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García-Rudolph A, Cusso H, Carbonell C, Lopez S, Pla L, Sabaté M, Vazquez P, Opisso E, Hervas A. Community integration after spinal cord injury rehabilitation: Predictors and causal mediators. J Spinal Cord Med 2024:1-12. [PMID: 39133061 DOI: 10.1080/10790268.2024.2386738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/13/2024] Open
Abstract
CONTEXT/OBJECTIVE Community integration (CI) is a crucial rehabilitation goal after spinal cord injury (SCI). There is a pressing need to enhance our understanding of the factors associated with CI for individuals with traumatic or non-traumatic etiologies, with the latter being notably understudied. Accordingly, our research explores the associations and potential mediators influencing CI across these populations. SETTING Specialized neurological rehabilitation center. PARTICIPANTS Community-dwelling individuals who were admitted as inpatients within 3 months post-injury (n = 431, 51.9% traumatic, 48.1% non-traumatic), assessed in relation to community integration within 1-3 years after discharge. OUTCOME MEASURE Community Integration Questionnaire (CIQ). Covariates: American Spinal Injury Association Impairment Scale (AIS), Functional Independence Measure (FIM) and Hospital Anxiety and Depression Scale (HADS). RESULTS Multiple linear regression yielded age, B AIS grade, educational level (< 6 years and <12 years), time since injury to admission, length of stay, HADS-depression at discharge, total FIM at discharge and three social work interventions (support in financial, legal and transportation services) as significant predictors of total CIQ score (Adjusted R2 = 41.4). Multiple logistic regression identified age, traumatic etiology, educational level (< 6 years and <12 years), length of stay, HADS depression at discharge, total FIM at discharge and one social work intervention (transportation support) as significant predictors of good community integration, AUC (95% CI): 0.82 (0.75-0.89), Sensitivity:0.76, Specificity:0.73. We identified motor FIM at discharge and motor FIM efficiency as causal mediators of total CIQ. CONCLUSIONS We identified modifiable factors during rehabilitation-functional independence, depression, and social work interventions-that are associated with CI.
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Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Hector Cusso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Carola Carbonell
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Sandra Lopez
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Laura Pla
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Marina Sabaté
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Pilar Vazquez
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Angels Hervas
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
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Quel de Oliveira C, Bundy A, Middleton JW, Refshauge K, Rogers K, Davis GM. Activity-Based Therapy for Mobility, Function and Quality of Life after Spinal Cord Injuries-A Mixed-Methods Case Series. J Clin Med 2023; 12:7588. [PMID: 38137657 PMCID: PMC10743935 DOI: 10.3390/jcm12247588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/01/2023] [Accepted: 12/05/2023] [Indexed: 12/24/2023] Open
Abstract
(1) Background: Despite inconclusive evidence on the benefits of activity-based therapies (ABTs) in people with spinal cord injuries, implementation has occurred in clinics worldwide in response to consumers' requests. We explored the clinical changes and participants' perceptions from engaging in an ABT program in the community. (2) Methods: This mixed-methods study involved a pragmatic observational multiple-baseline design and an evaluation of participants' perceptions. Fifteen participants were included. Outcome measures were balance in sitting using the Seated Reach Distance test, mobility using the Modified Rivermead Mobility Index and quality of life using the Quality of Life Index SCI version pre- and post-participation in an ABT community-based program. Linear mixed models and logistic regressions were used to analyse the effects of intervention. Semi-structured interviews explored participants' perceptions using inductive thematic analysis. (3) Results: There was an increase of 9% in the standardised reach distance (95% CI 2-16) for sitting balance, 1.33 points (95% CI: 0.81-1.85) in mobility and 1.9 points (0.17-2.1) in quality of life. Two themes emerged from the interviews: (1) reduced impact of disability and an increased sense of life as before, and (2) the program was superior to usual rehabilitation. No adverse events related to the intervention were observed. (4) Conclusion: ABT delivered in the community improved clinical outcomes in people with a chronic SCI. High levels of satisfaction with the program were reported.
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Affiliation(s)
- Camila Quel de Oliveira
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
- Discipline of Physiotherapy, Graduate School of Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia
| | - Anita Bundy
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
- Department of Occupational Therapy, Colorado State University, Fort Collins, CO 80524, USA
| | - James W. Middleton
- John Walsh Center for Rehabilitation Research, Kolling Institute, Northern Sydney Local Health District and Sydney Medical School Northern, The University of Sydney, Sydney, NSW 2006, Australia;
| | - Kathryn Refshauge
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
| | - Kris Rogers
- Graduate School of Health, Faculty of Health, University of Technology Sydney, Ultimo, NSW 2007, Australia;
| | - Glen M. Davis
- Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia; (A.B.); (K.R.); (G.M.D.)
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Tucker J, Marshall T, Beitscher I, Mueller K, Colucio E, Koc TA. The effect of self-reported balance confidence on community integration after brain injury: an observational study. BRAIN IMPAIR 2023; 24:601-610. [PMID: 38167354 DOI: 10.1017/brimp.2022.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the correlation between self-reported balance confidence and community integration related to home management for community-dwelling adults with acquired brain injury (ABI). METHODS This is a study of 141 participants over the age of 18 with a history of ABI, living in the community, who completed an online survey. The survey included a series of demographic questions followed by the Activities-Specific Balance Confidence Scale (ABC) and the Home Integration subscale of the Community Integration Questionnaire (CIQ-H). RESULTS Data from 119 completed surveys were included in the analysis. Significant positive correlations were found between the ABC and the CIQ-H total scores (rs = 0.241, p = 0.008). There was no significant difference between CIQ-H total scores in individuals by injury type (traumatic vs non-traumatic) or by level of severity (mild, moderate, severe) (p > 0.05). There was no significant difference between ABC total scores by injury type (p > 0.05). CONCLUSIONS Higher levels of balance confidence may be associated with improved community integration related to home management for individuals with traumatic and non-traumatic BI. This study's results support future research to evaluate the integration of strategies to improve balance confidence as a component of interdisciplinary assessment and rehabilitation to maximize community integration in community-dwelling adults with ABI.
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Affiliation(s)
- Jenna Tucker
- School of Physical Therapy, Kean University, Union, NJ, USA
| | | | - Ilana Beitscher
- Rehabilitation Specialists, Fair Lawn, NJ, USA
- Department of Occupational Therapy, Kean University, Union, NJ, USA
| | | | - Eric Colucio
- School of Physical Therapy, Kean University, Union, NJ, USA
| | - Thomas A Koc
- School of Physical Therapy, Kean University, Union, NJ, USA
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García-Rudolph A, Saurí J, López Carballo J, Cegarra B, Wright MA, Opisso E, Tormos JM. The impact of COVID-19 on community integration, quality of life, depression and anxiety in people with chronic spinal cord injury. J Spinal Cord Med 2022; 45:681-690. [PMID: 34061728 PMCID: PMC9542626 DOI: 10.1080/10790268.2021.1922230] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
CONTEXT/OBJECTIVE Compare community integration, quality of life, anxiety and depression of people with chronic spinal cord injury (SCI) living in the community before the outbreak of coronavirus SARS-CoV-2 disease (COVID-19) and during it. DESIGN Prospective observational cohort study. SETTING In-person follow-up visits (before COVID-19 outbreak) to a rehabilitation hospital in Spain and on-line during COVID-19. PARTICIPANTS Community dwelling adults (≥ 18 years) with chronic SCI. OUTCOME MEASURES Hospital Anxiety and Depression Scale (HADS), Community Integration Questionnaire (CIQ) and World Health Organization Quality of Life (WHOQOL-BREF) were compared using the Wilcoxon ranked test or paired t-test when appropriate. RESULTS One hundred and seventy five people with SCI assessed on-line between June 2020 and November 2020 were compared to their own assessments before COVID-19. Participants reported significantly decreased Social Integration during COVID-19 compared to pre-pandemic scores (P = 0.037), with a small effect size (d = -0.15). Depression (measured using HADS) was significantly higher than before COVID-19 (P < 0.001) with a moderate effect size (d = -0.29). No significant differences were found in any of the 4 WHOQOL-BREF dimensions (Physical, Psychological, Social and Environmental).Nevertheless, when all participants were stratified in two groups according to their age at on-line assessment, the younger group (19-54 years, N = 85) scored lower during COVID-19 than before, in WHOQOL-BREF Physical (P = 0.004), (d = -0.30) and Psychological dimensions (P = 0.007) (d = -0.29). The older group (55-88 years, N = 0) reported no significant differences in any dimension. CONCLUSIONS COVID-19 impacted HADS' depression and CIQ's social integration. Participants younger than 55 years were impacted in WHOQOL-BREF's physical and psychological dimensions, meanwhile participants older than 55, were not.
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Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain,Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain,Correspondence to: Alejandro García-Rudolph, Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Cami Can Ruti s/n 08916, Badalona, Barcelona, Spain.
| | - Joan Saurí
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain,Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Jaume López Carballo
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain,Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Blanca Cegarra
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain,Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Mark Andrew Wright
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain,Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain,Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Josep María Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain,Fundació Institut d’Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
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Panuccio F, Galeoto G, Valente D, Ioncoli M, Marquez MA, Tofani M, Berardi A. Psychometric properties of the Community Integration Questionnaire - Revised (CIQ-R) in an Italian population with spinal cord injury. Spinal Cord Ser Cases 2022; 8:18. [PMID: 35124691 PMCID: PMC8818046 DOI: 10.1038/s41394-022-00486-x] [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: 09/14/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 02/07/2023] Open
Abstract
STUDY DESIGN Psychometric study. OBJECTIVES The aim of this study was to evaluate the internal consistency and validity of the Community Integration Questionnaire - Revised (CIQ-R) in Italian individuals with spinal cord injury (SCI). SETTING Patients' associations, foundations, sport clubs, and federations in Italy. METHODS The psychometric properties were evaluated following international guidelines. Internal consistency was assessed using Cronbach's alpha (α) coefficient, and test-retest reliability was assessed using intraclass correlation coefficient (ICC); concurrent validity was assessed through Pearson's Correlation Coefficient with the Short Form-12 health survey (SF-12). RESULTS The test was administered to 80 people with SCI. Cronbach's α showed a value of 0.825 for the Home Integration subscale, while the other subscales and the total showed values <0.70. 30 of the 80 recruited individuals were submitted to test-retest, which showed ICC values ranging from 0.94 to 1. CIQ-R also showed a correlation between Physical Component Summary (PCS12) of the SF-12, and between Social Integration subscale's score and PCS12 and Mental Component Summary (MCS12). Correlations are also shown between Productivity subscale and PCS12 and MCS12, as well as between the total score and PCS12 and MCS12. CONCLUSION This study provided Italian clinicians and researchers with the first international outcome measure for measuring community integration. The validation of this measurement tool for people with SCI allows to compare outcomes of various studies. It is useful for testing the effectiveness of a treatment in various diseases and define which treatment is more effective than others.
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Affiliation(s)
| | - Giovanni Galeoto
- grid.7841.aDepartment of Human Neurosciences, Sapienza University of Rome, Viale dell’università 30, 00185 Rome, Italy ,IRCSS Neuromed, Via Atinense 18, Rome, 86077 Pozzilli (IS) Italy
| | - Donatella Valente
- grid.7841.aDepartment of Human Neurosciences, Sapienza University of Rome, Viale dell’università 30, 00185 Rome, Italy ,IRCSS Neuromed, Via Atinense 18, Rome, 86077 Pozzilli (IS) Italy
| | - Melissa Ioncoli
- grid.7841.aSapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Maria Auxiliadora Marquez
- grid.512367.4Universidad Fernando Pessoa-Canarias, Las Palmas, Spain ,grid.23520.360000 0000 8569 1592Health Sciences, University of Burgos, Burgos, Spain
| | - Marco Tofani
- grid.7841.aDepartment of Public Health and Infectious Disease, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185 Rome, Italy
| | - Anna Berardi
- grid.7841.aDepartment of Human Neurosciences, Sapienza University of Rome, Viale dell’università 30, 00185 Rome, Italy
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Huong PTT, Wu CY, Lee MB, Chen IM. Associations of Suicide Risk and Community Integration Among Patients With Treatment-Resistant Depression. Front Psychiatry 2022; 13:806291. [PMID: 35308876 PMCID: PMC8924132 DOI: 10.3389/fpsyt.2022.806291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/17/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION Treatment-resistant depression (TRD) is one of the primary causes of disability and a major risk for suicide among patients living in the community. However, the suicide risks and care needs for safety among patients with TRD during the community reintegration process appear to be underestimated. This study aimed to investigate the association between community integration and suicide risks among patients with treatment-resistant depression (TRD) with sub-analysis by gender. METHODS Patients diagnosed with major depressive disorder were recruited upon psychiatrists' referral in two general hospitals in northern Taiwan during 2018-2019. The participants who experienced more than two failed treatments of antidepressants with partial remission were defined as TRD. A structured questionnaire was used to collect socio-demographic, suicidality, and psychosocial information. RESULTS In a total of 125 participants, gender difference was identified in certain community integration aspects such as home integration, productivity, and electronic social networking. The male participants appeared to have better involvement in social contact with internet but slightly less video link than women, while women had higher level of home integration in the past month. The participants who performed worse in the social integration and better home-based activity or productivity levels had higher suicide risks including suicide ideation and overall suicide risks. CONCLUSIONS Community integration levels of home, social, and productivity were associated with suicidality in terms of overall suicide risk and recent suicide ideation. Facilitation of community integration at home and life arrangements might reduce suicide risks in TRD patients.
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Affiliation(s)
- Pham Thi Thu Huong
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan.,Faculty of Nursing and Midwifery, Hanoi Medical University, Hanoi, Vietnam.,National Institute of Mental Health, Bach Mai Hospital, Hanoi, Vietnam
| | - Chia-Yi Wu
- School of Nursing, National Taiwan University College of Medicine, Taipei, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.,Taiwanese Society of Suicidology and Taiwan Suicide Prevention Center, Taipei, Taiwan
| | - Ming-Been Lee
- Taiwanese Society of Suicidology and Taiwan Suicide Prevention Center, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan.,Department of Psychiatry, Shin Kong Wu Ho Su Memorial Hospital, Taipei, Taiwan
| | - I-Ming Chen
- Taiwanese Society of Suicidology and Taiwan Suicide Prevention Center, Taipei, Taiwan.,Department of Psychiatry, National Taiwan University Hospital, Taipei, Taiwan
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García-Rudolph A, Cegarra B, Opisso E, Tormos JM, Saurí J. Relationships Between Functionality, Depression, and Anxiety With Community Integration and Quality of Life in Chronic Traumatic Spinal Cord Injury. Am J Phys Med Rehabil 2021; 100:840-850. [PMID: 33935149 DOI: 10.1097/phm.0000000000001773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of the study were (1) to identify relationships between functional and psychological aspects with community integration and quality of life assessments in people with chronic traumatic spinal cord injury and (2) to analyze clinical and demographic predictors of quality of life dimensions. DESIGN This is an observational cohort study, and correlation coefficients were calculated between the Functional Independence Measure, the Hospital Anxiety and Depression Scale, the Community Integration Questionnaire, and the World Health Organization Quality of Life-BREF dimensions (physical [D1], psychological [D2], social [D3], and environmental [D4]). Quality of life predictors were identified using multiple linear regression analyses. RESULTS Nine hundred seventy-five people with traumatic spinal cord injury assessed since 2007-2020 were included. The Community Integration Questionnaire home integration correlated strongly with the Functional Independence Measure self-care (r = 0.74) and transfers (r = 0.62) for participants with tetraplegia. The specific Hospital Anxiety and Depression Scale items (known as the anhedonia subscale) correlated strongly with D1 (r = -0.65), D2 (r = -0.69), D3 (r = -0.53), and D4 (r = -0.51) for participants with paraplegia and D1 (r = -0.53), D2 (r = -0.61), D3 (r = -0.47), and D4 (r = -0.53) for participants with tetraplegia. The Hospital Anxiety and Depression Scale-depression was the most relevant predictor of D1 (β = -0.61) and D2 (β = -0.76). CONCLUSIONS The Functional Independence Measure transfers and self-care were strongly associated with the Community Integration Questionnaire home integration (in participants with tetraplegia). Anhedonia was strongly related to all four World Health Organization Quality of Life-BREF Scale dimensions, being the Hospital Anxiety and Depression Scale-depression the most relevant predictor of D1 and D2. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to (1) Determine the associations between functional and psychological measures with community integration domains and quality of life from a multidimensional perspective (physical, psychological, social, and environmental) in persons with chronic traumatic paraplegia or tetraplegia living in the community; (2) Identify long-term clinical and demographic predictors of specific quality of life dimensions (e.g., physical and psychological) in persons with paraplegia or tetraplegia living in the community; and (3) Illustrate the strength of the identified associations and the impact of the quality of life predictors to suggest possible specific aspects to be addressed by professionals in clinical practice. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
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Affiliation(s)
- Alejandro García-Rudolph
- From the Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; and Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
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Crosscultural Validation of the Community Integration Questionnaire-Revised in an Italian Population. Occup Ther Int 2020; 2020:8916541. [PMID: 32934614 PMCID: PMC7481919 DOI: 10.1155/2020/8916541] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/10/2020] [Indexed: 12/14/2022] Open
Abstract
Objective The aims of this study are the translation, cultural adaptation, and validation of the Community Integration Questionnaire–Revised (CIQ-R) in Italian in a group of individuals with no clinical evidence of disability. Methods The test's internal consistency and validity were assessed by following international guidelines. The test's internal consistency was examined using Cronbach's alpha (α) coefficient. Pearson's correlation coefficient was calculated to assess the test's concurrent validity compared with the Short Form-12 (SF-12) health survey. Results The CIQ-R was administrated to 400 people with no clinical evidence of disease, impairment, or disability, aged between 18 and 64. Cronbach's α reported a value of 0.82 in the home integration subscale. The test also showed a good test-retest reliability, with an Intraclass Correlation Coefficient of 0.78, and a significant correlation between the total score of the CIQ-R and the Physical Component Summary (PCS) of the SF-12 (r = 0.118), between the “social integration” subscale's score and PCS12 (r = 0.121) and between the “Electronic Social Networking integration” subscale's score and PCS12 (r = 0.184), with p < 0.05. Conclusion This is the first study to report the results of the translation and validation of the CIQ-R in Italian. The CIQ-R is an important tool for Italian professionals and can be useful in both clinical practice and research for measuring the level of community integration among the healthy population.
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Barclay L, Robins L, Migliorini C, Lalor A. Community integration programs and interventions for people with spinal cord injury: a scoping review. Disabil Rehabil 2020; 43:3845-3855. [PMID: 32356499 DOI: 10.1080/09638288.2020.1749889] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aim: The focus of this scoping review was to identify the extent, range, and nature of studies that have been published regarding community integration programs and interventions that support people during the transition home from hospital following spinal cord injury.Methods: Four electronic databases and one search engine were searched for articles published between 2010 and 2020. Grey literature and manual searches were also done.Results: Of the 16 articles included, 8 were published in peer-reviewed journals. Two of these did not include an evaluation. Study designs included but were not limited to pilot studies (n = 2); mixed methods evaluations (n = 2); single-site randomized controlled trials (n = 3); and, non-randomized single-arm study design (n = 1). The articles were from the United States (n = 12), Canada (n = 2), Australia (n = 1), and the United Kingdom (n = 1).Conclusion: The majority of interventions focused on addressing health-related educational needs, followed by community mobility. Goal setting and promoting self-efficacy were identified as important components, and the importance of involvement of people with lived experience was also highlighted. There was a lack of focus on management of relationships, including addressing sexuality needs. This review highlights the need for further empirical evaluation of implemented programs and interventions in this area, particularly in countries other than the USA, to inform service development.IMPLICATIONS FOR REHABILITATIONSuccessful community integration is an important outcome of spinal cord injuries rehabilitation.The majority of published programs focus on health-related educational needs, followed by community mobility.It is recommended that goal setting and promoting self-efficacy are included in programs.It is recommended that people with lived experience of spinal cord injuries are involved in interventions.It is recommended that programs include a focus on management of relationships, including addressing sexuality needs.
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Affiliation(s)
- Linda Barclay
- Department of Occupational Therapy, Monash University, Frankston, VIC, Australia
| | - Lauren Robins
- School of Primary and Allied Health Care, Monash University, Frankston, VIC, Australia
| | - Christine Migliorini
- Psychosocial Research Centre, Department of Psychiatry, University of Melbourne, Hawthorn, VIC, Australia
| | - Aislinn Lalor
- Department of Occupational Therapy, Monash University, Frankston, VIC, Australia
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10
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Kee KM, Mohamad NZ, Koh PPW, Yeo JPT, Ng YS, Kam JC, Asano M. Return to work after spinal cord injury: a Singaporean pilot community-based rehabilitation program. Spinal Cord 2020; 58:1096-1103. [PMID: 32273565 DOI: 10.1038/s41393-020-0459-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective analysis of data collected as part of a pilot program. OBJECTIVES The primary objective of our study was to document the return-to-work rate of individuals with SCI who participated in a community-based interdisciplinary vocational rehabilitation program. The secondary objectives were to assess changes in their levels of community integration and functional independence. SETTING A community-based rehabilitation center in Singapore. METHODS Participants were individuals with SCI between 21 and 55 years. They identified return to work as a rehabilitation goal, and were certified fit to undergo rehabilitation by their physicians. Primary outcome was the return-to-work rate at discharge from the program. Secondary outcomes were community integration and functional independence, measured by the Community Integration Questionnaire (CIQ) and the Spinal Cord Independence Measure III (SCIM-III), respectively. We summarized participants' clinical and socio-demographic characteristics descriptively, and used inferential statistics to compare pre- and postprogram scores for secondary outcome measures. RESULTS Thirty-nine participants were included for this study. Thirty-two completed the program, of which 84% (n = 27) reported returning to work. Participants who completed the program had mean change in total CIQ and SCIM-III scores of 7 (95% CI, 5-8) and 11 (95% CI, 7-15), respectively. There were differences (p < 0.05) between pre- and postprogram scores for both secondary outcome measures. CONCLUSIONS Our findings suggest that our vocational rehabilitation program facilitated participants with SCI in Singapore to return to work and was beneficial to enhance their levels of community integration and functional independence. Future interventional studies are recommended to estimate the efficacy of such programs.
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Affiliation(s)
- Kalya M Kee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
| | - Nizar Z Mohamad
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
| | | | - Joanna P T Yeo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Miho Asano
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. .,National University Health System, Singapore, Singapore.
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11
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Razaob NA, Tham SY, Mohd Rasdi HF, Wan Yunus F, Kadar M. Translation, Validation and Reliability Testing of Community Integration Questionnaire-Revised (CIQ-R) Malay Version: A Preliminary Study. Occup Ther Health Care 2020; 34:32-47. [PMID: 31920126 DOI: 10.1080/07380577.2020.1712632] [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: 10/25/2022]
Abstract
The Community Integration Questionnaire-Revised (CIQ-R) is a self-report standardized instrument designed to assess an individual's degree of community integration. The aim of this study was to translate, validate and conduct a reliability test of the CIQ-R Malay version. The development involved the three phases of translation, content validation and cognitive interviewing, test-retest reliability and internal consistency of the CIQ-R Malay version. The Content Validity Index (CVI) showed perfect agreement between the panel experts. The Intra-class Correlation Coefficient (ICC) demonstrated a moderate to excellent level of test-retest agreement (ICC 0.72 to 0.93). The Total CIQ-R Malay version and Home Integration subscale showed good internal consistency, with values of Cronbach's alpha ranging from 0.81 to 0.90. The findings from the present study provided preliminary support for the psychometric properties of the CIQ-R Malay version as a valid and reliable instrument to be used in Malaysia.
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Affiliation(s)
- Nor Afifi Razaob
- Occupational Therapy Programme, Centre for Rehabilitation & Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Si Yan Tham
- Occupational Therapy Programme, Centre for Rehabilitation & Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.,Tan Tock Seng Hospital, Singapore, Singapore
| | - Hanif Farhan Mohd Rasdi
- Occupational Therapy Programme, Centre for Rehabilitation & Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Farahiyah Wan Yunus
- Occupational Therapy Programme, Centre for Rehabilitation & Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
| | - Masne Kadar
- Occupational Therapy Programme, Centre for Rehabilitation & Special Needs, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
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12
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Turcotte S, Beaudoin M, Vallée C, Vincent C, Routhier F. Psychometric properties of the Community Integration Questionnaire: a systematic review of five populations. Clin Rehabil 2019; 33:1775-1787. [PMID: 31397182 DOI: 10.1177/0269215519867998] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES This systematic review documents the content and the quality of the psychometric evidence concerning the utilization of the Community Integration Questionnaire for individuals living with a disability other than a traumatic brain injury. DATA SOURCES Medline, Embase, CINAHL, OTseeker and PsycINFO (searched from inception to June 2019). REVIEW METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used for conducting and reporting this review. Studies that investigated at least one psychometric property of the Community Integration Questionnaire for individuals living with a disability other than traumatic brain injury were included. Data extraction and critical methodological appraisal of the articles (MacDermid checklist, COnsensus-based Standards for the selection of health Measurement INstruments checklist) were independently performed and validated by the first two authors. RESULTS Ten studies representing 3000 individuals met the inclusion criteria. Five populations were documented. There are positive and trustable data regarding internal consistency for adults living with multiple sclerosis, spinal cord injury or burns and in mixed samples (α = 0.71-0.84). Construct validity is fairly documented for adults living with multiple sclerosis or aphasia and in mixed samples. Test-retest reliably is acceptable for adults living with multiple sclerosis (intraclass correlation coefficient = 0.91-0.97) as well as responsiveness (area under the receiver operating characteristic curve = 0.81). Other psychometric properties could not be demonstrated sufficiently solid. CONCLUSION Many psychometric properties of the Community Integration Questionnaire are still poorly evaluated for adults living with a disability other than a traumatic brain injury. However, promising data have been documented in each population included in this review.
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Affiliation(s)
- Samuel Turcotte
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
- Université Laval, Québec City, QC, Canada
| | - Maude Beaudoin
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
- Université Laval, Québec City, QC, Canada
| | - Catherine Vallée
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
- Center for Research on Primary Care and Services, Université Laval, Québec City, QC, Canada
| | - Claude Vincent
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
- Université Laval, Québec City, QC, Canada
| | - François Routhier
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, Québec City, QC, Canada
- Université Laval, Québec City, QC, Canada
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13
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Atler KE, Schmid AA, Klinedinst TC, Grimm LA, Marchant TP, Marchant DR, Malcolm MP. The Relationship between Quality of Life, Activity and Participation among People with Type 2 Diabetes Mellitus. Occup Ther Health Care 2018; 32:341-362. [PMID: 30380958 DOI: 10.1080/07380577.2018.1522017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The cross-sectional study investigated the relationship between quality of life, activity, and participation in 93 adults with type 2 diabetes mellitus at a primary care center. Moderately strong correlations were found between quality of life and leisure/work, outdoor and social activities, but not with domestic activities. Leisure/work, outdoor, and social activities accounted for 18% of the variance in the quality of life variables. In a follow-up model, age, depression, and falls efficacy accounted for another 51% of the variance in total quality of life. Findings provide support for the expansion of occupational therapy's role in diabetes self-management, to incorporate leisure, social, and community activities and fall risk management interventions.
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Affiliation(s)
- Karen E Atler
- a Occupational Therapy Department , Colorado State University , Fort Collins , CO , USA
| | - Arlene A Schmid
- a Occupational Therapy Department , Colorado State University , Fort Collins , CO , USA
| | - Tara C Klinedinst
- a Occupational Therapy Department , Colorado State University , Fort Collins , CO , USA
| | - Laura A Grimm
- a Occupational Therapy Department , Colorado State University , Fort Collins , CO , USA
| | - Tasha P Marchant
- b Family Medicine Center , University of Colorado Health , Fort Collins , CO , USA
| | - David R Marchant
- b Family Medicine Center , University of Colorado Health , Fort Collins , CO , USA
| | - Matt P Malcolm
- c Occupational Therapy Department, Colorado School of Public Health , Colorado State University , Fort Collins , CO , USA
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Tršinski D, Tadinac M, Bakran Ž, Klepo I. Utility of the Croatian translation of the community integration questionnaire-revised in a sample of adults with moderate to severe traumatic brain injury. Disabil Rehabil 2018; 41:1711-1718. [DOI: 10.1080/09638288.2018.1443349] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Dubravko Tršinski
- Department of Neurology, Hospital for Medical Rehabilitation, Krapinske Toplice, Croatia
| | - Meri Tadinac
- Department of Psychology, University of Zagreb Faculty of Humanities and Social Sciences, Zagreb, Croatia
| | - Žarko Bakran
- Department of Neurology, Hospital for Medical Rehabilitation, Krapinske Toplice, Croatia
| | - Ivana Klepo
- Department of Neurology, Hospital for Medical Rehabilitation, Krapinske Toplice, Croatia
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15
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Callaway L, Enticott J, Farnworth L, McDonald R, Migliorini C, Willer B. Community integration outcomes of people with spinal cord injury and multiple matched controls: A pilot study. Aust Occup Ther J 2016; 64:226-234. [DOI: 10.1111/1440-1630.12350] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/26/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Libby Callaway
- Occupational Therapy Department; Monash University; Frankston Australia
| | - Joanne Enticott
- Department of Psychiatry; Southern Clinical School; Monash University; Australia
- Southern Synergy; Clayton Australia
| | - Louise Farnworth
- Occupational Therapy Department; Monash University; Frankston Australia
| | - Rachael McDonald
- Department of Health and Medical Sciences; Swinburne University of Technology; Hawthorn Australia
| | | | - Barry Willer
- Department of Psychiatry; State University of Buffalo; Buffalo New York USA
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16
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Callaway L, Winkler D, Tippett A, Herd N, Migliorini C, Willer B. The Community Integration Questionnaire - Revised: Australian normative data and measurement of electronic social networking. Aust Occup Ther J 2016; 63:143-53. [PMID: 27072343 DOI: 10.1111/1440-1630.12284] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND/AIM Consideration of the relationship between meaningful participation, health and wellbeing underpins occupational therapy intervention, and drives measurement of community integration following acquired brain injury (ABI). However, utility of community integration measures has been limited to date by lack of normative data against which to compare outcomes, and none examine the growing use of electronic social networking (ESN) for social participation. This research had four aims: (i) develop and pilot items assessing ESN to add to the Community Integration Questionnaire, producing the Community Integration Questionnaire-Revised (CIQ-R); (ii) examine factor structure of the CIQ-R; (iii) collect Australian CIQ-R normative data; and (iv) assess test-retest reliability of the revised measure. METHODS SETTING Australia. PARTICIPANTS A convenience sample of adults without ABI (N = 124) was used to develop and pilot ESN items. A representative general population sample of adults without ABI aged 18-64 years (N = 1973) was recruited to gather normative CIQ-R data. DESIGN Cross-sectional survey. MAIN MEASURES Demographic items and the CIQ-R. RESULTS The CIQ-R demonstrated acceptable psychometric properties, with minor modification to the original scoring based on the factor analyses provided. Large representative general population CIQ-R normative data have been established, detailing contribution of a range of independent demographic variables to community integration. CONCLUSION The addition of electronic social networking items to the CIQ-R offers a contemporary method of assessing community integration following ABI. Normative CIQ-R data enhance the understanding of community integration in the general population, allowing occupational therapists and other clinicians to make more meaningful comparisons between groups.
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Affiliation(s)
- Libby Callaway
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | | | - Alice Tippett
- Summer Foundation Ltd, Blackburn, Victoria, Australia
| | - Natalie Herd
- Empirica Research, Melbourne, Victoria, Australia
| | - Christine Migliorini
- Department of Occupational Therapy, Monash University, Frankston, Victoria, Australia
| | - Barry Willer
- Department of Psychiatry Medicine, University at Buffalo, Buffalo, New York, USA
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17
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Kratz AL, Ehde DM, Hanley MA, Jensen MP, Osborne TL, Kraft GH. Cross-Sectional Examination of the Associations Between Symptoms, Community Integration, and Mental Health in Multiple Sclerosis. Arch Phys Med Rehabil 2016; 97:386-94. [PMID: 26529470 PMCID: PMC4769914 DOI: 10.1016/j.apmr.2015.10.093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 09/04/2015] [Accepted: 10/09/2015] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the frequency and severity of 8 symptoms in persons with multiple sclerosis (MS) and to examine the association between these symptoms and community integration and mental health. DESIGN Cross-sectional survey that assessed 8 symptoms (pain, fatigue, imbalance, numbness, weakness, shortness of breath, vision loss, and memory loss), disease progression (self-report version of the Expanded Disability Status Scale), community integration, and mental health. SETTING Community. PARTICIPANTS Adults with self-reported MS who responded to a mailed survey (N=180). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The presence and intensity of symptoms were measured with a symptoms checklist. Community integration was assessed with the Community Integration Questionnaire, and mental health was measured by the Mental Health Index of the Medical Outcomes Study 36-Item Short-Form Health Survey. RESULTS The average number of symptoms reported was 5.07±2.18. The most common symptoms (fatigue, weakness, and imbalance) were also rated as the most severe. Not all symptoms were associated with level of disease progression or with MS subtype. Symptoms related to mobility were more likely to be associated with these variables. The 8 symptoms as a whole accounted for significant amounts of variance (range, 13%-21%) in measures of community integration and mental health, with specific symptoms making differential independent contributions to these measures. CONCLUSIONS This study demonstrates that most individuals with MS report a number of bothersome symptoms. Type of MS or level of progression does not tell the whole story regarding the impact of symptoms.
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Affiliation(s)
- Anna L Kratz
- Department of Physical Medicine and Rehabilitation Medicine, University of Michigan, Ann Arbor, MI.
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - Mark P Jensen
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | | | - George H Kraft
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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18
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Tomaszewski R, Mitrushina M. Utility of the Community Integration Questionnaire in a sample of adults with neurological and neuropsychiatric disorders receiving prevocational training. Disabil Rehabil 2015; 38:1016-22. [DOI: 10.3109/09638288.2015.1070296] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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