title: Psychological resources, appraisals, and coping and their relationship to participation in spinal cord injury: a path analysis.
abstract: OBJECTIVE
  To test the Spinal Cord Injury Adjustment Model and gain a better understanding about whether and how the psychological resources general self-efficacy (SE), purpose in life (PIL), appraisals, and coping influence participation in persons with spinal cord injury (SCI).
  
  
  METHODS
  Cross-sectional data collection within the Swiss Spinal Cord Injury Cohort.
  
  
  METHODS
  Community setting.
  
  
  METHODS
  Persons with SCI (N=516) who are ≥ 16 years old and living in the community in Switzerland.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Participation was measured with the restrictions subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation, General SE with the General Self-Efficacy Scale, PIL with the Purpose in Life Test-Short Form, appraisals with the Appraisal of Life Events Scale, and coping with the Brief COPE.
  
  
  RESULTS
  General SE (r=.32) and PIL (r=.23) were associated with less participation restrictions. The initial model yielded a poor model fit. The modified final model had an acceptable fit (χ(2)11=36.2; P<.01; root mean square error of approximation=.067 [90% confidence interval: .045-.09]; comparative fit index=.98). A total of 15% of the variance of participation was explained. In the final model, general SE had a moderate direct effect (β=.24) and mediated effects via threat appraisal and challenge appraisal and humor on participation, indicating a partial mediation effect. The association between PIL and participation was indirect: challenge appraisal and humor acted as mediators.
  
  
  CONCLUSIONS
  The results only partly support the double-mediating effect as suggested in the SCI adjustment model because both direct and indirect effects on participation were observed. Individuals with higher general SE and PIL perceive less participation restrictions. General SE seems an appropriate target to enhance participation. Longitudinal studies are needed to support our findings.
authors.affiliation: Swiss Paraplegic Research (SPF), Nottwil, Switzerland; Unit for Biopsychosocial Health, Chair for Public Health and Health Care Research, Department of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany. Electronic address: claudio.peter@paraplegie.ch.
authors.forename: Claudio
authors.initials: C
authors.lastname: Peter
authors.affiliation: Swiss Paraplegic Research (SPF), Nottwil, Switzerland; Unit for Biopsychosocial Health, Chair for Public Health and Health Care Research, Department of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany.
authors.forename: Rachel
authors.initials: R
authors.lastname: Müller
authors.affiliation: Swiss Paraplegic Research (SPF), Nottwil, Switzerland; Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat, Utrecht, The Netherlands.
authors.forename: Marcel W M
authors.initials: MW
authors.lastname: Post
authors.affiliation: Swiss Paraplegic Research (SPF), Nottwil, Switzerland; Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat, Utrecht, The Netherlands.
authors.forename: Christel M C
authors.initials: CM
authors.lastname: van Leeuwen
authors.affiliation: Psychological Methods, Evaluation and Statistics, Department of Psychology, University of Zurich, Zurich, Switzerland.
authors.forename: Christina S
authors.initials: CS
authors.lastname: Werner
authors.affiliation: Swiss Paraplegic Research (SPF), Nottwil, Switzerland; Department Health Sciences and Health Policy, University of Lucerne and at SPF, Nottwil, Switzerland.
authors.forename: Szilvia
authors.initials: S
authors.lastname: Geyh
mesh_terms: D000223:Adaptation, Psychological; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D008960:Models, Psychological; D010358:Patient Participation / Q000523:psychology*; D011788:Quality of Life; D020377:Self Efficacy; D057566:Self Report; D013119:Spinal Cord Injuries / Q000523:psychology*; D011795:Surveys and Questionnaires
keywords: Adaptation, psychological; Models, structural; Rehabilitation; Self efficacy; Social participation; Spinal cord injuries