Quadriplegic care: an assessment of the impact of the carer

Couples' experiences with sexuality after spinal cord injury

PURPOSE

To explore sexuality after spinal cord injury (SCI) from the perspectives of individuals with SCI and their romantic partners.

METHODS

A sample of 8 Canadian adults with SCI (6 men, 2 women) and their partners participated in this study (N = 16). Semi-structured dyadic and individual interviews were conducted, discussions surrounding sexuality and intimacy were extracted, and a qualitative description of the interview data was performed using thematic analysis.

RESULTS

Three major themes were identified: the changing definition of sex; emotions; and practical support. Couples' conversations around the changing definition of sex after SCI addressed the taboo topic of sexuality and the importance of communication between couples, peers, and healthcare providers. Emotions included fears of losing intimacy, embarrassment in managing bladder and bowel interference, and acceptance in balancing being a romantic partner and a caregiver. Finally, couples reported challenges accessing practical support including medical interventions and sexual health nurses, but saw value in peer mentorship programs.

CONCLUSION

Couples explored a changing definition of sex following SCI that was complicated by the taboo nature of discussing sexuality, experienced a range of emotions throughout the recovery process, and had difficulties navigating the healthcare system for appropriate support.IMPLICATIONS FOR REHABILITATIONHealthcare professionals should promote discussion and provide support for sexuality following SCI, but during initial rehabilitation may be too early.Healthcare providers should prepare people with SCI and their partners for the inevitable trial-and-error process involved in sexual rehabilitation.Rehabilitation professionals could direct couples to SCI peer mentorship programs to help normalize the experiences and emotions of sexual rehabilitation.

Psychological distress, quality of life, and burden in caregivers during community reintegration after spinal cord injury

OBJECTIVES

To examine relations between psychological distress, health-related quality of life (HR-QOL), and burden among caregivers of people with traumatic spinal cord injury (SCI) over time, and to determine whether the data are more consistent with a wear and tear or adaptation trajectory.

DESIGN

Prospective longitudinal cohort study with measurements at 4 time points (6wk prior to discharge from subacute inpatient rehabilitation and 6wk, 1y, and 2y postdischarge to community).

SETTING

Rehabilitation units.

PARTICIPANTS

Participants (N=44; spouses, parents, others) nominated as a primary caregiver by the person with SCI.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

General Health Questionnaire-28 (GHQ-28), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and Caregiver Strain Index (CSI) assessed the extent of psychological distress, HR-QOL, and burden, respectively, among caregivers. Functional status and community participation/care needs of the persons with SCI were assessed by the FIM and Craig Handicap Assessment and Reporting Technique, respectively.

RESULTS

Multilevel piecewise models showed that psychological distress (GHQ-28 score) decreased significantly after discharge (slope estimate =-.03, P<.008). At the predischarge time point, the caregivers' mental component summary score on the SF-36 was significantly lower than Australian national norms. The scores improved from predischarge to 6 weeks postdischarge (slope estimate =.39, P<.001), but they did not change significantly across the following 2 time points (slope estimate =.02, P=.250). At all 3 postdischarge time points, the mental component summary scores were not significantly different to national norms. In contrast, the physical component summary score of the SF-36 did not significantly change across the predischarge and 6-week postdischarge time points (slope estimate =-.14, P=.121) and the 3 postdischarge time points (slope estimate <.01, P=.947). Scores at all 4 time points were not significantly different to the national norms. Caregiver burden showed no significant change over the study period (predischarge to 6wk postdischarge slope estimate =.02, P=.426; 3 postdischarge time point slope estimates <-.01, P=.334). Reflecting this, 42% of caregivers met CSI caseness criterion at the first time point, and 46% met the criterion at the fourth (2y) time point. Higher burden was significantly correlated with increased hours of care being provided by the caregiver and lower FIM scores and lower community participation (for the person with SCI) at each time point. Psychological distress correlated with caregiver burden at 6 weeks and 1 year postdischarge but not at 2 years postdischarge.

CONCLUSIONS

The trajectory of scores for psychological distress and HR-QOL was consistent with caregiver adaptation to the challenge of providing support to a person with SCI in the early postdischarge period. Caregiver burden did not display similar reductions but did not worsen over the study period.

Psychological impact and the burden of caregiving for persons with spinal cord injury (SCI) living in the community in Fiji

STUDYDESIGN: This study was designed as a cross-sectional one. A set of structured questionnaires was administered.

OBJECTIVES

The purpose of the study was to explore the psychological response of the caregivers of people with spinal cord injury (SCI) and to assess the burden of caregiving for SCI persons living in the community in Fiji.

SETTING

Fiji, South Pacific.

METHODS

A total of 30 primary caregivers of persons with SCI. The Index of Psychological Well-Being (IPWB) was used to assess the psychological impact of care giving, and Caregiver Burden Inventory (CBI) was used to evaluate the burden associated with caregiving for persons with SCI. Barthel Index (BI) scale was used to measure the functional abilities of the care recipients.

RESULTS

The majority of the participants (n=20) were women, who had an ethnic Fijian background (n=18) and were married (n=18), and were spouses (n=13). Mean BI of the persons with SCI was 7.1 (s.d.=5.23) on a 0-20 scale, with 90% (n=27) suffering from moderate-to-very severe disability (BI<15). The mean duration of caregiving was 6.1 years (s.d.=4.23). On average, the caregivers provided 6.1 h (s.d.=2.19) of caregiving per day. The experiences of caregiving adversely affected the caregiver psychological well-being. Participants demonstrated high levels of time-dependent and development burden. Caregiving was significantly related to the number of hours spent providing care (r (s)=0.35, P<0.05), and the older caregiver age (r (s)=0.46, P<0.01).

CONCLUSION

Being a primary caregiver of a SCI person contributes to caregiver burden and psychological distress. The findings indicate that the contributions of these people should be recognized and interventions should be tailored not only toward the needs of the care recipients but also to the needs of the caregivers.

Electric-powered indoor/outdoor wheelchairs (EPIOCs): users' views of influence on family, friends and carers

PURPOSE

This study explored the effects of electric-powered indoor/outdoor wheelchair (EPIOC) provision to users on their family and carers.

METHOD

EPIOC users receiving their chairs between February and November 2002 (N = 74) were invited to participate in a telephone questionnaire/interview, and 64 agreed. This study examined the responses to the question 'Has the use of your EPIOC affected your family or friends in any way?' and related comments. Interviews were analysed using a qualitative framework approach to identify emergent themes. In addition, the proportion of individuals raising issues related to each theme was determined. Participants were interviewed 10-19 (mean = 14.3) months after chair delivery.

RESULTS

The following themes emerged: reduced physical burden on family/friends and increased independence and freedom. However, an EPIOC does not eliminate other practical problems particularly during transportation and negotiating kerbs and slopes. Users also reported anxiety/worry in relationship to EPIOC use, e.g., weather conditions, personal safety (muggings), use of ramps and kerbs.

CONCLUSION

There are considerable benefits to families and carers associated with powered wheelchair use. A reduction in the physical demand for pushing and increased freedom were identified. These benefits appear to outweigh the residual practical difficulties and worries.

Leisure satisfaction and psychiatric morbidity among informal carers of people with spinal cord injury

STUDY DESIGN

Cross sectional survey.

OBJECTIVE

To examine the nature and prevalence of common mental disorders among informal carers of people with Spinal Cord Injury (SCI) and the association with their leisure satisfaction.

SETTING

Christian Medical College, Vellore, Tamilnadu, India.

METHODS

A cross-sectional survey of informal carers of people SCI at the Department of Physical Medicine and Rehabilitation. Fifty-three informal carers of people with SCI were interviewed using the Revised Clinical Interview Schedule to assess psychiatric morbidity, and using the Leisure Satisfaction Scale to measure leisure and contentment. Data on carers with psychiatric morbidity were compared to those without common mental disorders using univariate and multivariate statistics.

RESULTS

Study reported a high morbidity (53%), with most consistent diagnoses of depression and anxiety. Carers who were spouses, women, currently married and those with lower education had greater psychiatric morbidity and lesser leisure satisfaction, even after adjusting for age and education using logistic/linear regression. Age, occupation, residence, socioeconomic status, type and duration of SCI were not associated with either morbidity or leisure satisfaction.

CONCLUSION

Many carers of people with SCI suffer from psychiatric morbidity and also have low scores on leisure satisfaction.

Re-examining the psychology of spinal cord injury: a meaning centered approach from a cultural perspective

OBJECTIVES

To examine the impact of SCI from a non-Western cultural perspective.

SETTING

India.

METHODS

A philosophical approach.

CONCLUSION

Management of the individual with spinal cord injury needs to take in to account the individual's beliefs and cultural context.

Quality of life of primary caregivers of spinal cord injury survivors living in the community: controlled study with short form-36 questionnaire

OBJECTIVE

To compare the quality of life scores of primary caregivers of spinal cord injury survivors living in the community with healthy age matched-population based controls and to determine the relationship between some severity parameters related with spinal cord injury and the quality of life scores of primary caregivers.

SETTING

University hospital, rehabilitation centre.

METHODS

Fifty primary caregivers of spinal cord injured patients living in the community and 40 healthy age-matched controls completed SF-36 (short form-36) questionnaire forms. Questionnaires were administered by interviewers who were physiatrists and the authors of the present study. All the patients were rehabilitated by the authors and data about the duration of injury, lesion levels, ASIA scores, degree of spasticity, presence of bladder and bowel incontinence and pressure sores were gathered from the hospital recordings and/or by physical examinations during control visits when the primary caregivers were administered the questionnaires.

RESULTS

Quality of life scores measured by SF-36 were significantly low in the primary caregivers group compared to age-matched healthy population based controls. No significant relation was demonstrated between the quality of life scores of primary caregivers and parameters such as the duration of injury, lesion levels, ASIA scores, degree of spasticity, bladder and/or bowel incontinence and pressure sores respectively.

CONCLUSION

According to the results of the present study, being a primary caregiver of a spinal cord injured victim significantly interferes with quality of life; some severity parameters related to the injury however do not seem to have an additional impact on the primary caregiver's life quality.

Do 'social relief' admissions have any effect on patients or their care-givers?

Dependent patients and their care-givers were studied before and 1 week after a social relief admission in order to assess the effects on physical and psychological problems. Data about care-givers stress and mental health were gathered, as well as patient data. Patients' self-care abilities improved slightly but care requirements remained constant. Care-giver stress levels did not change, but there was a highly significant improvement in their mental health. The results suggest that social relief admissions enabled care-givers to continue to look after very dependent people in the community.

Psychosocial outcome following spinal cord injury

Studies have indicated that loss of social contact remains the primary complaint of people with head injuries many years after discharge. In an attempt to disentangle specific and nonspecific effects of head injury a study was undertaken to compare a group of 15 men with severe closed head injuries and their wives, with a group of 15 men with complete, traumatic spinal cord injuries and their partners (n = 60). Time since discharge extended from 4 months to several years. This paper focuses primarily upon the results and implication of the responses from the group of men with spinal cord injuries and their partners. The Interview Schedule for Social Interaction was correlated with the Leeds Scale for the Self Assessment of Anxiety and Depression. All groups reported low availability and adequacy of social integration and exhibited high levels of depression. The group of men with spinal cord injuries had the lowest scores for the availability of social integration, indicating that the social isolation which has previously been identified amongst people with head injuries may not be attributable solely to brain damage.