Denise G. Tate

Perceived barriers to exercise in people with spinal cord injury.

Scelza WM, Kalpakjian CZ, Zemper ED, Tate DG: Perceived barriers to exercise in people with spinal cord injury. Am J Phys Med Rehabil 2005;84:576–583. Objective:To identify barriers to physical fitness faced by individuals with spinal cord injury preventing them from participating in a physical fitness program. Design:In this cross-sectional study, a survey of barriers to exercise was administered to 72 individuals with spinal cord injury. Results:Although 73.6% of the participants expressed an interest in an exercise program, less than half (45.8%) were currently active in an exercise program. Less than half (47.2%) reported that their physician had recommended an exercise program for them. The most frequently cited concerns about barriers to exercise fell into three areas: (1) intrapersonal or intrinsic (e.g., lack of motivation, lack of energy, lack of interest), (2) resources (e.g., cost of an exercise program, not knowing where to exercise), and (3) structural or architectural (e.g., accessibility of facilities and knowledgeable instructors). More individuals with tetraplegia reported concerns over exercise being too difficult and that health concerns kept them from exercising. Greater number of concerns was significantly related to higher levels of perceived stress. Conclusions:People with spinal cord injury face multiple barriers to physical fitness in functional, psychological, and architectural domains. Identification of these barriers can facilitate the participation of individuals with spinal cord injury in an exercise program, improving long-term health and wellness.

Types of spiritual well-being among persons with chronic illness: Their relation to various forms of quality of life

OBJECTIVES Derive a spiritual well-being classification and thereby enhance understanding of the relation between spiritual well-being, quality of life (QOL), and health among persons with chronic illness or disability. DESIGN Cluster analyses were performed to develop a spiritual well-being classification. Analysis of variance was used to compare cluster groups on various dimensions of QOL. SETTING Part of a larger QOL study conducted at a midwestern medical center. PATIENTS A convenience sample of 216 inpatients: amputation (n = 74), postpolio (n = 37), spinal cord injury (n = 34), breast cancer (n = 36), and prostate cancer (n = 35). Minors were excluded from the study. MAIN OUTCOME MEASURES Spiritual Well-Being Scale (SWBS), Functional Assessment of Cancer Therapy (FACT), Functional Living Index-Cancer (FLIC), Sickness Impact Profile (SIP), Medical Outcome Survey-Short Form (SF-36), and the Satisfaction With Life Scale (SWLS). RESULTS Three types of spiritual well-being were identified: religious (n = 146), existential (n = 37), and nonspiritual (n = 30). Significant cluster differences (p < .03 to p < .001) were observed across all QOL domains and life satisfaction. Compared with the other cluster groups, the nonspiritual group reported significantly lower levels of QOL and life satisfaction and the highest proportion of health status change with respect to both improvement and decline in health. CONCLUSIONS Three types of spiritual well-being were empirically identified in this sample. Subtypes differed significantly with respect to various aspects of QOL. Further research is needed to validate this classification and to determine if type of spiritual well-being has a causal effect on treatment outcome or on the recovery process.

Predicting community reintegration after spinal cord injury from demographic and injury characteristics

OBJECTIVE To determine the influence of demographic and injury characteristics on the community reintegration of people with spinal cord injury (SCI). DESIGN Prospective cross-sectional and longitudinal examination of individuals with SCI. SETTING Follow-up of individuals at 1, 2, 5, 10, 15, and 20 years after SCI who received their initial rehabilitation in a Regional Model Spinal Cord Injury System. PARTICIPANTS A total of 3,835 individuals who met the inclusion criteria for the National SCI Database were studied cross-sectionally, and a subset of 347 individuals who were also enrolled in a longitudinal study of aging with SCI. MAIN OUTCOME MEASURES Subscales of the Craig Handicap Assessment and Reporting Technique (CHART). RESULTS Neurologic classification, age, years postinjury, gender, ethnicity, and education explain 29% of the variance in physical independence, 29% of the variance in mobility, 28% of the variance in occupation. 9% of the variance in social integration, and 18% of the variance in economic self-sufficiency. CONCLUSIONS Although these factors are inadequate to explain most of the variation in community reintegration (handicap) after SCI, they might appropriately be used to adjust for case-mix differences when comparing rehabilitation facilities and techniques.

Quality of life, life satisfaction, and spirituality: comparing outcomes between rehabilitation and cancer patients.

Tate DG, Forchheimer M: Quality of life, life satisfaction, and spirituality: Comparing outcomes between rehabilitation and cancer patients. Am J Phys Med Rehabil 2002;81:400–410. Objective To determine differences in quality of life, life satisfaction, and spirituality across different patient groups and to determine what factors may relate to these three outcomes across rehabilitation and cancer patients. Design Subjects were first stratified by five diagnostic groupings. Patient data were then regrouped for additional analytic purposes into two large cohorts. All subjects completed questionnaires once. Differences in scores and correlations were computed, and regression models were specified. Results Group differences were found across the quality of life measures used in the study. There were also differences in life satisfaction and spiritual well-being. Spirituality was found to be associated with both quality of life and life satisfaction, although it was not a significant predictor in a multivariate context. Conclusions In general, subjects with prostate cancer reported higher scores across all measures. Spirituality showed a strong association with both life satisfaction and quality of life, and it was a significant predictor of life satisfaction among rehabilitation subjects. Factors such as age, marital status, and work status, in addition to specific dimensions of quality of life, such as social functioning and functional well-being, were found to be associated with total quality of life.

Use of the SF-36 among persons with spinal cord injury.

Forchheimer M, McAweeney M, Tate DG: Use of the SF-36 among persons with spinal cord injury. Am J Phys Med Rehabil 2004;83:390–395. The purpose of this study was to explore the applicability of the SF-36 for assessing health-related quality of life among persons with spinal cord injuries. A sample of 215 persons who had experienced new, traumatic spinal cord injury and who had been discharged from their initial hospitalizations for at least 1 yr were included in the study. Correlations between the SF-36s physical and mental component scores appraised and the relationship of each component to level of neurologic impairment was assessed. As expected, the two components measured separate and distinct constructs; only physical component scores were associated with impairment severity.

Depression After Spinal Cord Injury: Comorbidities, Mental Health Service Use, and Adequacy of Treatment

OBJECTIVE To provide data for depression rates and psychiatric comorbid conditions, mental health service use, and adequacy of depression treatment in depressed and nondepressed adults with spinal cord injury (SCI). DESIGN Cross-sectional survey as part of the Project to Improve Symptoms and Mood after SCI (PRISMS). SETTING Community setting. PARTICIPANTS Community-residing people with traumatic SCI (N=947). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patient Health Questionnaire-9 (PHQ-9) Depression Scale, psychiatric history questionnaire, Cornell Service Index (mental health service use), and current medication use. RESULTS The prevalence of probable major depression (PHQ-9 score ≥10) was 23%. There was a high lifetime prevalence of other psychiatric conditions, particularly anxiety disorders. In depressed participants, 29% currently were receiving any antidepressant and 11% were receiving guideline-level antidepressant dose and duration, whereas 11% had been receiving any psychotherapy in the past 3 months and 6% had been receiving guideline-level psychotherapy in the past 3 months. Serotonergic antidepressants and individual psychotherapy were the most common types of treatment received, and there was a wide range of provider types and treatment settings. Demographic and clinical variables were not associated with receipt of mental health service or guideline-level care. CONCLUSIONS Findings from this study document the low rate of mental health treatment for persons with SCI and probable major depression. These findings have implications for improving the effectiveness of depression treatment in people with SCI.

Assessment of a holistic wellness program for persons with spinal cord injury

Zemper ED, Tate DG, Roller S, Forchheimer M, Chiodo A, Nelson VS, Scelza W: Assessment of a holistic wellness program for persons with spinal cord injury. Am J Phys Med Rehabil 2003;82:957–968. ObjectiveTo test the effectiveness of a holistic (comprehensive and integrated) wellness program for adults with spinal cord injury. DesignA total of 43 adults with spinal cord injury were randomly assigned to intervention or control groups. The intervention group attended six half-day wellness workshops during 3 mos, covering physical activity, nutrition, lifestyle management, and prevention of secondary conditions. Outcome measures included several physical measures and standard psychosocial measures. Statistical analyses included paired t tests, used to determine within-group differences, and multiple regression conducted to assess between-group differences. ResultsWhen comparing within-group baseline and final results, the intervention group reported fewer and less severe secondary conditions by the end of the study. Similarly, significant improvements were found in health-related self-efficacy and health behaviors. No significant changes in physiologic variables were observed. Although no significant between-group differences were observed, regression analyses suggested participation in the wellness program may be associated with improved health behaviors. ConclusionWithin-group comparisons suggest improvements in several areas of the participants’ overall health behaviors. These findings, although preliminary, emphasize the potential role of health behaviors in positively influencing long-term health outcomes and quality of life.

Bladder Management After Spinal Cord Injury in the United States 1972 to 2005

PURPOSE Studies have shown that bladder management with an indwelling catheter for patients with spinal cord injury is associated with more urological complications such as stones, urinary infection, urethral strictures and bladder cancer. However, little is known about actual bladder management for these patients in clinical practice. MATERIALS AND METHODS Using the National Spinal Cord Injury Database the bladder management method was determined at discharge from rehabilitation and at each 5-year followup period for 30 years. RESULTS At discharge from rehabilitation (24,762 patients) the selection of bladder management with a condom catheter decreased steadily from a peak of 34.6% in 1972 to a low of 1.50% in 2001. The use of clean intermittent catheterization increased from 12.6% in 1972 to a peak of 56.2% in 1991. Indwelling catheter use initially decreased from 33.1% in 1972 to 16.5% in 1991 but increased to 23.1% in 2001. Of 12,984 individuals with followup data those originally using an indwelling catheter for bladder management were unlikely to switch to another method, with 71.1% continuing to use an indwelling catheter at 30 years. Individuals using clean intermittent catheterization and condom catheterization at discharge home did not continue to use these methods with only 20% and 34.6% remaining on the same management, respectively. CONCLUSIONS With time bladder management with clean intermittent catheterization has increased in popularity. However, only 20% of patients initially on clean intermittent catheterization remained on this form of bladder management. More research on the safety of each of these methods needs to be performed to provide better guidance to aid with this decision.

An Integrative Conceptual Framework of Disability: New Directions for Research

Advances in research on disability and rehabilitation are essential to creating equal opportunity, economic self-sufficiency, and full participation for persons with disabilities. Historically, such initiatives have focused on separate and specific areas, including neuroscience, molecular biology and genetics, gerontology, engineering and physical sciences, and social and behavioral sciences. Research on persons with disabilities should examine the broader context and trends of society that affect the total environment of persons with disabilities. This article examines the various disability paradigms across time, assessing the relative contribution of the socioecological perspective in guiding research designed to improve the lives of persons with disabilities. The authors recommend new research directions that include a focus on life span issues, biomedicine, biotechnology, the efficacy and effectiveness of current interventions, an emphasis on consumer-driven investigations within a socioecological perspective of disability, and the implications for research and practice.

Spinal cord injury and aging challenges and recommendations for future research

ABSTRACTPopulation aging, caused by reductions in fertility and increasing longevity, varies by country and is anticipated to continue and to reach global proportions during the 21st century. Although the effects of population aging have been well documented for decades, the impact of aging on people with spinal cord injury (SCI) has not received similar attention. It is reasonable to expect that population aging features such as the increasing mean age of the population, share of the population in the oldest age groups, and life expectancy would be reflected in SCI population demographics. Although the mean age and share of the SCI population older than 65 yrs are increasing, data from the National Spinal Cord Injury Statistical Center suggest that life expectancy increases in the SCI population have not kept the same pace as those without SCI in the last 15 yrs. The reasons for this disparity are likely multifactorial and include the changing demographics of the SCI population with more older people being injured; susceptibility of people with SCI to numerous medical conditions that impart a health hazard; risky behaviors leading to a disproportionate percentage of deaths as a result of preventable causes, including septicemia; changes in the delivery of health services during the first year after injury when the greatest resources are available; and other unknown factors. The purposes of this paper are (1) to define and differentiate general population aging and aging in people with SCI, (2) to briefly present the state of the science on health conditions in those aging with SCI, and finally, (3) to present recommendations for future research in the area of aging with SCI.