title: Multiple mediation path model of pain's cascading influence on physical disability in individuals with SCI from Colombia, South America.
abstract: BACKGROUND
  Research has begun to document the bivariate connections between pain in individuals with spinal cord injury (SCI) and various aspects of health related quality of life (HRQOL), such as fatigue, social functioning, mental health, and physical functioning.
  
  
  OBJECTIVE
  The purpose of this study was to construct and test a theoretical path model illuminating the stage-wise and sequential (cascading) HRQOL pathways through which pain increases physical disability in individuals with SCI in a sample from Colombia, South America. It was hypothesized that increased pain would lead to decreased energy, which would lead to decreased mental health and social functioning, which both would lead to emotional role limitations, which finally would lead to physical role limitations.
  
  
  METHODS
  A cross-sectional study assessed individuals with SCI (n = 40) in Neiva, Colombia. Participants completed a measure indexing various aspects of HRQOL.
  
  
  RESULTS
  The path model overall showed excellent fit indices, and each individual path within the model was statistically significant. Pain exerted significant indirect effects through all possible mediators in the model, ultimately suggesting that energy, mental health, social functioning, and role limitations-emotional were likely pathways through which pain exerted its effects on physical disability in individuals with SCI.
  
  
  CONCLUSIONS
  These findings uncover several potential nodes for clinical intervention which if targeted in the context of rehabilitation or outpatient services, could result in salubrious direct and indirect effects reverberating down the theoretical causal chain and ultimately reducing physical disability in individuals with SCI.
authors.affiliation: Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Paul B
authors.initials: PB
authors.lastname: Perrin
authors.affiliation: Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA.
authors.forename: Alejandra Morlett
authors.initials: AM
authors.lastname: Paredes
authors.affiliation: Grupo de Investigación Carlos Finlay, Surcolombiana University, Neiva, Colombia.
authors.forename: Silvia Leonor
authors.initials: SL
authors.lastname: Olivera
authors.affiliation: Grupo de Investigación Carlos Finlay, Surcolombiana University, Neiva, Colombia.
authors.forename: Juan Esteban
authors.initials: JE
authors.lastname: Lozano
authors.affiliation: Grupo de Investigación Carlos Finlay, Surcolombiana University, Neiva, Colombia.
authors.forename: Wendy Tatiana
authors.initials: WT
authors.lastname: Leal
authors.affiliation: Carolina Pain & Rehabilitation Specialists, Charlotte, NC, USA.
authors.forename: Usman F
authors.initials: UF
authors.lastname: Ahmad
authors.affiliation: BioCruces Health Research Institute, Cruces University Hospital Barakaldo, Bizkaia, Spain.|IKERBASQUE, Basque Foundation for Science, Bilbao, Spain.
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: Arango-Lasprilla
mesh_terms: D000328:Adult; D003105:Colombia; D006233:Persons with Disabilities / Q000523:psychology* / Q000534:rehabilitation / Q000706:statistics & numerical data; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D010146:Pain / Q000453:epidemiology / Q000523:psychology*; D011788:Quality of Life; D012917:Social Adjustment; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000523:psychology* / Q000534:rehabilitation
keywords: Spinal cord injury; disability; health-related quality of life; pain