Developing a Model of Associations Between Chronic Pain, Depressive Mood, Chronic Fatigue, and Self-Efficacy in People With Spinal Cord Injury

Craig, Ashley; Tran, Yvonne; Siddall, Philip J.; Wijesuriya, Nirupama; Lovas, Judy; Bartrop, Roger; Middleton, James

doi:10.1016/j.jpain.2013.03.002

Cited by 139 publications

(148 citation statements)

References 43 publications

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“…Fatigue in people with SCI has been linked with increased depressive mood, increased anxiety and pain. 7,8,25 Results indicate that fatigue is also associated with ANS dysfunction--that is, reduced sympathetic (LF and LF/HF) activity. The lack of association between HRV and fatigue in the AB participants contrasts with the association found between these variables in the SCI sample.…”

Section: Discussionmentioning

confidence: 99%

Influence of neurological lesion level on heart rate variability and fatigue in adults with spinal cord injury

et al. 2015

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Study design: Group cohort design. Objectives: To determine the influence of spinal cord injury (SCI) and neurological level on heart rate variability (HRV) and associations with fatigue. Setting: SCI rehabilitation outpatient and community settings in New South Wales, Australia. Methods: Participants included 45 adults with SCI living in the community and 44 able-bodied controls. Socio-demographic, neurological injury, psychological, HRV and eye blink variables were assessed. Multivariate analysis of variance and post hoc protected t-tests were used to determine differences in HRV and fatigue as a function of the neurological level. Pearson's correlation analysis was used to determine the relationships between these factors. Results: Participants with SCI had significantly reduced sympathetic activity. Those with tetraplegia had lowered sympathetic activity compared with those with paraplegia and able-bodied controls. Neither were differences in parasympathetic activity found between groups nor were there any significant differences found for the time domain or non-linear domains. Higher levels of fatigue were found in the SCI sample, and participants with tetraplegia had higher fatigue levels compared with those with paraplegia. Fatigued participants were more likely to have altered autonomic function--that is, reduced sympathetic activity. Conclusions: Higher levels of neurological impairment in people with SCI are more likely to result in disordered cardiovascular control involving reduced sympathetic activity, whereas elevated fatigue was found to be associated with increased sympathetic dysfunction. Findings highlight the need to address risks associated with this dysfunction, such as improved HRV and fatigue screening for people with SCI and improved education on cardiovascular risk factors.

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Section: Discussionmentioning

confidence: 99%

Influence of neurological lesion level on heart rate variability and fatigue in adults with spinal cord injury

et al. 2015

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“…Within our sample, 11.4% of respondents indicated that they experienced depressive mood most or all of the time, within the range of prevalence of depression in SCI research. 24 Depression has been associated with fatigue in SCI, 10 and therefore it is not surprising that depressive mood is an important covariate. In fact, fatigue is listed as one of the 9 potential symptoms considered in the diagnosis of major depressive disorder.…”

Section: Discussionmentioning

confidence: 99%

“…10 This paindepression-fatigue triad is commonly reported clinically and in the literature as a complex multifactorial relationship that impacts function for individuals after SCI 11 and has been demonstrated to be associated with factors such as physical activity. 5 Pain 8 and depression 12 have each been shown to be associated with participation in community activities, an outcome recognized for its relationship to overall health 13 and quality of life.…”

Section: Introductionmentioning

confidence: 99%

The relationship between fatigue and participation in spinal cord injury

et al. 2015

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Study design: Cross-sectional national survey. Objectives: To explore the association between fatigue and community participation frequency and provide an adjusted model of the relationship including important covariates. Setting: Canada; Community. Methods: Data were obtained from the Rick Hansen Spinal Cord Injury Registry Community Survey. We used multi-variable regression analyses with hierarchical backward elimination, including variable specification, interaction assessment and confounding assessment. Variables with statistically significant correlation with the primary-dependent variable (participation) were included for modeling.Results: The crude model of association between fatigue and participation accounted for 7.2% of the variance in participation scores. The full model with all a priori selected variables accounted for 25.1% of variance in participation scores. The adjusted model, including the identified confounders (pain, depressive mood, comorbidities and level of injury), accounted for 21.1% of variance in participation scores. Depressive mood variables had the highest standardized beta coefficients, reflecting the largest contribution to this model. Conclusion: Fatigue has a statistically significant negative association with participation for individuals with spinal cord injury, when controlling for pain, depressive mood, comorbidities and level of injury. Multifaceted clinical interventions and research addressing fatigue, pain and depressive symptoms are warranted.

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“…This is the case in Australia, if not in many SCI units worldwide. Psychosocial management is certainly required when specific problems are examined, for instance, high occurrence of psychological morbidity [18][19][20][21][22][23][24][25][26][27][28][29][30][31]. Rates of depression are estimated to range between 20 to 40% of the adult SCI population, almost 10 times the rates of depressive mood in the able-bodied [4,8,28].…”

Section: Introductionmentioning

confidence: 99%

“…Rates of depression are estimated to range between 20 to 40% of the adult SCI population, almost 10 times the rates of depressive mood in the able-bodied [4,8,28]. Incapacitating severe chronic fatigue and pain can be experienced by at least 50% of adults with SCI [7,12,13,22,23], unemployment is prevalent in the majority of adults with SCI [14,15,21], and suicide rates can be more than twice the rate in the able-bodied population [20].…”

Section: Introductionmentioning

confidence: 99%

A Clinical Perspective on the Need for Psychosocial Care Guidelines in Spinal Cord Injury Rehabilitation

Middleton¹,

Perry²,

Craig³

2014

Int J Phys Med Rehabil

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Objective: Spinal cord injury (SCI) is a catastrophic physical injury presenting substantial obstacles to adjustment in the long-term, often being associated with additional challenges, including traumatic brain injury, frequent hospitalization, substance abuse, co-morbid psychiatric conditions, chronic pain and fatigue, social discrimination and poor employment prospects. Methods:In an effort to improve rehabilitation and outcomes for people with SCI in the state of NSW, Australia, psychosocial guidelines have been developed to provide direction for enhanced service delivery, staff training and care processes. A major goal was to ensure persons with SCI would receive comprehensive psychosocial care, arguably leading to improved quality of life and functionality in daily living. It is believed that implementation of psychosocial recommendations into care settings will improve decision-making concerning assessment, treatment, referral and living arrangements by rehabilitation health professionals (such as physicians, psychologists, social workers, occupational and physical therapists, rehabilitation counselors and nurses). A secondary goal was to provide guidelines that would promote improved understanding of the psychosocial needs of people with SCI in legislators, policy-makers and other stakeholders within the health and social care environments. Conclusion:This paper provides details of the developed guidelines, discussing implications for their application in rehabilitation practice within the hospital inpatient setting, as well as the significance for research directions into psychosocial aspects of SCI rehabilitation.

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Developing a Model of Associations Between Chronic Pain, Depressive Mood, Chronic Fatigue, and Self-Efficacy in People With Spinal Cord Injury

Cited by 139 publications

References 43 publications

Influence of neurological lesion level on heart rate variability and fatigue in adults with spinal cord injury

Influence of neurological lesion level on heart rate variability and fatigue in adults with spinal cord injury

The relationship between fatigue and participation in spinal cord injury

A Clinical Perspective on the Need for Psychosocial Care Guidelines in Spinal Cord Injury Rehabilitation

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