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Study design:Systematic reviewObjectives:To determine the effect of respiratory muscle training (RMT) on pulmonary function in tetraplegia.Methods:A comprehensive search of the research literature included MEDLINE, EMBASE, CINAHL, ISI Web of Science, PubMed, the relevant Cochrane and clinical trials registers and hand-searching the reference lists of appropriate papers. There was no language restriction. All randomised controlled trials that involved RMT vs control were considered for inclusion. Two reviewers independently selected articles for inclusion, evaluated the methodological quality and extracted data. Additional information was sought from the authors when necessary.Results:Eleven studies (212 participants) were included. A significant benefit of RMT was revealed for five outcomes: vital capacity (mean difference (95% confidence interval))=0.41(0.17-0.64) l, maximal inspiratory pressure=10.66(3.59, 17.72) cmH2O, maximal expiratory pressure=10.31(2.80-17.82) cmH2O, maximum voluntary ventilation=17.51(5.20, 29.81) l min−1 and inspiratory capacity=0.35(0.05, 0.65) l. No effect was found for total lung capacity, peak expiratory flow rate, functional residual capacity, residual volume, expiratory reserve volume or forced expiratory volume in 1 second.Conclusion:RMT increases respiratory strength, function and endurance during the period of training. Further research is needed to determine optimum dosages and duration of effect. This article is based in part on a Cochrane review published in the Cochrane Database of Systematic Reviews (CDSR) 2013, DOI:10.1002/14651858.CD008507.pub2. Cochrane reviews are regularly updated as new evidence emerges and in response to feedback, and the CDSR should be consulted for the most recent version of the review. [ABSTRACT FROM AUTHOR]

Objectives:Spinal cord injury (SCI) research has highlighted links between psychological variables and employment outcome; however, there remains a need to consolidate the available heterogenous data.Methods:Meta-analytic techniques were used to examine and quantify differences in psychological functioning and employment status among adults with an acquired SCI. Fourteen observational studies (N=9, 868 participants) were identified from an electronic database search. Standardised mean difference scores between employed and unemployed groups were calculated using Cohen's d effect sizes. Additionally, 95% confidence intervals, fail-safe Ns, percentage overlap scores and heterogeneity statistics were used to determine the significance of d.Results:Moderate to large and positive weighted effects were noted across three broad psychological constructs: affective experience or feelings (dw=3.16), quality of life (dw=1.06) and life satisfaction (dw=0.70). However, the most compelling non-heterogeneous finding was associated with life satisfaction, a finding that was also not subject to publication bias. Inconsistent and weak associations between employment and individual measures of vocational attitude, self-efficacy, locus of control, adjustment and personality were also noted.Conclusion:Psychological factors and attributes are linked to employment post-SCI; however, the available data are limited in quantity. Longitudinal research is also needed to determine whether these variables can help to preserve employment over time. [ABSTRACT FROM AUTHOR]

Study design:Systematic review.Objectives:To determine the different treatment modalities aimed at achieving fecal continence in spina bifida (SB) patients and their effectiveness.Setting:International literature.Method:Electronic databases were searched ('Pubmed', 'Web of science', 'CINAHL' and 'Cochrane') identifying studies published since the mid-eighties and screened for relevance according to the Centre for Reviews and Dissemination procedure guidelines. A total of 37 studies were selected for inclusion.Results:Studies on toilet sitting, biofeedback, anal plug, retrograde colon enemas (RCE) and antegrade colon enemas were found. Fecal continence was achieved in 67% of SB patients using conservative methods (n=509). In patients using RCE (n=190) an 80% continence rate was reached. Patients following surgical treatment (n=469) reached an 81% continence rate, however, 23% needed redo surgery because of complications. Better fecal continence was associated with an improved quality of life, which was negatively influenced by the amount of time spent on bowel management.Conclusion:Evidence favors an individually tailored stepwise approach with surgery as a final step in case of failure of conservative measures. Continued specialized support throughout life remains important to maintain continence. Cross-over and comparative trials are needed in order to optimize treatment. [ABSTRACT FROM AUTHOR]

Study design:Review.Objectives:To review literature on subjective well-being (SWB; mental health and life satisfaction) and on psychological and social support factors associated with these outcomes in people with spinal cord injury (SCI), in order to identify gaps in scientific knowledge and recommend research priorities.Setting:Non applicable.Methods:Narrative review of the SCI literature on life satisfaction and mental health (depression, anxiety, post-traumatic stress syndrome) outcomes in people with SCI. Further, reviews were performed of the SCI literature on psychological and social support variables associated with SWB and on psychosocial interventions aimed to improve SWB.Results:People with SCI experience, on average, higher levels of distress and lower levels of life satisfaction compared with the general population. Individual differences, however, are large, and most people with SCI adapt well to their condition. A set of psychological and social support factors is strongly related to SWB. Intervention studies on cognitive behavioural therapy or coping effectiveness training to improve SWB show promising results, but suffer from methodological weaknesses (for example, lack of randomization and small sample size).Conclusion:There is a need for cohort studies with sufficient sample size, which include people early after onset of SCI in order to enhance our understanding of the course of mental health and well-being after SCI. Cohort studies could also identify which people are at risk for long-term impairment of SWB. Finally, intervention studies on psychosocial interventions are needed to identify which interventions may improve SWB of people with SCI. [ABSTRACT FROM AUTHOR]

Study design:Systematic literature review.Objectives:The purpose of this study was to gain a systematic overview of the role of psychological resources in the adjustment to spinal cord injury (SCI).Methods:A systematic literature review was performed. The literature search was conducted in the databases Pubmed, PsycINFO, the Social Sciences Citation Index, the Education Resources Information Center, Embase and the Citation Index of Nursing and Allied Health Literature. The assessed variables, measurement instruments, results and the methodological quality of the studies were extracted, summarized and evaluated.Results:A total of 83 mainly cross-sectional studies were identified. Psychological resources were categorized into seven groups: self-efficacy (SE), self-esteem, sense of coherence (SOC), spirituality, optimism, intellect and other personality characteristics. SE and self-esteem were consistently associated with positive adjustment indicators such as high well-being and better mental health. Interrelations between psychological resources and key rehabilitation outcome variables such as participation were rarely studied. Only a few interventions, which were aimed at strengthening psychological resources were identified. Longitudinal studies suggested that SE, SOC, spirituality and purpose in life were potential determinants of adjustment outcomes in the long term.Conclusion:Research on psychological resources in SCI is broad, but fragmented. Associations of psychological resources with mental health and well-being were frequently shown, while associations with participation were rarely studied. Further development of resource-based interventions to strengthen persons with SCI is indicated. This review can serve as guide for clinical practice and can add to the design of future SCI research. [ABSTRACT FROM AUTHOR]

Study design:Systematic review.Objectives:To review the literature on relationships between psychological factors and quality of life (QOL) of persons with spinal cord injury (SCI).Setting:NA.Methods:A systematic literature search was conducted in several online databases (PubMed, Embase and PsychInfo). Articles were included if they provided quantitative information on associations between QOL-related dependent variables and psychological factors as independent variables in an SCI population. The search was limited to empirical studies published in English. The methodological quality of the included articles was assessed.Results:A total of 48 studies were included. Total locus of control, sense of coherence, self-worth, hope, purpose in life and positive affect were consistently associated with greater QOL. Negative affect and posttraumatic cognitions were consistently associated with lower QOL. Inconsistent evidence was found for subscales of locus of control, the role of attribution of blame, spirituality, personality, appraisals, passive coping and emotion-focused coping. No evidence was found for an association between active problem-focused coping styles and QOL.Conclusion:Many psychological factors were strongly and consistently related to QOL, but for some others no or inconsistent evidence was found. Further research should (1) use larger study groups, preferably in longitudinal designs, (2) improve terminological precision and avoid conceptual overlap between determinants and outcomes, (3) increase uniformity of questionnaires and (4) reexamine concepts that have been abandoned prematurely, such as personality and social comparison. [ABSTRACT FROM AUTHOR]