Appraisals, coping and adjustment pre and post SCI rehabilitation: a 2-year follow-up study.

STUDY DESIGN: Longitudinal, multi-wave panel design. OBJECTIVES: To explore the changes in and the relationships between appraisals and coping with mood, functioning and quality-of-life (QOL) pre- and post-rehabilitation for acute spinal cord injury (SCI). SETTING: The data collected was part of an ongoing study from specialist units in selected British, Swiss, German and Irish SCI centres. METHODS: Questionnaires (Functional Independence, QOL, Mood, Appraisals, Coping and Support) were administered to 232 patients at 12 weeks post injury and sent to participants at 1 and 2 years post injury by post. RESULTS: Significant changes were observed in various outcome measures between 12 weeks and 1 year post injury, with little significant change occurring during the following year. Appraisals and coping at 12 weeks post injury were significantly related to outcome scores and also contributed significantly to the variance in QOL, mood and stress-related growth at 2 years post injury. CONCLUSION: The study provides further evidence for the link between appraisals, coping and subsequent adjustment to injury. Suggestion is made for the potential benefit of early assessment and intervention for patients at risk of poor adjustment to SCI.

Sense of coherence and psychological outcomes in people with spinal cord injury: appraisals and behavioural responses.

STUDY DESIGN: Longitudinal, multi-wave design. OBJECTIVES: To investigate the contribution of sense of coherence (SOC), appraisals, and behavioural responses when predicting psychological outcomes to spinal cord injury (SCI). METHOD: Patients (N=237) sustaining a SCI aged 17 or above were recruited from specialist spinal injuries centres across six European countries. Measures of SOC, appraisals, coping strategies, and psychological well-being were administered at 6 and 12 weeks post-injury and at a 1 year follow-up. RESULTS: People scoring high on SOC at 6 weeks post-injury showed significantly better psychological outcomes at 1 year post-injury and SOC showed significant relationships with appraisals at 12 weeks post-injury and coping strategies 1 year post-injury. Significant relationships were found between appraisals at 12 weeks post-injury and psychological outcomes, adaptive coping strategies were significantly related to psychological well-being at 1 year post-injury. Regression analyses found SOC, appraisals, and coping behaviours to explain 61.8% of the variance in psychological quality of life, 66.5% of the variance in depression, and 37.7% of the variance in anxiety at 1 year post-injury. CONCLUSION: This study provides further evidence in support of previous findings which suggest SOC to have a primary role in long-term psychological well-being. The relationship described here - from SOC to the appraisal of injury and subsequent behavioural responses - suggests SOC to be an influential factor in the long-term adjustment of people with SCI.

Cognitive appraisals, coping and quality of life outcomes: a multi-centre study of spinal cord injury rehabilitation.

STUDY DESIGN: Longitudinal, multiple wave panel design. OBJECTIVES: To investigate the degree to which current thinking in terms of early appraisals and coping predicts adjustment and quality of life outcomes after spinal cord injury, and to what degree social and demographic variables are involved. SETTING: Data were analysed from 266 patients recruited as part of an ongoing study from specialist units in selected British, Swiss, German and Irish spinal centres. METHOD: Questionnaire booklets were administered as soon as possible after injury onset and after 12 weeks to patients with newly acquired spinal cord injuries. Individuals included had sustained their injury between the ages of 16 and 83. RESULTS: Significant improvements in outcome measures were found across the data set within the first 12 weeks after spinal cord injury and changes observed in the appraisals and coping strategies employed. Significant differences were found between participating centres on both outcome measures and in the coping and appraisal processes used. Coping and appraisal processes at 6 weeks after injury were found to contribute significantly to the variation in psychological well-being at 12 weeks after injury. CONCLUSION: This study shows the process of adjustment to spinal cord injury to begin in the early stages of rehabilitation, and initial appraisals are important to how an individual will cope with their injury and to their psychological well-being. Support is also given to the importance of psychological factors to functional outcomes.

Life satisfaction, appraisals and functional outcomes in spinal cord-injured people living in the community.

STUDY DESIGN: Multi-centre, single cohort. OBJECTIVES: To assess the relationship between cognitive appraisals in a spinal cord-injured population living in the community, and examine how these factors affect social participation, life satisfaction and functional outcomes. SETTING: The National Spinal Injuries Centre, Stoke Mandeville, UK; Princess Royal Spinal Injuries Centre, Sheffield UK; Midlands Centre for Spinal Injuries, Oswestry, UK. METHOD: Participants (n=81) sustaining injury aged 18 or above were recruited from one of three spinal cord injuries units 3-18 months after discharge. Postal packs containing questionnaires, consent forms and information were distributed and a 2-week reminder sent. RESULTS: Participation was found to be strongly related to life satisfaction, negative appraisals of disability were found to explain 12.9% of the variance in total participation scores. The variance in scores on Life Satisfaction Questionnaires was explained by appraisals, participation and secondary complications to a total of 69.6%. Functional Independence Scores were explained by negative perceptions of disability, growth and resilience and total secondary complication scores, explaining 49.4% of the variance in this measure. CONCLUSION: Participation, functional independence and life satisfaction were significantly related to appraisal styles in this population. Negative perceptions of disability, fearful despondency and overwhelming disbelief were themes that impacted on the likelihood of participation and independence and involved in expressed levels of life satisfaction. Our results suggest the need to tackle cognitive styles of SCI patients before discharge to improve the rehabilitation process.

It is not how much you crave but what you do with it that counts: behavioural responses to food craving during weight management.

BACKGROUND/OBJECTIVES: The relationship between food craving and dieting is mixed and uncertain, with little evidence during active weight management. Accordingly, the frequency and nature of food cravings were investigated in people attending a commercial weight management programme. SUBJECTS/METHODS: An online survey was completed by 2932 participants (97% female, mean age=43.0 years, mean body mass index=31.6 kg/m2). Assessments included the Control of Eating Questionnaire, measuring the frequency, intensity, specificity and behaviour following food cravings. Others included body weight, dietary restraint, perceived success of dieting and mood. Forty-two per cent of the sample completed a second survey 7 weeks later. RESULTS: Cross-sectional analysis showed those currently dieting to lose weight (55% of sample) had significantly fewer, less intense and more resisted food cravings than those watching what they ate so as not to gain weight (35% of sample). Cravings were fewer for chocolate and other sweet foods. Longitudinally, food cravings decreased over the period of weight loss (2.0 kg). Fewer foods were craved and the cravings were less intense, easier to resist and to control. Eating in response to food cravings was a significant predictor of weight change. CONCLUSIONS: People with obesity and recent experience of resisting eating in response to food cravings lost more weight over the next 7 weeks. Feeling in control of eating was also associated with greater weight loss. This suggests it is the behaviour that follows food cravings rather than simply their frequency or intensity that contributes to successful weight management. This has implications for interventions to help address food cravings.