Background:

Individuals with spinal cord injury/disorder (SCI/D) must learn to adjust to and manage functional challenges after SCI/D onset. For these individuals, resilience (ie, the adaptive response to stressful events) may be related to their willingness and ability to conduct self-care behaviors.

Objective:

The study objectives were to examine the relationship between patient-reported perceptions of independence in performing self-care behaviors and resilience among Veterans with SCI/D and to examine variables (including resilience) associated with high self-care scores (controlling for confounders).

Methods:

In this cross-sectional survey, we conducted bivariate analyses to examine differences in demographic, injury, and health characteristics and resilience scores for individuals with SCI/D. We conducted a multivariate block-design linear regression to examine factors associated with ability to perform self-care.

Results:

Level of injury (β = 7.74, P < .0001), resilience (β = 0.08, P = .0216), marital status (β = 1.75, P = .0445), and living arrangement (β = 4.37, P < .0001) were positively related to higher self-care behaviors. Completeness of injury (β = -2.79, P < .0001), age (β = -0.09, P = .0052), age at injury (β = -0.05, P = .0129), and number of comorbid health conditions (β = -0.72, P < .0001) showed negative relationships with higher self-care.

Conclusions:

Self-care ability is related to multiple factors, including resilience. The positive relationship between resilience and self-care suggests that greater resilience, independent of injury level/severity, may contribute to improved self-care behaviors in individuals with SCI/D. Other factors that showed a positive relationship with self-care included younger age, living alone, paraplegic level injury, and fewer health conditions. Understanding the profile of persons with SCI/D with regard to self-care behaviors is important to the development of tailored interventions to improve self-care.

This work was supported by the Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development, Quality Enhancement Research Initiative [RRP 13-248]. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

None of the authors have a financial or other relationship that might signify a conflict of interest.

The researchers followed all ethical guidelines in the conduct of this study and respondents gave informed consent to participate. This study was reviewed and approved by the Hines VA Institutional Review Board.

1.
Craig
A
,
Nicholson Perry
K
,
Guest
R
,
Tran
Y
,
Middleton
J
.
Adjustment following chronic spinal cord injury: Determining factors that contribute to social participation [published online ahead of print June 2, 2015]
.
Br J Health Psychol.
2.
LaVela
SL
.
Older adults with spinal cord impairments: Implications for long-term care
.
SCI Nurs.
2006
;
23
(
2
):online publication.
3.
Bonanno
GA
,
Kennedy
P
,
Galatzer-Levy
IR
,
Lude
P
,
Elfström
ML
.
Trajectories of resilience, depression, and anxiety following spinal cord injury
.
Rehabil Psychol.
2012
;
57
(
3
):
236
-
247
.
4.
Stoller
EP
.
Dynamics and processes of self-care in old age
. In:
Ory
MG
,
DeFriese
GH
, eds.
Self-Care in Later Life
.
New York
:
Springer
;
1998
:
24
-
61
.
5.
LeViseur
C
,
Sonka-Maarek
S
.
Activities of daily living
. In:
Lin
VW
,
Cardenas
DD
,
Cutter
NC
, et al, eds.
Spinal Cord Medicine Principles and Practice
.
New York
:
Demos Medical Publishing
;
2003
:
691
-
704
.
6.
Ahern
NR
,
Kiehl
EM
,
Sole
ML
,
Byers
J
.
A review of instruments measuring resilience
.
Issues Compr Pediatr Nurs.
2006
;
29
(
2
):
103
-
125
.
7.
Bonanno
GA
.
Loss, trauma, and human resilience: Have we underestimated the human capacity to thrive after extremely aversive events?
Am Psychol.
2004
;
59
(
1
):
20
-
28
.
8.
Davydov
DM
,
Stewart
R
,
Ritchie
K
,
Chaudieu
I
.
Resilience and mental health
.
Clin Psychol Rev.
2010
;
30
(
5
):
479
-
495
.
9.
Cicchetti
D
.
Resilience under conditions of extreme stress: A multilevel perspective
.
World Psychiatry
.
2010
;
9
(
3
):
145
-
154
.
10.
Bonanno
GA
,
Westphal
M
,
Mancini
AD
.
Resilience to loss and potential trauma
.
Ann Rev Clin Psychol.
2011
;
7
:
511
-
535
.
11.
Ability Coach
. Resilience and disability.http://abilitycoach.com/disability/index.html.Accessed
August
20
,
2015
.
12.
US Department of Veterans Affairs
. Spinal cord injury & disorders.http://www.sci.va.gov/.Accessed
September
16
,
2015
.
13.
Model Systems Knowledge Translation Center (MSKTC)
. Evaluating the sensitivity and responsiveness of the SCI-QOL CATs.http://www.msktc.org/projects/detail/1092.Accessed
August
14
,
2015
.
14.
Tulsky
DS
,
Jette
AM
,
Kisala
PA
, et al.
Spinal cord injury-functional index: Item banks to measure physical functioning in individuals with spinal cord injury
.
Arch Phys Med Rehabil.
2012
;
93
(
10
):
1722
-
1732
.
15.
Victorson
D
,
Tulsky
DS
,
Kisala
PA
,
Kalpakjian
CZ
,
Weiland
B
,
Choi
SW
.
Measuring resilience after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Resilience item bank and short form
.
J Spinal Cord Med.
2015
;
38
(
3
):
366
-
376
.
16.
Craig Hospital
. Enhancement and evaluation of the SCI-FI instrument.https://craighospital.org/programs/research/enhancement-and-evaluationof-the-sci-fi-instrument.Accessed
August
6
,
2015
.
17.
Jette
A
,
Coster
W
.
Tulsky
D
,
Noonan
V
. Development and initial evaluation of the SCI-CAT functional assessment instrument [symposium]. American Congress of Rehabilitation Medicine;
2012
; Vancouver, Canada.
18.
Windle
G
,
Bennett
K
,
Noyes
J
.
A methodological review of resilience measurement scales
.
Health Qual Life Outcomes
.
2011
;
9
:
8
.
19.
Tulsky
DS
,
Kisala
PA
,
Victorson
D
, et al.
Developing a contemporary patient-reported outcomes measure for spinal cord injury
.
Arch Phys Med Rehabil.
2011
;
92
(
10 suppl
):
S44
-
51
.
20.
Driver
S
,
Warren
AM
,
Reynolds
M
, et al.
Identifying predictors of resilience at inpatient and 3-month postspinal cord injury [published online ahead of print October 9, 2014]
.
J Spinal Cord Med.
21.
Machida
M
,
Irwin
B
,
Feltz
D
.
Resilience in competitive athletes with spinal cord injury: The role of sport participation
.
Qual Health Res.
2013
;
23
(
8
):
1054
-
1065
.
22.
White
B
,
Driver
S
,
Warren
AM
.
Resilience and indicators of adjustment during rehabilitation from a spinal cord injury
.
Rehabil Psychol.
2010
;
55
(
1
):
23
-
32
.
23.
Post
MW
,
van Leeuwen
CM
.
Psychosocial issues in spinal cord injury: A review
.
Spinal Cord
.
2012
;
50
(
5
):
382
-
389
.
24.
Monden
KR
,
Trost
Z
,
Catalano
D
, et al.
Resilience following spinal cord injury: A phenomenological view
.
Spinal Cord
.
2014
;
52
(
3
):
197
-
201
.
25.
Bloemen-Vrencken
JHA
,
de Witte
LP
,
Post
MWM
,
van den Heuvel
WJA
.
Health behaviour of persons with spinal cord injury
.
Spinal Cord
.
2007
;
45
:
243
-
249
.
26.
Suzuki
R
,
Krahn
GL
,
McCarthy
MJ
,
Adams
EJ
.
Understanding health outcomes: Physical secondary conditions in people with spinal cord injury
.
Rehabil Psychol.
2007
;
52
(
3
):
338
-
350
.
27.
Gulati
A
,
Yeo
CJ
,
Cooney
AD
,
McLean
AN
,
Fraser
MH
,
Allan
DB
.
Functional outcome and discharge destination in elderly patients with spinal cord injuries
.
Spinal Cord
.
2011
;
49
:
215
-
218
.
28.
Boucher
N
,
Miller
WC
,
Smith
ME
.
Housing and attendant services: Cornerstone of community reintegration after spinal cord injury
. In:
Eng
JJ
,
Teasell
RW
,
Miller
WC
, et al, eds.
Spinal Cord Injury Rehabilitation Evidence. Version 5.0
.
Vancouver
,
Canada
;
2014
:
1
-
27
.
29.
Hetz
SP
,
Latimer
AE
,
Ginis
KA
.
Activities of daily living performed by individuals with SCI: Relationships with physical fitness and leisure time physical activity
.
Spinal Cord
.
2009
;
47
(
7
):
550
-
554
.
30.
Kroll
T
,
Neri
MT
,
Ho
PS
.
Secondary conditions in spinal cord injury: Results from a prospective survey
.
Disabil Rehabil.
2007
;
29
(
15
):
1229
-
1237
.
31.
Kilic
SA
,
Dorstyn
DS
,
Guiver
NG
.
Examining factors that contribute to the process of resilience following spinal cord injury
.
Spinal Cord
.
2013
;
51
(
7
):
553
-
557
.