Revisiting functioning recovery in persons with spinal cord injury undergoing first rehabilitation: Trajectory and network analysis of a Swiss cohort study.

Information about an individual's functioning and its longitudinal development is key to informing clinical rehabilitation. However, the description and understanding of the detailed longitudinal course of functioning, i.e., functioning trajectories, is rare in the current SCI literature. The aim of this study was to re-estimate previously identified functioning trajectories of individuals with spinal cord injury (SCI) undergoing initial rehabilitation in Switzerland using trajectory analysis, and to identify highly influential functioning domains that could become trajectory-specific targets for clinical interventions using network analysis. The study was based on data from the Swiss SCI Cohort Study and included individuals with SCI (N = 1099) who completed their rehabilitation in one of four collaborating centers between May 2013 and March 2022. For the trajectory analysis, functioning was operationalized using the total sum score of the Spinal Cord Independence Measure version III (SICM III), which was assessed at up to four time points (T1-T4) during rehabilitation. For the network analysis, individual SCIM III items were used to operationalize relevant functioning problems at T1 (admission) and T4 (discharge). The re-estimation of trajectory analysis confirmed the previously identified mean functioning trajectory classes of stable high functioning (N = 239; 21.75%), early (N = 33; 3.00%), moderate (N = 753; 68.52%), and slow (N = 74; 6.73%) functioning improvement. The network analysis revealed highly connected functioning problems at T1 for the moderate functioning improvement class, including "Feeding", "Dressing upper body", and "Dressing lower body", "Mobility in bed", and "Use of toilet". These functioning domains might indicate potential trajectory-specific targets for clinical interventions. This study has increased our knowledge about functioning trajectories of individuals with SCI undergoing initial rehabilitation in Switzerland and its findings may inform discussions about the application and use of functioning trajectories in clinical practice. Due to the exploratory nature of this study, further research is needed to confirm the findings presented.

Longitudinal measurement invariance of the international spinal cord injury quality of life basic data set (SCI-QoL-BDS) during spinal cord injury/disorder inpatient rehabilitation.

PURPOSE: This study aimed at testing the internal consistency and longitudinal measurement invariance of a brief quality of life questionnaire-the spinal cord injury quality of life basic data set (SCI-QoL-BDS)-among individuals with spinal cord injury/disorder undergoing first inpatient rehabilitation. METHODS: Longitudinal data from the Swiss spinal cord injury inception cohort study were used. Participants (n = 218) completed the SCI-QoL-BDS at one and three months post injury and at discharge. The SCI-QoL-BDS consists of three items assessing satisfaction with life as a whole, physical health, and psychological health. Internal consistency was examined at each time point and longitudinal measurement invariance was tested using longitudinal confirmatory factor analysis. RESULTS: Internal consistency coefficients ranged between .82 and .90. The confirmatory factor analysis revealed invariance of the factor structure and of all factor loadings across time. Additionally, all item intercepts except the one of satisfaction with physical health were invariant across time, suggesting partial intercept invariance of the SCI-QoL-BDS. Indeed, a response shift was observed in satisfaction with physical health. This item was evaluated more negatively in the early phase of inpatient rehabilitation, indicating the change of the evolving physical situation after the onset of a spinal cord injury. CONCLUSION: The SCI-QoL-BDS is a consistent and valid measure to assess quality of life among individuals undergoing first spinal cord injury/disorder inpatient rehabilitation. However, we recommend using latent variable frameworks instead of mean scores when examining longitudinal changes in the measure to account for potential response shift.

Longitudinal changes in psychological adaptation outcomes during spinal cord injury inpatient rehabilitation.

OBJECTIVES: To determine average changes and individuals' patterns of change in depressive symptoms, anxiety symptoms, general distress, and life satisfaction between admission to spinal cord injury inpatient rehabilitation and discharge; and to identify factors associated with change. METHOD: Longitudinal data collection as part of a national cohort study (N = 281). Changes in the psychological adaptation outcomes were analyzed using latent change score models. Reliable change indexes were calculated for each outcome to identify individuals' patterns of change. Biopsychosocial factors were examined as covariates of change. RESULTS: On average, depressive symptoms, anxiety symptoms, and general distress decreased between admission and discharge, while life satisfaction increased. According to the reliable change indexes, several adaptation patterns were identified. The proportion of individuals following each pattern varied depending on the analyzed outcome: resilience (absence of clinically relevant symptoms at admission and discharge) was the most common for symptoms of depression (61.57%) and anxiety (66.55%), whereas vulnerability (clinically relevant symptoms at both measurement times) was the most common for distress (57.32%). Improvement patterns (statistically significant decreases) were identified for 6.41%, 4.27%, and 7.83% of participants in depressive symptoms, anxiety symptoms and distress, respectively. For life satisfaction, improvement (statistically significant increases) was found for 8.54%. Male sex, tetraplegia, self-efficacy, optimism, and social support were associated with average changes in the psychological adaptation outcomes. CONCLUSIONS: On average, participants showed improvement in all analyzed outcomes. Still, there is substantial variability in change. Self-efficacy, social support, and optimism are potential intervention targets during inpatient rehabilitation to promote a favorable psychological adaptation process. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Adaptation during spinal cord injury rehabilitation: The role of appraisal and coping.

OBJECTIVE: To test the spinal cord injury adjustment model (SCIAM) by examining whether primary appraisals (threat or loss) and coping strategies (approach-oriented and denial) sequentially mediate the impact of functional independence, psychological resources, and social support on depressive and anxiety symptoms among individuals with spinal cord injury during inpatient rehabilitation. METHOD: Path analyses of longitudinal data from a Swiss inception cohort study (N = 207). Models were implemented separately for depressive and anxiety symptoms. RESULTS: The initial models based on the SCIAM yielded poor fit and were respecified. Different from the SCIAM's assumptions, psychological resources and threat appraisal showed direct effects on depressive symptoms (ß = -.28, SE = .07, p < .001 and ß = .33, SE = .07, p < .001, respectively), while social support and threat appraisal showed direct effects on anxiety symptoms (ß = -.23, SE = .06, p < .001 and ß = .42, SE = .06, p < .001, respectively). Primary appraisals and coping strategies partially mediated the effects of psychological resources on depressive symptoms and fully mediated their effect on anxiety symptoms. However, this did not only happen via the SCIAM's sequential double mediation, since indirect effects were also observed via threat appraisal only. The final models explained 40 and 30% of the variance of depressive and anxiety symptoms, respectively. CONCLUSIONS: The findings only partially supported the SCIAM's sequential double mediation mechanism. Psychological resources, social support, and primary appraisals can have direct effects on psychological adaptation outcomes and may be suitable intervention targets during inpatient rehabilitation. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Profiles of Psychological Adaptation Outcomes at Discharge From Spinal Cord Injury Inpatient Rehabilitation.

OBJECTIVE: To evaluate the effect of a newly acquired spinal cord injury (SCI) by identifying profiles of psychological adaptation outcomes at discharge from inpatient rehabilitation, using several outcome measures in parallel and to examine biopsychosocial factors associated with profile membership. DESIGN: Cross-sectional analysis of data from the Swiss Spinal Cord Injury inception cohort study. SETTING: Inpatient rehabilitation. PARTICIPANTS: Individuals 16 years old or older with recently diagnosed SCI who finished clinical rehabilitation in 1 of the 4 major national rehabilitation centers (N=370). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Life satisfaction, general distress, and symptoms of depression and anxiety were assessed using a single item from the International SCI Quality of Life Basic Data Set, the Distress Thermometer, and the Hospital Anxiety and Depression Scale respectively. RESULTS: Using latent profile analysis, 4 profiles of psychological adaptation outcomes were identified displaying different levels of impact, ranging from Minimal to Severe. Regarding covariates associated with profile membership, higher optimism, purpose in life, and self-efficacy indicated a higher probability of having a Minimal impact profile. Additionally, males, individuals with better functional independence, and those with an absence of pain were more likely to show a Minimal impact profile. CONCLUSIONS: Among the participants, 70% showed Minimal or Low impact profiles. Our findings support that individuals can show positive responses across several outcome measures even at an early time after the injury onset (eg, at discharge from inpatient rehabilitation). Moreover, our results indicate that beyond functional independence, improvement, and pain management, a rehabilitation process that strengthens psychological resources might contribute to better adaptation outcomes.

Bienestar subjetivo, imagen corporal y funcionalidad de candidatos a cirugía bariátrica o sometidos a la misma / Subjective well-being, body image, and functional capacity in people candidate for or undergoing bariatric surgery

Los estudios aquí presentados buscaron evaluar y comparar el bienestar subjetivo (BES), la funcionalidad y la imagen corporal de personas con obesidad mórbida, candidatas a cirugía bariátrica (CB) y sometidas a la misma, e identificar la relación de los componentes del BES con el IMC, la funcionalidad y la imagen corporal, controlando las características de personalidad extroversión y neuroticismo. Participaron 48 personas en periodo prequirúrgico y 29 en posquirúrgico. Se usó la Escala de Satisfacción con la Vida (ESV), la escala PANAS, el WHODAS 2.0, la Escala de Figuras y Siluetas y la Batería Factorial de Personalidad. Se identificaron diferencias significativas en todas las variables, a excepción del afecto positivo, la comprensión y la comunicación y la relación con las personas. La funcionalidad se correlacionó con todos los componentes del BES y contribuyó a explicar la varianza de la ESV y el afecto negativo. Los factores de personalidad fueron más importantes para explicar el afecto positivo

This paper presents two studies that aimed (1) at assessing and comparing the subjective well-being (SWB), and functional capacity and body image of people with morbid obesity, candidate for or undergoing bariatric surgery (BS), and (2) at identifying the relationship among the components of SWB, BMI, functional capacity, and body image. The sample was composed by 48 patients in pre-surgery period, and 29 in post-surgery. Instruments used were the Life Satisfaction Scale, the Positive and Negative Affect Scale, WHODAS 2.0, the Brazilian scale of figures and silhouettes, and the bateria fatorial da personalidade. Statistically significant differences were found between both groups in all the variables, except positive affect, comprehension and communication, and relationships with others. FC was correlated to all the components of SWB and contributed to explaining the variance of life satisfaction and negative affect. Personality traits turned out to be more important than other variables for explaining the variance of positive affect

Sobrecarga en cuidadores informales de pacientes con Alzheimer y la relación con su ingreso salarial / Burden in caregivers of Alzheimer's disease patients, and its relation with their incomes

Resumen La sobrecarga es el resultado psicológico de combinaciones emocionales, físicas y sociales que surge al cuidar una persona enferma, especialmente si es de Alzheimer. El ingreso salarial puede repercutir en la sobrecarga, ya que hacerse responsable de un paciente genera gastos que la familia debe soportar. Este estudio correlaciona sobrecarga e ingreso salarial en una muestra por conveniencia de 100 cuidadores informales de la ciudad de Bucaramanga, aplicando la escala de sobrecarga Zarit (Martín, Salvadó, Nadal, Miji, Rico, Sanz & Taussing, 1996) y la ficha de datos sociodemográficos (Cerquera, Granados & Buitrago, 2012). Los resultados muestran que si bien la mayoría de cuidadores devengan más del salario mínimo colombiano vigente, así mismo presentan sobrecarga, y ya que no se ha establecido correlación, esto indica que el ingreso económico no es un determinante para la situación anotada.

Abstract Burden is the psychological result of emotional, physical and social combinations that come from looking after a sick person, especially if it's Alzheimer's. Wage income can affect overload, taking care of a patient generates expenses that the family must endure. This study correlates overhead and salary income in a convenience sample of 100 caregivers from Bucaramanga, using the Zarit Burden Interview (Martin et al., 1996) and Sociodemographic Data Sheet (Cerquera et al., 2012). The results show that most caregivers earn more than the Colombian minimum wage and are overloaded, not establishing correlations, indicating that wage income is not determining for overload.

Efectos de cuidar personas con Alzheimer: un estudio sobre cuidadores formales e informales / Effects of Caring for People with Alzheimer's Disease: A Study on Formal and Informal Caregivers / Efeitos de cuidar das pessoas com Alzheimer: um estudo sobre cuidadores formais e informais

Objetivo. Se buscó identificar los efectos psicológicos del cuidado referidos a depresión y sobrecarga subjetiva en una muestra de 62 cuidadores formales y 53 informales de pacientes con Alzheimer en Bucaramanga y su área metropolitana, así como conocer sus estrategias de afrontamiento y comparar el nivel de afectación de ambos grupos. Método. Se realizó un estudio no experimental, transversal, descriptivo y comparativo, utilizando el Inventario de Depresión Estado - rasgo IDER, la Escala de Sobrecarga de Zarit y la Escala de Estrategias de Coping Modificada. Se analizaron las frecuencias de aparición de cada variable y se compararon las puntuaciones de los grupos. Resultados. Se encontró presencia de eutimia estado en 36% de los cuidadores informales y 21% de los formales. Además, 58.5% de los cuidadores informales y 33.9% de los formales presentaron sobrecarga subjetiva intensa. La estrategia de afrontamiento más utilizada en ambos grupos fue la religión. Se encontraron diferencias significativas entre el nivel de sobrecarga de los cuidadores formales y los informales, pero no entre sus niveles de depresión. Conclusión. De acuerdo con los resultados, es necesario explorar la relación entre el nivel de afectación y factores personales y sociodemográficos. Igualmente, se requiere profundizar en la relación entre las estrategias de afrontamiento utilizadas por los participantes y su nivel de afectación.

Objective. To determine the psychological effects of caring, related to depression and subjective work overload in a sample of 62 formal and 53 family caregivers of Alzheimer's disease patients, in Bucaramanga and its metropolitan area; becoming familiar with their coping strategies and comparing their scores in depression and burden. Method. A non - experimental, cross - sectional, descriptive and comparative study was carried out , using the State - Trait Depression Inventory, the Zarit Burden Interview, and the Coping Strategies Scale CSS-R. The frequencies of the occurrence of each variable were analyzed, and the scores of the groups compared. Results. The presence of a state of Euthymia was found in 36% of the informal, and 21% of the formal caregivers. Also, 58.5% of the informal and 33.9% of the formal caregivers presented high levels of work overload, and the coping strategy most used by both groups was religion. Statistically significant differences were found between levels of work overload in both groups. Conclusion. It is necessary to explore the relationship between the negative effects of caring, and personal and socio - demographic factors. It is also necessary to analyze the relationship between the coping strategies used by participants, and their level of involvement.

Escopo. Procurou-se identificar os efeitos psicológicos do cuidado referido a depressÃo e sobrecarga subjetiva em uma amostra de 62 cuidadores formais e 53 informais de pacientes com Alzheimer em Bucaramanga e sua área metropolitana, assim como conhecer suas estratégias de afrontamento e comparar o nível de afetaçÃo de ambos grupos. Metodologia. Foi feito um estudo nÃo experimental, transversal, descritivo e comparativo, utilizando o inventario de depressÃo estado - rasgo IDER, a escada de sobrecarga de Zarit e a escada de estratégias de coping modificada. Foram analisadas as frequências de apariçÃo de cada variável e foram comparadas as pontuações dos grupos. Resultados. Foi achada a existência de eutímia estado em 36% dos cuidadores informais e 21% dos formais. Além, 58.5% dos cuidadores informais e 33.9% dos formais presentaram sobrecarga subjetiva intensa. A estratégia de afrontamento mais utilizada em ambos grupos foi a religiÃo. Foram achadas diferencias significativas ente o nível de sobrecarga dos cuidadores formais e informais mas nÃo entre seus níveis de depressÃo. ConclusÃo. De acordo com os resultados, é preciso explorar a relaçÃo entre o nível de afetaçÃo e fatores pessoais e sociodemográficos. Assim, é requerido aprofundar a relaçÃo entre as estratégias de afrontamento utilizadas pelos participantes, e seu nível de afetaçÃo.

Diferencias en el apoyo social percibido entre cuidadores informales y formales de pacientes con demencia tipo álzheimer / Differences in perceived social support between family and formal caregivers of Alzheimer's disease patients

Este estudio de tipo no experimental transversal comparativo tuvo como objetivo identificar las diferencias de apoyo social percibido entre cuidadores informales y formales de la ciudad de Bucaramanga (Colombia) y su área metropolitana. Se evaluaron 53 informales y 62 cuidadores formales de pacientes con demencia tipo Alzheimer por medio del cuestionario MOS de apoyo social percibido. Se logró determinar que existe una diferencia estadísticamente significativa entre interacción social (p=0,03); apoyo afectivo (p=0,032) y apoyo global (p=0,037) de los grupos de cuidadores formales e informarles; los cuidadores formales presentan mayor puntuación, lo que denota una mejor percepción del apoyo social que reciben.

This non-experimental, cross-sectional and comparative research, aims to identify the differences in perceived social support between family and formal caregivers of Bucaramanga (Colombia) and its metropolitan area. It was evaluated 53 family caregivers and 62 formal caregivers of Alzheimer's disease patients, using the MOS social support survey. It was found that there is a statistically significant difference between social interaction (p=0,03), affective support (p=0,032), and total support (p=0,037) in both groups, being formal caregivers which had higher scores, what means that they have a better perception of the social support they receive.

Aspectos bioétioos en la atención al enfermo de alzheimer y sus cuiaddores / Bioetical aspectts incare and attention for patients with alzheimer''s disease and their caregivers / Asectos bioéticoos no atendimento ao doente de alzheimer e seus cuidadoees

La Bioética se ha difundido y desarrollado en casi todo el mundo influyendo en la toma de conciencia respecto a la vida humana. El énfasis actual está en hacer prevalecer los derechos fundamentales de la persona, el respeto a la dignidad y la defensa de la libertad, hasta el final de sus vidas. Dada la importancia de este constructo, se hace énfasis en la aplicación de los principios bioéticos en una de las enfermedades más incapacitantes del ser humano, el Alzheimer. Igualmente, teniendo en cuenta el impacto social y familiar de tener una persona con Alzheimer, se reflexiona sobre el enfermo y su cuidador, y en aquellos aspectos éticos que deben guiar la atención que ambos reciben durante el proceso de enfermedad.

Bioethics has spread and developed throughout most of the world, influencing awareness with respect to human life. The current emphasis is on prevalence of the person's fundamental rights, respect for human dignity and defense of freedom up to the end life. Given the importance of this hypothesis, the focus is on applying bioethical principles to one of the most disabling of all human diseases: Alzheimer's. Considering the impact having a person with Alzheimer's has on society and the family, the article reflects on the patient and the caregiver, as well as the ethical aspects that should guide the care and attention both receive during the course of the illness.

A Bioética vem sendo difundida e desenvolvida em quase todo o mundo influenciando na conscientização a respeito da vida humana. A ênfase atual está em fazer prevalecer os direitos fundamentais da pessoa, o respeito à dignidade e a defesa da liberdade, até o final de suas vidas. Dada a importância desse construto, enfatiza-se na aplicação dos princípios bioéticos em uma das doenças mais incapacitantes do ser humano, o Alzheimer. Além disso, ao se considerar o impacto social e familiar de ter uma pessoa com Alzheimer, reflete-se sobre o doente e seu cuidador, e naqueles aspectos éticos que devem guiar o atendimento que ambos recebem durante o processo de doença.

Validación de constructo de la escala ESTE-R para medición de la soledad en la vejez en Bucaramanga, Colombia / Construct Validation of the ESTE-R Scale for Measuring Loneliness in Old Age in Bucaramanga, Colombia

Existen múltiples instrumentos que permiten medir propiedades que aunque no son observables, son de vital importancia para comprender la conducta humana y el trabajo con esta. La soledad es una condición que afecta a todos los grupos de edad; sin embargo, en la vejez hay condiciones que pueden favorecer su aparición, y sus consecuencias pueden ser más temidas y fuertes que en otras etapas de la vida, constituyéndose así en un fenómeno de interés para ser estudiado e intervenido. La escala ESTE-R es un instrumento útil en la medición de la soledad, pero este debe ser validado en el contexto en que sea aplicado, para obtener así resultados confiables. Por esta razón se realizó un estudio instrumental, con una muestra de 383 personas mayores residentes en Bucaramanga, Colombia. Se hizo la medición del alfa de Cronbach y el análisis factorial, obteniéndose los siguientes resultados: elevada fiabilidad (0,925) para todas las variables de la escala y una solución de 4 factores que explican el 58,6% de la varianza de los datos. Se concluye que la estructura original de cuatro factores es adecuada para el contexto bumangués y que la propuesta de treinta ítems aquí presentada permite medir el fenómeno de la soledad.

There are many instruments that measure properties that are not observable, but are very important for understanding human behavior and work with it. Loneliness is a condition that affects all age groups, however, in old age there are conditions that may favor its occurrence and its consequences may be more feared and stronger than in other stages of life, becoming in a phenomenon of interest to be studied and intervened. ESTE-R scale is a useful tool for measuring loneliness, but must be validated to the context it is applied to obtain reliable results. For this reason was realized an Instrumental study, with a sample of 383 elder people residents in Bucaramanga, Colombia. Measurement was performed by Cronbach's alpha and factor analysis, obtaining the following results: High reliability (0,925) for all scale variables and a solution of 4 factors that explain 58,6% of the data variance. Was concluded that the original structure of 4 factors is appropriate for Bucaramanga's context and the proposal of 30 items presented here lets measure loneliness phenomenon.

Amor, sexualidad e inicio de nuevas relaciones en la vejez: percepción de tres grupos etarios / Love, sexuality and beginning of new relationships in old age: perception of three age groups

La sexualidad suele ser un tema tabú, más si se habla de esta en la vejez, pues se considera que las personas mayores no son aptas para vivirla y mucho menos para disfrutarla tal como una persona joven. Por esto, a partir de dos reactivos extraídos del cuestionario Actitudes hacia la sexualidad en la vejez desarrollado por Orozco y Rodríguez en el año 2006 y adaptado al contexto de Floridablanca, se busca conocer por medio de diseño no experimental de corte transversal descriptivo las percepciones de107 adolescentes, 68 adultos y153 personas mayores, sobre el derecho de estos últimos al amor, la vida sexual y que una persona mayor que haya enviudado establezca nuevamente una relación afectiva. Ante estos mitos se obtuvieron respuestas positivas en las tres poblaciones, la mayoría de los participantes afirman estar de acuerdo con los reactivos. El grupo etario con la percepción más negativa aunque en un pequeño porcentaje para cada ítem estudiado (15,9% y 20,6% para el primero y segundo respectivamente), fue el de los adolescentes. En conclusión, el amor y la sexualidad continúan siendo aspectos de gran importancia en la vida del ser humano, aún en etapas avanzadas del ciclo vital. Sin embargo, cada grupo generacional tiene sus propias percepciones respecto a la misma, las cuales pueden limitar o favorecer su expresión y disfrute aún en la vejez.

Sexuality is usually a taboo, even more if we talk about this in the older adults, because is considerate that they are not suitables to live it and much less to enjoy it like a young person. For this reason two items were taken from the questionnaire "Actitudes hacia la sexualidad en la vejez" developed by Orozco y Rodríguez in 2006, which was adapted to Floridablanca context. With this we want to know thought a non-experimental, transversal descriptive design, the perceptions that 107 teenagers, 68 adults and 153 older people have about the right of elderly people to love and have a sexual life and the fact that widowed elderly people start again a relationship. The answers obtained in front of this myths, were positives in the three population age groups, most of them claimed to be agree with the items. The age group that had the most negative perception although in a small percentage (5,9% y 20,6% for the first and second item respectively) was teenagers. In conclusion, love and sexuality continue to be matters of great importance in human life, even in advanced stages of the vital life cycle. However, each age group has its own perceptions of it, which may limit or facilitate its expression and enjoyment even in old age.