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The influence of psychological need on rehabilitation outcomes for people with spinal cord injury

Spinal Cord volume 61, pages 83–92 (2023)Cite this article

Subjects

Abstract

Study design

Single-centre, retrospective study of people with a spinal cord injury or disorder (PwSCI/D) and identified psychological need.

Objectives

To examine the effect of psychological need on rehabilitation outcomes.

Setting

National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, United Kingdom.

Methods

Self-reported data from the Stoke Mandeville Spinal Needs Assessment Checklist (SMS-NAC) were used to examine identified psychological need (characterised by referral for psychological treatment, or scoring above clinical threshold in admission psychometric measures) on SCI rehabilitation outcome domains. Participants were grouped according to whether they were referred, not referred, scored above or below clinical threshold.

Results

234 participants were included (Mean age at injury (years) = 53, 70% Male, 29% tetraplegia, 38% paraplegia, 33% ASIA D). There was a significant improvement in outcome scores from admission to discharge across all domains irrespective of participant group, however individuals with identified psychological need scored lower across all rehabilitation domains than those without. While individuals with psychological need demonstrated longer rehabilitation stays, more frequent and longer discharge delays, they also showed comparatively greater rehabilitation improvements. Psychological screening measures were more effective at detecting psychological need than individuals identified via referral, and participants scoring above clinical threshold had poorest overall rehabilitation outcomes.

Conclusions

Individuals with psychological need have greater rehabilitation need and may require longer rehabilitation and benefit from additional discharge planning. Early, proactive psychometric screening can better facilitate improvements for delivering rehabilitation. Future research should consider specific contributing factors to psychological need, such as pre-existing mental health conditions or socio-demographic influences.

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Data availability

The data used in the current study are part of a standard clinical database which contains identifiable patient information and are therefore not publicly available. Pseudonymised data can be made available upon reasonable request to Buckinghamshire Healthcare NHS Trust.

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Acknowledgements

Thank you to the patients and staff of the National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, for completion of the standard clinical outcome tool (SMS-NAC) which comprised this research.

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Authors and Affiliations

  1. Department of Clinical Psychology National Spinal Injuries Centre (NSIC), Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, Aylesbury, UK

    Martha Wallace, Jane Duff & Lucy C. Grant

Authors
  1. Martha Wallace
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  2. Jane Duff
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  3. Lucy C. Grant
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Contributions

MW was responsible for study design, extracting and analysing the data, and writing the report. JD was responsible for the study design, contributed to the interpretation of results and writing of the report, and had oversight into the final version and submission of the research. LG contributed to analysing the data, writing the report and the submission of the manuscript.

Corresponding author

Correspondence to Jane Duff.

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The authors declare no competing interests.

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Wallace, M., Duff, J. & Grant, L.C. The influence of psychological need on rehabilitation outcomes for people with spinal cord injury. Spinal Cord 61, 83–92 (2023). https://doi.org/10.1038/s41393-022-00864-0

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