Determinants of self-efficacy among persons with spinal cord injuries

Trajectories of Self-Efficacy, Depressed Mood, and Anxiety From Admission to Spinal Cord Injury Rehabilitation to 1 Year After Discharge

OBJECTIVE

Self-efficacy (SE) is an important determinant for the psychological adjustment of people with spinal cord injury (SCI). However, little is known about the course of SE during inpatient rehabilitation up to 1 year after discharge. The aim of this study was to determine latent trajectory classes of SE, depressive mood, and anxiety in people with SCI, as well as the interrelationships between these trajectories.

DESIGN

Longitudinal inception cohort study.

SETTING

Eight specialized SCI rehabilitation centers.

PARTICIPANTS

The participants (N=268) were mainly men 183 of 268 (68.3%) with a mean age of 55.6 years. Almost half had a traumatic SCI 135 of 268 (50.4%) and tetraplegia (53.7%), and the minority had a motor complete SCI (32.2%).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

SE was measured using the University of Washington Self-Efficacy Scale. In addition, the Hospital Anxiety and Depression Scale was used to asses distress and perform dual trajectory modeling analyses.

RESULTS

Three trajectories of SE, indicating low, middle, and high SE, could be distinguished. Furthermore, a 2-class trajectory solution for depressive mood and a 4-class solution for anxiety were found to be most suitable. All trajectories were stable over time. Developmental connections between SE and depressive mood and between SE and anxiety were revealed. In particular, participants who adjusted well, reporting low scores on depressive mood and anxiety, could be identified by their high SE scores. However, the group of participants with high depressive mood scores and anxiety scores could not always be identified based on their SE trajectory.

CONCLUSIONS

In accordance with our hypotheses, distinct trajectories of SE, depressive mood, and anxiety were identified and high probabilities that SE trajectories were interrelated to the trajectories from depressive mood and anxiety were confirmed. Concurrent screening for SE and distress might best detect people at risk for adjustment problems.

Re-inventing yourself after spinal cord injury: a site-specific randomized clinical trial

Study Design:

Parallel-arm randomized controlled trial comparing an interactive group format versus a no-intervention control.

Objective:

To evaluate the efficacy of a replicable group treatment program for improving self-efficacy after spinal cord injury (SCI) in a single center cohort of adults.

Setting:

Regional SCI center.

Methods:

Participants included 81 individuals with SCI who were at least 4 weeks post-discharge from initial rehabilitation. Those randomized to treatment participated in six interactive learning sessions (2 hours each, one session per week) with structured and facilitated group interactions to improve self-efficacy. A wait-list control group was followed at matching time points for all outcome measures. The primary outcome measure was the Moorong Self-Efficacy Scale (MSES); secondary outcomes were the Generalized Self-Efficacy Scale (GSES); Diener Satisfaction with Life Scale (SWLS); Participation Assessment with Recombined Tools – Objective (PART-O); Patient Health Questionnaire – 9 (PHQ-9); and General Anxiety Disorder 7-item (GAD-7).

Results:

Individuals in the Treatment group had greater increases in MSES scores from baseline to immediately post-intervention (6 weeks) than the Control group, but that difference did not remain significant after controlling for multiple comparisons. However the improvement in the treatment group relative to the control group was not maintained through follow-up at 30 weeks. There was no evidence of an immediate or sustained treatment effect on any of the secondary outcomes.

Conclusions:

Self-efficacy improved for participants with SCI in the Treatment group, however, this improvement was not significant or maintained on follow-up.

Reexamining the Validity and Dimensionality of the Moorong Self-Efficacy Scale: Improving Its Clinical Utility

OBJECTIVE

To improve the clinical utility of the Moorong Self-Efficacy Scale (MSES) by reexamining its factor structure and comparing its performance against a measure of general self-efficacy in persons with spinal cord injury (SCI).

DESIGN

Cross-sectional survey design.

SETTING

Community.

PARTICIPANTS

Adults with SCI (N=161; 118 men and 43 women) recruited from Australia (n=82) and the United States (n=79), including 86 with paraplegia and 75 with tetraplegia.

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Confirmatory factor analysis deriving fit indices on reported 1-, 2-, and 3-factor structures for the MSES. Exploratory factor analysis of MSES using principal component analysis with promax oblique rotation and structure validation, with correlations and multiple regression using cross-sectional data from the Sherer General Self-Efficacy Scale and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36).

RESULTS

The MSES was confirmed to have a 3-factor structure, explaining 61% of variance. Two of the factors, labeled social function self-efficacy and personal function self-efficacy, were SCI condition-specific, whereas the other factor (accounting for 9.7% of variance) represented general self-efficacy, correlating most strongly with the Sherer General Self-Efficacy Scale. Correlations and multiple regression analyses between MSES factors, Sherer General Self-Efficacy Scale total score, SF-36 Physical and Mental Component Summary scores, and SF-36 domain scores support validity of this MSES factor structure. No significant cross-cultural differences existed between Australia and the United States in total MSES or factor scores.

CONCLUSIONS

The findings support a 3-factor structure encompassing general and SCI domain-specific self-efficacy beliefs and better position the MSES to assist SCI rehabilitation assessment, planning, and research.

Testing the measurement invariance of the University of Washington Self-Efficacy Scale short form across four diagnostic subgroups

PURPOSE

The University of Washington Self-Efficacy Scale (UW-SES) was originally developed for people with multiple sclerosis (MS) and spinal cord injury (SCI). This study evaluates the measurement invariance of the 6-item short form of the UW-SES across four disability subgroups. Evidence of measurement invariance would extend the UW-SES for use in two additional diagnostic groups: muscular dystrophy (MD) and post-polio syndrome (PPS).

METHODS

Multi-group confirmatory factor analysis was used to evaluate successive levels of measurement invariance of the 6-item short form, the UW-SES: (a) configural invariance, i.e., equivalent item-factor structures between groups; (b) metric invariance, i.e., equivalent unstandardized factor loadings between groups; and (c) scalar invariance, i.e., equivalent item intercepts between groups. Responses from the four groups with different diagnostic disorders were compared: MD (n = 172), MS (n = 868), PPS (n = 225), and SCI (n = 242).

RESULTS

The results of this study support that the most rigorous form of invariance (i.e., scalar) holds for the 6-item short form of the UW-SES across the four diagnostic subgroups.

CONCLUSIONS

The current study suggests that the 6-item short form of the UW-SES has the same meaning across the four diagnostic subgroups. Thus, the 6-item short form is validated for people with MD, MS, PPS, and SCI.

Health, Personal, and Environmental Predictors of Wheelchair-Use Confidence in Adult Wheelchair Users

BACKGROUND

There are no predictive models of wheelchair-use confidence. Therefore, clinicians and researchers are limited in their ability to screen for and identify wheelchair users who may be more prone to low wheelchair-use confidence and may benefit from clinical intervention.

OBJECTIVE

The purpose of this study was to identify health-related, personal, and environmental factors that predict perceived wheelchair-use confidence in community-dwelling adults who use manual wheelchairs.

DESIGN

A cross-sectional study was conducted.

METHODS

Community-dwelling manual wheelchair users (N=124) were included in the study if they were ≥50 years of age, had ≥6 months of wheelchair use experience, and had no cognitive impairment. The Wheelchair Use Confidence Scale was used to assess wheelchair-use confidence. The sociodemographic information form, Functional Comorbidity Index, Seating Identification Tool, Interpersonal Support and Evaluation List, and Home and Community Environment Instrument captured the independent variables. Blocks of health, personal, and environmental variables were sequentially entered into the regression model.

RESULTS

Five personal variables (age, standardized beta [β]=-0.18; sex, β=-0.26; daily hours of wheelchair occupancy, β=0.20; wheelchair-use training, β=0.20; and wheelchair-use assistance, β=-0.34) and one environmental variable (need for seating intervention, β=-0.18) were statistically significant predictors, explaining 44% of the confidence variance.

LIMITATIONS

The sample comprised volunteers and, therefore, may underrepresent or overrepresent particular groups within the population. The study's cross-sectional research design does not allow for conclusions to be made regarding causality.

CONCLUSION

Older women who use wheelchairs and who require assistance with wheelchair use may have low wheelchair-use confidence. The same is true for individuals who have no formal wheelchair-use training, who are in need of a seating intervention, and who report few hours of daily wheelchair use. These wheelchair users may require clinical attention and benefit from intervention.

Changing factors associated with parent activation after pediatric hematopoietic stem cell transplant

PURPOSE

To identify factors associated with parent activation in parents of children undergoing pediatric hematopoietic stem cell transplant (HSCT) in the 6 months following HSCT, and to address if their association with parent activation changes over time.

METHODS

Measures for this analysis, including the Parent-Patient Activation Measure (Parent-PAM), were completed by parents (N = 198) prior to their child's HSCT preparative regimen and again at 6 months post-HSCT. Clinical data were also collected. A repeated measures model was built to estimate the association between clinical and demographic factors and parent well-being on Parent-PAM scores. Interactions with time were considered to test for changing effects over time.

RESULTS

Throughout the HSCT course, older parent age was associated with lower Parent-PAM scores (β = -0.29, p = 0.02) and never being married was associated with higher scores (versus married, β = 12.27, p = 0.03). While higher parent emotional functioning scores were not associated with activation at baseline, they were important at 6 months (baseline, β = -0.002, p = 0.96; interaction, β = 0.14, p = 0.03). At baseline, longer duration of illness was associated with increased activation, but this effect diminished with time (baseline, β = 3.29, p = 0.0002; interaction, β = -2.40, p = 0.02). Activation levels dropped for parents of children who went from private to public insurance (baseline, β = 2.95, p = 0.53; interaction, β = -13.82, p = 0.004). Clinical events did not affect Parent-PAM scores.

CONCLUSIONS

Our findings reveal important changes in the factors associated with parent activation in the first 6 months after pediatric HSCT. These findings may reflect the emotional and financial toll of pediatric HSCT on parent activation.

Test of Wheeled Mobility (TOWM) and a short wheelie test: a feasibility and validity study

Objective:

To assess the feasibility and validity of both the Test of Wheeled Mobility (TOWM) and a wheelie test.

Design:

Cross-sectional study.

Setting:

KU Leuven gymnasium.

Subjects:

Thirty male manual wheelchair users (age range 23–53 years) with spinal cord injury.

Interventions:

Participants preformed both tests after completing a personal information form and a ‘Perceived self-efficacy in WM’ scale. The TOWM consists of 30 tasks reflecting functional wheeled mobility. The wheelie test consists of eight tasks measuring the ability to perform a ‘wheelie’ in challenging situations.

Main measure:

Ability, performance time, qualitative and anxiety scores were assessed. Convergent validity was tested by correlating the TOWM and the wheelie test scores. Construct validity was assessed by testing whether the four scores of both tests are significantly related to perceived self-efficacy in wheeled mobility, time since injury and sport participation.

Results:

TOWM average total testing time was 24.7 minutes (±5.93) and the wheelie test was 12.62 minutes (±5.08). Convergent validity was confirmed by the positive correlation between the TOWM and wheelie test total ability scores ( r = 0.84; P < 0.001), quality scores ( r = 0.88) and anxiety scores ( r = 0.66). Moderate correlations were found between the total time scores of the TOWM and wheelie test ( r = 0.47). Construct validity was confirmed by fair to moderate correlations between both test’s scores with time since injury, self-efficacy and sport participation after injury.

Conclusion:

The TOWM and the wheelie tests are feasible and valid instruments for assessing manual wheelchair mobility in persons with spinal cord injury.

University of Washington self-efficacy scale: a new self-efficacy scale for people with disabilities

OBJECTIVE

To develop a self-efficacy scale for people living with multiple sclerosis (MS) and spinal cord injury (SCI) that can be used across diagnostic conditions.

DESIGN

The scale was developed using modern psychometric methods including item response theory. Items were administered at 3 time-points of a longitudinal survey of individuals with MS and SCI.

SETTING

Survey participants with MS were recruited from the National MS Society, and participants with SCI were recruited from the Northwest Regional Spinal Cord Injury Model System and the Shepherd Center at the Virginia Crawford Research Institute in Atlanta, GA.

PARTICIPANTS

Adults aged 18 years and older reporting a definitive diagnosis of MS (N=473) or SCI (N=253).

INTERVENTIONS

None.

MAIN OUTCOME MEASURES

Evaluation of the new self-efficacy measure called the University of Washington Self-Efficacy Scale (UW-SES) included comparisons with the Chronic Disease Self-Efficacy Scale and other patient-reported outcome measures.

RESULTS

UW-SES has excellent psychometric properties including well-functioning response categories, no floor effects, and low ceiling effects. A long form (17 items) and a short form (6 items) are available. The correlation between the score on the newly developed scale and the Chronic Disease Self-Efficacy Scale was high (.83), providing support for convergent validity. Higher self-efficacy scores were statistically significantly associated with better mental health, better physical health, less fatigue, less stress, less pain interference, less pain, fewer sleep problems, and lower depressive symptoms.

CONCLUSIONS

The UW-SES is a psychometrically sound instrument for measuring self-efficacy, validated in MS and SCI, and can be used across both conditions. Both the long form and the short form are available free of charge.

Effects of bone density feedback and group education on osteoporosis knowledge and osteoporosis self-efficacy in premenopausal women: a randomized controlled trial

In this 2-yr randomized controlled trial, we examined the effect of bone mineral density feedback and two different educational interventions (an osteoporosis information leaflet and group-based behavioral education [OPSMC]) on osteoporosis knowledge and self-efficacy in 470 women aged 25-44 yr. Osteoporosis knowledge increased across all intervention groups. Women receiving the OPSMC had a greater increase in both short (beta = +1.33, 95% confidence interval [CI] = 0.72-1.94) and long-term (beta = +0.64, 95% CI = 0.0034-1.25) osteoporosis knowledge, compared to those receiving the leaflet. In contrast, a low T-score was associated with a significant increase in long-term (beta = +0.66, 95% CI = 0.0034-1.25) but not short-term (beta = +0.57, 95% CI = -0.036 to 1.17) osteoporosis knowledge, compared to a normal T-score. Changes in osteoporosis self-efficacy were not associated with either low bone mineral density or receiving the OPSMC but were negatively associated with number of children (beta = -0.9, 95% CI = - 1.4 to -0.3) and working more than 20 h per week (beta = -2.7, 95% CI = -4.6 to -0.8). In conclusion, both the OPSMC and bone density feedback increased osteoporosis knowledge but not self-efficacy over 2 yr. Women with children or who worked full time have decreased osteoporosis self-efficacy, suggesting that this group should be a specific target for future interventional strategies.

Spinal cord injury research: review and synthesis

This article provides a substantive review and synthesis of major areas of emphasis in spinal cord injury (SCI) research. Comprehensive examination of the current status and future implications for SCI research includes consideration of investigations from the following arenas: epidemiology, functional classification and prediction, neurophysiologic testing, models of injury and recovery, psychosocial considerations, surgical strategies, animal laboratory research, economic implications, life expectancy, complication rates, gender differences, pharmacological management, and prevention. Synthesis of these research conclusions from a broad spectrum of laboratory, clinical, and scientific domains provides opportunity for improving SCI prevention, treatment, and adaptation.