ABSTRACT
OBJECTIVE: To test the effectiveness of a peer-led online self-management program for individuals with spinal cord injury (SCI). DESIGN: Randomized waitlist control trial. SETTING: Community. PARTICIPANTS: 184 adults with SCI. INTERVENTIONS: SCI Thrive is a peer-led self-management program with self-paced online content and video-sessions for live discussion. OUTCOME MEASURES: Perceived quality of life, self-efficacy for health, participation. RESULTS: A total of 97 individuals (86 randomized plus 9 assigned to the final group) were assigned to treatment and 86 randomized to the waitlist. Participants were 51 years old on average (SD = 14.9), with 58% male, mean of 15.5 (SD = 14.0) years injured, with 59% cervical injuries and 64% incomplete injuries. The treatment group had significantly higher scores on CHART occupational subscale (P = .022), but no other differences were found at the end of 6 weeks. Analysis of all participants who completed SCI Thrive showed significant increase in self-efficacy between baseline (6.32) and 6 weeks (6.81; P < .001) which was maintained at 3 months post treatment (6.83; P = .001). Those who were more engaged in SCI Thrive reported higher quality of life (P = .001), self-efficacy (P = .007), and increased mobility on the CHART (P = .026). CONCLUSION: SCI Thrive is a highly accessible program for individuals with SCI and shows promise for improving self-efficacy. Strategies to increase engagement should be added to maximize benefits. Measurement tools may have been impacted by COVID-19 pandemic. Further research on the efficacy of SCI Thrive is needed given feedback on benefit of a group focus area, such as on physical activity.
ABSTRACT
Advancements in critical care medicine have improved survival rates for patients experiencing critical illness in intensive care units (ICUs). Although mortality has declined, more than half of ICU survivors experience functional impairments that persist beyond discharge. Of particular concern is ICU-related cognitive impairment, which can extend across the care continuum, ranging from acute and transient presentations in the ICU (eg, delirium) to long-term impairments years after discharge. ICU-related cognitive impairment has received increased attention in the literature, particularly as it relates to ICU survivors who have received and survived critical care in the context of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic and are now experiencing postacute sequelae of SARS-CoV-2 infection. The medical complexity and heterogeneity of ICU survivors, coupled with the multifactorial etiology of ICU-related cognitive impairments, lead to challenges in how to optimize care for ICU survivors at various stages of recovery. This review aims to provide an overview of cognitive outcomes associated with critical illness by integrating recent literature focused on etiology, assessment, and interventions in the context of ICU-related cognitive impairments. The narrative review employs a biopsychosocial framework to comprehensively evaluate the multifactorial nature of ICU-related cognitive outcomes. Authors also highlight that multidisciplinary teams composed of key rehabilitation providers are likely best suited for optimizing recovery trajectories of ICU survivors.