title: Functional independence in pediatric-onset spinal cord injury: two levels of mediation.
abstract: OBJECTIVE
  To test 3 models that examine the relationship of posttraumatic stress (PTS), family functioning (FF), and level of spinal cord injury (SCI) to functional independence (FI) among patients with pediatric-onset SCI.
  
  
  METHODS
  Participants were 109 pediatric spinal cord injury patients, ages 11-24 years, from 2 surgical and rehabilitation hospitals. Data from 2 previous cross-sectional studies included the Posttraumatic Diagnostic Scale, the Family Assessment Device, and the Pediatric Orthopedic Surgeons of North America Pediatric Musculoskeletal Functional Health Questionnaire. Path analyses were used to test 3 hypothesized models: that PTS would mediate the relationship between FF and FI, that PTS Avoidance symptoms would mediate the relationship between other PTS symptom clusters and FI, and that these 2 models would show adequate fit to the data when integrated into an overarching model to depict the interrelationship of level of SCI (tetraplegia v. paraplegia), FF, PTS symptom clusters, and FI.
  
  
  RESULTS
  Results from the first model indicated that PTS mediated the relationship between FF and FI. In addition, the Avoidance symptom cluster of PTS mediated the relationships between PTS Reexperiencing symptoms and FI and between the PTS Arousal symptom cluster and FI. A third model integrated the previous 2 models and supported these 2 levels of mediation.
  
  
  CONCLUSIONS
  Level of SCI related directly to FI, and PTS mediated the relationship between FF and FI; PTS Avoidance mediated the relationships between Intrusive Reexperiencing and FI and between PTS Arousal and FI.
authors.affiliation: Institute for Graduate Clinical Psychology, Widener University, Chester, PA 19013, USA. baboyer@mail.widener.edu
authors.forename: Bret A
authors.initials: BA
authors.lastname: Boyer
authors.forename: Catherine A
authors.initials: CA
authors.lastname: Nowcid
authors.forename: Christine
authors.initials: C
authors.lastname: Ware
mesh_terms: D000293:Adolescent; D000328:Adult; D017668:Age of Onset; D017028:Caregivers / Q000523:psychology*; D015984:Causality; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D005191:Family Characteristics; D054541:Family Conflict / Q000523:psychology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008960:Models, Psychological; D010264:Paraplegia / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D010555:Personality Inventory / Q000706:statistics & numerical data; D011594:Psychometrics; D011782:Quadriplegia / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000523:psychology / Q000534:rehabilitation*; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis* / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult