John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, New South Wales, Australia.
John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, New South Wales, Australia; Australian Institute of Health Innovation, Macquarie University, North Ryde, New South Wales, Australia.
Arch Phys Med Rehabil. 2019 Mar;100(3):441-447. doi: 10.1016/j.apmr.2018.07.442. Epub 2018 Sep 13.
To establish self-efficacy and depressive mood trajectories in adults with spinal cord injury (SCI), determine their interrelationship over time, and determine the influence that appraisals and comorbid physical conditions have on the development of self-efficacy.
A prospective cohort design.
Inpatient rehabilitation and community settings.
Adults (N=88) admitted consecutively into 3 SCI units (mean age, 42.6 years, 70.4% male, 61% paraplegia).
Multidisciplinary inpatient SCI rehabilitation.
The Moorong Self-Efficacy Scale and Hospital Anxiety and Depression Scale were used to model self-efficacy and depressive mood trajectories. Appraisals were assessed using the Appraisals of Disability Scale and frequency/type of secondary conditions using the Secondary Conditions Scale. Growth mixture modeling was used to determine trajectories. Dual trajectory probability analysis was used to determine concurrent changes in self-efficacy and depressive mood. Linear mixed modeling incorporating repeated measures determined the contribution of appraisals and physical complications to self-efficacy trajectories.
Modeling identified 4 trajectories of self-efficacy and depressive mood. The majority (around 60%) of the sample was estimated to have moderate to high self-efficacy and low levels of depressive mood. Dual trajectory analysis revealed that robust self-efficacy was strongly connected to low depressive mood over time, while low self-efficacy was strongly linked to clinically elevated depressive mood. Low self-efficacy was related to higher severity of secondary conditions and negative appraisals.
Findings highlight the importance of self-efficacy not only as a strategic clinical measure for assessing adjustment following SCI but also in relation to the implications it raises for improving SCI rehabilitation.
建立脊髓损伤（SCI）成人的自我效能和抑郁情绪轨迹，确定它们随时间的相互关系，并确定评估和合并的身体状况对自我效能发展的影响。
前瞻性队列设计。
住院康复和社区环境。
连续入住 3 个 SCI 病房的成年人（平均年龄 42.6 岁，70.4%为男性，61%为截瘫）。
多学科住院 SCI 康复。
使用 Moorong 自我效能量表和医院焦虑抑郁量表来建立自我效能和抑郁情绪轨迹模型。使用残疾评估量表评估评估，使用次级状况量表评估次级状况的频率/类型。使用增长混合建模来确定轨迹。双轨迹概率分析用于确定自我效能和抑郁情绪的并发变化。线性混合模型包含重复测量，以确定评估和身体并发症对自我效能轨迹的贡献。
模型确定了自我效能和抑郁情绪的 4 种轨迹。大多数（约 60%）样本被估计为具有中度到高度的自我效能和低度的抑郁情绪。双轨迹分析表明，强大的自我效能与随时间推移的低抑郁情绪密切相关，而低自我效能与临床显著的抑郁情绪密切相关。低自我效能与更严重的次级状况和负面评估有关。
研究结果强调了自我效能的重要性，不仅作为评估 SCI 后调整的临床策略，而且对改善 SCI 康复也有重要意义。
