the biopsychosocial model, beginning with acknowledgement of the larger societal effects of ableism and stigma before addressing the many unique psychosocial aspects of living with SCI. Included in this review are qualitative studies and systematic reviews on current psychosocial outcomes and consequences. This paper attempts to structure this information by dividing it into the following sections: relationships and family; changes in finances and employment; issues related to the person’s living situation; community reintegration; factors associated with mood and coping (e.g., depression, anxiety, substance use, and PTSD); self-harm behaviors (ranging from nonadherence to suicide); effects of traumatic brain injury; considerations regarding sexual health; aging with SCI; and concludes with a brief discussion about post-traumatic growth. Cultivating an understanding of the unique and interrelated psychosocial consequences of people living with SCI may help mitigate the psychosocial aftermath and serve as a reminder to providers to maintain a person-centered approach to care.
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Affiliation(s)
- Maggi A. Budd
- Spinal Cord Injury/Disease Service, VA Boston Healthcare System, Boston, MA 02130, USA;
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Center for Bioethics, Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Isabella Channell
- Spinal Cord Injury/Disease Service, VA Boston Healthcare System, Boston, MA 02130, USA;
- Mental Health Counseling and Behavioral Medicine Graduate Program, Boston University School of Medicine, Boston, MA 02128, USA
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Dutch-Flemish translation and cross-cultural adaption of the Spinal Cord Injury-Quality of Life (SCI-QOL) short forms. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1349-1357. [PMID: 35376985 DOI: 10.1007/s00586-022-07190-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 02/25/2022] [Accepted: 03/12/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE A spinal cord injury (SCI) has a large impact on a person's physical, psychological, and social health. Previous studies focused on physical recovery in patients with SCI and assessed their health-related quality of life (HRQOL) with general questionnaires, which often contain irrelevant questions. The SCI-QOL questionnaire was developed to specifically assess the HRQOL of the SCI population. A comprehensive translation and cross-cultural adaptation are required to use this questionnaire in the Netherlands and Flanders, Belgium. METHODS All 23 short forms of the SCI-QOL for adults were translated from English into Dutch-Flemish using the Functional Assessment of Chronic Illness Therapy translation methodology, with a cognitive debriefing being performed with 10 patients with SCI and 10 persons from the general population. RESULTS The Dutch-Flemish PROMIS group previously translated 46 of the 207 items in the 23 short forms. Here, we achieved an acceptable translation of the other 161 items. A single Dutch-Flemish translation was obtained for 20 short forms, while separate Dutch and Flemish translations were necessary for the short forms Ambulation, Manual Wheelchair, and Stigma. CONCLUSION The Dutch-Flemish translation of the SCI-QOL is now available for clinical and research purposes. Future studies should focus on the psychometric properties of this cross-culturally adapted version.
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Tulsky DS, Kisala PA. Overview of the Spinal Cord Injury-Functional Index (SCI-FI): Structure and Recent Advances. Arch Phys Med Rehabil 2021; 103:185-190. [PMID: 34756875 DOI: 10.1016/j.apmr.2021.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 10/18/2021] [Indexed: 11/02/2022]
Abstract
The Spinal Cord Injury - Functional Index is a system of patient reported outcomes (PRO) measures of functional activities developed specifically with and for individuals with spinal cord injury (SCI). The SCI-FI was designed to overcome limitations in measurement of the full range of activities and breadth of content of physical functioning commonly used in SCI research. Generic measurement tools of physical function (i.e., those focused on the general population) tend to overemphasize mobility and do not contain enough items at the lower end of the functional range (e.g., appropriate for individuals with tetraplegia). The SCI-FI consists of nine item response theory (IRT)-calibrated item banks that represent relevant and meaningful item content for individuals with SCI, span a wide range of functional abilities, and subdivide physical functioning into important subdomains, including basic mobility, self-care, and fine motor function. Since the original publication of the SCI-FI in 2012, there have been significant advances in and publications on the reliability and psychometric properties of the measures. The manuscripts presented in this special section clarify the SCI-FI structure and present new research on the SCI-FI measurement system.
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Affiliation(s)
- David S Tulsky
- Center for Health Assessment Research and Translation (CHART), University of Delaware, Newark, DE; Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE.
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation (CHART), University of Delaware, Newark, DE
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11
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Validation of the Injustice Experience Questionnaire (IEQ) in a spinal cord injury population. Spinal Cord 2021; 59:1177-1186. [PMID: 34052836 DOI: 10.1038/s41393-021-00645-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN Retrospective analysis of cross-sectional data. OBJECTIVES To verify the factor structure of the Injustice Experience Questionnaire (IEQ) using a sample of individuals with spinal cord injury (SCI) and to assess IEQ scale reliability and construct validity using the same population. SETTING Two SCI rehabilitation sites in the United States. METHODS Three datasets were combined to conduct this validation study. The sample consisted of 341 adults with SCI who completed the IEQ, measures of psychological distress and pain, and provided sociodemographic and injury-related information. A series of confirmatory factor analyses (CFA) and exploratory factor analyses (EFA) were conducted to verify the two-factor structure of the IEQ, Cronbach's alpha was used to demonstrate scale reliability, and correlations between the IEQ and measures of pain and psychological distress were examined to assess construct validity. RESULTS Poor model fit was observed for the two-factor structure of the IEQ as well as for the subsequent factor-structures that were explored. The IEQ demonstrated strong scale reliability (α = 0.89) and correlations between the IEQ and measures of pain and psychological distress were in the expected direction, indicating good construct validity. CONCLUSIONS In this preliminary validation study, we failed to confirm the two-factor structure of the IEQ in a population of individuals with SCI. Though good scale reliability and construct validity were observed, further study is needed to refine the IEQ for use in this population.
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Lu Q, Deng C, Fu L, Wu R, Chang L, Qi H, Wang K, Jiang L, Yang X, Wang Y, Li L, Zhao Y. Reliability and validity of a Chinese version of the Stigma Scale for Chronic Illness (SSCI) in patients with stroke. Top Stroke Rehabil 2019; 26:312-317. [PMID: 30900522 DOI: 10.1080/10749357.2019.1592306] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Affiliation(s)
- Qi Lu
- School of Nursing, Tianjin Medical University,Tianjin, China
| | - Cuiyu Deng
- Nursing Department, The second hospital of Tianjin Medical University, Tianjin, China
| | - Li Fu
- Nursing Department, The second hospital of Tianjin Medical University, Tianjin, China
| | - Rui Wu
- Department of rehabilitation medicine, The general hospital of Tianjin Medical University, Tianjin, China
| | - Lianxia Chang
- Department of neurology, Tianjin first center hospital, Tianjin, China
| | - Huaying Qi
- Department of neurology, Tianjin first center hospital, Tianjin, China
| | - Kuijie Wang
- Department of neurology, Tianjin first center hospital, Tianjin, China
| | - Lihong Jiang
- Department of neurology, Tianjin Huanhu hospital, Tianjin, China
| | - Xuan Yang
- Cancer Institute & Hospital, Tianjin Medical University, Tianjin, China
| | - Yulu Wang
- School of Nursing, Tianjin Medical University,Tianjin, China
| | - Liya Li
- School of Nursing, Tianjin Medical University,Tianjin, China
| | - Yue Zhao
- School of Nursing, Tianjin Medical University,Tianjin, China
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Cook KF, Kallen MA, Hayes D, Deutscher D, Fritz JM, Werneke MW, Mioduski JE. Calibration and validation of an item bank for measuring general physical function of patients in medical rehabilitation settings. PATIENT-RELATED OUTCOME MEASURES 2018; 9:11-16. [PMID: 29343994 PMCID: PMC5749388 DOI: 10.2147/prom.s148788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective The objective of this study was to report the item response theory (IRT) calibration of an 18-item bank to measure general physical function (GPF) in a wide range of conditions and evaluate the validity of the derived scores. Methods All 18 items were administered to a large sample of patients (n=2337) who responded to the items in the context of their outpatient rehabilitation care. The responses, collected 1997– 2000, were modeled using the graded response model, an IRT model appropriate for items with two or more response options. Inter-item consistency was evaluated based on Cronbach’s alpha and item to total correlations. Validity of scores was evaluated based on known-groups comparisons (age, number of health problems, symptom severity). The strength of a single, general factor was evaluated using a bi-factor model. Results were used to evaluate IRT assumption and as an indicator of construct validity. Local independence of item responses was also evaluated. Results Response data met the assumptions of unidimensionality and local independence. Explained common variance of a single general factor was 0.88 (omega hierarchical =0.86). Only two of the 153 pairs of item residuals were flagged for local dependence. Inter-item consistency was high (0.93) as were item to total correlations (mean =0.61). Substantial variation was found in both IRT location (difficulty) and discrimination parameters. All omnibus known-groups comparisons were statistically significant (p<0.001). Conclusion Item responses fit the IRT unidimensionality assumptions and were internally consistent. The usefulness of GPF scores in discriminating among patients with different levels of physical function was confirmed. Future studies should evaluate the validity of GPF scores based on an adaptive administration of items.
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Affiliation(s)
- Karon F Cook
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Michael A Kallen
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Deanna Hayes
- Focus On Therapeutic Outcomes, Inc., Knoxville, TN, USA
| | - Daniel Deutscher
- Department of Physical Therapy, Maccabi Healthcare Services, Tel-Aviv, Israel
| | - Julie M Fritz
- Department of Orthopaedics, University of Utah School of Medicine, Salt Lake City, UT, USA.,Department of Physical Therapy and Athletic Training, University of Utah School of Medicine, Salt Lake City, UT, USA
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Le J, Dorstyn D. Anxiety prevalence following spinal cord injury: a meta-analysis. Spinal Cord 2016; 54:570-8. [PMID: 26951738 DOI: 10.1038/sc.2016.15] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Revised: 01/12/2016] [Accepted: 01/14/2016] [Indexed: 01/06/2023]
Abstract
STUDY DESIGN Meta-analysis. OBJECTIVES Prevalence estimates indicate that anxiety following spinal cord injury (SCI) is a common problem. However, methodological differences between studies may impact the clinical interpretation of these data. METHODS Data from 18 independent studies (Nparticipants=3158), which reported the prevalence of an anxiety disorder or associated symptoms, were identified from the Embase, PubMed and PsycInfo databases. Proportions were the primary effect size estimate. Confidence intervals, fail-safe Ns and the I(2) statistic were additionally calculated to identify the extent to which findings were robust and consistent across studies. RESULTS Five per cent of participants met the criteria for either GAD or panic disorder, with Agoraphobia identified in 2.5%. These diagnostic data were, however, limited to two studies. Higher rates were noted for self-reported 'caseness' of anxiety, with 27% reporting clinically significant symptoms. Anxiety prevalence estimates varied across the individual self-report measures (range: 15-32%). Method of administration (range: 26-32%) did not impact significantly on these estimates nor did recruitment source, with similarly high anxiety levels reported by hospital (27%) and community (29%) samples. CONCLUSIONS Early identification and treatment of anxiety are important in SCI rehabilitation, with a subgroup of individuals experiencing chronic symptoms. Further research is needed to establish guidelines for the interpretation of self-report data, including the use of clinical cutoffs.
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Affiliation(s)
- J Le
- School of Psychology, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
| | - D Dorstyn
- School of Psychology, Faculty of Health Sciences, University of Adelaide, Adelaide, SA, Australia
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Tulsky DS, Kisala PA. The Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system: Development, psychometrics, and item bank calibration. J Spinal Cord Med 2015; 38:251-6. [PMID: 26010961 PMCID: PMC4445017 DOI: 10.1179/2045772315y.0000000035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Department of Physical Therapy, University of Delaware, College of Health Sciences, 540 S. College Ave., Newark, DE 19713.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
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Tulsky DS, Kisala PA, Victorson D, Tate DG, Heinemann AW, Charlifue S, Kirshblum SC, Fyffe D, Gershon R, Spungen AM, Bombardier CH, Dyson-Hudson TA, Amtmann D, Z. Kalpakjian C, W. Choi S, Jette AM, Forchheimer M, Cella D. Overview of the Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system. J Spinal Cord Med 2015; 38:257-69. [PMID: 26010962 PMCID: PMC4445018 DOI: 10.1179/2045772315y.0000000023] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
CONTEXT/OBJECTIVE The Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system was developed to address the shortage of relevant and psychometrically sound patient reported outcome (PRO) measures available for clinical care and research in spinal cord injury (SCI) rehabilitation. Using a computer adaptive testing (CAT) approach, the SCI-QOL builds on the Patient Reported Outcomes Measurement Information System (PROMIS) and the Quality of Life in Neurological Disorders (Neuro-QOL) initiative. This initial manuscript introduces the background and development of the SCI-QOL measurement system. Greater detail is presented in the additional manuscripts of this special issue. DESIGN Classical and contemporary test development methodologies were employed. Qualitative input was obtained from individuals with SCI and clinicians through interviews, focus groups, and cognitive debriefing. Item pools were field tested in a multi-site sample (n=877) and calibrated using item response theory methods. Initial reliability and validity testing was performed in a new sample of individuals with traumatic SCI (n=245). SETTING Five Model SCI System centers and one Department of Veterans Affairs Medical Center across the United States. PARTICIPANTS Adults with traumatic SCI. INTERVENTIONS n/a OUTCOME MEASURES n/a RESULTS The SCI-QOL consists of 19 item banks, including the SCI-Functional Index banks, and 3 fixed-length scales measuring physical, emotional, and social aspects of health-related QOL (HRQOL). CONCLUSION The SCI-QOL measurement system consists of psychometrically sound measures for individuals with SCI. The manuscripts in this special issue provide evidence of the reliability and initial validity of this measurement system. The SCI-QOL also links to other measures designed for a general medical population.
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Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David Victorson
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Denise G. Tate
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | | | | | - Richard Gershon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | | | | | - Alan M. Jette
- Boston University School of Public Health, Boston, MA, USA
| | | | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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