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Arora M, Pozzato I, McBain C, Tran Y, Sandalic D, Myles D, Middleton JW, Craig A. Cognitive Reserve and Its Association with Cognitive and Mental Health Status following an Acute Spinal Cord Injury. J Clin Med 2023; 12:4258. [PMID: 37445291 DOI: 10.3390/jcm12134258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 06/14/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND Mild cognitive impairment (MCI) is a common secondary condition associated with spinal cord injury (SCI). Cognitive reserve (CR) is believed to protect against cognitive decline and can be assessed by premorbid intelligence (pmIQ). Despite the potential utility of pmIQ as a complementary metric in the evaluation of MCI in SCI, this approach has been infrequently employed. The purpose of this study was to examine the association between MCI and pmIQ in adults with SCI with the aim of exploring the potential value of pmIQ as a marker of CR in this population. METHODS Cognitive function was assessed on three occasions in adults with SCI over a 12-month period post-injury, and pmIQ was assessed once at baseline. Demographic and mental health measures were also collected, and logistic regression was conducted to determine the strength of association between pmIQ and MCI while adjusting for factors such as mental health and age. RESULTS The regression analysis revealed that at the time of admission to SCI rehabilitation, the MCI assessed by a valid neurocognitive screen was strongly associated with pmIQ. That is, if a person has MCI, there was 5.4 greater odds (p < 0.01) that they will have poor pmIQ compared to a person without MCI after adjustment for age and mental health. CONCLUSIONS The assessment of CR is an important area that should be considered to improve the process of diagnosing MCI in adults with an acute SCI and potentially facilitate earlier intervention to slow or prevent cognitive decline.
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Affiliation(s)
- Mohit Arora
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Ilaria Pozzato
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Candice McBain
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Yvonne Tran
- Australian Institute of Health Innovation, Macquarie University, North Ryde, NSW 2113, Australia
| | - Danielle Sandalic
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Daniel Myles
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - James Walter Middleton
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
| | - Ashley Craig
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2000, Australia
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia
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Investigating Dynamics of the Spinal Cord Injury Adjustment Model: Mediation Model Analysis. J Clin Med 2022; 11:jcm11154557. [PMID: 35956172 PMCID: PMC9369731 DOI: 10.3390/jcm11154557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/28/2022] [Accepted: 08/01/2022] [Indexed: 01/25/2023] Open
Abstract
Spinal cord injury (SCI) is a severe neurological injury that results in damage to multiple bodily systems. SCI rehabilitation requires a significant focus on improving adjustment to the injury. This paper presents a detailed description of the Spinal Cord Injury Adjustment Model (SCIAM), which clarifies how individuals adjust to SCI and contends that adjustment to SCI is a multifactorial process involving non-linear dynamic adaptation over time. Evidence supporting SCIAM is also discussed. Mediation analyses were conducted to test the mediator dynamics proposed by the model. The analyses tested the relationship between two moderators (self-care and secondary health conditions), mediators (two self-efficacy items and appraisal of quality of life or QoL), and positive versus negative vitality/mental health as outcomes. Results showed that higher self-efficacy and perceived QoL was related to greater independence in self-care and reduced negative impacts of secondary health conditions. This study supported the mediation role of self-efficacy and other appraisals such as perceived QoL in enhancing self-care and buffering the negative impact of health challenges. In conclusion, it is important to employ a holistic model such as SCIAM to conceptualise and increase understanding of the process of adjustment following a severe neurological injury such as SCI.
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Yang SH, Mu PF, Huang WC. Cognitive behaviour therapy in adults with spinal cord injury: A scoping review. Int J Nurs Pract 2022:e13078. [PMID: 35770855 DOI: 10.1111/ijn.13078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/13/2022] [Accepted: 06/15/2022] [Indexed: 11/28/2022]
Abstract
AIM The aim of this study is to report on the extent and range of the research evaluating cognitive behaviour therapy (CBT) in adults with spinal cord injury. BACKGROUND Spinal cord injury is a devastating event that can lead to permanent neurologic deficit. Compared with the average person, spinal cord injury (SCI) patients are at twice the risk of developing mood disorders, highlighting vulnerability of SCI patients' mental states which can be easily hurt. CBT is the most commonly used psychosocial intervention. DESIGN This was a scoping review. REVIEW METHOD Five electronic databases (MEDLINE, CINAHL, EMBASE, PsycINFO and Airiti Library) were searched for articles published between 1990 and 2021. Google Scholar was utilized to search additional articles listed in the reference lists of included articles. RESULTS Overall, 16 articles met the inclusion criteria, with the majority reporting on CBT, that focused on psychological distress and neuropathic pain. The core concept of intervention included disease identification, cognitive distortion/modification and coping strategies. CONCLUSIONS There were significant knowledge gaps on the interventions' content and effectiveness for psychological distress of persons with SCI. Development of multifaceted cognitive behaviour interventions, especially to strengthen self-identity and to inspire patients' hope, is needed. Further research is required to investigate the long-term effectiveness of CBT.
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Affiliation(s)
- Shu-Hua Yang
- Department of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Nursing, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Pei-Fan Mu
- Department of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Taiwan Evidence Based Practice Center: A JBI Centre of Excellence, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Cheng Huang
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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Jeyathevan G, Jaglal SB, Hitzig SL, Linassi G, Mills S, Noonan VK, Anzai K, Clarke T, Wolfe D, Bayley M, Aslam L, Farahani F, Alavinia SM, Omidvar M, Craven BC. Conception and development of Self-Management indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2021; 44:S94-S117. [PMID: 34779736 PMCID: PMC8604486 DOI: 10.1080/10790268.2021.1961054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
CONTEXT Although self-management is linked to reduced secondary health complications (SHCs) and enhanced overall quality of life post-spinal cord injury or disease (SCI/D), it is poorly integrated into the current rehabilitation process. Promoting self-management and assuring equity in care delivery is critical. Herein, we describe the selection of Self-Management structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. METHODS Experts in self-management across Canada completed the following tasks: (1) defined the Self-Management construct; (2) conducted a systematic search of available outcomes and their psychometric properties; and (3) created a Driver diagram summarizing available evidence related to Self-Management. Facilitated meetings allowed development and selection following rapid-cycle evaluations of proposed structure, process and outcome indicators. RESULTS The structure indicator is the proportion of staff with appropriate education and training in self-management principles. The process indicator is the proportion of SCI/D inpatients who have received a self-management assessment related to specific patient self-management goal(s) within 30 days of admission. The outcome indicator is the Skill and Technique Acquisition, and Self-Monitoring and Insight subscores of the modified Health Education Impact Questionnaire. CONCLUSION The structure indicator will heighten awareness among administrators and policy makers regarding the need to provide staff with ongoing training related to promoting self-management skill acquisition. Successful implementation of the Self-Management process and outcome indicators will promote self-management education and skill acquisition as a rehabilitation priority, allow for personalization of skills related to the individual's self-management goal(s), and empower individuals with SCI/D to manage their health and daily activities while successfully integrating into the community.
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Affiliation(s)
- Gaya Jeyathevan
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Susan B. Jaglal
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sander L. Hitzig
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada,Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Rehabilitation Sciences Institute, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Linassi
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sandra Mills
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | | | - Karen Anzai
- GF Strong Rehab Centre, Vancouver, British Columbia, Canada
| | | | - Dalton Wolfe
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada,School of Health Studies, Western University, London, Ontario, Canada
| | - Mark Bayley
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lubna Aslam
- Spinal Cord Injury Ontario, Toronto, Ontario, Canada
| | - Farnoosh Farahani
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - S. Mohammad Alavinia
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Maryam Omidvar
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Correspondence to: B. Catharine Craven, KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 206-H 520 Sutherland Drive, Toronto, ON, M4G3V9, Canada; Ph: 416-597-3422x6122.
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Zhao MC, Yang K, Yang BH, Guo S, Wang YP, Zhang XW, Li HP. Prognosis of C4 dislocation with spinal cord injury following psychological intervention. J Int Med Res 2021; 49:3000605211004520. [PMID: 33823641 PMCID: PMC8033484 DOI: 10.1177/03000605211004520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/03/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To investigate the effect of psychological intervention on the prognosis of patients with C4 dislocation and spinal cord injury. METHODS We investigated target patients admitted between 2010 and 2018. Patients' mental state, quality of life and neurological function at different time points were evaluated to examine the relationship between psychological intervention and recovery and prognosis of acute and critical spinal cord injury. RESULTS All patients showed improvements in clinical symptoms, neurological function and quality of life. Psychological intervention significantly improved Zung Self-Rating Anxiety Scale score, Zung Self-Rating Depression Scale score and SF-36 Mental Component Summary score within 3 months. Japanese Orthopaedic Association neurological function score and SF-36 Physical Component Summary score were significantly improved after 1-year follow-up. Psychological intervention did not improve 2-year survival. CONCLUSION Timely and professional psychological intervention can eliminate the psychological disorders of C4 dislocation patients with spinal cord injury. This has a positive effect on their quality of life and prognosis.
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Affiliation(s)
- Min-Chao Zhao
- Department of Orthopaedics, Second Affiliated Hospital of Xi’an
Jiaotong University, Xi’an, China
| | - Kai Yang
- Department of Orthopaedics, Second Affiliated Hospital of Xi’an
Jiaotong University, Xi’an, China
| | - Bao-Hui Yang
- Department of Orthopaedics, Second Affiliated Hospital of Xi’an
Jiaotong University, Xi’an, China
| | - Shuai Guo
- Department of Orthopaedics, Second Affiliated Hospital of Xi’an
Jiaotong University, Xi’an, China
| | - Ya-Ping Wang
- Department of Psychology and Psychiatry, Second Affiliated
Hospital of Xi’an Jiaotong University, Xi’an, China
| | - Xiao-Wei Zhang
- Department of Orthopaedics, First Affiliated Hospital of Xi’an
Jiaotong University, Xi’an, China
| | - Hao-Peng Li
- Department of Orthopaedics, Second Affiliated Hospital of Xi’an
Jiaotong University, Xi’an, China
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McIntyre A, Marrocco SL, McRae SA, Sleeth L, Hitzig S, Jaglal S, Linassi G, Munce S, Wolfe DL. A Scoping Review of Self-Management Interventions Following Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 26:36-63. [PMID: 32095066 PMCID: PMC7015175 DOI: 10.1310/sci2601-36] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To conduct a scoping review to identify what components of self-management are embedded in self-management interventions for spinal cord injury (SCI). Methods: In accordance with the approach and stages outlined by Arksey and O'Malley (2005), a comprehensive literature search was conducted using five databases. Study characteristics were extracted from included articles, and intervention descriptions were coded using Practical Reviews in Self-Management Support (PRISMS) (Pearce et al, 2016), Barlow et al (2002), and Lorig and Holman's (2003) taxonomy. Results: A total of 112 studies were included representing 102 unique self-management programs. The majority of the programs took an individual approach (52.0%) as opposed to a group (27.4%) or mixed approach (17.6%). While most of the programs covered general information, some provided specific symptom management. Peers were the most common tutor delivering the program material. The most common Barlow components included symptom management (n = 44; 43.1%), information about condition/treatment (n = 34; 33.3%), and coping (n = 33; 32.4%). The most common PRISMS components were information about condition and management (n = 85; 83.3%), training/rehearsal for psychological strategies (n = 52; 51.0%), and lifestyle advice and support (n = 52; 51.0%). The most common Lorig components were taking action (n = 62; 60.8%), resource utilization (n = 57; 55.9%), and self-tailoring (n = 55; 53.9%). Conclusion: Applying self-management concepts to complex conditions such as SCI is only in the earliest stages of development. Despite having studied the topic from a broad perspective, this review reflects an ongoing program of research that links to an initiative to continue refining and testing self-management interventions in SCI.
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Affiliation(s)
- Amanda McIntyre
- Lawson Health Research Institute, Parkwood Institute, Ontario, Canada
| | | | | | - Lindsay Sleeth
- Lawson Health Research Institute, Parkwood Institute, Ontario, Canada
| | - Sander Hitzig
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Gary Linassi
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Sarah Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto
| | - Dalton L. Wolfe
- Lawson Health Research Institute, Parkwood Institute, Ontario, Canada
- Health Sciences, Western University, Ontario, Canada
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Craig A, Tran Y, Guest R, Middleton J. Trajectories of Self-Efficacy and Depressed Mood and Their Relationship in the First 12 Months Following Spinal Cord Injury. Arch Phys Med Rehabil 2019; 100:441-447. [DOI: 10.1016/j.apmr.2018.07.442] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/18/2018] [Accepted: 07/21/2018] [Indexed: 01/10/2023]
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Li Y, Bressington D, Chien WT. Pilot evaluation of a coping-oriented supportive program for people with spinal cord injury during inpatient rehabilitation. Disabil Rehabil 2017; 41:182-190. [PMID: 28994618 DOI: 10.1080/09638288.2017.1386238] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To report the feasibility and preliminary effects of a psychosocial care program entitled "coping-oriented supportive program" (COSP) for people with spinal cord injury (SCI) during inpatient rehabilitation. METHODS This was a pilot test of the COSP using a convenience sample of 22 participants with SCI (11 participants per group) with pre- and post-test, comparison group design. The feasibility, acceptability, and preliminary effects of the COSP were examined. RESULTS Nine patients with SCI in the intervention group and 11 in the comparison group who completed five or more sessions of the intervention were included in the data analysis. The COSP was feasible with high levels of recruitment, retention and protocol adherence. Good acceptability was suggested by the participants' feedback on the intervention program. The intervention group had a statistically significant greater improvement in self-efficacy (z = -1.978, p = 0.048), life enjoyment and satisfaction (z = -2.801, p = 0.005), and satisfaction of social support (z = -2.298, p = 0.022) at post-test, when compared to the comparison group. Whereas, no significant improvement was found for coping. CONCLUSIONS Our findings support the feasibility and acceptability of the COSP, and suggest that this intervention is a promising psychosocial care program to enhance people's life satisfaction and well-being as well as the satisfaction of social support after SCI. Further testing of this program with a larger-sized and diverse sample of people with SCI is needed. Implications for Rehabilitation The Chinese culturally-sensitive psychosocial care program (coping-oriented supportive program) is feasible, and has the potential to enhance people's self-efficacy in coping with spinal cord injury, and improve their psychosocial well-being and life satisfaction. The conventional inpatient spinal cord injury rehabilitation services could be improved by providing this "first-line" psychosocial care program in line with the current medical rehabilitation service.
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Affiliation(s)
- Yan Li
- a School of Nursing, The Hong Kong Polytechnic University , Hung Hom , Kowloon , Hong Kong
| | - Daniel Bressington
- a School of Nursing, The Hong Kong Polytechnic University , Hung Hom , Kowloon , Hong Kong
| | - Wai-Tong Chien
- a School of Nursing, The Hong Kong Polytechnic University , Hung Hom , Kowloon , Hong Kong
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Gopinath B, Craig A, Kifley A, Liew G, Bloffwitch J, Vu KV, Joachim N, Cummins R, Heraghty J, Broady T, Hayes A, Mitchell P. Implementing a multi-modal support service model for the family caregivers of persons with age-related macular degeneration: a study protocol for a randomised controlled trial. BMJ Open 2017; 7:e018204. [PMID: 28780563 PMCID: PMC5724127 DOI: 10.1136/bmjopen-2017-018204] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Age-related macular degeneration (AMD) is a leading cause of blindness and low vision among older adults. Previous research shows a high prevalence of distress and disruption to the lifestyle of family caregivers of persons with late AMD. This supports existing evidence that caregivers are 'hidden patients' at risk of poor health outcomes. There is ample scope for improving the support available to caregivers, and further research should be undertaken into developing services that are tailored to the requirements of family caregivers of persons with AMD. This study aims to implement and evaluate an innovative, multi-modal support service programme that aims to empower family caregivers by improving their coping strategies, enhancing hopeful feelings such as self-efficacy and helping them make the most of available sources of social and financial support. METHODS AND ANALYSIS A randomised controlled trial consisting of 360 caregiver-patient pairs (180 in each of the intervention and wait-list control groups). The intervention group will receive the following: (1) mail-delivered cognitive behavioural therapy designed to improve psychological adjustment and adaptive coping skills; (2) telephone-delivered group counselling sessions allowing caregivers to explore the impacts of caring and share their experiences; and (3) education on available community services/resources, financial benefits and respite services. The cognitive behavioural therapy embedded in this programme is the best evaluated and widely used psychosocial intervention. The primary outcome is a reduction in caregiver burden. Secondary outcomes include improvements in caregiver mental well-being, quality of life, fatigue and self-efficacy. Economic analysis will inform whether this intervention is cost-effective and if it is feasible to roll out this service on a larger scale. ETHICS AND DISSEMINATION The study was approved by the University of Sydney human research ethics committee. Study findings will be disseminated via presentations at national/international conferences and peer-reviewed journal articles. TRIAL REGISTRATION NUMBER The trial registration number is ACTRN12616001461482; pre-results.
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Affiliation(s)
- Bamini Gopinath
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Kolling Medical Research Institute, University of Sydney, Sydney, Australia
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Kolling Medical Research Institute, University of Sydney, Sydney, Australia
| | - Annette Kifley
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Kolling Medical Research Institute, University of Sydney, Sydney, Australia
| | - Gerald Liew
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Jaye Bloffwitch
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Kim Van Vu
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
- John Walsh Centre for Rehabilitation Research, Sydney Medical School, Kolling Medical Research Institute, University of Sydney, Sydney, Australia
| | - Nichole Joachim
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
| | - Rob Cummins
- Macular Disease Foundation Australia, Sydney, Australia
| | | | | | - Alison Hayes
- Sydney School of Public Health, University of Sydney, Sydney, Australia
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, Sydney, New South Wales, Australia
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Managing pain and fatigue in people with spinal cord injury: a randomized controlled trial feasibility study examining the efficacy of massage therapy. Spinal Cord 2016; 55:162-166. [DOI: 10.1038/sc.2016.156] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 07/31/2016] [Accepted: 09/15/2016] [Indexed: 11/09/2022]
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Craig A, Guest R, Tran Y, Middleton J. Cognitive Impairment and Mood States after Spinal Cord Injury. J Neurotrauma 2016; 34:1156-1163. [PMID: 27717295 DOI: 10.1089/neu.2016.4632] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Spinal cord injury (SCI) is believed to be associated with high rates of cognitive impairment, which can result in complications in recovery. This study concerned two groups of adults with SCI. The first sample involved 150 participants with SCI who were assessed once for cognitive capacity with comparisons made with 45 able-bodied adults. Sample 2 were drawn from Sample 1, and included 88 participants with SCI who were prospectively assessed for mood states (anxiety, depressive mood, and fatigue) and pain intensity at three time periods: at admission to SCI rehabilitation, at discharge, and 6 months after transition into the community. Results showed that the SCI sample had significantly lower cognitive performance than the able-bodied control group. Further, almost 29% of the adults with SCI had lowered cognitive performance believed to be indicative of cognitive impairment. The risk of an adult with SCI having cognitive impairment was almost 13 times that of someone without an SCI. Results from Sample 2 revealed that the development of negative mood states was a significant problem in those with cognitive impairment after they transitioned into the community, a time when personal resources are severely challenged. Findings suggest all adults with SCI admitted to rehabilitation should receive a cognitive screen, and that rehabilitation strategies should then be guided by the cognitive performance of the person. Special attention should also be given to improving skills of those with cognitive impairment before they transition into the community, so as to reduce risk of comorbid mental health problems.
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Affiliation(s)
- Ashley Craig
- 1 John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School-Northern, The University of Sydney , New South Wales, Australia
| | - Rebecca Guest
- 1 John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School-Northern, The University of Sydney , New South Wales, Australia
| | - Yvonne Tran
- 1 John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School-Northern, The University of Sydney , New South Wales, Australia .,2 Key University Centre for Health Technologies, University of Technology , Sydney, Broadway, New South Wales, Australia
| | - James Middleton
- 1 John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Sydney Medical School-Northern, The University of Sydney , New South Wales, Australia
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Craig A, Tran Y, Guest R, Gopinath B, Jagnoor J, Bryant RA, Collie A, Tate R, Kenardy J, Middleton JW, Cameron I. Psychological impact of injuries sustained in motor vehicle crashes: systematic review and meta-analysis. BMJ Open 2016; 6:e011993. [PMID: 27609849 PMCID: PMC5020848 DOI: 10.1136/bmjopen-2016-011993] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE The aim of this meta-analysis was to determine the psychological impact associated with motor vehicle crash (MVC)-related physical injuries. DESIGN Systematic review and meta-analysis. DATA SOURCES Multiple search engines included MEDLINE (via OVID), PsycINFO and Embase, and studies were sourced from scientific journals, conference papers and doctoral theses. STUDY SELECTION A high-yield search strategy was employed. Terms like 'psychological distress', 'depression', 'PTSD' and 'motor vehicle accident' were employed. These key words were run primarily and secondary searches were then conducted in association with the major injury types. Studies needed to compare psychological distress in people injured in an MVC with uninjured controls who had not recently experienced an MVC. DATA EXTRACTION Searches resulted in the identification of 2537 articles, and after eliminating duplicates and studies not meeting inclusion criteria, 24 studies were selected involving 4502 injured participants. These studies were entered into separate meta-analyses for mild to moderate traumatic brain injury (mTBI), whiplash-associated disorder (WAD) and spinal cord injury (SCI). RESULTS Elevated psychological distress was associated with MVC-related injuries with a large summary effect size in WAD (0.90), medium to large effect size in SCI (0.69) and small to medium effect size in mTBI (0.23). No studies meeting inclusion criteria were found for burns, fractures and low back injury. Increased psychological distress remains elevated in SCI, mTBI and WAD for at least 3 years post-MVC. CONCLUSIONS Rehabilitation strategies are needed to minimise distress subsequent to MVC-related physical injuries and the scientific robustness of studies requires improvement.
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Affiliation(s)
- Ashley Craig
- John Walsh Centre for Rehabilitation Research, Kolling Institute for Medical Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia
| | - Yvonne Tran
- John Walsh Centre for Rehabilitation Research, Kolling Institute for Medical Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia
| | - Rebecca Guest
- John Walsh Centre for Rehabilitation Research, Kolling Institute for Medical Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia
| | - Bamini Gopinath
- John Walsh Centre for Rehabilitation Research, Kolling Institute for Medical Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia
| | - Jagnoor Jagnoor
- John Walsh Centre for Rehabilitation Research, Kolling Institute for Medical Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia
| | - Richard A Bryant
- School of Psychology, University of New South Wales, Kensington, New South Wales, Australia
| | - Alex Collie
- Institute for Safety Compensation and Recovery Research, Monash University, Melbourne, Victoria, Australia
| | - Robyn Tate
- John Walsh Centre for Rehabilitation Research, Kolling Institute for Medical Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia
| | - Justin Kenardy
- School of Psychology and Centre of National Research on Disability and Rehabilitation Medicine (CONROD), University of Queensland, Brisbane, Queensland, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Kolling Institute for Medical Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia
| | - Ian Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute for Medical Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia
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Fiori KL, Hays JC, Meador KG. Spiritual Turning Points and Perceived Control over the Life Course. Int J Aging Hum Dev 2016; 59:391-420. [PMID: 15612200 DOI: 10.2190/kbxl-18w0-fpj4-f1gy] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Recent evidence indicates that spirituality and religion are associated with both physical and psychological health. Because a belief that rewards are largely determined by external forces tends to be detrimental to mental health, the idea that God can be equated with such an external force seems contradictory to the proven benefits of religion and spirituality. The purpose of this article is to examine changes in perceived control in the context of spiritual turning points as uncovered in the narrative histories of 30 elderly people. We propose that for many people who derive benefits from religion or spirituality, God may act as a mediator, in the sense that trusting in God provides personal control. In addition to creating a model of God-mediated control, the study's findings suggest a relationship between recall for type of control during a spiritual turning point and the interpretation of that turning point in late life.
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Arya S, Xue S, Embuldeniya A, Narammalage H, da Silva T, Williams S, Ravindran A. Coping strategies used by traumatic spinal cord injury patients in Sri Lanka: a focus group study. Disabil Rehabil 2016; 38:2008-15. [PMID: 26733185 DOI: 10.3109/09638288.2015.1111433] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Psychosocial consequences of traumatic spinal cord injury (SCI) have been well documented in Western populations, but there is no published literature on such incidence in the Sri Lankan population. The purpose of this study was to explore the psychosocial impact of SCI in a Sri Lankan population and to examine this population's coping mechanisms. METHODS Participants were recruited purposively at the Ragama Rheumatology and Rehabilitation Hospital, the sole rehabilitation facility for SCI patients in Sri Lanka. Focus groups were conducted with 23 consenting individuals. Interview transcripts were analysed using descriptive thematic analysis. RESULTS Four domains of life impact, three types of active coping strategies and four types of external supports were identified. Decreased ambulation and burden on family life were significant concerns for male and female participants alike. Religious practices were reported most frequently as active coping strategies, followed by positive reframing and goal-setting. Reported external supports included guided physiotherapy, informational workshops, social support and peer networks. CONCLUSION Rehabilitation efforts for Sri Lankan SCI patients should be sensitive to psychosocial concerns in addition to physical concerns in order to help patients re-integrate into their family lives and community. Furthermore, religious practices should be respected as possible aids to rehabilitation. Implications for Rehabilitation Rehabilitative efforts should be conscientious of patients' psychosocial well-being in addition to their physical well-being. Hospital-based rehabilitative efforts for traumatic spinal cord injury patients should promote functional independence and community re-integration. Spiritual and/or religious practices should be respected as ways by which traumatic spinal cord injury patients may confront personal challenges that arise following injury.
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Affiliation(s)
- Sumedha Arya
- a Faculty of Medicine, University of Toronto , Toronto , Ontario , Canada
| | - Siqi Xue
- a Faculty of Medicine, University of Toronto , Toronto , Ontario , Canada
| | - Amanda Embuldeniya
- b Department of Psychiatry, Faculty of Medicine , University of Kelaniya , Ragama , Sri Lanka
| | - Harsha Narammalage
- b Department of Psychiatry, Faculty of Medicine , University of Kelaniya , Ragama , Sri Lanka
| | - Tricia da Silva
- a Faculty of Medicine, University of Toronto , Toronto , Ontario , Canada ;,c Division of Mood and Anxiety Disorders , Centre for Addiction and Mental Health (CAMH) , Toronto , Ontario , Canada
| | - Shehan Williams
- b Department of Psychiatry, Faculty of Medicine , University of Kelaniya , Ragama , Sri Lanka
| | - Arun Ravindran
- c Division of Mood and Anxiety Disorders , Centre for Addiction and Mental Health (CAMH) , Toronto , Ontario , Canada ;,d Department of Psychiatry , University of Toronto , Toronto , Ontario , Canada
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Influence of neurological lesion level on heart rate variability and fatigue in adults with spinal cord injury. Spinal Cord 2015; 54:292-7. [PMID: 26458970 DOI: 10.1038/sc.2015.174] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Revised: 07/03/2015] [Accepted: 08/30/2015] [Indexed: 12/20/2022]
Abstract
STUDY DESIGN Group cohort design. OBJECTIVES To determine the influence of spinal cord injury (SCI) and neurological level on heart rate variability (HRV) and associations with fatigue. SETTING SCI rehabilitation outpatient and community settings in New South Wales, Australia. METHODS Participants included 45 adults with SCI living in the community and 44 able-bodied controls. Socio-demographic, neurological injury, psychological, HRV and eye blink variables were assessed. Multivariate analysis of variance and post hoc protected t-tests were used to determine differences in HRV and fatigue as a function of the neurological level. Pearson's correlation analysis was used to determine the relationships between these factors. RESULTS Participants with SCI had significantly reduced sympathetic activity. Those with tetraplegia had lowered sympathetic activity compared with those with paraplegia and able-bodied controls. Neither were differences in parasympathetic activity found between groups nor were there any significant differences found for the time domain or non-linear domains. Higher levels of fatigue were found in the SCI sample, and participants with tetraplegia had higher fatigue levels compared with those with paraplegia. Fatigued participants were more likely to have altered autonomic function-that is, reduced sympathetic activity. CONCLUSIONS Higher levels of neurological impairment in people with SCI are more likely to result in disordered cardiovascular control involving reduced sympathetic activity, whereas elevated fatigue was found to be associated with increased sympathetic dysfunction. Findings highlight the need to address risks associated with this dysfunction, such as improved HRV and fatigue screening for people with SCI and improved education on cardiovascular risk factors.
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Craig A, Nicholson Perry K, Guest R, Tran Y, Middleton J. Adjustment following chronic spinal cord injury: Determining factors that contribute to social participation. Br J Health Psychol 2015; 20:807-23. [PMID: 26037456 DOI: 10.1111/bjhp.12143] [Citation(s) in RCA: 85] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Revised: 03/18/2015] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Spinal cord injury (SCI) is a catastrophic event that may result in diminished physical, social, and mental health. The main objective of this research was to establish inpatient factors that contribute to social participation following discharge into the community. DESIGN Prospective longitudinal design with measures taken three times, soon after admission to rehabilitation (N = 88), at discharge from the inpatient phase (N = 81) and 6 months following discharge (N = 71). METHODS Participants included adults with SCI admitted into three SCI units over a 33-month period. Assessment included demographic, injury, and psychosocial health measures. Adjustment was defined by the extent of social re-integration or participation post-discharge after 6 months in the community. Social participation was measured by the Impact on Participation and Autonomy Questionnaire (IPAQ). Logistic regression models were used to establish inpatient factors that significantly predicted social participation 6 months post-discharge. RESULTS Six months after discharge, around 55% of the sample had difficulties with social participation. The odds against being employed for an adult with poor social participation was found to be 8.4 to 1. Factors that predicted social participation included a younger age, having less severe secondary medical complications like bladder and bowel dysfunction, having a higher cognitive capacity, perceiving one has control (self-efficacy) over one's life and environment, and having greater perceived social support. CONCLUSIONS These results provide direction for enhancing existing psychosocial health strategies within SCI rehabilitation, affording an opportunity for every person who sustains a permanent SCI to have optimal capacity for social participation. Statement of contribution What is already known on this subject? Spinal cord injury (SCI) is associated with significant challenges to wellbeing, including a high risk of secondary chronic illnesses, risk of co-morbid mental health problems, financial insecurity and social isolation. Research has shown poor social participation can lead to problems in re-integration into society following discharge from inpatient rehabilitation. Research to date has examined various factors related to poor social participation, but the majority of this research has been survey based with convenience samples. What does this study add? This study adds results of prospective longitudinal research on adjustment following SCI, where adjustment was defined by the rate of social participation when living in the community. About one-third of SCI participants were found to have very poor social participation, and only one-third had found some form of employment 6 months after discharge. Multiple factors were found to predict and contribute to poor social participation, including older age when injured, more severe medical complications, cognitive deficits, poor perceptions of control or self-efficacy, and poor social support.
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Affiliation(s)
- Ashley Craig
- John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia
| | - Kathryn Nicholson Perry
- Australian College of Applied Psychology, Sydney, New South Wales, Australia.,School of Social Sciences and Psychology, The University of Western Sydney, New South Wales, Australia
| | - Rebecca Guest
- John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia
| | - Yvonne Tran
- John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia.,Key University Centre for Health Technologies, University of Technology, Sydney, New South Wales, Australia
| | - James Middleton
- John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia
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Dating and Relationship Psychoeducational Group for Veterans with Spinal Cord Injury/Dysfunction: A Historical Account of an Initial Clinical Course. SEXUALITY AND DISABILITY 2013. [DOI: 10.1007/s11195-013-9330-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Thompson A, Papas A, Bartholomeusz C, Nelson B, Yung A. Externalized attributional bias in the Ultra High Risk (UHR) for psychosis population. Psychiatry Res 2013. [PMID: 23177592 DOI: 10.1016/j.psychres.2012.10.017] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Specific externalizing attributional biases appear to be common in early psychosis. They may represent trait risk factors for the later development of a psychotic disorder, yet few studies have investigated this in clinical "at risk" populations. We aimed to investigate one particular bias, the Locus of Control of reinforcement (LOC) in a "Ultra High Risk" (UHR) for psychosis group. We recruited UHR individuals from an established at risk clinical service and a community control group. LOC was measured using the Adult Nowicki Strickland Internal External scale (ANSIE). Neuropsychological functioning, social functioning and psychopathology were assessed. We analyzed data from 30 controls and 30 UHR individuals. The UHR sample had a significantly more externalized LOC (control for events perceived to be external to the person) than controls. This difference remained statistically significant after adjusting for covariates (age, gender and IQ). More externalized LOC scores were negatively correlated with social and occupational functioning scores in the control group but not in the UHR group and positively correlated with negative symptoms and paranoid symptoms in the UHR group. These findings have implications for identifying potential psychological vulnerabilities for the development of psychosis and informing treatment approaches within the at risk group.
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Affiliation(s)
- Andrew Thompson
- Orygen Youth Health and Research Centre, Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia.
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Wegener ST, Adams LL, Rohe D. Promoting optimal functioning in spinal cord injury: the role of rehabilitation psychology. HANDBOOK OF CLINICAL NEUROLOGY 2012; 109:297-314. [PMID: 23098721 DOI: 10.1016/b978-0-444-52137-8.00019-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Comprehensive treatment and rehabilitation includes attention to the psychological needs of individuals with SCI and their families. This chapter is designed to familiarize neurologists and other practitioners with psychological issues and care in SCI. While psychologists play a key role, attention to psychosocial health is a responsibility shared by all members of the rehabilitation team, beginning with the patient and family, and including clinicians who are not formally identified as mental health providers. Treatment planning for a person with SCI begins with a thorough assessment of the cognitive, emotional, personality, and social factors that influence functioning and rehabilitation. Rehabilitation psychologists use a mixture of assessment tools, including clinical interviews, behavioral observations, and a wide range of standardized test instruments. Psychological interventions can involve direct intervention with the patient, in individual, family or group-based therapies. Other psychological strategies involve assistance through less direct methods - consultation and training to other rehabilitation team members or facilitating peer role-modeling and support groups. The chapter provides an overview of core clinical issues (emotional responses, substance use, pain, cognitive deficits, sexuality and vocational rehabilitation), delineates the process of psychological assessment and intervention, and provides guidance on incorporation of rehabilitation psychology into SCI rehabilitation.
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Affiliation(s)
- Stephen T Wegener
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Livneh H, Antonak RF. Psychosocial Adaptation to Chronic Illness and Disability: A Primer for Counselors. JOURNAL OF COUNSELING AND DEVELOPMENT 2011. [DOI: 10.1002/j.1556-6678.2005.tb00575.x] [Citation(s) in RCA: 185] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Thompson A, Sullivan S, Lewis G, Zammit S, Heron J, Horwood J, Thomas K, Gunnell D, Hollis C, Wolke D, Harrison G. Association between locus of control in childhood and psychotic symptoms in early adolescence: results from a large birth cohort. Cogn Neuropsychiatry 2011; 16:385-402. [PMID: 21623488 DOI: 10.1080/13546805.2010.546077] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION. Specific attributional styles have been demonstrated in individuals with psychotic disorders and are implicated in the development of psychotic symptoms. We aimed to examine the association between locus of control (LOC) assessed in childhood and psychotic symptoms reported in early adolescence. METHODS. We used a prospective longitudinal design using data from a large birth cohort (the Avon Longitudinal Study of Parents and Children, ALPSAC). 6455 subjects completed a semistructured clinical interview assessing 12 individual psychotic symptoms at a mean age of 12.9 years. A measure of LOC was previously collected in the cohort at the age of 8. RESULTS. Children who reported an externalised LOC at age 8 were at increased risk of reporting both broadly defined (OR 1.77, 95% CI 1.49 to 2.08) and narrowly defined (OR 2.06, 95% CI 1.58 to 2.67) psychotic symptoms at age 13 years. These associations were only slightly attenuated after adjustment for potential confounders. The associations were similar for broadly defined specific paranoid symptoms but weaker for narrowly defined specific paranoid symptoms. CONCLUSIONS. An externalised LOC appears to be associated with later reporting of psychotic symptoms in early adolescence. Further investigation of the role of attributional styles, such as LOC, in increasing the risk for psychotic disorders, is warranted.
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Abstract
STUDY DESIGN This study was carried out as a postal survey. OBJECTIVES The aim of this study was to ascertain employment after paraplegia in India. SETTING This study was conducted in India. METHODS The study was conducted by means of a questionnaire. This questionnaire was mailed to the identified individuals (n=600) on the addresses obtained from the medical records section of hospitals and from various organisations. Data analysis was carried out by using descriptives. RESULTS The return rate was 46% (276/600) and the employment rate was 41% (114/276). Among 114 subjects who were employed, 68 (59.6%) were living in centres run by armed force and 46 (40.4%) were living in specialised centres or under the region of non-governmental organisations. CONCLUSIONS Individuals who were employed were living either in centres run by armed force or in specialised centres. None of the individuals living in community was employed.
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Mehta S, Orenczuk S, Hansen KT, Aubut JAL, Hitzig SL, Legassic M, Teasell RW. An evidence-based review of the effectiveness of cognitive behavioral therapy for psychosocial issues post-spinal cord injury. Rehabil Psychol 2011; 56:15-25. [PMID: 21401282 PMCID: PMC3206089 DOI: 10.1037/a0022743] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To examine the evidence supporting the effectiveness of cognitive behavioral therapy (CBT) for improving psychosocial outcomes in individuals with spinal cord injury (SCI). METHOD Electronic databases (MEDLINE, CINAHL, EMBASE, and PsycINFO) were searched for studies published between 1990 and October 2010. Randomized control trials (RCTs) and nonrandomized control trials (non-RCTs) utilizing a CBT intervention to improve psychosocial outcomes (depressive symptomatology, anxiety, coping, and adjustment to disability) in outpatient persons with SCI were included for review. Levels of evidence were assigned to each study using a modified Sackett scale. Effect size calculations for the interventions were provided where possible. RESULTS Nine studies met the inclusion criteria. The studies reviewed included two RCTs, six prospective controlled trials (PCTs) and one cohort study. All studies examined at least two groups. There is Level 1 and Level 2 evidence supporting the use of specialized CBT protocols in persons with SCI for improving outcomes related to depression, anxiety, adjustment, and coping. CONCLUSIONS CBT holds promise as an effective approach for persons with SCI experiencing depression, anxiety, adjustment, and coping problems. As CBT may involve many different components, it is important in the future to determine which of these elements alone or in combination is most effective in treating the emotional consequences of SCI.
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Affiliation(s)
- Swati Mehta
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
| | | | | | - Jo-Anne L. Aubut
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
| | | | - Matthew Legassic
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
| | - Robert W. Teasell
- Aging, Rehabilitation and Geriatric Care Program, Lawson Health Research Institute, London ON
- St. Joseph’s Parkwood Hospital, London ON
- Department of Physical Medicine and Rehabilitation, Schulich School of Medicine and Dentistry, University of Western Ontario, London ON
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Dorstyn D, Mathias J, Denson L. Efficacy of cognitive behavior therapy for the management of psychological outcomes following spinal cord injury: a meta-analysis. J Health Psychol 2010; 16:374-91. [PMID: 20978150 DOI: 10.1177/1359105310379063] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This meta-analysis evaluated the impact of cognitive behavior therapy (CBT) on the psychological adjustment of adults with spinal cord injury (SCI). A comprehensive search of six electronic databases identified 10 studies (424 participants) that met the inclusion criteria. Pre- and post-data for participants who received CBT were pooled and analyzed. Large and significant group differences were noted for measures of assertiveness, coping, self-efficacy, depression and quality of life. These data suggest that CBT has a significant positive impact on short-term psychological outcomes following SCI. However, further research is needed to establish the long-term benefits.
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Affiliation(s)
- Diana Dorstyn
- Hampstead Rehabilitation Centre, South Australia, Australia
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Comparison of a Pain Management Program With Usual Care in a Pain Management Center for People With Spinal Cord Injury-related Chronic Pain. Clin J Pain 2010; 26:206-16. [DOI: 10.1097/ajp.0b013e3181bff8f3] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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De Silva M, MacLachlan M, Devane D, Desmond D, Gallagher P, Schnyder U, Brennan M, Patel V. Psychosocial interventions for the prevention of disability following traumatic physical injury. Cochrane Database Syst Rev 2009; 2009:CD006422. [PMID: 19821365 PMCID: PMC3428876 DOI: 10.1002/14651858.cd006422.pub3] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Traumatic physical injury can result in many disabling sequelae including physical and mental health problems and impaired social functioning. OBJECTIVES To assess the effectiveness of psychosocial interventions in the prevention of physical, mental and social disability following traumatic physical injury. SEARCH STRATEGY The search was not restricted by date, language or publication status. We searched the following electronic databases; Cochrane Injuries Group Specialised Register, CENTRAL (The Cochrane Library 2009, Issue 1), MEDLINE (Ovid SP), EMBASE (Ovid SP), PsycINFO (Ovid SP), Controlled Trials metaRegister (www.controlled-trials.com), AMED (Allied & Complementary Medicine), ISI Web of Science: Social Sciences Citation Index (SSCI), PubMed. We also screened the reference lists of all selected papers and contacted authors of relevant studies. The latest search for trials was in February 2008. SELECTION CRITERIA Randomised controlled trials that consider one or more defined psychosocial interventions for the prevention of physical disability, mental health problems or reduced social functioning as a result of traumatic physical injury. We excluded studies that included patients with traumatic brain injury (TBI). DATA COLLECTION AND ANALYSIS Two authors independently screened the titles and abstracts of search results, reviewed the full text of potentially relevant studies, independently assessed the risk of bias and extracted data. MAIN RESULTS We included five studies, involving 756 participants. Three studies assessed the effect of brief psychological therapies, one assessed the impact of a self-help booklet, and one the effect of collaborative care. The disparate nature of the trials covering different patient populations, interventions and outcomes meant that it was not possible to pool data meaningfully across studies. There was no evidence of a protective effect of brief psychological therapy or educational booklets on preventing disability. There was evidence from one trial of a reduction in both post-traumatic stress disorder (PTSD) and depressive symptoms one month after injury in those who received a collaborative care intervention combined with a brief psycho-educational intervention, however this was not retained at follow up. Overall mental health status was the only disability outcome affected by any intervention. In three trials the psychosocial intervention had a detrimental effect on the mental health status of patients. AUTHORS' CONCLUSIONS This review provides no convincing evidence of the effectiveness of psychosocial interventions for the prevention of disability following traumatic physical injury. Taken together, our findings cannot be considered as supporting the provision of psychosocial interventions to prevent aspects of disability arising from physical injury. However, these conclusions are based on a small number of disparate trials with small to moderate sample sizes and are therefore necessarily cautious. More research, using larger sample sizes, and similar interventions and patient populations to enable pooling of results, is needed before these findings can be confirmed.
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Affiliation(s)
- Mary De Silva
- London School of Hygiene & Tropical MedicineNutrition & Public Health Intervention Research UnitKeppel StreetLondonUKWC1E 7HT
| | - Malcolm MacLachlan
- Trinity College, University of DublinCentre for Global Health and School of PsychologyDublinIreland
| | - Declan Devane
- National University of Ireland GalwaySchool of Nursing and MidwiferyÁras MoyolaUniversity RoadGalwayIreland
| | - Deirdre Desmond
- National University of IrelandDepartment of PsychologyJohn Hume BuildingMaynoothCo. KildareIreland
| | | | - Ulrich Schnyder
- University HospitalDepartment of PsychiatryCulmannstrasse 8ZurichSwitzerlandCH‐9091
| | - Muireann Brennan
- Centers for Disease Control and PreventionInternational Emergency & Refugee Health Branch1600 Clifton Road NE MS E‐97AtlantaGAUSA30333
| | - Vikram Patel
- London School of Hygiene & Tropical MedicineNutrition & Public Health Intervention Research UnitKeppel StreetLondonUKWC1E 7HT
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Gorski JA, Slifer KJ, Townsend V, Kelly-Suttka J, Amari A. Behavioural treatment of non-compliance in adolescents with newly acquired spinal cord injuries. ACTA ACUST UNITED AC 2009; 8:187-98. [PMID: 16087553 DOI: 10.1080/13638490400021438] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To demonstrate the efficacy of using differential reinforcement to treat non-compliance in adolescents with spinal cord injury. METHOD A case series design was used to examine three adolescents (aged 14-16 years) with tetraplegia who received multi-disciplinary rehabilitation treatment and a behavioural contract programme during an in-patient hospital admission. Assessment included collecting data on each patient's weekly percentage of compliance with all rehabilitation goals, weekly percentage of negative affect observed in therapy sessions and scores on a measure of mobility in physical therapy. RESULTS Compliance with rehabilitation demands improved from a baseline of 20-65% to 80% or greater after the patients received differential reinforcement for participating in the rehabilitation regimen. Patients exhibited less anger, sadness and frustration during therapy sessions once contracts were started. CONCLUSIONS The adolescents demonstrated greater compliance after the implementation of a behavioural contract. Future studies should identify the specific variables that affect psychological adjustment and predict 'readiness' to participate in rehabilitation.
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Khamis V. Post-traumatic stress and psychiatric disorders in Palestinian adolescents following intifada-related injuries. Soc Sci Med 2008; 67:1199-207. [DOI: 10.1016/j.socscimed.2008.06.013] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2007] [Indexed: 10/21/2022]
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Craig A. Clinical Psychology and Neurological Disability: Psychological Treatment for Spinal Cord Injury. CLIN PSYCHOL-UK 2008. [DOI: 10.1080/13284200008521067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Jones SR, Fernyhough C. The roles of locus of control and self-esteem in hallucination- and delusion-proneness in a non-clinical sample. PERSONALITY AND INDIVIDUAL DIFFERENCES 2007. [DOI: 10.1016/j.paid.2007.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Chung MC, Preveza E, Papandreou K, Prevezas N. Locus of control among spinal cord injury patients with different levels of posttraumatic stress disorder. Psychiatry Res 2007; 152:253-60. [PMID: 17628694 DOI: 10.1016/j.psychres.2004.09.013] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2003] [Revised: 09/13/2004] [Accepted: 09/15/2004] [Indexed: 10/23/2022]
Abstract
Two hypotheses were investigated in the present study: 1) Patients with full posttraumatic stress symptoms following spinal cord injury (SCI) would experience more general health problems than those with partial posttraumatic stress disorder (PTSD), with no-PTSD and the control group; 2) Patients with full PTSD would endorse the external locus of control more than those with partial PTSD, no-PTSD and the control group. Sixty-two patients were recruited from a specialized rehabilitation clinic for spinal cord injury. The control group comprised 60 participants without SCI. Patients with SCI were assessed using the Posttraumatic Stress Disorder Checklist, the General Health Questionnaire-28 (GHQ-28) and the Multidimensional Health Locus of Control (MHLC). The control group was assessed using the GHQ-28 and the MHLC. The full PTSD group experienced more somatic problems, anxiety, social dysfunction and depression than the partial PTSD, the no-PTSD and the control groups. The results also showed that the full PTSD group endorsed significantly more external health locus of control than the control group. However, no significant differences were found between the three patient groups in health locus of control. The three PTSD sub-scales were positively correlated with general health problems. Further analyses showed that partial PTSD patients with paraplegia and partial PTSD patients whose SCI had a medically related cause were more likely to report less internal locus of control than other patients. Patients who suffered from full PTSD experienced more general health problems than those with fewer PTSD symptoms and those without SCI. External locus of control was a distinctive strategy that SCI-PTSD patients used in coping with the effects of SCI-PTSD.
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Affiliation(s)
- Man Cheung Chung
- University of Plymouth, Clinical Psychology Teaching Unit, Peninsula Allied Health Centre, Derriford Road, Plymouth, PL6 8BH, UK.
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Widerström-Noga EG, Cruz-Almeida Y, Martinez-Arizala A, Turk DC. Internal Consistency, Stability, and Validity of the Spinal Cord Injury Version of the Multidimensional Pain Inventory. Arch Phys Med Rehabil 2006; 87:516-23. [PMID: 16571391 DOI: 10.1016/j.apmr.2005.12.036] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2005] [Accepted: 12/29/2005] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To evaluate the internal consistency, stability, and construct validity of a spinal cord injury (SCI) version of the Multidimensional Pain Inventory (MPI-SCI). DESIGN Interview. SETTING Veterans Affairs medical center and university-based institute. PARTICIPANTS Community sample of persons with SCI and chronic pain (N=161). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The MPI-SCI. RESULTS The internal consistency of the MPI-SCI subscales ranged from fair (.60) for affective distress to substantial (.94) for pain interference with activities. The subscales of the MPI-SCI (ie, life interference [r=.81], affective distress [r=.71], solicitous responses [r=.86], distracting responses [r=.85], general activity [r=.69], pain interference with activities [r=.78], pain severity [r=.69], negative responses [r=.69]) showed adequate stability. In contrast, the stability of the support (r=.59) and the life control subscales (r=.31) was unacceptably low. All MPI-SCI subscales with the exception of the perceived responses by significant others subscales showed good convergent, discriminant, and concurrent validity. CONCLUSIONS The MPI-SCI appears to be a reasonable measure for evaluating chronic pain impact after SCI. In clinical trials, however, supplementary instruments should be included to assess changes in affect, social support, and perceptions of life control.
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Chung MC, Preveza E, Papandreou K, Prevezas N. Spinal cord injury, posttraumatic stress, and locus of control among the elderly: a comparison with young and middle-aged patients. Psychiatry 2006; 69:69-80. [PMID: 16704333 DOI: 10.1521/psyc.2006.69.1.69] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This study aimed to investigate the extent to which spinal cord injury posttraumatic stress (SCI PTSD) responses and the use of the external or internal health locus of control might vary according to age. Sixty-two patients with SCI were recruited for the study and divided into young (n = 23), middle-aged (n = 25) and elderly (n = 14) groups. They were assessed using the Posttraumatic Stress Disorder Checklist (PCL), the General Health Questionnaire-28 (GHQ-28), and the Multidimensional Health Locus of Control (MHLC). The results showed no significant differences between the three age groups in terms of PTSD symptoms. The elderly patients were significantly more socially dysfunctional than the other patients. The young patients believed in chance locus of control (CHLC) significantly more than the middle-aged and elderly patients. Correlation results revealed no significant relationship between PTSD symptoms and type of locus of control for the middle-aged patients. Otherwise, for both the young and elderly patients, internal health locus of control (IHLC) was negatively correlated with the avoidance symptom. For the elderly patients, powerful other locus of control (POLC) was positively correlated with the avoidance symptom. Both young and middle-aged patients revealed significant positive correlations between POLC, CHLC, and general health problems. For the elderly patients, POLC was positively correlated with social dysfunction and depression. SCI-PTSD responses did not differ according to age; however, the use of health locus of control differed depending on whether patients were younger or older.
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Affiliation(s)
- Man Cheung Chung
- University of Plymouth School of Applied Psychosocial Studies, Plymouth, England.
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Abstract
This article provides a substantive review and synthesis of major areas of emphasis in spinal cord injury (SCI) research. Comprehensive examination of the current status and future implications for SCI research includes consideration of investigations from the following arenas: epidemiology, functional classification and prediction, neurophysiologic testing, models of injury and recovery, psychosocial considerations, surgical strategies, animal laboratory research, economic implications, life expectancy, complication rates, gender differences, pharmacological management, and prevention. Synthesis of these research conclusions from a broad spectrum of laboratory, clinical, and scientific domains provides opportunity for improving SCI prevention, treatment, and adaptation.
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Affiliation(s)
- J Sullivan
- Thomas Jefferson University & Hospital, Philadelphia, Pennsylvania, USA
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