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The "Well On Wheels" Intervention Increases Life Satisfaction Among People With Spinal Cord Injury

People who experience a spinal cord injury (SCI) often suffer from chronic pain, physical disability, and other impairments that can reduce their ability to complete daily tasks or maintain steady employment. Research suggests that these long-term effects of SCI are associated with reduced satisfaction with life (SWL), especially in the months following injury. Additionally, reduced SWL can cause psychological effects (such as depression and anxiety) that may further reduce an individual’s functioning and quality of life after SCI. As a result, health care providers are motivated to identify factors related to SWL, which they can use to design intervention and rehabilitation strategies that improve quality of life among people with SCI.

Recently, a team of researchers across the United States collaborated to investigate patient characteristics that influence SWL and to deliver a wellness intervention to increase SWL among individuals with SCI. The researchers recruited 72 participants, all of whom completed assessments about their SWL, their perceived stress level, and their ability to self-implement health-promoting behaviors. The research team also collected information about each participant’s injuries and secondary health conditions. The results of these evaluations indicated that:

  • People who were injured recently (within the last four years) were more likely to have lower SWL than those who were injured in the distant past.
  • Participants with high SWL tended to be married and had been injured more than four years prior.
  • Even among the married participants (most of whom had high SWL), those older than 49 years had significantly lower SWL than younger participants.

After identifying SWL-related factors, the research team delivered a “Well On Wheels” holistic wellness intervention to 39 of the participants. The Well On Wheels program consists of six four-hour workshops for lifestyle management, physical activity, nutrition, and preventing secondary conditions. During these workshops, people with SCI were trained to improve their self-efficacy, helping them to engage in health-promoting behaviors in everyday life. Over a two-year period after the intervention concluded, the researchers collected follow-up assessments from the participants. They found that:

  • Participants who started the study with low SWL were more likely to show significant improvements in their SWL after completing the Well On Wheels intervention, compared to those who already had higher SWL.
  • Among people who started with low SWL at baseline, overall SWL continued to increase during the two-year follow-up period.
  • Those who began the intervention with high SWL maintained a high SWL in the years following the intervention.

Contrary to prior research, which suggests that reduced SWL persists for about a year following an SCI, these findings indicate that people with SCI may struggle with low SWL for five or more years after injury. Fortunately, the Well On Wheels intervention is a promising way to improve quality of life and other health-related factors among people with low SWL, who are at the highest risk for poor emotional, physical, and social outcomes. Clinicians are advised to look for signs of low SWL among people with SCI, especially older, unmarried patients who were injured in the last five years. These individuals are likely to benefit from clinical referrals to social-cognitive interventions such as Well On Wheels.

Silveira SL, Ledoux TA, Johnston CA, et al. Well on wheels intervention: Satisfaction with life and health for adults with spinal cord injuries.Spinal Cord Medicine. (2020).

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