Study design: Qualitative research design involving semi-structured focus groups. Objectives: To increase current understanding of how persons with spinal cord injuries (SCI) define resilience and what factors contribute to their resilience or the resilience of others. Setting: Inpatient rehabilitation program in a large urban city in the Southwestern United States. Methods: A convenience sample of 28 participants (14 current patients; 14 former patients) participated in semi-structured focus groups led by the research investigators. Results: Through a constant comparative analysis of the data, six themes emerged in participants' responses regarding what they believed contributed to their own resilience in adapting to SCI. The six themes included psychological strength, social support, perspective, adaptive coping, spirituality or faith, and serving as a role model or inspiring others. Conclusion: Consistent with previous research findings, individuals with SCI identified positive thinking (for example, optimism, hope and positive attitude), perseverance and determination, and social support from friends and family as important contributors to their ability to adapt in spite of experiencing traumatic events that resulted in SCI.
INTRODUCTIONTraumatic spinal cord injuries (SCI) present serious public health and quality of life concerns. Costs associated with SCI are estimated at US$9.7 billion annually, with average yearly expenses per individual ranging from $508 904 to $1 044 197 in the first year following injury, and from $67 415 to $181 328 each subsequent year. 1 SCI can result from an array of issues that affect physical, psychological and social functioning, which is reflected in the high cost of health-related services. Individuals who acquire an SCI experience numerous associated and chronic conditions (for example, spasticity, heart disease) and secondary complications (for example, pressure sores, chronic pain). Depression is a significant secondary complication for B30% of individuals with SCI, which often impacts physical health. 2 In turn, depression has been associated with frequency of pressure sores, 3 urinary tract infections, spending more time in bed and longer hospital stays. 4 Given the interaction between psychological and physical health, an understanding of psychosocial functioning in the SCI population is essential. Despite an emphasis in the literature on less adaptive psychological outcomes following SCI, recent research shows that B60% of individuals who acquire SCI are not in fact depressed. 2 Recent research also demonstrates that many individuals with SCI report moderate to very high resilience and a strong sense of self-efficacy. 5 Recently, investigators have begun to explore the association between resilience and adaptation to traumatic injuries (and