Clinical Bottom Line
“How could I apply this information?”
According to the authors, physical therapists (PTs) should be cautious to presume that patients with spinal cord injury (SCI) would have lower values for quality of life and higher rates of anxiety/depression as a result of an acquired injury versus a congenital condition such as spina bifida (SB). As this study demonstrated, mental health has a strong effect on patient participation especially for those with SB. This knowledge should cause PTs to have increased awareness of the effects of the patient's mental health on interventions and education for patients with SCI to increase their participation.
There is a need for PTs to be more attentive to the psychosocial factors of mobility, activity, and participation within the school and community for patients with SB. The PT should have a more active role in ensuring that services beyond therapy are addressed within the school and with the family. Therapists should also reinforce participation within the community and school through patient and family education, in order to improve mental health for patients with SB. This may require a reassessment of equipment recommendations so that patients are better prepared to participate in activities with their peers versus attaining the highest level of mobility ideal to the therapist.
“What should I be mindful about when applying this information?”
Although the groups appeared comparable with respect to ethnicity and language, it may be beneficial for future studies to include a subject group more reflective of the population with SB. Socioeconomic status and culture may affect the accessibility of community resources as well as the overall acceptance and expectations of patient participation by the families of patients with SB. This may in turn contribute to the decreased level of participation in the community and school as well as leading to anxiety and depression. Physical therapists can assist patients and families in securing the necessary resources to avoid this potential spiral.
Amber Richards, PT, MPT
Sally Marcos, PT, DPT, PCS
Children's Hospital Los Angeles
Los Angeles, California