title: Adjustment following chronic spinal cord injury: Determining factors that contribute to social participation.
abstract: OBJECTIVE
  Spinal cord injury (SCI) is a catastrophic event that may result in diminished physical, social, and mental health. The main objective of this research was to establish inpatient factors that contribute to social participation following discharge into the community.
  
  
  METHODS
  Prospective longitudinal design with measures taken three times, soon after admission to rehabilitation (N = 88), at discharge from the inpatient phase (N = 81) and 6 months following discharge (N = 71).
  
  
  METHODS
  Participants included adults with SCI admitted into three SCI units over a 33-month period. Assessment included demographic, injury, and psychosocial health measures. Adjustment was defined by the extent of social re-integration or participation post-discharge after 6 months in the community. Social participation was measured by the Impact on Participation and Autonomy Questionnaire (IPAQ). Logistic regression models were used to establish inpatient factors that significantly predicted social participation 6 months post-discharge.
  
  
  RESULTS
  Six months after discharge, around 55% of the sample had difficulties with social participation. The odds against being employed for an adult with poor social participation was found to be 8.4 to 1. Factors that predicted social participation included a younger age, having less severe secondary medical complications like bladder and bowel dysfunction, having a higher cognitive capacity, perceiving one has control (self-efficacy) over one's life and environment, and having greater perceived social support.
  
  
  CONCLUSIONS
  These results provide direction for enhancing existing psychosocial health strategies within SCI rehabilitation, affording an opportunity for every person who sustains a permanent SCI to have optimal capacity for social participation. Statement of contribution What is already known on this subject? Spinal cord injury (SCI) is associated with significant challenges to wellbeing, including a high risk of secondary chronic illnesses, risk of co-morbid mental health problems, financial insecurity and social isolation. Research has shown poor social participation can lead to problems in re-integration into society following discharge from inpatient rehabilitation. Research to date has examined various factors related to poor social participation, but the majority of this research has been survey based with convenience samples. What does this study add? This study adds results of prospective longitudinal research on adjustment following SCI, where adjustment was defined by the rate of social participation when living in the community. About one-third of SCI participants were found to have very poor social participation, and only one-third had found some form of employment 6 months after discharge. Multiple factors were found to predict and contribute to poor social participation, including older age when injured, more severe medical complications, cognitive deficits, poor perceptions of control or self-efficacy, and poor social support.
authors.affiliation: John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia.
authors.forename: Ashley
authors.initials: A
authors.lastname: Craig
authors.affiliation: Australian College of Applied Psychology, Sydney, New South Wales, Australia.|School of Social Sciences and Psychology, The University of Western Sydney, New South Wales, Australia.
authors.forename: Kathryn
authors.initials: K
authors.lastname: Nicholson Perry
authors.affiliation: John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Guest
authors.affiliation: John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia.|Key University Centre for Health Technologies, University of Technology, Sydney, New South Wales, Australia.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Tran
authors.affiliation: John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney, St Leonards, New South Wales, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Middleton
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058443:Catastrophization / Q000523:psychology; D000066498:Emotional Adjustment; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D062707:Return to Work / Q000523:psychology; D058992:Social Participation / Q000523:psychology*; D013119:Spinal Cord Injuries / Q000523:psychology*; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: adjustment; fatigue; self-efficacy; social support; spinal cord injury