Self-management of pain and depression in adults with spinal cord injury: A scoping review

Role of self-efficacy on functional limitations among persons with spinal cord injury

ObjectivesSpinal cord injury (SCI) results in mild to severe functional limitations, decreasing a person's ability to perform activities of daily living. This study aims to identify the influence of SCI characteristics and self-efficacy on functional limitations, controlling for sociodemographic factors.MethodsParticipants for this cross-sectional descriptive study included 272 persons with SCI. The participants completed questionnaires on sociodemographic information, secondary physical conditions, self-efficacy, and functional limitations, using an online Qualtrics Survey. Multiple hierarchical regression analysis was performed to test the hypothesis.ResultsParticipants reported higher functional limitations on dressing the lower body and managing their bowels compared to other activities of daily living. The sociodemographics, injury characteristics, and self-efficacy collectively accounted for 66% variance in functional limitations. A higher level of secondary physical conditions and tetraplegia injury contributed to higher functional limitations. As hypothesized, greater self-efficacy significantly contributed to low functional limitations above and beyond sociodemographic and SCI-related variables.DiscussionFunctional limitations following SCI are a pervasive challange in persons with SCI. Early recognition and management of secondary conditions and implementation of psychological interventions to strengthen self-efficacy in performing activities and managing secondary complications could potentially enhance functional independence and, ultimately, quality of life in this population.

Robotic assisted and exoskeleton gait training effect in mental health and fatigue of multiple sclerosis patients. A systematic review and a meta-analysis

PURPOSE

Robotic and Exoskeleton Assisted Gait Training (REAGT) has become the mainstream gait training module. Studies are investigating the psychosocial effects of REAGT mostly as secondary outcomes. Our systematic review and meta-analysis aims to investigate the effects of REAGT in MS patients' mental health and fatigue.

MATERIALS AND METHODS

We searched the electronic databases (Scopus, PubMed, Pedro, Cochrane Trials, Dare) for RCT studies fulfilling our inclusion criteria. A meta-analysis of available assessment tools was conducted calculating the summary mean differences in two different timepoints, before and after the intervention using random-effects models.

RESULTS

The systematic search of the electronic databases identified 302 studies. Seven RCT studies were considered eligible for data extraction and meta-analysis, according to our eligibility criteria. We were able to obtain adequate data to proceed with a quantitative synthesis for QoL SF36-MC (Mental Component), QoL SF-36 mental and psychosocial subscales, Multiple Sclerosis Quality of Life-54-Mental Health Composite (MSQoL-54-MHC), Patient's Health Questionnaire (PHQ-9) and Fatigue Severity Scale (FSS).

CONCLUSIONS

Overall, REAGT seems to have a positive effect to Quality of Life, especially in MS patients' perspective of General and Mental Health and a slight positive effect in depression as measured by PHQ-9.Implications for rehabilitationMultiple Sclerosis (MS) decreases physical and non-physical aspects of patients' quality of life perspective.Rehabilitation strategy must take into consideration the non-physical effects of a training intervention.Robotic and Exoskeleton Gait Training has a positive effect in MS patients' non-physical quality of life and a slight positive effect in depression.

Exploring and prioritizing content to include in a medication self-management toolkit for persons with spinal cord injury/dysfunction: A concept mapping approach

BACKGROUND

Adults with spinal cord injury/dysfunction (SCI/D) face challenges with medications they take to manage their secondary conditions (e.g., pain, urinary tract infections, autonomic dysreflexia). With many healthcare providers typically involved in care, there are additional challenges with care fragmentation and self-management. Prior research emphasized the desire for more support with medication self-management among this population.

OBJECTIVE

To explore what content should be included in a medication self-management resource (i.e., toolkit) for adults with SCI/D, as well as considerations for delivery from the perspectives of adults with SCI/D, caregivers, healthcare providers, and representatives from community organizations.

METHODS

A concept mapping study was conducted. Participants took part in one or more of three activities: brainstorming; sorting and rating; and mapping. Participants generated ideas about the content to include in a medication self-management toolkit. Participants sorted the statements into conceptual piles and assigned a name to each. All statements were rated on a five-point Likert-type scale on importance and realistic to include in the toolkit. Participants decided on the final cluster map, rearranged statements, and assigned a name to each cluster to create visual representations of the data.

RESULTS

Forty-four participants took part in this study. The final map contained eight clusters: 1) information-sharing and communication; 2) healthcare provider interactions and involvement; 3) peer and community connections; 4) supports and services for accessing prescription medications and medication information; 5) information on non-prescription medication and medication supplies; 6) safety and lifestyle considerations; 7) general medication information; and 8) practical information and strategies related to medication-taking. Safety and lifestyle considerations was rated as the most important and realistic to include in the toolkit.

CONCLUSIONS

Given the limited tools to help adults with SCI/D with managing their medications, there is great potential to better support this population across all areas of medication self-management.

Acupuncture for the treatment of anxiety and depression in patients with spinal cord injury: A study protocol for systematic review and meta analysis

BACKGROUND

Spinal cord injury patients frequently suffer from anxiety and depression, which can seriously affect their quality of life and recovery. Acupuncture, as a traditional Chinese therapy, has been used to treat anxiety and depression for more than 2000 years. The aim is to evaluate the clinical efficacy of acupuncture in the treatment of anxiety and depression in spinal cord injury patients.

METHODS

The literature on acupuncture treating anxiety and depression in patients with spinal cord injury in PubMed, Embase, Cochrane Library, Chinese Biomedical Literature Database, China National Knowledge Infrastructure, Chinese Scientific Journal Data, and Wanfang data were searched through computers from the establishment of the database to May 2024. In the study, the Cochrane tool for assessing the risk of bias was used and the meta-analyses were carried out using the software package Review Manager 5.4.

RESULTS

Ten trials were included in this systematic review, with 361 cases in the experimental group and 355 cases in the control group. Meta-analysis showed that compared with conventional treatment, acupuncture combined with conventional treatment was beneficial in improving the total clinical efficacy (odds ratio = 3.55 [95% confidence interval {CI}: 1.34-9.37], P < .001). We found acupuncture-assisted therapy could be beneficial in improving the Modified Barthel Index (MD = 10.48 [95% CI: 4.78-16.19], P < .001) and reducing anxiety or depression scores (such as the Self-Rating Anxiety Scale [MD = -6.08 {95% CI: -6.85 to -5.30}, P < .001]; reducing the Self-Rating Depression Scale [MD = -6.01 {95% CI: -6.95 to -5.07}, P < .001]). In addition, the study showed that the application of acupuncture treatment could improve 5-hydroxytryptamine compared to control group (MD = 44.99 [95% CI: 40.04-49.95], P < .001) and reduce TNF-α compared to control group (MD = -7.78 [95% CI: -8.73 to -6.83], P < .001).

CONCLUSION

Acupuncture could be used as a complementary therapy to reduce anxiety and depression in spinal cord injury patients. Further original and high-quality research is needed to verify the conclusions of this study.

Development of a pain self-management intervention framework for people with spinal cord injury

BACKGROUND

 Pain is the most common reason for medical visits to primary health care practitioners. Pain self-management interventions are encouraged and there is no known self-management intervention framework available that clinicians and people with spinal cord injury (PWSCI) can use to guide treatment selection.

AIM

 This study aimed to develop a pain self-management intervention framework for PWSCI.

SETTING

 Online and facilitated in Gauteng, South Africa.

METHODS

 A three-round modified e-Delphi method was used to reach an 80% consensus among a 21-expert panel. Fifty-nine interventions were distributed via REDCap and a final online audio meeting was held to either include or exclude interventions in the final framework. SPSS v27 was used to analyse descriptive data and content analysis was used for qualitative responses.

RESULTS

 The final developed pain self-management framework consists of 56 interventions and includes interventions from multiple health professions to encompass medical, psychological, therapeutic and social interventions. Interventions are also specified for nociceptive and/or neuropathic pain and grouped according to the biopsychosocial model.

CONCLUSION

 The interprofessional framework may be used as a guideline for PWSCI to alleviate pain, as well as assist health professionals in clinical decision-making, by providing them with the freedom to choose acceptable and adequate interventions that may be appropriate to treat the affected individual's pain.Contribution: Pain management is a basic need at the primary healthcare level and PWSCI need access to the broad range of interventions available to manage their pain. The framework highlights the variety of appropriate interventions to guide both health professionals and PWSCI with pain relief options.

Tetramethylpyrazine and Astragaloside IV have synergistic effects against spinal cord injury-induced neuropathic pain via the OIP5-AS1/miR-34a/Sirt1/NF-κB axis

BACKGROUND

Both Tetramethylpyrazine (TMPZ) and Astragaloside IV (AGS-IV) can ameliorate neuronal apoptosis and neuroinflammation in CNS diseases. This study revolves around the underlying mechanism of TMPZ and AGS-IV in spinal cord injury (SCI)-associated neuropathic pain (NP).

MATERIALS AND METHODS

An in-vivo NP model was constructed in Sprague-Dawley (SD) rats via SCI. qRT-PCR was employed to detect OIP5-AS1 and miR-34a. The paw withdrawal threshold (PWT) and paw withdrawal latency (PWL) of the rats were evaluated. Neuronal apoptosis in the spinal cord of rats was examined by Nissl staining and TUNEL staining. The interactions between OIP5-AS1 and miR-34a as well as miR-34a and Sirt1 were investigated through dual luciferase assay and RIP assay. The protein expressions of Bad, Bax, Caspase-3, iNOS, COX2, NF-κB, and Sirt1 were examined by western blot.

RESULTS

TMPZ and AGS-IV combination relieved behavioral symptoms of neuropathic pain in the SCI rat model, enhanced the levels of OIP5-AS1 and Sirt1, and lowered the profile of miR-34a. OIP5-AS1 downregulation weakened the neuroprotective function of TMPZ and AGS-IV in SCI rats and reversed their anti-inflammatory and anti-apoptotic effects on LPS-elicited primary spinal cord neurons. miR-34a was identified as a target of OIP5-AS1. Upregulated miR-34a partly abated the protective functions of TMPZ and AGS-IV in primary spinal cord neurons. Additionally, miR-34a targeted and repressed Sirt1, thus activating the NF-κB pathway and inflammatory reactions. Sirt1 inhibition reduced the protective effects mediated by OIP5-AS1.

CONCLUSION

TMPZ and AGS-IV ameliorate SCI-elicited NP via the OIP5-AS1/miR-34a/Sirt1/NF-κB pathway.

Effects of a coach-guided videoconferencing acceptance and commitment therapy intervention combined with psychoeducation on distressed individuals living with spinal cord injury: a preliminary mixed-methods study

PURPOSE

This study examined effects of coach-guided videoconferencing acceptance and commitment therapy (ACT) accompanied by psychoeducation on distressed individuals with spinal cord injury (SCI) and explored participants' experiences in the intervention.

MATERIALS AND METHODS

Ten people with SCI participated in 8 individual videoconferencing sessions delivered by trained coaches. Data using self-reported questionnaires and individual interviews was collected at pretest and posttest and analyzing using Wilcoxon signed-rank tests and interpretative phenomenological analysis (ClinicalTrials.gov ID: NCT04670406).

RESULTS

Statistically significant improvements were found in depression, anxiety, stress, grief, engagement in meaningful activities, and self-compassion with medium to large effect sizes. There was no significant change in quality of life, resilience, and ACT processes. Participants gained a new way of thinking by: being aware of thoughts and emotions; exploring perceptions of others; and focusing on the present. Also, the intervention equipped participants to deal with challenges by: improving coping with SCI-related conditions; practicing self-compassion, acceptance, and meditation; and acquiring skills of value-based decision making and committed action.

CONCLUSIONS

Findings contribute to the limited evidence as the first study that measured effects of videoconferencing ACT on people with SCI. Future randomized controlled trials are needed to measure efficacy of internet-delivered ACT for people with SCI.IMPLICATIONS FOR REHABILITATIONGuided videoconferencing ACT may reduce depressive symptoms, anxiety, stress, and grief and increase engagement in meaningful activities and self-compassion in people with SCI.Professionals may consider ACT as a supportive or adjunct service for people with SCI who experience psychological distress.

The Outcomes of Robotic Rehabilitation Assisted Devices Following Spinal Cord Injury and the Prevention of Secondary Associated Complications

Spinal cord injuries (SCIs) have major consequences on the patient’s health and life. Voluntary muscle paralysis caused by spinal cord damage affects the patient’s independence. Following SCI, an irreversible motor and sensory deficit occurs (spasticity, muscle paralysis, atrophy, pain, gait disorders, pain). This pathology has implications on the whole organism: on the osteoarticular, muscular, cardiovascular, respiratory, gastrointestinal, genito-urinary, skin, metabolic disorders, and neuro-psychic systems. The rehabilitation process for a subject having SCIs can be considered complex, since the pathophysiological mechanism and biochemical modifications occurring at the level of spinal cord are not yet fully elucidated. This review aims at evaluating the impact of robotic-assisted rehabilitation in subjects who have suffered SCI, both in terms of regaining mobility as a major dysfunction in patients with SCI, but also in terms of improving overall fitness and cardiovascular function, respiratory function, as well as the gastrointestinal system, bone density and finally the psychosocial issues, based on multiple clinical trials, and pilot studies. The researched literature in the topic revealed that in order to increase the chances of neuro-motor recovery and to obtain satisfactory results, the combination of robotic therapy, a complex recovery treatment and specific medication is one of the best decisions. Furthermore, the use of these exoskeletons facilitates better/greater autonomy for patients, as well as optimal social integration.

Australian arm of the International Spinal Cord Injury (Aus-InSCI) Community Survey: 2. Understanding the lived experience in people with spinal cord injury

STUDY DESIGN

Cross-sectional survey.

OBJECTIVES

To identify common problems across key domains of functioning, health and wellbeing, as well as evaluate self-reported quality of life (QoL) by people with SCI, examining differences by age, gender, injury characteristics and level of mobility.

SETTING

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

METHODS

Participants were 18 years or over with SCI and at least 12 months post-injury, recruited between Mar'18 and Jan'19. The Aus-InSCI questionnaire comprised 193 questions, including socio-demographics, SCI characteristics, body functions and structures, activities and participation, environmental and personal factors, and appraisal of health and well-being. General linear model was used to examine differences in functioning and QoL.

RESULTS

Participants (mean age 57 years, range 19-94 years) with tetraplegia and/or complete injuries had more health problems, activity/participation problems and environmental barriers. However, self-rated overall QoL did not differ for injury level or completeness. Participants with more recent injuries exhibited lower independence levels, more mental health problems and poorer satisfaction with self and their living conditions. Major activity/participation problems related to intimate relationships and accessing public transportation. Less than half of the working age population were engaged in paid work. The top two environmental barriers frequently related to accessing public places or homes and unfavourable climatic conditions.

CONCLUSIONS

This large, comprehensive community survey draws a detailed picture of the lived experience of people with SCI in Australia, identifying priority needs, gaps in services and barriers to achieving a full and satisfying life.

Prevalence, severity, and self-management of depressive mood among community-dwelling people with spinal cord injury in Nepal

Background

Depression is a common psychological condition after spinal cord injury. There are increased incidences of self-harm, suicidal behavior, and lower quality of life among people with spinal cord injury and depression. However, self-management of depressive symptoms in the community is less explored.

Objective

This study aimed to examine the prevalence, severity, and self-management of depressive mood in community-dwelling people with spinal cord injury.

Methods

A descriptive study was conducted in 2019 among 115 people with spinal cord injury discharged from three health centers and living in the 13 districts of Bagmati Province. Participants were selected using stratified random sampling. Questionnaires were related to demographics, health and environment, depressive mood, and self-management. Descriptive statistics and quantitative content analysis were used to analyze the data.

Results

Ninety-seven (84.3%) people with spinal cord injury had a depressive mood. Of these, 60.8% had moderate to severe depressive moods. They mainly used the internet and social media, shared feelings with family members, and practiced Hindu religious activities for depressive mood management because of the physical barriers to accessing a healthcare facility and easiness to use of non-pharmacological methods. Nearly half of participants who used sharing of feelings felt their depressive mood disappeared when they often used the method.

Conclusion

Depressive mood following initial hospitalization is highly prevalent among people with spinal cord injury in Nepal, most of whom live in rural settings. Therefore, nurses and other health professionals should provide psychoeducation for this population and their family members to better address mental health problems. Facilitating pathways for those in rural areas to engage in social activities and timely treatment access may improve depressive mood. Nurses and other rehabilitation professionals can use social media to assess depressive moods and deliver management approaches in the community.

Nanoparticles in traumatic spinal cord injury: therapy and diagnosis

Nanotechnology has been previously employed for constructing drug delivery vehicles, biosensors, solar cells, lubricants and as antimicrobial agents. The advancement in synthesis procedure makes it possible to formulate nanoparticles (NPs) with precise control over physico-chemical and optical properties that are desired for specific clinical or biological applications. The surface modification technology has further added impetus to the specific applications of NPs by providing them with desirable characteristics. Hence, nanotechnology is of paramount importance in numerous biomedical and industrial applications due to their biocompatibility and stability even in harsh environments. Traumatic spinal cord injuries (TSCIs) are one of the major traumatic injuries that are commonly associated with severe consequences to the patient that may reach to the point of paralysis. Several processes occurring at a biochemical level which exacerbate the injury may be targeted using nanotechnology. This review discusses possible nanotechnology-based approaches for the diagnosis and therapy of TSCI, which have a bright future in clinical practice.

Prevalence of prescribed opioid claims among persons with nontraumatic spinal cord dysfunction in Ontario, Canada: a population-based retrospective cohort study

STUDY DESIGN

Cohort study.

OBJECTIVE

To determine the prevalence and to identify predictors of prescription opioid use among persons with nontraumatic spinal cord dysfunction within 1 year after discharge from inpatient rehabilitation.

SETTING

Ontario, Canada.

METHODS

We conducted a retrospective cohort study using administrative data to determine predictors of receiving prescription opioids during the 1 year after discharge from inpatient rehabilitation among persons with nontraumatic spinal cord dysfunction between April 1, 2004 and March 31, 2015. We modeled the outcome using a Poisson multivariable regression and reported relative risks with 95% confidence intervals.

RESULTS

We identified 3468 individuals with nontraumatic spinal cord dysfunction (50% male) with 67% who were aged ≥66. Over half of the cohort (60%) received opioids during the observation period. Older adults (≥66 years old) were significantly more likely to experience comorbidities (p < 0.05) but less likely to be dispensed opioids following rehabilitation discharge. Being female, previous opioid use before rehabilitation, experiencing lower continuity of care, increasing comorbidity level, low functional status, and having a previous diagnosis of osteoarthritis or mental illness were significant risk factors for receiving opioids after discharge, as shown in a multivariable analysis. Increasing length of rehabilitation stay and higher income were protective against opioid receipt after discharge.

CONCLUSION

Many individuals with nontraumatic spinal cord dysfunction in Ontario are prescribed opioids after discharge from inpatient rehabilitation. This may be problematic due to the number of severe complications that may arise from opioid use and their use in this population warrants future research.

A Cognitive Behavioral Therapy-Informed Self-Management Program for Acute Respiratory Failure Survivors: A Feasibility Study

Background: The number of people surviving critical illness is rising rapidly around the globe. Survivorship comes at a cost, with approximately half of patients with acute respiratory failure (ARF) experiencing clinically significant symptoms of anxiety, and 32–40% of survivors having substantial anxiety symptoms in the months or years after hospitalization. Methods: This feasibility study reports on 11 consecutive ARF patients receiving up to six sessions of a psychological intervention for self-management of anxiety. Results: All 11 patients accepted and received the psychological intervention. Four patients did not fully complete all 6 sessions due to death (n = 1, 2 sessions completed), and early hospital discharge (n = 3, patients completed 2, 3 and 5 sessions). The median (IQR) score (range: 0–100; minimal clinically important difference: 13) for the Visual Analog Scale-Anxiety (VAS-A) pre-intervention was 70 (57, 75) points. During the intervention, all 11 patients had a decrease in VAS-A, with a median (IQR) decrease of 44 (19, 48) points. Conclusions: This self-management intervention appears acceptable and feasible to implement among ARF patients during and after an ICU stay.

Pain and its impact on functioning and disability in manual wheelchair users with spinal cord injury: a protocol for a mixed-methods study

INTRODUCTION

Approximately 80% of people with spinal cord injury experience clinically significant chronic pain. Pain (whether musculoskeletal or neuropathic) is consistently rated as one of the most difficult problems to manage and negatively affects the individual's physical, psychological and social functioning and increases the risk of pain medication misuse and poor mental health. The aim of this study is to therefore determine the presence of pain and its impact on functioning and disability as well as to develop a framework for self-management of pain for South African manual wheelchair users with spinal cord injury.

METHODS AND ANALYSIS

Community-dwelling participants with spinal cord injury will be invited to participate in this three-phase study. Phase 1 will use a quantitative, correlational design to determine factors related to pain such as pectoralis minor length, scapular dyskinesis, wheelchair functioning, physical quality of life, community reintegration and pain medication misuse. Demographic determinants of pain such as age, gender, type of occupation, completeness of injury and neurological level of injury will also be investigated. Participants with pain identified in phase 1 will be invited to partake in a qualitative descriptive and contextually designed phase 2 to explore their lived experience of pain through in-depth interviews. The results of phases 1 and 2 will then be used with the assistance from experts to develop a framework for self-management of pain using a modified Delphi study. Data analysis will include descriptive and inferential statistics (quantitative data) and thematic content analysis (qualitative data).

ETHICS AND DISSEMINATION

Approval for this study is granted by the Faculty of Health Sciences Research Ethics Committee of the University of the Pretoria (approval number 125/2018). This study is registered with the South African National Health Research Database (reference GP201806005). This study's findings will be shared in academic conferences and published in scientific peer-reviewed journals.

Pilot Study of a Self-Management Program for Parents With Spinal Cord Injury or Disease

IMPORTANCE

This study lays the groundwork for a self-management program run by occupational therapy practitioners for parents with spinal cord injury or disease (SCI/D).

OBJECTIVE

To develop and implement the Parenting Self-Management Program with people with SCI/D and evaluate the potential impact on knowledge, self-efficacy, and participation.

DESIGN

A mixed-methods approach was used to develop (Phase 1) and implement and evaluate (Phase 2) a pilot group intervention for parents with SCI/D.

SETTING

Community-based occupational therapy settings.

PARTICIPANTS

Phase 1 participants were professionals working in the field of disability and SCI/D (n = 11) and experienced parents with SCI/D (n = 9). Phase 2 participants were people with SCI/D who were newly injured or inexperienced in parenting (n = 10). All participants were paid volunteers.

INTERVENTION

The 4-wk Parenting Self-Management Program was piloted with 10 parents with SCI/D. Participants attended a weekly program with other parents with SCI/D led by occupational therapists in which they received parenting resources and presentations and set weekly goals.

OUTCOMES AND MEASURES

The General Self-Efficacy Scale, a modified version of the Participation Survey/Mobility, and open-ended questions regarding parents' participation in parenting tasks were administered during Phase 2.

RESULTS

Significant increases (p < .05) in perceived knowledge were found for the topics of emergency preparedness, home modifications, adapted equipment, fatigue management, pain management, and community resources among Phase 2 participants.

CONCLUSIONS AND RELEVANCE

A self-management approach combined with pertinent resources for parents with SCI/D yielded positive outcomes.

WHAT THIS ARTICLE ADDS

This research demonstrates that a self-management structure for a specific population (people with SCI/D) in combination with a targeted occupation (parenting) and delivered through group occupational therapy services, improved client outcomes.