The CONECSI trial: Results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury Psychological intervention during spinal rehabilitation: a preliminary study A comprehensive pain management programme comprising educational, cognitive and behavioural interventions for neuropathic pain following spinal cord injury. Long-term outcomes of a multidisciplinary cognitive behavioural programme for coping with chronic neuropathic spinal cord injury pain. Resilience following spinal cord injury: A prospective controlled study investigating the influence of the provision of group cognitive behavior therapy during inpatient rehabilitation. A randomized controlled clinical trial of a nurse-led structured psychosocial intervention program for people with first-onset mental illness in psychiatric outpatient clinics Coping effectiveness training reduces depression and anxiety following traumatic spinal cord injuries. SCALE DEVELOPMENT OF A MEASURE TO ASSESS COMMUNITY-BASED AND CLINICAL INTERVENTION GROUP ENVIRONMENTS. Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: a randomized clinical trial. Coping effectiveness training for people with spinal cord injury: preliminary results of a controlled trial. Long-term psychological outcomes in spinal cord injured persons: results of a controlled trial using cognitive behavior therapy. Is increasing physical activity necessary to diminish fatigue during cancer treatment? Comparing cognitive behavior therapy and a brief nursing intervention with usual care in a multicenter randomized controlled trial.
Summary A multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic spinal cord injury pain . ABSTRACT Many people with spinal cord injury ( SCI ) rate chronic neuropathic pain as one of the most difficult problems to manage . The aim of the CONECSI ( COping with NEuropathiC Spinal cord Injury pain ) trial was to evaluate a multidisciplinary cognitive behavioral treatment program for persons with chronic neuropathic pain after SCI . The intervention consisted of educational , cognitive , and behavioral elements .  A total of 61 people were r and omized to either the intervention group or the waiting list control group in 4 Dutch rehabilitation centers . Primary outcomes were pain intensity and pain‐related disability ( Chronic Pain Grade question naire ) , and secondary outcomes were mood ( Hospital Anxiety and Depression Scale ) , participation in activities ( Utrecht Activities List ) , and life satisfaction ( Life Satisfaction Question naire ) . Measurements were performed at baseline , and at 3 , and 6 months follow‐up . The primary statistical technique was r and om coefficient analysis . The analyses showed significant changes over time on both primary ( t1–t2 ) , and 2 out of 4 secondary outcomes ( both t1–t2 and t1–t3 ) . Significant intervention effects ( Time * Group interactions ) were found for anxiety and participation in activities , but not for the primary outcomes . Subsequent paired t tests showed significant changes in the intervention group that were not seen in the control group : decrease of pain intensity , pain‐related disability , anxiety , and increase of participation in activities . This study implies that a multidisciplinary cognitive behavioral program might have beneficial effects on people with chronic neuropathic SCI pain 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 whether a comprehensive multidisciplinary pain management programme could contribute to improvement regarding sleep quality , mood , life satisfaction , health-related quality of life , sense of coherence and pain for patients with a spinal cord injury and neuropathic pain . DESIGN A prospect i ve intervention study . PATIENTS Twenty-seven patients with spinal cord injury and neuropathic pain participated in a pain management programme  in parallel with 11 patients in a control group . METHODS A comprehensive pain management programme comprising educational , cognitive , and behavioural interventions was created for patients with spinal cord injury and neuropathic pain . The pain management programme consisted of 20 sessions over a 10-week period and included educational sessions , behavioural therapy , relaxation , stretching , light exercise and body awareness training . All patients were followed-up 3 , 6 and 12 months after completion of the programme . RESULTS At the 12-month follow-up , levels of anxiety and depression in the treatment group decreased compared with baseline values , and a tendency towards better quality of sleep was seen . In comparison with the control group , patients in the treatment group improved regarding sense of coherence and depression . CONCLUSION This study implies that a multidimensional pain management programme can be a valuable complement in the treatment of spinal cord injured patients with neuropathic pain OBJECTIVE To explore the long-term outcomes of CONECSI ( COping with NEuropathiC Spinal cord Injury pain ) , a multidisciplinary cognitive behavioural treatment programme in persons with spinal cord injury . DESIGN Long-term follow-up pre-post-intervention design . SUBJECTS A total of 29 subjects with a spinal cord injury and chronic neuropathic pain from 4 Dutch rehabilitation centres . METHODS Primary outcomes were pain intensity and pain-related disability ( Chronic Pain Grade question naire ) . Secondary outcomes were mood ( Hospital Anxiety and Depression Scale ) , participation in activities ( Utrecht Activities List ) , and life satisfaction ( Life Satisfaction Question naire ) . R and om coefficient analysis was used for the analyses of measurements before ( t1 ) , immediate post-intervention ( t2 ) , and 6 ( t3 ) , 9 ( t4 ) , and 12 ( t5 ) months follow-up . RESULTS The analyses showed significant improvements on pain intensity ( t1-t2 and t1-t5 ) and pain-related disability ( t1-t2 , t1-t4 , and t1-t5 ) , anxiety and participation in activities ( t1-t2 , t1-t3 , and t1-t5 ) . CONCLUSION This exploratory study suggests that a multidisciplinary cognitive behavioural programme might have lasting improvements on pain intensity , pain-related disability , anxiety , and participation in activities in people with chronic neuropathic spinal cord injury pain and highlights the potential of such programmes PURPOSE To examine change in resilience in people with spinal cord injury ( SCI ) when  group cognitive behavior therapy ( GCBT ) was added to routine psychosocial rehabilitation ( RPR ) . RESEARCH METHOD / DESIGN A prospect i ve repeated- measures cohort design was used to determine the efficacy of the addition of  GCBT ( n = 50 ) . The control group consisted of individuals receiving RPR  , which included access to individual CBT ( ICBT ) when required  ( n = 38 ) . Groups were assessed on 3 occasions : soon after admission , within 2 weeks of discharge , and 6-months postdischarge . Measures included sociodemographic , injury , and psychosocial factors . The outcome variable was resilience , considered an important outcome measure for recovery . To adjust for baseline differences in self-efficacy , depressive mood and anxiety between the 2 groups , these factors were entered into a repeated measures multivariate analysis of covariance ( MANCOVA ) as covariates . Latent class analysis was used to determine the best-fitting model of resilience trajectories for both groups . RESULTS The MANCOVA indicated that the addition of GCBT to psychosocial rehabilitation did not result in improved resilience compared with the ICBT group . Trajectory data indicated over 60 % were demonstrating acceptable resilience irrespective of group . CONCLUSION / IMPLICATION S Changes in resilience mean scores suggest the addition of GCBT adds little to resilience outcomes . Latent class modeling indicated both groups experienced similar trajectories of improvement and deterioration . Results highlight the importance of conducting multivariate modeling analysis that isolates subgroups of related cases over time to underst and complex trajectories . Further research is needed to clarify individual differences in CBT intervention preference as well as other factors which impact on resilience This study aim ed to test the effectiveness of a nurse-led structured psychosocial intervention program in Chinese patients with first-onset mental illness . A single-blind , parallel group , r and omized controlled trial design was used . The study involved 180 participants with mild to moderate-severe symptoms of psychotic or mood disorders who were newly referred to two psychiatric outpatient clinics in Hong Kong . Patients were r and omly assigned to either an eight-session nurse-led psychosocial intervention program ( plus usual care ) or usual psychiatric outpatient care ( both n=90 ) . The primary outcome was psychiatric symptoms . Outcomes were measured at recruitment , one week and 12 months post-intervention . Patients in the psychosocial intervention group reported statistically significant improvements in symptoms compared to treatment as usual . There were also significant improvements in illness insight and perceived quality of life and reduction in length of re-hospitalizations over the 12-month follow-up . The findings provide evidence that the nurse-led psychosocial intervention program result ed in improved health outcomes in Chinese patients with first-onset mental illness 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 Though group interventions are widely used in community-based and clinical setting s , there are few brief instruments for assessing the group environment . Two studies on the development of a brief measure to assess intervention group environments are described , and psychometric properties of the new scale are presented . The new measure is based on Moos ' ( 1994 ) Group Environment Scale ( GES ) .  Participants in the studies were from two independent r and omized controlled clinical trials ( RCTs ) of group interventions ( combined N = 334 ) . In Study 1 ( N = 139 ) , the factor content of the original 90-item GES was examined . The scale was shortened , the response format was changed , and items were adapted and added to in an effort to increase applicability to community-based and clinical intervention groups . In Study 2 ( N = 195 ) , the new scale was evaluated , the factor solution obtained in Study 1 was cross-vali date d , and subsequently the length of the scale was shortened again . The final scale contains 25 items with three subscales . Reliability and validity of the new scale was examined . Finally , the research and practice implication s of the scale are discussed 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 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 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 BACKGROUND Two interventions for fatigue were given during curative cancer treatment .  The aim of this multicenter r and omized controlled trial ( RCT ) with three conditions was to demonstrate the efficacy and to determine the contribution of physical activity . METHODS Recruited from seven hospitals , 220 patients with various malignancies participated in a RCT . The brief nursing intervention ( BNI ) consisted of two 1-hour sessions , 3 months apart , given by 12 trained nurses , focusing only on physical activity . Cognitive behavior therapy ( CBT ) consisted of up to ten 1-hour sessions , within 6 months , provided by two therapists , focusing on physical activity and psychosocial elements . The control group received only usual care ( UC ) . Assessment s took place before and at least 2 months after cancer treatment , when patients had recovered from acute fatigue . Fatigue was the primary outcome . Efficacy was tested using analyses of covariance . A nonparametric bootstrap approach was used to test whether the effect on fatigue was mediated by physical activity . RESULTS The CBT group was significantly less fatigued than the UC group . Between the BNI and the UC groups , no significant difference was found in fatigue . The mediation hypothesis was rejected . DISCUSSION CBT given during curative cancer treatment proved to be an effective intervention to reduce fatigue at least 2 months after cancer treatment . The BNI was not effective . Contrary to what was expected , physical activity did not mediate the effect of CBT on fatigue . Thus , the reduction in fatigue elicited by CBT was realized without a lasting increase in physical activity
BACKGROUND The bio-psychosocial model of spinal cord injury ( SCI ) highlights that psychosocial care is of equal importance as physical rehabilitation , and should be offered in the earlier stages of inpatient rehabilitation .
AIM This systematic review aim ed to identify interventional research regarding psychosocial care for people with SCI during inpatient rehabilitation and synthesize the evidence of the effects and characteristics of these studies .