Exploring the impact of fatigue on cognitive appraisals in Spinal Cord
Research type
Research Study
Full title
Exploring the impact of fatigue on cognitive appraisals during Spinal Cord Injury Rehabilitation: a mixed-method design
IRAS ID
291095
Contact name
Rebecca Eaton
Contact email
Sponsor organisation
University of Oxford / Clinical Trials and Research Governance
Duration of Study in the UK
1 years, 5 months, 30 days
Research summary
Research Summary
Within Spinal Cord Injury (SCI) research, the way people think about their injury (appraisals) has been shown to be more predictive of adaptive adjustment following a spinal cord injury, over and above injury level (Craig et al., 2015; Eaton et al., 2018; Geyh et al., 2016; Kennedy et al., 2006). Within the community, research has shown that 56% of individuals with a SCI have excessive fatigue levels which is associated with high levels of mental distress (Craig, Tran, Wijesuriya, & Middleton, 2012). Within other long term condition, such as cancer or chronic fatigue, fatigue has been linked to more negative thoughts about illness. Taken together, there has been evidence of high presence of fatigue for individuals with SCI and high levels of fatigue having negative consequences on appraisals in a non-SCI population. However, there is currently no research investigating the relationship between fatigue and adjustment in SCI. The research is a mixed-method design. Participants will be asked to complete questionnaires to explore whether individuals with high fatigue compared to with low fatigue have differences in the way they think about their SCI. A smaller number of participants will be interviewed to gain a richer understanding of the experience of fatigue in rehabilitation. Individuals will be recruited till April 2022. Individuals who have a SCI, are over 18 and are in SCI rehabilitation at the National Injuries Spinal Centre will be included. The results of the study may inform whether fatigue should be included within spinal-specific models of adjustment which may lead to practical adjustments needed in clinical practice.
Summary of Research
Why the study was conducted Following a spinal cord injury, many individuals adjust well to their injury, however, for some there are increased anxiety, depression, and adjustment difficulties. It is understood that how people think about their injury is more important than injury type. The evidence shows that how individuals think about their spinal cord injury is measured by three threat thinking styles (negative view of disability, overwhelming disbelief, and fearful hopelessness) and resilience (determination, personal control, and development). Psychological factors associated with adjustment are an individual’s perception they feel able to complete or achieve a task (self- efficacy), the strength people have in their belief that they are in control of the situation (locus of control) and constant worrying about the stressor (rumination). Thinking processes are affected by multiple factors which need to be explored to understand the influence. One factor that has been linked to increased negative thinking is fatigue. Fatigue is understood as exhaustion that is constant, persistent, and repetitive. Fatigue can affect individuals both physically and mentally. There is a high level of fatigue in individual’s living with spinal cord injuries in the community and within the early stages of rehabilitation. Given the high levels of fatigue within this population, the understanding that fatigue influences thinking styles and the impact that threat thinking can have on adjustment following a spinal cord injury it is important to understand the associated impact of fatigue on how individuals think about their injury.
The aims of the study
1. Individuals with high levels of fatigue thought about their injury more negatively than individuals with lower levels of fatigue.
2. To understand whether how individuals think about their injury can be explained by symptoms of low mood and fatigue.
3. Using interviews, to understand individuals’ experiences of having fatigue following a spinal cord injury whilst they are in the early stages of rehabilitation.
What the study involved
The study was conducted in-person at the National Spinal Injuries Centre, Stoke Mandeville Hospital. The study was developed with an individual with experience of a spinal cord injury to increase the achievability and acceptability. The study was reviewed by an NHS Ethics committee and given the approval to start recruitment.
Individuals who had a spinal cord injury and were having rehabilitation for the first time were invited to take part in the study. Individuals who wanted to take part in the study completed three questionnaires. The questionnaires asked individuals about their experiences of fatigue, how they think about their injury and symptoms of low mood. There are six different ways individuals can think about their injury. Using the measure of fatigue, individuals who scored 30 or more were considered to have high fatigue. Individuals with high fatigue were invited to take part in an interview to better explore their experience of fatigue.What the study found
Forty individuals met the inclusion criteria and completed the questionnaires. There were 18 individuals in the high fatigue group and 22 individuals in the low fatigue group. Analysis of the questionnaire data showed that individuals that reported high levels of fatigue reported more thoughts about their spinal cord injury being a threat compared to individuals with low fatigue. Specifically, individuals with high fatigue showed increased negative views of disability, overwhelming disbelief, and fearful hopelessness. For thoughts about resilience following a spinal cord injury, findings showed some differences. Individuals with high fatigue were found to have more positive feelings about determination compared to low fatigue. However, individuals with high fatigue scored lower on feelings of personal control. There was no difference between groups on development.When exploring the influence of symptoms of low mood and fatigue on how people think about their spinal cord injury, it was found that depression could account for 29.9% of the relationship to threat thinking. When adding in fatigue the percentage increased by 16.6%. This means that fatigue is uniquely contributing to the relationship with threat appraisals. There was no influence found on resilience thinking from depression or fatigue.
From the interviews three themes were found. Firstly, how individuals understand and the meaning they associate with fatigue. Individuals associated their fatigue to feeling worn out and exhausted by the littlest of things, which was different to how it was experienced before having a spinal cord injury. It was sometimes hard for individuals to pinpoint specific times when they have experienced fatigue. Secondly, individuals spoke about how fatigue has interfered with their rehabilitation, relationships with others, and negatively impacting on their mood. Thirdly, individuals embraced fatigue to feel a connection with their brain and body. Individuals often used fatigue to motive themselves towards their rehabilitation goals increasing their own sense of determination.
Conclusions
The study investigated the impact on fatigue on how individuals think about their spinal cord injury. Findings showed that individuals with high levels of fatigue had more threat thinking styles about their injury and increased determination compared with individuals with low level fatigue. Additionally, fatigue also has a unique influence on threat thinking over symptoms of low mood. Individuals’ understanding of fatigue impacted on their rehabilitation by reducing their ability to do activities. However, there were positives with increasing an individual’s awareness of their bodies and self-motivation to achieve rehabilitation goals. The study provides evidence that individuals who experience high fatigue are more likely to develop negative threat thinking styles following their spinal cord injury. How individuals think about their injury influences adjustment to their injury, so highlights individuals with high fatigue are a vulnerable subgroup and fatigue should be addressed in clinical settings.REC name
East of England - Cambridge Central Research Ethics Committee
REC reference
21/EE/0117
Date of REC Opinion
11 May 2021
REC opinion
Further Information Favourable Opinion