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Kennedy P.,University of Oxford | Kennedy P.,National Spinal Injuries Center | Kennedy P.,Isis Education Center | Lude P.,Swiss Paraplegic Research and Swiss Paraplegic Center | And 2 more authors.
Archives of Physical Medicine and Rehabilitation | Year: 2011

Objective: To investigate the contribution of prerehabilitation appraisals of spinal cord injury (SCI) and patient's coping strategies to the variance in functional independence postdischarge. Design Longitudinal, cohort study. Patients aged 16 and older and sustaining an SCI were recruited from English- and German-speaking specialist spinal injuries centers. Measures of appraisals, coping strategies, mood, and functional independence were administered on commencing active rehabilitation (12-weeks postinjury) and following hospital discharge (1-y postinjury). Setting Specialist SCI rehabilitation centers in England, Germany, Switzerland, and Ireland. Participants Patients (N=127) completed questionnaires at both time points. Sample age ranged between 17.5 and 64.5 years with a mean age of 39.3 years. Demographic and injury characteristics were similar to those reported in international statistics databases. Interventions Not applicable. Main Outcome Measure FIM (motor subscale). Results Injury characteristics, age, sex, current depression, and the utilization of the coping strategy, social reliance, at 12-weeks postinjury explained 33.5% of the variance in motor FIM at 1-year postinjury. Strong relationships were found between appraisals, coping styles, mood, and functional outcomes. Conclusions The coping strategy, social reliance, was found to contribute significantly when explaining the variance in functional outcomes. Suggestions were made to assess appraisals and coping strategies early in rehabilitation in order to provide effective interventions and additional support to those scoring highly on negative coping styles. Further research is recommended to provide support for the relationship between dependent coping strategies and functional outcomes. © 2011 American Congress of Rehabilitation Medicine. Source


Bonanno G.A.,Columbia University | Kennedy P.,University of Oxford | Galatzer-Levy I.R.,New York University | Lude P.,Swiss Paraplegic Research and Swiss Paraplegic Center | Elfstrom M.L.,Sustainable Development Technology
Rehabilitation Psychology | Year: 2012

Purpose/Objective: To investigate longitudinal trajectories of depression and anxiety symptoms following spinal cord injury (SCI) as well as the predictors of those trajectories. Research Method/Design: A longitudinal study of 233 participants assessed at 4 time points: within 6 weeks, 3 months, 1 year, and 2 years from the point of injury. Data were analyzed using latent growth mixture modeling to determine the best-fitting model of depression and anxiety trajectories. Covariates assessed during hospitalization were explored as predictors of the trajectories. Results: Analyses for depression and anxiety symptoms revealed 3 similar latent classes: a resilient pattern of stable low symptoms, a pattern of high symptoms followed by improvement (recovery), and delayed symptom elevations. A chronic high depression pattern also emerged but not a chronic high anxiety pattern. Analyses of predictors indicated that compared with other groups, resilient patients had fewer SCI-related quality of life problems, more challenge appraisals and fewer threat appraisals, greater acceptance and fighting spirit, and less coping through social reliance and behavioral disengagement. Conclusion/Implications: Overall, the majority of SCI patients demonstrated considerable psychological resilience. Models for depression and anxiety evidenced a pattern of elevated symptoms followed by improvement and a pattern of delayed symptoms. Chronic high depression was also observed but not chronic high anxiety. Analyses of predictors were consistent with the hypothesis that resilient individuals view major stressors as challenges to be accepted and met with active coping efforts. These results are comparable to other recent studies of major health stressors. © 2012 American Psychological Association. Source


Kennedy P.,University of Oxford | Kennedy P.,National Spinal Injuries Center | Lude P.,Swiss Paraplegic Research and Swiss Paraplegic Center | Elfstrom M.L.,Malardalen University | Smithson E.,National Spinal Injuries Center
Spinal Cord | Year: 2010

Study design:Longitudinal, multiple wave panel design.Objectives:To investigate the degree to which current thinking in terms of early appraisals and coping predicts adjustment and quality of life outcomes after spinal cord injury, and to what degree social and demographic variables are involved.Setting:Data were analysed from 266 patients recruited as part of an ongoing study from specialist units in selected British, Swiss, German and Irish spinal centres.Method:Questionnaire booklets were administered as soon as possible after injury onset and after 12 weeks to patients with newly acquired spinal cord injuries. Individuals included had sustained their injury between the ages of 16 and 83.Results:Significant improvements in outcome measures were found across the data set within the first 12 weeks after spinal cord injury and changes observed in the appraisals and coping strategies employed. Significant differences were found between participating centres on both outcome measures and in the coping and appraisal processes used. Coping and appraisal processes at 6 weeks after injury were found to contribute significantly to the variation in psychological well-being at 12 weeks after injury.Conclusion:This study shows the process of adjustment to spinal cord injury to begin in the early stages of rehabilitation, and initial appraisals are important to how an individual will cope with their injury and to their psychological well-being. Support is also given to the importance of psychological factors to functional outcomes. © 2010 International Spinal Cord Society All rights reserved. Source


Kennedy P.,University of Oxford | Kennedy P.,National Spinal Injuries Center | Lude P.,Swiss Paraplegic Research and Swiss Paraplegic Center | Elfstrom M.L.,Malardalen University | Cox A.,National Spinal Injuries Center
Topics in Spinal Cord Injury Rehabilitation | Year: 2013

Background: Significant research has focused on psychological difficulties following spinal cord injury (SCI), and there is a small prevalence of individuals who experience distress after injury. However, the converse is that many adjust well to injury and rate their quality of life highly. Despite this, there has been a comparative dearth of research investigating positive psychological outcomes after SCI, perceived by individuals living with this disability. Objective: To explore individuals' perceptions of gain following the experience of SCI. Methods: Participants, who had sustained an SCI between the ages 16 and 83, responded to an open-ended written question: "What do you think you have gained from the experience of spinal cord injury?" This was administered at 4 time points post injury: 6 weeks, 12 weeks, 1 year, and 2 years. Results: Participants' responses were analyzed qualitatively using the framework of thematic analysis. Thirteen themes were identified: relationships, appreciation of relationships, perspective and appreciation of life, new goals or priorities, understanding of SCI or disability, appreciation of health or health care, changed personality, opportunity or challenge, knowledge of SCI or body, newly acquired skills, spirituality, acceptance, and nothing. Descriptive statistics were incorporated in the presentation of the data. Conclusions: This study provides evidence that a broad range of positive as well as negative psychological outcomes are possible following SCI. More research is needed to better understand the process through which these outcomes arise and to inform how such outcomes may be communicated to persons experiencing this type of injury. Source

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