The relation between spirituality and quality of life among individuals with spinal cord injury.

Objective: To determine how spiritual-based coping relates to quality of life in individuals with spinal cord injury (SCI). Design, Setting, & Participants: A telephone interview of 75 participants, primarily Caucasian single men aged 19 to 71 (enrolled in the Northern New Jersey Spinal Cord Injury Model System). Measures: Ellison's Spiritual Well-Being Scale, Duke Health Profile, Craig Handicap Assessment and Reporting Technique, Diener's Satisfaction With Life Survey. Results: Virtually all participants (98.7%) reported using some form of spiritual-based coping. Quality of life was highest among participants who use existential spiritual as opposed to religious spiritual coping. In particular, existential spirituality shared 27% variance with overall perceived life quality. Conclusions: Spiritual-based coping might be encouraged as a possible strategy to improve life quality. Clinicians should be cognizant of ongoing spiritual practices among persons with SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exercise as stigma management for individuals with onset-controllable and onset-uncontrollable spinal cord injury.

Studies have suggested that individuals with physical disabilities are often stigmatized and are perceived to possess less favorable physical and psychological characteristics than individuals without disability. Purpose: To investigate whether able-bodied adults' perceptions of people with different causes of spinal cord injury (SCI) are influenced by physical activity status information. Method and Participants: Each participant (N = 198) read all five vignettes describing individuals with SCI who had varying levels of physical activity participation and cause of injury information (e.g., onset-uncontrollable [hit by impaired driver] and onset-controllable [caused by impaired driving]). After reading each vignette, participants completed a 12-item Warmth and Competence Questionnaire to evaluate each target. One-way repeated measures multivariate analyses of variance were conducted to examine the within-subjects differences. Results: Physically active individuals with onset-uncontrollable SCI were rated most favorably on warmth and competence. Physically active individuals with onset-controllable SCI also were rated more favorably on warmth and competence than physically inactive targets with onset-controllable SCI. Conclusion: A physically active lifestyle may be beneficial in managing the stigma experienced by individuals with both onset-controllable and onset-uncontrollable SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Improving the quality of life of caregivers of persons with spinal cord injury: A randomized controlled trial.

Objective: To assess the efficacy of two psychosocial interventions for caregivers of older persons with spinal cord injury (SCI). Design: A multisite, three-group, randomized controlled trial comparing two active intervention conditions with each other and to an information-only control group. One hundred seventy-three caregiver and care-recipient dyads were randomly assigned to one of three conditions: a caregiver-only treatment condition in which caregivers received a multicomponent intervention based on their risk profile; a dual-target condition in which the caregiver intervention was complemented by a treatment targeting the care recipient, designed to address both caregiver and care recipient risk factors; and an information-only control condition in which the caregiver received standard printed information about caregiving, SCI, and aging. Outcome Measures: A multivariate outcome comprised of six indicators linked to the goals of the interventions was the primary outcome of the study. The multivariate outcome included measures of depressive symptoms, burden, social support and integration, self-care problems, and physical health symptoms. Results: At 12 months, caregivers in the dual-target condition had improved quality of life as measured by our multivariate outcome when compared to the control condition. Using the dyad as the unit of analysis, the dual-target condition was superior to both the control condition and the caregiver-only condition in our multivariate outcomes analysis. Dyads enrolled in the dual-target condition had significantly fewer health symptoms than control condition and caregiver-only condition participants and were less depressed when compared to participants in the caregiver-only condition. In follow-up analyses we found that a higher proportion of caregivers in the dual-target condition had clinically significant improvements in depression, burden, and health symptoms when compared with the caregiver-only condition. Conclusion: Caregivers are in need of and can benefit from interventions that help them manage the medical and functional limitations of the care recipient. Intervention strategies that target both the caregiver and care recipient are particularly promising strategies for improving the quality of life of caregivers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Preferred methods and messengers for delivering physical activity information to people with spinal cord injury: A focus group study.

Objective: To explore the perceptions of people with spinal cord injury (SCI) regarding preferred messengers and methods for obtaining physical activity (PA) information. Design: Using a phenomenological approach and interviewing techniques, five focus groups discussed PA information delivery methods and messengers. Participants: Sixteen community-dwelling adults with SCI (62.5% tetraplegia, 37.5% paraplegia; at least one-year postinjury) whose PA levels ranged from sedentary to regularly active. Results: Content analyses revealed that the preferred media for obtaining PA information were passive sources (e.g., Internet, DVDs, newsletters). The preferred messengers were peers and health service providers. There were diverse perspectives about the value and types of PA messages to share with people in the acute, rehabilitation, and postdischarge stages. Conclusions: The methods and messengers identified in this study illustrate the need for interdisciplinary engagement among various program and health care providers to work together to effectively deliver PA information to all individuals with SCI. People will be receptive to different messages, from different channels, at different times. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Qualitative analysis of the peer-mentoring relationship among individuals with spinal cord injury.

Objectives: To identify salient dimensions and outcomes of the peer-mentoring relationship among individuals with spinal cord injury (SCI). To understand from the perspective of the mentee how the mentoring relationship differs from other supportive relationships. Study Design: Qualitative. Participants: Convenience sample of 7 mentees from a hospital-based SCI peer-mentoring project. Method: Telephone interviews with mentees were conducted 1-4 months postdischarge, and results were coanalyzed with grounded theory methodology. Results: Mentees emphasized the impact of the mentor in terms of his or her practical, emotional, and identity-changing influence. Relationship quality was influenced by multiple factors (e.g., age, friendliness). Five components of the relationship (credibility, equitability, mutuality, acceptance, normalization) differentiated mentoring from other supportive relationships. Conclusions: Peer mentors provide a unique combination of supportive elements not replicated by other relationships. Mentoring programs are useful interventions for facilitating adjustment after SCI. Recommendations for implementing a mentoring program are provided on the basis of participant suggestions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A volitional help sheet to encourage smoking cessation: A randomized exploratory trial.

Objective: The volitional help sheet draws on Gollwitzer's (1993) concept of implementation intentions by encouraging smokers to link temptations to smoke with appropriate behavioral responses derived from Prochaska and DiClemente's (1983) transtheoretical model. Design: There were 193 smokers who were randomly allocated to receive questionnaires, planning instruction, and a volitional help sheet or one of three control conditions: Questionnaire-only; questionnaire plus planning instruction; or questionnaire, planning instruction plus volitional help sheet without the explicit instruction to link temptations to smoke with appropriate behavioral responses. Main Outcome Measures: Nicotine dependence, number of cigarettes smoked and quit status. Results: Findings revealed significant decreases in nicotine dependence, number of cigarettes smoked, and increases in quitting in the volitional help sheet condition, relative to the control conditions, Fs(3, 189) = 7.48 to 10.78, ps ps = .11 to .15. This pattern of findings did not hold for social?cognitive variables, with few differences between the volitional help sheet (standard instructions) group and the other conditions. Conclusion: The findings provide support for the use of implementation intentions to protect against health risk behaviors and are congruent with laboratory research showing that implementation intentions are a case of strategic automaticity. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Theory of Planned Behavior in Prediction of Leisure Time Physical Activity Among Individuals With Spinal Cord Injury.

Objective: To examine the utility of the theory of planned behavior (TPB) for predicting leisure time physical activity (LTPA) among individuals with spinal cord injury (SCI). Study Design: Prospective correlational design. Participants: 104 men (n=75) and women (n=29) with SCI. Method: Baseline telephone interview assessing attitudes, subjective norms, perceived behavioral control (PBC), and intentions for engaging in LTPA. One-week follow-up telephone interview assessing frequency of LTPA. Results: Attitudes (β=.29), subjective norms (β=.29), and PBC (β=.47) each predicted LTPA intentions. LTPA intentions (β=.45) but not PBC (β=-.05) predicted LTPA. Furthermore, intentions mediated the attitudes-LTPA, subjective norms-LTPA, and PBC-LTPA relationships. Conclusions: These findings support the tenets of the TPB and provide a foundation for developing interventions promoting LTPA in the SCI population. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Sleep problems in individuals with spinal cord injury: Frequency and age effects.

Objectives: The two objectives of this study were (a) to replicate the previous finding of more severe sleep difficulties in a sample of individuals with spinal cord injury (SCI) compared with normative samples, and (b) to examine the associations between aging variables (specifically, chronological age, duration of SCI, age at SCI onset) and the severity of sleep difficulties. Design: Cross-sectional survey. Research Method: A survey was administered to 620 individuals with SCI that included measures of demographic characteristics and sleep difficulties. Results: The findings indicated that sleep problems are more common in individuals with SCI than in normative samples. In addition, younger participants in our sample reported more sleep problems than did older participants. Duration of SCI and age at onset, however, were not significantly associated with sleep difficulties. Conclusion: The analyses used in this study provide a model for examining age effects using concurrent survey data that may be useful for other investigators interested in studying the associations between age-related variables and important health-related domains. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ethnicity and age issues: Attitudes affecting rehabilitation of individuals with spinal cord injury.

The individual with spinal cord injury, family, staff, and significant others bring attitudes regarding age and ethnicity into the rehabilitation team dynamic. Such preconceived attitudes may direct one's ability to be open to change and incorporate new information. The authors present 3 cases that highlight the bidirectional nature of bias challenges and the potential impact of bias issues on the hospital setting, staff, individual, family, and significant others. The bidirectional nature of bias challenges is illustrated with 2 cases of bias issues presented by individuals with spinal cord injury during hospitalization and with I case of bias impact on an individual health care provider. Interventions and strategies to maximize information sharing, education, and adjustment during hospitalization, discharge planning, and community living are discussed. Individuals may face increasing challenges in maximizing the derived benefit from both health care delivery and community services if personal bias plays a role in excluding qualified personnel from consideration. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: A randomized clinical trial.

Purpose: To compare coping effectiveness training (CET) with supportive group therapy (SGT) for anxiety, depression, and adjustment to injury in an acute spinal cord injury/dysfunction (SCI/D) rehabilitation population. CET was shown to result in decreased anxiety and depression symptoms when compared to historical no-treatment control groups (Kennedy, Duff, Evans, & Beedie, 2003; King & Kennedy, 1999). The present study sought to extend those findings with a comparison of CET to an alternative active therapy condition, SGT. Research Method: Participants (N = 40) entering a hospital-based program were assigned to treatment condition using block randomization. Questionnaire mood measures were completed at program admission, program discharge, and 3-month postdischarge follow-up. Adjustment to disability was assessed at follow-up only. Analyses of variance tested for group differences in anxiety, depression, and adjustment to injury. Results: Both groups reported reductions in mood symptoms with no differences between treatment conditions. However, similar reductions were obtained after fewer sessions of CET. Symptoms of depression increased in both groups following hospital discharge. Conclusions: Clinical and research implications, including innovative interventions during the period after discharge, are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

A connectionist implementation of the theory of planned behavior: Association of beliefs with exercise intention.

The theory of planned behavior suggests attitudes are a product of salient beliefs. This study examined whether aggregating salient beliefs was plausible within a more biologically centered information-processing environment. A neural network was used to examine associations among beliefs relating to exercise intention. Data on intentions and behavioral, normative, and control beliefs from 114 respondents were used to train (by error backpropagation) a neural network to associate beliefs with intention. The R2 between the network's estimated and self-reported intention was .66. The network's representation comprised 6 belief profiles associated with high, moderate, or low behavioral intention. The neural network accommodated complex relationships among beliefs and belief-intention associations and indicated how high-level constructs such as attitudes may be viewed as the best fit (compromise state) between aroused beliefs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Making self-help more helpful: A randomized controlled trial of the impact of augmenting self-help materials with implementation intentions on promoting the effective self-management of anxiety symptoms.

Objective: The effectiveness of self-help materials may be constrained by failures to undertake recommended exercises or to deploy the techniques that one has learned at the critical moment. The present randomized controlled trial investigated whether augmenting self-help materials with if–then plans (or implementation intentions) could overcome these problems and enhance the self-management of anxiety symptoms. Method: At baseline, participants who reported anxiety symptoms completed the Hospital Anxiety and Depression Scale (HADS) and the state version of the State–Trait Anxiety Inventory (STAI). Participants were then randomized via a computer program to standard self-help (n = 86), augmented self-help (n = 90), or no-intervention (n = 86) conditions. Eight weeks later, 95% (n = 249) of the participants completed the HADS and STAI again. Results: Findings showed a significant reduction in anxiety in the augmented self-help condition compared with both the standard self-help and no-intervention conditions (caseness rates on the HADS at follow-up were 21%, 49%, and 44%, respectively). Mediation analyses indicated that the benefits of augmented self-help materials were explained by improved detection of anxiety-related triggers and greater experienced benefits of the self-help techniques. Conclusions: These findings suggest that implementation intentions offer a valuable supplement to self-help materials that can enhance their impact on outcomes. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Efficacy of a brief worksite intervention to reduce smoking: The roles of behavioral and implementation intentions.

The effectiveness of worksite interventions to reduce smoking needs to be enhanced because randomized controlled trials to date have produced mixed findings. The present study tested the ability of social-cognitive variables to mediate the past behavior-future behavior relationship and the effectiveness of implementation intentions to break the past behavior-future behavior relationship in a brief theory-based worksite intervention designed to reduce smoking. Smoking behavior and psychosocial orientation to quit (operationalized by theory of planned behavior variables and temptations) were measured at baseline; participants (N=90) randomized to the experimental condition were also asked to form an implementation intention in their place of work. Identical measures taken 2 months postbaseline revealed that intention was a potent mediator of the past behavior-future behavior relationship. More important, significantly more people quit smoking in the experimental condition than in the control condition. Decomposition of these effects showed that implementation intentions worked best for individuals who were more motivated to quit at baseline and suggest that harnessing both motivational and volitional processes might enhance the effectiveness of worksite smoking cessation programs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Planning to lose weight: Randomized controlled trial of an implementation intention prompt to enhance weight reduction among overweight and obese women.

Objective: The trial investigates the effects of augmenting an established weight-reduction intervention with implementation intention prompts. Design: Fifty-five overweight or obese women (ages 18 to 76 years; body mass index from 25.28 to 48.33) enrolled in a commercial weight reduction program were randomly assigned to either an implementation intention prompt or a control condition. Data were collected twice, with a time gap of 2 months. Main Outcome Measures: The primary outcome was participants' change in weight and body mass index from preintervention to follow-up. Results: Repeated measures analysis of variance revealed a significant Time = Condition interaction: On average, implementation intention prompt participants lost 4.2 kg (95% confidence interval = 3.19, 5.07), whereas control participants lost 2.1 kg (95% confidence interval = 1.11, 3.09). The change in frequency of planning mediated the effects of the intervention on weight and body mass index change. Conclusion: Among obese or overweight women participating in a commercial weight loss program, those who learn to form implementation intentions can achieve greater weight reduction. Planning facilitation is a key mechanism explaining enhanced weight loss generated by implementation intention formation. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Communal behaviors and psychological adjustment of family caregivers and persons with spinal cord injury.

Objective: Examined the influence of mutual communal behaviors on the adjustment reported by persons with spinal cord injury (SCI) and their family caregivers. Previous research has found that persons who have a history of mutually communal behaviors in relationships may react differently to relationship changes after an acquired physical disability than dyads with few communal behaviors. Method: Family caregivers and persons with SCI were administered measures of mutual communal behaviors, depression, and life satisfaction. Structural equation modeling was used to test the relations among caregivers' communal behaviors and care recipients' communal behaviors, depression, and life satisfaction. Results: Caregiver and care recipient reports of communal behaviors were not significantly correlated. Significant paths indicated that care recipients' communal behavior scores were positively associated with their life satisfaction, and care recipients' depression was inversely associated with their life satisfaction. Caregivers' communal behavior scores were unrelated to their self-reported adjustment. Conclusions: Caregiver-care recipient dyads may differ in their perceptions of communal behaviors in their relationships. Although care recipient reports of communal behavior may be related to their life satisfaction, communal behaviors may not serve a similar function among caregivers of persons with SCI. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Life activities among individuals with spinal cord injury living in the community: Perceived choice and perceived barriers.

Objective: To apply the World Health Organization model of functioning to a study of perceived choice over life activities and barriers to engaging in life activities among persons with spinal cord injury. Participants and Setting: This large community-dwelling sample included 255 participants from 2 urban sites and 1 rural site. Measure: Items from the Participation of People With Mobility Limitations Survey were used. Results: Approximately half of the participants reported little or no perceived choice with employment, and the majority reported low levels of satisfaction with choice with employment. Access to employment was limited by physical barriers (48%) and transportation (46%). Physical impairment, pain, and fatigue were also barriers. Conclusions: Improvements of workplace and transportation accessibility, increased vocational supports, and interventions to decrease pain and fatigue are needed to ensure participation for persons with spinal cord injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Psychosocial predictors of employment status among men living with spinal cord injury.

Objective: To explore the relationship between employment status and community access, perceived community discrimination, social support from significant others, depressive symptoms, and gender-related variables for 83 men living with spinal cord injury. Study Design: Correlational research. Setting: Internet-based investigation employing spinal cord injury listservs. Main Outcome Measure: Participant employment status. Results: A forced-entry hierarchical logistic regression indicated that means of injury, community access and perceived community discrimination, social support from significant others, depressive symptoms, and men’s adherence to masculine norms for primacy of work, self-reliance, and emotional control significantly predicted employment status. Conclusions: Psychosocial variables such as community access, perceived discrimination, social support from significant others, depressive symptoms, and gender identity represent important and understudied predictors of employment status among men living with spinal cord injury. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The positive by-products of spinal cord injury and their correlates.

Objective: To assess positive by-products from the struggles with traumatic spinal cord injury and to explore their correlates. Study Design: Forty-two participants and nominated proxy informants were interviewed 18-36 months post spinal cord injury. Main Outcome Measures: The Perceived Benefit Scales (J. C. McMillen & R. Fisher, 1998) and Symptom Checklist 90-Revised (L. R. Derogatis, 1994). Results: Increased compassion and family closeness and decreased alcohol consumption were commonly reported following injury. Correlations between self- and proxy ratings of positive by-products were low. Positive by-products were not related to psychopathology and had different correlates. Conclusion: Positive by-products are different from other kinds of outcomes, but because loved ones do not necessarily notice these benefits, their validity remains in doubt. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Long-term effects of implementation intentions on prevention of smoking uptake among adolescents: A cluster randomized controlled trial.

Objective: To test the efficacy of implementation intentions in reducing smoking uptake in a sample of adolescents. Design: Classes of adolescents (aged 11–12 years) were randomly allocated to one of four conditions: implementation intention, self-efficacy, two control conditions. An implementation intention or a self-efficacy manipulation (both formed in relation to how to refuse offers of cigarettes) was completed by intervention condition participants at 0, 4, 8, 12, 16, 20, and 24 months. Main Outcome Measures: Long-term smoking behavior (self-report and objective) was assessed at 48 months post-baseline. Results: There were no differences between the two control conditions and the self-efficacy condition. Controlling for baseline smoking, sex, attitudes to smoking, friends and family smoking, and the multilevel nature of the data, intention-to-treat analyses indicated the implementation intention manipulation significantly reduced self-reported smoking compared to the other three conditions combined. Analyses on objectively assessed smoking (carbon monoxide breath measure) in a random subsample of participants also indicated that the implementation intention manipulation compared to the other three conditions significantly reduced smoking. Conclusion: Implementation intentions can reduce smoking in adolescent samples. Implications for using implementation intentions to reduce smoking in adolescents are discussed. (PsycINFO Database Record (c) 2010 APA, all rights reserved)