Pre-rehabilitation beliefs and appraisals predict post discharge dependent coping strategy and functional independence in SCI

Abstract

The purpose of the study was to examine the relationships of pre-rehabilitation personal beliefs and appraisals to post discharge dependent coping strategy and functional independence. In a longitudinal cohort study design, all patients sustaining a spinal cord injury aged 16 or above were approached in selected British, Swiss, Swedish, German, Austrian and Irish spinal centres, and were asked to complete a questionnaire booklet at 6 and 12 weeks post injury and again 1 and 2 years post injury. Seventy-three persons participated at all four measurements. The mean age was 42.4 years (SD = 14.3). A path-model was hypothesized from the stress, appraisal and coping model and empirical results. Structural equational modelling was used to test the hypothesized model. Alternative models, including gender, age and concurrent depression were also tested. In the final model, sense of coherence and perceived manageability scores at 6 weeks significantly predicted loss appraisal scores at 12 weeks, which in turn predicted coping strategy social reliance scores at 1 year. Social reliance at 1 year, and severity of injury at 6 weeks predicted functional independence scores at 2 years. The final model was identical to the hypothesized model, with the exclusion of threat appraisals. Model fit indices were very acceptable. Gender, age, and concurrent depression did not significantly contribute to the path-model. The significant relations were confirmed in cross-sectional analyses in another sample. To conclude, as hypothesized, pre-rehabilitation personal beliefs and appraisals significantly predicted post discharge dependent coping strategy, this predicted later functional independence.