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Functional independence in pediatric-onset spinal cord injury: two levels of mediation

Bret A Boyer1, Catherine A Nowcid, Christine Ware

  • 1Institute for Graduate Clinical Psychology, Widener University, Chester, PA 19013, USA. baboyer@mail.widener.edu

Rehabilitation Psychology
|October 3, 2012
PubMed

Insights

Posttraumatic stress (PTS) and family functioning (FF) impact functional independence (FI) in pediatric spinal cord injury (SCI). PTS Avoidance symptoms significantly mediate this relationship, influencing outcomes for SCI patients.

Area of Science:

  • Rehabilitation Medicine
  • Clinical Psychology
  • Pediatric Neurology

Background:

  • Pediatric spinal cord injury (SCI) presents complex challenges affecting functional independence (FI).
  • Understanding the interplay between psychological factors like posttraumatic stress (PTS) and family functioning (FF) is crucial for improving outcomes in pediatric SCI.
  • Existing models often overlook the nuanced relationships between these variables.

Purpose of the Study:

  • To investigate the mediating roles of posttraumatic stress (PTS) and its symptom clusters in the relationship between family functioning (FF) and functional independence (FI) among pediatric SCI patients.
  • To test three distinct models examining these relationships, including the direct impact of SCI level.
  • To develop an integrated model illustrating the interconnections between SCI level, FF, PTS, and FI.

Main Methods:

  • Path analysis was employed to test hypothesized models in a cohort of 109 pediatric SCI patients (ages 11-24).
  • Data were collected using validated instruments including the Posttraumatic Diagnostic Scale and the Family Assessment Device.
  • The study examined mediation pathways involving PTS, FF, and FI, considering SCI level (tetraplegia vs. paraplegia).

Main Results:

  • Posttraumatic stress (PTS) was found to significantly mediate the relationship between family functioning (FF) and functional independence (FI).
  • Specifically, PTS Avoidance symptoms mediated the association between Reexperiencing and Arousal symptoms and FI.
  • An integrated model confirmed these mediation pathways and the direct effect of SCI level on FI.

Conclusions:

  • Family functioning (FF) indirectly influences functional independence (FI) in pediatric SCI through posttraumatic stress (PTS).
  • PTS Avoidance symptoms play a critical role in mediating the impact of other PTS symptoms on functional outcomes.
  • Interventions targeting PTS, particularly Avoidance behaviors, may enhance functional independence in pediatric SCI survivors.
Abstract

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