Using the Multidimensional Model of Acceptance to Investigate How Different Facets of Acceptance are Related to Quality of Life Following Spinal Cord Injury

Objective: To determine how different facets of acceptance are related to quality of life (QoL) following spinal cord injury, after controlling for sociodemographic factors, injury-related variables, depression, and anxiety. Participants: Adults with spinal cord injury. Methods: Questionnaires were completed via research electronic data capture (REDCap). Three separate hierarchical multivariate linear regression analyses were performed, with physical QoL, psychological QoL, and global QoL as outcomes. Sex, age, time since injury, depression, anxiety, and 4 facets of acceptance (i.e. “accepting reality”, “valuechange”, “letting go of control” and “behavioural engagement”) were independent variables. Results: Of the 686 eligible participants, 453 responded (66.0%). The sample included 303 men (66.9%), mean (standard deviation; SD) age 56.6 (15.0) years and mean (standard deviation) time since injury 14.6 (11.4) years. The final regression models (n = 376) explained 46% of global QoL, 47% of psychological QoL and 31% of physical QoL. The 4 facets of acceptance significantly increased the amount of variance explained by 6% for psychological QoL, 8% for physical QoL and 14% for global QoL. The facets “value-change” and “behavioural engagement” made significant contributions to all domains of QoL, while “letting go of control” only contributed to global QoL, and “accepting reality” only contributed to psychological QoL. Conclusion: Acceptance may support higher QoL in more ways than simply reducing psychological distress, and could be an important process to facilitate in rehabilitation after spinal cord injury. LAY ABSTRACT Acceptance of spinal cord injury refers to psychological processes involved in acknowledging reality, re-evaluating life values, and engaging in meaningful activities despite psychological distress. Acceptance is believed to play an important role in helping individuals achieve a better quality of life following spinal cord injury. However, it is unclear whether acceptance adds something more to the experience of quality of life than simply reducing psychological distress. This study explored the association between acceptance and quality of life using a multifaceted understanding of acceptance. Data were collected from 453 individuals with spinal cord injury. Statistical analysis showed that acceptance was associated with quality of life even after adjusting for the effect of psychological distress. It further showed that 2 facets of acceptance, entitled “value-change” and “behavioural engagement”, were the most important facets in explaining quality of life. In sum, acceptance might be an important process to facilitate in rehabilitation following spinal cord injury. Specifically, it might be beneficial to support individuals with spinal cord injury in finding new values and interests (i.e. “value-change”), and motivating them to engage in meaningful activities even in the presence of psychological distress (i.e. “behavioural engagement”).