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1.
BMC Psychol ; 8(1): 108, 2020 Oct 19.
Artigo em Inglês | MEDLINE | ID: mdl-33076995

RESUMO

BACKGROUND: Self-efficacy is an important determinant of adjustment following spinal cord injury. Self-efficacy is defined as the belief that one can successfully execute behavior required to produce the desired outcomes. In its original conceptualization, self-efficacy refers to the confidence that people have in their ability to accomplish specific tasks and behaviors within a specific context. Over the years these situation specific aspects have been unconfined and multiple constructs of self-efficacy have been proposed. The most common is a division in trait and state self-efficacy. Another used division that is utilized is between general, domain-specific and task-specific self-efficacy. The scientific support for these constructs is to date still unclear. The objective of this study was to enhance the understanding of the self-efficacy construct by comparing four self-efficacy scales designed to measure three aspects of self-efficacy (general versus domain-specific versus task-specific) in people with spinal cord injury. METHODS: Dutch and Australian adults with spinal cord injury (N = 140) completed four frequently used self-efficacy scales; the Moorong Self-efficacy Scale, General Self-efficacy Scale, University of Washington Self-efficacy Scale and a Self-care Self-efficacy Scale approximately 6 months after their inpatient rehabilitation. Pearson correlations examined inter-relationships between the scales. RESULTS: Hypothesized strong correlations between scales measuring similar aspects of self-efficacy were found (correlations 0.50-0.65). However, the hypothesized weak to moderate correlations between scales measuring diverging aspects of self-efficacy were only partly found (correlations 0.31-0.74), with 7 out of 12 correlations being strong instead of moderate. CONCLUSIONS: The expected distinctions between the three aspects of self-efficacy was not demonstrated. All four scales measure a common latent construct, most likely general self-efficacy aspects. Further research is necessary to find ways to improve the measurement of domain-specific and task-specific aspects of SE, so that they are sensitive enough to capture change over time, and thus enhance clinical outcomes of people with SCI as they adjust to their disability.


Assuntos
Autoeficácia , Traumatismos da Medula Espinal/psicologia , Austrália , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Psicometria , Reprodutibilidade dos Testes
2.
PLoS One ; 15(8): e0238116, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32857793

RESUMO

INTRODUCTION: Wheelchair users with spinal cord injury are at a high risk of falls. However, the perspectives of wheelchair users with spinal cord injury on their fall circumstances and their preferences for fall prevention strategies/interventions remain understudied. Therefore, we aimed to: a) describe the circumstances of falls experienced by wheelchair users with spinal cord injury over a six-month period, b) explore their perspectives of why falls occurred in certain situations, and c) explore their perspectives on recommended content/structure of fall prevention strategies/interventions. METHODS: This sequential explanatory mixed methods study had two phases. Phase I involved tracking of falls experienced by wheelchair users with spinal cord injury over six months, in which participants completed a survey after experiencing a fall to track the number/circumstance of each fall. Data from the surveys were descriptively reported. Phase II involved a photovoice focus group discussion of the survey findings and their preferences for fall prevention strategies/interventions. Data from the focus group discussion were analyzed using a thematic analysis. RESULTS: Thirty-two participants completed phase I. More than half of the participants fell at least once in six months. Falls commonly occurred in the afternoon during a transfer, or when participants were wheeling over uneven ground. One-third of the falls caused an injury. Eleven participants that fell during phase I participated in the focus group. Two main themes were identified from the discussion: 1) "circumstances surrounding the falls" (e.g. when falls occurred, the home is a 'safe space') and 2) "suggestions and preferences for fall prevention strategies/interventions" (e.g. fall prevention involves all, fall prevention training available as needed). CONCLUSION: Fall prevention strategies/interventions should be an integral component of rehabilitation practices across the lifespan. Participants recommend customizing fall prevention strategies/interventions to their specific needs to guide the structure, content, and delivery of targeted fall prevention programs.


Assuntos
Acidentes por Quedas/prevenção & controle , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/reabilitação , Cadeiras de Rodas/psicologia , Adulto , Idoso , Pessoas com Deficiência , Feminino , Grupos Focais , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Preferência do Paciente , Medicina de Precisão , Adulto Jovem
3.
Arch Phys Med Rehabil ; 101(9): 1532-1540, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32502564

RESUMO

OBJECTIVES: This study investigated (1) the effect of engaging with 20-minute simulated natural environments delivered via virtual reality (VR) on current mood state and (2) the effect of engaging with multiple VR sessions over a period of a week on the depressive symptoms of people with a spinal cord injury (SCI). DESIGN: Randomized controlled trial design. SETTING: Spinal Cord Injury Rehabilitation Unit in Australia. PARTICIPANTS: Participants (N=24) were assigned to a group engaging in VR sessions during week 1 (group 1, n=10) or week 2 (group 2, n=14). INTERVENTIONS: The intervention week involved participation in up to three 20-minute VR sessions over 3 consecutive days. The control condition involved regular rehabilitation practice over a week. MAIN OUTCOME MEASURES: The Patient Health Questionnaire-8 (PHQ-8) was completed prior to the first week (T1), after the first week and prior to the second week (T2), and after the second week (T3). Current feeling states, including depressed/happy, anxious/relaxed, and not feeling good/feeling good, were rated immediately prior and after each VR session. RESULTS: Levels of happiness, relaxation, and feeling good were significantly higher subsequent to engaging with each VR session. Between-group differences in PHQ-8 scores were significantly greater for participants who experienced the intervention during the first week compared to participants within the control group: intervention participants had significant improvements in psycho-emotional health. Within-group PHQ-8 scores were reduced for each group subsequent to experiencing the intervention; however, differences were not significant. CONCLUSIONS: Engaging with simulated natural environments delivered via VR can favorably affect the psycho-emotional health of people with SCI receiving rehabilitation in hospital. Future research including larger samples and investigating the effect over a longer time period is required to confirm the findings presented.


Assuntos
Depressão/terapia , Saúde Mental , Traumatismos da Medula Espinal/reabilitação , Realidade Virtual , Adulto , Afeto , Idoso , Idoso de 80 Anos ou mais , Austrália , Depressão/etiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Natureza , Projetos Piloto , Fatores Socioeconômicos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/psicologia , Índices de Gravidade do Trauma
4.
Artigo em Inglês | MEDLINE | ID: mdl-32575553

RESUMO

Background: The aim of this study was to assess the relationship between physical activity (PA) levels and mental health in individuals with spinal cord injury (SCI). Methods: Three hospitals in the Seoul metropolitan area were invited to recruit patients with SCI (n = 103). PA levels were measured by the Leisure Score Index of the Godin Leisure-Time Exercise Questionnaire (GLTEQ). The Patient Health Questionnaire-9 (PHQ-9), the Generalized Anxiety Disorder-7 (GAD-7) questionnaire, and Multidimensional Scale of Perceived Social Support (MSPSS) were used to assess mental health. Results: Compared to the least physically active participants (1st tertile, 44.09 ± 52.74 min/week), the most physically active participants (3rd tertile, 670.86 ± 354.97 min/week) scored significantly lower on PHQ-9 (17.03 ± 5.70 vs. 12.49 ± 4.01, p < 0.001), GAD-7 (13.24 ± 4.78 vs. 9.86 ± 3.15, p < 0.001), while significantly higher MSPSS (51.24 ± 10.17 vs. 61.37 ± 11.90, p < 0.001) after the results were adjusted for age, gender, American Spinal Cord Injury Association impairment scale, and impaired spinal cord levels. Multivariate linear regression analysis showed that the PA was a significant predictor of depression (ß = -1.50, p = 0.01), anxiety (ß = -1.12, p = 0.02), and social support (ß = 4.04, p = 0.01). Conclusion: Higher PA participation was associated with lower depression, anxiety, and higher social support scores.


Assuntos
Exercício Físico , Saúde Mental , Traumatismos da Medula Espinal , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , República da Coreia , Seul , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/terapia
5.
J Rehabil Med ; 52(5): jrm00058, 2020 05 20.
Artigo em Inglês | MEDLINE | ID: mdl-32399579

RESUMO

OBJECTIVE: To evaluate the quality of life of patients with chronic spinal cord injury in mainland China. DESIGN: Cross-sectional study. SUBJECTS: A total of 247 adults ≥ 1 year post-SCI in mainland China. METHODS: The WHOQOL-BREF and WHOQOL-DIS module were used to assess quality of life. Anxiety/depression was measured using the Zung Self-Rating Anxiety/Depression Scale. Quality of life was compared with that of reference populations from China, Korea, etc. Multivariate linear regression was conducted to determine the factors that might be associated with quality of life. RESULTS: The means of the 4 domains of the WHOQOL-BREF varied from 11.5 to 13.0. The mean of the 12-item WHOQOL-DIS module was 38.7. The quality of life of the participants as measured by the WHOQOL-BREF was 1.1-4.7 points lower than that of the global reference population, while quality of life as measured by the WHOQOL-DIS module was 1.2 points lower than that of the Korean data. Anxiety and depression were negative factors associated with quality of life (p < 0.05). Better community integration was a positive factor for physical quality of life and quality of life as measured by the WHOQOL-DIS module (p <0.01). CONCLUSION: The quality of life of adults with chronic spinal cord injury in mainland China was lower compared with reference populations. Duration of spinal cord injury, sex, community integration, anxiety, and depression were related to quality of life.


Assuntos
Qualidade de Vida/psicologia , Traumatismos da Medula Espinal/psicologia , Adulto , China , Doença Crônica , Estudos Transversais , Feminino , Humanos , Masculino
6.
BMC Psychol ; 8(1): 51, 2020 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-32434585

RESUMO

BACKGROUND: Many significant others of persons with serious conditions like spinal cord injury (SCI) and acquired brain injury (ABI) report high levels of psychological distress. In line with the stress-coping model, the aim of the present study was to investigate the relationship between personal resource resilience and psychological distress, and whether appraisals of threat and loss, and passive coping mediate this relationship. METHODS: Significant others (n = 228) of persons with SCI or ABI completed questionnaires shortly after admission to first inpatient rehabilitation after onset of the condition. The questionnaire included measures to assess psychological distress (Hospital Anxiety and Depression Scale), resilience (Connor-Davidson Resilience Scale-10), appraisals (Appraisals of Life Events scale, threat and loss) and passive coping (Utrecht Coping List). The PROCESS tool was used to test the presence of mediation. Confounding and differences between SCI and ABI were investigated. RESULTS: High levels of psychological distress among significant others were found (34-41%). Fifty-five percent of the variance in psychological distress was explained by the relationship between resilience and psychological distress. This relationship was mediated by appraisals of threat and loss, and passive coping. The relationship between resilience and psychological distress was similar in the SCI and ABI groups. CONCLUSIONS: The results of our study indicate that appraisals of threat and loss and passive coping are mediating factors in the relationship between resilience and psychological distress. It seems useful to investigate if interventions focussing on psychological factors like resilience, appraisal and coping are effective to prevent or reduce psychological distress among significant others of persons with SCI or ABI. TRIAL REGISTRATION: Dutch trial register NTR5742. Registered January 9, 2016.


Assuntos
Lesões Encefálicas/psicologia , Relações Interpessoais , Traumatismos da Medula Espinal/psicologia , Adaptação Psicológica , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
7.
PLoS One ; 15(4): e0231649, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32315373

RESUMO

INTRODUCTION: Survival after trauma has considerably improved. This warrants research on non-fatal outcome. We aimed to identify characteristics associated with both short and long-term health status (HS) after trauma and to describe the recovery patterns of HS and psychological outcomes during 24 months of follow-up. METHODS: Hospitalized patients with all types of injuries were included. Data were collected at 1 week 1, 3, 6, 12, and 24 months post-trauma. HS was assessed with the EuroQol-5D-3L (EQ-5D-3L) and the Health Utilities Index Mark 2 and 3 (HUI2/3). For the screening of symptoms of post-traumatic stress, anxiety and depression, the Impact of Event Scale (IES) and the Hospital Anxiety and Depression Scale (HADS) subscale anxiety (HADSA) and subscale depression (HADSD) were used. Recovery patterns of HS and psychological outcomes were examined with linear mixed model analyses. RESULTS: A total of 4,883 patients participated (median age 68 (Interquartile range 53-80); 50% response rate). The mean (Standard Deviation (SD)) pre-injury EQ-5D-3L score was 0.85 (0.23). One week post-trauma, mean (SD) EQ-5D-3L, HUI2 and HUI3 scores were 0.49 (0.32), 0.61 (0.22) and 0.38 (0.31), respectively. These scores significantly improved to 0.77 (0.26), 0.77 (0.21) and 0.62 (0.35), respectively, at 24 months. Most recovery occurred up until 3 months. At long-term follow-up, patients of higher age, with comorbidities, longer hospital stay, lower extremity fracture and spine injury showed lower HS. The mean (SD) scores of the IES, HADSA and HADSD were respectively 14.80 (15.80), 4.92 (3.98) and 5.00 (4.28), respectively, at 1 week post-trauma and slightly improved over 24 months post-trauma to 10.35 (14.72), 4.31 (3.76) and 3.62 (3.87), respectively. DISCUSSION: HS and psychological symptoms improved over time and most improvements occurred within 3 months post-trauma. The effects of severity and type of injury faded out over time. Patients frequently reported symptoms of post-traumatic stress. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT02508675.


Assuntos
Lesões Encefálicas Traumáticas/psicologia , Traumatismos da Medula Espinal/psicologia , Ferimentos e Lesões/psicologia , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , Ansiedade/fisiopatologia , Ansiedade/psicologia , Lesões Encefálicas Traumáticas/epidemiologia , Lesões Encefálicas Traumáticas/fisiopatologia , Estudos de Coortes , Depressão/epidemiologia , Depressão/fisiopatologia , Depressão/psicologia , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes , Estudos Prospectivos , Qualidade de Vida , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/patologia , Inquéritos e Questionários , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/fisiopatologia
8.
Mayo Clin Proc ; 95(5): 920-928, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32299672

RESUMO

OBJECTIVE: To compare the longitudinal incidence of psychological morbidities and multimorbidity and estimates of chronic diseases among adults with spinal cord injuries (SCIs) as compared with adults without SCIs. METHODS: Privately insured beneficiaries who had medical coverage at any time between January 1, 2001, and December 31, 2017 were included if they had an International Classification of Diseases, Ninth Revision, Clinical Modification diagnostic code for a traumatic SCI (n=6,847). RESULTS: Adults with SCIs (n=6847) had a higher incidence of adjustment reaction (7.2% [n=493] vs 5.0% [n=42,862]), anxiety disorders (19.3% [n=1,322] vs 14.1% [n=120,872]), depressive disorders (29.3% [n=2,006] vs 9.3% [n=79,724]), alcohol dependence (2.4% [n=164] vs 1.0% [n=8,573]), drug dependence (2.3% [n=158] vs 0.8% [n=6,858]), psychogenic pain (1.0% [n=69] vs 0.2% [n=1,715]), dementia (6.5% [n=445] vs 1.5% [n=12,859]), insomnia (10.9% [n=746] vs 7.2% [n=61,722]), and psychological multimorbidity (37.4% [n=2,561] vs 23.9% [n=204,882]) as compared with adults without SCIs (n=857,245). The adjusted hazard ratios (HRs) of each psychological outcome were significantly higher for individuals with SCI and ranged from 1.18 (95% CI, 1.08-1.29) for anxiety disorders to 3.32 (95% CI, 1.93-5.71) for psychogenic pain. Adults with SCIs also had a significantly higher prevalence of all chronic diseases and chronic disease multimorbidity (51.1% vs 14.1%), except human immunodeficiency virus infection/AIDS. After propensity matching for age, education, race, sex, and chronic diseases (n=5884 matched pairs), there was still a significantly higher incidence of most psychological disorders and psychological multimorbidity among adults with SCIs. CONCLUSION: Adults with traumatic SCIs experienced an increased incidence of psychological morbidities and multimorbidity as compared with adults without SCIs. Clinical efforts are needed to improve mental health screening and targeted interventions to reduce the risk for psychological disease onset in the traumatic SCI population.


Assuntos
Transtornos Mentais/epidemiologia , Transtornos Mentais/etiologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/psicologia , Adulto , Idoso , Doença Crônica/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Seguro Saúde , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Morbidade , Multimorbidade
10.
NeuroRehabilitation ; 46(1): 17-30, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32039867

RESUMO

BACKGROUND: Spirituality has been positively associated with key adjustment indicators for individuals affected by traumatic brain injury or spinal cord injury. OBJECTIVE: To explore the perceptions of health professionals working in rehabilitation in relation to spirituality and spiritual care practice. METHODS: An observational study. An adapted version of the Royal College of Nursing Spirituality Survey was emailed to specialty networks of rehabilitation health professionals across Australia. RESULTS: The majority of the 125 participants were female (92.8%), from a nursing (67.2%) background, and selected 'Christian' as their religious affiliation (68.8%). A range of spiritual needs for rehabilitation clients were identified, including a source of hope and strength. Although 84% agreed that spirituality was a fundamental aspect of healthcare, 85% agreed that staff did not receive enough education or training. Thematic analysis identified three key ways participants felt their workplaces could better address spirituality: increasing staff knowledge and skills in providing spiritual care, incorporating spirituality into rehabilitation processes, and providing patients with access to spiritual resources. CONCLUSIONS: Spirituality is considered to play an important role after traumatic injury, but most staff do not feel well equipped to provide spiritual care. Training in spiritual care for rehabilitation professionals is warranted.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde/psicologia , Traumatismos da Medula Espinal/reabilitação , Espiritualidade , Adulto , Austrália , Feminino , Esperança , Humanos , Masculino , Traumatismos da Medula Espinal/psicologia , Inquéritos e Questionários
11.
NeuroRehabilitation ; 46(1): 3-15, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32039872

RESUMO

BACKGROUND: A deficits approach to understanding psychological adjustment in family caregivers of individuals with a neurological disability is extensive, but further research in the field of positive psychology (spirituality, resilience, hope) may provide a potential avenue for broadening knowledge of the family caregiver experience after traumatic brain injury (TBI) or spinal cord injury (SCI). OBJECTIVE: To test a proposed model of spirituality among family caregivers of individuals with TBI or SCI, using structural equation modelling (SEM). METHODS: A cross-sectional design was employed to survey ninety-nine family participants (TBI = 76, SCI = 23) from six rehabilitation units from NSW and Queensland. Assessments comprised Functional Assessment of Chronic Illness Therapy-Spiritual Well-being Scale-Expanded, Connor -Davidson Resilience Scale, Herth Hope Index, and three measures of psychological adjustment including Caregiver Burden Scale, Positive and Negative Affect Scale, and Depression Anxiety Stress Scale. RESULTS: SEM showed the proposed model was a good fit. The main findings indicated spirituality had a direct negative link with burden. Spirituality had a direct positive association with hope which, in succession, had a positive link with resilience. Spirituality influenced positive affect indirectly, being mediated by resilience. Positive affect, in turn, had a negative association with depression in caregivers. CONCLUSIONS: This study contributes to better targeting strength-based family interventions.


Assuntos
Adaptação Psicológica , Lesões Encefálicas Traumáticas/psicologia , Cuidadores/psicologia , Modelos Psicológicos , Traumatismos da Medula Espinal/psicologia , Adulto , Lesões Encefálicas Traumáticas/reabilitação , Feminino , Esperança , Humanos , Masculino , Pessoa de Meia-Idade , Resiliência Psicológica , Traumatismos da Medula Espinal/reabilitação , Espiritualidade
12.
Top Spinal Cord Inj Rehabil ; 26(1): 1-10, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32095063

RESUMO

Background: Motivation could be considered as a critical factor for being and staying physically active in the spinal cord-injured population. Objectives: Our goals were (1) to describe motivation to exercise in people with paraplegia, comparing those who engage in regular physical exercise with those who do not and (2) to establish whether such motivation is related to the type of physical exercise practiced. Methods: This study was quantitative, cross-sectional descriptive research. One-hundred and six participants with chronic paraplegia completed the Spanish version of the Exercise Motivations Inventory (EMI-2). Participants were divided into the non-exerciser group (NEG) and the exerciser group (EG). EG was subclassified into sports players (SPs) and physical exercisers (PEs). Results: Participants in both EG and NEG presented a similar motivation toward physical exercise. The most important motive to practice or to adhere to exercise in participants with SCI was ill-health avoidance (mean, 8.45; SD, 1.33). Fitness was the second most important motive (ie, nimbleness, flexibility, strength, and endurance). Motives that distinguished EG from NEG included enjoyment and revitalization [t(41.9) = -2.54, p < .05, r = 0.36], competition [t(56.8) = 2.24, p < .05, r = 0.28], and health pressure [t(104) = 3.22, p < .01, r = 0.30]. Furthermore, we found that motivation was related to the type of physical exercise performed. SPs showed a statistically significantly higher score for competition and enjoyment and revitalization than PEs (p < .05). Conclusion: Ill-health avoidance and fitness are the key motivational factors to practice and adhere to physical exercise. Motivation is related to the type of physical exercise performed. Health providers need to understand these factors to promote and sustain long-term adherence to exercise in the SCI population.


Assuntos
Exercício Físico , Motivação , Paraplegia/psicologia , Traumatismos da Medula Espinal/psicologia , Cadeiras de Rodas , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paraplegia/reabilitação , Traumatismos da Medula Espinal/reabilitação , Inquéritos e Questionários
13.
Top Spinal Cord Inj Rehabil ; 26(1): 11-20, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32095064

RESUMO

Background: In neurologically healthy individuals, exercise positively impacts depressive symptoms, but there is limited knowledge regarding the association between exercise behaviors and depression after spinal cord injury (SCI). Objective: To examine associations between doing planned exercise and probable major depressive disorder (PMDD) after SCI. Methods: Community-dwelling adults, who were one or more years post traumatic SCI, completed self-report assessments at baseline (Time 1) and an average of 3.29 years later (Time 2). Patient Health Questionnaire-9 was used to assess depressive symptoms. Participants self-reported frequency of doing planned exercise. There were 1,790 participants who responded at both Time 1 and 2. Associations were analyzed using logistic regression. Results: Prevalence of PMDD was 10% at Time 1 and 12% at Time 2. Only 34% of participants at Time 1 and 29% at Time 2 reported doing planned exercise three or more times per week. The majority of participants (47%) reported no change in frequency of doing planned exercise between Times 1 and 2. Significant risk factors for PMDD at Time 2 included low household income (p = .0085), poor to fair self-perceived health (p < .0001), and doing less planned exercise at Time 2 (p = .0005). Meanwhile, number of years post injury (p = .04), doing planned exercise three or more times per week at Time 1 (p = .0042), and doing more planned exercise at Time 2 (p = .0005) were associated with decreased odds of PMDD at Time 2. Conclusion: These results demonstrate that a negative association exists between doing planned exercise and PMDD post SCI. Future longitudinal studies are needed to further explain these findings.


Assuntos
Transtorno Depressivo Maior/etiologia , Exercício Físico , Traumatismos da Medula Espinal/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/reabilitação , Inquéritos e Questionários , Adulto Jovem
14.
J Neurosci ; 40(9): 1943-1955, 2020 02 26.
Artigo em Inglês | MEDLINE | ID: mdl-31974206

RESUMO

Currently, the role of transient receptor potential vanilloid type 4 (TRPV4), a nonselective cation channel in the pathology of spinal cord injury (SCI), is not recognized. Herein, we report the expression and contribution of TRPV4 in the pathology of scarring and endothelial and secondary damage after SCI. TRPV4 expression increased during the inflammatory phase in female rats after SCI and was expressed primarily by cells at endothelial-microglial junctions. Two-photon microscopy of intracellular-free Ca2+ levels revealed a biphasic increase at similar time points after SCI. Expression of TRPV4 at the injury epicenter, but not intracellular-free Ca2+, progressively increases with the severity of the injury. Activation of TRPV4 with specific agonist altered the organization of endothelial cells, affected tight junctions in the hCMEC/D3 BBB cell line in vitro, and increases the scarring in rat spinal cord as well as induced endothelial damage. By contrast, suppression of TRPV4 with a specific antagonist or in female Trpv4 KO mouse attenuated inflammatory cytokines and chemokines, prevented the degradation of tight junction proteins, and preserve blood-spinal cord barrier integrity, thereby attenuate the scarring after SCI. Likewise, secondary damage was reduced, and behavioral outcomes were improved in Trpv4 KO mice after SCI. These results suggest that increased TRPV4 expression disrupts endothelial cell organization during the early inflammatory phase of SCI, resulting in tissue damage, vascular destabilization, blood-spinal cord barrier breakdown, and scarring. Thus, TRPV4 inhibition/knockdown represents a promising therapeutic strategy to stabilize/protect endothelial cells, attenuate nociception and secondary damage, and reduce scarring after SCI.SIGNIFICANCE STATEMENT TRPV4, a calcium-permeable nonselective cation channel, is widely expressed in both excitable and nonexcitable cells. Spinal cord injury (SCI) majorly caused by trauma/accidents is associated with changes in osmolarity, mechanical injury, and shear stress. After SCI, TRPV4 was increased and were found to be linked with the severity of injury at the epicenter at the time points that were reported to be critical for repair/treatment. Activation of TRPV4 was damaging to endothelial cells that form the blood-spinal cord barrier and thus contributes to scarring (glial and fibrotic). Importantly, inhibition/knockdown of TRPV4 prevented these effects. Thus, the manipulation of TRPV4 signaling might lead to new therapeutic strategies or combinatorial therapies to protect endothelial cells and enhance repair after SCI.


Assuntos
Endotélio/patologia , Traumatismos da Medula Espinal/metabolismo , Traumatismos da Medula Espinal/patologia , Medula Espinal/patologia , Canais de Cátion TRPV/metabolismo , Animais , Comportamento Animal , Quimiocinas/metabolismo , Citocinas/metabolismo , Células Endoteliais/metabolismo , Células Endoteliais/patologia , Feminino , Locomoção , Camundongos , Camundongos Knockout , Microglia/metabolismo , Microglia/patologia , Ratos , Ratos Sprague-Dawley , Traumatismos da Medula Espinal/psicologia , Canais de Cátion TRPV/genética , Junções Íntimas/metabolismo , Junções Íntimas/patologia
15.
Rehabilitation (Stuttg) ; 59(4): 205-213, 2020 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-31962349

RESUMO

PURPOSE: Multiple organizations like UN and WHO call for the collection of internationally comparable data on living and supply conditions of people with disabilities. Furthermore, reliable national data are necessary for ensuring appropriate care. Regarding patients with Spinal Cord Injury (SCI) in Germany, only data on diagnostics or therapeutic interventions is currently available. The International Spinal Cord Injury Survey aims at collecting reliable data of people with SCI in 21 countries and developing recommendations for actions to be taken by policy-makers and other decision-makers. METHODS: In 2017, eight specialized SCI-centers across Germany sent a standardized questionnaire to their patients who had diagnosis of SCI, and were older than 18 years (n=5,598). The questionnaire could be completed paper-based or online. RESULTS: 1,479 patients participated in the study and were included in data analysis. On average, participants were 55.3 years (SD=14.6) old, ¾ were male. The mean time of onset of paralysis was 13.9 years. Two thirds of the spinal cord injury causes were traumatic. In 51.2% SCI was classified as paraplegia. The most frequently cited health problem was sexual dysfunction. Medical treatment for this problem was rarely used. Serious environmental barriers were the inadequate accessibility of private households and public places. 42.5% of the respondents in working age were employed, which is 10% less than in Switzerland. DISCUSSION: Serious problems in environmental barriers, medical care and labor market participation were identified for people with SCI. The results will be reported to and discussed with political decision makers and further actors to create solutions. This requires extensive efforts, like modification in building law and home support.


Assuntos
Pessoas com Deficiência/estatística & dados numéricos , Qualidade de Vida , Traumatismos da Medula Espinal/reabilitação , Adolescente , Adulto , Distribuição por Idade , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição por Sexo , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/psicologia , Inquéritos e Questionários
16.
Arch Phys Med Rehabil ; 101(4): 658-666, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31891714

RESUMO

OBJECTIVE: Estimate (1) prevalence of major depressive disorder (MDD) diagnosis; (2) risk factors associated with MDD diagnosis; (3) time at which MDD is diagnosed post-spinal cord injury (SCI); and (4) interaction of inferred mobility status (IMS) in a commercially insured population over 3 years. DESIGN: Retrospective longitudinal cohort design. SETTING: A commercial insurance claims database from January 1, 2010 to December 31, 2013. PARTICIPANTS: Individuals with an index cervical or thoracic SCI in 2011 or 2012, without history of MDD ≤30 days pre-SCI (N=1409). INTERVENTION: Not applicable. MAIN OUTCOME MEASURES: Prevalence of, risk factors associated with, and time to MDD diagnosis post-SCI. A stratified survival analysis using IMS, based upon durable medical equipment (DME) claims, was also completed. RESULTS: Post-SCI, 294 out of 1409 (20.87%) were diagnosed with new-onset MDD. Significant (P<.05) risk factors included: employment, length of index hospitalization, discharge from index hospitalization with healthcare services, rehabilitation services post-SCI, and 2 of 5 IMS comparisons. Median time to MDD was 86 days. Survival analysis demonstrated a significant difference between 6 of 10 IMS comparisons. Regarding new-onset or recurring MDD, 432 out of 1409 (30.66%) were diagnosed post-SCI. Significant risk factors included: female, employment, length of index hospitalization, discharge from index hospitalization with healthcare services, rehabilitation services post-SCI, MDD>30 days pre-SCI, catheter claims, and 2 of 5 IMS comparisons. Median time to MDD was 74 days. Survival analysis demonstrated a significant difference between 4 of 10 IMS comparisons. CONCLUSIONS: Prevalence of MDD post-SCI is greater than the general population. Stratification by IMS illustrated that individuals with greater inferred reliance on DME are at a greater risk for MDD and have shorter time to MDD diagnosis post-SCI.


Assuntos
Transtorno Depressivo Maior/epidemiologia , Traumatismos da Medula Espinal/psicologia , Adolescente , Adulto , Estudos de Coortes , Transtorno Depressivo Maior/diagnóstico , Pessoas com Deficiência/psicologia , Emprego , Feminino , Serviços Hospitalares de Assistência Domiciliar , Humanos , Tempo de Internação , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Prevalência , Centros de Reabilitação , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Instituições de Cuidados Especializados de Enfermagem , Traumatismos da Medula Espinal/epidemiologia , Estados Unidos/epidemiologia , Adulto Jovem
17.
BMC Neurol ; 20(1): 32, 2020 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-31964353

RESUMO

BACKGROUND: Populations with reduced sensory and motor function, such as spinal cord injury (SCI) are at increased risk of depression, anxiety, pain, and poorer quality of life (QoL). Mindfulness-Based Interventions (MBIs) have been developed with the aim of improving outcomes for people with SCI. To understand the value of MBIs, a systematic review was conducted pertaining to the use of MBIs, and interventions including elements of mindfulness, with people with SCI. METHODS: Databases were reviewed from 1996 to October 2018 (updated January 2020). Eligibility criteria included the assessment of at least one of the common secondary consequences of SCI (i.e. risk of depression, anxiety, pain, and QoL), describe the use of mindfulness training as a component part of an intervention, or as the whole intervention. The Cochrane Collaboration Risk of Bias and The Effective Public Health Practice Project Quality Assessment Tools were utilised for quality appraisals. Two assessors appraised the studies and demonstrated good agreement (Cohen's k = .848, p < .001). RESULTS: Five papers met the inclusion criteria, and demonstrated a range of results of interventions delivered individually, in a group format, in person, and online. Only one study reported significant reductions in pain-related outcomes (with moderate effect sizes), with the remaining studies (n = 4) demonstrating no change. Four studies described reductions in depressive symptoms and three reported reductions in anxiety. Despite the importance of good QoL as a goal for people with SCI, few studies (n = 2) assessed this as an outcome with no improvements reported. Study quality ranged from high to low/weak. CONCLUSIONS: The findings in this review provide mixed support for the use of mindfulness to improve outcomes after SCI. In particular, findings indicate that mindfulness may be particularly effective for improving symptoms of depression and anxiety. This review highlights the requirement for more rigorous, high-quality research, particularly larger randomised-controlled trials with long-term follow-up, in this area. The small number of studies included in the present review mean that conclusions drawn are preliminary and thus reflects the paucity of the research in the area to date.


Assuntos
Atenção Plena/métodos , Qualidade de Vida/psicologia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/psicologia , Ansiedade/etiologia , Dor Crônica/etiologia , Depressão/etiologia , Feminino , Humanos , Masculino
18.
PLoS One ; 15(1): e0226128, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31940312

RESUMO

Secondary manifestations of spinal cord injury beyond motor and sensory dysfunction can negatively affect a person's quality of life. Spinal cord injury is associated with an increased incidence of depression and anxiety; however, the mechanisms of this relationship are currently not well understood. Human and animal studies suggest that changes in the composition of the intestinal microbiota (dysbiosis) are associated with mood disorders. The objective of the current study is to establish a model of anxiety following a cervical contusion spinal cord injury in rats and to determine whether the microbiota play a role in the observed behavioural changes. We found that spinal cord injury caused dysbiosis and increased symptoms of anxiety-like behaviour. Treatment with a fecal transplant prevented both spinal cord injury-induced dysbiosis as well as the development of anxiety-like behaviour. These results indicate that an incomplete unilateral cervical spinal cord injury can cause affective disorders and intestinal dysbiosis, and that both can be prevented by treatment with fecal transplant therapy.


Assuntos
Ansiedade/complicações , Ansiedade/prevenção & controle , Comportamento Animal , Disbiose/complicações , Disbiose/prevenção & controle , Transplante de Microbiota Fecal , Traumatismos da Medula Espinal/complicações , Animais , Disbiose/microbiologia , Microbioma Gastrointestinal , Aprendizagem em Labirinto , Ratos , Recuperação de Função Fisiológica , Traumatismos da Medula Espinal/microbiologia , Traumatismos da Medula Espinal/fisiopatologia , Traumatismos da Medula Espinal/psicologia
19.
Am J Phys Med Rehabil ; 99(8): 752-763, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31860592

RESUMO

Rehabilitation medicine has recently embraced resilience, and research in this area has surged within the past decade. Several systematic reviews of resilience research have been conducted in traumatic brain injury, chronic diseases, and stroke populations. A decade into research into the role of resilience in the lives of individuals with spinal cord injury, a review of the current state of the research literature is needed to identify trends and knowledge gaps. The aims of this scoping review were (a) to classify study methods and designs used for resilience research in spinal cord injury to date, (b) to describe how researchers have defined "resilience," and (c) to identify knowledge gaps and suggest future directions for research. Literature searches were conducted to identify English-language, peer-reviewed articles on resilience and spinal cord injury. Most of the 40 studies reviewed were correlational using cross-sectional data, although descriptive, longitudinal, qualitative, test development, and intervention studies and review articles were found as well. As is the case outside of rehabilitation medicine, there is considerable definitional and conceptual heterogeneity that limits our ability to apply resilience research to clinical practice. Moving forward, the field needs model-driven, longitudinal research that offers clear, conceptual distinctions between risk and protective factors, processes, and outcomes.


Assuntos
Acontecimentos que Mudam a Vida , Resiliência Psicológica , Traumatismos da Medula Espinal/psicologia , Adaptação Psicológica , Ansiedade/etiologia , Depressão/etiologia , Humanos
20.
Disabil Health J ; 13(1): 100842, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31558388

RESUMO

BACKGROUND: Individuals with spinal cord injuries (SCI) often struggle with lifestyle adjustment following injury. Effective wellness interventions may aid in improving quality of life; however, treatment response heterogeneity is a concern for behavioral interventions. OBJECTIVE: To identify differences among adults with SCI who were responders and non-responders in a wellness intervention. METHODS: There were 29 persons with SCI who received a wellness intervention. Participants engaged in six in-person workshops over a 3-month period, led by wellness experts with peer mentors available. Individual intervention participant change was compared to the mean among control group participants target outcomes variables (i.e., satisfaction with life, self-efficacy for health practices, secondary conditions, health promoting behaviors, and perceived stress) to classify responders versus non-responders. RESULTS: Of the 29 participants, 18 who completed the intervention were classified as responders and 11 were non-responders. The mean age was 43.2 ±â€¯11.2 years, and years post-injury were 12.0 ±â€¯9.8. Decision tree regression analysis for demographic variables and injury characteristics showed that single/divorced participants were more likely to not respond to the intervention (52%), compared to married participants (17%). Further, participants who were single/divorced and ≤50 years old were more likely to not respond to the intervention (62%) than those who were older (25%). CONCLUSIONS: Single/divorced individuals with SCI may respond differently to behavioral wellness interventions than married individuals. Additionally, the effects of age on treatment response in behavioral interventions should be further examined. Identifying non-modifiable factors related to response heterogeneity may help guide the creation of tailored interventions specific to patient characteristics.


Assuntos
Pessoas com Deficiência/psicologia , Pessoas com Deficiência/reabilitação , Promoção da Saúde/métodos , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/reabilitação , Adulto , Feminino , Humanos , Masculino , Grupo Associado , Satisfação Pessoal , Qualidade de Vida/psicologia , Autoeficácia , Resultado do Tratamento
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