Effects of behaviour change interventions on physical activity in people with spinal cord injury: A systematic review and meta-analysis

ObjectivesThis review investigated the effectiveness of behaviour-change interventions to improve physical activity (PA) participation in individuals with a spinal cord injury. Additionally, the review sought to analyse the change in PA behaviour that might be expected by utilising behaviour change in PA interventions and what specific intervention characteristics, application of behaviour change theories, and behaviour change techniques are most efficacious.MethodsThe protocol was prospectively registered on PROSPERO: CRD42021252744, and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed in this review. Eight databases were comprehensively searched using a well-defined strategy developed in collaboration with an academic liaison librarian. Randomised, non-randomised controlled, and non-controlled studies were included in this review; however, controlled and non-controlled studies were analysed separately. Studies were included if participants were older than 16 years and had an SCI of any cause, level or severity, regardless of the time since injury. The behaviour change technique taxonomy version 1 was used to code the intervention characteristics for behaviour modification. The combined effects across studies were pooled in a meta-analysis, and the risk of bias was assessed using the Cochrane Risk of Bias 2 tool.ResultsThe search retrieved 10,155 titles and abstracts. After duplicate removal and screening against the eligibility criteria, 23 studies were included. The overall effect estimate of the change in PA participation in the controlled trials post-intervention was medium (d = 0.50, 95% CI = 0.31–0.70) in favour of behaviour-targeted interventions. The mean difference in PA volume between pre- and post-intervention was an increase of 22 minutes per week (95% CI = 5.96–38.90). Interventions that provided practical support (d = 0.81, 95% CI = 0.46–1.16), which were individualised (d = 0.62, 95% CI = 0.34–0.90) and that utilised monitoring (d = 0.59, 95% CI = 0.34–0.83) had a greater effect on change to PA than those that were group-based and did not utilise those specific techniques.ConclusionsInterventions that target behaviour change to increase PA in people with SCI appear effective. Utilising behaviour change frameworks and specific behaviour change techniques augments PA uptake and levels, and interventions aimed at improving PA in people with SCI should incorporate a behaviour modification component. More research is needed on the isolated effect of intervention structure parameters and specific behaviour change techniques.     

A pilot investigation of a psychosocial activity course for people with spinal cord injuries

This study investigated the general benefits and impact that sports activity courses organized by Back-Up, a charitable trust, have on quality of life, mood, self-efficacy and perceived manageability. Participants were 35 community-based individuals with spinal cord injuries (SCI). Questionnaires were completed at the start and end of the course. Fourteen participants also completed the follow-up questionnaire. Questionnaires included demographic questions, the Life Satisfaction Questionnaire, the Hospital Anxiety and Depression Scale, a measure of Perceived Manageability, the Generalised Self-Efficacy Scale and four questions about what participants had gained. Results found that participants' satisfaction with leisure, generalized self-efficacy and motivation to engage in activities was significantly increased between the start and end of the courses and anxiety significantly reduced. Such results were in line with participants' responses relating to overall gains from the course. At both the start and end of the course, higher Perceived Manageability scores correlated with greater self-efficacy and higher Perceived Manageability scores and self-efficacy were correlated with lower depression and anxiety. The study provides evidence of the benefits of sports participation and teamwork for people with SCI, confirming the results of previous research.     

Social comparison,coping and depression in people with spinal cord injury

The present study among 70 people with spinal cord injury examined the prevalence and correlates of identification (seeing others as a potential future) and contrast (seeing others in competitive terms) in social comparison as related to coping and depression. The most prevalent social comparison strategy was downward contrast (a positive response to seeing others who were worse-off), followed by upward identification (a positive response to perceiving better-off others as a potential future), downward identification (a negative response to perceiving worse-off others as a potential future), and upward contrast (a negative response to seeing others who were better-off). Those with less severe lesions reported the highest levels of upward contrast, coping through blaming others, and depression. Downward contrast was particularly related to constructive coping, and upward identification to wishful thinking. The less adaptive social comparison strategies, i.e., upward contrast and downward identification, were quite strongly related to wishful thinking and blaming others. Particularly upward contrast, i.e., feeling bad as response to seeing that others are better-off, was related to depression.     

Psychosocial adaptation to spinal cord injury: a dimensional perspective

From 313 individuals who sustained spinal cord injuries self-reported responses were examined on their psychosocial adaptation to disability and perceived quality of life. A multidimensional scaling analysis yielded a 2-dimensional structure of adaptation. The first dimension indicated adaptive versus nonadaptive reactions. The second dimension was suggestive of denial versus realization of the affect related to the medical impairment.     

Impact of social support on health status and life satisfaction in people with a spinal cord injury

Abstract

Purpose: Assessment of the impact of received social support on functional health status and life satisfaction in people with spinal cord injury (SCI). Design: Respondents were 176 people with SCI between 18 and 65 years of age and living in the community. Mean time after injury was 3.6 years. Problem-oriented and emotion-oriented support, received from family members, friends and relatives, and professionals were assessed with the Sources of Social Support Inventory. Health status was assessed with the Sickness Impact Profile 68 and life satisfaction with the Life Satisfaction Questionnaire. Structural equation modelling with LISREL V8 was used to study relationships of different types and sources of social support with health status and life satisfaction.Results: Emotion-oriented support led to better psychological functioning and to greater life satisfaction. In addition, emotion-oriented support from the family led to greater satisfaction with relationships and emotion-oriented support from friends and acquaintances led to less satisfaction with social life. Problem-oriented support was not clearly related to health status and life satisfaction; there was only a negative relation between problem-oriented support and satisfaction with social life. Support, problem-oriented or emotion-oriented, from health-care professionals showed no relationships with health status or life satisfaction.Conclusions: Emotion-oriented support from family members and friends was most important for people with SCI. Greater problem-oriented support appears to be related to poorer life satisfaction.     

Difficulties adjusting to post-discharge life following a spinal cord injury: an interpretative phenomenological analysis

Individual semi-structured interviews were conducted with 17 individuals who had experienced a traumatic spinal cord injury (SCI), focusing on the participants' lived experience of SCI. The interviews were transcribed verbatim and were analysed for recurrent themes using interpretative phenomenological analysis (IPA). Here, we present three inter-related recurrent themes all concerning difficulties in adjusting to home life following hospital discharge: "loss of camaraderie", "lack of post-discharge care" and "other people's reactions to spinal cord injury". Participants reported that the camaraderie they formed with fellow patients during their rehabilitative stay in hospital generated feelings of security and community. This was discussed in stark contrast to the isolation and loneliness that they subsequently experienced post-hospital discharge. A perceived lack of physical, practical and psychological support coupled with negative and stigmatising reactions of the wider community served to make adjustment to home life post-SCI particularly difficult for the participants. The findings are discussed in relation to extant SCI literature, and recommendations for future health care of individuals with SCI are made.     

A focus group study on the potential of autonomous vehicles as a viable transportation option: Perspectives from people with disabilities and public transit agencies

Autonomous vehicle (AV) technology is becoming one of the most promising alternatives to improve mobility for people with disabilities. Nevertheless, how people with disabilities perceive AV as transportation services has not been explored. Also, limited information exists about how public transit agencies comprehend and perceive autonomous vehicle transportation (AVT) services. This study discusses mobility issues for people with disabilities and explores the potential of AVT to serve that population, particularly those with visual impairments or physical disabilities. Researchers conducted six focus groups comprising people with disabilities (N = 23) and public transit service experts (N = 10) in Austin, Texas and Houston, Texas. Each session was audio-recorded and analyzed using conventional content analysis. This study identified people with disabilities’ mobility issues related to: (1) current transit services (including fixed-route and paratransit services) and (2) the quality of neighborhood built environments. Both people with disabilities and transit experts expected that AVT could mitigate current mobility issues, especially in improved built environments. However, participants with disabilities also expressed concerns and anxieties regarding AVT. Transit experts agreed that more targeted strategies would be needed to overcome possible barriers to AVT for people with disabilities. This study provides insights on shaping AVT strategies and policies relevant to improving mobility for people with disabilities.     

A preliminary psychometric evaluation of the Hospital Anxiety and Depression Scale (HADS) in 963 people living with a spinal cord injury

This study aimed to evaluate the preliminary psychometric properties of the Hospital Anxiety and Depression Scale (HADS) in a community sample of adults living with a spinal cord injury (SCI). A cross-sectional design was used with 963 people living in the community with an SCI. Participants were recruited via three spinal centres in the United Kingdom. They completed the HADS and the Life Satisfaction Questionnaire. Psychometric analyses were conducted for the whole sample, by gender and level of injury. The HADS demonstrated good internal consistency, with promising content validity. Two factors, approximating to anxiety and depression were extracted via factor analysis for the whole sample, by gender and level of injury. In line with existing literature, females scored significantly higher than males on the anxiety subscale. Item 7 ("I can sit at ease and feel relaxed") was found to be a complex item, with a potentially different meaning within this population. This study presents preliminary findings, which support the psychometric integrity of the HADS within an outpatient population with SCI. Items that included potential somatic components revealed a more complex factor loading profile. Recommendations are made to further investigate this measure with amendments to such items, incorporating inpatients and independent measures of anxiety and depression to address validity directly.     

Deciding to give to charity: a focus group study in the context of the household economy

Research on charitable giving has tended to examine either the individual characteristics of donors, or those of households. However, both approaches overlook the interactive processes that take place within households which may influence charitable donation in a variety of ways. For example, the system of financial organisation adopted by a couple can set limits on the degree of individual financial autonomy, and this in turn can influence the financial decision‐making of each partner. This paper presents the results of a study that examined charitable decision‐making within the context of household financial behaviour. It investigated whether such decisions tend to be individual or joint, and the extent to which they are regarded as an integral part of household financial management. Six focus groups were carried out with people who were currently married or living with a partner. The results suggest that charitable giving is dealt with in accordance with the style of money management of the household, although it occupies a more marginal position than other items of expenditure. Copyright © 2005 John Wiley & Sons, Ltd.     

Positive living: A pilot study of group positive psychotherapy for people with schizophrenia

Positive psychology interventions target positive emotions in order to increase happiness, engagement in life, and well being while also ameliorating the impact of symptoms on a person's life. We examined an adapted version of group positive psychotherapy for people with schizophrenia (Positive Living (PL)) in a pilot study. Sixteen participants were recruited to participate in two separate PL groups and were assessed at baseline, post-intervention and at 3-month follow-up. We examined feasibility of this intervention in addition to a preliminary exploration of well-being outcomes including psychological well-being, hope, savoring, and self-esteem as well as clinically related outcomes including symptoms, psychological recovery, and social functioning. Findings indicate that the PL group was feasible and associated with possible improvements in psychological well-being, hope, savoring, psychological recovery, self-esteem, and psychiatric symptoms.     

Emotional support and counselling for people with visual impairment: Quantitative findings from a mixed methods pilot study

Aims: This paper reports on mainly quantitative findings from a mixed methods evaluation of a new model of emotional support and counselling for people with moderate visual impairment. Method: The CORE Outcome Measure was completed with service users at baseline and post‐intervention to assess the impact of the new service on psychological wellbeing and social functioning. Their perceived needs and expectations of the service were also explored. Results: Of the 35 individuals providing data at each assessment time, mean item scores on the CORE fell significantly (p<.001), taking the sample from within a clinical population before therapy, to a mean score below this following therapy. A more positive outlook accompanied this improvement in functioning. Discussion: Findings from the study augment the growing evidence that emotional support and counselling services can play an important role alongside and within related vision services. Implications for practice: The study indicates that therapeutic input for the visually impaired client group may need to target both wellbeing (feelings about oneself and the future) and problems (depression, anxiety, physical health, and trauma). Conclusions: Our findings suggest that a dual model of emotional support and counselling offers considerable benefit for people with visual impairment.     

Smoking,self-regulation and moral positioning: A focus group study with British smokers from a disadvantaged community

Smoking in many Western societies has become a both moral aand health issue in recent years, but little is known about how smokers position themselves and regulate their behaviour in this context. In this article, we report the findings from a study investigating how smokers from an economically disadvantaged community in the East Midlands (UK) respond to concerns about the health impact of smoking on others. We conducted ten focus group (FG) discussions with mixed groups (by smoking status and gender; N?=?58 participants) covering a range of topics, including smoking norms, self-regulation, and smoking in diverse contexts. We transcribed all FG discussions before analysing the data using techniques from discourse anlysis. Smokers in general positioned themselves as socially responsible smokers and morally upstanding citizens. This position was bolstered in two main ways: ‘everyday accommodation’, whereby everyday efforts to accommodate the needs of non-smokers were referenced, and ‘taking a stand’, whereby proactive interventions to prevent smoking in (young) others were cited. We suggest that smoking cessation campaigns could usefully be informed by this ethic of care for others.     

Accelerometer feedback to promote physical activity in adults with type 2 diabetes: a pilot study

This study examined whether giving activity feedback to obese, sedentary adults with Type 2 diabetes would improve their adherence to a home-based walking program. 49 subjects were recruited. Ten failed a treadmill cardiovascular test. Another 9 dropped out before the intervention, and 4 dropped out during the intervention. The remaining 26 adults (14 women, 12 men; age M = 48.1 yr., SD = 7.1) received behavioral counseling monthly for 3 mo. regarding exercise. All subjects wore a triaxial accelerometer during these 3 months. Randomly, half of the subjects were blind to the data from the accelerometers, i.e., no feedback, and had counseling based on their self-report diaries. The other half had access to the accelerometer data, got a computerized graph of their physical activity for the period between counseling sessions, and had counseling based on these objective data, i.e., feedback. The feedback group showed an increase in exercise over the 3 mo. The nonfeedback group showed an increase in activity at 1.5 mo. but reverted to their baseline exercise levels at 3 mo. However, analysis of variance showed there was at least an 8% probability that this effect was due to chance, so the hypothesis that feedback would improve exercise adherence could not be supported. Further studies with larger sample sizes and greater control of experimental conditions are needed to determine the utility of objective activity feedback.     

Long term symptoms and limitations of activity of people with traumatic brain injury: a ten-year follow-up

This study examined the effect of Traumatic Brain Injury 10 years post-injury. Frequencies of head injury symptoms and activity limitation by level of severity were measured in a consecutive series of 61 adults who were admitted to a tertiary-care center for traumatic brain injury. Irritability and Anxiety were the most frequently reported symptoms from the Head Injury Symptom Checklist. Bothered by noise and Bothered by light were the least frequently reported. Trouble hearing what is said in a group conversation and Trouble hearing what is said in a one-to-one conversation were the most commonly reported limitations of activity from the Health and Activity Limitations Survey. Overall, this study illustrates that symptoms remain many years following brain injury, irrespective of the injury's severity.