Psychological intervention during spinal rehabilitation: a preliminary study

Study design: A repeated measures, non-randomised controlled trial. Objective: To examine the effectiveness of individualised cognitive behaviour therapy (CBT) on the psychological adjustment of patients undergoing rehabilitation for newly acquired spinal cord injury. Setting: South Australian Spinal Cord Injury Service, Hampstead Rehabilitation Centre, South Australia, Australia. Methods: Eleven participants received individual CBT as part of their spinal rehabilitation. Self-reported levels of depression, anxiety and stress were assessed before the intervention, at week 12 of rehabilitation and at 3 months post-discharge, using the depression, anxiety and stress scales (DASS-21). Functional independence was also assessed, using the Functional Independence Measure (FIM). Responses were compared with 13 participants, closely matched on demographic and injury variables, who received standard psychological care (that is, assessment and monitoring only). Results: Depression scores for treatment participants showed a significant time effect, with worsening symptoms reported at three-month follow-up, after CBT was discontinued. In contrast, the DASS-21 scores of standard care participants remained at subclinical levels throughout the study. Clinical improvements in symptoms of anxiety and stress were also reported by the treatment group as inpatient therapy progressed. Conclusion: Targeted, individualised psychological treatment contributed to short-term, meaningful improvements in emotional outcomes for individuals reporting psychological morbidity after recent spinal injury. The results also highlight the need for ongoing access to specialised, psychological services post-discharge. Replication of these results with a larger sample is required before definitive conclusions can be drawn. Spinal Cord (2010) 48, 756-761; doi:10.1038/sc.2009.161; published online 22 December 2009