Appraisals of DisAbility Primary and Secondary Scale-Short Form (ADAPSS-sf): Psychometrics and association with mental health among U.S. military veterans with spinal cord injury.

OBJECTIVE: Cognitive appraisals, that is, interpretations of what is observed and the personal relevance attributed to those observations, affect one's behavior and well-being. Despite the centrality of appraisals in the transactional model of stress and coping, the application of spinal cord injury (SCI)-specific appraisals to adjustment is a recent development. This study examined the psychometric properties of a measure of SCI-specific appraisals, the Appraisals of DisAbility Primary and Secondary Scale-Short Form (ADAPSS-sf). METHOD: A retrospective study using clinical data from SCI annual evaluations at a U.S. Department of Veterans Affairs medical center was employed (N = 262). RESULTS: Findings supported the ADAPSS-sf's 2-factor structure of catastrophic negativity and determined resilience. SCI appraisals were associated with mental health concerns, mental disorders, life satisfaction, racial minority status, age, SCI severity (based on the American Spinal Injury Association Impairment Scale [AIS]), and SCI etiology (traumatic or nontraumatic). Counterintuitively, those with less severe injuries (i.e., AIS D) had the greatest catastrophic negativity. Although veterans with SCI were heterogeneous in their appraisals, it is encouraging that they tended to endorse determined resilience and disavow catastrophic negativity. CONCLUSIONS: The ADAPSS-sf demonstrated many desirable characteristics, including brevity, convergent validity, and face-valid content. An implication of this study is that to understand the adjustment experience, one must look beyond injury severity and impairment to the individual's personal and subjective experience of SCI. The ADAPSS-sf offers clinicians and researchers a potentially valuable tool to assess SCI appraisals and personalize treatment. (PsycINFO Database Record

Mental disorder prevalence among U.S. Department of Veterans Affairs outpatients with spinal cord injuries.

OBJECTIVES: Depression and other mental disorders are more prevalent among individuals living with spinal cord injury (SCI) than in the community at large, and have a strong association with quality of life. Yet little is known about the prevalence and predictors of mental disorders among U.S. military Veterans living with SCI. The primary aim of this study was to present an estimate of mental disorder point prevalence in this population. The secondary aim was to examine the relationship of mental disorders to demographics, injury characteristics, and other clinically relevant features such as impairment from mental health problems and life satisfaction. DESIGN: Cross-sectional. SETTING: A SCI & Disorders Center at a U.S. Veterans Affairs Medical Center. PARTICIPANTS/METHODS: Administrative and medical records of 280 Veterans who attended annual comprehensive SCI evaluations were evaluated. Demographics, injury characteristics, self-reported mental and emotional functioning (i.e. SF-8 Health Survey), and clinician-determined mental disorder diagnoses were attained. RESULTS: Overall, 40% of patients received at least one mental disorder diagnosis, most commonly depressive disorders (19%), posttraumatic stress disorder (12%), and substance or alcohol use disorders (11%). Several patient characteristics predicted mental disorders, including age, racial minority identity, non-traumatic SCI etiology, and incomplete (i.e. AIS D) vs. complete injury. Mental disorders were associated with greater impairment from health and mental health-related problems and less satisfaction with life. CONCLUSIONS: Mental disorders are common among outpatients receiving VA specialty care for SCI. These findings highlight the importance of having adequate and effective available mental health services available for Veterans with SCI.

Efficacy of a multidisciplinary treatment program on one-year outcomes of individuals with Parkinson's disease.

The efficacy of the multidisciplinary treatment approach to the management of Parkinson's disease (PD) was examined at a regional Veteran's Administration Parkinson's Disease Research, Education and Clinical Center (PADRECC). The records of 43 consecutive individuals with PD were examined. The Unified Parkinson's Disease Rating Scale (UPDRS) was employed to assess disease progression. Changes between initial and one-year follow-up UPDRS motor functioning (Part III) scores were compared to expected disease progression from prior research. In this cohort, thirty patients (69.8%) had improved, 2 were unchanged (4.7%) and 11 patients (25.6%) had worsened at the mean 12.2-month follow-up period. The range of multidisciplinary interventions included neurology (100%), physiatrist (93%), and psychology (41.9%) visits, medication changes (60.5%), rehabilitation therapy (62.8%), functional diagnostic testing (16.3%), support group (9.3%), home exercise programs (86%), and disease and wellness education (83.7%). Statistical analyses of the individual components of the program did not demonstrate significant differences between improvers and non-improvers. Clinical implications and study limitations are discussed.

Efficacy of multidisciplinary treatment program on long-term outcomes of individuals with Parkinson's disease.

We examined the impact of multidisciplinary clinical management of the Parkinson's Disease Research, Education, and Clinical Center program on Parkinson's disease progression. Initial and follow-up scores on the Part III Motor Examination subscale of the Unified Parkinson's Disease Rating Scale (UPDRS) were examined. Overall, 37 (75.5%) of the 49 patients demonstrated stable or improved UPDRS motor scores at 1- to 3-year follow-up; in the 1-year group (n = 28), 22 patients (78.6%) improved, while 6 (21.4%) worsened. In the 2-year group (n = 15), 10 (66.7%) improved, while 5 (33.3%) worsened. In the 3-year group (n = 6), 5 (83.3%) improved, while 1 (16.7%) worsened. Multidisciplinary interventions included neurology (95.9% of patients), physiatry (93.9%), nursing (87.8%), psychology (42.9%), medication changes (59.2% increases, 18.4% decreases), rehabilitation therapies (physical, occupational, speech-language, 67.3%), functional diagnostic testing (18.4%), support group (16.3%), home exercise instruction (85.7%), and disease and wellness education (81.6%). Improved and worsened patients did not significantly differ on the individual program components. Clinical implications and study limitations are discussed.