Psychological intervention during spinal rehabilitation: a preliminary study

Abstract

Study design: A repeated measures, non-randomised controlled trial. Objective: To examine the effectiveness of individualised cognitive behaviour therapy (CBT) on the psychological adjustment of patients undergoing rehabilitation for newly acquired spinal cord injury. Setting: South Australian Spinal Cord Injury Service, Hampstead Rehabilitation Centre, South Australia, Australia. Methods: Eleven participants received individual CBT as part of their spinal rehabilitation. Selfreported levels of depression, anxiety and stress were assessed before the intervention, at week 12 of rehabilitation and at 3 months post-discharge, using the depression, anxiety and stress scales (DASS-21). Functional independence was also assessed, using the Functional Independence Measure (FIM). Responses were compared with 13 participants, closely matched on demographic and injury variables, who received standard psychological care (that is, assessment and monitoring only). Results: Depression scores for treatment participants showed a significant time effect, with worsening symptoms reported at three-month follow-up, after CBT was discontinued. In contrast, the DASS-21 scores of standard care participants remained at subclinical levels throughout the study. Clinical improvements in symptoms of anxiety and stress were also reported by the treatment group as inpatient therapy progressed. Conclusion: Targeted, individualised psychological treatment contributed to short-term, meaningful improvements in emotional outcomes for individuals reporting psychological morbidity after recent spinal injury. The results also highlight the need for ongoing access to specialised, psychological services post-discharge. Replication of these results with a larger sample is required before definitive conclusions can be drawn.

An evidence-based review of the effectiveness of cognitive behavioral therapy for psychosocial issues post-spinal cord injury.

“…Duchnick et al (2009) reported a sample size estimate of 0.80 with an alpha error protection rate of 0.05, while Dorstyn et al (2010) reported their study to be underpowered. Sample sizes of all the studies reported herein ranged from 18 to 296, with an average sample size of 76.1.…”

“…Dorstyn et al (2010) reported providing amitriptyline to five participants in the treatment group for distress, and five participants in the control group for neuropathic pain. Participants in both the control and treatment groups of the Kahan et al (2006) and Kemp et al (2004) studies were prescribed antidepressants on an individual basis, with paroxetine and sertraline most commonly prescribed.…”

Psychosocial issues in spinal cord injury: a review

“…96 On the positive side, all studies showed a significant decrease of depressive symptoms during the intervention, although this effect was not always maintained at follow-up. 93 In one study, 94 subgroup analyses showed that for people with baseline levels of depression in the clinical range, the CBT group improved more than the control group, suggesting that CBT might be more effective in people with more severe mental health disorders. Only one study examined possible mechanisms of treatment.…”

“…52 We found six psychological intervention studies primarily aimed at improving mental health of people with SCI (Table 5). 54,[93][94][95][96][97] The study design of most studies was weak; only one was a randomized controlled trial. 97 Other studies used people as controls who were treated in earlier years or elsewhere, 94-96 who were not eligible for the intervention 93 or who declined the intervention.…”

“…54,[93][94][95][96][97] The study design of most studies was weak; only one was a randomized controlled trial. 97 Other studies used people as controls who were treated in earlier years or elsewhere, 94-96 who were not eligible for the intervention 93 or who declined the intervention. 54 A significant treatment effect (interaction between group and time) was demonstrated by only one study evaluating coping effectiveness training (CET).…”