Exploring perspectives on assistive technology use: barriers, facilitators, and access.

PURPOSE: This qualitative study explored perceived barriers and facilitators to access and utilization of assistive technology (AT) among Veterans and civilians living with tetraplegia. We also explored differences in access to and utilization of AT between civilians and Veterans. MATERIALS AND METHODS: Semi-structured focus groups were conducted with 32 adults (15 Veterans, 17 non-Veterans) living with tetraplegia between the ages of 18 and 65 and who were at least one-year post-injury. Focus groups were conducted at two rehabilitation sites: Craig Hospital and the Louis Stokes Cleveland VA Medical Center. Participants were asked to discuss what they perceive as (1) the facilitators and barriers of AT access and utilization, and (2) the value of AT use in everyday living. Data were analyzed using thematic analysis of verbatim transcripts. RESULTS AND CONCLUSIONS: Facilitators of AT utilization and access included being connected to resources, trial-and-error, and knowledge gained from peers. Barriers to AT use included cost of devices, a general lack of awareness of resources, and requirements for eligibility; the latter two themes were endorsed solely by Veteran participants. Benefits of AT included increased independence, participation, productivity, quality of life, and safety. Findings highlight key facilitators of AT procurement and use, barriers that contribute to underutilization of AT, and important benefits experienced as a result of using AT that underscore the importance of AT for individuals with SCI.

The need to maintain connections with rehabilitation resources (e.g., the Department of Vocational Rehabilitation, occupational and physical therapists, the VA, inpatient facilities) is vital to learning about and procuring AT.There is a need for a tailored approach to address AT underutilization in civilian and Veteran populations.Despite the barriers to AT use and the challenges associated with discovery of AT, utilization of AT may lead to increased independence, participation, productivity, quality of life, and safety.

Going Remote: A Revised Study Protocol for a Pilot Randomized Controlled Trial for Biofeedback Treatment of Anxiety Associated With Chronic Spinal Cord Injury.

Background: The incidence of anxiety in adults with spinal cord injury/disorder (SCI/D) exceeds that of the general population. Heart rate variability (HRV) biofeedback training is a potential treatment associated with a reduction in stress and anxiety, however HRV training has not been explored in the SCI/D population. Objectives: To describe a modified protocol piloting HRV training to reduce anxiety associated with SCI/D and detail the COVID-19-related modifications. Methods: To test the feasibility of the biofeedback treatment, 30 adults with SCI/D will complete this pilot randomized controlled trial. Enrollment started in January 2020, halted in March 2020 due to the COVID-19 pandemic, and resumed in March 2021 with a modified protocol. Protocol modifications are documented using the Framework for Reporting Adaptations and Modifications (FRAME). Participants are allocated to the treatment or control arm and undergo eight sessions of physiological monitoring at home using a commercially available HRV sensor and mobile application, which also delivers biofeedback training for those in the treatment arm. Surveys are administered following each session to capture self-reported stress, anxiety, and mood. The study is approved by the HCA-HealthONE institutional review board and is registered with clinicaltrials.gov (NCT# 03975075). Conclusion: COVID-19 has changed the research landscape, forcing scientists to rethink their study designs to address patient and staff safety in this new context. Our modified protocol accomplished this by moving the treatment setting and delivery out of the clinic and into the home. In doing so, we address patient and staff safety, increase external validity, and reduce participant burden.

The pet project: A qualitative exploration into the experience of pet ownership following spinal cord injury.

STUDY DESIGN: Qualitative study OBJECTIVES: To explore the unique experience of facilitators, barriers, rewards, and challenges related to pet ownership after spinal cord injury (SCI). SETTING: Zoom for Healthcare videoconferencing platform hosted from an American neuro-rehabilitation hospital in Colorado. METHODS: Sixteen individuals with SCI participated in three semi-structured focus groups of 5-6 participants each. Resulting discussions were transcribed and coded using a hybrid approach to thematic analysis. RESULTS: Experiences of pet ownership were categorized by their representativeness of four key themes: facilitators (conditions that make obtaining or maintaining pets easier), barriers (conditions that were prohibitive or that prevented people from having pets), rewards (benefits of pet ownership), and challenges (difficulties associated with pet ownership). Participants cited equipment, tools, and services as the most common facilitator for owning pets after SCI, with environment being the most commonly cited barrier. Companionship, love, and comfort/security were most commonly cited as rewards, while mobility was cited as a primary challenge of pet ownership after SCI. Additionally, two unexpected response themes emerged. Positive outweighs negative included assertions that benefits of having pets were not overshadowed by drawbacks, and Wishlist included desires for training and access to tools to facilitate pet ownership. CONCLUSIONS: Pet ownership is largely unexplored in individuals with SCI. Participants in this study indicated that pet ownership provides many benefits, though it is not without its challenges. Participants also noted the desire for training and resources to make pet ownership more accessible. Further exploration into informing development of those tools is warranted.

Prevalence and Impact of Neuropathic and Nonneuropathic Pain in Chronic Spinal Cord Injury.

OBJECTIVE: To compare prevalence, intensity ratings, and interference ratings of neuropathic pain (NeuP) and nociceptive pain in people with chronic spinal cord injury (SCI) DESIGN: Cross-sectional survey. SETTING: Six SCI Model System centers in the United States. PARTICIPANTS: Convenience sample of 391 individuals (N=391) with traumatic SCI, 18 years or older, 81% male, 57% White. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Survey based on the International Spinal Cord Injury Pain Basic Data Set and the Spinal Cord Injury Pain Instrument, including 0-10 numeric ratings of pain intensity and pain interference with daily activities, mood, and sleep RESULTS: A total of 80% of those surveyed reported having at least 1 pain problem; 58% reported 2 or more pain problems; 56% had probable NeuP; and 49% had non-NeuP. When comparing ratings for all pains (n=354 for NeuP, n=290 for non-NeuP) across participants, probable NeuPs were significantly more intense (6.9 vs 5.7) and interfered more with activities (5.2 vs 3.7), mood (4.9 vs 3.2), and sleep (5.4 vs 3.6) than non-NeuPs (all P<.001). However, when comparing ratings for probable NeuPs and non-NeuPs within participants, for the subgroup of 94 participants with both pain types, only ratings for sleep interference were found to be significantly different between the pain types. Additionally, we found significantly greater prevalence of NeuP and non-NeuP for women compared with men and of NeuP for those with paraplegia compared with those with tetraplegia. CONCLUSIONS: Independent assessment of the pain conditions experienced by an individual with SCI is useful in understanding the differential effect that pain type has on quality of life. This is particularly important regarding sleep interference and should be kept in mind when determining treatment strategies for meeting patient-centered outcome goals.

Validation of the Injustice Experience Questionnaire (IEQ) in a spinal cord injury population.

STUDY DESIGN: Retrospective analysis of cross-sectional data. OBJECTIVES: To verify the factor structure of the Injustice Experience Questionnaire (IEQ) using a sample of individuals with spinal cord injury (SCI) and to assess IEQ scale reliability and construct validity using the same population. SETTING: Two SCI rehabilitation sites in the United States. METHODS: Three datasets were combined to conduct this validation study. The sample consisted of 341 adults with SCI who completed the IEQ, measures of psychological distress and pain, and provided sociodemographic and injury-related information. A series of confirmatory factor analyses (CFA) and exploratory factor analyses (EFA) were conducted to verify the two-factor structure of the IEQ, Cronbach's alpha was used to demonstrate scale reliability, and correlations between the IEQ and measures of pain and psychological distress were examined to assess construct validity. RESULTS: Poor model fit was observed for the two-factor structure of the IEQ as well as for the subsequent factor-structures that were explored. The IEQ demonstrated strong scale reliability (α = 0.89) and correlations between the IEQ and measures of pain and psychological distress were in the expected direction, indicating good construct validity. CONCLUSIONS: In this preliminary validation study, we failed to confirm the two-factor structure of the IEQ in a population of individuals with SCI. Though good scale reliability and construct validity were observed, further study is needed to refine the IEQ for use in this population.

The impact of stigma on psychosocial outcomes following spinal cord injury: A cross-sectional analysis of stigma-mediated relationships.

Purpose/Objective: The purpose of this study was to (a) assess the relationship between stigma and psychosocial outcomes and (b) examine the potential mediating influence of stigma on the relationship between sociodemographic and injury-related characteristics and psychosocial outcomes after spinal cord injury (SCI). Research Method/Design: This cross-sectional, observational study included participants enrolled in the Rocky Mountain Regional Spinal Cord Injury Model System. Questionnaires were administered via telephone. Stigma was assessed using the Spinal Cord Injury Quality of Life Stigma Short Form. Results: Questionnaires were completed by 225 participants (78% male; 22% female). Stigma was significantly, positively associated with depression symptoms, perceived disability, injustice appraisals, and participation (physical independence and mobility). Stigma was significantly, negatively associated with quality of life and self-efficacy. Stigma partially mediated several relationships between sociodemographic or injury-related characteristics and psychosocial outcomes. Stigma fully mediated the relationships between each time since injury and self-efficacy, length of rehabilitation stay and injustice appraisals, wheelchair use and self-efficacy, and wheelchair type and quality of life. Conclusions/Implication: Stigma is an important psychological factor associated with several person- and injury-related characteristics and psychosocial outcomes. Furthermore, stigma mediates particular relationships between sociodemographic or injury-related characteristics and outcomes. These findings will inform the development of interventions designed to mitigate stigma's negative impact on outcomes such as mood, quality of life, and participation after SCI. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

A qualitative exploration of perceived injustice among individuals living with spinal cord injury.

PURPOSE/OBJECTIVE: The purpose of the present qualitative study was to explore how people living with spinal cord injury (SCI) conceptualize 2 factors believed to contribute to perceptions of injustice (i.e., severity/irreparability of loss and blame/sense of unfairness) and identify specific sources that contribute to these perceptions. Research Method/Design: To assess perceived injustice, the 12-item Injustice Experience Questionnaire (IEQ) was administered via telephone to individuals enrolled in the National Spinal Cord Injury Statistical Center database who were 1 or 5 years postinjury. Participants then took part in individual, semistructured interviews exploring their experiences of perceived injustice following SCI. Four items from the IEQ formed the basis of the interviews. Two items representing each aforementioned factor of the IEQ were chosen. Qualitative data from 15 participants were subjected to content analysis to identify common themes. RESULTS: In response to items related to blame/unfairness, participants spoke about who and/or what was responsible for their injury, and these sources fell into 2 categories: fate or circumstance and internalized blame. In response to items related to severity/irreparability of loss, the predominant themes that emerged were life with disability, lack of understanding by others, and focus on the positive. CONCLUSIONS/IMPLICATIONS: The present study contributes a level of richness and depth to current conceptualizations of perceived injustice. Findings suggest that for individuals living with SCI, perceived injustice may be less related to fault and blame but instead more closely related to a lack of understanding of the injury. Further quantitative research is needed to elucidate these relationships. (PsycINFO Database Record (c) 2020 APA, all rights reserved).