Psychological Screening, Standards and Spinal Cord Injury: Introducing Change in NHS England Commissioned Services.

Psychologist resourcing across the United Kingdom (UK) spinal cord injury centres (SCICs) varies considerably, which has detrimentally impacted standardising service provision for people with spinal cord injuries/disorders (PwSCI/D) compared with other nations. This paper presents the outcome of a project involving the Spinal Cord Injury Psychology Advisory Group (SCIPAG) and NHS England Clinical Reference Group/SCI transformation groups to agree upon screening and standards and shares data from the National Spinal Injuries Centre (NSIC) and the Yorkshire and Midlands Regional SCICs. Inpatients completed the GAD-7, the PHQ-9, and the short form of the Appraisals of DisAbility: Primary and Secondary Scale (ADAPSSsf), assessing adjustment. A total of 646 participants were included, with 43% scoring above the clinical threshold on at least one of the measures on admission. A subset of 272 participants also completed discharge measures and 42% remained above the threshold on discharge, demonstrating sustained psychological need. This paper provides support for services to move to a screen-and-assessment model supplemented by referral options for those with changing needs or who present with difficulties outside the remit of screening. The findings also support the efficacy of universal screening across the system and consideration of screening and standards for psychological care by the wider psychology community.

Individual's experiences of adjusting to changes in body image after spinal cord injury: a literature review and thematic synthesis.

PURPOSE: To understand how individuals experience and adjust to changes in body image after spinal cord injury (SCI). METHODS: A systematic search using four databases identified eleven articles that met the inclusion criteria. The studies were critically appraised to determine quality. Interpretative thematic synthesis was used to explore adults' experiences of adjusting to changes in body image after SCI. RESULTS: Three themes described the influence of sociocultural factors on body image: 'Sociocultural influences', 'Responses of others' and 'Experience of rehabilitation'. Six themes described individuals' experiences of body image. 'Loss and threat of difference', 'Discomfort and disconnection' and 'Resistance' negatively influenced body image. 'Reconnecting with the body and re-negotiating identity', 'Support network' and 'Challenging beliefs about disability' promoted positive body image. Adjustment was a dynamic process, influenced by interactions between individual, relational and sociocultural factors. CONCLUSIONS: The physical impacts of SCI, individual's perceptions, relationships and sociocultural discourses influenced body image. Rehabilitation professionals could support adjustment to changes in body image by considering individual, relational and systemic influences. Furthermore, it is important to include an individual's support network within their care as social factors influenced body image experiences. Peer support could promote hope and challenge negative sociocultural beliefs about disability.IMPLICATIONS FOR REHABILITATIONFollowing spinal cord injury (SCI) individuals described a dynamic process of adjustment to changes in their body image, which can include positive and negative body image experiences.Rehabilitation environments and interactions with clinicians can influence individuals' body image experiences.Multidisciplinary interventions which consider sociocultural, relational and individual influences on body image may promote positive body image experiences and the renegotiation of identity after SCI.

An exploration of cognitive appraisals following spinal cord injury.

This study explored the cognitive appraisals that people make following spinal cord injury (SCI) about their situation and their ability to cope with it. Appraisals are thought to be important in determining individual responses to different events and have been shown to predict psychological well-being following injury. A cross-sectional interview study was used. Ten individuals who had recently started rehabilitation at the National Spinal Injuries Centre following an SCI were interviewed. Eight men and two women with a variety of injury level and completeness participated. Interviews were semi-structured and aimed to elicit participants' appraisals of their experiences and their ability to cope. Interviews were analysed qualitatively using interpretative phenomenological analysis. Four super-ordinate themes emerged from the interviews. These were making sense of a traumatic experience, impact of the SCI, coping and altered view of self and life. The interviews revealed that appraisals following SCI are complex and relate not only to the individual but also to their context, life stage, roles and relationships. The study adds to the theoretical understanding of the appraisal process following SCI. Ideas for further research are generated and clinical implications for improving patient experiences and developing appraisal-focused interventions are considered.