Jillian M.R. Clark

Pain medication misuse among participants with spinal cord injury

Study design:Self-reported survey.Objective:Our purpose was to identify the predictors of pain medication misuse (PMM) among participants with spinal cord injury (SCI).Setting:A medical university in the southeastern United States.Methods:A total of 919 adults with impairment from traumatic SCI of at least 1-year duration, who reported at least one painful condition and were taking prescription medication to treat pain, were included in this study. PMM was measured by the Pain Medication Questionnaire (PMQ).Results:The average PMQ score was 19.7, with 25.8% of participants scoring at or above the cutoff of 25, which is indicative of PMM. A three-stage logistic regression analysis was conducted by sequentially adding three sets of predictors to the equation: (1) demographic and injury characteristics; (2) pain characteristics and (3) frequency of pain medication use. Age and education level were protective of PMM, whereas pain intensity, pain interference and pain medication use were risk factors. Number of painful days was not significant in the final model.Conclusion:PMM must be of concern after SCI, given its high prevalence among those with at least one painful condition and its relationship with pain indicators.

Stability of vocational interests after recent spinal cord injury.

OBJECTIVE We sought to identify the stability of vocational interests among persons with spinal cord injury (SCI) first assessed during inpatient rehabilitation. DESIGN Initial assessments were completed during inpatient rehabilitation an average of 50 days after SCI onset (n = 521). Follow-up measures, collected by mail, were obtained an average of 16.6 months postinjury (n = 190) and 29.1 months postinjury (n = 296). Participants (n = 135) completed all 3 assessments. Participants completed the 1994 Strong Interest Inventory (Campbell, 1971; Harmon, Hansen, Borgen, & Hammer, 1994), Form T317, a 317-item measure of vocational interests. RESULTS Comparison of scale means across 3 times of measurement indicated significant changes in 2 of 6 general occupational themes (GOT), 8 basic interest scales (BIS), and 2 special scales (leadership style, risk taking/adventure). With 1 exception, a linear trend indicating an increase in reported interests accounted for observed relationships. An age by time interaction occurred with 1 GOT and 3 BIS. The average stability coefficient was 0.61 for the GOT, 0.59 for the BIS, and 0.70 for the special scales. The average coefficients were somewhat lower for the oldest participants. CONCLUSION Interests do not appear to be static when first measured during inpatient rehabilitation after SCI. Rather, they evolve with average increases on select themes more compatible with the limitations of SCI. Stability coefficients suggest that interests are likely to change more than indicated in earlier studies.

Exercise self-efficacy and symptoms of depression after cardiac rehabilitation: predicting changes over time using a piecewise growth curve analysis.

Background:Cardiac rehabilitation is often recommended after experiencing a cardiac event and has been shown to significantly improve health outcomes among patients. Several psychosocial variables have been linked with cardiac rehabilitation program success, including exercise self-efficacy. However, little is known about temporal patterns in patients’ exercise self-efficacy after program completion. Objective:This study examined changes in exercise self-efficacy among 133 cardiac rehabilitation patients and whether symptoms of depression impacted the rate of change in exercise self-efficacy. Method:Participants completed questionnaires at the beginning and end of cardiac rehabilitation and at 6-month intervals for 2 years. Results:Growth curve analyses showed that exercise self-efficacy levels were highest at the beginning of cardiac rehabilitation, significantly declined 6 months after cardiac rehabilitation, and leveled off over the next 18 months. Results also showed that baseline depressive symptoms interacted with time: Compared with participants with fewer symptoms, participants high in depressive symptoms began cardiac rehabilitation with lower levels of exercise self-efficacy and evidenced significant declines 6 months after cardiac rehabilitation. At no time were they equal to their counterparts in exercise self-efficacy, and their means were lower 2 years after cardiac rehabilitation than before cardiac rehabilitation. Conclusions:Our findings imply that patients show unrealistic optimism surrounding the ease of initiating and maintaining an exercise program and that integrating efficacy-building activities into cardiac rehabilitation, especially for patients who show signs of distress, is advisable.

The natural course of spinal cord injury: changes over 40 years among those with exceptional survival

Objectives:To identify 40-year longitudinal changes in health, activity, employment, life satisfaction and self-rated adjustment after spinal cord injury.Study design:Longitudinal, mailed self-report.Methods:Participants were identified from outpatient records of a Midwestern USA university hospital in 1973. Follow-ups were conducted in 1984 and approximate 10-year intervals thereafter. A total of 49 participants completed each of the five assessments. Data were reviewed and analyzed by research team members and a research associate with experience in biostatistics at a medical university in Southeastern USA. Life Situation Questionnaire included the following: (1) demographic and injury characteristics, (2) educational status and employment, (3) community participation, (4) life satisfaction, (5) adjustment, and (6) recent medical history.Results:Proportion of individuals with 10+ non-routine physician visits increased from consistently <10% to >40% during the 40 years. Proportion who spent a week or more in hospital increased from a low of 10% at 20-year follow-up to 43% at 40-year follow-up. Percentage employed and average hours employed initially improved over time but decreased substantially during the last two times of measurement. Satisfaction with health, sex life and social life declined over time, whereas satisfaction with employment improved initially and was maintained over time. Self-rated current adjustment remained stable, whereas predicted future adjustment declined steadily over 40 years.Conclusions:Age-related declines were apparent for need of physician visits and hospitalizations, with notable declines in satisfaction with sex life, social life and health. However, not all indices declined over time. Participants appeared to maintain stability when rating their own adjustment.

Comparison of factor structure models for the Beck Anxiety Inventory among cardiac rehabilitation patients

OBJECTIVE Individuals with cardiovascular disease (CVD) experience greater rates of distress symptoms, such as anxiety and depressive symptoms, than the general population. These psychological outcomes have been linked to greater risk for negative outcomes following a cardiac event; however, research examining the relationship between specific components of anxiety and outcomes in CVD is limited. Further, prior research has not investigated the structure of anxiety symptoms in CVD. This study sought to compare previously established one, two, and four-factor models of the Beck Anxiety Inventory (BAI) in individuals enrolled in cardiac rehabilitation (CR). METHODS Our sample included 208 individuals with CVD recruited during enrollment in a phase II CR program. Participants completed the BAI at enrollment in CR (Time 1) and again 12weeks later at CR completion (Time 2, n=151). RESULTS Consistent with prior literature, 41% of our sample reported at least mild symptoms of anxiety (BAI>8), and the BAI proved to be a reliable measure within this sample (α=0.89). Confirmatory factor analysis (CFA) results indicated that a second-order model with four first order factors, consisting of cognitive, autonomic, neuromotor, and panic components, fit our data well. A multi-group CFA approach supported measurement invariance across time. CONCLUSION These results suggest that anxiety following CVD can be evaluated based on cognitive, autonomic, neuromotor, and panic components as well as the encompassing anxiety construct.

Emergency room visits and hospitalizations among participants with spinal cord injury.

BACKGROUND Literature examining emergency room visits (ERV) and emergency room related hospitalizations (ERH) after spinal cord injury (SCI) is limited. OBJECTIVE Identify (1) the annual frequency of ERV and ERH and (2) their likelihood as a function of demographic, injury, and socioeconomic characteristics. METHODS Participants (n = 1,579) with SCI completed mailed self-report questionnaires. RESULTS 37% reported at least one ERV, with an average of 85 ERV per 100 participants. 19% reported at least one ERH and an average of 33 ERH annually per 100 participants. A greater likelihood of ERV was observed among non-whites, those with more severe SCI, less education, and lower income. Among those with at least one ERV, greater risk of ERH was observed among non-Hispanic whites, those with more severe SCI, lower education, and higher age. CONCLUSIONS ERV are common after SCI and should be accounted for when predicting SCI related expenses. Those with the most severe SCI and those in the oldest age group were most likely to be hospitalized after an ERV.

Latent Structural Analysis of Health Outcomes in People Living With Spinal Cord Injury

OBJECTIVE To develop a latent structural model of health outcomes in people with spinal cord injury (SCI) that accounts for the measurement of underlying factors and their association with demographic and injury-related exogenous variables. DESIGN Cross-sectional study. SETTING Specialty hospital and medical university. PARTICIPANTS Participants with traumatic SCI (N=1871) of at least 1-year duration. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Exploratory factor analysis was used to identify latent health outcome structures. Several key exogenous variables were also linked with the latent health outcome factors. RESULTS Six latent health outcome factors were identified by the exploratory factor analysis with excellent model fit (root mean square error of approximation=.040). These latent factors included (1) global health problems; (2) chronic disease; (3) acute treatments; (4) symptoms of SCI complications, (5) pressure ulcers; and (6) subsequent injuries. Sex, race/ethnicity, age, years since injury, and injury severity were all significantly associated with at least 1 latent health outcome factor, which indicates that these latent health outcomes varied as a function of the exogenous variables. CONCLUSIONS This study improved our understanding of the structure of health outcomes, and utilization of latent health outcome factors provides more stable and comprehensive composite scores than does utilization of a single observed health outcome indicator.

Preinjury cigarette smoking among those with traumatic spinal cord injury.

OBJECTIVE Identify the prevalence of cigarette smoking at the time of spinal cord injury (SCI) onset, compare the rate of cigarette smoking to that of the general population in the same geographic area, and identify the relationship of cigarette smoking with demographic, injury, behavioral, and psychological characteristics. RESEARCH METHOD Self-report assessments were completed during inpatient rehabilitation for new SCI. RESULTS The prevalence of smokers at the time of their SCI onset was 37.9%, substantially higher than the rate for those in the general population from the same geographic region (22.8%). Those who were smokers at SCI onset, on average, were older, had less education, were more likely to have consumed alcohol in the month prior to SCI onset, and had higher personality scores indicative of Impulsive/Sensation Seeking and Neuroticism/Anxiety. CONCLUSIONS At the time of SCI, cigarette smoking is elevated over the general population and is related to behavioral and psychological factors that may be important to consider with smoking cessation interventions.

Compensatory Cognitive Training for psychosis: Effects on negative symptom subdomains

Research identifying the effects of cognitive training on negative symptoms of psychosis is limited. We examined the effects of Compensatory Cognitive Training (CCT) on expressive deficits and social amotivation in a randomized controlled trial comparing CCT to standard pharmacotherapy alone in 43 individuals with psychosis. ANCOVA analyses demonstrated significant CCT-associated effects on both expressive deficits and social amotivation. Moreover, improvements in both sub-domains were associated with improvements in global life satisfaction, with improvements in social amotivation also related to increased social contact. CCT appears to be a beneficial treatment approach for improving multiple aspects of negative symptoms.

Vocational interests by gender and race 10 years after spinal cord injury.

Objective: To examine and compare vocational interests as a function of gender and race among 247 participants with spinal cord injury (SCI) approximately 10 years after SCI onset utilizing the 2004 edition of the Strong Interest Inventory (SII). Research Method: For this cross-sectional analysis nested within a prospective cohort study, data were collected via mail and analyzed at a medical university in the Southeastern United States. Among the 563 adults with traumatic SCI initially enrolled during inpatient rehabilitation at a specialty hospital, 247 met current study eligibility criteria and completed the SII approximately 10 years postinjury. The SII is a 291-item measure of vocational interests. Results: Male participants scored highest on the Realistic theme and females scored highest on the Social theme. White participants scored highest on the Realistic theme, whereas Black participants scored highest on the Conventional theme. Differences in vocational interests by gender were seen on two of the six General Occupational Themes (GOT; Realistic and Social) and 12 of the 30 Basic Interest Scales (BIS). Race differences were observed on the Enterprising and Conventional GOT and 11 of 30 BIS. Conclusions: For both female and Black participants, interests are more physically compatible with employment post-SCI than male and White participants. Yet, employment rates in White males with SCI are greater than those of female and Black individuals with SCI. These data suggest further research on factors influencing gender and racial disparities in employment among those with SCI is indicated.