Associations of proactive coping and self-efficacy with psychosocial outcomes in individuals after stroke

Objective: To examine the associations of proactive coping and self-efficacy with psychosocial outcomes in individuals after stroke. Design: Cross-sectional study. Regression analyses were performed. Setting: Outpatient settings of hospitals and rehabilitation centers. Participants: Individuals after stroke (N=112; mean age +/- SD, 57.1 +/- 8.9y; mean time +/- SD since stroke, 18.9 +/- 28.5mo). Interventions: Not applicable. Main Outcome Measures: Proactive coping was measured using the Utrecht Proactive Coping Competence scale (UPCC), and self-efficacy was measured using the General Self-Efficacy Scale (GSES). Psychosocial outcomes were measured as (1) participation with the use of the restriction and satisfaction subscales of the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation); (2) emotional problems with the use of the Hospital Anxiety and Depression Scale (HADS); (3) life satisfaction with the use of 2 questions (2LS); and (4) health-related quality of life (HRQOL) with the use of the Short Stroke-Specific Quality of Life scale (SS-QOL-12). Results: Higher UPCC scores were associated with lower HADS scores (beta=-.55, P.0025). Conclusions: Proactive coping and self-efficacy have different associations with each of the psychosocial outcomes. Therefore, outcome-specific models appear to be necessary to describe these associations. (C) 2015 by the American Congress of Rehabilitation Medicin

Complications following spinal cord injury: occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation

Objective: To assess the occurrence and risk factors for complications following spinal cord injury during and after inpatient rehabilitation. Design: Multicentre longitudinal study. Subjects: A total of 212 persons with a spinal cord injury admitted to specialized rehabilitation centres. Methods: Assessments at the start of active rehabilitation (n = 212), 3 months later (n = 143), at discharge (n = 191) and 1 year after discharge (n = 143). Results: Multi-level random coefficient analyses revealed that complications were common following spinal cord injury. Most subjects reported neurogenic and musculoskeletal pain, or had spasticity at each assessment. During the year after discharge, complications remained common: urinary tract infections and pressure sores affected 49% and 36% of the population, respectively. The degree of pain decreased, whereas the degree of spasticity increased significantly during inpatient rehabilitation. Overall, increased age, increased body mass index, traumatic lesion, tetraplegia, and complete lesion all increased the risk of complications. Conclusion: Complications are common following spinal cord injury. They need specific attention after discharge from inpatient rehabilitation and within subpopulations. © 2007 Foundation of Rehabilitation Information

The Wheelchair Circuit: Construct Validity and Responsiveness of a Test to Assess Manual Wheelchair Mobility in Persons With Spinal Cord Injury

Kilkens OJ, Dallmeijer AJ, de Witte LP, van der Woude LH, Post MW. The Wheelchair Circuit: construct validity and responsiveness of a test to assess manual wheelchair mobility in persons with spinal cord injury. Arch Phys Med Rehabil 2004;85:424-31. Objective To assess the validity and responsiveness of the Wheelchair Circuit, a test to assess manual wheelchair mobility in persons with spinal cord injury (SCI). Design Longitudinal. Subjects performed the Wheelchair Circuit at the start (T1) and at the end (T3) of inpatient functional rehabilitation. Construct validity and responsiveness were assessed. Setting Eight rehabilitation centers in the Netherlands. Participants Seventy-four subjects with SCI admitted for inpatient rehabilitation. Interventions Not applicable. Main outcome measures The Wheelchair Circuit consists of 8 wheelchair skills and results in 3 test scores: ability, performance time, and physical strain. The construct validity of the Wheelchair Circuit was assessed by testing whether the test scores were significantly related to the subjects' functional status, physical capacity, lesion level, motor completeness of the lesion, and age. To prove the test's responsiveness, it was assessed whether the test scores had significantly improved between T1 and T3. Results For construct validity, 4 of the 5 hypotheses were confirmed. For test responsiveness, all 3 test scores had significantly improved during rehabilitation, and the standardized response mean values ranged from 0.6 to 0.9. Conclusions The Wheelchair Circuit is a valid and responsive instrument with which to measure manual wheelchair mobility in subjects with SCI. © 2004 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation

An assessment of Evans' unified field theory I

Evans developed a classical unified field theory of gravitation and electromagnetism on the background of a spacetime obeying a Riemann-Cartan geometry. This geometry can be characterized by an orthonormal coframe theta and a (metric compatible) Lorentz connection Gamma. These two potentials yield the field strengths torsion T and curvature R. Evans tried to infuse electromagnetic properties into this geometrical framework by putting the coframe theta to be proportional to four extended electromagnetic potentials A; these are assumed to encompass the conventional Maxwellian potential in a suitable limit. The viable Einstein-Cartan(-Sciama-Kibble) theory of gravity was adopted by Evans to describe the gravitational sector of his theory. Including also the results of an accompanying paper by Obukhov and the author, we show that Evans' ansatz for electromagnetism is untenable beyond repair both from a geometrical as well as from a physical point of view. As a consequence, his unified theory is obsolete.Comment: 39 pages of latex, modified because of referee report, mistakes and typos removed, partly reformulated, taken care of M.W.Evans' rebutta

Functional independence and health-related functional status following spinal cord injury: A prospective study of the association with physical capacity

Objective: To determine changes in functional independence following spinal cord injury and to evaluate the association between functional independence and physical capacity. Design: Multi-centre prospective cohort study. Subjects: Patients with spinal cord injury admitted for initial rehabilitation. Methods: The motor Functional Independence Measure (FIMmotor) was determined at the start of rehabilitation (n=176), 3 months later (n=124), at discharge (n=160) and one year after discharge from inpatient rehabilitation (n=133). One year after discharge, physical and social dimensions of health-related functional status (Sickness Impact Profile 68; SIP68) were determined. On each occasion, physical capacity was established by measuring arm muscle strength, peak power output and peak oxygen uptake. Results: Multi-level random coefficient analyses revealed that FIMmotor improved during inpatient rehabilitation, but stabilized thereafter. Changes in FIMmotor were associated with peak power output. Multiple regression models showed that FIMmotor and peak power output at discharge were associated with FIMmotor one year after discharge (R2=0.85), and that peak power output at discharge was associated with the social dimension of the SIP68 (R2=0.18) one year after discharge. Conclusion: Functional independence improves during inpatient rehabilitation, and functional independence is positively associated with peak power output

Immunophenotypic analysis reveals differences in circulating immune cells in the peripheral blood of patients with segmental and nonsegmental vitiligo

Accumulating studies have indicated immune-based destruction of melanocytes in both segmental vitiligo (SV) and non-SV (NSV). Whereas SV often occurs unilaterally during childhood and stabilizes after an initial period of activity, the disease course of NSV is usually slowly progressive, with new lesions occurring bilaterally during life. This suggests an involvement of distinct pathophysiology pathways, specifically increased systemic immune activation in patients with NSV but not in patients with SV. This research aimed to identify the differences in immune cells in the blood of patients with SV and NSV through immunophenotyping of circulating cells. Regulatory T cells were unaffected in patients with SV compared with that in healthy controls but decreased in patients with NSV. In patients with NSV, the reduction in regulatory T cells was associated with the presence of other systemic autoimmune comorbidities, which were less present in SV. Similarly, the absence of a melanocyte-specific antibody response in patients with SV suggests less involvement of B-cell immunity in SV. These data show that in contrast to patients with NSV, no increased systemic immunity is found in patients with SV, indicating that SV pathogenesis is associated with a localized cytotoxic reaction targeting epidermal melanocytes

Effectiveness of a Self-Management Intervention to Promote an Active Lifestyle in Persons With Long-Term Spinal Cord Injury: The HABITS Randomized Clinical Trial

Background. Most people with long-term spinal cord injury (SCI) have a very inactive lifestyle. Higher activity levels have been associated with health benefits and enhanced quality of life. Consequently, encouraging an active lifestyle is important and behavioral interventions are needed to establish durable lifestyle changes. Objective. The Healthy Active Behavioral Intervention in SCI (HABITS) study was aimed to evaluate the effectiveness of a structured self-management intervention to promote an active lifestyle in inactive persons with long-term SCI. Methods. This assessor-blinded randomized controlled trial was conducted at 4 specialized SCI units in the Netherlands. Sixty-four individuals with long-term SCI (>10 years), wheelchair-user and physically inactive, were included. Participants were randomized to either a 16-week self-management intervention consisting of group meetings and individual counseling and a book, or to a control group that only received information about active lifestyle by one group meeting and a book. Measurements were performed at baseline, 16 weeks, and 42 weeks. Primary outcome measures were self-reported physical activity and minutes per day spent in wheelchair driving. Secondary outcomes included perceived behavioral control (exercise self-efficacy, proactive coping), stages of change concerning exercise, and attitude toward exercise. Results. Mixed models analyses adjusted for age, sex, level of SCI, time since injury, baseline body mass index, and location did not show significant differences between the intervention and control groups on the primary and secondary outcomes (P ≥.05). Conclusions. A structured 16-week self-management intervention was not effective to change behavior toward a more active lifestyle and to improve perceived behavioral control, stages of change, and attitude

Appraisals and coping mediate the relationship between resilience and distress among significant others of persons with spinal cord injury or acquired brain injury: A cross-sectional study

Background: Many significant others of persons with serious conditions like spinal cord injury (SCI) and acquired brain injury (ABI) report high levels of psychological distress. In line with the stress-coping model, the aim of the present study was to investigate the relationship between personal resource resilience and psychological distress, and whether appraisals of threat and loss, and passive coping mediate this relationship. Methods: Significant others (n = 228) of persons with SCI or ABI completed questionnaires shortly after admission to first inpatient rehabilitation after onset of the condition. The questionnaire included measures to assess psychological distress (Hospital Anxiety and Depression Scale), resilience (Connor-Davidson Resilience Scale-10), appraisals (Appraisals of Life Events scale, threat and loss) and passive coping (Utrecht Coping List). The PROCESS tool was used to test the presence of mediation. Confounding and differences between SCI and ABI were investigated. Results: High levels of psychological distress among significant others were found (34-41%). Fifty-five percent of the variance in psychological distress was explained by the relationship between resilience and psychological distress. This relationship was mediated by appraisals of threat and loss, and passive coping. The relationship between resilience and psychological distress was similar in the SCI and ABI groups. Conclusions: The results of our study indicate that appraisals of threat and loss and passive coping are mediating factors in the relationship between resilience and psychological distress. It seems useful to investigate if interventions focussing on psychological factors like resilience, appraisal and coping are effective to prevent or reduce psychological distress among significant others of persons with SCI or ABI