title: Pain and fatigue as mediators of the relationship between mobility aid usage and depressive symptomatology in ambulatory individuals with SCI.
abstract: METHODS
  Cross-sectional cohort study.
  
  
  OBJECTIVE
  To investigate a mediational model where pain (intensity and interference) and fatigue mediate the relationship between the use of mobility aids and moderate-to-severe depressive symptomatology among ambulatory participants with spinal cord injury (SCI).
  
  
  METHODS
  A medical university in the southeastern United States.
  
  
  METHODS
  Ambulatory adults (N=652) with chronic SCI responded to a mail-in survey. The Patient Health Questionnaire-9 was used to assess moderate-to-severe depressive symptomatology. The Brief Pain Inventory was used to assess pain intensity and interference, and the Modified Fatigue Impact Scale-5-item version was used to assess fatigue. Participants self-reported use of mobility aids.
  
  
  RESULTS
  On examining mobility aids used for ambulation, 65% were found to have used at least one aid. Severe pain intensity was reported by 11%, and 14% reported severe pain interference. Disabling fatigue was reported by 10% of the participants. Twenty-one percent (n=138) reported moderate-to-severe levels of depressive symptoms. On examining the relationships between mobility aids and depressive symptomatology, using people as a mobility aid was associated with increased odds of depressive symptomatology (2.6) and always using a wheelchair was associated with lower odds (0.3). However, these relationships were no longer significant after controlling for the mediating variables pain intensity, pain interference and fatigue.
  
  
  CONCLUSIONS
  Pain and fatigue mediate the relationship between usage of certain mobility aids and depressive symptomatology. The use of people to assist in ambulation is associated with greater odds of moderate-to-severe depressive symptomatology, while always using a wheelchair is associated with lower odds.
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: N D
authors.initials: ND
authors.lastname: Dipiro
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: L L
authors.initials: LL
authors.lastname: Saunders
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: S
authors.initials: S
authors.lastname: Brotherton
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: S
authors.initials: S
authors.lastname: Kraft
authors.affiliation: Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
authors.forename: J S
authors.initials: JS
authors.lastname: Krause
mesh_terms: D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003863:Depression / Q000503:physiopathology*; D005221:Fatigue / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009983:Orthopedic Equipment; D010146:Pain / Q000503:physiopathology*; D010147:Pain Measurement; D011569:Psychiatric Status Rating Scales; D057566:Self Report; D012656:Self-Help Devices; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000503:physiopathology* / Q000523:psychology / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D014910:Wheelchairs