Investigating Dynamics of the Spinal Cord Injury Adjustment Model: Mediation Model Analysis

Ashley Craig; Yvonne Tran; Mohit Arora; Ilaria Pozzato; James W Middleton

doi:10.3390/jcm11154557

Investigating Dynamics of the Spinal Cord Injury Adjustment Model: Mediation Model Analysis

J Clin Med. 2022 Aug 4;11(15):4557. doi: 10.3390/jcm11154557.

Authors

Ashley Craig^{1

2}, Yvonne Tran³, Mohit Arora^{1

2}, Ilaria Pozzato^{1

2}, James W Middleton^{1

2

4}

Affiliations

¹ John Walsh Centre for Rehabilitation Research, The Kolling Institute, Royal North Shore Hospital, Northern Sydney Local Health District, St Leonards, NSW 2065, Australia.
² Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2006, Australia.
³ Macquarie University Hearing, Faculty of Medicine, Health and Human Sciences, The Australian Hearing Hub, Macquarie University, Sydney, NSW 2109, Australia.
⁴ Spinal Outreach Service, Royal Rehab, Ryde, NSW 2112, Australia.

Abstract

Spinal cord injury (SCI) is a severe neurological injury that results in damage to multiple bodily systems. SCI rehabilitation requires a significant focus on improving adjustment to the injury. This paper presents a detailed description of the Spinal Cord Injury Adjustment Model (SCIAM), which clarifies how individuals adjust to SCI and contends that adjustment to SCI is a multifactorial process involving non-linear dynamic adaptation over time. Evidence supporting SCIAM is also discussed. Mediation analyses were conducted to test the mediator dynamics proposed by the model. The analyses tested the relationship between two moderators (self-care and secondary health conditions), mediators (two self-efficacy items and appraisal of quality of life or QoL), and positive versus negative vitality/mental health as outcomes. Results showed that higher self-efficacy and perceived QoL was related to greater independence in self-care and reduced negative impacts of secondary health conditions. This study supported the mediation role of self-efficacy and other appraisals such as perceived QoL in enhancing self-care and buffering the negative impact of health challenges. In conclusion, it is important to employ a holistic model such as SCIAM to conceptualise and increase understanding of the process of adjustment following a severe neurological injury such as SCI.

Keywords: adjustment; depression; mediation; mental health; neurological injury; rehabilitation; spinal cord injury; vitality.

Grants and funding

We acknowledge and thank the four state-based organisations who contributed funding to undertake the Aus-InSCI survey. The coordinating National Study Centre in New South Wales based at the John Walsh Centre for Rehabilitation Research at the Kolling Institute, The University of Sydney received funding from Insurance and Care NSW (icare NSW). The site in Victoria received funding from the Spinal Research Institute (SRI) and Australasian Spinal Cord Injury Network Ltd. (voluntarily revoked, effective 31 July 2019). The site in South Australia received funding from Lifetime Support Authority South Australia. The site in Queensland was supported by the Division of Rehabilitation, Princess Alexandra Hospital and The Hopkins Centre, Griffith University. The funding organisations do not take direct responsibility for any of the following: study design, data collection, drafting of the manuscript, or decision to publish. No grant numbers were issued for these grants.