How Do Fluctuations in Pain, Fatigue, Anxiety, Depressed Mood, and Perceived Cognitive Function Relate to Same-Day Social Participation in Individuals With Spinal Cord Injury?

Published:August 26, 2021DOI:



      This study aimed to examine same-day associations of pain, fatigue, depressed mood, anxiety, and perceived cognitive function with social participation in the daily lives of adults with spinal cord injury (SCI).


      Observational study used a combination of baseline surveys and 7 end-of-day (EOD) diaries.


      General community.


      Individuals with SCI (N=168; mean age, 49.8y; 63% male, 37% female).

      Main Outcome Measures

      Patient-Reported Outcomes Measurement Information System short form measures (Ability to Participate in Social Roles and Activities, Pain Intensity, Depression, Anxiety, Cognitive Function Abilities) were adapted for daily administrations as EOD diaries.


      Results of multivariable model showed that daily increases in fatigue (B=−0.10; P=.004) and depressive symptoms (B=−0.25; P=<.001) and decreases in perceived cognitive function (B=0.11; P=<.001) were significantly related to worse same-day social participation. Daily fluctuations in anxiety and pain were unrelated to same-day social participation.


      This is the first study that shows within-person associations of common SCI symptoms with social participation in the daily lives of adults with SCI. Results from the current study may help to develop more effective individualized treatments of symptoms and symptom effect aimed at improving social participation.


      List of abbreviations:

      EOD (end-of-day), ICF (International Classification of Functioning, Disability, and Health), PROMIS (Patient-Reported Outcomes Measurement Information System), SCI (spinal cord injury)
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        • Middleton J
        • Tran Y
        • Craig A
        Relationship between quality of life and self-efficacy in persons with spinal cord injuries.
        Arch Phys Med Rehabil. 2007; 88: 1643-1648
        • Westgren N
        • Levi R
        Quality of life and traumatic spinal cord injury.
        Arch Phys Med Rehabil. 1998; 79: 1433-1439
        • Finnerup NB
        • Jensen MP
        • Norrbrink C
        • et al.
        A prospective study of pain and psychological functioning following traumatic spinal cord injury.
        Spinal Cord. 2016; 54: 816-821
        • Hancock KM
        • Craig AR
        • Dickson HG
        • Chang E
        • Martin J
        Anxiety and depression over the first year of spinal cord injury: a longitudinal study.
        Paraplegia. 1993; 31: 349-357
        • Kennedy P
        • Rogers BA
        Anxiety and depression after spinal cord injury: a longitudinal analysis.
        Arch Phys Med Rehabil. 2000; 81: 932-937
        • Williams R
        • Murray A
        Prevalence of depression after spinal cord injury: a meta-analysis.
        Arch Phys Med Rehabil. 2015; 96: 133-140
        • Craig AR
        • Hancock KM
        • Dickson HG
        A longitudinal investigation into anxiety and depression in the first 2 years following a spinal cord injury.
        Paraplegia. 1994; 32: 675-679
        • Wijesuriya N
        • Tran Y
        • Middleton J
        • Craig A
        Impact of fatigue on the health-related quality of life in persons with spinal cord injury.
        Arch Phys Med Rehabil. 2012; 93: 319-324
        • Craig A
        • Tran Y
        • Siddall P
        • et al.
        Developing a model of associations between chronic pain, depressive mood, chronic fatigue, and self-efficacy in people with spinal cord injury.
        J Pain. 2013; 14: 911-920
        • Davidoff G
        • Roth EJ
        • Richards JS
        Cognitive deficits in spinal cord injury: epidemiology and outcome.
        Arch Phys Med Rehabil. 1992; 73: 275-284
        • Roth E
        • Davidoff G
        • Thomas P
        • et al.
        A controlled study of neuropsychological deficits in acute spinal cord injury patients.
        Paraplegia. 1989; 27: 480-489
        • Davidoff G
        • Morris J
        • Roth E
        • Bleiberg J
        Cognitive dysfunction and mild closed head injury in traumatic spinal cord injury.
        Arch Phys Med Rehabil. 1985; 66: 489-491
        • Dowler RN
        • Harrington DL
        • Haaland KY
        • Swanda RM
        • Fee F
        • Fiedler K
        Profiles of cognitive functioning in chronic spinal cord injury and the role of moderating variables.
        J Int Neuropsychol Soc. 1997; 3: 464-472
        • Dowler RN
        • O'Brien SA
        • Haaland KY
        • Harrington DL
        • Feel F
        • Fiedler K
        Neuropsychological functioning following a spinal cord injury.
        Appl Neuropsychol. 1995; 2: 124-129
        • Wilmot CB
        • Cope DN
        • Hall KM
        • Acker M
        Occult head injury: its incidence in spinal cord injury.
        Arch Phys Med Rehabil. 1985; 66: 227-231
        • Hess MJ
        • Zhan EH
        • Foo DK
        • Yalla SV
        Bladder cancer in patients with spinal cord injury.
        J Spinal Cord Med. 2003; 26: 335-338
        • Lazzaro I
        • Tran Y
        • Wijesuriya N
        • Craig A
        Central correlates of impaired information processing in people with spinal cord injury.
        J Clin Neurophysiol. 2013; 30: 59-65
        • Bradbury CL
        • Wodchis WP
        • Mikulis DJ
        • et al.
        Traumatic brain injury in patients with traumatic spinal cord injury: clinical and economic consequences.
        Arch Phys Med Rehabil. 2008; 89: S77-S84
        • Macciocchi S
        • Seel R
        • Thompson N
        The impact of mild traumatic brain injury on cognitive functioning following co-occurring spinal cord injury.
        Arch Clin Neuropsychol. 2013; 28: 684-691
        • Richards JS
        • Brown L
        • Hagglund K
        • Bua G
        • Reeder K
        Spinal cord injury and concomitant traumatic brain injury. Results of a longitudinal investigation.
        Am J Phys Med Rehabil. 1988; 67: 211-216
        • Battalio SL
        • Glette M
        • Alschuler KN
        • Jensen MP
        Anxiety, depression, and function in individuals with chronic physical conditions: a longitudinal analysis.
        Rehabilitation Psychology. 2018; 63: 532-541
        • Pollard C
        • Kennedy P
        A longitudinal analysis of emotional impact, coping strategies and post-traumatic psychological growth following spinal cord injury: a 10-year review.
        Br J Health Psychol. 2007; 12: 347-362
        • Craig A
        • Nicholson Perry K
        • Guest R
        • Tran Y
        • Middleton J
        Adjustment following chronic spinal cord injury: determining factors that contribute to social participation.
        Br J Health Psychol. 2015; 20: 807-823
        • Jensen MP
        • Molton IR
        • Groah SL
        • et al.
        Secondary health conditions in individuals aging with SCI: terminology, concepts and analytic approaches.
        Spinal Cord. 2012; 50: 373-378
        • Donnelly C
        • Eng JJ
        Pain following spinal cord injury: the impact on community reintegration.
        Spinal Cord. 2005; 43: 278-282
        • Erosa NA
        • Berry JW
        • Elliott TR
        • Underhill AT
        • Fine PR
        Predicting quality of life 5 years after medical discharge for traumatic spinal cord injury.
        Br J Health Psychol. 2014; 19: 688-700
        • Boschen KA
        • Tonack M
        • Gargaro J
        Long-term adjustment and community reintegration following spinal cord injury.
        Int J Rehabil Res. 2003; 26: 157-164
        • Carpenter C
        • Forwell SJ
        • Jongbloed LE
        • Backman CL
        Community participation after spinal cord injury.
        Arch Phys Med Rehabil. 2007; 88: 427-433
        • Henwood P
        • Ellis JA
        Chronic neuropathic pain in spinal cord injury: the patient's perspective.
        Pain Res Manag. 2004; 9: 39-45
        • Hreha KP
        • Smith AE
        • Wong JL
        • Mroz TM
        • Fogelberg DJ
        • Molton I
        Impact of secondary health conditions on social role participation for a long-term physical disability cohort.
        Psychol Health Med. 2019; 24: 1159-1170
        • Jensen MP
        • Kuehn CM
        • Amtmann D
        • Cardenas DD
        Symptom burden in persons with spinal cord injury.
        Arch Phys Med Rehabil. 2007; 88: 638-645
        • Hemmingsson H
        • Jonsson H
        An occupational perspective on the concept of participation in the International Classification of Functioning, Disability and Health–some critical remarks.
        Am J Occup Ther. 2005; 59: 569-576
        • World Healht Organization
        International Classification of Functioning, Disability, and Health: Children & Youth Version: ICF-CY.
        World Health Organization, Geneva, Switzerland2007
        • Piškur B
        • Daniëls R
        • Jongmans MJ
        • et al.
        Participation and social participation: are they distinct concepts?.
        Clin Rehabil. 2014; 28: 211-220
        • Piatt JA
        • Nagata S
        • Zahl M
        • Li J
        • Rosenbluth JP
        Problematic secondary health conditions among adults with spinal cord injury and its impact on social participation and daily life.
        J Spinal Cord Med. 2016; 39: 693-698
        • Hahn EA
        • Beaumont JL
        • Pilkonis PA
        • et al.
        The PROMIS satisfaction with social participation measures demonstrated responsiveness in diverse clinical populations.
        J Clin Epidemiol. 2016; 73: 135-141
        • Chen WH
        • Revicki DA
        • Amtmann D
        • Jensen MP
        • Keefe FJ
        • Cella D
        Development and Analysis of PROMIS Pain Intensity Scale.
        Qual Life Res. 2012; 20: 18
        • Stone AA
        • Broderick JE
        • Junghaenel DU
        • Schneider S
        • Schwartz JE
        PROMIS fatigue, pain intensity, pain interference, pain behavior, physical function, depression, anxiety, and anger scales demonstrate ecological validity.
        J Clin Epidemiol. 2016; 74: 194-206
        • Cella D
        • Lai JS
        • Jensen SE
        • et al.
        PROMIS fatigue item bank had clinical validity across diverse chronic conditions.
        J Clin Epidemiol. 2016; 73: 128-134
        • Cook KF
        • Bamer AM
        • Roddey TS
        • Kraft GH
        • Kim J
        • Amtmann D
        A PROMIS fatigue short form for use by individuals who have multiple sclerosis.
        Qual Life Res. 2012; 21: 1021-1030
        • Pilkonis PA
        • Choi SW
        • Reise SP
        • et al.
        Item banks for measuring emotional distress from the Patient-Reported Outcomes Measurement Information System (PROMIS®): depression, anxiety, and anger.
        Assessment. 2011; 18: 263-283
        • Lai JS
        • Wagner LI
        • Jacobsen PB
        • Cella D
        Self-reported cognitive concerns and abilities: two sides of one coin?.
        Psychooncology. 2014; 23: 1133-1141
        • Schneider S
        • Choi SW
        • Junghaenel DU
        • Schwartz JE
        • Stone AA
        Psychometric characteristics of daily diaries for the Patient-Reported Outcomes Measurement Information System (PROMIS®): a preliminary investigation.
        Qual Life Res. 2013; 22: 1859-1869
        • Kratz AL
        • Braley TJ
        • Foxen-Craft E
        • Scott E
        • Murphy 3rd, JF
        • Murphy SL
        How do pain, fatigue, depressive, and cognitive symptoms relate to well-being and social and physical functioning in the daily lives of individuals with multiple sclerosis?.
        Arch Phys Med Rehabil. 2017; 98: 2160-2166
        • Geyh S
        • Peter C
        • Müller R
        • et al.
        The personal factors of the International Classification of Functioning, Disability and Health in the literature - a systematic review and content analysis.
        Disabil Rehabil. 2011; 33: 1089-1102
        • Heutink M
        • Post MW
        • Overdulve CW
        • et al.
        Which pain coping strategies and cognitions are associated with outcomes of a cognitive behavioral intervention for neuropathic pain after spinal cord injury?.
        Top Spinal Cord Inj Rehabil. 2013; 19: 330-340
        • Kemp BJ
        • Kahan JS
        • Krause JS
        • Adkins RH
        • Nava G
        Treatment of major depression in individuals with spinal cord injury.
        J Spinal Cord Med. 2004; 27: 22-28
        • Duchnick JJ
        • Letsch EA
        • Curtiss G
        Coping effectiveness training during acute rehabilitation of spinal cord injury/dysfunction: a randomized clinical trial.
        Rehabil Psychol. 2009; 54: 123-132
        • Torabian S
        • Sabet VH
        • Meschi F
        The effectiveness of acceptance and commitment therapy on anxiety, depression, and stress in patients with spinal cord injuries.
        Int Clin Neurosci J. 2019; 6: 46
        • McCracken LM
        • Vowles KE
        Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress.
        Am Psychol. 2014; 69: 178-187
        • Jacobsen HB
        • Kallestad H
        • Landrø NI
        • Borchgrevink PC
        • Stiles TC
        Processes in acceptance and commitment therapy and the rehabilitation of chronic fatigue.
        Scand J Psychol. 2017; 58: 211-220
        • Hicken BL
        • Putzke JD
        • Richards JS
        Bladder management and quality of life after spinal cord injury.
        Am J Phys Med Rehabil. 2001; 80: 916-922
        • Carlozzi NE
        • Schilling S
        • Freedman J
        • Kalpakjian CZ
        • Kratz AL
        The reliability of end of day and ecological momentary assessments of pain and pain interference in individuals with spinal cord injury.
        Qual Life Res. 2018; 27: 3003-3012