Impact of injury level and self-monitoring on free time boredom of people with spinal cord injury

Purpose: The purpose of this study was to determine whether or not level of injury and personality characteristics creates an interaction effect that impacts the free time boredom of individuals with spinal cord injury (SCI).

Method: Using a survey method, a packet containing a cover letter, a consent form, research questionnaires, and a self-addressed, stamped envelope was sent to 500 individuals with SCI who were randomly selected by computer at one of the rehabilitation centres in USA. The research questionnaires included the measures of self-monitoring (SM) and free time boredom (FTB) along with some demographic factors such as gender, ethnicity, age, injury level, and etc.

Results: This study found that a significant interaction effect between injury level and SM on FTB. That is, low self-monitors with tetraplegia reported higher levels of boredom in free time than high self-monitors with paraplegia.

Conclusion: Not all individuals with similar injury levels rate FTB in a similar degree. Individuals' personality characteristics play an important role in experiencing FTB. In particular, the significant interaction effect indicates a potential risk factor for clients with tetraplegia who are low in SM which should be an important consideration in the lives of people with tetraplegia following rehabilitation.     

Earnings among people with spinal cord injury

Krause JS, Terza JV, Dismuke C. Earnings among people with spinal cord injury.

Objective

To identify differences in conditional and unconditional earnings among participants with spinal cord injury (SCI) attributable to biographic, injury, educational, and employment factors by using a 2-part model (employment, earnings).

Design

A secondary analysis of cross-sectional survey data.

Setting

A Midwestern university hospital and a private hospital in the Southeastern United States.

Participants

All participants (N=1296) were adults between the ages of 18 and 64 who had a traumatic SCI at least 1 year before study initiation.

Interventions

Not applicable.

Main Outcome Measures

Earnings were defined by earnings within the previous 12 months and were measured by a single categoric item. Conditional earnings reflect the earnings of employed participants, whereas unconditional earnings reflect all participants with $0 in earnings recorded for those unemployed.

Results

Sex and race were significantly related to conditional earnings, even after controlling for educational and vocational variables. Additionally, conditional earnings (employed participants only) were related to 16 or more years of education, number of years employed, the percentage of time after SCI spent employed, and working in either government or private industry (not self-employed or family business). There was a greater number of significant variables for unconditional earnings, largely reflective of the influence of the portion employed (those not working having $0 in earnings).

Conclusions

Efforts to improve employment outcomes should focus on facilitating return to work immediately after injury, returning to preinjury job, maintaining regular employment, and working for placement in government or private industry. Special efforts may be needed to promote vocational outcomes among women and nonwhites.     

Inactivated influenza vaccination for people with spinal cord injury

OBJECTIVE: To examine the antibody responses of people with spinal cord injury (SCI) to the commercially available trivalent influenza vaccine. DESIGN: Prospective trial of patients and controls. SETTING: Veterans Affairs medical center. PARTICIPANTS: Forty people with SCI and 40 able-bodied subjects. INTERVENTION: Intramuscular administration of inactivated influenza vaccine. MAIN OUTCOME MEASURES: Antibody responses were determined by using the standard hemagglutination-inhibition test before and 4 weeks after vaccination. Serum antibody responses were assessed as follows: (1) percentage of each cohort achieving a 4-fold or greater rise in antibody titer, (2) percentage of each cohort achieving a postvaccination antibody titer of 32 or more, and (3) postvaccination geometric mean antibody titers. RESULTS: The serum antibody responses to each vaccine antigen were similar for the SCI and the control cohorts for the 3 outcomes. Neither the time since injury (1 y) nor the level of injury (paraplegia vs quadriplegia) affected the vaccine antibody responses in the SCI cohort. Subjects older than 65 years had lower postvaccination serum antibody levels than those younger than 65 years ( P <.05). CONCLUSIONS: People with SCI responded to influenza vaccination in a manner similar to able-bodied subjects and would be expected to benefit from vaccination.     

Forgiveness and health-related outcomes among people with spinal cord injury

Purpose.?As motor vehicle accidents and violence cause the majority of spinal cord injuries (SCI) sustained in the USA and people with SCI will likely struggle with emotional issues related to the offender, the purpose of this exploratory study was to examine potential salutary effects of forgiveness among people with SCI incurred traumatically. Specifically, we hypothesized that forgiveness would have positive associations with health-related outcomes.

Method.?A community-based sample of 140 adults (19–82 years of age) with SCI completed a self-report survey regarding dispositional forgiveness of self and others, health behavior, health status, and life satisfaction. Hierarchical multiple regression analyses were employed to examine the relationships in question.

Results.?After controlling for demographic variables, forgiveness of self was significantly associated with health behavior and life satisfaction (uniquely accounting for 7% and 13% of the variance, respectively) and forgiveness of others was significantly associated with health status (uniquely accounting for 9% of the variance).

Conclusion.?Results suggest that forgiveness may play a role in the health and life satisfaction of people with traumatic SCI, with the benefit depending on the type of forgiveness offered.     

Seating and mobility considerations for people with spinal cord injury

For people with spinal cord injuries, the selection of a wheelchair and seating system involves many factors. This clinical perspective describes a model that includes consideration of the person, the wheelchair, the immediate environment between the person and the wheelchair, the intermediate environment of the home and work, and the community environment. The seated posture is examined biomechanically, and literature is reviewed that highlights the differences in the seated position of people with spinal cord injuries and people without spinal cord injuries. Reports regarding overuse injuries of the shoulder and wrists are discussed along with methods of relieving pressure at the buttock and seat interface. The impact that research findings should have on current clinical practice and the need for more research to provide evidence to either support or change current practice is discussed.     

Mediators of disability and hope for people with spinal cord injury

Purpose: To test potential strength-based mediators of functional disability and hope in adults with spinal cord injury. Method: Two hundred and forty-two participants with spinal cord injury were recruited for this study. The mean age of participants was 44.6 years (standard deviation?=?13.2), and 66.1% were men. Participants completed a survey containing a demographic questionnaire, as well as measures of functional disability, hope, self-esteem, proactive coping, perceived social support and disability acceptance. Mediation analysis was conducted using a bootstrap test for multiple mediators. Results: Proactive coping, self-esteem and perceived social support significantly mediated the relationship between functional disability and hope, while disability acceptance did not. The combination of mediators resulted in functional disability no longer being a significant predictor of hope. Conclusions: The strength-based constructs of proactive coping, self-esteem and social support appear effective in predicting hope regardless of severity of spinal cord injury. Functional disability was no longer predictive of hope after controlling for these strength-based constructs. Disability acceptance did not significantly add to the mediation model. These results provide further evidence for strength-based interventions in rehabilitation.

• Implications for Rehabilitation

• Strength-based constructs of proactive coping, self-esteem and social support are important factors for addressing hope following spinal cord injury, regardless of level of severity.

• Rehabilitation services providers should focus efforts on supporting clients in the accurate appraisal of predictable stressors and then generate means for addressing them as a form of proactive coping.

• Rehabilitation services providers must be cautious when addressing self-esteem to focus on perceived competence and learning processes rather than self-esteem directly or through the accomplishment of goals that may not be achieved.

• Knowing that social supports are related to hope post-spinal cord injury, it is important for rehabilitation services providers to recognize potential social supports early in the rehabilitation process and involve those social supports in the rehabilitation process when possible.

     

Preventive skin care beliefs of people with spinal cord injury

Although health beliefs have been correlated with self-care adherence in other chronic conditions, little is known about skin care beliefs after spinal cord injury (SCI). The purpose of this qualitative study was to identify the skin care beliefs of individuals with SCI. The conceptual framework was the Health Belief Model (HBM), which proposes that adherence to a health regimen is motivated by beliefs about susceptibility, severity, barriers, benefits, and self-efficacy. Purposive sampling was used to recruit 22 people with SCI. Content analysis of data collected using semistructured questions was used to identify domains of skin care beliefs, including HBM components. Themes that emerged about skin care beliefs included taking vigilant care, taking charge, maintaining health, and passing up care. Although most participants believed they were susceptible to pressure ulcers and preventive care was important, paradoxical statements about beliefs and preventive behaviors were common. These incongruent responses may reflect ambivalence about competing priorities or the efficacy of preventive practices. Further research is needed to understand this phenomenon. Increased understanding of skin care beliefs will assist in developing tailored teaching programs for people with SCI.     

Reliability and validity tests of the leisure time physical activity questionnaire for people with spinal cord injury

Martin Ginis KA, Phang SH, Latimer AE, Arbour-Nicitopoulos KP. Reliability and validity tests of the Leisure Time Physical Activity Questionnaire for People with Spinal Cord Injury.ObjectiveTo examine the criterion validity and test-retest reliability of the Leisure Time Physical Activity Questionnaire for People with Spinal Cord Injury (LTPAQ-SCI), a brief measure of leisure time physical activity (LTPA) for people with spinal cord injury (SCI).DesignSurvey with a 1-week follow-up.SettingGeneral community.ParticipantsMen and women with SCI (N=103; mean age ± SD, 48.1±12.7y; mean years postinjury ± SD, 17.9±11.9) who used a wheelchair as the primary mode of mobility.InterventionsNot applicable.Main Outcome MeasuresParticipants completed the Physical Activity Recall Assessment for People with SCI (PARA-SCI) and the LTPAQ-SCI. A subset of the participants (n=35) completed the LTPAQ-SCI a second time, 7 days later.ResultsStatistically significant, positive correlations emerged between the LTPAQ-SCI and PARA-SCI measures of mild, moderate, and heavy intensity LTPA as well as total LTPA. All 4 intraclass correlation coefficients were significant across the test-retest period.ConclusionsThis study provides preliminary evidence of the criterion validity and reliability of the LTPAQ-SCI as a brief measure of LTPA performed by people with SCI.     

Perceived barriers to exercise in people with spinal cord injury

OBJECTIVE: To identify barriers to physical fitness faced by individuals with spinal cord injury preventing them from participating in a physical fitness program. DESIGN: In this cross-sectional study, a survey of barriers to exercise was administered to 72 individuals with spinal cord injury. RESULTS: Although 73.6% of the participants expressed an interest in an exercise program, less than half (45.8%) were currently active in an exercise program. Less than half (47.2%) reported that their physician had recommended an exercise program for them. The most frequently cited concerns about barriers to exercise fell into three areas: (1) intrapersonal or intrinsic (e.g., lack of motivation, lack of energy, lack of interest), (2) resources (e.g., cost of an exercise program, not knowing where to exercise), and (3) structural or architectural (e.g., accessibility of facilities and knowledgeable instructors). More individuals with tetraplegia reported concerns over exercise being too difficult and that health concerns kept them from exercising. Greater number of concerns was significantly related to higher levels of perceived stress. CONCLUSIONS: People with spinal cord injury face multiple barriers to physical fitness in functional, psychological, and architectural domains. Identification of these barriers can facilitate the participation of individuals with spinal cord injury in an exercise program, improving long-term health and wellness.     

Remote monitoring of sitting behavior of people with spinal cord injury

The clinical assessment of risk factors leading to pressure sores is normally undertaken in a hospital clinic. However, knowledge of the sitting behavior of the patient outside the clinic may more realistically and comprehensively identify these factors. Many patients, for example, are thought to sit habitually with more pressure on one buttock than the other, and this may significantly increase the risk. This sitting asymmetry may be due to the layout of a work area, the home, or a simple habit. Furthermore, busy wheelchair users may be too preoccupied to remember to reposition themselves regularly but may do so frequently at less hectic times. The applicants have developed a miniature remote pressure logger, which keeps a record of the sitting behavior of the wheelchair user. This study examines the feasibility of using the device for long-term monitoring of sitting pressure distributions during daylong wheelchair activities.     

Impact of associated conditions resulting from spinal cord injury on health status and quality of life in people with traumatic central cord syndrome

Noonan VK, Kopec JA, Zhang H, Dvorak MF. Impact of associated conditions resulting from spinal cord injury on health status and quality of life in people with traumatic central cord syndrome.

Objective

To determine the effect of associated spinal cord injury (SCI) conditions on the health status and quality of life (QOL) in people with traumatic central cord syndrome.

Design

Cross-sectional design.

Setting

Community-based.

Participants

Subjects (N=70) with traumatic central cord syndrome who were a minimum of 2 years postinjury.

Interventions

Not applicable.

Main Outcome Measures

Presence of associated SCI conditions (neuropathic pain, spasticity, bowel, bladder, and/or sexual dysfunction, decreased motor function); health status (36-Item Short-Form Health Survey [SF-36], symptom satisfaction); and QOL.

Results

The SF-36 physical component score (PCS) was lower in subjects who reported problems with bowel, bladder, and/or sexual function (−6.9; 95% confidence interval [CI], −11.6 to −2.2). The PCS was decreased in subjects with a lower motor score and this relationship was negatively affected by spasticity and being less educated. The SF-36 mental component score was negatively affected by neuropathic pain and a lower motor score. Neuropathic pain and a lower motor score were both associated with subjects being dissatisfied with their symptoms. Subjects who had a higher motor score were more likely to have a higher QOL (odds ratio, 1.7; 95% CI, 1.1 to 2.7).

Conclusions

The associated SCI conditions bowel, bladder, and/or sexual dysfunction, neuropathic pain, decreased motor function, and spasticity negatively affect the health status of persons with traumatic central cord syndrome. Diminished motor recovery was the only associated SCI condition to impact QOL. By developing a conceptual model and adjusting for confounders, an estimate for each associated SCI condition's effect on patient outcomes was obtained. Our results indicate the importance of treating or ameliorating associated SCI conditions in order to maximize physical and mental functioning.     

Primary care of people with spinal cord injury: Scoping review

Objective

To perform a scoping review of the empirical evidence between 1980 and 2009 regarding primary care for adults with spinal cord injury (SCI).

Data sources

Peer-reviewed journals were searched from 1980 to 2009 using CINAHL, PubMed-MEDLINE, EMBASE, PsycINFO, Social Sciences Abstracts, and Social Work Abstracts.

Study selection

The key word–driven electronic search identified 42 articles on primary care and SCI. Inclusion criteria narrowed the set to 21 articles that were published in English, that had a sample size of greater than 3, and that offered empirical analysis.

Synthesis

Approximately 90% of people with SCI identify family physicians as their regular doctors; 63% have SCI specialists. People with long-term SCI develop complex rubrics for navigating their personal health care systems. There is conflicting evidence about the effectiveness of outreach programs for maintaining health and preventing complications following SCI. Regular follow-up by specialized teams and annual comprehensive health examination are supported by the evidence. The research shows a high level of consistency in identifying the most common issues raised by people with SCI in primary care, most of which are related to disability—specifically, secondary complications such as bowel or bladder dysfunction and pain. There is also good evidence that many general health issues require attention in this population, such as bone density problems, depression, and sexual and reproductive health issues. There is level 4 and 5 evidence for unmet health needs among individuals living with SCI in the community. Despite patients with SCI being high users of primary care and health services in general, the evidence suggests that the information needs of these patients in particular are poorly met.

Conclusion

A robust system of primary care is the best assurance of good health outcomes and reasonable health service use for people with SCI, including annual comprehensive examination, appropriate specialist use, and attention to accessibility and unmet needs.In most typical primary care practices there are only a handful of patients with spinal cord injury (SCI), and there is considerable uncertainty among family physicians about how to provide them with an optimal standard of care.^1–5 Approximately 1400 new SCIs occur in Canada every year, and although prevalence estimates are highly variable, it is safe to assume that at least 50 000 Canadians live with SCI.⁶ At these rates, the average family medicine case load would have only 1 or 2 patients at a time with SCI.Family physicians play an important coordinating role, acting as a link between patients with SCI and multiple health care providers.⁷ Primary care is good, economical, holistic care, but the literature suggests that family medicine does not serve patients with SCI as well as other patients.^8–11The objective of this study is to describe the empirical evidence currently available regarding primary care for adults with SCI. The scoping study is an emerging method of literature synthesis, defined as a way of mapping key concepts within a research area by assembling multiple sources and types of evidence.¹² The emphasis of a scoping study is on comprehensive coverage, rather than on a particular standard of evidence. Arksey and O’Malley¹² define 4 reasons to undertake a scoping review. This review fulfills their third purpose: to summarize and disseminate research findings to key stakeholders.For the purposes of this study, primary care is defined according to Health Canada’s definition, as “health services provided at the first point of contact with the health care system ... including health promotion, illness and injury prevention, and diagnosis and treatment of illness and injury.”¹³ While primary care can involve a number of service providers (medical and allied health), most people still think of their family doctors first when seeking primary care.¹⁴     

Predictors of personal care assistance for people with spinal cord injury

OBJECTIVE: To assess the predictors of personal care assistance (PCA) use in people with spinal cord injury (SCI). DESIGN: Cross-sectional. SETTING: Follow-up of individuals crossing their 1st, 5th, 10th, 15th, 20th, or 25th anniversary of injury who underwent their initial rehabilitation at a Spinal Cord Injury Model Systems center. PARTICIPANTS: A total of 2154 participants (2547 records) who met the inclusion criteria for the National Spinal Cord Injury Database and had valid values for the main outcome measures. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Daily hours of paid, unpaid, and occasional PCA services. RESULTS: Differences in an interval version of the motor portion of the FIM trade mark instrument accounted for 26.3% of the variance in total PCA hours, Model Systems differences accounted for 9.3%, and no other predictor accounted for more than 2.1% of the variance. CONCLUSION: Activities of daily living functioning, as measured by the motor portion of the FIM, was the strongest predictor of PCA use among people with SCI.     

Wheelchair-specific fitness of persons with a long-term spinal cord injury: cross-sectional study on effects of time since injury and physical activity level

Purpose: To study the impact of time since injury (TSI) and physical activity (PA) on fitness of persons with spinal cord injury (SCI). Method: Cross-sectional study. Persons with SCI (N?=?158) in three TSI strata: 10–19, 20–29 and ≥30 years after SCI and divided in an active and inactive group. Fitness [peak power output (POpeak) and peak oxygen uptake (VO2peak)] was assessed. Results: In persons with tetraplegia, no significant relationship was found between TSI and fitness after controlling for confounders, while a higher activity level was related to a higher POpeak in this group. Active people with tetraplegia also showed less decline in POpeak with an increase in TSI compared to inactive people. In persons with paraplegia, after controlling for confounders, it was shown that TSI had a negative effect on POpeak, while PA was not significantly associated with fitness in people with paraplegia. Conclusions: In people with paraplegia, fitness was significantly lower in those with a longer TSI. Persons with a long TSI might need more attention to remain fit and PA might be an important element in that respect as shown by the results of the group with a tetraplegia.

• Implications for Rehabilitation

• Wheelchair-specific fitness seems to diminish over time after paraplegia.

• An active lifestyle is related to wheelchair-specific fitness in persons with tetraplegia.

• Prevention of long-term deconditioning is very important.

     

损伤程度和损伤时间对脊髓损伤后痉挛的影响

目的:探讨损伤程度和损伤时间对脊髓损伤患者痉挛的发生率的影响.方法:对2003-2008年间广西医科大学第一附属医院康复医学科和眷柱骨科收冶的143例外伤性脊髓损伤患者进行回顾性分析,X2检验比较不同损伤程度、损伤时间的脊髓损伤后痉挛的发生卒,Logistic回归分析判断损伤程度、损伤时间是否为脊髓损伤后痉挛的独立影响因素.结果:不完全性脊髓损伤比完全性脊髓损伤患者痉挛的发生率高(X2=17.781,P=0.000);按损伤后1、2、3个月开始接受治疗分组,1个月组的痉挛的发生率最低,其余依次是2个月组、3个月组(X2=10.515,P=0.005).结论:不完全性脊髓损伤比完全性脊髓损伤患者痉挛的发生率高;越早开始治疗,痉挛发生率越小;损伤程度和损伤时间均是脊髓损伤后痉挛的独立影响因素.     

Depression and life satisfaction among people ageing with post-polio and spinal cord injury

Purpose and background: Attention has recently begun to focus on the ageing of individuals with disability, not only as a longterm follow-up issue but as a unique developmental issue itself. The majority of individuals with an onset of disability before age 30 can now expect to live into their 60s, 70s and beyond. Most of the secondary medical conditions that foreshortened life expectancy have been controlled and improved rehabilitation techniques have evolved over the last 50 years. The average age of persons with post-polio in the United States is over 50 and the average age of persons with spinal cord injury is in the late 40s. New medical, functional and psychosocial problems have been discovered among persons ageing with these and other disabilities. Most of these problems lack sufficient scientific explanation, and therefore, clinical interventions. Quality of life (QOL) issues become involved as these changes occur. From a psychological perspective, QOL can be either positive, as reflected in high life satisfaction, or negative, as reflected in distress and depression. Methods: This study reports on life satisfaction and depression in 360 persons, 121 with post-polio, 177 with SCI and 62 nondisabled age-matched comparisons. The Geriatric Depression Scale and the Older Adult Health and Mood Questionnaire assess depressive symptomatology and a 10-item life satisfaction scale with four-point ratings on each item used. Results: Life satisfaction varied by the group, with the nondisabled group higher than one or both of the other two groups on all scales and the post-polio group higher than the SCI group on six scales. Satisfaction with health, finances, work and overall life were most different. 22% of the post-polio group, 41% of the SCI group and 15% of the non-disabled group had at least significant repressive symptomatology. Conclusion: The results for each group are discussed in terms of their relation to other coping variables that were assessed, particularly social support and coping methods.     

Predictors of psychosocial adaptation among people with spinal cord injury or disorder

OBJECTIVE: To examine the influence of disability-related medical and psychologic variables on psychosocial adaptation to spinal cord injury or disorder (SCI/D). DESIGN: A structural equation modeling design linking 3 sets of predictive variables to an outcome measure of adaptation. SETTING: Two outpatient SCI clinics (1 veteran, 1 civilian) in Texas. PARTICIPANTS: Veterans (n=181) and civilians (n=132) with SCI/D. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The adaptation outcome was measured by 2 subscales (acknowledgment, adjustment) of the Reactions to Impairment and Disability Inventory (RIDI) and by the Quality of Life Scale. The predictive variables were measured by a demographic questionnaire, 3 subscales (intrusion, re-experiencing, hyperarousal) of the Purdue Posttraumatic Stress Disorder-Revised scale, the McMordie-Templer Death Anxiety Scale, and 3 subscales (anxiety, depression, denial) of the RIDI. RESULTS: Goodness-of-fit indices suggested that a revised model of adaptation was a moderately good fit to the data. The revised model of adaptation indicated that there were medium total effects (direct plus indirect) on psychosocial adaptation by 2 latent variables (disability severity and impact, negative affectivity) and small total effects on psychosocial adaptation by disengagement coping. The latent factor of disengagement coping had the strongest direct effect on adaptation (although not statistically significant). Disability severity and impact had medium indirect effects and negative affectivity had small indirect effects on psychosocial adaptation. All of the aforementioned effects had a negative coefficient. CONCLUSIONS: Negative emotional responses (eg, depression, anxiety) to SCI/D, disengagement-type coping (eg, disability denial, avoidance), and the severity and impact of disability were related to lower levels of adaptation to SCI/D.