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Hakbijl-van der Wind AJ, Rohn EJ, Tate DG, van Leeuwen CMC, Forchheimer M, Stolwijk-Swüste JM, Charlifue S, Greve JMD, New PW, Post MWM. The social dimension of quality of life following spinal cord injury or disease: an international ICF-linking study. Spinal Cord 2024; 62:104-109. [PMID: 38158409 DOI: 10.1038/s41393-023-00954-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 11/21/2023] [Accepted: 12/13/2023] [Indexed: 01/03/2024]
Abstract
STUDY DESIGN International Classification of Functioning, Disability and Health (ICF) linking study. OBJECTIVE Analyze cognitive interview data using the ICF as an analytic framework, to examine aspects of social life relevant to quality of life (QoL) according to people with spinal cord injury or disease (SCI/D). This study builds upon results of an international study about the cross-cultural validity of the International SCI QoL Basic Data Set (QoL-BDS). SETTING Four specialized outpatient clinics in SCI/D rehabilitation, from the US, Brazil and Australia. METHODS Analysis of qualitative data from 39 cognitive interviews with SCI/D patients at least one year post onset. Participants were asked to define their concept of QoL, overall life satisfaction, physical health and psychological health, and other relevant matters. Four independent researchers coded text fragments related to the items, and fragments were linked to ICF chapters d6-d9, following established linking rules. RESULTS The proportion of text referring to social life was 35.8% (definition QoL), 24.9% (QoL life as whole), 6.0% (physical health) and 34.9% (psychological health). The most frequent ICF categories were d760 Family relationships, d770 Intimate relationships and d920 Recreation and leisure. Most frequent responded social topics to the 'other issues' item were d770 Intimate relationships, d760 Formal relationships, and d870 Economic self-sufficiency. CONCLUSION The importance of social life aspects to the QoL was highlighted based on responses of SCI/D patients, clearly demonstrated through the ICF linking process. Adding a satisfaction with social life item to the QoL-BDS has made this instrument a more comprehensive measure.
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Affiliation(s)
- Aline J Hakbijl-van der Wind
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands.
| | - Edward J Rohn
- Department of Interdisciplinary Health Sciences, Oakland University, Rochester, MI, USA
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Denise G Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Christel M C van Leeuwen
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Martin Forchheimer
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Janneke M Stolwijk-Swüste
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | | | - Julia M D Greve
- Department of Orthopedics and Traumatology, Medical School of University of São Paulo, São Paulo, Brazil
| | - Peter W New
- Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Melbourne, VIC, Australia
- Epworth-Monash Rehabilitation Medicine Unit, Monash University, Melbourne, VIC, Australia
- Department of Epidemiology and Preventative Medicine, School of Public Health & Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Marcel W M Post
- Centre of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Centre, University Medical Centre Utrecht and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, The Netherlands
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Rohn EJ, Hearn JH, Philippus AM, Monden KR. "It's been a double-edged sword": An online qualitative exploration of the impact of COVID-19 on individuals with spinal cord injury in the US with comparisons to previous UK findings. J Spinal Cord Med 2024; 47:51-63. [PMID: 36260026 PMCID: PMC10795552 DOI: 10.1080/10790268.2022.2129164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVE The impact of COVID-19 lockdowns and social distancing for persons with spinal cord injury (SCI) are poorly understood. This exploratory online qualitative study collected self-reported COVID-19 experiences from persons with SCI in the United States (US). To enrich understanding, these data were compared to similar previously-published data from a sample of SCI participants from the United Kingdom (UK). DESIGN Explorative, online qualitative study. Participants completed an online survey of open-ended qualitative questions pertaining to their experiences during the pandemic. Thematic analysis was utilized to generate themes from the US data. These themes were compared to our previously-published thematic analysis of data from the UK. SETTING Community-based sample of persons with SCI in the US. PARTICIPANTS Participants were recruited via SCI-focused research registries and social media outlets serving the SCI community, using convenience sampling (n = 36). Key themes identified in the US data were compared to themes identified in a similar sample from the UK (n = 42) collected at the same time and published previously. RESULTS Analysis resulted in three themes from the US data, each containing positive and negative qualitative reflections. Themes included (1) health and access to care, (2) making sense of the pandemic, and (3) daily life during the pandemic. Each theme captured common facets of life during the pandemic, often shared by those without physical disabilities, but included accounts particularly relevant to persons with disabilities. Comparisons to thematic findings from the UK study revealed similarities (e.g. healthcare access challenges, isolation) and differences (e.g. importance of previous SCI experiences). CONCLUSION We detailed common experiences of COVID-19 pandemic lockdowns and their impact on people with SCI, while contrasting these with sense-making positive reflections and social benefits that appeared to be helpful in managing distress and coping with the pandemic.
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Affiliation(s)
- Edward J. Rohn
- Department of Interdisciplinary Health Sciences, Oakland University, Rochester, Michigan, USA
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Jasmine H. Hearn
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Angela M. Philippus
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - Kimberley R. Monden
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Tate DG, Rohn EJ, Forchheimer M, Walsh S, DiPonio L, Rodriguez GM, Cameron AP. Factors influencing decisions about neurogenic bladder and bowel surgeries among veterans and civilians with spinal cord injury. J Spinal Cord Med 2023; 46:215-230. [PMID: 34726578 PMCID: PMC9987721 DOI: 10.1080/10790268.2021.1970897] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE This study investigated factors influencing surgical decision-making (DM) to treat neurogenic bladder and bowel (NBB) dysfunction for veterans and civilians with spinal cord injury (SCI) in the United States (US). DESIGN Semi-structured interviews complemented by survey measures. SETTING Community-dwelling participants who received treatment at a major Midwestern US medical system, a nearby Veterans Affairs (VA) facility, and other VA sites around the US. PARTICIPANTS Eighteen participants with SCI who underwent surgeries; completed semi-structured interviews and survey measures. INTERVENTIONS Not applicable. OUTCOMES MEASURES Semi-structured interviews were coded to reflect factors, DM enactment, and outcomes, including surgery satisfaction and quality of life (QOL). Quantitative measures included COMRADE, Ways of Coping Questionnaire, Bladder and Bowel Treatment Inventory, PROMIS Global Health and Cognitive Abilities scales, and SCI-QOL Bladder and Bowel short form. RESULTS Themes identified about factors influencing DM included: recurrent symptoms and complications; balancing dissatisfaction with NBB management against surgery risks; achieving independence and life style adjustments; participant's driven solutions; support and guidance and trust in doctors; and access and barriers to DM. DM enactment varied across surgeries and individuals, revealing no clear patterns. Most participants were satisfied with the surgery outcomes. Some differences in demographics were observed between veterans and civilians. CONCLUSIONS We have attempted to illustrate the process of NBB DM as individuals move from factors to enactment to outcomes. Attending to the complexity of the DM process through careful listening and clear communication will allow clinicians to better assist patients in making surgical decisions about NBB management.
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Affiliation(s)
- Denise G Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Edward J Rohn
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA.,Department of Interdisciplinary Health Sciences, Oakland University, Rochester, Michigan, USA
| | - Martin Forchheimer
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Suzanne Walsh
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa DiPonio
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA.,Veterans Administration Ann Arbor Health Care System, Ann Arbor, Michigan, USA
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Anne P Cameron
- Department of Urology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Hearn JH, Rohn EJ, Monden KR. Isolated and anxious: A qualitative exploration of the impact of the COVID-19 pandemic on individuals living with spinal cord injury in the UK. J Spinal Cord Med 2022; 45:691-699. [PMID: 34292136 PMCID: PMC9542803 DOI: 10.1080/10790268.2021.1949562] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE People living with spinal cord injury (SCI) are often immunocompromised, and at increased risk of respiratory infection. Given the restrictions in response to the COVID-19 pandemic, those with SCI may be at increased risk of health deterioration, though how this is experienced is poorly understood. This study explored the experiences of people living with SCI during the COVID-19 pandemic. DESIGN Participants completed an online survey consisting of demographic questions, and open-ended qualitative questions pertaining to their experiences during the pandemic. Thematic analysis was utilized for the analytical approach. SETTING Community-based sample in the UK. PARTICIPANTS Participants were recruited via social media outlets of UK-based SCI-specific support charities, and snowball sampling (N = 42, F = 34, M = 8). RESULTS Key themes included: (1) lost access to health services and support, capturing concerns surrounding barriers to healthcare and rehabilitation, which intensified secondary consequences of SCI such as spasm and pain; (2) health anxiety, which was perpetuated by perceived heightened vulnerabilities to respiratory complications; (3) social isolation, with significantly reduced social contact, even with care providers, compounding health experiences. CONCLUSION People living with SCI during the COVID-19 pandemic experienced a variety of personal physical, psychological, and social challenges, each of which could disrupt daily functioning and quality of life. Increased utilization of telehealth is recommended to support continued engagement in rehabilitation, and foster connection and community amongst others with SCI and health professionals.
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Affiliation(s)
- Jasmine Heath Hearn
- The Department of Psychology, Manchester Metropolitan University, Manchester, UK,Correspondence to: Jasmine Heath Hearn, Department of Psychology, Manchester Metropolitan University, Bonsall Street, ManchesterM15 6GX, UK.
| | - Edward J. Rohn
- The Department of Interdisciplinary Health Sciences, Oakland University, Rochester, Michigan, USA
| | - Kimberley R. Monden
- The Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA
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Rohn EJ, Hakbijl-van der Wind AJ, Post MWM, Forchheimer M, Charlifue S, New PW, Greve JMD, Tate DG. A cross-cultural mixed methods validation study of the spinal cord injury quality of life basic dataset (SCI QoL-BDS). Spinal Cord 2022; 60:177-186. [DOI: 10.1038/s41393-021-00742-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 12/16/2021] [Accepted: 12/19/2021] [Indexed: 11/09/2022]
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Kim S, Rohn EJ, Kratz AL. Linguistic indicators of chronic pain acceptance in individuals with spinal cord injury. Rehabil Psychol 2021; 66:520-531. [PMID: 34516167 DOI: 10.1037/rep0000399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Pain acceptance is a robust predictor of adjustment to chronic pain, including pain in those with spinal cord injury (SCI). This preliminary study aimed to identify linguistic patterns indicative of chronic pain acceptance to gain new insights into the underlying cognitive-emotional process of this construct. METHOD Individuals with SCI and chronic pain (N = 30) completed the Chronic Pain Acceptance Questionnaire (CPAQ) and a semistructured interview about their pain. Linguistic Inquiry and Word Count software was used to quantify linguistic categories of interest in transcribed interviews. RESULTS Results of hierarchical linear regressions (controlling for pain intensity, age, and education) showed that personal pronouns explained an additional 26.9% of the variance in CPAQ activity engagement, which was associated with a lower frequency of first-person plural pronouns and a higher frequency of third person pronouns. Conjunction words explained an additional 12.8% and 19.2% of the variance in CPAQ total and pain willingness scores, respectively; frequency of conjunction words was negatively associated with acceptance. Perceptual processes words accounted for an additional 39.9% of the variance in pain willingness, which was associated with a lower frequency of seeing words and a higher frequency of hearing and feeling words. CONCLUSIONS Findings suggest that pain acceptance is associated with unique linguistic patterns that can be identified in natural word use among individuals with SCI and chronic pain. Future research to further investigate linguistic indicators of pain acceptance and other clinically relevant pain constructs is warranted and could advance theoretical models of pain adaptation and clinical approaches to treating pain. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Samsuk Kim
- Department of Psychology, University of Detroit Mercy
| | - Edward J Rohn
- Department of Interdisciplinary Health Sciences, Oakland University
| | - Anna L Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan
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Rohn EJ, Tate DG, Forchheimer M, DiPonio L. Contextualizing the lived experience of quality of life for persons with spinal cord injury: A mixed-methods application of the response shift model. J Spinal Cord Med 2019; 42:469-477. [PMID: 30188802 PMCID: PMC6718176 DOI: 10.1080/10790268.2018.1517471] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objective: The objective of this study was to gain greater insight into individuals' quality of life (QOL) definitions, appraisals, and adaptations following spinal cord injury (SCI). Design: A mixed-methods design, applying the Schwartz and Sprangers response shift (RS) model. RS is a cognitive process wherein, in response to a change in health status, individuals change internal standards, values, or conceptualization of QOL Setting: Community-dwelling participants who receive medical treatment at a major Midwestern medical system and nearby Veterans' Affairs hospital. Participants: A purposive sample of participants with SCI (N = 40) completed semi-structured interviews and accompanying quantitative measures. Interventions: Not applicable. Outcome Measures: Qualitative data were analyzed using content analysis to identify themes. Analysis of variance were performed to detect differences based on themes and QOL, well-being, and demographic and injury characteristics. Results: Four RS themes were identified, capturing the range of participant perceptions of QOL. The themes ranged from complete RS, indicating active engagement in maintaining QOL, to awareness and comparisons redefining QOL, to a relative lack of RS. Average QOL ratings differed as a function of response shift themes. PROMIS Global Health, Anxiety, and Depression also differed as a function of RS themes. Conclusion: The RS model contextualizes differences in QOL definitions, appraisals, and adaptations in a way standardized QOL measures alone do not.
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Affiliation(s)
- Edward J. Rohn
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA,Correspondence to: Edward J. Rohn, Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower Parkway, Suite 300, Ann Arbor, MI 48108, USA.
| | - Denise G. Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Martin Forchheimer
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa DiPonio
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA,Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Rohn EJ, Sankar A, Hoelscher DC, Luborsky M, Parise MH. How Do Social-Psychological Concerns Impede the Delivery of Care to People with HIV? Issues for Dental Education. J Dent Educ 2006. [DOI: 10.1002/j.0022-0337.2006.70.10.tb04175.x] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
| | | | - Diane C. Hoelscher
- Department of Patient Management; University of Detroit Mercy School of Dentistry
| | | | - Mary H. Parise
- Department of Patient Management; University of Detroit Mercy School of Dentistry
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Rohn EJ, Sankar A, Hoelscher DC, Luborsky M, Parise MH. How do social-psychological concerns impede the delivery of care to people with HIV? Issues for dental education. J Dent Educ 2006; 70:1038-42. [PMID: 17021282 PMCID: PMC4213128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
Oral health is an essential aspect of the overall medical care for patients with HIV. However, fear of status disclosure is a significant barrier to access to care. Preparing future oral health care providers to maintain all aspects of confidentiality and to understand the role stigma plays in the lives of HIV-positive individuals are critical issues that must be addressed by dental education. To provide important perspectives regarding HIV-related stigma and confidentiality, data from the HAART (Highly Active Antiretroviral Therapy) Project is presented. This study is a five-year National Institute of Allergy and Infectious Disease (NIAID)-funded longitudinal qualitative study of sero-positive African Americans' adherence to antiretroviral therapy (N=137). The current literature regarding HIV patient confidentiality and student attitudes regarding HIV/AIDS is also reviewed. Findings suggest that dental student attitudes may be improved by providing more comprehensive experiences and information and that procedures in place in dental clinics should be continuously monitored to ensure that patient confidentiality is maintained. Strategies for addressing these important issues in dental education are presented. Ensuring that dental school graduates are well prepared to maintain confidentiality with sensitivity to the role stigma plays in HIV disease has the potential to enhance access to health care.
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Affiliation(s)
- Edward J Rohn
- The HAART Project, Knapp Building, Detroit, MI 48202, USA.
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