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Study Design: Systematic review. Objectives: To identify, critically appraise, and synthesize research findings on the associations between acceptance, quality of life (QOL), and mental health outcomes in individuals living with spinal cord injury (SCI). Methods: Five databases (PubMed, PsycINFO, Embase, Web of Science, and Scopus) were systematically searched. Studies were included if they provided findings on the association between acceptance and QOL, mental health outcomes, or both in an SCI population aged 16 years or older. Only peer-reviewed original quantitative and qualitative studies were included. Screening, quality assessment, and data extraction were conducted independently by two researchers. Findings were tabulated and synthesized by outcome. Results: Forty-one studies were included. Greater acceptance was consistently associated with greater global and psychological QOL, life satisfaction, sense of well-being, mental health, and with lower levels of depression and anxiety. Inconsistent evidence was found with regards to social QOL and post-traumatic stress disorder. Acceptance was generally not associated with adjustment outcomes further than two years into the future. Study quality of the quantitative studies was mostly fair (n = 17) followed by good (n = 13), and poor (n = 9). Conclusion: Health-care professionals may regard acceptance as a psychological resource they can aim to support in improving QOL and mental health following SCI. A range of methodological and conceptual limitations were present in the research. Future studies should prioritize longitudinal designs, consider dyadic effects, explore subjective meaning(s) of acceptance, and investigate the effectiveness of therapeutic approaches that stimulate the acceptance process. AA was responsible for designing and writing the review protocol, conducting the literature search, screening identified records, conducting quality assessment, extracting and synthesizing data, interpreting results, creating figures and tables, and writing the manuscript. SLR was responsible for screening identified records, conducting quality assessment, and extracting and synthesizing data. She further contributed with guidance and continuous feedback on the review protocol, tables and figures, and revisions of the manuscript. HK contributed with guidance and continuous feedback on the review protocol, tables and figures, and revisions of the manuscript. TEA was responsible for arbitrating potentially eligible studies and further contributed with guidance and continuous feedback on the review protocol, tables and figures, and revisions of the manuscript.

Objective: To determine the multidimensionality of acceptance of spinal cord injury (SCI). Participants: Adults with SCI who were admitted to an SCI centre between 1991 and 2020. Methods: All eligible participants (n=686) were invit-ed to complete a survey via REDCap. A 4-dimensional model was hypothesized, which included “Accepting Reality”, “Value Change”, “Letting Go of Control” and “Behavioural Engagement”. Items from 3 accept-ance scales were selected to collectively reflect these 4 dimensions: (i) Spinal Cord Lesion-related Coping Strategies Questionnaire, (ii) Coping Orientations to Problems Experienced, and (iii) a modified Acceptance and Action Questionnaire. A split-sample principal component analysis (PCA) and confirmatory factor analysis (CFA) approach was used. Results: Complete data were provided by 431 participants (62.8%). A PCA on sub-sample one suggest-ed a 4-factor model based on eigenvalues ≥ 1, corresponding to the hypothesized model of acceptance. A CFA on sub-sample 2 showed good model fit, adding further support to the model. Conclusion: These findings suggest that acceptance is a multidimensional construct with 4 facets that represent distinct, but interconnected, psychological processes. This model of acceptance can be used as a framework for future research and clinical practice to deepen our understanding of acceptance processes following severe injuries, such as SCI. Lay abstract Acceptance has long been considered a core principle of adjustment in rehabilitation psychology. However, several distinct ways of defining and measuring acceptance exist in the literature. The aim of this study was therefore to explore the nuances of acceptance by combining these different definitions in a multidimensional model of acceptance, and testing it empirically. The sample included 431 adults with spinal cord injury who responded to 3 acceptance questionnaires that defined acceptance differently. The statistical analysis showed that acceptance should be regarded a multidimensional construct with 4 facets: “Accepting Reality”, “Value Change”, “Letting Go of Control” and “Behavioral Engagement”. These facets of acceptance reflect distinct, but interconnected, psychological processes, which necessitates a shift in how researchers and healthcare professionals approach this complex topic. We need to be mindful of these nuances in our understanding of acceptance, but also in our measurement strategy and communication with other professionals and patients.

Long-distance walking is an ancient activity practiced across cultures for many reasons, including the improvement of one’s health. It has even been suggested that long-distance walking may be considered a form of psychotherapy. This scoping review examined the relationship between long-distance walking and mental health among adults. Publication trends and definitions were also examined, and the reason why long-distance walking may have therapeutic effects was discussed. Systematic searches in three online databases were performed using a selection of long-distance walking terms. Both quantitative and qualitative studies were included if they examined associations between long-distance walking and mental health in an adult population. Mental health was conceptualized in broad terms, including descriptions of mental states as well as more specific measurements or notions of mental health. A total of 8557 records were screened and 26 studies were included, out of which 15 were quantitative, 9 were qualitative, and 2 were mixed. The findings showed that long-distance walking was positively related to mental health. This was most consistent with regard to emotional distress compared to somewhat inconsistent findings regarding well-being. Therefore, long-distance walking may be more appropriately used to counter some personal or emotional struggle rather than to achieve hedonic pleasure.

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