The role of mindfulness in quality of life of persons with spinal cord injury: a cross-sectional study.

BACKGROUND: Quality of life is considered the most overarching psychosocial adaptation outcome following the rehabilitation of persons with spinal cord injury. Literature suggests that the quality of life of persons with spinal cord injury is determined by many personal and psychological factors, including mindfulness. This study aimed to identify the direct and indirect effect of mindfulness on the quality of life of persons living with spinal cord injury. METHODS: Participants consisted of 231 members of three spinal cord injury organizations in the United States: United Spinal Association, North American Spinal Cord Injury Consortium, and Paralyzed Veterans of America-Wisconsin Chapter. The participants completed a set of standardized self-report questionnaires in an online Qualtrics survey. A hierarchical regression analysis was performed to identify the contribution of mindfulness to quality of life, controlling for sociodemographic and injury-related factors. A serial mediation analysis was performed to examine the indirect effect of mindfulness on quality of life. RESULTS: In the hierarchical regression analysis, sociodemographic and injury-related factors (i.e., age, gender, race, marital status, education, employment, level and completeness of injury, comorbidities, frequency of hospitalization, pain intensity, and functional limitation) and mindfulness explained 59% variance on quality of life of the participants with spinal cord injury. Mindfulness uniquely contributed to the higher quality of life above and beyond sociodemographic and injury-related variables. In the serial mediation analysis, pain and functional limitation did not significantly mediate the relationship between mindfulness and quality of life. However, the indirect effects of mindfulness on functional limitation and quality of life through pain were significant. CONCLUSION: The findings underscore the vital role of mindfulness in improving the quality of life of persons with spinal cord injury. Implications of these findings for future research and clinical practice are discussed.

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

AIMS: To examine the contribution of self-efficacy, social support, and resilience to subjective well-being (SWB), to examine the mediating effect of resilience in the relationship between social support and SWB, and to investigate if marital status moderates the relationship between social support and SWB among people with spinal cord injuries (SCI). DESIGN: A descriptive cross-sectional study, conducted from November 2017-January 2018. METHODS: One hundred and two individuals with SCI were recruited from a rehabilitation center and a community setting in Nepal. SWB, self-efficacy, social support, resilience, demographics and injury-related information was collected using self-reported questionnaires. Hierarchical regression analysis, mediation analysis, and moderation analysis were performed in SPSS and R to test the hypotheses. RESULTS: Self-efficacy, social support, and resilience uniquely explained 19% of the variance on SWB after controlling for demographic covariates. In the mediation analysis, resilience partially mediated the relationship between social support and SWB. In the moderation analysis, marital status moderated the relationship between resilience and SWB. CONCLUSION: Subjective well-being of persons with SCI is associated with many factors. Interventions to strengthen self-efficacy, resilience, and social networks can be effective to enhance SWB. A stronger association between resilience and SWB among single participants reflects the need to provide specific considerations for persons with SCI who are single. Longitudinal and/or experimental studies are needed to further validate these findings. IMPACT: This study identified external and internal factors contributing to SWB in persons with SCI. Self-efficacy, social support, and resilience were found to be significantly associated with SWB. Resilience acted as a mediator between social support and SWB. The relationship between resilience and SWB was stronger in single participants than married participants. The findings have potential implications in the field of nursing since nurses are one of the integral members of the SCI rehabilitation team.

An analysis of the relationship of character strengths and quality of life in persons with multiple sclerosis.

PURPOSE: To examine the relationship of character strengths and quality of life (QOL) in persons with multiple sclerosis (MS). Specifically, this study examined the relationship of the 24 character strengths in Peterson and Seligman's model with QOL and three negative effects of MS (disability, fatigue, and depression). It also investigated whether the three negative effects of MS mediate the relationship of each of the character strengths and QOL. METHODS: Six hundred and twenty-four individuals with MS completed an online survey measuring character strengths, QOL, as measured by the Leeds Multiple Sclerosis Quality of Life Scale, disability, fatigue, and depression. SPSS was used to complete the correlational analysis, and Hayes' PROCESS macro for SPSS was used to conduct the mediation analyses. RESULTS: The strengths endorsed most frequently by the participants were honesty, kindness, and fairness. The least-endorsed strengths were self-regulation, zest, and spirituality. The strengths with the strongest association with QOL were zest, hope, and gratitude. Disability was not found to mediate any of the relationships between character strengths and QOL. Many of the character strengths were associated with QOL both directly and indirectly through fatigue and depression. CONCLUSIONS: Many of the character strengths in the Peterson and Seligman model enhance QOL in persons with MS, both directly and through their influence on negative effects of MS. The results provide support for the development of character strengths interventions to impact QOL, both directly and indirectly through improvements to MS-related symptoms such as fatigue and depression.

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

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

The unique contribution of character strengths to quality of life in persons with multiple sclerosis.

OBJECTIVE: The purpose of this study was to investigate the impact of the 24 character strengths in Peterson and Seligman's (2004) model on quality of life in persons with multiple sclerosis (MS), controlling for more commonly investigated biopsychosocial variables including resilience, social support, personality traits, depression, fatigue, and disability. METHOD: Six hundred and 24 individuals with MS completed an online survey. Hierarchical regression analysis was used to test the contribution of character strengths over the control variables. RESULTS: The character strengths variables were significantly related to quality of life, even after controlling for the other variables. Individually, appreciation for beauty, gratitude, hope, and zest all significantly contributed to quality of life. The control variables, as a group, were significantly associated with quality of life. Individually, fatigue, depression, resilience, social support from family, conscientiousness, emotional stability, extraversion, and openness all significantly contributed to quality of life. CONCLUSIONS: The findings of this study provide support for the development of character strengths interventions to help increase quality of life in individuals with multiple sclerosis. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Substance abuse and psychosocial adaptation to physical disability: analysis of the literature and future directions.

PURPOSE: To analyse the current state of the literature with respect to substance abuse and psychosocial adjustment in persons with disabilities. METHOD: The two primary databases containing the literature related to rehabilitation and disability issues (PsychINFO and MedLine) were searched to identify articles addressing the psychosocial impact of substance abuse in persons with disabilities. Eleven empirical articles specifically measuring the strength of the relationship between substance use and psychosocial outcomes in persons with disabilities were selected for analysis. RESULTS: Of the studies identified, five were related to spinal cord injury, three were related to traumatic brain injury, one was related to chronic back pain, one was related to HIV/AIDS, and one was related to persons with any type of disability. Each of the studies used different methodologies, measured substance abuse in different ways, and examined different psychosocial outcome variables. Examination of trends suggested that pre-injury substance abuse appears to be unrelated to acceptance of disability in persons with spinal cord injury and negatively associated with satisfaction in persons with traumatic brain injury. Recent substance abuse tends to have a detrimental effect on psychosocial outcomes across all disability groups. CONCLUSIONS: Future research, combined with appropriate pre-service and continuing education related to substance abuse and disability for rehabilitation practitioners, has the potential to lead to improved psychosocial outcomes in persons with disabilities.

The relationship among frequency and type of internet use, perceived social support, and sense of well-being in individuals with visual impairments.

PURPOSE: To determine the relationship among amount and type of internet use and perceived social support and subjective well-being in persons with visual impairments. METHOD: One hundred seventy-five participants were recruited through a letter sent out over 46 national and state listservs for persons with visual impairments and blindness. The mean age of participants was 46.7 years (SD = 13.3), and 50.9% were women. The participants completed a survey containing a demographic questionnaire, an internet use questionnaire, the personal resources questionnaire - 2000 (PRQ-2000), and the sense of well-being inventory (SWBI). RESULTS: Frequency and type of internet use was not significantly related to perceived social support in persons with visual impairments. There was a marginally significant positive association between internet use and overall sense of well-being. Specifically, online chat had a positive association with social support and well-being. Disability-related information seeking and participation in online support groups were negatively associated with well-being. CONCLUSIONS: Despite the mixed results of this study, the internet has potential practical implications for increasing the independence and social connectedness in persons with visual impairments.

Evaluation of a concentric biopsychosocial model of well-being in persons with spinal cord injuries.

OBJECTIVE: The objective of this study was to evaluate a concentric biopsychosocial model of well-being in individuals with spinal cord injuries (SCI). METHOD: Adults (N = 235) with SCI participated in this study. A cross-sectional design with hierarchical regression and Andrew Hayes' (2013) PROCESS mediation analysis procedure was used to evaluate the model. RESULTS: Each step of the hierarchical regression on life satisfaction, in which biological variables were entered first, social variables were entered second, and psychological variables were entered third, was significant. Examining the standardized partial coefficients, pain, interpersonal self-efficacy, social support, hope-agency, and self-esteem were all significantly associated with life satisfaction, controlling for variables in each outward ring of the concentric model. Four serial mediational analyses were also conducted in which the social and psychological variables significantly partially mediated the relationship between pain and life satisfaction. CONCLUSIONS: The results provide support for a concentric biopsychosocial model of well-being in persons with SCI. Rehabilitation interventions should focus on augmenting biopsychosocial factors to allow for maximum improvement in well-being outcomes in individuals with SCI. (PsycINFO Database Record

Psychometric validation of the Core Self-Evaluations Scale in people with spinal cord injury.

PURPOSE: Core self-evaluations (CSE) are the perceptions that people have about their overall worth and capability. CSE may be a useful global indicator of adaptation to disability and subjective well-being. The Core Self-Evaluations Scale (CSES) is the most common direct measure of CSE, but its use with persons with disabilities has not been validated. This study aims to evaluate the factorial and concurrent validity of the CSES in persons with spinal cord injury. METHOD: Two hundred forty-seven individuals with spinal cord injury completed an online survey consisting of the CSES, measures of the four CSE traits, and selected psychosocial variables. RESULTS: Confirmatory factor analysis results provide support for the one-factor measurement structure of the CSES. When correlated with selected psychosocial variables, the CSES was found to perform in a similar fashion to an indirect measure of CSE constructed from measures of the individual CSE traits. CONCLUSIONS: The CSES demonstrated acceptable psychometric properties, and its use as a brief, cost-effective measure of CSE in rehabilitation research and practice is supported. IMPLICATIONS FOR REHABILITATION: Core self-evaluations (CSE) are the perceptions that people have about their overall worth and capability, and the construct has promise as a global indicator of adaptation to disability and subjective well-being in rehabilitation research and practice. The Core Self-Evaluations Scale (CSES) is a brief, valuable and cost-effective instrument that can be easily used in both rehabilitation research and practice and has the potential to reduce burden associated with client/participant assessment. This study provided evidence of the factorial and concurrent validity of the CSES in persons with spinal cord injury, and supports its use in rehabilitation settings.

Core self-evaluations and well-being in persons with disabilities.

PURPOSE: The purpose of this article is to introduce the concept of core self-evaluations (CSE), which is conceptualized as the overall, fundamental perception that individuals have about their worth and capability as people (Judge, Locke, Durham, & Kluger, 1998). CSE is a higher order variable that is reflective of the self-concept and comprises personality traits including self-esteem, generalized self-efficacy, locus of control, and emotional stability. METHOD: In this article, the theoretical background of the CSE construct is reviewed, the existing literature on CSE in the general population is summarized, and future directions for the use of CSE in rehabilitation psychology research and clinical settings is proposed. IMPLICATIONS: CSE has great potential as a global positive contributor of well-being in persons with disabilities, and research addressing its relationship with outcomes such as well-being and its clinical applications has great promise to augment rehabilitation psychology practice in the future.

Core self-evaluations and Snyder's hope theory in persons with spinal cord injuries.

OBJECTIVE: The objective of the study was to evaluate a motivational model of core self-evaluations (CSE), hope (agency and pathways thinking), participation, and life satisfaction in persons with spinal cord injuries. DESIGN: A cross-sectional, correlational design with path analysis was used to evaluate the model. PARTICIPANTS: 187 adults with spinal cord injuries participated in this study. RESULTS: The results indicated an excellent fit between the data and the proposed model. Specifically, CSE was found to directly predict agency and pathways thinking, participation, and life satisfaction. CSE was also found to indirectly predict participation and life satisfaction through agency thinking. CONCLUSIONS: Although CSE contributes directly to participation and life satisfaction, it also has a unique role in increasing individuals' motivation to pursue goals, which also predicts participation and life satisfaction. Counseling interventions should be multifaceted and address the components of CSE to increase hope, participation, and life satisfaction.

The impact of humorous media on attitudes toward persons with disabilities.

PURPOSE: To examine the relationship between disability-related humor and attitudes toward persons with disabilities in business students (i.e. "future employers"). METHOD: Students watched one of two films designed to reduce negative attitudes toward persons with disabilities (one humorous in tone and the other serious in tone) or no film at all, and completed a measure of attitudes toward persons with disabilities. RESULTS: Results indicated that, after controlling for previous contact with persons with disabilities, age, and gender, students who watched the humorous film reported significantly more positive attitudes toward persons with disabilities. CONCLUSIONS: Disability humor may be an effective means of positively influencing attitudes toward persons with disabilities in future employers. [ IMPLICATIONS FOR REHABILITATION: • The acceptance and integration of persons with disabilities into society continues to be limited by negative attitudes.• Previous research has shown that employers with positive attitudes toward persons with disabilities maybe more likely to hire a person with a disability than employers with negative attitudes.• In this study, students who watched a humorous film reported significantly more positive attitudes toward persons with disabilities than students who watched a serious film or no film at all.• Consequently, it may be beneficial to embed disability humor into job-placement strategies in order to improve attitudes and positively influence hiring decisions.]