Clinical Practice Abstracts
Rebecca Adcock, PhD
In an effort to provide readers with timely access to current information in the field of spinal cord injury (SCI), the American Association of Spinal Cord Injury Psychologists and Social Workers (AASCIPSW) Clinical Practice Committee (CPC) will begin publishing annotated abstracts of recent articles, books, and other publications as a regular feature in the SCI Psychosocial Process.
The annotations for this issue come from the November 2004 issue of Archives of Physical Medicine and Rehabilitation, Volume 85. Over half of the articles in this journal are included in the most recent update of the CPC Reading List posted to members electronically in January 2005 and we plan to publish additional abstracts from this volume in future issues. Articles in the Archives are a result of current research outcomes funded by the National Institute on Disability Rehabilitation Research to the Model Spinal Cord Injury Systems Program (MSCIS). Many of our members are actively involved in obtaining MSCIS grants and are authors of the articles in this journal.
Research From the Model Spinal Cord Injury Systems: Findings From the Current 5-year Grant Cycle.
Lammertse, D. P., Jackson, A. B., & Sipski, M. L.
A history of the MSCIS program and grants is provided with an explanation of how the current 16
designated regional spinal cord injury centers in the 2000-2005 grant cycle contribute to the National
Spinal Cord Injury Database. There is an overview of the 17 original research articles in the journal, which
include topic areas related to SCI outcome, such as morbidity and mortality data, adjustment, pain, life
satisfaction, quality of life, assistive technology, substance use, vocational, and aging issues.
Archives of Physical Medicine and Rehabilitation, 85, 1737-1739. 2004
Symptoms of Major Depression in People With Spinal Cord Injury: Implications for Screening.
Bombardier, C. H., Richards, J. S., Krause, J. S., Tulsky, D., & Tate, D. G.
The authors studied the utility of using the Patient Health Questionnaire-9 (PHQ-9) as a screening measure for the presence of Major Depressive Disorder (MDD) in individuals with SCI. The PHQ-9 is a 9-item questionnaire corresponding directly to the Diagnostical and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) criteria for MDD. It was chosen for study primarily because it was developed, researched, and refined for use with medical patients. A second objective was to see whether the inclusion of somatic symptoms should be used toward a MDD diagnosis with a SCI population.
Eight hundred forty-nine people with SCI were assessed at 1 year post-injury, primarily by telephone survey, and given the PHQ-9 along with other measures designed to assess daily role functioning, subjective health, and life satisfaction. Ninety-six subjects, or 11.4%, were found to meet criteria for probable MDD. Moreover, both psychological and somatic factors predicted probable MDD. Further results indicated that probable MDD was not related to variables of demographics or ASIA scale impairment level, but higher scores on the PHQ-9 were inversely correlated to subjective health, life satisfaction, and daily role function.
This study suggests that the PHQ-9 may be useful as a systematic screening tool to identify MDD in people with SCI. It is a brief measure that uses diagnostic criteria for MDD, including somatic symptoms. Its accuracy in identifying probable MDD in people with SCI implies that somatic symptoms may be a result of depression and not necessarily a primary result of SCI. Although the results are limited to individuals 1 year post-injury, the PHQ-9 may be useful in the acute care setting to track symptoms of depression and provide for early intervention.
Archives of Physical Medicine and Rehabilitation, 85, 17491756. 2004
Gender and Minority Differences in the Pain Experience of People With Spinal Cord Injury
Cardenas, D. D., Bryce, T. N., Shem, K., Richards, J. S., & Elhefni, H.
The objective of this study was to investigate the prevalence and severity of pain experienced by persons with SCI, especially with regard to the study’s main independent variables of gender and race, since neither have been well studied in the SCI population. A large sample of survey data (7,379 cases) collected by the Model Systems National Spinal Cord Injury Statistical Center between 1998 and 2002 served as the database. These data reflected responses from persons with SCI assessed by questionnaire 1 year post-injury and then every 5 years afterward. From two variables utilized to assess pain, the authors obtained estimates of their main outcome measures: 1) pain prevalence; 2) severity of pain; and 3) frequency of pain interference with work (PIWW) or usual activity.
The primary data analysis utilized cross-sectional data, stratified by gender, then by race. Overall, the prevalence of pain (present vs. absent) appeared to be stable over time whereas PIWW (present vs. absent), decreased. When stratified by race (white vs. non-white), the occurrence of pain differed significantly at follow-up for years 10 and 20, where whites reported greater prevalence. Non-whites, however, reported higher pain intensity at years 1, 10, and 15. No significant differences were found for PIWW among races. When stratified by gender, there were no significant differences with regard to pain prevalence or PIWW. Women tended to report higher pain severity at follow-up years, although this was non-significant.
Many other variables of interest known to be associated with the experience of pain were also studied, including education, occupational status, marital status, level, and etiology of injury. These results and cultural differences associated with pain perception and expression were discussed. On the whole, given the large sample of cross-sectional data available, this study was able to look at a wide array of variables associated with pain.
Archives of Physical Medicine and Rehabilitation, 85, 17741781. 2004
Environmental Factors and Their Role in Participation and Life Satisfaction After Spinal Cord Injury
Whiteneck, G., Meade, M. A., Dijkers, M., Tate, D. G. , Bushn, T., & Forchheimer, M. B.
Participation in society and life satisfaction after SCI can depend on a multitude of factors. Here, the authors investigated the role of perceived barriers in the environment, their relationship to SCI characteristics, activity limitations, and general demographics. Individuals with SCI (N = 2,276) living in the community served as subjects, completing the Craig Hospital Inventory of Environmental Factors-Short Form (CHIEFSF), the Craig Handicap Assessment and Reporting Technique-SF (CHART-SF; a measure of societal participation), and the Satisfaction with Life Scale (SWLS). Other data collection included demographic variables, etiology and neurological status of SCI, and activity limitations as assessed by the Functional Independence Measurement.
The top five environmental barriers (in descending order) reported by people with SCI were: the natural environment; transportation; help at home; health care; and government policies. Significant differences in perceived barriers were found across variables. Older and younger age groups reported the fewest barriers. Women, minorities, unmarried people, those with higher levels of injury, and persons with greater activity limitations were associated with the perception of more barriers. Overall, the inclination to perceive the presence of barriers lessened over time as measured by years post-injury.
Subscales of the CHIEF-SF were used to compare environmental barriers with demographic, impairment, and activity limitations of people with SCI. Overall, these subscales predicted 4% of the variability in CHART-SF scores, suggesting that environmental barriers did not significantly affect societal participation. The CHIEF-SF subscales did, however, predict 10% of the variability in life satisfaction scores. Variables that were predictive of life satisfaction were environmental factors, participation, years post-injury, and gender.
Archives of Physical Medicine and Rehabilitation, 85, 17931803. 2004