To investigate differences between mother’s and father’s perceptions of marital relationship quality, child rearing disagreements, and family functioning over the initial 18 months following traumatic brain injury (TBI) in early childhood relative to an orthopedic-injury comparison group.
Participants included 147 parent-dyads of children with TBI (n = 53) and orthopedic injuries (OI; n = 94) who were between the ages of 3 and 7 years at injury. Family functioning, marital quality, and child-rearing disagreements were assessed shortly after injury and at 6, 12, and 18-month follow-ups, with ratings at the initial assessment completed to reflect preinjury functioning. Mixed model analyses were used to examine mother and father’s reports of family functioning, marital quality, and child-rearing disagreements over time as a function of injury severity and parent gender.
We found a significant Group x Gender interaction for ratings of love and parenting disagreements. As hypothesized, mothers of children with severe TBI rated the relationship as significantly less loving than did their partners, and mothers of children with both moderate and severe TBI endorsed more parenting disagreements than did their partners. However, fathers reported higher levels of family dysfunction than their partners, regardless of injury type or severity.
Implications for treatment based on differences in mothers’ and fathers’ perceptions of family and marital functioning, and future directions for research, are discussed.
brain injury; family functioning; marital relationship; parental perceptions
This study examined the effects of age at injury on the persistence of behavior problems and social skill deficits in young children with complicated mild to severe traumatic brain injury (TBI).
A concurrent cohort/prospective research design was used with repeated assessments of children with TBI (n = 82) or Orthopedic Injury (OI) (n = 114). Parents completed the Child Behavior Checklist, the Behavior Rating Inventory of Executive Functions, and the Preschool and Kindergarten Behavior Scales or the Home and Community Social and Behavior Scales shortly after injury to assess preinjury functioning, and at an extended follow-up an average of 38 months postinjury. Generalized linear modeling was used to examine the relationship of age at injury to the maintenance of behavior problems, and logistic regression was used to examine the persistence of clinically significant behavior problems.
At the extended follow-up, severe TBI was associated with significantly greater anxiety problems relative to the Group OI. With increasing time since injury, children who sustained a severe TBI at an earlier age had significantly higher levels of parent-reported symptoms of ADHD and anxiety than children who were older at injury.
Findings suggest that longer-term treatment for behavior problems may be needed after severe TBI, particularly for those injured at an earlier age.
traumatic brain injury; long-term behavior problems; young children
The goal of this study was to examine how parenting style (authoritarian, authoritative, permissive) and family functioning are related to behavioral aspects of executive function following traumatic brain injury (TBI) in young children.
Participants included 75 children with TBI and 97 children with orthopedic injuries (OI), ages 3–7 years at injury. Pre-injury parenting behavior and family functioning were assessed shortly after injury, and postinjury executive functions were assessed using the Behavior Rating Inventory of Executive Functioning (BRIEF; Gioia & Isquith, 2004) at 6, 12, and 18 months postinjury. Mixed model analyses, using pre-injury executive functioning (assessed by the BRIEF at baseline) as a covariate, examined the relationship of parenting style and family characteristics to executive functioning in children with moderate and severe TBI compared to OI.
Among children with moderate TBI, higher levels of authoritarian parenting were associated with greater executive difficulties at 12 and 18 months following injury. Permissive and authoritative parenting styles were not significantly associated with postinjury executive skills. Finally, fewer family resources predicted more executive deficits across all of the groups, regardless of injury type.
These findings provide additional evidence regarding the role of the social and familial environment in emerging behavior problems following childhood TBI.
traumatic; parenting; permissive; authoritarian; preschool
Widely accepted models of disability suggest that actual use of an impaired upper-extremity in everyday life frequently deviates from its motor capacity, as measured by laboratory tests. Yet, direct measures of real-world use of an impaired upper-extremity are rare in pediatric neurorehabilitation. This paper examines how well the Pediatric Motor Activity Log-Revised (PMAL-R) measures this parameter, when the PMAL-R is administered as a structured interview as originally designed.
Parents of sixty children between 2–8 years with upper-extremity hemiparesis due to cerebral palsy (CP) completed the PMAL-R twice. Additionally, the children were videotaped during play structured to elicit spontaneous arm use. More-affected arm use was scored by masked raters; it was thought to reflect everyday activity since no cues were given about which arm to employ. Testing sessions were separated by 3 weeks, during which 29 children received upper-extremity rehabilitation and 31 did not.
The PMAL-R had high internal consistency (Cronbach's α = .93) and test-retest reliability (r = .89). Convergent validity was supported by a strong correlation between changes in PMAL-R scores and more-affected arm use during play, r(53) = .5, p < .001.
The PMAL-R interview is a reliable and valid measure of upper-extremity pediatric neurorehabilitation outcome.
arm; function; daily living activity; hemiparesis; cerebral palsy
To compare psychometric functioning of the Fatigue Severity Scale (FSS) and the Modified Fatigue Impact Scale (MFIS) in a community sample of persons with multiple sclerosis (MS).
A self-report survey including the FSS, MFIS, demographic and other health measures was completed by 1271 individuals with MS. Analyses evaluated the reliability and validity of the scales, assessed their dimensional structures, and estimated levels of floor and ceiling effects. Item response theory (IRT) was used to evaluate the precision of the MFIS and FSS at different levels of fatigue.
Participants had a mean score on the FSS of 5.1 and of 44.2 on the MFIS. Cronbach’s alpha values for FSS and MFIS were all 0.93 or greater. Known-groups and discriminant validity of MFIS and FSS scores were supported by the analyses. The MFIS had low floor and ceiling effects, while the FSS had low floor and moderate ceiling effects. Unidimensionality was supported for both scales. IRT analyses indicate the FSS is less precise in measuring both low and high levels of fatigue compared to the MFIS.
Researchers and clinicians interested in measuring physical aspects of fatigue in samples whose fatigue ranges from mild to moderate can choose either instrument. For those interested in measuring both physical and cognitive aspects of fatigue, and whose sample is expected to have higher levels of fatigue, the MFIS is a better choice even though it is longer. IRT analyses suggest both scales could be shortened without a significant loss of precision.
Fatigue Severity Scale; Modified Fatigue Impact Scale; multiple sclerosis; psychometrics; Item Response Theory
To develop and test the efficacy of a web-based intervention for alleviating depression in male stroke survivors (SSs) and their spousal caregivers (CGs) that blends both peer and professional support.
Design and Methods
The research consisted of an intervention protocol evaluated by a focus group of rehabilitation professionals, a “think aloud” session conducted with female stroke CGs, and a usability test of the intervention’s online features with 7 female stroke CGs. Efficacy of the final protocol was tested in a two-group randomized clinical trial with a sample of 32 CG-SS dyads. The CGs in the intervention condition received an online group intervention. Intervention components were based on the Stress Process Model. Those CGs in a control condition received minimal support with individualized access to relevant online information. Measures of depression, as well as the secondary outcomes of mastery, self-esteem, and social support, were obtained from SSs and CGs at pretest, post-test, and one-month later.
At posttest and one month later, CGs in the intervention condition reported significantly lower depression than CGs in the control condition with baseline depression controlled. There was no significant effect on depression among SSs. Although no significant treatment effects for either SSs or CGs were found on the secondary outcomes, post-treatment changes on some constructs were significantly correlated with change in depression.
CGs benefit from web-based programs that help them better understand both their emotional needs and those of the SS.
This study examined the relationship between level of treatment engagement through completion of homework and treatment outcomes within non-pharmacological interventions for participants with ME/CFS.
A sample of 82 participants with ME/CFS was randomly assigned to one of four non-pharmacological interventions. Each intervention involved 13 sessions over the course of six months. Change scores were computed for self-report measures taken at baseline and 12-month follow-up. Homework compliance was calculated as the percentage of completed assignments across the total number of sessions and grouped into three categories: minimum (0–25%), moderate (25.1–75%), or maximum (75.1–100%).
Findings revealed that after controlling for treatment condition, those who completed a maximum amount of homework had greater improvement on a number of self-report outcome measures involving role, social and mental health functioning. There were no differential improvements in physical and fatigue functioning based on level of homework compliance.
Findings from this study suggest homework compliance can have a positive influence on some aspects of physical, social, and mental health functioning in participants with ME/CFS. It should be emphasized that these interventions do not cure this illness. The lack of significant changes in physical functioning and fatigue levels suggests a need for more multidisciplinary treatment approaches that can elicit improvement in these areas.
Myalgic Encephalomyelitis; chronic fatigue syndrome; Non-pharmacological; Homework; Outcomes
To examine whether an individualized problem-solving intervention provided to family caregivers of persons with severe disabilities provides benefits to both caregivers and their care recipients.
Family caregivers were randomly assigned to an education-only control group or a problem-solving training (PST) intervention group. Participants received monthly contacts for 1 year.
Family caregivers (129 women, 18 men) and their care recipients (81 women, 66 men) consented to participate.
Main Outcome Measures
Caregivers completed the Social Problem-Solving Inventory–Revised, the Center for Epidemiological Studies-Depression scale, the Satisfaction with Life scale, and a measure of health complaints at baseline and in 3 additional assessments throughout the year. Care recipient depression was assessed with a short form of the Hamilton Depression Scale.
Latent growth modeling was used to analyze data from the dyads. Caregivers who received PST reported a significant decrease in depression over time, and they also displayed gains in constructive problem-solving abilities and decreases in dysfunctional problem-solving abilities. Care recipients displayed significant decreases in depression over time, and these decreases were significantly associated with decreases in caregiver depression in response to training.
PST significantly improved the problem-solving skills of community-residing caregivers and also lessened their depressive symptoms. Care recipients in the PST group also had reductions in depression over time, and it appears that decreases in caregiver depression may account for this effect.
caregivers; brain injury; disability; randomized clinical trial; problem-solving
Stigmatizing attitudes toward people with disabilities can jeopardize such individuals' well-being and recovery through denial of employment and community isolation. By shaping social norms that define group membership, the construct of individualism may partially explain differences in stigmatizing attitudes across cultures. Further, widespread globalization has brought intensely individualistic social practices to certain segments of non-Western cultures. This paper examines whether the construct of individualism can help to explain cross-cultural differences in stigmatizing attitudes observed between American and Chinese employers.
Employers (N = 879) from Beijing, Hong Kong, and Chicago provided information on their attitudes toward hiring people with disabilities, and Path Analyses were conducted to examine potential mediating relationships.
Path analyses indicated that vertical individualism, along with perceived responsibility for acquiring a condition, partially mediated the relationship between culture and employers' negative attitudes about job candidates with disabilities.
These results suggested that greater espousal of competitive and individualist values may drive stigmatizing attitudes across cultures.
Individualism; China; Employers; Stigma
To examine the association between positive affect at discharge from inpatient medical rehabilitation and pain ratings three months post-discharge in persons with stroke aged 50 or older.
A longitudinal study using information from the Stroke Recovery in Underserved Population (SRUP) data base. A 4-item positive affect scale and an 11-point visual analog pain scale were collected at discharge and at 3 months post-discharge.
The study included 917 adults aged 50 and older with first-time stroke admitted to one of eleven inpatient medical rehabilitation facilities across the United States.
The mean age of the sample was 71 years, 51.0% were women, and 51.6% were married. One third of the sample reported pain and the mean positive affect score was 9.2 (range 0–12). Cumulative logit models showed higher positive affect scores at discharge were significantly associated with lower pain ratings (OR: 0.87, 95% CI 0.81, 0.92) at 3 month follow-up after adjusting for discharge pain ratings, negative affect, and demographic and clinical characteristics.
High positive affect at discharge from inpatient medical rehabilitation was associated with lower pain ratings three months post discharge after controlling for pain and negative affect at discharge and clinical and demographic characteristics. The identification of links between positive affect and pain may contribute to a better understanding of functional recovery processes post stroke and the planning of therapeutic programs directed at the positive psychological strengths in elderly persons with stroke.
Positive affect; pain; cerebrovascular accident; stroke
This study evaluated the ability of three measures of physical status (physical activity, physical condition, and body mass index [BMI]) to moderate the relationship between dual sensory loss (DSL) and depressive symptoms in older adults.
Nationally representative longitudinal data were used to develop multilevel models predicting depressive symptoms among two groups of older adults, 1380 who developed DSL during the study and 1308 without sensory loss.
All three measures were associated with depressive symptoms for persons who had or would develop a DSL: participation in physical activity and being in better physical condition were associated with lower levels of depressive symptoms, while lower BMI levels were associated with higher levels of depressive symptoms. All moderator variables had a larger effect for persons with DSL as compared to persons without sensory loss.
The implication of these findings is that participation in a regular program of physical activity may provide multiple benefits to older persons with DSL. Families and health care providers can offer support for being physically active by ensuring the person has the best possible correction for the sensory losses, providing encouragement, and/or providing physical assistance with exercise.
There is a need for natural history chronic fatigue syndrome (CFS) studies from random, community-based, multi-ethnic populations. Design: The present study examined the course of CFS from Wave 1 to Wave 2, which spanned over a ten year period of time, and, assessed whether socio-environmental and symptomatology factors were associated with CFS status over the ten year period.
There was relative stability over time on critical measures of disability, fatigue, support, optimism and coping over time. One cardinal symptoms of CFS, post-exertional malaise, best differentiated the CFS group from the others. By Wave 2, of the original group of 32 individuals diagnosed with CFS, 4 had died, and 24 were found and agreed to be re-evaluated, and of this group, 16 continued to have CFS, 5 developed exclusionary illnesses, 2 were classified as Idiopathic chronic fatigue, and one had remitted. Conclusions: The current study found that over time in a community-based sample, unbiased by help seeking behavior the CFS group remained rather ill with a variety of different conditions over time.
Chronic fatigue syndrome; natural history; epidemiology
To determine whether deficits in prospective memory (i.e., “remembering to remember”) confer an increased risk of unemployment in individuals living with chronic HIV infection.
Fifty-nine Unemployed and 49 Employed individuals with HIV infection underwent comprehensive neuropsychological and medical evaluations, including measures of prospective memory.
The Unemployed participants demonstrated significantly lower performance on time- and event-based prospective memory, which was primarily characterized by errors of omission. Importantly, prospective memory impairment was an independent predictor of unemployment when considered alongside other neurocognitive abilities, mood disturbance, and HIV disease severity.
Prospective memory impairment is a salient predictor of unemployment in persons living with HIV infection and might be considered in screening for unemployment risk and developing vocational rehabilitation plans.
AIDS dementia complex; employment; prospective memory; episodic memory; everyday functioning
Based on social ecological theory, this study examined the joint relations among adolescents’ family, peer, and school contexts and depressive symptoms in youth with spina bifida using cumulative, protective, and specific effects models.
Sixty families of adolescents with spina bifida and 65 comparison families reported on adolescent’s positive experiences within these contexts and on depressive symptoms when youth were 14–15 and 16–17 years old.
Adolescents with spina bifida had fewer total positive contexts and less positive experience within peer and school contexts, as compared to typically developing adolescents. Greater total number of positive contexts and higher levels of positive experiences within family and school contexts were associated with fewer depressive symptoms for both groups; peer positive experiences were related to lower depressive symptoms for typically developing adolescents only.
Adolescents with spina bifida have fewer positive contexts, which may place them at risk for higher levels of depressive symptoms.
Spina bifida; adolescence; depression; family functioning; school functioning; peers
To examine the evidence supporting the effectiveness of cognitive behavioral therapy (CBT) for improving psychosocial outcomes in individuals with spinal cord injury (SCI).
Electronic databases (MEDLINE, CINAHL, EMBASE, and PsycINFO), were searched for studies published between 1990 and October 2010. Randomized control trials (RCTs) and non-randomized control trials (non-RCTs) utilizing a CBT intervention to improve psychosocial outcomes (depressive symptomatology, anxiety, coping and adjustment to disability) in outpatient persons with SCI were included for review. Levels of evidence were assigned to each study using a modified Sackett scale. Effect size calculations for the interventions were provided where possible.
Nine studies met the inclusion criteria. The studies reviewed included two RCTs, six prospective controlled trials (PCTs) and one cohort study. All studies examined at least two groups. There is Level 1 and Level 2 evidence supporting the use of specialized CBT protocols in persons with SCI for improving outcomes related to depression, anxiety, adjustment and coping.
CBT holds promise as an effective approach for persons with SCI experiencing depression, anxiety, adjustment and coping symptoms. As CBT may involve many different components, it is important in future to determine which of these elements alone or in combination is most effective in treating the emotional consequences of SCI.
PMID: 21401282 CAMSID: cams1980
cognitive behavioral therapy; spinal cord injury; rehabilitation
Anxiety is highly comorbid with depression, but little is known about the impact of anxiety disorders on the effectiveness of empirically supported psychotherapies for depression. We examined such outcomes for people with Multiple Sclerosis (MS) and depression, with versus without comorbid anxiety disorders.
Participants with MS (N = 102) received 16 weeks of telephone-administered psychotherapy for depression and were followed for one year post-treatment.
Participants with comorbid anxiety disorders improved to a similar degree during treatment as those without anxiety disorders. Outcomes during follow-up were mixed, and thus we divided the anxiety diagnoses into distress and fear disorders. The distress disorder (GAD) was associated with elevated anxiety symptoms during and after treatment. In contrast, fear disorders (i.e., panic disorder, agoraphobia, social phobia, specific phobia) were linked to depression, specifically during follow-up, across 3 different measures.
People with GAD receiving treatment for depression may benefit from additional services targeting anxiety more specifically, while those with comorbid fear disorders may benefit from services targeting maintenance of gains after treatment.
Depression; Anxiety; Multiple Sclerosis; Tele-Mental Health; Comorbidity; Psychotherapy; Treatment Outcome
To investigate change in positive emotion over a 3-month follow-up period and determine whether this change is associated with recovery of functional status in persons with stroke.
A longitudinal study using information from the Stroke Recovery in Underserved Patients (SRUP) database. Positive emotion and functional status were assessed within 72 hours of discharge from an in-patient medical rehabilitation facility and at 3-month follow-up using established measurement instruments.
The study included 840 adults 55 years old or older with a first-time stroke and admitted to one of eleven in-patient medical rehabilitation facilities in the United States.
The mean age was 72.9 (SD = 9.52) years, 78.6% were non-Hispanic white and 51.7% were women. The average length of stay was 20.2 (SD = 10.1) days and the most prevalent type of stroke was ischemic (75.0%). Positive emotion increased for 35.6% of the sample, decreased for 29.2%, and 35.2% reported no change. Increases in positive emotion change score compared to no change (b = −3.2, SE = 1.5, p = .032) or a decline (b = −8.9, SE = 1.4, p = <.001) was significantly associated with improved functional status at the 3-month follow-up after adjusting for sociodemographic and clinical variables as well as depressive symptoms.
Positive emotion is a dynamic process and can change over time. In persons with stroke, increases in positive emotion over a 3-month period was significantly associated with an increasing likelihood of recovery of functional status compared to no change or a decline in positive emotion. Understanding factors that influence both increases and decreases in positive emotion has implications for stroke rehabilitation programming and quality of life post-hospital discharge.
cerebrovascular accident; recovery; functional status; positive emotion
To examine between-group differences in the associations between aspects of processing speed assessed with an inspection time task, and attention-deficit/hyperactivity disorder (ADHD) symptoms.
Two groups comprised of 34 children with cerebral palsy (CP) and 70 nonaffected peers (Control), ages 8 – 16, participated in a prospective correlational study. Measures included a visual inspection time task and the Conners’ Parent Rating Scale – Revised: Long Version.
Children with CP exhibited significantly slower processing speed, and more symptoms of inattention and hyperactivity than Controls. Significant associations between inspection time and ADHD symptoms were found only in the Control group.
Findings have implications for clinical assessment and understanding of attentional risks associated with CP.
cerebral palsy; attention; processing speed; Attention-Deficit/Hyperactivity Disorder (ADHD); visual inspection time; neuropsychology
Evaluate psychometric properties of the Functional Arm Activity Behavioral Observation System for measuring hemiparetic arm use.
Participants and Measures
All participants acquired their brain injury > 1-year prior to study entry; most had mild-to-moderate upper-extremity hemiparesis. In Study 1, nine stroke survivors wore accelerometers and were videotaped for 15 minutes in the hospital or at home after they were asked to behave as usual. In Study 2, one traumatic brain injury and eight stroke survivors wore accelerometers and were videotaped at home for 3 days with a motion-triggered camera. Observers independently rated 15-minute segments of the Study 1 and 2 videotapes in 2-s blocks with a 4-step arm-activity coding scheme.
Inter-rater reliability was excellent; the mean Cohen’s κ in each study was ≥ .84. For data from both studies combined, validity was supported by a strong correlation between amount of hemiparetic arm functional activity, as determined by the observers, and the ratio of hemiparetic to other arm movement, as determined by accelerometry.
FAABOS reliably and validly quantifies amount of spontaneous hemiparetic arm activity outside the laboratory.
arm; observation; rehabilitation; treatment outcome; stroke
To directly compare estimates of potential depressive disorders and clinically significant depressive symptoms using the Patient Health Questionnaire (PHQ-9) and Older Adult Health and Mood Questionnaire (OAHMQ) among participants with spinal cord injury (SCI).
727 participants from a hospital in the Southeastern United States were administered the PHQ-9 and OAHMQ during a follow-up survey. We compared the rates of depressive disorders using cutoff scores and diagnostic criteria for each instrument. No independent psychiatric diagnostic interviews were conducted.
The PHQ-9 and OAHMQ were significantly correlated (r=.78) and both were correlated with satisfaction with life (r=-.48, -.54). Using recommended diagnostic scoring procedures, 10.7% of participants met the diagnostic criteria for major depressive disorder with the PHQ-9, 9.3% met the criteria for major depression based on PHQ-9 ≥ 10, and 19.7% based on PHQ-9 ≥ 15. Using the OAHMQ, 19.7% reported probable major depression and 44.5% clinically significant symptomatology.
The measures were highly correlated overall. However, the estimated prevalence of depressive disorders varied substantially between the two instruments. These estimates were comparable to those previously reported for each instrument (i.e., higher rates with the OAHMQ). Therefore, differing estimates of depressive disorders reported in the literature using these instruments were largely attributable to the instruments themselves.
spinal cord injury; depression; psychometrics
Examine the diurnal variation of salivary cortisol in adults with spinal cord injury (SCI) and the effect of stressors on cortisol and mood.
Ecological momentary assessment (EMA) to capture cortisol, stress and mood from 25 persons with SCI and 26 without SCI. Data were analyzed using linear mixed models.
There were no systematic differences between groups on missing data. Diurnal variation of cortisol of participants with SCI reflected an expected pattern. No significant group differences for cortisol diurnal pattern, stress or mood; when group interactions were significant, results indicated lower cortisol reactivity to stress in participants with SCI. Stress had a significant impact on positive, negative and agitated moods.
Stress in daily life and its association with cortisol and mood were largely similar between persons with and without SCI. A key methodological contribution is the demonstration of using EMA to collect biological and behavioral data in the field from participants with SCI. The use of EMA in rehabilitation psychology research has great potential to advance our understanding of the dynamics of daily life with disability.
spinal cord injuries; stress, psychological; hydrocortisone; ecological momentary assessment
To identify cognitive predictors of medical decision-making capacity (MDC) in participants with traumatic brain injury (TBI) at time of acute injury (baseline) and at six-month follow-up.
At baseline, participants were 34 adults with moderate to severe TBI and 20 healthy adults. At six-month follow-up, participants were 24 adults with moderate to severe TBI and 20 normal adults.
Main Outcome Measures
Participants were administered a consent capacity instrument (Capacity to Consent to Treatment Instrument: CCTI) and neuropsychological test measures. In the TBI group, univariate and multivariate cognitive predictor models were developed at baseline and six-month follow-up for clinically relevant CCTI consent abilities/standards (S) of understanding (S5); reasoning (S4); and appreciation (S3).
At baseline, measures of short-term verbal memory and semantic fluency predicted TBI group performance on understanding (S5); short-term verbal memory and attention predicted performance on reasoning (S4); and working memory predicted performance on appreciation (S3). Regarding six-month follow-up models, measures of basic executive function, verbal processing speed, and working memory predicted TBI performance on understanding (S5); working memory and short-term memory predicted reasoning (S4); and basic executive functioning predicted appreciation (S3).
Multiple cognitive functions are associated with acute impairment and partial recovery of MDC in patients with moderate to severe TBI. Short-term verbal memory was strongly associated with impairments in consent capacity in TBI participants at the time of acute inpatient hospitalization. As patients experience cognitive and functional recovery post-hospitalization, executive functioning and working memory abilities were associated with improved capacity at six-month follow-up. The results offer insight into the relationship between different standards of competency and cognitive changes and recovery following acute TBI.
medical decision-making capacity; competency; traumatic brain injury; neurocognitive functioning
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.
A survey was administered to 620 individuals with SCI that included measures of demographic characteristics and sleep difficulties.
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.
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.
spinal cord injury; sleep problems; aging; multiple regression
Little is known about how pain and depression after burn injury may influence long-term outcomes such as physical functioning. This prospective study examined associations between pain, depression, and physical functioning in a sample of burn injury survivors.
Design and Participants
Questionnaires assessing pain, depression, and physical functioning were completed by 64 (52% of original sample) adult burn survivors shortly after discharge from burn care and at 1- and 2-year follow-ups.
Pain and physical functioning improved over the 2 years of the study, whereas depression levels were stable. Pain and depression were associated with poorer physical functioning over time, but associations varied according to the time span under consideration. Also, the association between pain and physical functioning was strongest among persons with higher depression scores.
Pain and depression may contribute independently to compromises in physical functioning. The co-occurrence of pain and depression represents even greater risk for reduced physical functioning over time among burn survivors.
pain; depression; burn injury; functioning; quality of life