The purpose of the study is to explore the impact of spinal cord injury on the individual and the ways in which people react to and cope with the imposed conditions of a spinal cord injury over time. Contemporary research questions traditional concepts of adjustment and increasingly emphasises the complexity and multiplicity of factors, which impact on adjustment following spinal cord injury. Historically research in this field has largely focused on a narrow range of factors and psychological reactions to spinal cord injury. Traditional research approaches have largely studied the crisis period of adjustment while the injured individual is still in hospital highlighting factors that are predictive of positive adjustment outcomes.
Historically, a whole range of social and environmental factors has been neglected when the process of adjustment is considered. With few exceptions, the research has failed to adequately account for the complexities of the process and the vast array of variables that impact on adjustment. Thus the understanding of "how" adjustment is achieved is limited. The need for longitudinal research into the adjustment process has long been recognised in the field. In the Australian context research addressing the psychosocial aspects of adjustment following spinal cord injury has been extremely limited.
This study has adopted a holistic approach, incorporating an ecological perspective of the coping process and recognising the complexity and range of issues which impact on the adjustment process. Spinal cord injury results in a disruption in the balance of life in the psychosocial, health and environmental life spheres. For the purposes of the study adjustment is conceptualised as the attempts to restore balance with these various life spheres. The approach adopted in this study acknowledges the strengths within the individual and the systems (physical and social) in which they live and function.
This is a study of 44 people who sustained a spinal cord injury and were discharged from hospital between November 1992 and March 1994, with data being collected from the participants on five occasions over the three year period immediately following the participant's discharge from hospital. The study uses both quantitative and qualitative methodologies to examine the impact of the injury on the adjustment of the participants over time. Data was collected on a range of variables identified in previous research as impacting on the process of adjustment. These included demographic, health related, psychosocial and environmental variables. In addition qualitative data was collected utilising a life history approach to identify coping strategies and factors which impacted either positively or negatively on the overall process of adjustment.
A questionnaire was developed which incorporated measures of depression, life satisfaction, health-related concerns and problems of life as well as collecting data about environmental challenges encountered. Quantitative data was analysed using descriptive statistics and repeated measures procedures in the Statistical Package for Social Scientists (SPSS).
Thus the study addresses a crucial gap in the current understanding of the adjustment process by adopting a holistic approach that adequately addresses the complexities inherent in the adjustment process over time and accommodates the various life spheres in which the individual operates. It expands the current understanding of the process, by identifying variables that relate to successful outcomes and the strategies that are used to achieve these outcomes. The study further expands the understanding of the process of adjustment by examining the way in which the variables relate to and interact with each other and thus impact on the process.
A new comprehensive model of adjustment is developed from the data and discussed in relation to indicators for effective social work and rehabilitation practice. Multiple levels of interventions are identified reflecting the complexity and interactive nature of the factors impacting on adjustment.
The findings indicate that overall the respondents made a good adjustment to the disruption caused in their lives by sustaining a spinal cord injury. However a number of challenges, which confronted the respondents, were identified in the both the qualitative and the quantitative data. The respondents utilise a variety of coping strategies to overcome the barriers and challenges they confronted. The effectiveness of the coping efforts of the respondents is mediated by a variety of health and environmental factors in interaction with the intra-personal resources of the individual.
Thus the main findings from the study highlight the complexity of the adjustment process and the range of interacting factors that impact on the process. The findings further highlight the variety of individual responses to spinal cord injury and the unique influence of the individuals' social and physical environments. Interventions focusing on the strengths of the individual, social networks, problems solving, environmental issues and social change are discussed. The importance of interventions targeted at both the micro (individual) level and the macro level (influencing social and cultural attitudes, policy and programs) are discussed.