The relationship between fatigue and participation in spinal cord injury.

STUDY DESIGN: Cross-sectional national survey. OBJECTIVES: To explore the association between fatigue and community participation frequency and provide an adjusted model of the relationship including important covariates. SETTING: Canada; Community. METHODS: Data were obtained from the Rick Hansen Spinal Cord Injury Registry Community Survey. We used multi-variable regression analyses with hierarchical backward elimination, including variable specification, interaction assessment and confounding assessment. Variables with statistically significant correlation with the primary-dependent variable (participation) were included for modeling. RESULTS: The crude model of association between fatigue and participation accounted for 7.2% of the variance in participation scores. The full model with all a priori selected variables accounted for 25.1% of variance in participation scores. The adjusted model, including the identified confounders (pain, depressive mood, comorbidities and level of injury), accounted for 21.1% of variance in participation scores. Depressive mood variables had the highest standardized beta coefficients, reflecting the largest contribution to this model. CONCLUSION: Fatigue has a statistically significant negative association with participation for individuals with spinal cord injury, when controlling for pain, depressive mood, comorbidities and level of injury. Multifaceted clinical interventions and research addressing fatigue, pain and depressive symptoms are warranted.

Fatigue and spinal cord injury: a qualitative analysis.

OBJECTIVES: To explore experiences of fatigue among people with spinal cord injuries (SCIs) and factors perceived to contribute to fatigue. SETTING: Kelowna, Prince George, Vancouver and Victoria, British Columbia, Canada. STUDY DESIGN: Collaborative, qualitative methodology. METHODS: Four focus groups were undertaken simultaneously with a total of 29 participants, comprising a purposive sample of men and women: 21 people with complete and incomplete SCI of high and low tetraplegia and paraplegia, 2 family members, 2 assistants and 4 occupational therapists. Interpretive analysis was grounded in the themes identified in the data. RESULTS: Fatigue was perceived to have cognitive, emotional and physical dimensions and to exert a profound effect on the lives of many people with SCI, such that pleasurable activities were often eschewed to enable the accomplishment of more mundane tasks. Factors most consistently associated with fatigue were pain, depression and hopelessness, side effects of medications, poor quality sleep, spasticity, poor posture, diet, and the effort required to accomplish routine and self-care tasks. CONCLUSIONS: Fatigue is a complex phenomenon, interlinked with pain, depression and hopelessness that significantly diminishes the quality of life following SCI. Further research is required to provide greater understanding of this issue and to determine appropriate and comprehensive forms of intervention.

Cultural competence in New Zealand and Canada: occupational therapy students' reflections on class and fieldwork curriculum.

The first year of a twin study undertaken between two occupational therapy programs in Canada and New Zealand is described. The primary aims of the study were to illuminate the lived experiences of students as they learn about cultural difference and had contact with clients of differing cultural backgrounds to themselves during fieldwork placements. While there are similarities between educational programs and the demographic profiles of the two cohorts of students, there are curricular differences primarily based on the described socio-political content of the two countries; Aotearoa/New Zealand as a bicultural society and Canada as multicultural. The paper discusses how these cultural differences interweave with other aspects of the students' educational program, as perceived and experienced by the students. Narrative data was thematically analyzed to reflect the experiences and the attendant thoughts and feelings of the participants.