Psychological intervention during spinal rehabilitation: a preliminary study Improving the quality of life of caregivers of persons with spinal cord injury: a randomized controlled trial. Client-Centered Occupational Therapy for Individuals with Spinal Cord Injury Coping effectiveness training reduces depression and anxiety following traumatic spinal cord injuries. Treatment Of Major Depression In Individuals With Spinal Cord Injury The role of the therapeutic alliance in psychotherapy and pharmacotherapy outcome: findings in the National Institute of Mental Health Treatment of Depression Collaborative Research Program. Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: a randomized clinical trial. Reliability of the PEDro scale for rating quality of randomized controlled trials. Coping effectiveness training for people with spinal cord injury: preliminary results of a controlled trial. Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Anxiety and depression after spinal cord injury: a longitudinal analysis. Telehealth: Reaching Out to Newly Injured Spinal Cord Patients Immunizing against depression and anxiety after spinal cord injury. Long-term psychological outcomes in spinal cord injured persons: results of a controlled trial using cognitive behavior therapy.
Study design : A repeated measures , non-r and omised 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 .  Self-reported 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  st and ard 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 st and ard care participants remained at sub clinical 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 OBJECTIVE To assess the efficacy of two psychosocial interventions for caregivers of older persons with spinal cord injury ( SCI ) . DESIGN A multisite , three-group , r and omized controlled trial comparing two active intervention conditions with each other and to an information-only control group .  One hundred seventy-three caregiver and care-recipient dyads were r and omly assigned to one of three conditions : a caregiver-only treatment condition in which caregivers received a multicomponent intervention based on their risk profile ; a dual-target condition in which the caregiver intervention was complemented by a treatment targeting the care recipient , design ed to address both caregiver and care recipient risk factors ; and an information-only control condition in which the caregiver received st and ard printed information about caregiving , SCI , and aging . OUTCOME MEASURES A multivariate outcome comprised of six indicators linked to the goals of the interventions was the primary outcome of the study . The multivariate outcome included measures of depressive symptoms , burden , social support and integration , self-care problems , and physical health symptoms . RESULTS At 12 months , caregivers in the dual-target condition had improved quality of life as measured by our multivariate outcome when compared to the control condition . Using the dyad as the unit of analysis , the dual-target condition was superior to both the control condition and the caregiver-only condition in our multivariate outcomes analysis . Dyads enrolled in the dual-target condition had significantly fewer health symptoms than control condition and caregiver-only condition participants and were less depressed when compared to participants in the caregiver-only condition . In follow-up analyses we found that a higher proportion of caregivers in the dual-target condition had clinical ly significant improvements in depression , burden , and health symptoms when compared with the caregiver-only condition . CONCLUSION Caregivers are in need of and can benefit from interventions that help them manage the medical and functional limitations of the care recipient . Intervention strategies that target both the caregiver and care recipient are particularly promising strategies for improving the quality of life of caregivers A r and omized controlled trial investigated the effect of client-centered Occupational Therapy on individuals with spinal cord injuries ( SCI ) . Twenty-one subjects , 4 to 6 months post acute rehabilitation , received eight in-home , client-centered Occupational Therapy sessions or eight visits from social visitors . The Functional Independence Measure ( FIM ) , the Craig H and icap Reporting and Assessment Technique ( CHART ) , the Role Checklist and the Life Satisfaction Inventory-A ( LSIA )  were administered pre and post interventions . Analyses showed no differences between groups on the CHART and the FIM ; the Role Checklist showed the Occupational Therapy group took on a limited number of new life roles ; however , a statistically significant difference was found between groups post intervention for LSIA ( p < 0.05 ) OBJECTIVE To extend the findings of a pilot study that evaluated a brief group-based psychological intervention aim ed at improving psychological adjustment , self-perception and enhancing adaptive coping following spinal cord injury . The theoretical underpinnings of the Coping Effectiveness Training ( CET ) Programme are Lazarus and Folkman 's ( 1984 ) cognitive theory of stress and coping , and cognitive behavioural therapy techniques . DESIGN A controlled trial comparing patients that received the CET intervention with matched controls on measures of psychological adjustment and coping . METHOD A total of 45 intervention group participants and 40 matched controls were selected from in patients at a hospital-based spinal cord injury centre . Outcome measures of anxiety and depression , self-perception and coping were collected before , immediately after and 6 weeks following the intervention . RESULTS Intervention group participants showed a significant reduction in depression and anxiety , compared to the matched controls following the intervention . There was no evidence of a significant change in the pattern of coping strategies used by the intervention group compared to controls . The intervention group alone completed measures of self-perception . There was a significant decrease in the discrepancy between participants ' ' ideal ' self and ' as I am ' , and between ' as I would be without the injury ' and ' as I am ' following the intervention and at follow-up . Significant correlations were also found between self-perception , and anxiety and depression over time . CONCLUSIONS These results confirm the findings of the pilot study , that the CET intervention facilitated a significant improvement in psychological adjustment to spinal cord injury . It is proposed that this improvement may be understood in terms of changing participants ' negative appraisal s of the implication s of spinal cord injury with the result of increasing the perceived manageability of its consequences . Such decatastrophizing alters appraisal s which are associated with current mood . Participants found shared discussion and problem-solving to be particularly helpful . Avenues for further research are discussed Abstract Objective : This study evaluated the effects of treating major depression in individuals with spinal cord injury ( SCI ) , focusing on the degree of improvement and correlated changes that could be expected in 6 months of treatment . Design : Apretreatment – posttreatment design was used . R and om assignment to a nontreatment group could not be implemented ethically . Therefore , this study compared participants who declined treatment to persons who accepted treatment over a 24–month period . Setting and Participants : Participants were out patients of a large urban rehabilitation center in southern California . Twenty – eight participants who accepted treatment were assigned to a treatment group ; 15 individuals who declined treatment were assigned to a nontreatment group . The age of the participants ranged from 20 to 7 4 years . Varying Ieveis of SCI dysfunction were represented . lnterventio1,1s : A 6–month combination of psychotherapy and antidepressant medication . Outcome Measures : Adepression inventory , a community activities checklist , and a life satisfaction scale . Results : A significant ( P < 0.001 ) 57 % reduction in depressive symptoms occurred in the treatment group , whereas there was no significant change in the nontreatment group . At theend of 6 months , 30 % of participants had no depression , 42%had minor depression , and 297 % still had major depression , butto a lesser degree . Community activities increased significantly over the treatment period , as did life satisfaction . Conclusion : The results suggest that depression is treatable in this population , although 6 months may not be sufficient to reach maximum benefit in all cases . This study further identified obstacles that limited the ability to r and omize participants into treatment arms and made it difficult to deliver services to all those in need . Complications related to SCI , such as difficulties in transportation , likely restriet the ability to implement needed services to many individuals with SCI The relationship between therapeutic alliance and treatment outcome was examined for depressed out patients who received interpersonal psychotherapy , cognitive-behavior therapy , imipramine with clinical management , or placebo with clinical management .  Clinical raters scored videotapes of early , middle , and late therapy sessions for 225 cases ( 619 sessions ) . Outcome was assessed from patients ' and clinical evaluators ' perspectives and from depressive symptomatology . Therapeutic alliance was found to have a significant effect on clinical outcome for both psychotherapies and for active and placebo pharmacotherapy .  Ratings of patient contribution to the alliance were significantly related to treatment outcome ; ratings of therapist contribution to the alliance and outcome were not significantly linked . These results indicate that the therapeutic alliance is a common factor with significant influence on outcome PURPOSE To compare coping effectiveness training ( CET ) with supportive group therapy ( SGT ) for  anxiety , depression , and adjustment to injury in an acute spinal cord injury/dysfunction ( SCI/D ) rehabilitation population .  CET was shown to result in decreased anxiety and depression symptoms when compared to historical no-treatment control groups ( Kennedy , Duff , Evans , & Beedie , 2003 ; King & Kennedy , 1999 ) . The present study sought to extend those findings with a comparison of CET to an alternative active therapy condition , SGT . RESEARCH METHOD Participants ( N = 40 ) entering a hospital-based program were assigned to treatment condition using block r and omization . Question naire mood measures were completed at program admission , program discharge , and 3-month postdischarge follow-up . Adjustment to disability was assessed at follow-up only . Analyses of variance tested for group differences in anxiety , depression , and adjustment to injury . RESULTS Both groups reported reductions in mood symptoms with no differences between treatment conditions . However , similar reductions were obtained after fewer sessions of CET .  Symptoms of depression increased in both groups following hospital discharge . CONCLUSIONS Clinical and research implication s , including innovative interventions during the period after discharge , are discussed BACKGROUND AND PURPOSE Assessment of the quality of r and omized controlled trials ( RCTs ) is common practice in systematic review s. However , the reliability of data obtained with most quality assessment scales has not been established . This report describes 2 studies design ed to investigate the reliability of data obtained with the Physiotherapy Evidence Data base ( PEDro ) scale developed to rate the quality of RCTs evaluating physical therapist interventions . METHOD In the first study , 11 raters independently rated 25 RCTs r and omly selected from the PEDro data base . In the second study , 2 raters rated 120 RCTs r and omly selected from the PEDro data base , and disagreements were resolved by a third rater ; this generated a set of individual rater and consensus ratings . The process was repeated by independent raters to create a second set of individual and consensus ratings . Reliability of ratings of PEDro scale items was calculated using multirater kappas , and reliability of the total ( summed ) score was calculated using intraclass correlation coefficients ( ICC [ 1,1 ] ) . RESULTS The kappa value for each of the 11 items ranged from.36 to.80 for individual assessors and from.50 to.79 for consensus ratings generated by groups of 2 or 3 raters . The ICC for the total score was.56 ( 95 % confidence interval=.47-.65 ) for ratings by individuals , and the ICC for consensus ratings was.68 ( 95 % confidence interval=.57-.76 ) . DISCUSSION AND CONCLUSION The reliability of ratings of PEDro scale items varied from " fair " to " substantial , " and the reliability of the total PEDro score was " fair " to " good . OBJECTIVES To develop and evaluate a brief group-based psychological intervention for improving psychological adjustment and enhancing adaptive coping following spinal cord injury . The Coping Effectiveness Training ( CET ) programme is grounded on the cognitive theory of stress and coping of Lazarus & Folkman ( 1984 ) , and represents an original adaptation of the theory to the needs of this client group . DESIGN A controlled trial comparing patients receiving the CET intervention  to matched controls in measures of psychological adjustment and coping was used . METHODS Nineteen intervention group participants and 19 matched controls were selected from in- patients at a hospital-based spinal injury rehabilitation centre . Outcome measures of depression , anxiety and coping were collected before , immediately after and six weeks after the intervention . RESULTS Intervention group participants showed significantly greater reductions in levels of depression ( p < .01 ) and anxiety ( p < .05 ) compared to matched controls immediately after the intervention and at six weeks follow-up . There was no evidence of a significantly greater change in the coping strategies used by the intervention group . Participants highlighted their interactions with other group members as the most helpful aspect of the intervention . CONCLUSIONS This evidence suggests that the CET intervention facilitated a significant improvement , in psychological adjustment to spinal cord injury . It is proposed this may be understood in terms of changes in participants ' appraisal of the implication s of spinal cord injury and of the coping skills needed to continue living meaningful and satisfying lives OBJECTIVE To determine the incremental cost-effectiveness and net benefit of a depression collaborative care program compared with usual care for patients with diabetes and depression . RESEARCH DESIGN AND METHODS This article describes a preplanned subgroup analysis of patients with diabetes from the Improving Mood-Promoting Access to Collaborative ( IMPACT ) r and omized controlled trial . The setting for the study included 18 primary care clinics from eight health care organizations in five states . A total of 418 of 1,801 patients r and omized to the IMPACT intervention ( n = 204 ) versus usual care ( n = 214 ) had coexisting diabetes . A depression care manager offered education , behavioral activation , and a choice of problem-solving treatment or support of antidepressant management by the primary care physician . The main outcomes were incremental cost-effectiveness and net benefit of the program compared with usual care .  RESULTS Relative to usual care , intervention patients experienced 115 ( 95 % CI 72 - 159 ) more depression-free days over 24 months . Total outpatient costs were 25 dollars ( 95 % CI -1,638 to 1,689 ) higher during this same period . The incremental cost per depression-free day was 25 cents ( -14 dollars to 15 dollars ) and the incremental cost per quality -adjusted life year ranged from 198 dollars ( 144 - 316 ) to 397 dollars ( 287 - 641 ) . An incremental net benefit of 1,129 dollars ( 692 - 1,572 ) was found . CONCLUSIONS The IMPACT intervention is a high-value investment for older adults with diabetes ; it is associated with high clinical benefits at no greater cost than usual care OBJECTIVE To examine the prevalence of anxiety and depression longitudinally in a sample of patients with a spinal cord injury ( SCI ) . DESIGN A prospect i ve , longitudinal , multiple wave panel design with measures taken on 14 observational periods ranging from initial contact in the acute stages of hospitalization to 2 years ' postdischarge to the community . SETTING The National Spinal Injuries Centre , Stoke M and eville Hospital , Aylesbury , UK , and the general community . PARTICIPANTS The cohort consisted of 104 patients with traumatic SCI ( 19 women , 85 men ) , although the numbers assessed at each interval ranged from 5 to 85 . MAIN OUTCOME MEASURES Measures included the Beck Depression Inventory , the Beck Hopelessness scale , the State Anxiety Inventory , the functional independence measure , and the Social Support Question naire . RESULTS When examined longitudinally , the data illustrate a consistent pattern of results across measures , with scores highest in the acute phase of the injury and during the months leading up to discharge . CONCLUSION The numbers of persons scoring above clinical cut-off scores for anxiety and depression highlight the need to continue to ensure that appropriate psychological care is available within SCI rehabilitation setting s. Moreover , the nature of the longitudinal results provides an indicator of subtle changes in anxiety and depression over time Objectives . The authors present preliminary results on health-related outcomes of a r and omized trial of telehealth interventions design ed to reduce the incidence of secondary conditions among people with mobility impairment result ing from spinal cord injury ( SCI ) . Methods . Patients with spinal cord injuries were recruited during their initial stay at a rehabilitation facility in Atlanta , They received a video-based intervention for nine weeks , a telephone-based intervention for nine weeks , or st and ard follow-up care . Participants are followed for at least one year , to monitor days of hospitalization , depressive symptoms , and health-related quality of life . Results . Health-related quality of life was measured using the Quality of Well-Being ( QWB ) scale . QWB scores ( n = 111 ) did not differ significantly between the three intervention groups at the end of the intervention period . At year one post discharge , however , scores for those completing one year of enrollment ( n = 47 ) were significantly higher for the intervention groups compared to st and ard care . Mean annual hospital days were 3.00 for the video group , 5.22 for the telephone group , and 7.95 for the st and ard care group . Conclusions . Preliminary evidence suggests that in-home telephone or video-based interventions do improve health-related outcomes for newly injured SCI patients .  Telehealth interventions may be cost-saving if program costs are more than offset by a reduction in rehospitalization costs , but differential advantages of video-based interventions versus telephone alone warrant further examination OBJECTIVE To further report on the effectiveness of early psychological intervention in reducing anxiety and depressive mood in persons with spinal cord injury 2 years after injury . DESIGN A nonr and omized , longitudinal , controlled trial . SETTING , OUTCOME MEASURES , AND INTERVENTION : Twenty-eight spinal cord injured persons participated in group cognitive behavior therapy  during  hospital rehabilitation . They were assessed for depressive mood and anxiety before , immediately after , and 12 and 24 months after treatment . The intervention group 's responses on the measures were compared with a control group of 31 spinal cord injured persons who only received traditional rehabilitation services during their hospitalization . RESULTS Subjects in the treatment group with high depression and anxiety scores before treatment were significantly less depressed and reduced their anxiety to a greater extent 2 years after the injury in comparison with similar persons in the control group . CONCLUSIONS Group cognitive behavior therapy for spinal cord injured persons who are abnormally depressed and anxious appears to reduce depressive mood and anxiety in the short and long term OBJECTIVE Although there are many anecdotal reports that psychological intervention is effective in enhancing adjustment to spinal cord injury ( SCI ) , there are little data to support this assertion . To date , reports of few longitudinal-based controlled trials that assessed psychological outcomes for SCI persons have been published . This study was conducted to determine long-term efficacy of cognitive behavior therapy during rehabilitation . DESIGN The study employed a nonr and omized controlled trial , and measures were taken on three occasions : before , immediately after , and 12 months after treatment . SETTING , OUTCOME MEASURES , AND INTERVENTION : Anxiety , depressive mood , and self-esteem were assessed in 28 SCI persons consecutively selected on admission to hospital , who participated in  specialized group cognitive behavior therapy ( CBT ) during rehabilitation . CONTROLS The intervention group 's responses on the measures were compared with a  control group of 41 SCI persons who only received traditional rehabilitation services during their hospitalization . RESULTS There were no overall group differences on anxiety , depressive mood , and self-esteem , although there was a trend for the treatment group to have greater levels of improvement in depression scores across time in comparison to the control group . However , those in the treatment group who reported high levels of depressive mood before the CBT treatment were significantly less depressed 1 year after injury , compared to similar persons in the control group . CONCLUSIONS While it appears not everyone who experiences SCI needs CBT , at least in the hospital phase of their rehabilitation , those who report high levels of depressive mood benefited greatly from CBT
The evidence about psychological therapies used to manage co-morbid depression after a spinal cord injury is presented here .