Margareta Kreuter

Partner relationships, functioning, mood and global quality of life in persons with spinal cord injury and traumatic brain injury

The aim of this study was to assess and compare spinal cord injured (SCI) and traumatic brain injured (TBI) persons and people from the general population concerning partner relationships, functioning, mood and global quality of life.One hundred and sixty seven SCI persons, 92 TBI persons and 264 controls participated in the study. The median age was: SCI persons 33 years (range 19 to 79 years), TBI persons 40 years (range 20 to 70 years), and controls 31 years (range 19 to 79 years). Age at injury ranged among SCI persons from 14 to 76 years (Md 28 years), and among TBI persons from 16 to 56 years (Md 32 years). Half of the SCI group (51%), 58% of the TBI group and 59% of the controls had a stable partner relationship at the time of the investigation. Many of these SCI and TBI relationships (38% and 55% respectively) were established after injury. Both SCI and TBI persons showed significantly more depressive feelings compared with the controls. Perceived quality of life (global QL rating) was significantly lower in the SCI group compared with the controls, whereas the ratings of TBI persons and controls did not differ significantly. SCI and TBI persons did not differ significantly in level of education, perceived quality of life or distress. In all three groups, global quality-of-life ratings were significantly lower among single persons compared to those with a partner relationship. It was concluded that both SCI and TBI appear to affect overall quality of life and mental well-being negatively. The number of partner relationships contracted after injury among both SCI and TBI persons indicates, however, that the injury is not a major barrier to establishing close partner relationships. Being in good spirits, that is, lack of depressive feelings has a profound impact on the perception of a high quality of life in all three groups. For the SCI and TBI persons, a high level of physical and social independence were further positive determinants of a perceived high quality of life.

Sexual adjustment and quality of relationships in spinal paraplegia: A controlled study

OBJECTIVE To identify determinants of sexual adjustment by persons with spinal cord injury (SCI) and quality of the relationship compared with persons in the general population. DESIGN Controlled survey. SETTING Postdischarge community setting. PARTICIPANTS A consecutive series of 252 persons admitted to our spinal unit between November 1982 and July 1991 with traumatic SCI were contacted, 85 of whom persons were excluded: 36 were dead, 37 had recovered, 5 could not be located, 4 were younger than 18 years, 2 had language difficulties, and 1 had a psychiatric illness. Of the remaining 167 persons with SCI, 85 had a stable partner relationship, 75 of whom (88%) completed and returned the questionnaires (median age, 33 years; range 19 to 76). An age- and sex-matched control group was randomly selected from the general population. Of the 264 respondents, 155 (59%) had a stable partner relationship. MAIN OUTCOME MEASURES The 80-item questionnaire addressed experiences concerning sexual functioning, desire, and activity, sexual behavior, satisfaction with sex life, and aspects of the emotional quality of the relationship. RESULTS Sexual activity and satisfaction was lower among persons with SCI compared with the controls; the emotional quality of the relationship did not differ. The most important correlates for sexual fulfillment in both groups were found to be the use of a varied repertoire of sexual behaviors and the perception that the partner enjoys and is satisfied with the sexual part of the relationship. CONCLUSION Psychosocial rather than physical factors were important for a satisfying sexual life and relationship. A qualitative study should be undertaken to further explore the complexity of sexual adjustment after SCI.

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.

Home rehabilitation after hip fracture. A randomized controlled study on balance confidence, physical function and everyday activities:

Objective: To investigate whether home rehabilitation can improve balance confidence, physical function and daily activity level compared to conventional care in the early phase after hip fracture. Design: A randomized controlled study. Setting: Geriatric rehabilitation clinic. Subjects: One hundred and two community-dwelling elderly people. Interventions: A geriatric, multiprofessional home rehabilitation programme focused on supported discharge, independence in daily activities, and enhancing physical activity and confidence in performing daily activities was compared with conventional care in which no structured rehabilitation after discharge was included. Main measures: Falls efficacy, degree of dependency and frequency in daily activities, habitual physical activity and basic functional performance. Results: When comparing status one month after discharge with baseline, the home rehabilitation group showed a higher degree of recovery in self-care (P<0.0001), mobility (P = 0.002), locomotion (P = 0.0036) and domestic activities (P = 0.0098), as well as larger increase in balance confidence on stairs (P = 0.0018) and instrumental activities (mean increase home rehabilitation 19.7 and conventional care 7.1, P<0.0001) compared with the conventional care group. At one month, a majority of the home rehabilitation participants (88%) took outdoor walks, compared with less than half (46%) of the conventional care group (P<0.001) and were also more independent in outdoor activities (P = 0.0014). Conclusions: This study indicates that home rehabilitation, focused on supported discharge and enhancing self-efficacy, improves balance confidence, independence and physical activity in community-dwelling older adults in the early phase after hip fracture.

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.

SEXUALITY AND SEXUAL LIFE IN WOMEN WITH SPINAL CORD INJURY: A CONTROLLED STUDY

OBJECTIVE To describe sexual life in women with spinal cord injury. DESIGN Controlled cross-sectional, questionnaire. PARTICIPANTS AND METHODS Women, 18-65 years, treated at spinal cord centres in Sweden, Denmark, Norway, Finland and Iceland. 545 women (57%) completed the questionnaires. The age-matched control group consisted of 507 women. The 104-item Spinal Cord Injury Women Questionnaire, was designed to assess different dimensions of sexuality. RESULTS 80% of the women with spinal cord injury had engaged in sex after the injury. Reasons for not wanting or not having the courage to be intimate and sexual were physical problems, low sexual desire, low self-esteem and feelings of being unattractive. The motivations of both the women with spinal cord injury and controls to engage in sexual activity were intimacy-based rather than primarily sexual. Being in the right mood both before and during sex to become receptive to sexual stimulation was important. CONCLUSION For women who are able to overcome the physical restrictions and mental obstacles due to injury, it is possible to regain an active and positive sexual life together with a partner. Sexual information and counselling should be available both during initial rehabilitation and later when the women have returned to their homes.

Women's sexual functioning and sex life after spinal cord injury

Study design:Cross-sectional, mail-back questionnaire study.Objectives:To describe womens experiences of sexual functioning and sex life after spinal cord injury (SCI).Setting:Sweden, Denmark, Norway, Finland, and Iceland.Methods:All community-living SCI women treated at spinal cord centres in Sweden, Denmark, Norway, Finland, and Iceland meeting inclusion criteria (n=963) were mailed the study-specific SCI Women Questionnaire. Out of the 532 respondents, 392 reported having had sex after injury and were thus included in the study. The included women had a mean age of 42 years (range 18–68) and a mean time since injury of 11 years (range 2–54).Results:The SCI women reported that the injury caused many changes in their sex life and affected many aspects of their sexuality negatively. Some changes were of a physical nature (for example, decreased, lost, or changed sensation; difficulties to achieve orgasm; bladder or bowel problems; and difficulties to move and position oneself) whereas other changes were of a psychological nature (for example, feeling unattractive or less attractive, having less self-confidence, and difficulties to meet or find a partner).Conclusion:Successful SCI rehabilitation requires a holistic approach, taking into account the patients physical, psychological, and interpersonal circumstances. Given that many women with SCI remain sexually active but often experience less satisfaction after injury, it is important that rehabilitation efforts address this aspect of the patients life. Our results elucidating strategies applied by women with SCI to compensate for loss of genital sensation and cope with physiological impairment during sexual activity may serve to help professionals in developing rehabilitation programmes for women with SCI.

Fear of falling, balance, and gait velocity in patients with stroke

After a stroke balance can be impaired, that may influence the physical activities which can be undertaken. A persons confidence in performing activities without falling could be as important as the real balance ability in situations of daily living. The aims of the study were to evaluate the relationship between perceived self-confidence in task performance without falling, using the Falls Efficacy Scale, Swedish version, (FES(S)) and observer-assessed balance, measured by the BDL Balance Scale (BDL BS) and also between the FES(S) and gait velocity. Thirty-one subjects with stroke, 32–62 years of age, time since onset between 3 and 104 months, participated. The FES(S) was significantly correlated with the BDL BS (r = 0.49, p = 0.008). Furthermore there were significant correlations between the FES(S) and self-selected (r = 0.53, p = 0.003) as well as for maximum (r = 0.55, p = 0.002) gait velocity. The results indicate that the use of the FES(S) can be recommended in subjects with stroke and balance deficit in order to map out the dimension of self-confidence in balance problems. However, in more highly functioning subjects with stroke other fall-efficacy assessments with major demands on balance performance may be preferable due to partly ceiling effect in the study population.

Long-term effects of home rehabilitation after hip fracture – 1-year follow-up of functioning, balance confidence, and health-related quality of life in elderly people

Purpose. To investigate the long-term effects of home rehabilitation (HR) after hip fracture in elderly people. Method. A randomized, controlled longitudinal study on geriatric hospital-based HR was compared with conventional care (CC) in 102 patients. Independence in activities of daily living (ADL), frequency of activity, basic physical performance, balance confidence, health-related quality of life, mood and perceived recovery were measured 6 and 12 months after discharge. Results. One year post-discharge the HR participants reported significantly higher degree of independence in self-care and locomotion, as well as of balance confidence in stairs and instrumental activities and perceived physical function, than the CC group. One year after discharge 14 persons (29%) in the HR group and five persons (9%) in the CC group considered themselves fully recovered. Conclusions. The positive long-term effects were more pronounced among the participants in the HR group than among those who received CC, possibly due to the early start of the HR programme in hospital and its focus on self-efficacy and training of daily activities. However, one year after discharge a mojority of participants in both groups did not consider themselves to be fully recovered when they compared to their situation before the fracture.