Internal consistency and convergent validity of the International Spinal Cord Injury Quality of Life Basic Data Set at discharge from first rehabilitation.

STUDY DESIGN: This study is a cross-sectional analysis using data from the Swiss Spinal Cord Injury Cohort Study. OBJECTIVES: To examine internal consistency and convergent validity of the International Spinal Cord Injury Quality of Life Basic Data Set (QoL-BDS) at discharge from first inpatient rehabilitation. SETTING: The study was performed at four rehabilitation centers in Switzerland. METHODS: Participants were Swiss residents aged over 16 years newly diagnosed with traumatic or non-traumatic spinal cord injury (SCI). Measures included the QoL-BDS, World Health Organization Quality of Life (WHOQOL) items, Hospital Anxiety and Depression Scale (HADS), and Spinal Cord Independence Measure III (SCIM). RESULTS: A total of 495 participants were included. In all, 57% had a traumatic SCI, 71.1% a motor complete SCI, and 33.3% had tetraplegia. Mean age was 53 (SD = 16.4) years and 68% were male. No floor or ceiling effects were found. Inter-correlations were strong (0.73-0.80) and Cronbach's alpha was good (0.88). QoL-BDS mean scores were 6.4 (SD = 2.2) for life satisfaction, 5.8 (SD = 2.4) for physical health, 6.9 (SD = 2.4) for psychological health, and 6.4 (SD = 2.1) for total QoL. Correlations with reference measures were strongest for QoL-BDS total and WHOQOL general quality of life (r = 0.67), QoL-BDS physical health and WHOQOL health and daily activities (r = 0.64 and 0.53), and QoL-BDS psychological health and HADS depression and anxiety (r = -0.64 and -0.69). SCIM correlated weakly with all QoL-BDS items. CONCLUSIONS: The QoL-BDS revealed no floor or ceiling effects and demonstrated good internal consistency and convergent validity in individuals with SCI assessed at discharge from first rehabilitation. This study supports the clinical routine use of the QoL-BDS.

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.

Body experience during post-acute rehabilitation in individuals after a traumatic spinal cord injury: a qualitative interview-based pilot study.

STUDY DESIGN: Qualitative interview-based pilot study. OBJECTIVES: A traumatic spinal cord injury (TSCI) profoundly disrupts the way individuals experience their body. Awareness of one's body is an important element in the psychological adjustment process after TSCI. This pilot study aimed to explore the body experience of individuals during post-acute rehabilitation following TSCI. SETTING: Specialized acute care and rehabilitation center in Switzerland. METHODS: Eight semi-structured face-to-face interviews were conducted with patients in the post-acute phase of their TSCI. Body experience was explored in relation to perceptive, cognitive, emotional, and behavioral aspects. The interviews were transcribed verbatim, and a structured content analysis was performed according to the Mayring method. RESULTS: The individuals verbalized body experience in all explored aspects. The two participants with tetraplegia described high body-related awareness, including dependence on other persons or aids, whereas individuals with paraplegia focused on their ability to regain activity and perceived autonomy, which was sustained by increasing injury- and self-related comprehension. They expressed uncertainty in their understanding of their paralyzed body while also verbalizing to see a continuity in their identity pre and post TSCI. Their emotions varied from anxiety and anger to hope and optimism. The interviewees confirmed that the growing ability to describe perceptions related to their body increased their active participation in the rehabilitation process and stimulated hope for the future. CONCLUSIONS: Exploration of individual body experience after a recent TSCI can strengthen patients' body awareness, communication and engagement in rehabilitation and help the interprofessional rehabilitation team individualize the rehabilitation process.

Trajectories of resilience, depression, and anxiety following spinal cord injury.

PURPOSE/OBJECTIVE: To investigate longitudinal trajectories of depression and anxiety symptoms following spinal cord injury (SCI) as well as the predictors of those trajectories. RESEARCH METHOD/DESIGN: A longitudinal study of 233 participants assessed at 4 time points: within 6 weeks, 3 months, 1 year, and 2 years from the point of injury. Data were analyzed using latent growth mixture modeling to determine the best-fitting model of depression and anxiety trajectories. Covariates assessed during hospitalization were explored as predictors of the trajectories. RESULTS: Analyses for depression and anxiety symptoms revealed 3 similar latent classes: a resilient pattern of stable low symptoms, a pattern of high symptoms followed by improvement (recovery), and delayed symptom elevations. A chronic high depression pattern also emerged but not a chronic high anxiety pattern. Analyses of predictors indicated that compared with other groups, resilient patients had fewer SCI-related quality of life problems, more challenge appraisals and fewer threat appraisals, greater acceptance and fighting spirit, and less coping through social reliance and behavioral disengagement. CONCLUSION/IMPLICATIONS: Overall, the majority of SCI patients demonstrated considerable psychological resilience. Models for depression and anxiety evidenced a pattern of elevated symptoms followed by improvement and a pattern of delayed symptoms. Chronic high depression was also observed but not chronic high anxiety. Analyses of predictors were consistent with the hypothesis that resilient individuals view major stressors as challenges to be accepted and met with active coping efforts. These results are comparable to other recent studies of major health stressors.

Psychological contributions to functional independence: a longitudinal investigation of spinal cord injury rehabilitation.

OBJECTIVES: To investigate the contribution of prerehabilitation appraisals of spinal cord injury (SCI) and patient's coping strategies to the variance in functional independence postdischarge. DESIGN: Longitudinal, cohort study. Patients aged 16 and older and sustaining an SCI were recruited from English- and German-speaking specialist spinal injuries centers. Measures of appraisals, coping strategies, mood, and functional independence were administered on commencing active rehabilitation (12-weeks postinjury) and following hospital discharge (1-y postinjury). SETTING: Specialist SCI rehabilitation centers in England, Germany, Switzerland, and Ireland. PARTICIPANTS: Patients (N=127) completed questionnaires at both time points. Sample age ranged between 17.5 and 64.5 years with a mean age of 39.3 years. Demographic and injury characteristics were similar to those reported in international statistics databases. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: FIM (motor subscale). RESULTS: Injury characteristics, age, sex, current depression, and the utilization of the coping strategy, social reliance, at 12-weeks postinjury explained 33.5% of the variance in motor FIM at 1-year postinjury. Strong relationships were found between appraisals, coping styles, mood, and functional outcomes. CONCLUSIONS: The coping strategy, social reliance, was found to contribute significantly when explaining the variance in functional outcomes. Suggestions were made to assess appraisals and coping strategies early in rehabilitation in order to provide effective interventions and additional support to those scoring highly on negative coping styles. Further research is recommended to provide support for the relationship between dependent coping strategies and functional outcomes.