Magnus L. Elfström

Relations between coping strategies and health-related quality of life in patients with spinal cord lesion

OBJECTIVE Although the use of appropriate coping strategies has been suggested to be a key factor in determining successful adjustment to severe physical illness/disability, little systematic support for this link has been found. We investigated relationships between spinal cord lesion-related coping strategies and health-related quality of life when studying for sociodemographic, disability-related and social support variables. DESIGN AND SUBJECTS We studied 256 persons with traumatically acquired spinal cord lesion (=1 year) from a typical rural/urban Swedish area in a cross-sectional design. METHODS Coping measure was the Spinal Cord Lesion-related Coping Strategies Questionnaire. Outcome measures were the Spinal Cord Injury Quality of Life Questionnaire, the Short-Form 36 Health Survey version 2.0, and a standardized global question of overall quality of life. Multiple regressions were performed. RESULTS Coping strategies were clear correlates of health-related quality of life when sociodemographic, disability-related and social support variables were studied. The relationship between coping strategies and quality of life was: the more revaluation of life values (Acceptance) and the fewer tendencies towards dependent behaviour (Social reliance) the better the health-related quality of life. CONCLUSION Our results suggest that greater focus needs to be directed to coping strategies and to ways of facilitating adaptive outcomes in rehabilitation.

Linkages between coping and psychological outcome in the spinal cord lesioned: development of SCL-related measures.

Study design: Cross-sectional.Objectives: To investigate relationships between coping and mental well-being with clinical relevance to spinal cord lesion (SCL).Setting: The Gothenburg Spinal Injuries Unit in Sweden.Methods: The study sample comprised 274 persons. From in-depth interviews, literature reviews, and the transactional theory of stress and coping, items reflecting coping and psychological outcome, respectively were generated. Principal components factor analysis, multi-trait analysis, and structural equation modelling were used.Results: The coping scale comprised three factors: Acceptance (i.e. revaluation of life values); Fighting spirit (i.e. efforts to behave independently); Social reliance (i.e. a tendency towards dependent behaviour). The outcome scale included the factors: Helplessness (i.e. feeling perplexed, out of control and low self-esteem); Intrusion (i.e. bitterness and brooding); Personal growth (i.e. positive outcomes of life crisis). Acceptance showed a positive relation to Personal growth and was inversely related to both Helplessness and Intrusion. Fighting spirit had a weak negative association to Helplessness and a weak positive association to Personal growth. Social reliance was positively related to Helplessness and Intrusion. Only Social reliance showed any association to neurological status. Those lesioned 1–4 years reported more Helplessness, Intrusion, Social reliance, and less Acceptance than those lesioned ⩾5 years.Conclusion: Coping is related to psychological outcome in SCL. Our situational coping measure may be a candidate to assess intervention effects.

Effects of coping on psychological outcome when controlling for background variables: a study of traumatically spinal cord lesioned persons

Study design: Cross-sectional.Objectives: In a previous study we found spinal cord lesion (SCL)-related coping factors to be distinctly related to levels of SCL-related psychological outcome. However, we did not control for other potentially confounding variables. In this study we investigated effects of coping strategies on psychological outcome reactions in traumatically spinal cord lesioned persons controlling for sociodemographic, disability-related and social support variables.Setting: The Gothenburg Spinal Injuries Unit in Sweden.Methods: The study sample comprised 255 persons and a subsample of 157 persons. A series of stepwise multiple regression analyses were performed.Results: SCL-related coping factors clearly predicted psychological outcome even when background variables were controlled. Higher levels of acceptance coping predicted decreased psychological distress and increased positive morale. Elevated social reliance coping predicted heightened distress. Higher levels of social support predicted lower feelings of helplessness. Sociodemographic and disability-related variables were weak predictors of psychological outcome with one exception: higher education predicted less bitterness and brooding.Conclusion: SCL-related coping remained the most important predictor of psychological outcome even when a wide range of variables was controlled. Thus we conclude that psychosocial interventions aimed at helping individuals develop their coping strategies might be of substantial value in their adjustment to SCL.

Cognitive appraisals, coping and quality of life outcomes: a multi-centre study of spinal cord injury rehabilitation.

Study design:Longitudinal, multiple wave panel design.Objectives:To investigate the degree to which current thinking in terms of early appraisals and coping predicts adjustment and quality of life outcomes after spinal cord injury, and to what degree social and demographic variables are involved.Setting:Data were analysed from 266 patients recruited as part of an ongoing study from specialist units in selected British, Swiss, German and Irish spinal centres.Method:Questionnaire booklets were administered as soon as possible after injury onset and after 12 weeks to patients with newly acquired spinal cord injuries. Individuals included had sustained their injury between the ages of 16 and 83.Results:Significant improvements in outcome measures were found across the data set within the first 12 weeks after spinal cord injury and changes observed in the appraisals and coping strategies employed. Significant differences were found between participating centres on both outcome measures and in the coping and appraisal processes used. Coping and appraisal processes at 6 weeks after injury were found to contribute significantly to the variation in psychological well-being at 12 weeks after injury.Conclusion:This study shows the process of adjustment to spinal cord injury to begin in the early stages of rehabilitation, and initial appraisals are important to how an individual will cope with their injury and to their psychological well-being. Support is also given to the importance of psychological factors to functional outcomes.

Sense of coherence and psychological outcomes in people with spinal cord injury: Appraisals and behavioural responses.

STUDY DESIGN Longitudinal, multi-wave design. OBJECTIVES To investigate the contribution of sense of coherence (SOC), appraisals, and behavioural responses when predicting psychological outcomes to spinal cord injury (SCI). METHOD Patients (N=237) sustaining a SCI aged 17 or above were recruited from specialist spinal injuries centres across six European countries. Measures of SOC, appraisals, coping strategies, and psychological well-being were administered at 6 and 12 weeks post-injury and at a 1 year follow-up. RESULTS People scoring high on SOC at 6 weeks post-injury showed significantly better psychological outcomes at 1 year post-injury and SOC showed significant relationships with appraisals at 12 weeks post-injury and coping strategies 1 year post-injury. Significant relationships were found between appraisals at 12 weeks post-injury and psychological outcomes, adaptive coping strategies were significantly related to psychological well-being at 1 year post-injury. Regression analyses found SOC, appraisals, and coping behaviours to explain 61.8% of the variance in psychological quality of life, 66.5% of the variance in depression, and 37.7% of the variance in anxiety at 1 year post-injury. CONCLUSION This study provides further evidence in support of previous findings which suggest SOC to have a primary role in long-term psychological well-being. The relationship described here - from SOC to the appraisal of injury and subsequent behavioural responses - suggests SOC to be an influential factor in the long-term adjustment of people with SCI.

Validation of the Swedish version of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM).

UNLABELLED The purpose of this study was to perform an initial validation of a Swedish translation of the Clinical Outcomes in Routine Evaluation Outcome Measure (CORE-OM). The CORE-OM is a broad self-report instrument of psychological problems, designed as an outcome measure for evaluating the effects of psychological therapy. Participants included a non-clinical group of 229 university students and a clinical group of 619 persons from four primary care sites. The Swedish CORE-OM showed excellent acceptability, high internal consistency and test-retest reliability, as well as acceptable convergent validity. There was strong differentiation of the clinical and non-clinical samples, with the clinical group scoring significantly more psychological problems than the non-clinical group. Sensitivity to change was demonstrated in psychological treatments in primary care. Overall, the psychometric characteristics of the Swedish CORE-OM were very similar to the original UK data. Nevertheless, the validity of the Swedish version needs to be examined more in detail, in larger and more diverse samples. Our results so far, however, provide support for using the Swedish CORE-OM as a psychological problems measure. To our knowledge, there are few other relatively short measures in Swedish that are free to reprint that meet the demands for psychometric properties and utility in primary care settings in which patients typically present a broad range of psychological problems. KEY PRACTITIONER MESSAGE The Swedish version of the CORE-OM is a valid questionnaire for assessing the severity of a broad range of psychological problems.

Psychological Contributions to Functional Independence: A Longitudinal Investigation of Spinal Cord Injury Rehabilitation

OBJECTIVES To investigate the contribution of prerehabilitation appraisals of spinal cord injury (SCI) and patients coping strategies to the variance in functional independence postdischarge. DESIGN Longitudinal, cohort study. Patients aged 16 and older and sustaining an SCI were recruited from English- and German-speaking specialist spinal injuries centers. Measures of appraisals, coping strategies, mood, and functional independence were administered on commencing active rehabilitation (12-weeks postinjury) and following hospital discharge (1-y postinjury). SETTING Specialist SCI rehabilitation centers in England, Germany, Switzerland, and Ireland. PARTICIPANTS Patients (N=127) completed questionnaires at both time points. Sample age ranged between 17.5 and 64.5 years with a mean age of 39.3 years. Demographic and injury characteristics were similar to those reported in international statistics databases. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE FIM (motor subscale). RESULTS Injury characteristics, age, sex, current depression, and the utilization of the coping strategy, social reliance, at 12-weeks postinjury explained 33.5% of the variance in motor FIM at 1-year postinjury. Strong relationships were found between appraisals, coping styles, mood, and functional outcomes. CONCLUSIONS The coping strategy, social reliance, was found to contribute significantly when explaining the variance in functional outcomes. Suggestions were made to assess appraisals and coping strategies early in rehabilitation in order to provide effective interventions and additional support to those scoring highly on negative coping styles. Further research is recommended to provide support for the relationship between dependent coping strategies and functional outcomes.

Condition-related coping strategies in persons with spinal cord lesion: a cross-national validation of the Spinal Cord Lesion-related Coping Strategies Questionnaire in four community samples

Study design:Cross-sectional, questionnaire.Objectives:Coping strategies employed to manage the consequences of a spinal cord lesion (SCL) have been found to be distinctly related to emotional well-being. However, research and clinical implications have been hampered by the lack of cross-validated measures that are directly related to the lesion and its consequences. This study investigates the psychometric performance of the SCL-related Coping Strategies Questionnaire in four different countries.Setting:Austria, Germany, Switzerland and UK.Methods:The study sample comprised 355 community residing persons with SCL. Multi-trait/multi-item analysis methods and non-parametric and parametric tests were used.Results:The Acceptance coping scale showed satisfactory psychometric qualities, whereas there were some problems in the Fighting spirit scale and greater problems in the Social reliance scale. Compared with the Swedish developmental sample, Acceptance was used more in the four study countries. Consistent with the original sample, Acceptance and Fighting spirit coping correlated with fewer signs of emotional distress, persons lesioned ⩾5 years tended to report more Acceptance than the newly lesioned and coping strategies were mainly unrelated to neurological status.Conclusion:The English and German language versions of the Acceptance coping scale were valid and reliable, whereas some translated items in the Fighting spirit scale need to be revised. Translations of the Social reliance scale need to be thoroughly revised and retested. The results add further evidence to the literature on the stability of the link between adapting life priorities (ie Acceptance) and emotional well-being.

Appraisals, coping and adjustment pre and post SCI rehabilitation: a 2-year follow-up study

Study design:Longitudinal, multi-wave panel design.Objectives:To explore the changes in and the relationships between appraisals and coping with mood, functioning and quality-of-life (QOL) pre- and post-rehabilitation for acute spinal cord injury (SCI).Setting:The data collected was part of an ongoing study from specialist units in selected British, Swiss, German and Irish SCI centres.Methods:Questionnaires (Functional Independence, QOL, Mood, Appraisals, Coping and Support) were administered to 232 patients at 12 weeks post injury and sent to participants at 1 and 2 years post injury by post.Results:Significant changes were observed in various outcome measures between 12 weeks and 1 year post injury, with little significant change occurring during the following year. Appraisals and coping at 12 weeks post injury were significantly related to outcome scores and also contributed significantly to the variance in QOL, mood and stress-related growth at 2 years post injury.Conclusion:The study provides further evidence for the link between appraisals, coping and subsequent adjustment to injury. Suggestion is made for the potential benefit of early assessment and intervention for patients at risk of poor adjustment to SCI.

Relationships between locus of control, coping strategies and emotional well-being in persons with spinal cord lesion

Relations between locus of control, coping strategies and emotional well-being in persons with traumatically acquired spinal cord lesion (SCL) were examined. The sample included 132 community-residing adults. Structural equation modelling, including confirmatory factor analysis, was used. A model was hypothesized based on the transactional theory of stress and coping where coping strategies mediated the relation between locus of control and emotional well-being. The model showed acceptable fit to the data and was compared with five alternative models. The alternative models fitted the data less well or were difficult to interpret. In the preferred model, persons indicating internal control reported more coping strategies (Acceptance, Fighting spirit) related to increased well-being, whereas persons indicating external control reported a coping strategy (Social reliance) related to poorer well-being. The findings support the stress and coping framework in medical rehabilitation and illustrate why some persons need coping effectiveness training to enhance emotional adjustment.