Abstract
Objective
To test the Spinal Cord Injury Adjustment Model and gain a better understanding about
whether and how the psychological resources general self-efficacy (SE), purpose in
life (PIL), appraisals, and coping influence participation in persons with spinal
cord injury (SCI).
Design
Cross-sectional data collection within the Swiss Spinal Cord Injury Cohort.
Setting
Community setting.
Participants
Persons with SCI (N=516) who are ≥16 years old and living in the community in Switzerland.
Interventions
Not applicable.
Main Outcome Measures
Participation was measured with the restrictions subscale of the Utrecht Scale for
Evaluation of Rehabilitation-Participation, General SE with the General Self-Efficacy
Scale, PIL with the Purpose in Life Test-Short Form, appraisals with the Appraisal
of Life Events Scale, and coping with the Brief COPE.
Results
General SE (r=.32) and PIL (r=.23) were associated with less participation restrictions. The initial model yielded
a poor model fit. The modified final model had an acceptable fit (χ211=36.2; P<.01; root mean square error of approximation=.067 [90% confidence interval: .045–.09];
comparative fit index=.98). A total of 15% of the variance of participation was explained.
In the final model, general SE had a moderate direct effect (β=.24) and mediated effects
via threat appraisal and challenge appraisal and humor on participation, indicating
a partial mediation effect. The association between PIL and participation was indirect:
challenge appraisal and humor acted as mediators.
Conclusions
The results only partly support the double-mediating effect as suggested in the SCI
adjustment model because both direct and indirect effects on participation were observed.
Individuals with higher general SE and PIL perceive less participation restrictions.
General SE seems an appropriate target to enhance participation. Longitudinal studies
are needed to support our findings.
Keywords
List of abbreviations:
CFI (comparative fit index), PIL (purpose in life), RMSEA (root mean square error of approximation), SCI (spinal cord injury), SE (self-efficacy), SwiSCI (Swiss Spinal Cord Injury Cohort Study)To read this article in full you will need to make a payment
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References
- International Classification of Functioning, Disability and Health: ICF.World Health Organization, Geneva2001
- Spinal cord medicine.Lippincott Williams & Wilkins, Philadelphia2002
- The aftermath of spinal cord injury.in: Stover S.L. DeLisa J.A. Whiteneck G.G. Spinal cord injury: clinical outcomes from the model systems. Aspen, Gaithersburg1995: 185-213
- Psychological adjustment to chronic disease.Lancet. 2008; 372: 246-255
- Community integration in spinal cord injury of long duration.NeuroRehabilitation. 2004; 19: 91-101
- Environmental factors and their role in participation and life satisfaction after spinal cord injury.Arch Phys Med Rehabil. 2004; 85: 1793-1803
- Perceptions of participation and predictors of perceived problems with participation in persons with spinal cord injury.J Rehabil Med. 2005; 37: 3-8
- Self-efficacy and self-esteem as predictors of participation in spinal cord injury–an ICF-based study.Spinal Cord. 2012; 50: 699-706
- Predicting community reintegration after spinal cord injury from demographic and injury characteristics.Arch Phys Med Rehabil. 1999; 80: 1485-1491
- Relationships between activities, participation, personal factors, mental health, and life satisfaction in persons with spinal cord injury.Arch Phys Med Rehabil. 2012; 93: 82-89
- Correlates and determinants of physical activity in persons with spinal cord injury: a review using the International Classification of Functioning, Disability and Health as reference framework.Disabil Health J. 2012; 5: 140-150
- Modeling social reintegration in persons with spinal cord injury.Disabil Rehabil. 2005; 27: 131-141
- Measurement and evidence of environmental determinants of participation in spinal cord injury: a systematic review of the literature.Top Spinal Cord Inj Rehabil. 2010; 15: 26-48
- The impact of internal and external resources on functional outcomes in chronic illness.Res Nurs Health. 1996; 19: 485-497
- Resources and coping with stressful events.J Organ Behav. 2009; 30: 685-707
- Social and psychological resources and adaptation.Rev Gen Psychol. 2002; 6: 307-324
- Psychological resources in spinal cord injury: a systematic literature review.Spinal Cord. 2012; 50: 188-201
- Sustaining exercise motivation and participation among people with spinal cord injuries - lessons learned from a 9-month intervention.Palaestra. 2002; 18: 38-40
- Perceived barriers to exercise in people with spinal cord injury.Am J Phys Med Rehabil. 2005; 84: 576-583
- Psychological challenges in treating persons with spinal cord injury.in: Craig A. Tran Y. Psychological aspects associated with spinal cord injury rehabilitation: new directions and best evidence. Nova Science Publishers, New York2008: 3-53
- Generalized self-efficacy scale.in: Weinman J. Wright S. Johnston M. Measures in health psychology: a user’s portfolio causal and control beliefs. NFER-Nelson, Windsor1995: 35-37
- Man’s search for meaning.Washington Square Pr, New York1959
- Design of the Swiss Spinal Cord Injury Cohort Study.Am J Phys Med Rehabil. 2011; 90: S5-16
- The Purpose in Life Test-Short Form: development and psychometric support.J Happiness Stud. 2011; 12: 861-876
- Is general self-efficacy a universal construct? Psychometric findings from 25 countries.Eur J Psychol Assess. 2002; 18: 242-251
- The assessment of optimistic self-beliefs: comparison of the German, Spanish, and Chinese versions of the General Self-efficacy Scale.Appl Psychol Int Rev. 1997; 46: 69-88
- Self-efficacy mediating the occurrence of secondary conditions after spinal cord injury.SCI Psychosocial Process. 2009; 22: 16-22
- The relationship between and predictors of quality of life after spinal cord injury at 3 and 15 months after discharge.Spinal Cord. 2010; 48: 73-79
- A pilot investigation of a psychosocial activity course for people with spinal cord injuries.Psychol Health Med. 2006; 11: 91-99
- The Appraisal of Life Events (ALE) scale: reliability and validity.Br J Health Psychol. 1999; 4: 97-116
- Primary appraisal of infertility: evaluation of the psychometric properties of a Greek version of the Appraisal of Life Events Scale (ALE) in a sample of infertile women undergoing fertility treatment.Women Health. 2010; 50: 688-704
- You want to measure coping but your protocol's too long: consider the Brief COPE.Int J Behav Med. 1997; 4: 92-100
- Validity of the utrecht scale for evaluation of rehabilitation-participation.Disabil Rehabil. 2012; 34: 478-485
- Statistical power analysis for the behavioural sciences.2nd ed. Lawrence Erlbaum Associates, Hillsdale1988
- lavaan: an R package for structural equation modeling.J Stat Softw. 2012; 48: 1-36
- Dimensionality of coping: an empirical contribution to the construct validation of the Brief-COPE with a Greek-speaking sample.J Health Psychol. 2010; 15: 215-229
- Coping Orientation to Problems Experienced-Nuova Versione Italiana (COPE-NVI): uno strumento per la misura degli stili di coping [Italian].Psicoterapia Cognitiva e Comportamentale. 2008; 14: 27-53
- An introduction to using structural equation models in rehabilitation psychology.Rehabil Psychol. 2008; 53: 340-356
- The relative performance of full information maximum likelihood estimation for missing data in structural equation models.Structural Equation Modeling. 2001; 8: 430-457
- Cutoff criteria for fit indexes in covariance structure analysis: conventional criteria versus new alternatives.Structural Equation Modeling. 1999; 6: 1-55
- Understanding the limitations of global fit assessment in structural equation modeling.Personality and Individual Differences. 2007; 42: 893-898
- Power analysis and determination of sample size for covariance structure modeling.Psychol Methods. 1996; 1: 130-149
Pornprasertmanit S, Miller P, Schoemann A. simsem: SIMulated structural equation modeling. 2013. Available at: http://cran.r-project.org/package=simsem. Accessed November 25, 2013.
- Relationship of life satisfaction to impairment, disability, and handicap among persons with spinal cord injury living in the community.Arch Phys Med Rehabil. 1992; 73: 552-557
- Understanding health outcomes: physical secondary conditions in people with spinal cord injury.Rehabil Psychol. 2007; 52: 338-350
- Enhancing community reintegration after inpatient rehabilitation for persons with spinal cord injury.Top Spinal Cord Inj Rehabil. 1998; 4: 42-55
- Self-efficacy and quality of life in people with spinal cord injuries in China.Rehabil Couns Bull. 2000; 43: 66-74
- Assessment of global function: The Reintegration to Normal Living Index.Arch Phys Med Rehabil. 1988; 69: 583-590
- Purpose in life: what is its relationship to happiness, depression, and grieving?.N Am J Psychol. 2000; 2: 113-119
- A confirmatory factor-analytic evaluation of the purpose in life test: preliminary psychometric support for a replicable two-factor model.J Happiness Stud. 2010; 11: 95-111
- The role of goal management for successful adaptation to arthritis.Patient Educ Couns. 2013; 93: 130-138
- Purposiveness and leisure-time physical activity in women in early midlife.Women Health. 2011; 51: 661-675
- Associations between psychological factors and quality of life ratings in persons with spinal cord injury: a systematic review.Spinal Cord. 2012; 50: 174-187
- Adjustment to chronic illness and disability: theoretical perspectives, empirical findings, and unresolved issues.in: Kennedy P. The oxford handbook of rehabilitation psychology. Oxford Univ Pr, New York2012: 47-87
- Cognitive appraisals, coping and quality of life outcomes: a multi-centre study of spinal cord injury rehabilitation.Spinal Cord. 2010; 48: 762-769
- Are funny people popular? An examination of humor orientation, loneliness, and social attraction.Communication Quarterly. 1996; 44: 42-52
- The involvement of sense of humor in the development of social relationships.Communication Reports. 1995; 8: 158-169
- A biopsychosocial perspective on adjustment and quality of life following brain tumor: a systematic evaluation of the literature.Disabil Rehabil. 2009; 31: 1038-1055
- Self-efficacy: toward a unifying theory of behavioral change.Psychol Rev. 1977; 84: 191-215
- Flourish: a visionary new understanding of happiness and well-being.Free Pr, New York2011
- SCI/D forum to increase active living: the effect of a self-efficacy and self-affirmation based SCI/D forum on active living in adults with spinal cord injury/disease.SCI Psychosocial Process. 2008; 21: 5-13
- The effect of a self-efficacy based forum on life satisfaction for individuals with spinal cord injury or disease.Annual in Therapeutic Recreation. 2008; 16: 49-56
- Comparison of a pain management program with usual care in a pain management center for people with spinal cord injury-related chronic pain.Clin J Pain. 2010; 26: 206-216
- A review and sythesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implication for health education practice (part I).Health Promot Pract. 2005; 6: 37-43
- A review and sythesis of research evidence for self-efficacy-enhancing interventions for reducing chronic disability: implication for health education practice (part II).Health Promot Pract. 2005; 6: 148-156
Article info
Publication history
Published online: May 01, 2014
Footnotes
Supported by the Swiss Paraplegic Association in the framework of the Swiss Spinal Cord Injury Cohort Study (SwiSCI, www.swisci.ch).
Disclosures: none.
Identification
Copyright
© 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
