Mandy Sans Crainte, MA OTR/L
Kathleen Matuska, PhD, OTR/L
Overview
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Selection of Topic
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Review of Literature
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Methods
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Results
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Discussion
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Implications for Occupational Therapy
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Questions
Selection of Topic
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4 years in care coordination for adults with disabilities
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Spinal cord injury (SCI) a primary diagnosis on
caseload
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Noted complexity in coordinating medical
appointments, care assistance and medical
complications in this population
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Questioned how life balance is impacted with
significant physical impairment
Review of Literature
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SCI Facts
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250,000‐400,000 currently have a SCI or spinal
dysfunction with 7,800 new injuries each year
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Increased life expectancy with medical advances
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Majority traumatic accidents
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18‐25 yr old males
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82% male
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62% Caucasian
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Education and employment level slightly lower than
average
(NSCIA, 2010)
Review of Literature
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Aspects of Injury
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Complete versus
Incomplete injuries
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Injury levels:
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Sacral S1‐S5
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Lumbar L1‐L5
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Thoracic T1‐T12
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Cervical C1‐C8
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Higher number in each
region = lower level
injury
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Paraplegia and
quadriplegia/tetraplegia
(www.sci‐recovery.org)
Review of Literature
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Stress and SCI
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No correlation level between stress and injury level
(Gerhart, Weitzenkamp, Kennedy, Glass, & Charlifue, 1999)y
25% of individuals with SCI have clinically elevated stress
(Migliorini, Tonge, & Taleporos, 2008)y
Emotional Impact
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Reports on loneliness, depression and dependency issue
(Krause, 2007)
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Close to 50% report a mental health condition of which 60%
report more than one condition
(Migliorini, Tonge, & Taleporos, 2008)y
Personality a factor
Review of Literature
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Participation and Time Use
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Disruption reported in activities of daily living (ADLs)
(Noreau & Fougeyrollas, 2000)y
Lower social role achievement in quadriplegia
(Whiteneck, Charlifue, Gerhart, Overholser & Richardson, 1992)y
Decrease in productivity and increase in leisure time
(Pentland, Harvey & Walker, 1998)y
Post Injury Employment
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37% of those employed at time of injury were employed post
injury
(Tomassen, Post, & Van Asbeck, 2000)y
No link to severity of injury
(Pentland, Harvey % Walker, 1998)y
Barriers: physical, health, stamina, benefit concerns &
inaccessibility
(Yasuda, Wehman, Targett, Cifu & West, 2002)Review of Literature
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Quality of Life (QOL)
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Objective studies reported lower QOL and subjective
studies found no differences
(Hammell, 2004)
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Barriers: impairments, pain, fighting the system &
medical complications
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Pain
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84% experience some degree of pain
(Jensen, Kuehn, Amtmann, & Cardenas, 2007; Siddall, McClelland, Rutkowski, & Cousins, 2003; Turner, Cardenas, Warms, & McClellan, 2001)y
Pain likely to maintain or increase with time
(Jensen, Kuehn, Amtmann, & Cardenas, 2007)y
Can interfere with coping and adaptation
(Raichle, Hanley, Jensen & Cardenas, 2007)Review of Literature
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Life Balance
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“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)y
5 dimensions
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Feeling interested, engaged, challenged and competent
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Biological health & physical safety
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Rewarding & self‐affirming relationships
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Meaningful personal identity
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Time & energy to meet goals
Research Questions
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Do individuals with spinal cord injuries report
different levels of life balance when compared to their
non‐disabled counterparts?
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Does perceived life balance differ amongst individuals
with different levels of spinal cord injury?
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Does the amount of pain typically experienced impact
perceived life balance in individuals with a spinal cord
injury?
Methods
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Participants
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Members of care coordination organization
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SCI
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Own legal guardian
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Identified by care coordinator
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Procedures
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Contacted potential participants
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Completed via mail or in person
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Non‐disabled age/gender matched group
Methods
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Tools
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Life Balance
Inventory (LBI)
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Perceived Stress Scale –
short version (PSS‐4)
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Demographic
Questionnaire
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Pain Scale
Methods
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Data Analysis
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Computer generated scores for life balance and stress
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Scores transferred to spreadsheet
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Compared means of groups:
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SCI and non‐disabled age/gender match
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Injury levels: C4/C5, C6/C7, thoracic
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Pain levels: 7/10 or greater and under 7/10
Results
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20 participants
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28‐56 years old
‐ average 41 years old
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T8 to C3/4
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14 males, 6 females
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7 complete, 13
incomplete
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Pain 2‐8
‐ average 5.33/10
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Pain level
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14 ‐ below 7/10
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6 ‐ 7/10 or greater
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Time since injury
Results
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Comparison of group means:
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No significant difference in stress & life balance scores:
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Comparing between injury levels
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Comparing between pain levels
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No significant difference in life balance scores:
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Comparing SCI group to non‐disabled match group
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Significant difference found in stress scores between
SCI group & non‐disabled match group
Differences in Stress Experience
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Participants with moderate to high stress:
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students, employed, seeking employment
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Individuals with SCI:
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lower marriages, increased leisure time, increased
homebound activities, lower employment suggests
lower exposure
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Individuals reporting higher community engagement
also reported higher stress levels
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Care coordination support
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Different stressors
Changes with Adaptation to Injury
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Average time since injury = 13.1 years
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Stress can decline significantly in 3 years of adaptation
(Gerhart, Weitzenkamp, Kennedy, Glass, & Charlifue, 1999)
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Changes in stressors
(Lequerica, Forchheimer, Tate, Roller, & Toussaint, 2008)
y
Coping results in physical, employment, and
relationship changes which impact stress
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Dynamic relationship of factors in adaptation makes it
difficult to identify which most significantly impacts
stress
Life Balance Preservation
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Individual factors
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Support system
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Personality
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Occupation Preferences
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Adaptation and changes in occupation
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Adaptive techniques
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New occupations
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Change in desired participation
Implications for
Occupational Therapy
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It is possible to maintain life balance after a SCI
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Stress is experienced differently for individuals with a
SCI
Implications for
Occupational Therapy
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Future research:
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Identifying specific stressors in conjunction with LBI
items
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Life balance in longitudinal study since injury
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Changes in participation related to life balance over
time
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Injury acceptance and life balance
References
y Atkins, M.S. (2008). Spinal cord injury. In C.A. Trombly Latham & M. Vining Radomski (Eds.), Occupational therapy for physical dysfunction (6thed., pp. 1171‐
1213). Philadelphia: Lippincott Williams & Wilkins. y Christiansen, C., & Matuska, K. (2006). Lifestyle balance: A review of concepts and research. Journal of Occupational Science, 13, 49‐61. y Cohen, S., Kamarck, T., & Mermelstein, R. (1983). A global measure of perceived stress. Journal of Health and Social Behavior, 24, 385‐396. y Craig, A., Tran, Y., & Middleton, J. (2009). Psychological morbidity and spinal cord injury: a systematic review. Spinal Cord: The Official Journal of the International Medical Society Of Paraplegia, 47, 108‐114. Retrieved from CINAHL Plus database. y Gerhart, K. A., Weitzenkamp, D.A., Kennedy, P., Glass, C.A., and Charlifue, S.W. (1999). Correlates of stress in long‐term spinal cord. Spinal Cord, 37, 183‐190. Retrieved from MEDLINE database. y Green, B.L. & Kimerling, R. (2004). Trauma, PTSD and health status. In P.P. Schurr & B.L. Green (Eds.), Physical health consequences of exposure to extreme stress (pp. 13‐42). Washington DC: American Psychological Association. y Hammell, K. (2004). Quality of life among people with high spinal cord injury living in the community. Spinal Cord, 42, 607‐620. Retrieved from CINAHL Plus database. y Hatcher, M., Whitaker, C., & Karl, A. (2009). What predicts post‐traumatic stress following spinal cord injury?. British Journal of Health Psychology, 14, 541‐ 561. Retrieved from CINAHL Plus database. y Isaksson, G., Skär, L., & Lexell, J. (2005). Women's perception of changes in the social network after a spinal cord injury. Disability & Rehabilitation, 27, 1013‐ 1021. Retrieved from CINAHL Plus database. y Jensen, M., Kuehn, C., Amtmann, D., & Cardenas, D. (2007). Symptom burden in persons with spinal cord injury. Archives of Physical Medicine & Rehabilitation, 88, 638‐645. Retrieved from CINAHL Plus database. y Judd, F.K. & Brown, D.J. (1992). Suicide following acute traumatic spinal cord injury. Paraplegia, 30, 173‐177. y Krause, J.S. (2007). Self‐reported problems after spinal cord injury: implications for practice. Topics in Spinal Cord Injury Rehabilitation, 12, 35‐44. y Krause, J.S., Sternberg, M., Maides, J., & Lottes, L. (1998). Employment after spinal cord injury: differences related to geographic region, gender, and race. Archives of Physical Medicine and Rehabilitation, 79, 615‐624. y Larzelere, M.M. & Jones, G.N. (2008). Stress and health. Primary Care, 35, 839‐856. y Lee, Y., & Mittelstaedt, R. (2004). Impact of injury level and self‐monitoring on free time boredom of people with spinal cord injury. Disability & Rehabilitation, 26, 1143‐1149. Retrieved from CINAHL Plus database. y Lequerica, A., Forchheimer, M., Tate, D., Roller, S., & Toussaint, L. (2008). Ways of coping and perceived stress in women with spinal cord injury. Journal of Health Psychology, 13, 348‐354. Retrieved from CINAHL Plus database. y Lidal, I., Hjeltnes, N., Roislien, J., Stanghelle, J., & Biering‐Sorensen, F. (2009). Employment of persons with spinal cord lesions injured more than 20 years ago. Disability & Rehabilitation, 31, 2174‐2184. doi:10.3109/09638280902946952 y Lund, M., Nordlund, A., Bernspång, B., & Lexell, J. (2007). Perceived participation and problems in participation are determinants of life satisfaction in people with spinal cord injury. Disability & Rehabilitation, 29), 1417‐1422. Retrieved from CINAHL Plus database.
References
y Matuska, K. (in press). Development and validity evidence of the Life Balance Inventory. Occupational Therapy Journal of Research. y Matuska, K., & Christiansen, C. (2008). A proposed model of lifestyle balance. Journal of Occupational Science, 15, 1, 9‐19. y Mayo Clinic (2010). Stress management: know your stressors. Retrieved from http://www.mayoclinic.com y McCaffrey, M., & Beebe, A. (1993). Pain: clinical manual for nursing practice. Baltimore: V.V. Mosby Company. y Migliorini, C., New, P., & Tonge, B. (2009). Comparison of depression, anxiety and stress in persons with traumatic and non‐traumatic post‐acute spinal cord injury. Spinal Cord: The Official Journal of The International Medical Society of Paraplegia, 47, 783‐788. Retrieved from CINAHL Plus database. y Migliorini, C., Tonge, B., and Taleporos, G. (2008). Spinal cord injury and mental health. Australian and New Zealand Journal of Psychiatry. 42, 309‐314. Retrieved from Health Source database.y Miller, L.V. (2007). Spinal cord injury. In B.J. Atchison & D.K. Dirette (Eds.), Conditions in occupational therapy: effect on occupational performance (3rded.,
pp. 311‐339). Philadelphia: Lippincott Williams & Wilkins. y Murphy, G., & Young, A. (2005). Employment participation following spinal cord injury: Relation to selected participant demographic, injury and psychological characteristics. Disability & Rehabilitation, 27, 1297‐1306. Retrieved from CINAHL Plus database. y National Spinal Cord Injury Association [NSCIA] (2007). Facts and figures about SCI. Retrieved from http://www.spinalcord.org y Nicholson Perry, K., Nicholas, M., & Middleton, J. (2009). Spinal cord injury‐related pain in rehabilitation: a cross‐sectional study of relationships with cognitions, mood and physical function. European Journal of Pain, 13, 511‐517. Retrieved from CINAHL Plus database. y Noreau, L., & Fougeyrollas, P. (2000). Long‐term consequences of spinal cord injury on social participation: the occurrence of handicap situations. Disability & Rehabilitation, 22, 170‐180. Retrieved from EBSCO MegaFILE database. y Pentland, W., Harvey, A., Smith, T., & Walker, J. (1999). The impact of spinal cord injury on men's time use. Spinal Cord, 37, 786‐792. Retrieved from CINAHL Plus database. y Protos, K., Stone, K. & Grinnell, M. (2009) Spinal cord injury. In E.B. Crepeau, E.S. Cohn, & B.A.B. Schell (Eds.), Willard and Spackman’s occupational therapy (11thed., pp. 1065‐1069). Philadelphia: Lippincott Williams & Wilkins. y Raichle, K., Hanley, M., Jensen, M., & Cardenas, D. (2007). Cognitions, coping, and social environment predict adjustment to pain in spinal cord injury. Journal of Pain, 8, 718‐729. Retrieved from CINAHL Plus database. y Schönherr, M., Groothoff, J., Mulder, G., & Eisma, W. (2005). Vocational perspectives after spinal cord injury. Clinical Rehabilitation, 19, 200‐208. Retrieved from CINAHL Plus database. y Siddall, P. J., McClelland, J. M., Rutkowski, S. B., & Cousins, M. J. (2003). A longitudinal study of the prevalence and characteristics of pain in the first 5 years following spinal cord injury. Pain, 103, 249‐257. Retrieved from EBSCO MegaFILE. y Siddall, P., Taylor, D., McClelland, J., Rutkowski, S., & Cousins, M. (1999). Pain report and the relationship of pain to physical factors in the first 6 months following spinal cord injury. Pain, 81, 187‐197. Retrieved from MEDLINE. y Tate, D., Forchheimer, M., Maynard, F., & Dijkers, M. (1994). Predicting depression and psychological distress in persons with spinal cord injury based on indicators of handicap. American Journal of Physical Medicine & Rehabilitation, 73, 175‐183. Retrieved from CINAHL Plus database. y Tomassen, P., Post, M., & Van Asbeck, F. (2000). Return to work after spinal cord injury. Spinal Cord, 38, 51‐55. Retrieved from CINAHL Plus database. y Turner, J., Cardenas, D., Warms, C., & McClellan, C. (2001). Chronic pain associated with spinal cord injuries: a community survey. Archives of Physical Medicine & Rehabilitation, 82, 501‐508. Retrieved from CINAHL Plus database. y Whiteneck, G.G., Charlifue, S.W., Gerhart, K.A., Overholser, J.D., & Richardson, G.N. (1992). Quantifying handicap: a new measure of long‐term rehabilitation outcomes. Archives of physical Medicine and Rehabilitation, 73, 519‐526. y Yasuda, S., Wehman, P., Targett, P., Cifu, D., & West, M. (2002). Return to work after spinal cord injury: a review of recent research. Neurorehabilitation, 17, 177‐186. Retrieved from CINAHL Plus database.
