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1.
Top Spinal Cord Inj Rehabil ; 25(3): 260-270, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31548793

RESUMO

Background: The effectiveness of dual-task training has been reported in individuals with cognitive impairments. To date, there is no clear evidence on the incorporation of dual-task training in ambulatory individuals with spinal cord injury (SCI) who have intact cognitive functions but have various degrees of sensorimotor dysfunction. Objectives: To compare the immediate effects of dual-task obstacle crossing (DTOC) and single-task obstacle crossing (STOC) training on functional and cognitive abilities in chronic ambulatory participants with SCI. Methods: This is a randomized 2 × 2 crossover design with blinded assessors. Twenty-two participants were randomly trained using a 30-minute DTOC and STOC training program with a 2-day washout period. Outcomes, including 10-Meter Walk Tests (single- and dual-task tests), percent of Stroop Color and Word Test task errors, Timed Up and Go Test (TUG), and five times sit-to-stand test, were measured immediately before and after each training program. Results: Participants showed significant improvement in all outcomes following both training programs (p < .05), except percent of Stroop Color and Word Test task errors after STOC training. Obvious differences between the training programs were found for the percent of Stroop task errors and TUG (ps = .014 and .06). Conclusion: Obstacle crossing is a demanding task, thus the obvious improvement was found immediately after both training programs in participants with long post-injury time (approximately 5 years). However, the findings primarily suggest the superior effects of DTOC over STOC on a complex motor task and cognitive activity. A further randomized control trial incorporating a complex dual-task test is needed to strengthen evidence for the benefit of DTOC for these individuals.


Assuntos
Cognição/fisiologia , Terapia por Exercício/métodos , Transtornos Neurológicos da Marcha/psicologia , Transtornos Neurológicos da Marcha/reabilitação , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/reabilitação , Adulto , Estudos Cross-Over , Teste de Esforço , Feminino , Transtornos Neurológicos da Marcha/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Método Simples-Cego , Traumatismos da Medula Espinal/fisiopatologia , Análise e Desempenho de Tarefas
2.
BMC Public Health ; 19(1): 803, 2019 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-31234804

RESUMO

BACKGROUND: The RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework is a useful tool for evaluating the impact of programs in community settings. RE-AIM has been applied to evaluate individual programs but seldom used to evaluate the collective impact of community-based, public health programming developed and delivered by multiple autonomous organizations. The purposes of this paper were to (a) demonstrate how RE-AIM can be operationalized and applied to evaluate the collective impact of similar autonomous programs that promote health and well-being and (b) provide preliminary data on the collective impact of Canadian spinal cord injury (SCI) peer mentorship programs on the delivery of peer mentorship services. METHODS: Criteria from all five RE-AIM dimensions were operationalized to evaluate multiple similar community-based programs. For this study, nine provincial organizations that serve people with SCI were recruited from across Canada. Organizations completed a structured self-report questionnaire and participated in a qualitative telephone interview to examine different elements of their peer mentorship program. Data were analyzed using summary statistics. RESULTS: Having multiple indicators to assess RE-AIM dimensions provided a broad evaluation of the impact of Canadian SCI peer mentorship programs. Peer mentorship programs reached 1.63% of the estimated Canadian SCI population. The majority (67%) of organizations tracked the effectiveness of peer mentorship through testimonials and reports. Setting-level adoption rates were high with 100% of organizations offering peer mentorship in community and hospital settings. On average, organizations allocated 10.4% of their operating budget and 9.8% of their staff to implement peer mentorship and 89% had maintained their programming for over 10 years. Full interpretation of the collective impact of peer mentorship programs was limited as complete data were only collected for 52% of survey questions. CONCLUSIONS: The lack of available organizational data highlights a significant challenge when using RE-AIM to evaluate the collective impact of multiple programs that promote health and well-being. Although researchers are encouraged to use RE-AIM to evaluate the collective impact of programs delivered by different organizations, documenting limitations and providing recommendations should be done to further the understanding of how best to operationalize RE-AIM in these contexts.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Implementação de Plano de Saúde/métodos , Tutoria/organização & administração , Avaliação de Programas e Projetos de Saúde/métodos , Canadá , Serviços de Saúde Comunitária/métodos , Humanos , Tutoria/métodos , Grupo Associado , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/reabilitação , Inquéritos e Questionários
3.
Fam Syst Health ; 37(2): 150-161, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31180708

RESUMO

INTRODUCTION: Few studies have investigated how caregivers manage stressors associated with their child's spinal cord injury (SCI) and how these patterns relate to their child's coping and adjustment. The current study explored empirically derived coping profiles among caregivers of youth with SCI and the relation of these patterns to parent and youth psychosocial outcomes. METHOD: This was a cross-sectional survey of 318 children (ages 1 to 18) and a primary caregiver. Participants completed measures assessing demographics, coping, quality of life (QOL), anxiety, and depression. We utilized hierarchical and nonhierarchical cluster analyses to identify unique coping patterns and one-way analysis of variance with control variables to assess relations between parental coping and psychosocial well-being. RESULTS: The analyses produced 3 parent coping clusters, which included avoidant (n = 47), constructive (n = 119), and adjusted/low (n = 152). ANCOVAs revealed that parents in the avoidant cluster, who utilized disengagement and blaming strategies, had significantly worse mental health symptoms compared to the constructive and adjusted low coping clusters. Specifically, avoidant coping was significantly related to increased symptoms of caregiver depression (p < .001) and anxiety (p < .001) as well as children's self-report of anxiety (p = .002), depression (p < .005) and emotional QOL (p < .001). DISCUSSION: These findings highlight the importance of fostering constructive and positive coping for both the children who face chronic illness and their caregivers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Adaptação Psicológica , Cuidadores/psicologia , Traumatismos da Medula Espinal/psicologia , Adolescente , Análise de Variância , Criança , Pré-Escolar , Análise por Conglomerados , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Relações Pais-Filho , Pais/psicologia , Pediatria/métodos , Traumatismos da Medula Espinal/enfermagem , Estresse Psicológico/complicações , Estresse Psicológico/psicologia , Inquéritos e Questionários
4.
Clin Rehabil ; 33(9): 1503-1514, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31056938

RESUMO

OBJECTIVE: To test a model of spiritual well-being and resilience among individuals with spinal cord injuries and their family members. DESIGN: Prospective cross-sectional observational data were analyzed by structural equation modelling. SETTING: Inpatient and community services at one rehabilitation hospital. SUBJECTS: Individual with spinal cord injury (n = 50) and family member (n = 50) dyads. INTERVENTIONS: Standard rehabilitation, both inpatient and community. MAIN MEASURE(S): Functional assessment of chronic illness therapy - spiritual well-being scale - expanded, Connor-Davidson resilience scale, positive and negative affect scale, depression anxiety and stress scale-21, satisfaction with life scale. RESULTS: Median time post-injury was 8.95 months (IQR (interquartile range) = 14.15). Individuals with spinal cord injury and family members reported high scores for both spiritual well-being (66.06 ± 14.89; 68.42 ± 13.75) and resilience (76.68 ± 13.88; 76.64 ± 11.75), respectively. Analysis found the model had acceptable fit (e.g. chi-square goodness of fit statistic = 38.789; P = .263). For individuals with spinal cord injury, spiritual well-being was positively associated with resilience which, in turn, was associated with increasing positive affect and satisfaction with life. Among family members, spiritual well-being was positively associated with resilience. Resilience was then associated with lowered levels of depression and mediated the impact of depression on satisfaction with life. Limited evidence was found for mutual dyadic links, with the only significant pathway finding that resilience in the individual with spinal cord injury was associated with increased satisfaction with life among family members. CONCLUSION: Increased spirituality and resilience make a significant contribution (both independently and in combination) to positive psychological outcomes for both individuals with spinal cord injury and their family members.


Assuntos
Ajustamento Emocional , Família/psicologia , Resiliência Psicológica , Traumatismos da Medula Espinal/psicologia , Espiritualidade , Adaptação Psicológica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Escalas de Graduação Psiquiátrica , Traumatismos da Medula Espinal/reabilitação
5.
Top Spinal Cord Inj Rehabil ; 25(2): 164-185, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31068748

RESUMO

Background: Various injury characteristics such as cause, level, severity, and time since injury divide individuals with spinal cord injury (SCI) into many subgroups. The heterogeneity among individuals' injuries and personal characteristics has significant implications for SCI rehabilitation practice, specifically directed toward community reintegration, which is a key goal of rehabilitation interventions for people with disabilities. Purpose: This study aims to summarize the evidence on attributes that make the SCI population heterogeneous, the impact of these attributes on community reintegration, and the implications of heterogeneity for rehabilitation interventions directed toward optimizing community reintegration. Methods: We used an integrative review approach to conduct this study. MEDLINE, PubMed, CINAHL, EMBASE, Google Scholar, and PsycINFO were searched from inception until May 2017. Out of 670 articles retrieved, 49 provided evidence on the impact of various attributes that make SCI heterogeneous on rehabilitation outcomes related to community reintegration. Results: An array of injury-related, personal, social, and environmental factors are associated with various rehabilitation outcomes that affect community reintegration of people with SCI. There is level 1 evidence that social support, self-efficacy, and self-esteem facilitate community reintegration among people with SCI while there is level 5 evidence that presence of psychological or medical complications decreases it. There is lack of clarity on the impact of injury-related factors on community reintegration. Conclusion: This integrative review found that social support and individuals' self-efficacy can improve community reintegration of people with SCI. However, evidence regarding the impact of injury characteristics on community reintegration is still underdeveloped. Approaches directed at community reintegration should involve components of psychosocial, physical, and vocational rehabilitation while considering personal and societal aspects of an individual's life.


Assuntos
Adaptação Psicológica/fisiologia , Integração Comunitária/psicologia , Traumatismos da Medula Espinal/reabilitação , Atitude Frente a Saúde , Planejamento Ambiental , Acesso aos Serviços de Saúde , Humanos , Características de Residência , Autoimagem , Apoio Social , Traumatismos da Medula Espinal/psicologia
6.
Artigo em Russo | MEDLINE | ID: mdl-31095129

RESUMO

BACKGROUND: The number of children who have received severe spinal cord injury (SCI) is steadily increasing during the recent years. The clinical picture of the post-injury condition is characterized by psychological and psychiatric disorders of varying severity. The literature publications concern emotions experienced after SCI by the adult patients whereas the data on the emotional disorders in the children and the approaches to their medical treatment are virtually absent. Nor is enough information about the status of the children in the early period after the spinal trauma treated jointly by a psychiatrist and a psychologist. AIM: The objective of the present study was the evaluation of the emotions and motivations in the children following the severe spinal trauma in the course of the early rehabilitation period as well as the development of an algorithm for the interaction of a psychiatrist and a psychologist in their joint efforts to manage the emotional and motivational disorders. MATERIAL AND METHODS: The study included 35 children at the age from 8 to 18 years presenting with the severe spinal trauma who had been admitted for the treatment and rehabilitation based at the Research Institute of Emergency Pediatric Surgery and Traumatology, Moscow Health Department, during the period from 2016 to 2018. All the patients were examined by a psychiatrist and a psychologist in dynamics, viz. before the beginning of the rehabilitation course as well as within the 7-10th and 21-25th days after its initiation. The relevant diagnostic scales and questionnaires were used to detect depression and assess the severity of individual symptoms. RESULTS: Three groups of children who had experienced the severe spinal trauma were distinguished depending on the character of emotional disorders and their severity. Group 1 was comprised of the children with depression (n=6) including 2 boys and 4 girls at the age from 14 to17 years (17.2%). Group 2 consisted of the children with emotional disorders, such as high anxiety, impaired motivation with sub-depressive prerequisites (n=11) including 4 girls and 7 boys at the age from 12 to16 years (31.4%). Group 3 was composed of the children free from depression or depressive manifestations (n=18) including 15 boys, 3 girls at the age from 8 to17 years (51.4%). The algorithm for the combined rehabilitative treatment of the children during the early period after the severe spinal trauma with the participation of the psychiatrist and the psychologist has been developed. It was shown that the patients with a reduced intensity of emotional expression combined with a moderate or low level of anxiety and sufficient motivation needed the supervision by the psychologist alone. The children with a reduced intensity of emotional expression combined with a moderate or high level of anxiety and impaired motivation had to be supervised and treated by both the psychiatrist and the psychologist. The children with pronounced depression, high anxiety and low motivation required the supervision and treatment by a psychiatrist with simultaneous pharmacological correction of their condition. CONCLUSION: The results of this study give evidence that 48.6% of the children after severe spinal trauma suffer from the emotional and motivational disorders requiring specialized psychiatric care including the differentiated psychological and psychiatric treatment during the early rehabilitation period with the use of the algorithm for the combined treatment based on the joint efforts of the psychiatrist and the psychologist supplemented by the pharmacological correction.


Assuntos
Psicoterapia , Traumatismos da Medula Espinal/psicologia , Traumatismos da Medula Espinal/reabilitação , Adolescente , Algoritmos , Ansiedade , Criança , Terapia Combinada , Depressão , Feminino , Humanos , Masculino , Moscou , Índices de Gravidade do Trauma
7.
Disabil Health J ; 12(4): 588-593, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31076226

RESUMO

BACKGROUND: Sleep problems are common for individuals living with physical disabilities and chronic pain. However, the factors that influence the relationship between pain and sleep problems in these populations remain unknown. OBJECTIVE: The aim of this study was to increase our understanding of the physical, emotional and cognitive factors associated with sleep disturbance in individuals with chronic health conditions often associated with physical disabilities. METHODS: Participants were recruited from a database of individuals with a variety of chronic health conditions, including multiple sclerosis, spinal cord injury, back pain, osteoarthritis, and amputations. To participate in the study, they needed to report having a chronic pain problem. Participants completed an online survey using REDCap assessing average pain intensity (Numerical Rating Scale-11), pain extent (number of painful body areas), sleep disturbance (PROMIS Sleep Disturbance), depression (PROMIS Emotional Distress-Depression) and catastrophizing (Coping Strategies Questionnaire). A total of 455 participants (Mage = 58.9; SD = 11.4), of which 292 (64%) were women, provided complete data. We performed a series of four regression analyses. RESULTS: After controlling for age and sex, the predictors explained an additional 7-16% of the variance in sleep disturbance. The final model with all of the predictors explained 22%. CONCLUSIONS: Consistent with the study hypothesis, all the variables examined made significant and independent contributions to the variance in sleep disturbance. The findings provide additional evidence that physical, emotional and cognitive factors all play a role in the sleep quality of individuals with chronic health conditions often associated with physical disabilities.


Assuntos
Dor Crônica/complicações , Cognição , Pessoas com Deficiência , Emoções , Transtornos do Sono-Vigília/etiologia , Adaptação Psicológica , Idoso , Amputação/efeitos adversos , Amputação/psicologia , Dor nas Costas/complicações , Dor nas Costas/psicologia , Catastrofização/complicações , Doença Crônica , Dor Crônica/psicologia , Depressão/complicações , Pessoas com Deficiência/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Esclerose Múltipla/complicações , Esclerose Múltipla/psicologia , Osteoartrite/complicações , Osteoartrite/psicologia , Medição da Dor , Exame Físico , Análise de Regressão , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/psicologia , Estresse Psicológico/complicações , Inquéritos e Questionários
8.
Rehabil Psychol ; 64(3): 351-359, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30958020

RESUMO

PURPOSE: Many individuals with a spinal cord injury (SCI) report significant symptoms of depression and/or anxiety post-SCI; however, access to mental health services can be limited. The purpose of this study was to evaluate patient perspectives on the acceptability of an 8-week guided Internet-delivered cognitive behavior therapy (ICBT) course (Chronic Conditions Course) for people with SCI. In particular, we sought to understand patient perceptions of facilitators and barriers of engaging in ICBT and strengths and weaknesses of ICBT program content. METHOD: Semistructured interviews were conducted with 8 SCI patients after completion of the ICBT course. The interviews were audio-recorded, transcribed verbatim, and examined by means of thematic analysis by 2 coders. RESULTS: Eight participants (mean age = 53.2 years; males = 50%; paraplegia = 67.5%) were interviewed. Four major themes emerged when examining facilitators to completing the program: accessibility, flexibility, motivation, and guided support. Barriers to completing the program included course timeframe and physical health. Strengths of the course included effective skill development and mental health prioritization. Suggested changes to the course included improved breadth of case stories, development of extra resources, adjusting the course timeframe to account for the SCI, and more support from the guide. CONCLUSIONS: ICBT was overall highlighted as an acceptable method of receiving care for people with SCI. The study provides direction for improving delivery of ICBT to ensure this method of treatment meets the needs of individuals with SCI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos de Ansiedade/terapia , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/terapia , Traumatismos da Medula Espinal/psicologia , Transtornos de Ansiedade/etiologia , Transtornos de Ansiedade/psicologia , Transtorno Depressivo/etiologia , Transtorno Depressivo/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/complicações
10.
Clin Rehabil ; 33(7): 1241-1251, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30935211

RESUMO

OBJECTIVE: To investigate whether the two briefest validated ICF-based (International Classification of Functioning, Disability and Health) tools can detect differences between different spinal conditions. DESIGN: Cross-sectional study. SETTING: University hospital rehabilitation clinic. SUBJECTS: A total of 84 patients with spinal cord injury and 81 with chronic spinal pain. MAIN MEASURES: Disability evaluated using self-reported and proxy 12-item WHODAS 2.0 ((World Health Organization Disability Assessment Schedule), and physician-rated WHO minimal generic data set covering functioning and health. FINDINGS: The two measures used showed severe disability in both patient populations, those with spinal cord injury (mean age 47.5 years, SD 13.2) and those with chronic spinal pain (mean age 47.2 years, SD 9.5), WHODAS patient sum being 18.4 (SD 9.6) versus 22.0 (SD 9.0), P < 0.05, and the WHO generic data set 15.6 (SD 4.4) versus 14.2 (SD 3.7), P < 0.01, respectively. Correlations between patient and proxy ratings and between the two disability scales were mostly strong. Severe restrictions were found in the working ability of both the populations, in mobility of patients with spinal cord injury and in pain function of patients with chronic spinal pain. In this tertiary clinic patient population, patients with spinal pain perceived more problems in emotional and cognitive functions, and in participation than patients with spinal cord injury. CONCLUSIONS: Both scales were able to find differences between two patient populations with severe disability.


Assuntos
Dor Crônica/fisiopatologia , Avaliação da Deficiência , Traumatismos da Medula Espinal/fisiopatologia , Atividades Cotidianas , Adulto , Idoso , Dor Crônica/complicações , Dor Crônica/psicologia , Estudos Transversais , Feminino , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Autorrelato , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/psicologia , Caminhada , Organização Mundial da Saúde
11.
Rev Bras Enferm ; 72(1): 241-247, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-30916291

RESUMO

OBJECTIVE: To investigate, based on scientific literature, evidence on social participation and personal autonomy of individuals with spinal cord injury. METHOD: Integrative review of the literature including studies published between January 2006 and September 2016, obtained in the databases PubMed, CINAHL and LILACS. The guiding question was: "What evidence is available in the scientific literature about the social participation and/or personal autonomy of individuals with spinal cord injury?" The data were processed by IRaMuTeQ and analyzed by the Hierarchical Descending Classification, according to the expertise of the researchers. RESULTS: Six selected studies discussed social participation, one discussed personal autonomy and two discussed both. 107 text segments were retained and gave rise to five classes. CONCLUSION: There is little specificity regarding the characteristics of social participation and personal autonomy of individuals with spinal cord injury. The existence of barriers forces them to adopt strategies to participate autonomously.


Assuntos
Autonomia Pessoal , Participação Social/psicologia , Traumatismos da Medula Espinal/complicações , Humanos , Traumatismos da Medula Espinal/psicologia , Inquéritos e Questionários
12.
Behav Neurol ; 2019: 1312934, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30881519

RESUMO

Background: Empathy has been conceptualized as comprising a cognitive and an emotional component, the latter being further divided into direct and indirect aspects, which refer, respectively, to the explicit evaluation of the observer's feelings while attending someone in an emotional situation and to the physiological response of the observer. Empathy has been previously investigated in several neurological disorders. Objective: This study is aimed at investigating empathy in patients with spinal cord injury (SCI). We hypothesize that, due to deafferentation following their injury, SCI patients will display difficulty in the processing of emotional stimuli and blunted empathic responses as compared to healthy controls. Materials and Methods: 20 patients with spinal cord injury (SCI) (12 males and 8 females, mean age = 50.9, standard deviation (SD) = 16.1 years; mean education = 10.9, SD = 4.1 years) were included in the study and compared to 20 matched healthy subjects. Participants were investigated using the State-Trait Anxiety Inventory (Form Y) (STAI-Y), the Beck Depression Scale, and the Toronto Alexithymia Scale. Moreover, participants were further evaluated by means of the Interpersonal Reactivity Index (IRI), which explores both cognitive and emotional aspects of empathy, and through an experimental protocol based on the use of a modified version of the computerized Multifaceted Empathy Test (MET) to evaluate emotional (direct and indirect) empathy and the ability to judge the valence of complex emotional scenes. Results: As compared to healthy controls, SCI patients reported higher scores on the Perspective-Taking subscale of the IRI, while, on the modified MET, they were less accurate in identifying the valence of neutral scenes, notwithstanding their spared direct and indirect emotional empathy ability. Furthermore, we found a significant negative correlation between the time interval since injury and the direct emotional empathy scores on the positive images, as well as a negative correlation with the indirect emotional empathy scores on both positive and neutral images, indicating a blunting of the empathic responses as time elapses. Conclusion: Results suggest that SCI patients, when analyzing the meaning of emotional stimuli, tend to rely on a cognitive empathy strategy rather than on emotion simulation.


Assuntos
Sintomas Afetivos/psicologia , Cognição/fisiologia , Emoções/fisiologia , Empatia/fisiologia , Traumatismos da Medula Espinal/psicologia , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inventário de Personalidade , Escalas de Graduação Psiquiátrica
13.
Medicine (Baltimore) ; 98(11): e14901, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30882708

RESUMO

BACKGROUND: The knowledge and attitude of nonpsychiatric physicians regarding suicide in spinal cord injury (SCI) patients is important to prevent the accident related to suicide. However, most existing studies have focused on perception of and attitudes among psychiatric physician and mental health care worker.The aim of this study is to investigate awareness and attitude regarding suicide among clinicians treating patients with spinal cord injury, and the necessity of education for suicide prevention. METHODS: A total of 29 subjects (N = 29; surgical group n = 17, nonsurgical group n = 12) participated in the study, 6 fellows and 23 residents. They answered a newly revised questionnaire that incorporated 18 items regarding perception of and attitude toward suicide, awareness of suicide in treatment of spinal cord injury patients, and psychiatric consultation; 13 items regarding education and experience; and 4 subjective items regarding their department. A χ test was performed to investigate differences in sociodemographic factors, awareness of and attitude toward suicide, and clinical experience with spinal cord injury patients. Binary logistic regression analysis was used to identify correlation between the questionnaire items. RESULTS: There were significant differences between surgical and nonsurgical clinicians in 1 question (Q6) about awareness of and attitude toward suicide (P < .05) and in 2 questions (Q21, Q25) about psychiatric consultation and experience with suicide-related education (P < .01). The correlation analysis revealed significant differences in certain questions among awareness and attitude (P < .05) and age (P < .05) and specialty (P < .01). Two sets of questions (Q16/Q31, Q17/Q26) showed correlation between clinical experience with spinal cord injury patients and awareness of and attitude toward suicide (P < .05). CONCLUSION: Education regarding suicide prevention and suicide-related clinical experience with spinal cord injury patients is important for nonpsychiatric clinicians, such as those in the fields of orthopedics, neurosurgery, and rehabilitation medicine.


Assuntos
Atitude do Pessoal de Saúde , Percepção , Médicos/psicologia , Traumatismos da Medula Espinal/mortalidade , Suicídio/prevenção & controle , Adulto , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Estudos Prospectivos , República da Coreia , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/psicologia , Suicídio/psicologia , Inquéritos e Questionários
14.
Rehabil Nurs ; 44(2): 123-127, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30830010

RESUMO

BACKGROUND: Evidence shows that having a bowel management program prevents rehospitalization postacute rehabilitation discharge for persons with a spinal cord injury (SCI). Peer mentors have been used to assist patients in managing their care. PURPOSE: The aim of the study was to illustrate how interprofessional collaboration led to utilizing resources of the inpatient rehabilitation facility's peer mentor program and incorporating peer mentors into bowel education for persons with SCI. METHODS: A descriptive case review of a continuous quality improvement (CQI) project, using an eight-item Likert scale evaluation survey with three open-ended questions to assess the utility of incorporating peer mentors into bowel education. FINDINGS AND CONCLUSIONS: Twenty-seven of the 28 participants responded to the survey. Results showed that the education program was useful, should be continued, and include the peer mentors. Responses from open-ended questions included themes related to knowledge, adherence, and taking charge of one's own care. Interprofessional collaboration and involvement of peer mentors as copresenters in SCI bowel education were feasible.


Assuntos
Comportamento Cooperativo , Incontinência Fecal/terapia , Tutoria/normas , Educação de Pacientes como Assunto/métodos , Traumatismos da Medula Espinal/complicações , Incontinência Fecal/prevenção & controle , Humanos , Relações Interprofissionais , Tutoria/métodos , Educação de Pacientes como Assunto/normas , Traumatismos da Medula Espinal/psicologia , Inquéritos e Questionários
15.
Top Spinal Cord Inj Rehabil ; 25(1): 1-22, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30774286

RESUMO

Objectives: To identify and classify tools for assessing the influence of neurogenic bowel dysfunction (NBD) on quality of life (QoL) after spinal cord injury (SCI). Methods: In this systematic review, MEDLINE/PubMed, CINAHL, and PsycInfo were searched to identify studies assessing the influence of NBD on QoL (or related construct) after SCI. Two independent reviewers screened titles and abstracts, and both reviewers classified tools as subjective or objective according to Dijkers' theoretical QoL framework. Results: Seventy-two studies were identified, and 35 studies met the inclusion criteria. Five objective measures assessed the influence of NBD on QoL, which were validated for use in SCI, but no measure was condition-specific to NBD. Eight measures were classified as subjective tools; two had an established reliability and validity for SCI while six had some psychometric evidence for use in the SCI population. Five subjective measures (NBD score, Burwood QoL Questionnaire, Impediments to Community Integration [ICI] Scale, SCI-QoL Bowel Management Difficulties, and Survey of Neurogenic Bowel Characteristics) were developed specifically for SCI. The NBD score showed sensitivity to the influence of NBD on QoL in experimental trials. Conclusion: Thirteen tools assessed the influence of NBD on QoL in SCI. Although not developed specifically for SCI, the Health Utility Index (HUI-III) was the only tool identified that provided data on "QoL as utility" on the impact of NBD. The validated NBD score was the only condition-specific tool to assess QoL as "subjective well-being." Further validation of existing tools could help to inform practice and policy related to resource allocation for bowel care post SCI.


Assuntos
Intestino Neurogênico/psicologia , Qualidade de Vida/psicologia , Traumatismos da Medula Espinal/psicologia , Atividades Cotidianas , Adolescente , Adulto , Idoso , Feminino , Indicadores Básicos de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Prognóstico , Inquéritos e Questionários/classificação , Adulto Jovem
16.
Top Spinal Cord Inj Rehabil ; 25(1): 23-30, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30774287

RESUMO

Background: Colostomy formation can solve complications of bowel management following spinal cord injury (SCI). Newly injured patients at this spinal unit have chosen colostomy as a preferred option for bowel management. Objectives: To discover the reasons patients choose colostomy formation early following SCI and make comparison with those choosing it later, and to establish whether early colostomy is safe and advisable. Methods: Medical and nursing records of patients with SCI who chose to have a colostomy during the period 2005-2016 were examined retrospectively. Data were gathered concerning reasons for choosing a colostomy, early and later complications, the need for further surgery, and independence with bowel care before and after surgery. Patients were divided into two groups: those who chose a colostomy "early" during inpatient rehabilitation and those who chose it "later" as is traditional. Results: Reasons for choosing colostomy differed. Reducing reliance on caregiver and independence were of more importance to the early group; the later group chose colostomy to solve bowel care problems. Early complication rates in both groups were low. Longer term complications were higher in the early group, with the most common complication being rectal discharge. Parastomal hernia rates were low in both groups, as was the need for further surgery. Colostomy formation led to 20.8% of all patients gaining independence with bowel care. Conclusion: This study found colostomy to be a safe and effective option when performed early after SCI and demonstrates colostomy can be a means of gaining independence and making bowel care easier and more acceptable to the newly injured patient.


Assuntos
Colostomia/psicologia , Intestino Neurogênico/cirurgia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Qualidade de Vida , Traumatismos da Medula Espinal/psicologia , Adulto , Idoso , Comportamento de Escolha , Colostomia/efeitos adversos , Colostomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Intestino Neurogênico/psicologia , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Fatores de Tempo
17.
Top Spinal Cord Inj Rehabil ; 25(1): 31-40, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30774288

RESUMO

Background: Pressure injuries negatively impact quality of life and participation for individuals with spinal cord injury (SCI). Objective: To examine the factors that may protect against the development of medically serious pressure injuries in adults with SCI. Methods: A qualitative analysis was conducted using treatment notes regarding 50 socioeconomically disadvantaged individuals who did not develop medically serious pressure injuries during a 12-month pressure injury prevention intervention program. Results: Eight types of potentially protective factors were identified: meaningful activity, motivation to prevent negative health outcomes, stability/resources, equipment, communication and self-advocacy skills, personal traits, physical factors, and behaviors/activities. Conclusions: Some protective factors (eg, personal traits) may be inherent to certain individuals and nonmodifiable. However, future interventions for this population may benefit from a focus on acquisition of medical equipment and facilitation of sustainable, health-promoting habits and routines. Substantive policy changes may be necessary to facilitate access to adequate resources, particularly housing and equipment, for socioeconomically disadvantaged individuals with SCI. Further research is needed to understand the complex interplay of risk and protective factors for pressure injuries in adults with SCI, particularly in underserved groups.


Assuntos
Área Carente de Assistência Médica , Lesão por Pressão/prevenção & controle , Traumatismos da Medula Espinal/complicações , Adulto , Cuidadores , Feminino , Comportamentos Relacionados com a Saúde , Promoção da Saúde , Humanos , Masculino , Motivação , Terapia Ocupacional/estatística & dados numéricos , Defesa do Paciente , Lesão por Pressão/psicologia , Qualidade de Vida/psicologia , Método Simples-Cego , Traumatismos da Medula Espinal/psicologia
18.
Top Spinal Cord Inj Rehabil ; 25(1): 41-61, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30774289

RESUMO

Background: It is important to develop further understanding regarding the facilitating and constraining factors that influence participation in daily activities, including social and human rights issues faced by persons with spinal cord injury (SCI) that affect their opportunities to lead full social lives. Objectives: To identify, describe, and compare factors that influence participation in daily activities by persons with SCI living in high-income countries (HICs) and in low- and middle-income countries (LMICs). Method: We performed a scoping review of 2,406 articles published between 2001 and 2016 that were identified from electronic databases. From these, 58 remained after checking inclusion and exclusion criteria. Analyses included (a) identifying factors that facilitate and constrain participation in daily activities; (b) categorizing the identified factors as issues related to medical, social, and human rights models; and (c) comparing determinants between LMICs and HICs. Results: The medical model factors pertained to long-term physical health and functional capacities, self-efficacy and adjustment skills, relearning capacities for performing daily activities, and availability of cost-effective adaptive equipment. The social model factors pertained to developing accommodating communities (accessible environments and mutual understanding). The factors of the human rights model pertained to autonomy (empowerment) and development of social justice (application of policies, advocacy, and negotiation). Conclusion: Eight lessons are proposed to enhance health and functional abilities, ensure disability friendly environments, develop social justice, and provide empowerment to enhance participation in daily activities among person with SCI living in LMICs.


Assuntos
Pessoas com Deficiência/reabilitação , Traumatismos da Medula Espinal/reabilitação , Logro , Atividades Cotidianas , Países em Desenvolvimento , Pessoas com Deficiência/psicologia , Nível de Saúde , Humanos , Paralisia/psicologia , Paralisia/reabilitação , Qualidade de Vida/psicologia , Autoeficácia , Traumatismos da Medula Espinal/psicologia
19.
World Neurosurg ; 125: e1016-e1022, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30771543

RESUMO

BACKGROUND: Depression is a prevalent and disabling condition associated with spinal cord injury (SCI). Such associated negative factor warrants the use of valid and reliable psychological assessment tools among this group. One of the available assessment means is the Patient Health Questionnaire-9 (PHQ-9), a short screening measure that evaluates depression status. Our aim is to test the psychometric properties of the Arabic version of the PHQ-9 including validity and reliability among Lebanese individuals with SCI. METHODS: This is a cross-sectional study conducted between January and June 2018, including 51 participants with SCI. Questionnaire and assessment measures were administered to the subjects. The internal consistency, test-retest reliability, and the factor structure of the PHQ-9 were evaluated in addition to the convergent validity, which was established by comparing the scale's total score with the scores of the Hamilton Depression Rating Scale. RESULTS: Exploratory factor analysis revealed 3 factors accounting for 66.2% of the total variance. The scale demonstrated good internal consistency (Cronbach's alpha = 0.71) and test-retest reliability (Intraclass correlation coefficient = 0.88). Significant correlation was found between the PHQ-9 and the Hamilton Depression Rating Scale (r = 0.71) suggesting good convergent validity. CONCLUSIONS: Our findings suggest that the PHQ-9 has good psychometric properties and is a valid and reliable measure of depression among the Lebanese individuals with SCI.


Assuntos
Depressão/diagnóstico , Questionário de Saúde do Paciente/normas , Traumatismos da Medula Espinal/psicologia , Adulto , Grupo com Ancestrais do Continente Asiático/psicologia , Estudos Transversais , Depressão/epidemiologia , Depressão/etiologia , Análise Fatorial , Feminino , Humanos , Líbano/epidemiologia , Masculino , Escalas de Graduação Psiquiátrica/normas , Curva ROC , Reprodutibilidade dos Testes , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/epidemiologia
20.
Clin Rehabil ; 33(6): 1045-1055, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30791702

RESUMO

OBJECTIVE: To determine the size of the effects and feasibility (recruitment and retention rates) of a therapeutic songwriting protocol for in-patients and community-dwelling people with acquired brain injury or spinal cord injury. DESIGN: Randomized controlled trial with songwriting intervention and care-as-usual control groups, in a mixed measures design assessed at three time points. PARTICIPANTS: A total of 47 participants (3 in-patients with acquired brain injury, 20 community participants with acquired brain injury, 12 in-patients with spinal cord injury, and 12 community participants with spinal cord injury: 23 1208 days post injury). INTERVENTIONS: The intervention group received a 12-session identity-targeted songwriting programme, where participants created three songs reflecting on perceptions of past, present, and future self. Control participants received care as usual. MEASURES: Baseline, postintervention, and follow-up measures comprised the Head Injury Semantic Differential Scale (primary outcome measure), Patient Health Questionnaire-9, Emotion Regulation Questionnaire, and Satisfaction with Life Scale. RESULTS: No significant between group pre-post intervention differences were found on the primary self-concept measure, the Head Injury Semantic Differential Scale ( p = 0.38, d = 0.44). Significant and large effect sizes from baseline to post between groups in favour of the songwriting group for Satisfaction with Life ( p = 0.04, n2 p = 0.14). There were no significant between group pre-post interaction effects for the Emotion Regulation Suppression subscale ( p = 0.12, n2 p = -0.08) although scores decreased in the songwriting group over time while increasing for the standard care group. There were no significant differences in baseline to follow-up between groups in any other outcome measures. Recruitment was challenging due to the small number of people eligible to participate combined with poor uptake by eligible participants, particularly the in-patient group. Retention rates were higher for the community-dwelling cohorts. CONCLUSION: This study demonstrates the challenges in recruitment and retention of participants invited to participate in a music therapy study. Findings suggest this identity-focused therapeutic songwriting protocols may be more beneficial for people who have transitioned from in-patient to community-contexts given the greater proportion of participants who consent and complete the intervention. Preliminary effects in favour of the intervention group were detected in a range of well-being measures suggesting that a larger study is warranted.


Assuntos
Lesões Encefálicas/reabilitação , Musicoterapia/métodos , Satisfação Pessoal , Autoimagem , Traumatismos da Medula Espinal/reabilitação , Adulto , Lesões Encefálicas/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , Traumatismos da Medula Espinal/psicologia
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