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

Patient activation during the first 6 months after the start of spinal cord injury rehabilitation: a cohort study

BACKGROUND

Spinal cord injury (SCI) is a serious injury that leads to motor and sensory disorders and ultimately affects people's physiological, psychological, and social well-being.

AIM

To test patient activation from discharge from the department of spinal surgery until 6-month follow-up.

DESIGN

Longitudinal inception cohort study.

SETTING

This study was conducted at the Spinal Surgery Department of the Third Affiliated Hospital of Soochow University in China.

POPULATION

A total of 367 participants with traumatic SCI received community-based or hospital-based rehabilitation between October 2020 and November 2023 and were recruited using convenience sampling.

METHODS

Patient activation was evaluated using the short version of the Patient Activation Measure (PAM). Assessments were conducted at baseline, 3-month, and 6-month follow-up.

RESULTS

At baseline, the mean PAM score was 53.2, with the number of participants in PAM levels 1, 2, 3, and 4 being 92, 142, 114, and 19, respectively. Between baseline and 6-month, 164 participants remained at the same PAM level, 85 participants increased, 86 participants decreased. The multivariate mixed-effects model analysis showed that the PAM score decreased significantly over time (P=0.007). Older age had a positive effect on improvement over time (P=0.023). Higher self-efficacy, resilience, health literacy, and Modified Barthel Index (MBI) remained significantly related with higher PAM scores over time (P<0.001, P<0.001, P<0.001, and P=0.010, respectively). Fewer symptoms of depression remained significantly related with higher PAM scores over time (P<0.001).

CONCLUSIONS

PAM scores decreased slightly over time from the start of rehabilitation up to the 6-month follow-up. Furthermore, about two-third of participants remained at low levels of patient activation, which suggests that patient-centered care interventions during rehabilitation to improve patient activation might be of value.

CLINICAL REHABILITATION IMPACT

This study examined the course of patient activation from the start of SCI rehabilitation to the 6-month follow-up period. These findings provide the necessary basis for the development and evaluation of effective interventions to promote patient activation levels and enhance self-management in people with SCI.

Changes in mood states during inpatient rehabilitation after spinal cord injury

DESIGN

Retrospective observational study.

OBJECTIVE

To analyze changes in mood states during the acute phase of inpatient rehabilitation for spinal cord injury (SCI) and the factors associated with worse mood states and less improvement.

SETTING

Spinal unit in Italy.

PARTICIPANTS

The study included people with SCI admitted between 2014 and 2019 and treated for psychological problems with a focus on 'emotion processing' and 'emotional adjustment'. The sample included 170 patients (71.8% male, mean age 47.1 ± 16, range 17-78), 46.5% with tetraplegia and 50% with comorbidities.

OUTCOME MEASURES

The Profile of Mood States (POMS) questionnaire was used to assess mood states at baseline and at the end of treatment. Multiple linear regression models were used to identify factors associated with changes in mood states during treatment.

RESULTS

At baseline, patients with distress related to SCI diagnosis reported lower levels of vigor, whereas those with distressing life events reported higher levels of anger and confusion-bewilderment. POMS subscales improved significantly by at least 4 points. ASIA Impairment Scale (AIS) C score, living with family of origin, comorbidities and critical events during hospitalization were associated with greater improvements, whereas higher education was associated with less improvement in depressive mood. In tetraplegic patients, higher improvements in depressive mood were associated with greater independence at discharge, whereas in patients with paraplegia, higher improvements in anxiety and vitality were associated with better mobility.

CONCLUSION

Our results indicate that mood states improved in people with SCI receiving a psychological treatment. Socio-demographic and SCI-related characteristics associated with a greater effect of psychological treatment should be considered in order to tailor the intervention.

Disability trajectories individuals with spinal cord injury in mainland China: do psychosocial resources and diseases factors predict trajectories?

STUDY DESIGN

Observational cohort study.

OBJECTIVE

To identify classes of disability trajectories from 1 month post-injury (acute hospital) to 6 months post-injury (individuals with SCI individuals who stay in rehabilitation setting or back in the community), and to investigate whether psychosocial resources and disease factors can predict disability trajectory.

SETTING

Spinal surgery in three Class III hospitals. Hospitals in China are divided into three classes (Class I, II and III).

METHODS

All the participants were submitted to WHO Disability Assessment Schedule (WHO-DAS 2.0) at three times; and personal data anamnesis, level of hope, level of PTSD, level of social support were recorded at first time. All the data collected by the master's students who participated in this study.

RESULTS

Two disability trajectories were identified using the latent class growth model: the continuous high disability group (N = 196, 93.3%) and the low starting point stabilization group (N = 14, 6.7%). Complete injury(ASIA-A) with SCI and more depression in the stable condition after SCI surgery were more likely to be classified as having higher disability than those with a lower disability trajectory. Occupation, annual family income, hope, social support, and Post-traumatic Stress Disorder (PTSD) cannot predict individuals belonging to trajectory classes.

CONCLUSION

These findings emphasize the importance of ASIA and depression in the early recovery stage after SCI and support the opinion that strengthening psychological nursing and rehabilitation management at an early stage after SCI will benefit individuals with a lower disability trajectory.

Mediating Effect of Emotional Symptoms on the Association Between Alexithymia and Substance Dependence in Patients with Substance Use Disorder: The Protective Role of Family Support and Self-Efficacy

Background

The etiology of the association between alexithymia and substance use is complex, and there is an urgent need to explore the related factors. The aims of this study were to develop a conceptual model to verify the mediating effect of emotional symptoms and moderating effect of family support and self-efficacy on the association between alexithymia and substance dependence.

Methods

A total of 117 participants (103 males and 14 females; age at 35.29 ± 8.72 years) with substance use disorder were analyzed. Outcome measures included demographic characteristics, severity of dependence, symptoms of alexithymia, emotional symptoms (depression, anxiety, and somatic symptoms), level of family support, and self-efficacy. The PROCESS macro in SPSS was used to estimate path coefficients and adequacy of the moderated mediation model, which was adjusted for demographic characteristics.

Results

Most of the participants had amphetamine use disorder (n = 42, 35.9%). After controlling for the effects of demographic characteristics, the moderated mediation model showed that the association between alexithymia and substance dependence was mediated by emotional symptoms and moderated by family support and self-efficacy. A higher level of family support reduced the effect of alexithymia on emotional symptoms, and a higher level of self-efficacy reduced the effect of emotional symptoms on substance dependence.

Conclusion

Family support and self-efficacy have a protective effect on the association between alexithymia and substance dependence in patients with substance use disorder. Early interventions to enhance these protective factors may be beneficial.

Does the disposition of passive coping mediate the association between illness perception and symptoms of anxiety and depression in patients with spinal cord injury during first inpatient rehabilitation?

PURPOSE

To examine associations between illness perception, also called illness cognitions or appraisals, disposition of passive coping, and symptoms of anxiety and depression, and to test whether passive coping mediates the associations between illness perception and symptoms of anxiety and depression.

MATERIALS AND METHODS

Longitudinal, multicentre study. Participants were inpatients of spinal cord injury (SCI) rehabilitation. Measures included the Brief Illness Perception Questionnaire (B-IPQ), the Utrecht Coping List passive coping subscale (UCL-P), and the Hospital Anxiety and Depression Scale (HADS). Mediation was tested with the PROCESS tool.

RESULTS

The questionnaires were completed by 121 participants at admission and at discharge. Of them, 70% were male, 58% had a paraplegia, and 82% an incomplete lesion. Weak to strong (0.294-0.650) significant associations were found between each pair of study variables. The use of passive coping strategies mediated the associations between illness perception and symptoms of anxiety and depression.

CONCLUSION

Symptoms of anxiety and depression were more frequent in people who have a threatening illness perception combined with a lower use of passive coping strategies. Therefore, it is advised that patients are screened and treated for threatening illness perception and high use of passive coping strategies during rehabilitation after SCI.

Psychosocial Outcomes Associated With Types and Intensities of Physical Activity in People With Spinal Cord Injury: The Mediating Role of Self-Efficacy and Functionality

BACKGROUND

Low rates of participation and quality of life (QoL) and high rates of psychological distress are common in spinal cord injury (SCI) population. Research has supported the mediating role of self-efficacy and functionality in improving psychosocial outcomes. Furthermore, evidence supports the impact of physical activity (PA) on psychosocial variables, but little is known about the types and intensities of PA. The objective of this study was to determine whether functionality and/or general self-efficacy (GSE) mediate the relationships between the various types of PA: (1) lifestyle and (2) leisure-time physical activity (LTPA); and various intensities of PA: (1) mild, (2) moderate, and (3) heavy PA with participation, psychological distress, and perception of QoL.

METHODS

The Physical Activity Recall Assessment for SCI, and measures of functionality, GSE, participation, psychological distress, and perception of QoL were administered to 159 participants. Path analysis was performed using Jeffrey's Amazing Statistics Program.

RESULTS

GSE significantly mediated, and functionality partially significantly mediated, the relationship between LTPA and psychosocial outcomes. GSE and functionality did not mediate the relationship between lifestyle activity and psychosocial outcomes.

CONCLUSIONS

It is recommended that people with SCI perform LTPA on a regular basis to achieve psychosocial benefits. These programs should be accompanied by strategies to improve GSE.

Association Between Anxiety Symptoms, Depression Symptoms, and Life Satisfaction Among Individuals 1 Year After Spinal Cord Injury: Findings From the SCIRehab Project

Objective

To examine the association between anxiety symptoms, depression symptoms, and life satisfaction 1 year after SCI.

Design

Cross-sectional analysis of data from the SCIRehab Project. A linear regression model estimated the association between anxiety symptoms and life satisfaction and tested the moderating effect of depression symptoms on the association between anxiety symptoms and depression symptoms with an interaction term.

Setting

Six rehabilitation facilities across the United States.

Participants

A total to 940 persons older than 12 years who received inpatient spinal cord injury (SCI) rehabilitation between 2007 and 2009 were followed up 1 year post injury (n=940).

Interventions

None

Main Outcome Measures

Life satisfaction 1 year after SCI measured via the Satisfaction With Life Scale.

Results

Unadjusted analyses showed anxiety symptoms were associated with decreased life satisfaction for individuals with SCI. In adjusted analyses, anxiety symptoms were not associated with life satisfaction. In adding an interaction term, anxiety symptoms were associated with 2 points lower life satisfaction holding the other variables constant (P=.02). There was a moderating effect of depression symptoms on the association between anxiety symptoms and life satisfaction. Persons with anxiety symptoms had lower life satisfaction scores at lower levels of depression symptoms but higher life satisfaction scores at higher levels of depression symptoms than persons with no anxiety.

Conclusions

In clinical settings, both anxiety and depression symptoms should be monitored, measured, and treated together to optimally improve life satisfaction for persons with SCI. Prioritizing interventions known to have transdiagnostic effects may achieve the best results.

Learning self-care skills after spinal cord injury: a qualitative study

BACKGROUND

People with a recent spinal cord injury (SCI) often follow intensive rehabilitation. Learning appropriate self-care, deal with their impairments and prevent secondary health conditions (SHCs), is highly important during rehabilitation. To date it is not clear how self-care skills are taught to people with SCI. The objective of this study was to understand how people with SCI experienced the learning of appropriate self-care skills during inpatient rehabilitation, including the role of the rehabilitation team.

METHODS

Individual semi-structured interviews were conducted with 15 people with SCI, recently discharged from initial inpatient rehabilitation. Interviews were audio-taped, transcribed and analyzed thematically.

RESULTS

Two main themes and seven sub-themes were identified. Participants stated that the contribution of the rehabilitation team to learning self-care, including prevention of SHCs, was mostly made by optimizing opportunities to learn through experience. For preventing SHCs, education and lessons learned from the professionals during therapy and the formal educational program, was experienced as especially important. Further, the motivational attitude of the professionals which participants found stimulating and was based on respect, combined with their positive contribution as one team, were seen as essentials elements for learning appropriate self-care. However participants did not recognize the contribution of the nursing staff as part of their rehabilitation, although it was seen as very important. An important aspect of the participants' own contribution was challenging oneself to learn self-care. This was done in different ways by the participants. Further, their own mental adjustment was considered important in the learning process. The gaining of confidence was by most participants seen as personal characteristic, although they also recognized the importance of the team effort and the experiences they underwent.

CONCLUSIONS

Learning appropriate self-care was mostly done through experience, by challenging themselves, and making use of the opportunities given by the members of the rehabilitation team. The same strategies used by the rehabilitation team to teach people with SCI to perform appropriate self-care, were also helpful for the participants to gain confidence. Explicit attention for self-care training as an important goal in SCI rehabilitation may strengthen the nursing staff's role and stimulate interdisciplinary working.