Exploring the mediating effects of coping strategies on adjustment after sustaining a spinal cord injury.

Study design: Cross-sectional study of adults living with a spinal cord injury (SCI) in Norway.

Objectives: Using the Norwegian data from the International Spinal Cord Injury Community Survey (InSCI), we firstly aimed to examine the mediating effect of self-efficacy and active coping strategies on the relationship between functional independence and level of adjustment as proposed by the Spinal Cord Injury Adjustment Model (SCIAM). Secondly, to examine potential gender differences in levels of adjustment after sustaining an SCI. This study used a comprehensive adjustment variable.

Setting: SCI population in Norway.

Methods: The first objective was tested with a measure of mediation analysis and the second objective with an independent two sample t-test.

Results: A total of 610 participants responded to the questionnaire, with a mean age of 57 years, and 68,5% being male. Psychological resources fully mediated the effect of functional independence on adjustment. There was a statistically significant double mediation effect, first through self-efficacy and, then through active coping strategies (β = 0,02; 95% CI 0.01-0.03). The pathway from functional independence through active coping strategies to adjustment showed the strongest mediation proportion of 0.49. The difference in adjustment levels between males and females was 2.90 out of 100 (95% CI: 0.19-5.61).

Conclusions: Self-efficacy and active coping strategies were found as mediating factors in the relationship between functional independence and adjustment. These factors are important to consider during SCI rehabilitation. Females had a slightly lower level of adjustment than males.