Psychometric validation of a subjective well-being measure for people with spinal cord injuries

Hindi translation and reliability testing of the international spinal cord injury quality of life basic data set version 1.0

STUDY DESIGN

Methodological study design: translation and test-retest reliability testing.

OBJECTIVES

To translate International Spinal Cord Injury Quality of Life Basic Data Set (ISCIQoLBDS) Version 1.0 into Hindi language and conduct reliability testing of Hindi ISCIQoLBDS (hISCIQoLBDS).

SETTING

The study was conducted at Indian Spinal Injuries Centre, New Delhi, India.

METHODS

The study was done in two phases-translation of ISCIQoLBDS Version 1.0 into Hindi language and reliability testing of hISCIQoLBDS. In the translation phase, the data set was forward translated by two independent professional translators. Then backward translation was done by another pair of professional translators to ensure the essence of the data set. For their feedback, field testing of hISCIQoLBDS was done on ten individuals with Spinal Cord Injury (SCI). After this, an expert panel reviewed their recommendations, and the final hISCIQoLBDS was administered on 50 participants with SCI for test-retest reliability of the data set.

RESULTS

hISCIQoLBDS was found to be equivalent to ISCIQoLBDS Version 1.0 on back-translation. It showed high test-retest reliability for each item in the data set. Intraclass Correlation Coefficient (95% CI) for items of hISCIQoLBDS was within the range of (0.91-0.98).

CONCLUSION

The hISCIQoLBDS is a stepwise systematic Hindi translation of the ISCIQoLBDS Version 1.0 for the Hindi literate population with high test-retest reliability. It can facilitate international data exchange on the quality of life (QoL) of Hindi literate individuals with SCI.

The relationships among self-efficacy, social support, resilience, and subjective well-being in persons with spinal cord injuries

AIMS

To examine the contribution of self-efficacy, social support, and resilience to subjective well-being (SWB), to examine the mediating effect of resilience in the relationship between social support and SWB, and to investigate if marital status moderates the relationship between social support and SWB among people with spinal cord injuries (SCI).

DESIGN

A descriptive cross-sectional study, conducted from November 2017-January 2018.

METHODS

One hundred and two individuals with SCI were recruited from a rehabilitation center and a community setting in Nepal. SWB, self-efficacy, social support, resilience, demographics and injury-related information was collected using self-reported questionnaires. Hierarchical regression analysis, mediation analysis, and moderation analysis were performed in SPSS and R to test the hypotheses.

RESULTS

Self-efficacy, social support, and resilience uniquely explained 19% of the variance on SWB after controlling for demographic covariates. In the mediation analysis, resilience partially mediated the relationship between social support and SWB. In the moderation analysis, marital status moderated the relationship between resilience and SWB.

CONCLUSION

Subjective well-being of persons with SCI is associated with many factors. Interventions to strengthen self-efficacy, resilience, and social networks can be effective to enhance SWB. A stronger association between resilience and SWB among single participants reflects the need to provide specific considerations for persons with SCI who are single. Longitudinal and/or experimental studies are needed to further validate these findings.

IMPACT

This study identified external and internal factors contributing to SWB in persons with SCI. Self-efficacy, social support, and resilience were found to be significantly associated with SWB. Resilience acted as a mediator between social support and SWB. The relationship between resilience and SWB was stronger in single participants than married participants. The findings have potential implications in the field of nursing since nurses are one of the integral members of the SCI rehabilitation team.

Time-related changes in quality of life in persons with lower limb amputation or spinal cord injury: protocol for a systematic review

BACKGROUND

Experiencing a lower limb amputation (LLA) or spinal cord injury (SCI) is a life-changing event, affecting physical and systemic function as well as having psychological and social impacts. However, the severity of the physical impairment and/or motor disability demonstrates a poor relationship with patient-reported quality of life, suggesting that other factors determine such outcomes. As such, holistic health-related quality of life (QoL) assessment is an important tool to monitor long-term outcomes. While there are some studies that have assessed the influence of variables such as age at time of injury occurrence and time since injury on changes in QoL, there are no systematic reviews which synthesise this evidence.

METHODS/DESIGN

All follow-up study designs will be included, where data from multiple time points are presented. Searches will target both SCI and LLA populations where a validated measure of QoL has been used: Medical Outcome Study Short-Form 36/12 or the World Health Organization Quality of Life instruments 100 and BREF. Studies must include adult participants (≥ 18 years at time of injury) and detail time since injury event and patient age. The primary objective is to establish the effects of participant age and time since injury on QoL scores. Secondary objectives include determining between-group effects (i.e. LLA vs. SCI). We will search PubMed, Embase and Web of Science databases, supplemented by hand-searching references within existing review articles and experimental studies. Reviewer pairs will conduct screening and quality assessment of included papers. Results will be stratified by impairment, QoL tool, age/time since injury and additional variables such as sex, race, comorbidity or disease aetiology, as appropriate. If sufficient high-quality data exist, a meta-analysis will be conducted.

DISCUSSION

The results of this systematic review will summarise evidence of how QoL changes across the life course, relative to both patient age and time since injury, for both LLA and SCI populations. By enabling a direct comparison of different chronic conditions, disability-specific differences in QoL changes over the life course can be identified.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018096633 .

Assessment of quality of life in relation to spasticity severity and socio-demographic and clinical factors among patients with spinal cord injury

Objective: To assess the impact of spasticity severity as well as socio-demographic and clinical factors on quality of life (QOL) and to identify factors predicting poor QOL among patients with spinal cord injury (SCI)Design: Descriptive cross-sectional study.Setting: Tertiary care clinic in Istanbul, Turkey.Participants: A total of 110 patients with SCI (mean (SD) age: 43.8 (14.7) years, 58.2% were males) were enrolled.Assessments: The American Spinal Injury Association (ASIA) Impairment Scale (AIS), Modified Ashworth Scale (MAS) and Turkish version of the World Health Organization Quality of life questionnaire (WHOQOL-BREF) were utilized to determine the SCI category, severity of spasticity and QOL scores, respectively.Outcome measures: The WHOQOL-BREF scores were evaluated with respect to the severity of spasticity, aetiology and duration of SCI, AIS category and method of bladder management.Results: The mean (SD) physical health (41.9 (15.3) vs. 46.5 (10.9), P = 0.029), social relationships (45.6 (20.2) vs. 53.8 (17.3), P = 0.025) and total WHOQOL-BREF scores were significantly lower in patients with more severe spasticity. Multivariate linear regression analysis revealed that severity of spasticity was a significant predictor of decreased WHOQOL-BREF total scores, physical domain scores and social relations domain scores by 11.381 (P = 0.007), 11.518 (P = 0.005) and 17. 965 (P = 0.004), respectively.Conclusion: In conclusion, addressing QOL in relation to severity of spasticity for the first time among Turkish SCI patients, our findings revealed a negative impact of the spasticity severity on the WHOQOL-BREF scores, particularly for physical health and social relationship domains.

Comparison of disability and quality of life between patients with pediatric and adult onset paraplegia

OBJECTIVE

To investigate the factors that affect disability and quality of life in patients with spinal cord injuries (SCIs) and to compare the degree of disability and quality of life in patients with SCI according to over and under 18 years of age when their injury occurred.

DESIGN

Cohort study.

SETTING

Two academic hospitals in Istanbul, Turkey.

PARTICIPANTS

Forty patients with SCI were included in this study. Group 1 included 20 patients with SCI who were younger than 18 years of age when their injury occurred, Group 2 included 20 patients who were older than 18 years of age when their injury occurred.

OUTCOME MEASURES

Patients' demographics, duration of SCI and degree of disability were assessed using the Craig Handicap Assessment and Reporting Technique (CHART). Quality of life was assessed using the World Health Organization Quality of Life Scale Short Form (WHOQOL-Bref). Depression was assessed using the Beck Depression Inventory (BDI).

RESULTS

Although there was no significant difference between the BDI scores and CHART scores of the two groups, environment domain scores in the WHOQOL-Bref were significantly higher in Group 2 than in Group 1 (P<0.05). No significant correlation was found between age of SCI onset, disease duration, ASIA scores, depression scores, total CHART scores for all patients.

CONCLUSION

Adaptation to environment was significantly better in those who suffered SCI during adulthood than in pediatric patients with SCI. Disability level was not associated with age of disease onset, disease duration, neurological status, depression level.

The Relationship of Coping, Self-Worth, and Subjective Well-Being: A Structural Equation Model

The purpose of this study was to determine the relationship between various coping-related variables and the evaluation of self-worth and subjective well-being among persons with spinal cord injury. Positive coping variables included hope, proactive coping style, and sense of humor, whereas negative coping variables included perceptions of stress, dysfunctional attitudes, and catastrophizing. Evaluations of self-worth were determined by measures of self-esteem and acceptance of disability. Quality of life and life satisfaction were indicators of subjective well-being. The results of the study indicate that negative coping has a negative association with both positive self-worth and subjective well-being. Feelings of positive self-worth were found to be positively associated with subjective well-being. In addition, positive coping appears to influence subjective well-being positively by first increasing feelings of positive self-worth. The findings indicate that coping strategies play an important role in the psychosocial adjustment of individuals with disabilities, and subsequently, in their quality of life. The implications for counseling individuals with disabilities are discussed.

Resilience and Quality of Life

The construct of resilience is key to understanding adaptation to disability from a strengths-based perspective. The objective of this study was to examine the impact of factors identified in Kumpfer’s resilience model on quality of life (QOL) outcomes for adults with spinal cord injury (SCI), specifically taking into account injury characteristics, self-efficacy, resiliency characteristics, and social support using hierarchical regression analysis. Participants included 255 adults with SCI. Findings revealed that the overall model accounted for 75% of the variance in QOL outcomes. In particular, coexisting pain, participation self-efficacy, core self-evaluation, resiliency characteristics, cognitive strength, general health, and social support independently contributed to the variance in QOL scores. Implications of these findings for developing theory-driven, strengths-based approaches for improving rehabilitation outcomes for individuals with SCI are discussed.

Starting a new conversation: Engaging Veterans with spinal cord injury in discussions of what function means to them, the barriers/facilitators they encounter, and the adaptations they use to optimize function

BACKGROUND

Assessments of function in persons with spinal cord injury (SCI) often utilize pre-defined constructs and measures without consideration of patient context, including how patients define function and what matters to them.

OBJECTIVES/HYPOTHESIS

We utilized photovoice to understand how individuals define function, facilitators and barriers to function, and adaptations to support functioning.

METHODS

Veterans with SCI were provided with cameras and guidelines to take photographs of things that: (1) help with functioning, (2) are barriers to function, and (3) represent adaptations used to support functioning. Interviews to discuss photographs followed and were audio-recorded, transcribed, and analyzed using grounded-thematic coding. Nvivo 8 was used to store and organize data.

RESULTS

Participants (n = 9) were male (89%), Caucasian (67%), had paraplegia (75%), averaged 64 years of age, and were injured, on average, for 22 years. Function was described in several ways: the concept of 'normalcy,' aspects of daily living, and ability to be independent. Facilitators included: helpful tools, physical therapy/therapists, transportation, and caregivers. Barriers included: wheelchair-related issues and interior/exterior barriers both in the community and in the hospital. Examples of adaptations included: traditional examples like ramps, and also creative examples like the use of rubber bands on a can to help with grip.

CONCLUSION(S)

Patient-perspectives elicited in-depth information that expanded the common definition of function by highlighting the concept of "normality," facilitators and barriers to function, and adaptations to optimize function. These insights emphasize function within a patient-context, emphasizing a holistic definition of function that can be used to develop personalized, patient-driven care plans.

Vocational rehabilitation case manager factors associated with vocational rehabilitation service program outcomes for people with disabilities in Taiwan - an exploratory study

Purpose The aim of this study is to explore whether/which vocational rehabilitation case manager (VRCMer) factors were significantly associated with the vocational rehabilitation service (VRS) program outcomes in Taiwan. Method This study used the 2011 VRS Program for People with Disabilities Database in a metropolitan city in Taiwan (N = 466) to do a secondary data analysis using hierarchical logistic regression. Results This study found that the employment rate and stable employment rate created by the 2011 VRS program in a metropolitan city in Taiwan were 48.7% and 42.1%, respectively. For the predictors of employment/stable employment, "occurrences of the services provided by the VRCMer" variable was definitely dominant. In addition, "level of the disability" was the second-ranking predictor, and was significantly negatively correlated with both employment and stable employment outcomes. Conclusions Vocational rehabilitation case manager factors in this study were significantly correlated with VRS program outcomes for people with disabilities in Taiwan after controlling for the clients' socio-demographic variables. The results indicate that greater input by VRCMers for people with disabilities equates to better employment outcomes in metropolitan Taiwan. Implications for Rehabilitation This is the first study to build an inferential statistical model in attempt to explain and predict the association between vocational rehabilitation case manager factors and vocational rehabilitation service program outcomes for people with disabilities in Taiwan. In cases of severe disability, a vocational rehabilitation case manager should seek out more in-kind and in-cash resources, and choose a suitable job coach to cooperate in assisting the client to become employed. Based on the findings, government has to continue implementing opportunities for people with disabilities to attain higher and better quality educational levels, for increasing their employment rate. Vocational rehabilitation case managers should raise the referral rate and cooperation with job coaches as this directly affects the quality of services and clients' employment rate.

The Sense of Well-Being Inventory as a Quality of Life Measure for People With Spinal Cord Injury

The purpose of this study was to validate theSense of Well-Being Inventory(SWBI), a quality of life measure, for people with spinal cord injury. Four hundred and five participants were recruited from the Canadian Paraplegia Association for this study. The participants were asked to complete a research packet containing a demographic questionnaire, the SWBI, theRosenberg Self-Esteem Scale, and theAcceptance of Disability Scale. Exploratory and confirmatory factor analyses of the SWBI and correlational analyses of the SWBI factors with other psychosocial variables were conducted. Exploratory and confirmatory factor analyses validated a four-factor structure (financial, family and social, psychological, and physical wellbeing) for the SWBI. SWBI factors are positively related to self-esteem and disability acceptance. With continuing research to document reliability and validity, the SWBI appears to have great potential as a vocational rehabilitation outcome measurement for people with spinal cord injury.

Impact of Employment and Age on Quality of Life of Individuals With Disabilities

The purposes of this study are (a) to explore how people with disabilities (PWD) experience differences in their quality of life (QOL) over the course of their lives, (b) to examine the effect of employment on QOL, and (c) to investigate the impact of age on overall QOL for PWD both inter- and intra-individually. To address these aims, this study used the data set for the Panel Survey of Employment for the Disabled (PSED) collected by the Korean Employment Agency for the Disabled (KEAD). The target populations of the study were 5,092 registered persons with disability. No longitudinal approach to examine the impact of employment and age on QOL for individuals with disabilities has been considered in the previous literature. Thus, multilevel modeling was used to examine the relationship between employment, age, and QOL for PWD. Results of this study indicated that employment status and age were significant predictors of QOL among PWD. These findings call attention for the need to consider the impact of employment and age on QOL of PWD both inter- and intra-individually.

Core Self-Evaluations as a Mediator Between Functional Disability and Life Satisfaction in College Students With Disabilities Majoring in Science and Technology

Purpose: To examine the mediational effect of core self-evaluations (CSE) on the relationship between functional disability and life satisfaction.

Methods: A quantitative descriptive design using multiple regression analysis. The participants were 97 college students with disabilities receiving services through Hunter College’s Minority-Disability Alliance (MIND Alliance) in science, technology, engineering, and mathematics.

Results: CSE was a partial mediator between functional disability and life satisfaction. After controlling for CSE, functional disability was no longer a significant predictor of life satisfaction.

Conclusions: CSE partially mediated the impact of functional disability on life satisfaction. Future research should explore the development of interventions to increase CSE to reduce the effect of disability and to improve life satisfaction and employment outcomes for individuals with disabilities.

Quality of Life As a Potential Rehabilitation Service Outcome

Vocational rehabilitation (VR) agencies, as well as other service providers, are under increased pressure to provide evidence of the effectiveness of services. The primary metric for evaluating services in the VR program is short-term employment outcomes. Although employment outcomes are crucial, they may serve as a poor proxy for the ultimate intended goal of services, namely, improved quality of life (QOL). In this study, a comprehensive framework (the International Classification of Functioning [ICF]) is used to assess QOL in two samples of adults with disabilities receiving educational and vocational services. The relationship between difficulty with work and daily living activities with QOL was compared with a more complex assessment based on the ICF framework, including other life areas such as social relationships and inclusion and environmental factors. Results indicated that the additional information provided by the ICF model substantially increases the prediction of QOL relative to the more traditional VR measures. Within-groups analysis provided more information specific to each sample.

Attachment Style, Social Support, and Coping as Psychosocial Correlates of Happiness in Persons With Spinal Cord Injuries

Objective: To examine the roles of attachment, social support, and coping as psychosocial correlates in predicting happiness in people with spinal cord injuries.

Design: Quantitative descriptive research design using multiple regression and correlation techniques.

Participants: 274 individuals with spinal cord injuries.

Outcome Measures: Happiness as measured by the Subjective Happiness Scale.

Results: Functional disability and psychosocial correlates including coping, attachment styles, and social support were found to be associated with happiness scores. Functional disability was found to have a large negative effect on happiness and the effect was significantly reduced after taking into consideration the effect of positive psychology factors.

Conclusion: Positive psychology variables are important for happiness and subjective well-being, and happiness in turn is related to better quality of life. The negative relationship between functional disability and happiness can be mediated by attachment, social support, and coping. Rehabilitation professionals should deemphasize negative characteristics related to poor psychological adjustment and focus on positive human traits and positive psychology interventions for people with disabilities.

Quality of life in persons with spinal cord injury: comparisons with other populations

Object

The aim of this study was to identify the quality of life (QOL) measures commonly used to assess patients with spinal cord injury (SCI) and to summarize studies using common QOL measures that have been validated in SCI populations to compare scores in persons with SCI with those in a control population.

Methods

A systematic search of PubMed was conducted to identify studies using common QOL measures in persons with SCI and those comparing scores for QOL measures in an SCI population with scores in other populations. The authors sought comparative studies utilizing QOL measures for which validity and reliability analyses had been done.

Results

Of 28 QOL measures found, validity and reliability studies had been conducted in patients with SCI for 5 measures. Twelve comparative studies compared QOL in SCI patients with QOL in healthy controls or in patients with other disabilities, or with normative data. The 36-Item Short Form Health Survey (SF-36) and the short version of the WHOQOL (WHOQOL-BREF) were the most widely used QOL instruments. Patients with SCI had a decreased QOL as compared with that in healthy controls or normative data, with the most pronounced deficits in the domains of physical functioning and physical role limitations. In 3 studies, patients with tetraplegia had a lower physical domain QOL than did those with paraplegia. Overall, however, the impact of injury level and injury completeness on QOL after SCI remains unclear due to a lack of longitudinal studies.

Conclusions

The SF-36 and WHOQOL-BREF are validated instruments that should be considered for use in SCI QOL studies. Future analysis of deficits in QOL among patients with SCI would benefit from the development of a QOL instrument specifically targeted to SCI. Longitudinal studies to assess the impact of injury level and injury completeness on SCI QOL are also needed.

Physical Disability and Substance Use Disorders: A Convergence of Adaptation and Recovery

This article explores issues related to substance use disorders in persons with physical disabilities and the commonalities of the parallel research in recovery and adaptation to disability. An approach for converging these areas of research is presented. Parallel research in substance abuse counseling and rehabilitation counseling reveals that quality of life is an indicator of both adaptation to disability and recovery from substance use disorders. Despite this common outcome, the interaction of adapting to a disability and recovery from a substance use disorder has not been adequately addressed in the literature. A more integrative approach to counseling individuals with disabilities may be achieved with a better understanding of the complex relationship between quality of life, adaptation to disability, and substance use disorder. A converged approach to research is discussed in relation to the development of counseling interventions that improve the quality of life of persons with physical disabilities.

Cross-cultural validity of four quality of life scales in persons with spinal cord injury

BACKGROUND

Quality of life (QoL) in persons with spinal cord injury (SCI) has been found to differ across countries. However, comparability of measurement results between countries depends on the cross-cultural validity of the applied instruments. The study examined the metric quality and cross-cultural validity of the Satisfaction with Life Scale (SWLS), the Life Satisfaction Questionnaire (LISAT-9), the Personal Well-Being Index (PWI) and the 5-item World Health Organization Quality of Life Assessment (WHOQoL-5) across six countries in a sample of persons with spinal cord injury (SCI).

METHODS

A cross-sectional multi-centre study was conducted and the data of 243 out-patients with SCI from study centers in Australia, Brazil, Canada, Israel, South Africa, and the United States were analyzed using Rasch-based methods.

RESULTS

The analyses showed high reliability for all 4 instruments (person reliability index .78-.92). Unidimensionality of measurement was supported for the WHOQoL-5 (Chi2 = 16.43, df = 10, p = .088), partially supported for the PWI (Chi2 = 15.62, df = 16, p = .480), but rejected for the LISAT-9 (Chi2 = 50.60, df = 18, p = .000) and the SWLS (Chi2 = 78.54, df = 10, p = .000) based on overall and item-wise Chi2 tests, principal components analyses and independent t-tests. The response scales showed the expected ordering for the WHOQoL-5 and the PWI, but not for the other two instruments. Using differential item functioning (DIF) analyses potential cross-country bias was found in two items of the SWLS and the WHOQoL-5, three items of the LISAT-9 and four items of the PWI. However, applying Rasch-based statistical methods, especially subtest analyses, it was possible to identify optimal strategies to enhance the metric properties and the cross-country equivalence of the instruments post-hoc. Following the post-hoc procedures the WHOQOL-5 and the PWI worked in a consistent and expected way in all countries.

CONCLUSIONS

QoL assessment using the summary scores of the WHOQOL-5 and the PWI appeared cross-culturally valid in persons with SCI. In contrast, summary scores of the LISAT-9 and the SWLS have to be interpreted with caution. The findings of the current study can be especially helpful to select instruments for international research projects in SCI.

Employment at Closure Is Associated With Enhanced Quality of Life and Subjective Well-Being for Persons With Spinal Cord Injuries

This study assessed whether persons with spinal cord injuries who had been successfully rehabilitated into employment following receipt of rehabilitation services had better quality of life and subjective well-being than the unsuccessfully rehabilitated who did not obtain employment following receipt of rehabilitation services. Persons who were successfully rehabilitated had a significantly higher overall quality of life and health and higher quality of life in their physical health, psychological health, social relationships, and environmental domains than the unsuccessfully rehabilitated. The successfully rehabilitated also had higher psychological, financial, and physical well-being than the unsuccessfully rehabilitated. Rehabilitation counselors can use quality of life and subjective well-being measures to provide more focused interventions during rehabilitation and as an outcome measure in addition to employment upon completion of rehabilitation services.

Quality of life instruments and definitions in individuals with spinal cord injury: a systematic review

STUDY DESIGN

A systematic review.

OBJECTIVE

To critically review quality of life (QOL) instruments used with spinal cord injury (SCI) populations.

SETTING

Vancouver, Canada.

METHODS

A systematic literature review was conducted for publications assessing the measurement properties of QOL outcome measures. Pre-established criteria were used to evaluate the measurement properties.

RESULTS

Fourteen articles reporting on 13 QOL instruments met the inclusion criteria, including the Patient Reported Impact of Spasticity Measure (PRISM), Quality of Well-being Scale, Qualiveen, Sickness Impact Profile (SIP68), Short Form (SF)-36, SF-36V, SF-12, SF-6D, Quality of Life Index, Quality of Life Profile for Adults with Physical Disabilities (QOLP-PD), Satisfaction with Life Scale, Sense of Well-being Index (SWBI), and the World Health Organization Quality of Life-BREF scale (WHOQOL-BREF). The SF-36 and WHOQOL-BREF have been widely used and validated. The SIP68, QOLP-PD, SF-36V, and SWBI are promising with limited investigation. The Qualiveen and PRISM performed well and are specific to SCI complications.

CONCLUSION

The WHOQOL-BREF is presently the most acceptable and established instrument to assess QOL after SCI. The SIP68, QOLP-PD, SF-36V, and SWBI are promising; however, require further evaluation of their measurement properties.

The Effect of Frequency and Type of Internet Use on Perceived Social Support and Sense of Well-Being in Individuals With Spinal Cord Injury

This article examines the effect of frequency and type of Internet use on perceived social support and sense of well-being in persons with spinal cord injury. The results show that Internet use is not significantly related to perceived social support. Bivariate analysis indicates that there is a significant negative association between total Internet use and overall sense of well-being. Simultaneous regression further investigated the nature of this relationship by examining the contribution of 10 online activities to four scales measuring sense of well-being. Frequency of online gaming was negatively associated with each scale. Disability-related information seeking was also negatively associated with psychological and financial well-being, as well as perceived social support. These results suggest that Internet use as a whole should not be overlooked by rehabilitation counselors for its practical uses to increase independence and social connectedness in persons with disabilities; however, care should be used, particularly with online gaming.

Confirmatory Factor Analysis of the World Health Organization Quality of Life Questionnaire—Brief Version for Individuals With Spinal Cord Injury

This study examined the factorial structure of the World Health Organization Quality of Life Questionnaire—Brief Version in a community sample of Canadians with spinal cord injuries. A confirmatory factor analysis provides evidence that the instrument is a multidimensional measure of quality of life. Additionally, the questionnaire is correlated in the predicted directions with education, income, time since injury, self-esteem, and acceptance of disability. Implications of its use in rehabilitation counseling practice and research are discussed.

Return to work following spinal cord injury: a review

PURPOSE

To review literature on return to work (RTW) and employment in persons with spinal cord injury (SCI), and present employment rates, factors influencing employment, and interventions aimed at helping people with SCI to obtain and sustain productive work.

METHODS

A systematic review for 2000 - 2006 was carried out in PubMed/Medline, AMED, (ISI) Web of Science, EMBASE, CINAHL, PsycInfo and Sociological abstracts database. The keywords 'spinal cord injuries', 'spinal cord disorder', 'spinal cord lesion' or 'spinal cord disease' were cross-indexed with 'employment', 'return to work', 'occupation' or 'vocational'.

RESULTS

Out of approximately 270 hits, 110 references were used, plus 13 more found elsewhere. Among individuals with SCI working at the time of injury 21 - 67% returned to work after injury. RTW was higher in persons injured at a younger age, had less severe injuries and higher functional independence. Employment rate improved with time after SCI. Persons with SCI employed ranged from 11.5% to 74%. Individuals who sustained SCI during childhood or adolescence had higher adult employment rates. Most common reported barriers to employment were problems with transportation, health and physical limitations, lack of work experience, education or training, physical or architectural barriers, discrimination by employers, and loss of benefits. Individuals with SCI discontinue working at younger age.

CONCLUSIONS

This review confirmed low employment rates after SCI. Future research should explore interventions aimed at helping people with SCI to obtain and sustain productive work.