Craig A, Guest R, Tran Y, Middleton J
John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, NSW, Australia.
Spinal Cord. 2017 Oct;55(10):926-934. doi: 10.1038/sc.2017.41. Epub 2017 May 2.
Prospective cohort controlled trial design.
(i) To investigate mood benefits of adding group cognitive behaviour therapy (group-CBT) to standard spinal cord injury (SCI) inpatient rehabilitation (SR) that included access to antidepressant medication and individually delivered CBT on demand. (ii) To determine whether those with elevated depressive mood during inpatient rehabilitation significantly improve.
SCI rehabilitation and community settings in New South Wales, Australia.
Participants included 50 adults with SCI who completed SCI rehabilitation that included group-CBT compared with 38 participants who also completed SCI rehabilitation that did not contain group-CBT. Comprehensive assessment occurred after admission, within 2 weeks of discharge and 12 months post-injury. Multivariate repeated measures analyses were conducted to examine differences between groups and over time.
The addition of group-CBT to SR did not result in significant improvement in mood. However, participants with clinically elevated depressive mood assessed during inpatient rehabilitation experienced significant reductions in depressive mood when assessed in the community regardless of CBT dosage. Anxiety correlated with mood while no sociodemographic/injury factors correlated with mood at any time period except education level.
There were no mood advantages over time of adding group-CBT to inpatient SCI rehabilitation that contains individually delivered CBT on demand and access to antidepressant medication. However, findings showed those with elevated depressive mood during inpatient rehabilitation significantly improved when assessed in the community; however, their levels of depressive mood remain high. Future research should investigate the efficacy of providing individual preferences for managing depression in people with SCI.
前瞻性队列对照试验设计。
（i）研究在标准脊髓损伤（SCI）住院康复（SR）中加入团体认知行为疗法（团体CBT）对情绪的益处，该标准康复包括使用抗抑郁药物以及按需提供的个体CBT。（ii）确定在住院康复期间抑郁情绪升高的患者是否有显著改善。
澳大利亚新南威尔士州的SCI康复和社区环境。
参与者包括50名完成包含团体CBT的SCI康复的成年SCI患者，与38名同样完成不包含团体CBT的SCI康复的参与者进行比较。在入院后、出院后2周内和受伤后12个月进行综合评估。进行多变量重复测量分析以检验组间差异和随时间的变化。
在SR中加入团体CBT并未使情绪得到显著改善。然而，在住院康复期间评估为临床抑郁情绪升高的参与者，无论CBT剂量如何，在社区评估时抑郁情绪都有显著降低。焦虑与情绪相关，而除教育水平外，在任何时间段均无社会人口统计学/损伤因素与情绪相关。
在包含按需提供的个体CBT和可使用抗抑郁药物的住院SCI康复中加入团体CBT，随着时间推移对情绪并无优势。然而，研究结果显示，在住院康复期间抑郁情绪升高的患者在社区评估时显著改善；然而，他们的抑郁情绪水平仍然很高。未来的研究应调查根据个体偏好管理SCI患者抑郁症的疗效。
