Modifiable Factors in Spinal Cord Injury

Along with colleagues, Michelle Meade, Ph.D., associate professor of physical medicine and rehabilitation at the University of Michigan, decided to investigate how they could help spinal cord patients manage their daily lives. Dr. Meade is co-editor of a two-part series of Topics in Spinal Cord Injury Rehabilitation focused on recent research studies about health behaviors and health management in individuals with spinal cord injury.

Dr. Meade told OTW, “I focus on health behaviors and health management because it is a modifiable factor—though not always an easily modifiable factor—that can lead to significantly better outcomes with regard to quality of life. The concept is also one that allows different people to be involved and take ownership of different parts of the equation—whether by assisting with providing information in the best way, helping to make the environment more organized or accessible or providing the support or motivation to regularly perform a behavior—there are usually components that you can work on to improve outcomes.

“I got to this point after doing a lot of listening. These patients naturally try to move forward with their life and figure out how to do so any number of ways—interactions with the healthcare systems are just one path. Because I am a psychologist who works within the healthcare system, I want to do what I can to allow those interactions to lead to improved outcomes.

“There were a couple of findings that stuck out to me. In the article by Forchheimer and colleagues, it was both the number of individuals who said that they could not remember who had provided them with the bowel management regimen that they currently used and the number who reported that they did not adjust their bowel management routine based on the results. In the article by Houlihan and colleagues, it was how participants felt, when looking for providers, the key factor was finding someone who would listen to them—sometimes over someone who had more knowledge of the area. Finally, in the two articles that I collaborated on related to health behaviors and employment, the surprising finding was how much employment seemed to rely on the ability of the individuals with SCI (spinal cord injury) to not just be able to do things themselves but to communicate their needs and educate individuals in their environment.

“Do patients know what they have to do to maintain or regain health? Do they know why and feel comfortable with performing the needed behaviors? Do patients know what things to monitor or keep an eye out for and the steps that they are supposed to take—whether calling the doctor or adjusting their medicine or limiting/increasing activity—when those occur? Are there emotional or other barriers to that get in the way of performing the needed steps?

“Take the time to include the family or other caregivers and provide them with information about expectations and approaches. Finally, do not assume that people know how to navigate the system—the more you can help them connect the dots, the easier their health management will be.”