Simon Driver

Perceived injustice after traumatic injury: Associations with pain, psychological distress, and quality of life outcomes 12 months after injury.

OBJECTIVE There is growing recognition that individuals who experience traumatic injuries perceive themselves as victims of injustice and that elevated levels of perceived injustice are associated with problematic physical and psychological outcomes. To date, research regarding injustice perception and injury outcomes has been restricted to a small number of musculoskeletal pain conditions. No research to date has examined the potential impact of perceived injustice among individuals admitted for trauma care. METHOD As part of this cross-sectional study, individuals (n = 155) admitted to a Level-1 trauma center completed measures of perceived injustice, pain, depression, posttraumatic stress, and health related (physical and mental/emotional) quality of life (HRQoL) outcomes 12 months after trauma admission. RESULTS Bivariate analyses revealed significant associations between perceived injustice and demographic variables (education, income, race, and age) as well as injury-related variables (type of injury and length of hospital stay). Perceived injustice was correlated with greater pain intensity, depression, and PTSD symptoms, as well as poorer physical and mental HRQoL. Controlling for relevant demographic and injury-related variables, perceived injustice accounted for unique variance in pain intensity, depression severity, the presence and intensity of PTSD symptoms, mental HRQoL, and was marginally significant for physical HRQoL. CONCLUSIONS This is the first study to examine perceived injustice in a trauma sample. Results support the presence of injustice perception in this group and its associations with pain and quality of life outcomes. Additional research is suggested to explore the impact of perceived injustice on recovery outcomes among individuals who have sustained traumatic injury.

Resilience following spinal cord injury: a phenomenological view

Study design:Qualitative research design involving semi-structured focus groups.Objectives:To increase current understanding of how persons with spinal cord injuries (SCI) define resilience and what factors contribute to their resilience or the resilience of others.Setting:Inpatient rehabilitation program in a large urban city in the Southwestern United States.Methods:A convenience sample of 28 participants (14 current patients; 14 former patients) participated in semi-structured focus groups led by the research investigators.Results:Through a constant comparative analysis of the data, six themes emerged in participants’ responses regarding what they believed contributed to their own resilience in adapting to SCI. The six themes included psychological strength, social support, perspective, adaptive coping, spirituality or faith, and serving as a role model or inspiring others.Conclusion:Consistent with previous research findings, individuals with SCI identified positive thinking (for example, optimism, hope and positive attitude), perseverance and determination, and social support from friends and family as important contributors to their ability to adapt in spite of experiencing traumatic events that resulted in SCI. Findings provide richness and depth to current empirical conceptualizations of resilience.

Creating an effective physical activity-based health promotion programme for adults with a brain injury

Primary objective: To describe the processes involved with developing and implementing a physical activity-based health promotion programme for people with a brain injury, summarize previous health promotion research efforts and provide an actual example of a programme entitled P.A.C.E, a ‘Physical Activity Centred Education’ programme. Reasoning behind literature selection: Brain injury is a serious public health issue due to the incidence, complexity and high healthcare costs. Health promotion programmes that incorporate physical activity have been shown to improve the health of people with a disability. However, if programmes are to be successful they have to be appropriately designed, otherwise individuals will not adopt and maintain the desired health behaviours. Main outcomes and results: Readers will have an understanding of (1) how a theoretical framework drives programme development, (2) the strategies required to facilitate behaviour change, (3) how previous research supports the use of a physical activity-based health promotion programme and (4) how to implement a programme. Conclusions: Future research ideas are provided so as to stimulate research in the area of physical activity-based health promotion programmes for people with a brain injury.

Systematic Framework to Classify the Status of Research on Spinal Cord Injury and Physical Activity

OBJECTIVES To systematically classify the physical activity research for individuals with a spinal cord injury by using the behavioral epidemiologic framework; and to identify where the physical activity research for individuals with a spinal cord injury has focused between 2000 and 2012. DESIGN Relevant research was identified and then categorized into 1 of 5 phases by following the coding rules of the behavioral epidemiology framework. Phase 1 studies link physical activity and health outcomes, phase 2 studies validate or develop measures of physical activity, phase 3 studies identify factors that influence behavior or examine explanatory theories of behavior, phase 4 studies evaluate interventions, and phase 5 studies disseminate health promotion programs or policies and translate research into practice. SETTING Specific keywords were identified and then searched through EBSCOhost, PubMed, and Google Scholar. PARTICIPANTS Not applicable. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Not applicable. RESULTS One hundred and thirteen articles met the criteria. Of the articles, 55% were categorized as phase 1, 12% as phase 2, 24% as phase 3, 5% as phase 4, and 4% as phase 5. CONCLUSIONS Most studies were categorized as phase 1, 2, or 3, which implies that this field is still in the early stages of development and research should focus on intervention development and dissemination.

Systematic framework to evaluate the status of physical activity research for persons with multiple sclerosis

BACKGROUND Exploring the current state of health behavior research for individuals with multiple sclerosis is essential to understanding the next steps required to reducing preventable disability. A way to link research to translational health promotion programs is by utilizing the Behavioral Epidemiological Framework, which describes a sequence of phases used to categorize health-related behavioral research. OBJECTIVE This critical audit of the literature examines the current state of physical activity research for persons with multiple sclerosis by utilizing the proposed Behavioral Epidemiological Framework. METHODS After searching MEDLINE, PUBMED, PsycINFO, Google Scholar and several major areas within EBSCOHOST (2000 to present), retrieved articles were categorized according to the framework phases and coding rules. RESULTS Of 139 articles, 49% were in phase 1 (establishing links between behavior and health), 18% phase 2 (developing methods for measuring behavior), 24% phase 3 (identifying factors influencing behavior and implications for theory), and 9% phase 4 and 5 (evaluating interventions to change behavior and translating research into practice). CONCLUSIONS Emphasis on phase 1 research indicates the field is in its early stages of development. Providing those with multiple sclerosis with necessary tools through health promotion programs is needed to reduce secondary conditions and co-morbidities. Reassessment of the field of physical activity and multiple sclerosis in the future could provide insight into whether the field is evolving over time or remaining stagnant.

The unfairness of it all: Exploring the role of injustice appraisals in rehabilitation outcomes.

OBJECTIVE A fundamental principle of rehabilitation psychology is that individual appraisals of the social and physical environment-including injury itself-have profound consequences for coping and adjustment. When core assumptions of a just and predictable world are violated and accompanied by ostensibly undeserved suffering and loss, perceptions of injustice can arise. Given the role of appraisal processes in adjustment to disability, mounting empirical support, and absence of targeted interventions, the current article considers perceptions of injustice regarding personal injury/disability as a fundamental appraisal affecting rehabilitation outcomes. RESEARCH METHOD The authors review theory underpinning the relevance of injustice appraisals and critically examine existing literature regarding the impact of perceived injustice and related constructs (i.e., attribution of blame, anger, and belief in a just world) on adjustment following injury. RESULTS The authors bring attention to perceptions of injustice regarding personal injury/disability as a fundamental appraisal affecting rehabilitation outcomes. Dimensions of the social environment that have not received substantial attention in current research on condition-related injustice appraisals are highlighted. IMPLICATIONS Perceived injustice is a potentially central appraisal process to physical and psychological outcomes in the context of rehabilitation. Research regarding the role of perceived injustice, related constructs, and potential social/environmental modulators of injustice perception is still in its infancy. Guided buy its foundational principles, the field of rehabilitation psychology can broaden and shape inquiry regarding perceived injustice. This article aims to guide future research, offer concepts for key areas of discourse, and consider potential interventions in the rehabilitation psychology domain.

A systematic framework to classify physical activity research for individuals with spina bifida

BACKGROUND Identifying the types of research conducted in the area of physical activity (PA) for the spina bifida (SB) population is important in order to move research forward to increase PA behaviors and improve health. The Behavioral Epidemiological Framework is a one way to systematically classify PA and SB literature by organizing research into one of five phases: phase 1 research links behaviors to health, phase 2 includes research focused on developing methods for measuring behavior, phase 3 research identifies factors that influence behavior, phase 4 research evaluates interventions to change the behavior, and phase 5 studies translates research into practice. OBJECTIVE To systematically classify PA research for individuals with SB by using the Behavioral Epidemiologic Framework and to identify where the research has focused. METHOD An audit of the literature was conducted using search engines and keywords related to PA and SB. Inter-rater reliability was established between the research team coding articles based on established inclusion criteria. Finally, literature was categorized into one of the five phases. RESULTS Seventy-seven articles met the inclusion criteria and were categorized. Forty three percent of the articles were categorized in phase 1, 21% in phase 2, 32% in phase 3, 4% in phase 4, and zero in phase 5. CONCLUSION The majority of articles are in phase 1, indicating that PA and SB research is still in early stages of development. Future research needs to move beyond phase 1 to examine factors that affect PA behaviors and ways to increase PA behaviors in the SB population.

Evaluation of a Physical Activity Behavior Change Program for Individuals With a Brain Injury.

OBJECTIVE To investigate the effectiveness of a physical activity intervention for use within a comprehensive outpatient rehabilitation program for individuals with brain injury. DESIGN Quasi-experimental comparison group design with 3-month follow-up. SETTING Comprehensive outpatient rehabilitation clinic that is a transitional setting between acute inpatient rehabilitation and community dwelling. PARTICIPANTS Individuals (N=47) with a brain injury were enrolled into either the intervention (n=22; 8 women, 14 men; mean age, 48.68y) or control group (n=25; 9 women, 16 men; mean age, 46.23y). INTERVENTION Consisted of an 8-week informational and social/behavioral program that focused on enabling individuals to become independently active. The control group completed the standard of care typically available to patients in comprehensive outpatient rehabilitation. MAIN OUTCOME MEASURES Behavioral Risk Factor Surveillance Survey self-report physical activity items, Exercise Self-Efficacy Scale, and Mayo-Portland Adaptability Inventory-4. RESULTS The intervention group reported significantly (P<.001) greater weekly activity, self-efficacy, and rehabilitation outcomes at the completion of the program as well as at the 3-month follow-up when compared with the control group. Significantly, individuals in the experimental group reported increasing their weekly activity from 45 minutes preprogram to 72 minutes postprogram (d=2.12; 95% confidence interval, 1.78-2.52), and 67 minutes at 3-month follow-up. CONCLUSIONS Findings suggest that the intervention may be effective in increasing the physical activity behaviors of individuals engaged in a comprehensive outpatient rehabilitation program after brain injury.

Classifying physical activity research following stroke using the behavioral epidemiologic framework

Abstract Background: Stroke is a significant public health issue in the USA and a need emerges to better understand how to reduce an individuals co-morbidity risk. Physical activity is one approach to improving the health of individuals and comprehensive literature supports increased activity as a means to reduce risk of morbidity and mortality. One approach to examining whether research in a field is addressing a public health issue is through application of the behavioral epidemiological framework. Objective: To classify physical activity research for individuals following stroke into distinct phases so that efforts can be made to systematically address gaps and disseminate evidence-based practice. Methods: Specific key words were identified and then searched through EBSCOhost, PubMed, and Google Scholar. Physical activity and stroke literature from 2000–2014 was categorized into one of five discrete phases. Research in Phase 1 identified associations between activity and health; Phase 2 established valid measures of activity; Phase 3 examined determinants of behavior; Phase 4 evaluated activity interventions; and Phase 5 disseminated evidence-based practice. Results: A comprehensive review of literature identified 202 articles with 70% categorized in Phase 1 (n = 141), 11% in Phase 2 (n = 23), 10% in Phase 3 (n = 20), 8% in Phase 4 (n = 15), and 1% in Phase 5 (n = 3). Conclusion: Findings suggest that physical activity research for individuals following stroke is in the early stages of development with less than 10% of research evaluating or disseminating interventions.

Identifying predictors of resilience at inpatient and 3-month post-spinal cord injury

Objectives: To identify (1) changes in psychosocial factors, (2) relationships between psychosocial factors, and (3) significant predictors of resilience in adults with spinal cord injury (SCI) during inpatient rehabilitation and at 3-month post-discharge. Design: Cross sectional with convenience sample based on inclusion/exclusion criteria. Setting: Inpatient rehabilitation hospital and community-based follow-up. Participants: Individuals with a SCI. Interventions: Not applicable. Outcome measures: Demographic, resilience, self-efficacy for managing a chronic health issue, depression, social roles/activity limitations, and pain. Results: The final sample consisted of 44 respondents (16 women and 28 men). Results of repeated measure analyses of variance indicated no significant changes in variables between inpatient and 3-month follow-up. Bivariate correlations revealed associations between resilience and self-efficacy at inpatient (r = 0.54, P < 0.001), and resilience and depression (r = −0.69, P < 0.001) and self-efficacy (r = 0.67, P < 0.001) at 3-month follow-up. Hierarchical regression analyses a significant model predicting resilience at inpatient stay (R = 0.61; adjusted R2 = 0.24, P = 0.023), and at 3-month follow-up (R = 0.83; adjusted R2 = 0.49, P = 0.022). Self-efficacy was the strongest predictor at inpatient stay (β = 0.46, P  =  0.006) and depression was strongest at 3-month follow-up (β = −0.80, P = 0.007). Conclusion: Results suggest that although resilience appears to be stable from inpatient to 3-month follow-up, different factors are stronger predictors of resilience across time. Based on current results, an assessment of self-efficacy during inpatient rehabilitation and an identification of depression at 3-month follow-up may be important factors to help identify those at risk of health issues overtime.