Diana Dorstyn

Examining factors that contribute to the process of resilience following spinal cord injury

Study design:Cross-sectional survey.Objective:To examine factors that contribute to the process of positive adjustment, or resilience, in an adult community sample with spinal cord injury (SCI).Setting:South Australian Spinal Cord Injury Service, Hampstead Rehabilitation Centre, South Australia, AustraliaMethods:A postal survey comprising standardised measures of resilience (Connor–Davidson Resilience Scale-10 item), self-efficacy (Moorong Self-Efficacy Scale), locus of control (Locus of Control of Behaviour Scale) and psychological distress (Depression Anxiety Stress Scale—21 item).Results:Of 60 respondents, 58% reported moderate to high levels of resilience. Resilience correlated significantly with high self-efficacy (r=0.68, P<0.01), internal locus of control (r=−0.52, P<0.01) and low psychological distress (depression r=−0.68, P<0.01; anxiety r=−0.55, P<0.01; stress r=−0.67, P<0.01). In comparison, resilience was not significantly influenced by degree of neuropathic pain (r=−0.23, P>0.05), time since injury (r=−0.14, P>0.05), gender (t(58)=−0.92, P>0.05), lesion completeness (t(57)=−0.86, P>0.05), or SCI diagnosis (t(58)=−1.21, P>0.05). A multiple regression indicated that psychological distress and self-efficacy were the only two variables that uniquely contributed to resilient behaviour.Conclusion:Resilience is an important psychological process in the longer-term management of SCI which can be promoted by targeting rehabilitation interventions towards mood management in addition to self efficacy beliefs. Larger-scale research will help to validate these results.

Efficacy of cognitive behavior therapy for the management of psychological outcomes following spinal cord injury : A meta analysis

This meta-analysis evaluated the impact of cognitive behavior therapy (CBT) on the psychological adjustment of adults with spinal cord injury (SCI). A comprehensive search of six electronic databases identified 10 studies (424 participants) that met the inclusion criteria. Pre- and post-data for participants who received CBT were pooled and analyzed. Large and significant group differences were noted for measures of assertiveness, coping, self-efficacy, depression and quality of life. These data suggest that CBT has a significant positive impact on short-term psychological outcomes following SCI. However, further research is needed to establish the long-term benefits.

Screening for depression and anxiety in spinal cord injury with DASS-21

Study design:Comparison of two self-report instruments with a structured diagnostic interview.Objective:To investigate the properties of the Depression Anxiety Stress Scales-21 (DASS-21) in patients with spinal cord injuries.Setting:South Australian Spinal Cord Injuries Service, Hampstead Rehabilitation Centre, Northfield, South Australia.Methods:Forty paraplegic or tetraplegic patients participated. Two self-report measures, DASS-21 and Brief Symptom Inventory (BSI), assessed Depression, Anxiety and Stress. These measures were compared with each other and with diagnoses based on the Mini International Neuropsychiatric Interview.Results:Mean scores on both self-report measures were below clinical threshold levels. Prevalence rates of anxiety and depression were higher on DASS-21 than on BSI. DASS-21 was as sensitive as BSI, but had lower specificity to detect anxiety and depression.Conclusion:DASS-21 is a promising screening measure for patients with spinal cord injury in a rehabilitation setting. It has greater sensitivity for identifying those with possible anxiety disorders than it does for those with depressive disorders.

Applications of telecounselling in spinal cord injury rehabilitation: a systematic review with effect sizes:

Objective: To investigate the short- and medium-term efficacy of counselling services provided remotely by telephone, video or internet, in managing mental health outcomes following spinal cord injury. Data sources: A search of electronic databases, critical reviews and published meta-analyses was conducted. Review methods: Seven independent studies (N = 272 participants) met the inclusion criteria. The majority of these studies utilized telephone-based counselling, with limited research examining psychological interventions delivered by videoconferencing (Nstudy = 1) or online (Nstudy = 1). Results: There is some evidence that telecounselling can significantly improve an individual’s management of common comorbidities following spinal cord injury, including pain and sleep difficulties (d = 0.45). Medium-term treatment effects were difficult to evaluate, with very few studies providing these data, although participants have reported gains in quality of life 12 months after treatment (d = 0.88). The main clinical advantages are time efficiency and consumer satisfaction. Conclusion: The results highlight the need for further evidence, particularly randomized controlled trials, to establish the benefits and clinical viability of telecounselling.

Telepsychology for Posttraumatic Stress Disorder: A systematic review

Summary The effectiveness of psychological services provided remotely, telepsychology, for the management of Posttraumatic Stress Disorder (PTSD) was evaluated. Eleven studies (n = 472 participants) were identified from electronic database searches. Study quality was assessed, with studies characterised by small and underpowered samples. Effect sizes and associated confidence intervals (CIs) were calculated to determine the direction and magnitude of treatment change. Short-term treatment gains were reported for internet and video-based interventions. This included significant medium to large improvements (d range = 0.66–3.22) in cognitive and behavioural symptoms of depression, generalised anxiety and posttraumatic stress. However, the equivalence of telepsychology and face-to-face psychotherapy could not be determined, with few comparative studies available. Both treatment gains and deterioration were noted 1 to 6 months following treatment cessation, although this was based on limited follow-up data. Further larger scale and longitudinal research will help to ascertain the minimum requirements for the management and treatment of PTSD in a technology-supported environment.

Resilience, self-esteem and self-compassion in adults with spina bifida

Study design:Cross-sectional survey.Objectives:To examine factors that may enhance and promote resilience in adults with spina bifida.Setting:Community-based disability organisations within Australia.Methods:Ninety-seven adults with a diagnosis of spina bifida (SB) completed a survey comprising of demographic questions in addition to standardised self-report measures of physical functioning (Craig Handicap Assessment and Reporting Technique), resilience (Connor-Davidson Resilience Scale, 10 item), self-esteem (Rosenberg Self-esteem Scale), self-compassion (Self-compassion Scale) and psychological distress (Depression Anxiety Stress Scales, 21 item).Results:The majority (66%) of respondents reported moderate to high resilience. Physical disability impacted on coping, with greater CD-RISC 10 scores reported by individuals who were functionally independent in addition to those who experienced less medical co-morbidities. Significant correlations between resilience and psychological traits (self-esteem r=0.36, P<0.01; self-compassion r=0.40, P<0.01) were also noted. However, the combined contribution of these variables only accounted for 23% of the total variance in resilience scores (R2=0.227, F(5,94)=5.23, P<0.01).Conclusion:These findings extend current understanding of the concept of resilience in adults with a congenital physical disability. The suggestion is that resilience involves a complex interplay between physical determinants of health and psychological characteristics, such as self-esteem and self-compassion. It follows that cognitive behavioural strategies with a focus on self-management may, in part, contribute to the process of resilience in this group. Further large-scale and longitudinal research will help to confirm these findings.

Psychological variables associated with employment following spinal cord injury: a meta-analysis.

Objectives:Spinal cord injury (SCI) research has highlighted links between psychological variables and employment outcome; however, there remains a need to consolidate the available heterogenous data.Methods:Meta-analytic techniques were used to examine and quantify differences in psychological functioning and employment status among adults with an acquired SCI. Fourteen observational studies (N=9, 868 participants) were identified from an electronic database search. Standardised mean difference scores between employed and unemployed groups were calculated using Cohen’s d effect sizes. Additionally, 95% confidence intervals, fail-safe Ns, percentage overlap scores and heterogeneity statistics were used to determine the significance of d.Results:Moderate to large and positive weighted effects were noted across three broad psychological constructs: affective experience or feelings (dw=3.16), quality of life (dw=1.06) and life satisfaction (dw=0.70). However, the most compelling non-heterogeneous finding was associated with life satisfaction, a finding that was also not subject to publication bias. Inconsistent and weak associations between employment and individual measures of vocational attitude, self-efficacy, locus of control, adjustment and personality were also noted.Conclusion:Psychological factors and attributes are linked to employment post-SCI; however, the available data are limited in quantity. Longitudinal research is also needed to determine whether these variables can help to preserve employment over time.

Psychological intervention during spinal rehabilitation: a preliminary study

Study design:A repeated measures, non-randomised controlled trial.Objective:To examine the effectiveness of individualised cognitive behaviour therapy (CBT) on the psychological adjustment of patients undergoing rehabilitation for newly acquired spinal cord injury.Setting:South Australian Spinal Cord Injury Service, Hampstead Rehabilitation Centre, South Australia, Australia.Methods:Eleven participants received individual CBT as part of their spinal rehabilitation. Self-reported levels of depression, anxiety and stress were assessed before the intervention, at week 12 of rehabilitation and at 3 months post-discharge, using the depression, anxiety and stress scales (DASS-21). Functional independence was also assessed, using the Functional Independence Measure (FIM). Responses were compared with 13 participants, closely matched on demographic and injury variables, who received standard psychological care (that is, assessment and monitoring only).Results:Depression scores for treatment participants showed a significant time effect, with worsening symptoms reported at three-month follow-up, after CBT was discontinued. In contrast, the DASS-21 scores of standard care participants remained at subclinical levels throughout the study. Clinical improvements in symptoms of anxiety and stress were also reported by the treatment group as inpatient therapy progressed.Conclusion:Targeted, individualised psychological treatment contributed to short-term, meaningful improvements in emotional outcomes for individuals reporting psychological morbidity after recent spinal injury. The results also highlight the need for ongoing access to specialised, psychological services post-discharge. Replication of these results with a larger sample is required before definitive conclusions can be drawn.

Psychosocial correlates of depression following spinal injury: A systematic review

Abstract Objectives Spinal cord injury (SCI) studies have identified a range of psychosocial risk and protective factors for depression post-injury. This study presents the first systematic and quantitative review of this body of research. Methods Twenty-four studies (N = 3172 participants) were identified through electronic database searches. Studies were evaluated according to recommended guidelines on Strengthening the Reporting of Observational Studies in Epidemiology (STROBE). The significance and magnitude of the relationships between standardised measures of depression and psychosocial outcome were examined using Pearsons effect size r, 95% confidence intervals and fail-safe Ns. Effect sizes were categorised according to the ICF psychosocial domains. Results STROBE ratings indicated discrepancies in procedural detail and statistical analyses. Individual personal variables including affective feelings, and thoughts and beliefs specific to SCI demonstrated the strongest relationship with depression self-ratings. Life satisfaction, disability acceptance, environmental supports and community participation had a medium to strong association, helping to reduce vulnerability to depression. Longitudinal studies revealed that symptoms of depression continued to impact on psychosocial outcome up to 10 years post-injury, although this was based on limited data. Conclusions Assessment of psychosocial factors in the acute stages of SCI rehabilitation can inform evidence-based interventions to treat and manage depressive symptomatology in the short to longer-term. Future studies would benefit from adopting a unified approach to the measurement of depression post-SCI to help inform targeted treatment.

Systematic review of leisure therapy and its effectiveness in managing functional outcomes in stroke rehabilitation

Abstract Background: Evidence suggests that the incorporation of leisure activities in adult stroke rehabilitation can contribute to improved physical, cognitive, and psychological outcomes. However, differences in study design and treatment delivery may affect these findings. Furthermore, the magnitude of therapeutic change associated with leisure therapy is unclear, with few quantitative reviews available. Objective: To synthesize and evaluate the empirical evidence examining leisure therapy in stroke rehabilitation. Methods: Eight independent studies (N = 615 participants) were identified from a comprehensive database search. Study quality was evaluated using the Oxford Levels of Evidence. Pre- and posttreatment data for participants who received leisure therapy, in comparison with peers who received standard care or no treatment, were evaluated by calculating Cohen’s d effect sizes and 95% confidence intervals. Results: No studies met the criteria for the highest level of methodological rigor, although all used randomization procedures. Leisure therapy contributed to significant short-term improvements in psychological outcomes, namely quality of life and mood (d range, 2.10 to 0.54), in addition to leisure-specific outcomes, including increased participation in and satisfaction with leisure activities (d range, 0.81 to 1.23). Longer term effects of treatment could not be determined, with one study providing data and reporting nonsignificant effects (d range, -0.07 to 0.17). Conclusions: There is some evidence that leisure therapy offers an opportunity to enhance short-term treatment gains in community-based stroke rehabilitation. Further controlled research is needed to establish its longer term effects and assist the development of evidence-based guidelines for this treatment.