Re-inventing yourself after spinal cord injury: a site-specific randomized clinical trial

Abstract

Study design: Parallel-arm randomized controlled trial comparing an interactive group format versus a no-intervention control. Objective: To evaluate the efficacy of a replicable group treatment program for improving self-efficacy after spinal cord injury (SCI) in a single center cohort of adults. Setting: Regional SCI center. Methods: Participants included 81 individuals with SCI who were at least 4 weeks post-discharge from initial rehabilitation. Those randomized to treatment participated in six interactive learning sessions (2 hours each, one session per week) with structured and facilitated group interactions to improve self-efficacy. A wait-list control group was followed at matching time points for all outcome measures. The primary outcome measure was the Moorong Self-Efficacy Scale (MSES); secondary outcomes were the Generalized Self-Efficacy Scale (GSES); Diener Satisfaction with Life Scale (SWLS); Participation Assessment with Recombined Tools – Objective (PART-O); Patient Health Questionnaire – 9 (PHQ-9); and General Anxiety Disorder 7-item (GAD-7). Results: Individuals in the Treatment group had greater increases in MSES scores from baseline to immediately post-intervention (6 weeks) than the Control group, but that difference did not remain significant after controlling for multiple comparisons. However, the improvement in the treatment group relative to the control group was not maintained through follow-up at 30 weeks. There was no evidence of an immediate or sustained treatment effect on any of the secondary outcomes. Conclusions: Self-efficacy improved for participants with SCI in the Treatment group, however, this improvement was not significant or maintained on follow-up.