Examination of the Relationships Among Social Networks and Loneliness on Health and Life Satisfaction in People with Spinal Cord Injury/Dysfunction

Measures for Persons with Spinal Cord Injury to Monitor Their Transitions in Care, Health, Function, and Quality of Life Experiences and Needs: A Protocol for Co-Developing a Self-Evaluation Tool

Evaluating the experiences of persons with spinal cord injury (PwSCI) regarding their transitions in care and changes in health, function, and quality of life is complex, fragmented, and involves multiple tools and measures. A staged protocol was implemented with PwSCI and relevant expert stakeholders initially exploring and selecting existing measures or tools through a modified Delphi process, followed by choosing one of two options. The options were to either support the use of the 10 selected tools from the Delphi method or to co-develop one unique condensed tool with relevant measures to evaluate all four domains. The stakeholders chose to co-develop one tool to be used by persons with SCI to monitor their transition experiences across settings and care providers. This includes any issues with care or support they needed to address at the time of discharge from acute care or rehabilitation and in the community at 3, 6, and 12 months or longer post-discharge. Once developed, the tool was made available online for the final stage of the protocol, which proposes that the tool be reliability tested prior to its launch, followed by validation testing by PwSCI.

Factors associated with perceived social isolation among veterans with spinal cord injury and disorders: Cross sectional survey

CONTEXT/OBJECTIVE

Examine demographics, injury characteristics, objective measures of social isolation and health factors that are associated with perceived social isolation (PSI) among Veterans with spinal cord injury and disorders (SCI/D).

DESIGN

Cross-sectional survey.

SETTING

The Veterans Health Administrations (VHA) SCI/D system of care.

PARTICIPANTS

Veterans with SCI/D who have used the VHA health care system.

INTERVENTION

Not applicable.

OUTCOMES MEASURES

We assessed unadjusted associations of high PSI (above population mean) vs low (normative/below population mean), and multivariable logistic regression for independent associations with PSI.

RESULTS

Out of 1942 Veterans with SCI/D, 421 completed the survey (22% response rate). Over half (56%) had PSI mean scores higher than the general population. Among the objective measures, having a smaller social network size was associated with increased odds of high PSI (OR 3.59, P < .0001); additionally, for health factors, having depression (OR 3.98, P < 0.0001), anxiety (OR 2.29, P = 0.009), and post-traumatic stress (OR 2.56, P = 0.003) in the previous 6 months, and having 4 or more chronically occurring secondary conditions (OR 1.78, P = 0.045) was associated with increased odds of high PSI. The most commonly identified contributors to feelings of PSI included mobility concerns (63%), having a SCI/D (61%), and concerns about being a burden on others (57%).

CONCLUSIONS

Factors such as social network size may be used to identify individuals with SCI/D at risk for PSI. Additionally, by identifying mental health problems, presence of multiple chronically occurring secondary conditions, and Veteran-identified contributors of PSI, we can target these factors in a patient-centered interventions to identify and reduce PSI.

Travel and Social Isolation of People With Spinal Cord Injury

Background

People with spinal cord injury (SCI) are at high risk for social isolation because they face barriers to social participation owing to limitations in physical functioning, secondary health conditions, and environmental barriers. Research has shown that social isolation, an objective lack of contact with others, can lead to loneliness, mental health issues, and low life satisfaction. Leisure travel, which involves interactions with others, may have the potential to reduce social isolation.

Objectives

To explore the association of travel participation with social isolation among people with SCI.

Methods

A total of 11,091 cases from 2016-2021 in the SCI Model Systems database were included in the study. Participants were categorized into low and high social isolation groups. A hierarchical logistic regression was performed with social isolation as the dependent variable and travel groups as the independent variable, while controlling for age, family income, and health conditions.

Results

Travel participation is negatively associated with social isolation. People with SCI who traveled for one to two nights (odd ratio [OR] 0.52, 95% CI 0.40-0.67), three to four nights (OR 0.56, 95% CI 0.43-0.72), or more than five nights (OR 0.41, 95% CI 0.35-0.49) in the past 12 months are less likely to be socially isolated compared to those who have not traveled in the past 12 months.

Conclusion

Travel participation may help reduce the social isolation of individuals with SCI. Therapists and rehabilitation professionals should design effective travel training programs that encourage patients with SCI to travel more often.

Reducing endocrine metabolic disease risk in adults with chronic spinal cord injury: strategic activities conducted by the Ontario-Quebec RIISC team

PURPOSE

The Rehabilitation Interventions for Individuals with a Spinal Cord Injury in the Community (RIISC) team aimed to develop and evaluate innovative rehabilitation interventions to identify endocrine metabolic disease (EMD) risk, intending to reduce the frequency and severity of EMD related morbidity and mortality among adults living with chronic spinal cord injury or disease (SCI/D).

MATERIALS AND METHODS

An interprovincial team from Ontario and Quebec reviewed available EMD literature and evidence syntheses and completed an inventory of health services, policies and practices in SCI/D care. The review outcomes were combined with expert opinion to create an EMD risk model to inform health service transformation.

RESULTS

EMD risk and mortality are highly prevalent among adults with chronic SCI/D. In stark contrast, few rehabilitation interventions target EMD outcomes. The modelled solution proposes: 1) abandoning single-disease paradigms and examining a holistic perspective of the individual's EMD risk, and 2) developing and disseminating practice-based research approaches in outpatient community settings.

CONCLUSIONS

RIISC model adoption could accelerate EMD care optimization, and ultimately inform the design of large-scale longitudinal pragmatic trials likely to improve health outcomes. Linking the RIISC team activities to economic evaluations and policy deliverables will strengthen the relevance and impact among policymakers, health care providers and patients.

Australian arm of the International Spinal Cord Injury (Aus-InSCI) Community Survey: 3. Drivers of quality of life in people with spinal cord injury

STUDY DESIGN

Cross-sectional population-based survey for the Australian cohort of the International Spinal Cord Injury (InSCI) Community Survey.

OBJECTIVES

To differentiate subgroups of people with spinal cord injury (SCI) who self-report good and poor overall quality of life (QoL) using domains of the International Classification of Functioning (ICF), and to evaluate how these factors contribute to QoL when considered together, while controlling confounders.

SETTING

Australian survey data from four state-wide SCI services, one government insurance agency, and three not-for-profit consumer organisations.

METHODS

Explanatory factors for QoL were compared between participants reporting poor vs. good QoL. Path models estimated total, direct and mediated contributions from each explanatory factor to QoL ratings after accounting for confounders.

RESULTS

Most participants (62%) reported good or very good QoL, 12% reported poor or very poor QoL. When explanatory factors were considered together, the strongest total effects on QoL involved social integration (+0.36 SDs), subjective social position (+0.29), secondary health condition burden (-0.28), activity/participation problem burden (-0.26), day-to-day assistance (-0.26), mental health (+0.18), pain (-0.16), self-efficacy (+0.15), vitality (+0.14) and environmental barriers (-0.11). Effects of social integration, mental health, vitality, self-efficacy, pain and activity/participation problems were partly or wholly direct.

CONCLUSION

Opportunities to improve QoL in people with SCI exist at every level of the health system. Virtually all aspects of the ICF framework make a substantive difference to QoL outcomes. Social and psychological factors and ability to complete desired activities have key direct effects and influence effects of secondary health condition burden and environmental barriers.

Randomised controlled trial of the Caring Connections intervention to reduce loneliness and perceived social isolation in persons with spinal cord injuries and disorders: study protocol

INTRODUCTION

Perceived social isolation and loneliness are understudied in individuals with spinal cord injuries and disorders (SCI/D). The few existing studies reported that they are common, yet poorly treated, in persons with SCI/D. We developed an intervention called Caring Connections (CC) aimed at reducing loneliness and perceived social isolation in persons with SCI/D. CC is a peer-based, recurrent letter writing programme designed to provide moments of positivity. We will conduct and evaluate a randomised controlled trial (RCT) to assess changes in loneliness and social isolation outcomes between the CC intervention and control conditions in community-dwelling individuals with SCI/D.

METHODS AND ANALYSIS

RCT to compare outcomes of community-dwelling individuals with SCI/D undergoing the CC intervention to an attention control group (receiving informational materials on life domains important to a good quality of life). Eligible participants include adults with chronic SCI/D who have been injured for >1 year. The primary outcome is loneliness, measured using the UCLA (University of California, Los Angeles) 3-item Loneliness Scale. Other outcomes include perceived social isolation and social support. A post-trial process evaluation will assess perceived benefits, negative impacts and satisfaction with the intervention, and areas for improvement. We will test the hypotheses of reduced loneliness and perceived social isolation in the CC intervention arm from baseline to 6 months and will also measure the magnitude of effect (difference between CC arm and attention control arm). We will use generalised linear models for repeated measures. We will assume a one-tailed, α=0.05 level of significance for comparisons. Process outcomes will be analysed using mixed methods, including frequencies for the rating items and thematic analysis for open-ended item responses.

ETHICS AND DISSEMINATION

This study has received Hines Veterans Affairs Institutional Review Board approval (#1673654). Findings will be disseminated widely through healthcare organisations, peer-reviewed publications and conferences.

TRIAL REGISTRATION NUMBER

NCT05295108.

Examination of social disconnectedness and perceived social isolation on health and life satisfaction in community-dwelling adults with dysvascular lower limb loss

BACKGROUND

People with physical disabilities are at risk for social isolation, which has been shown to negatively influence health and well-being.

OBJECTIVES

The purpose of this study was to examine the association of social disconnectedness and perceived social isolation (PSI) on health-related quality of life (HrQoL) and life satisfaction in adults with dysvascular lower extremity amputation (LEA).

STUDY DESIGN

Cross-sectional survey.

METHODS

Data were collected from community-dwelling adults with dysvascular major LEA (N = 231). The main outcome measures were the Short-Form 36 and the Life Satisfaction-11. Other measures were used to quantify comorbidities/secondary health conditions, PSI, social disconnectedness, self-efficacy, social support, and social engagement. Three hierarchical regression models were conducted to predict (1) physical HrQoL, (2) mental HrQoL, and (3) life satisfaction.

RESULTS

Approximately one-third of the sample had high levels of social disconnectedness and PSI. The regression model predicting physical HrQoL accounted for 47% of the variance and only found that higher levels of mobility, lower perceived impact of comorbidities/conditions, and higher levels of social engagement and self-efficacy were associated with better physical HrQoL. A model predicting mental HrQoL accounted for 36% of the variance, with older age, lower PSI, and higher levels of self-efficacy being significant predictors. Finally, the model predicting life satisfaction accounted for 56% of the variance, with older age, lower perceived impact of comorbidities/conditions, and higher self-efficacy remaining as significant predictors.

CONCLUSIONS

These findings highlight that one-third of our sample were at risk for being socially isolated and that PSI was influential on mental HrQoL and life satisfaction. There is a need for approaches to address social isolation for people with dysvascular LEA living in the community to optimize their long-term health and well-being.

Life Satisfaction in Individuals With Long-Term Traumatic Spinal Cord Injury: An Investigation of Associated Biopsychosocial Factors

OBJECTIVE

To investigate relationships between self-reported biological, psychological, and social factors and global, vocational, and home life satisfaction in individuals with traumatic spinal cord injury (SCI) an average of more than 30 years postinjury.

DESIGN

Cross-sectional analyses of self-report assessment data.

SETTING

Specialty and university hospitals in the southeastern and midwestern United States.

PARTICIPANTS

Individuals with a history of traumatic SCI (n=546) who responded to the most recent data collection period of the SCI Longitudinal Aging Study (2018-2019) and who were at least 2 years postinjury and at least 18 years or older at initial study enrollment.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Global life satisfaction, home life satisfaction, and vocational life satisfaction as measured by the Life Situation Questionnaire-Revised.

RESULTS

Taken together, the biopsychosocial variables explained 55.1% of the variance in global life satisfaction. Less severe depressive symptoms, greater emotional social support, and greater instrumental social support were significantly associated with greater global life satisfaction. Together, the independent variables explained 50.7% of the variance in home life satisfaction. Being in a relationship, having less severe depressive symptoms, having greater emotional social support, and having greater instrumental social support were significantly associated with home life satisfaction. Together, the independent variables explained 44.8% of the variance in vocational satisfaction. Being White, non-Hispanic, having more years of education, being in a relationship, having less severe depressive symptoms, and having greater emotional social support were significantly associated with greater vocational satisfaction.

CONCLUSION

These results support the need to assess psychological symptoms and available social support as potential modifiable factors related to several domains of life satisfaction in this aging population. Improving psychological symptoms and strengthening available social support may relate to improved life satisfaction.