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Self-efficacy (SE) is an important determinant for the psychological adjustment of people with spinal cord injury (SCI). However, little is known about the course of SE during inpatient rehabilitation up to 1 year after discharge. The aim of this study was to determine latent trajectory classes of SE, depressive mood, and anxiety in people with SCI, as well as the interrelationships between these trajectories. Longitudinal inception cohort study. Eight specialized SCI rehabilitation centers. The participants (N=268) were mainly men 183 of 268 (68.3%) with a mean age of 55.6 years. Almost half had a traumatic SCI 135 of 268 (50.4%) and tetraplegia (53.7%), and the minority had a motor complete SCI (32.2%). Not applicable. SE was measured using the University of Washington Self-Efficacy Scale. In addition, the Hospital Anxiety and Depression Scale was used to asses distress and perform dual trajectory modeling analyses. Three trajectories of SE, indicating low, middle, and high SE, could be distinguished. Furthermore, a 2-class trajectory solution for depressive mood and a 4-class solution for anxiety were found to be most suitable. All trajectories were stable over time. Developmental connections between SE and depressive mood and between SE and anxiety were revealed. In particular, participants who adjusted well, reporting low scores on depressive mood and anxiety, could be identified by their high SE scores. However, the group of participants with high depressive mood scores and anxiety scores could not always be identified based on their SE trajectory. In accordance with our hypotheses, distinct trajectories of SE, depressive mood, and anxiety were identified and high probabilities that SE trajectories were interrelated to the trajectories from depressive mood and anxiety were confirmed. Concurrent screening for SE and distress might best detect people at risk for adjustment problems. [ABSTRACT FROM AUTHOR]

Abstract Objectives To establish self-efficacy and depressive mood trajectories in adults with spinal cord injury (SCI), determine their interrelationship over time, and determine the influence that appraisals and comorbid physical conditions have on the development of self-efficacy. Design A prospective cohort design. Setting Inpatient rehabilitation and community settings. Participants Adults (N=88) admitted consecutively into 3 SCI units (mean age, 42.6 years, 70.4% male, 61% paraplegia). Interventions Multidisciplinary inpatient SCI rehabilitation. Main Outcome Measures The Moorong Self-Efficacy Scale and Hospital Anxiety and Depression Scale were used to model self-efficacy and depressive mood trajectories. Appraisals were assessed using the Appraisals of Disability Scale and frequency/type of secondary conditions using the Secondary Conditions Scale. Growth mixture modeling was used to determine trajectories. Dual trajectory probability analysis was used to determine concurrent changes in self-efficacy and depressive mood. Linear mixed modeling incorporating repeated measures determined the contribution of appraisals and physical complications to self-efficacy trajectories. Results Modeling identified 4 trajectories of self-efficacy and depressive mood. The majority (around 60%) of the sample was estimated to have moderate to high self-efficacy and low levels of depressive mood. Dual trajectory analysis revealed that robust self-efficacy was strongly connected to low depressive mood over time, while low self-efficacy was strongly linked to clinically elevated depressive mood. Low self-efficacy was related to higher severity of secondary conditions and negative appraisals. Conclusions Findings highlight the importance of self-efficacy not only as a strategic clinical measure for assessing adjustment following SCI but also in relation to the implications it raises for improving SCI rehabilitation. [ABSTRACT FROM AUTHOR]

Chronic pain is prevalent in people with spinal cord injury (SCI). We investigated how chronic pain intensity and catastrophizing varies in adults with SCI during inpatient rehabilitation up to 12 months postinjury after transitioning into the community. Eighty-eight participants with SCI were assessed for pain intensity and catastrophizing, depressive mood states, and cognitive performance. Participants were divided into subgroups of clinically elevated depressive mood and anxiety versus those with normal mood state levels. The rate of clinically elevated pain catastrophizing was 22.5% at 12 months postinjury. Participants with elevated anxiety reported significantly higher pain intensity 12 months postinjury. Participants with clinically elevated depressive mood and anxiety reported significantly elevated pain catastrophizing 12 month postinjury. Findings indicate those with elevated depressive mood states will be more likely to have high levels of pain and engage in cognitive appraisals involving pain-related catastrophizing. Importantly, however, risk of increased pain intensity and catastrophizing occurred only after transitioning into the community, when personal resources will be severely challenged. Implications of these results for models of pain catastrophizing are discussed and it is concluded there is a need for ongoing support in the community to develop self-management skills and strategies that strengthen social support networks.Perspective: We studied pain catastrophizing and negative mood states in adults with SCI. Catastrophizing was higher in those with depression, but only after discharge from hospital into the community. Results provide direction for improving treatment of pain catastrophizing in adults with SCI who are depressive and anxious. [ABSTRACT FROM AUTHOR]

Objective To improve the clinical utility of the Moorong Self-Efficacy Scale (MSES) by reexamining its factor structure and comparing its performance against a measure of general self-efficacy in persons with spinal cord injury (SCI). Design Cross-sectional survey design. Setting Community. Participants Adults with SCI (N=161; 118 men and 43 women) recruited from Australia (n=82) and the United States (n=79), including 86 with paraplegia and 75 with tetraplegia. Interventions None. Main Outcome Measures Confirmatory factor analysis deriving fit indices on reported 1-, 2-, and 3-factor structures for the MSES. Exploratory factor analysis of MSES using principal component analysis with promax oblique rotation and structure validation, with correlations and multiple regression using cross-sectional data from the Sherer General Self-Efficacy Scale and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Results The MSES was confirmed to have a 3-factor structure, explaining 61% of variance. Two of the factors, labeled social function self-efficacy and personal function self-efficacy, were SCI condition–specific, whereas the other factor (accounting for 9.7% of variance) represented general self-efficacy, correlating most strongly with the Sherer General Self-Efficacy Scale. Correlations and multiple regression analyses between MSES factors, Sherer General Self-Efficacy Scale total score, SF-36 Physical and Mental Component Summary scores, and SF-36 domain scores support validity of this MSES factor structure. No significant cross-cultural differences existed between Australia and the United States in total MSES or factor scores. Conclusions The findings support a 3-factor structure encompassing general and SCI domain–specific self-efficacy beliefs and better position the MSES to assist SCI rehabilitation assessment, planning, and research. [ABSTRACT FROM AUTHOR]

Objective To conduct a prospective study of the occurrence of psychological disorders and comorbidities after spinal cord injury (SCI), determine psychotropic medication usage, and establish predictors of psychological disorders after transition to the community. Design Longitudinal design with multiple measures. Setting Assessment occurred in SCI units and the community. Participants Adults with SCI (N=88) admitted over a period of 32 months into 3 SCI units. Interventions Participants completed inpatient rehabilitation for an acute SCI. Longitudinal assessment occurred up to 6 months postdischarge. Main Outcome Measures Measures were chosen that had a theoretical and clinical foundation for contributing to recovery after SCI. The Mini International Neuropsychiatric Interview, a structured diagnostic psychiatric interview, was conducted to determine the presence of psychological disorders. Medical measures included severity of secondary conditions or complications. Psychological measures included measures of anxiety and depressive mood, resilience, pain catastrophization, self-efficacy, and cognitive capacity. Results Rates of psychological disorders of 17% to 25% were substantially higher than rates found in the Australian community. The occurrence of psychological disorder comorbidities was also very high. Anxiety was significantly elevated in those with a psychological disorder. Psychotropic medications were prescribed to more than 36% of the sample, with most being antidepressants. Factors predictive of psychological disorders included years of education, premorbid psychiatric/psychological treatment, cognitive impairment, secondary complications, resilience, and anxiety. Conclusions SCI can have a substantial negative impact on mental health that does not change up to 6 months postdischarge. Findings suggest a substantial minority experience increased psychosocial distress after the injury and after transitioning into the community. Additional resources should be invested in improving the mental health of adults with SCI. [ABSTRACT FROM AUTHOR]

Abstract: Chronic pain, chronic fatigue, and depressive mood are prevalent conditions in people with spinal cord injury (SCI). The objective of this research was to investigate the relationship between these conditions in adults with SCI. Multivariate analysis of variance, contingency analyses, and hierarchical regression were used to determine the nature of the relationship, as well as the contribution to this relationship of self-efficacy, a potential mediator variable. Seventy participants with SCI living in the community completed an assessment regimen of demographic and psychometric measures, including validated measures of pain, fatigue, depressive mood, and self-efficacy. Results indicated that participants with high levels of chronic pain had clinically elevated depressive mood, confusion, fatigue, anxiety and anger, low vigor, and poor self-efficacy. Participants with high chronic pain had 8 times the odds of having depressive mood and 9 times the odds of having chronic fatigue. Regression analyses revealed that chronic pain contributed significantly to elevated depressive mood and that self-efficacy mediated (cushioned) the impact of chronic pain on mood. Furthermore, both chronic pain and depressive mood were shown to contribute independently to chronic fatigue. Implications of these results for managing chronic pain in adults with SCI are discussed. Perspective: The relationship between pain, negative mood, fatigue, and self-efficacy in adults with SCI was explored. Results support a model that proposes that chronic pain lowers mood, which is mediated (lessened) by self-efficacy, whereas pain and mood independently increase chronic fatigue. Results provide direction for treating chronic pain in SCI. [Copyright &y& Elsevier]

Abstract: Wijesuriya N, Tran Y, Middleton J, Craig A. Impact of fatigue on the health-related quality of life in persons with spinal cord injury. Objective: To study the impact of fatigue on health-related quality of life (HR-QOL) associated with spinal cord injury (SCI). Design: Matched group design with several independent measures. Setting: University-based laboratory. Participants: Persons with SCI (n=41) and an average 16.5 years duration of community living with SCI and a group of able-bodied controls (n=41) with similar sex ratio, age, and level of education. Participants with SCI were enrolled through rehabilitation unit contacts and through advertising in newsletters. Interventions: Not applicable. Main Outcome Measures: The main independent measures reported in this article include the Iowa Fatigue Scale and the Medical Outcomes Study 36-Item Short-Form Health Survey. Results: As expected, persons with SCI were found to have significantly lower HR-QOL. Fatigue was found to be more prevalent in the SCI group, and was associated with lower HR-QOL in both groups. Factorial analysis of variance indicated significant interactions in which persons with SCI with low fatigue levels had similar HR-QOL to the able-bodied controls regardless of their fatigue level, while persons with SCI with elevated fatigue had significantly reduced HR-QOL. Factors such as age, education, completeness and level of lesion, and community integration were not associated with increased fatigue levels. However, a shorter time since injury was found to be significantly associated with higher levels of fatigue. Conclusions: The Iowa Fatigue Scale data suggest over 50% of the SCI group had elevated fatigue, which was associated with significantly reduced HR-QOL. Research is needed that identifies factors that raise vulnerability to fatigue, and strategies designed to address the negative impacts of fatigue need to be evaluated. [Copyright &y& Elsevier]

Abstract: Purpose: This study investigated the influence of manual acupuncture on heart rate variability and the role which anxiety can play in modifying physiological outcomes. Method: Analysis of heart rate variability (HRV) was used as a sensitive and a reliable indicator of the balance between sympathetic and parasympathetic regulation of the heartbeat. Two groups of healthy female subjects were recruited into the study. The control group (n =30) attended one experimental session where no acupuncture treatment was used. The experimental group (n =30) attended three sessions in which unilateral manual stimulation of acupuncture points LU7 and KD6 was performed. Results: The stimulation of the acupuncture points LU7 and KD6 was not associated with significant changes in HRV. Previous familiarity with acupuncture did not influence the outcomes but level of anxiety had a strong impact on physiological outcomes. Stimulation of LU7 acupuncture point counterbalanced naturally occurring sympathetic increase over time and had relaxing and harmonizing effect on the heart rhythm without influencing subjective perception of increased anxiety. Stimulation of KD6 acupuncture point had sympathetic influence on HRV in subjects with low “trait” anxiety and this influence was nullified by simultaneous stimulation of LU7 acupuncture point. Conclusions: It seems likely that the level of anxiety can modify HRV during acupuncture treatment and up to 40min after the treatment. Psychological factors such as anxiety level should be considered as having important influence on physiological response to acupuncture. [Copyright &y& Elsevier]

Summary: Change in amplitude of skin potential is one of the physiological indicators of electrodermal activity (EDA) and has been associated with the onset of a variety of sensory, cognitive and emotional stimuli. This study investigated the EDA physiological response to manual acupuncture. A group of 60 healthy female volunteers were recruited into the study of which 30 were randomly assigned to a control group (no acupuncture) and 30 to the experimental group (received acupuncture). The experimental group attended three sessions in which acupuncture intervention consisting of unilateral manual stimulation of acupuncture points LU7 and KD6. Results showed that the insertion, stimulation and withdrawal of the acupuncture needles were associated with significant changes in EDA. The insertion of the needle was associated with the highest change in skin potential while the three consecutive manipulations of the needles showed a decline in EDA amplitude, thought to be consistent with physiological habituation. Anxiety level and previous familiarity with acupuncture did not influence outcomes. It is postulated that the change in EDA during needle insertion is non-specific to the type and the function of acupuncture points; however, EDA response may be associated with the precise location of the acupuncture point. If further studies confirm such findings, then EDA may become a valuable physiological marker for the acupuncture phenomenon. [Copyright &y& Elsevier]

Abstract: Middleton J, Tran Y, Craig A. Relationship between quality of life and self-efficacy in persons with spinal cord injuries. Objective: To study the interaction between quality of life in people with spinal cord injury (SCI) and expectations of daily living (self-efficacy) and pain. Design: Cross-sectional study with multiple independent measures. Setting: Home survey. Participants: Included 106 persons with SCI of 12 months or more in duration who were living in the community and had enrolled from past admission lists in a rehabilitation unit. Intervention: Participants received no treatments as part of the study but were asked to complete 2 questionnaires by postal survey in their postrehabilitation stage. Main Outcome Measures: The Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) and the Moorong Self-Efficacy Scale. Results: Persons with SCI were found to have lowered quality of life (QOL) compared with the Australian general population. Low self-efficacy and pain intensity were found to reduce QOL across all SF-36 domains even further. Factors such as completeness of lesion, sex, age at time of injury, and time since injury were not associated with reduced QOL. Tetraplegia was associated with lower QOL in physical functioning and greater limitation due to bodily pain. A combination of low self-efficacy and pain intensity was associated with an increased reduction in QOL compared with reductions seen for these factors by themselves. Conclusions: Rehabilitation strategies may need to concentrate on improving QOL by targeting factors like low self-efficacy. [Copyright &y& Elsevier]