Overview. Mandy Sans Crainte, MA OTR/L Kathleen Matuska, PhD, OTR/L

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1 Mandy Sans Crainte, MA OTR/L Kathleen Matuska, PhD, OTR/L Overview Selection of Topic Review of Literature Methods Results Discussion Implications for Occupational Therapy Questions

2 Selection of Topic 4 years in care coordination for adults with disabilities Spinal cord injury (SCI) a primary diagnosis on caseload Noted complexity in coordinating medical appointments, care assistance and medical complications in this population Questioned how life balance is impacted with significant physical impairment Review of Literature SCI Facts 250, ,000 currently have a SCI or spinal dysfunction with 7,800 new injuries each year Increased life expectancy with medical advances Majority traumatic accidents yr old males 82% male 62% Caucasian Education and employment level slightly lower than average (NSCIA, 2010)

3 Review of Literature Aspects of Injury Complete versus Incomplete injuries Injury levels: Sacral S1 S5 Lumbar L1 L5 Thoracic T1 T12 Cervical C1 C8 Higher number in each region = lower level injury Paraplegia and quadriplegia/tetraplegia ( recovery.org) Review of Literature Stress and SCI No correlation level between stress and injury level (Gerhart, Weitzenkamp, Kennedy, Glass, & Charlifue, 1999) 25% of individuals with SCI have clinically elevated stress (Migliorini, Tonge, & Taleporos, 2008) Emotional Impact Reports on loneliness, depression and dependency issue (Krause, 2007) Close to 50% report a mental health condition of which 60% report more than one condition (Migliorini, Tonge, & Taleporos, 2008) Personality a factor

4 Review of Literature Participation and Time Use Disruption reported in activities of daily living (ADLs) (Noreau & Fougeyrollas, 2000) Lower social role achievement in quadriplegia (Whiteneck, Charlifue, Gerhart, Overholser & Richardson, 1992) Decrease in productivity and increase in leisure time (Pentland, Harvey & Walker, 1998) Post Injury Employment 37% of those employed at time of injury were employed post injury (Tomassen, Post, & Van Asbeck, 2000) No link to severity of injury (Pentland, Harvey % Walker, 1998) Barriers: physical, health, stamina, benefit concerns & inaccessibility (Yasuda, Wehman, Targett, Cifu & West, 2002) Review of Literature Quality of Life (QOL) Objective studies reported lower QOL and subjective studies found no differences (Hammell, 2004) Barriers: impairments, pain, fighting the system & medical complications Pain 84% experience some degree of pain (Jensen, Kuehn, Amtmann, & Cardenas, 2007; Siddall, McClelland, Rutkowski, & Cousins, 2003; Turner, Cardenas, Warms, & McClellan, 2001) Pain likely to maintain or increase with time (Jensen, Kuehn, Amtmann, & Cardenas, 2007) Can interfere with coping and adaptation (Raichle, Hanley, Jensen & Cardenas, 2007)

5 Review of Literature Life Balance a satisfying pattern of daily activity that is healthful, meaningful, and sustainable to an individual within the context of his or her current life circumstances (Matuska & Christiansen, 2008, p.11) 5 dimensions Feeling interested, engaged, challenged and competent Biological health & physical safety Rewarding & self affirming relationships Meaningful personal identity Time & energy to meet goals Research Questions Do individuals with spinal cord injuries report different levels of life balance when compared to their non disabled counterparts? Does perceived life balance differ amongst individuals with different levels of spinal cord injury? Does the amount of pain typically experienced impact perceived life balance in individuals with a spinal cord injury?

6 Methods Participants Members of care coordination organization SCI Own legal guardian Identified by care coordinator Procedures Contacted potential participants Completed via mail or in person Non disabled age/gender matched group Methods Tools Life Balance Inventory (LBI) Perceived Stress Scale short version (PSS 4) Demographic Questionnaire Pain Scale

7 Methods Data Analysis Computer generated scores for life balance and stress Scores transferred to spreadsheet Compared means of groups: SCI and non disabled age/gender match Injury levels: C4/C5, C6/C7, thoracic Pain levels: 7/10 or greater and under 7/10 Results 20 participants years old average 41 years old T8 to C3/4 14 males, 6 females 7 complete, 13 incomplete Pain 2 8 average 5.33/10 Pain level 14 below 7/10 6 7/10 or greater Time since injury

8 Results Comparison of group means: No significant difference in stress & life balance scores: Comparing between injury levels Comparing between pain levels No significant difference in life balance scores: Comparing SCI group to non disabled match group Significant difference found in stress scores between SCI group & non disabled match group Differences in Stress Experience Participants with moderate to high stress: students, employed, seeking employment Individuals with SCI: lower marriages, increased leisure time, increased homebound activities, lower employment suggests lower exposure Individuals reporting higher community engagement also reported higher stress levels Care coordination support Different stressors

9 Changes with Adaptation to Injury Average time since injury = 13.1 years Stress can decline significantly in 3 years of adaptation (Gerhart, Weitzenkamp, Kennedy, Glass, & Charlifue, 1999) Changes in stressors (Lequerica, Forchheimer, Tate, Roller, & Toussaint, 2008) Coping results in physical, employment, and relationship changes which impact stress Dynamic relationship of factors in adaptation makes it difficult to identify which most significantly impacts stress Life Balance Preservation Individual factors Support system Personality Occupation Preferences Adaptation and changes in occupation Adaptive techniques New occupations Change in desired participation

10 Implications for Occupational Therapy It is possible to maintain life balance after a SCI Stress is experienced differently for individuals with a SCI Implications for Occupational Therapy Future research: Identifying specific stressors in conjunction with LBI items Life balance in longitudinal study since injury Changes in participation related to life balance over time Injury acceptance and life balance

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12 Thank You!