Engagement in spinal cord injury rehabilitation
Research type
Research Study
Full title
Exploring the impact of falls concern, anxiety and cognitive appraisals on engagement in spinal cord injury rehabilitation.
IRAS ID
321646
Contact name
Ruxandra Vasile
Contact email
Sponsor organisation
University of Oxford / Research Governance Ethics and Assurance
Duration of Study in the UK
0 years, 8 months, 1 days
Research summary
Spinal cord injuries and disorders (SCI/Ds) are characterised by damage to the cells and/or nerves in the spinal cord, which are responsible for communication between the brain and the body (Craig et al., 2022). The way in which people with spinal cord injury (SCI) cognitively appraise their injury has been found to impact their coping and adjustment, whether the effects of injury are considered to be a challenge, or threat, the latter often leading to depression and anxiety (Duff & Kennedy, 2003). However, it is unclear whether these cognitive appraisals also impact the extent to which someone engages with physical rehabilitation in the acute post-injury phase. This study will test whether people who engage in rehabilitation less have more negative cognitive appraisals of their injury. Secondary to this, we also know that aversive experiences during the early stages of SCI rehabilitation can also impact someone’s later engagement in rehabilitation – one such experience could be a fall (Lequerica & Kortte, 2010). Falls are known to lead to increased falls concern and worry, frustration, and embarrassment, and decreased mood, autonomy, and participation in daily activities (Khan et al., 2019). This poses questions around whether falls concern impacts inpatients’ engagement in rehabilitation, and whether there might be a more generalised anxiety problem impacting engagement in rehabilitation for SCI inpatients. Questionnaires measuring engagement in rehabilitation, cognitive appraisals of injury, generalised anxiety, and falls concern will be given to SCI patients and the physiotherapists involved with the patients' clinical care (for the engagement questionnaire). We will then see if there are differences in cognitive appraisals, generalised anxiety, and falls concern between 'high engagers' and 'low engagers'.
Lay summary of study results:
Findings from the questionnaires found that there was no relationship between engagement in rehabilitation and the way people think of their injury, fear of falling, or anxiety. We also found that those factors did not predict how well or not someone engaged in rehabilitation. Furthermore, we found that most inpatients were scored as engaging very well by their physiotherapists. Out of a total possible score of 30 (with higher scores indicating higher engagement), most people were scored 30, with the second most popular score being 29. This could be because the NSIC is a very intensive rehabilitation environment, making it hard for anyone to not engage in rehabilitation. It could also be because those people who were not as engaged in rehabilitation were also less engaged with research, and so did not agree to take part in the study. It is important to research what other psychological factors might be promoting such high engagement, so that these facilitators can be implemented in other settings where people might struggle to engage.
The study also found high rates of anxiety and fear of falling, indicating that this would be an important area for intervention. Further research should also further explore fear of falling and how/whether this is linked with actual falls.
Conclusions
The current study did not find relationships between the measured outcomes (how people thought of their injury, level of generalised anxiety, and amount of fear of falling) and how well people engaged with rehabilitation. We propose that future research should explore other factors that might impact engagement and be conducted in a variety of rehabilitation settings, where there may be a wider range of engagement levels. The current study was able to highlight the lack of norms around measuring engagement in this population, and the increased prevalence of anxiety and fear of falling in this population.REC name
South Central - Hampshire A Research Ethics Committee
REC reference
23/SC/0298
Date of REC Opinion
10 Sep 2023
REC opinion
Further Information Favourable Opinion