Rehabilitation Psychology

Nutrition and eating beliefs and behaviors among individuals with spinal cord injuries and disorders: Healthy or misconceived?
Purpose/Objective: Nutrition knowledge, beliefs, and behaviors have important implications for managing and preventing chronic and injury-related secondary conditions in persons with spinal cord injuries and disorders (SCI/D). Yet, the unique dietary and nutritional needs and recommendations specific to individuals with SCI/D and their eating beliefs and behaviors have been understudied. Aim is to describe nutrition and eating beliefs and behaviors from the perspectives of individuals with SCI/D. Research Method/Design: Descriptive qualitative design using in-depth semistructured interviews with a national sample of veterans with SCI/D (n = 33). Audio-recorded and transcribed verbatim transcripts were coded and analyzed using thematic analysis. Results: Participants were male (61%), aged 29–84 years, and 55% had tetraplegia. Five key themes were identified: extreme fasting/caloric restriction, perceived healthy eating behaviors, perceived unhealthy eating behaviors, modified eating behaviors due to SCI/D-related symptoms, and food/preparation choices based on abilities/independence and access. Conclusions/Implications: Nutrition among veterans with SCI/D may be impacted by many factors, such as nutrition knowledge and beliefs/behaviors about “healthy” and “unhealthy” nutrition, fasting, caloric restriction, imbalanced intake of macro- and micronutrients, overconsumption relative to energy needs, injury-related secondary complications, postinjury body composition and function changes, impairments related to satiety and hunger signals, and difficulty in obtaining and preparing food. Study findings provide many areas that would benefit from intervention. Findings can be used to inform ideal nutrition and healthy eating beliefs and behaviors which are important because nutritional inadequacies can lead to diet-related diseases, may exacerbate SCI secondary conditions, and lead to poor overall health. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Disparities between Native Americans and Whites in trajectories of functional independence and life satisfaction over the 5 years after traumatic brain injury.
Purpose: Traumatic brain injury (TBI) can lead to impairments in motor and cognitive function and reduced life satisfaction. TBI is one of the leading causes of death and disability worldwide and disproportionately affects Native Americans, who have the highest rates of TBI among all races in the United States and elevated likelihood for fatality and severe complications. This study investigated whether disparities in functional and life satisfaction outcomes exist longitudinally over the 5 years after complicated mild, moderate, or severe TBI between Native Americans and White individuals; it further explored which demographic and injury-related covariates account for them. Research Method: The current study used a subsample of the national TBI Model Systems Database of 80 demographically and injury-severity matched Native American and White pairs (total n = 160). Results: A series of longitudinal hierarchical linear models found that Native Americans experienced significantly lower Functional Independence Measure Cognitive and Motor trajectories than Whites; however, life satisfaction was comparable. Native Americans had declining cognitive function over time relative to a slight increase in White individuals. This differential movement dissipated with the addition of employment status at the time of injury and type of health insurance. Conclusions: These results demonstrate a profound need to further investigate the cultural and contextual variables unique to Native Americans that underlie these differences and highlight the importance of culturally responsive treatment and rehabilitation in bridging the gap in recovery. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Longitudinal measurement invariance of the Patient Health Questionnaire-9 across racial/ethnic groups: Results from the traumatic brain injury model system study.
Purpose/Objective: The aim of this article is to evaluate the measurement invariance (MI) of the Patient Health Questionnaire-9 (PHQ-9) in a sample of individuals during the first 2 years after traumatic brain injury (TBI). MI was examined among racial/ethnic groups and over time to determine the utility of the PHQ-9 across these dimensions. Research Method/Design: In total, N = 3,227 (20% of the total sample) at 1 year and N = 3,153 (19% of the total sample) at 2 years were included for cross-sectional analyses. For the longitudinal analyses, participants with the PHQ-9 at both time points (N = 2,234; 14% of the total study sample) were included. Results: Results were that the PHQ-9 is fully invariant and maintains its unidimensional factorial structure across racial/ethnic groups during the first 2 years after TBI, suggesting the scale measures the same construct equally well for participants from each group. Conclusion/Implications: Based on these results, clinicians should feel confident using the PHQ-9 with diverse TBI patient populations, and researchers can reliably and validly employ it in TBI studies across racial/ethnic groups in the United States. Given the high rates of depression among individuals after TBI and its negative impact on their lives, this instrument will continue to be a key tool to measure the prognosis and success of rehabilitation programs. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Positive impacts of psychological pain treatments: Supplementary analyses of a randomized clinical trial.
Objective: Clinical trials often focus on symptom reduction as a primary outcome, overlooking positive psychology factors of potential importance although many individuals can and do live well with pain. The Patient-Reported Outcomes Measurement Information System (PROMIS) Psychosocial Illness Impact—Positive (PIIP) scale assesses perceptions of adaptive psychosocial functioning (e.g., coping and meaning-making) after illness onset. This study evaluated the effects of hypnosis (HYP), mindfulness meditation (MM), and pain psychoeducation (ED) on PIIP scores, using data from a completed randomized clinical trial (RCT) of complementary and integrative chronic pain interventions. We hypothesized that treatment effects on PIIP would mirror the RCT’s primary pain intensity outcome, such that HYP and MM, relative to ED, would lead to greater improvements in PIIP during trial follow-up. Method: Our sample included 262 Veterans who completed the PROMIS PIIP Short-Form 8a at pre- and posttreatment and at 3- and 6-month follow-up. Linear regression was used to test between-group differences in PIIP at each time point, controlling for baseline PIIP, average pain intensity, and baseline perceptions of prepain psychosocial functioning. Results: There were no significant between-group differences in PIIP at posttreatment or 3-month follow-up. However, group differences emerged at 6-month follow-up: individuals randomized to MM and HYP showed improved PIIP relative to those randomized to ED. Conclusions: Positive psychosocial outcomes are a mostly untapped territory in clinical trials of pain interventions. The present work highlights the potential benefits of including positive psychology concepts in both research and clinical contexts, emphasizing the importance of understanding human flourishing in the presence of illness and disability. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Factors associated with pain intensity and analgesic use during inpatient rehabilitation for hip fracture.
Purpose: Effective pain management is vital for hip fracture recovery, yet the factors influencing pain reporting and pain medication use during inpatient rehabilitation for hip fractures are not well understood. This observational study aimed to (a) determine how cognitive abilities, expressive and receptive language abilities, and age are related to average daily pain intensity and analgesic use and (b) how average daily pain intensity and analgesic use are related to length of stay and functional outcomes in rehabilitation. Design: Data were retrospectively obtained from 163 patients recovering from unilateral trochanteric fractures of the femur. Results: During the first week of rehabilitation, patients received a daily average of 1,147.8 ± 978 mg of acetaminophen and a morphine milligram equivalent of 15.3 ± 18.2. Multivariable regression revealed independent relationships between more intact general cognitive abilities (B = −0.40, 95% CI [−0.70, −0.11]), and older age (B = −0.41, 95% CI [−0.70, −0.11]) with lower average daily pain intensity. Higher average daily pain intensity (B = 0.97, 95% CI [0.75, 1.20]) was independently related to greater opioid use. The length of stay was shorter among patients administered higher daily doses of acetaminophen (B = 0.03, 95% CI [−0.05, −0.01]). Average daily pain intensity and analgesic use were not related to functional outcomes in multivariable models. Conclusions: These findings inform the considerations for assessing and treating pain during inpatient rehabilitation. Supplemental strategies for assessing pain in older patients and alternative pain mitigation strategies for patients with impaired cognitive abilities should be considered. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Acceptance of disability, attitudes toward disability, and coping in adolescents with visual impairments: A cross-lagged study.
Purpose/Objective: This study aims to understand the reciprocal relationships among acceptance of disability, attitudes toward disability, and coping among Chinese adolescents with visual impairments. Research design: Adolescents with visual impairments (NT1 = 311, NT2 = 170) from four Chinese special education schools completed three questionnaires twice over 1 year. Cross-lagged panel modeling was carried out to analyze the questionnaire data. Results: The findings revealed that attitudes toward disability and self-directed coping at Time 1 (T1) positively predicted acceptance of disability at Time 2 (T2). Self-directed coping at T1 positively predicted attitudes toward disability at T2, and attitudes toward disability at T1 negatively predicted relinquished-control coping at T2. Conclusion/Implications: Visually impaired adolescents’ attitudes toward disability and coping serve as antecedents of their acceptance of disability. There is a positive reciprocal relationship between coping and attitudes toward disability. Psychological interventions aimed at optimizing psychosocial adjustment among students with visual impairments may benefit from targeting coping strategies and attitudes toward disability. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Service needs and neurobehavioral functioning following traumatic brain injury in U.S. military personnel.
Objective: The purpose of this study was to (a) identify the prevalence and barriers of self-reported service needs in a military sample with and without traumatic brain injury (TBI), (b) evaluate the influence of the number of service needs on overall neurobehavioral functioning, and (c) examine the longitudinal trajectories of service needs over time. Method: Participants were 941 U.S. service members and veterans (SMVs) prospectively enrolled into four groups: uncomplicated mild TBI (MTBI; n = 455); complicated mild, moderate, severe, and penetrating TBI combined (STBI; n = 164); injured controls (IC, n = 138); and noninjured controls (NIC, n = 184). Participants completed a battery of neurobehavioral measures, as well as a self-reported service need interview, 12 or more month’s postinjury. In addition, a longitudinal cohort (n = 553) was included using a subset of participants who had completed two or more evaluations. Results: When examining the total number of self-reported service needs, there was a greater proportion of the MTBI and STBI groups that had a higher number of service needs compared to the NIC and IC groups (p <.001). In the MTBI and STBI groups, as the number of service needs increased, worse scores were found on all neurobehavioral measures. In the longitudinal cohort, the STBI group reported the highest number of service needs that persisted or developed over time (six needs), followed by the MTBI (three needs), IC (one need), and NIC (zero need) groups. Conclusions: These findings call for the need to enhance the provision of information given to service members and veterans following TBI regarding available services. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Estimating anticipatory, immediate, and delayed effects of disability registration on depressive symptoms.
Purpose: This study examines (a) whether disability registration has anticipatory, immediate, and delayed effects on depressive symptoms and (b) how these effects differ by gender. Research Method/Design: Using data from the Korea Welfare Panel Study spanning over 16 waves between 2005 and 2020, this study employed the individual-level fixed effects models to estimate the trajectories of depressive symptoms before and after the registration of physical disability, for a cohort of 20,054 individuals. Furthermore, gender-stratified fixed effects models were used to examine gender differences. Results: Compared to the preregistration reference period (i.e., 4 or more years before disability registration), there was a sustained rise in depressive symptoms leading up to the year of registration, indicating the presence of anticipatory effects. After disability registration, depressive symptoms consistently remained at a statistically higher level than during the initial reference period, with a gradual return to the baseline level of depressive symptoms over time. These anticipatory, immediate, and delayed effects of disability registration were notably more pronounced among men than women. Conclusion/Implications: To develop more effective mental health interventions for people with disability, policymakers should consider gendered trajectories of depressive symptoms before and after disability registration. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Comparison, othering, and surveillance: Foucauldian discourse analysis of peer support in visual impairment rehabilitation services in South Africa.
Purpose: Peer support has been identified as an important aspect of rehabilitation for visually impaired adults. However, there is a limited exploration in rehabilitation studies literature of the identity-related impact of these interventions, both at an individual and collective level. Through attending to the discourses on blindness, well-being, and social inclusion that circulate in organization cultures, this article considers the role that peer support plays in forming “blind communities” with particular characteristics, and what these communities might model about life with blindness, both to newly blind persons and to society. Research Method: Foucauldian discourse analysis was conducted on semi-structured interviews with 18 visual impairment rehabilitation service users and eight rehabilitation practitioners at four organizations providing services in the Western Cape, South Africa. Results: Formal peer support is lacking in the sampled organizations, suggesting that relational aspects are not a priority in rehabilitation practice. The formal and informal peer support that does exist in these services is shadowed by largely negative sociocultural beliefs about blindness. Participants described a culture of comparison, othering, and surveillance within which, the article suggests, they are unable to explore and embrace authentic and positive blind identities. This has implications for both individual and collective empowerment. Conclusions: Greater attention must be paid to both rehabilitation practitioner training and the design and implementation of rehabilitation services to the identity-level impact of rehabilitation. This is essential to develop services that promote individual and collective empowerment and that respond to the multilayered practical, social, and psychoemotional needs of blind adults. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Longitudinal associations of time-varying homeboundness and life satisfaction after traumatic brain injury.
Purpose/Objective: To examine the association of changes in homebound status (i.e., never/rarely leaving the home) with life satisfaction in the first 10 years after traumatic brain injury (TBI). Research Method/Design: We analyzed data from 2,294 individuals with moderate-to-severe TBI from the TBI Model Systems National Database using a longitudinal multilevel model with time-varying predictors to account for within-person changes over time as well as between-person differences. We measured homebound status (defined as leaving the home ≤ 2 days/week) and life satisfaction (defined as the total score on the Satisfaction With Life Scale) at 1, 2, 5, and 10 years post-TBI. We adjusted the models for demographic and injury-related covariates and used inverse probability weighting to account for selection bias. Results: Forty-five (2%) individuals were homebound at all follow-up visits, 523 (22.8%) were homebound at least one follow-up visit, and 1,726 (75.2%) were never homebound. Individuals with TBI who were consistently homebound had > 1 SD lower life satisfaction compared to those who were never homebound, β = −8.07, 95% confidence interval (CI) = [−9.39, −6.76], p <.001. Individuals who became homebound experienced a significant, but modest, decline in life satisfaction (β = −2.13, 95% CI = [−2.66, −1.61], p <.001). Conclusions/Implications: Our results indicate that being homebound and becoming homebound are associated with decreased life satisfaction. Homeboundness is a potentially modifiable target to improve life satisfaction, and elucidation of contributing factors to homebound status will help develop interventions to ameliorate post-TBI homeboundness. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Predicting meditation practices among individuals with cardiovascular diseases: A logistic regression analysis.
Purpose/Objective: Since the prevalence and cost of cardiovascular diseases (CVD) are high in the United States, research on affordable preventative and treatment approaches is needed. While meditation shows promise for heart-health promotion, there is little knowledge about its use among people with CVD and factors that may influence its usage. In response, the purposes of the current research are to (a) shed light on the proportion of people with CVD who practice meditation; and (b) reveal variables that predict the use of meditation among them. Research Method: A secondary data analysis was conducted using data from the 2017 National Health Interview Survey. A total of 4,197 data entries (respondents with CVD) were included for analysis, and both descriptive and logistic regression analysis results were reported. Results: Approximately 16% of respondents with CVD practiced meditation. Among them, many used spiritual (82.5%) meditation, followed by mindfulness (29.9%), and mantra (24.9%) meditation. Females (odds ratio [OR] = 1.69), those advised to increase physical activity (OR = 1.34), and email users (OR = 1.63) had higher odds; and those able to afford medication (OR = 0.70) or mental health care/counseling (OR = 0.46) had lower odds to use meditation compared to respective counterparts. Conclusions/Implications: There is a significant proportion of people with CVD who used meditation practices, especially spiritual meditations. However, more research is needed to reveal the determinants of meditation use among people with CVD to facilitate their heart-health-self-care. (PsycInfo Database Record (c) 2025 APA, all rights reserved)
Positionality statements: Intersectional considerations for rehabilitation psychology.
Introduction: Positionality statements accompanying peer-reviewed publications are increasingly being implemented in academic journals across many disciplines, including psychology. These statements serve as transparent, public acknowledgments of the authors’ identities, which can offer valuable insight into the authors’ work in the context of their lived experiences and potential biases. However, journal editors and associated staff risk harm by uniformly adopting a policy on positionality statements without consideration of the unintended consequences of implementing such practices. Objective/Purpose: The purpose of the current article is to discuss the benefits and challenges of incorporating positionality statements, with a focus on the specific context and principles of rehabilitation psychology. Method: We reviewed the literature on positionality statements and disclosure and incorporated our own experiences as researchers and authors from marginalized and/or minoritized groups. Results: Editorial and research teams in rehabilitation psychology are encouraged to reflect on both the potential benefits of positionality statements (e.g., greater recognition of “insider perspectives,” recognition of potential biases) as well as the potential negative consequences (e.g., forced disclosure of characteristics and identities in published work, minimization of the impact of intersectional identities, dissolution of dynamic identities and stages of identity development). Conclusions/Implications: Positionality statements present complex challenges for rehabilitation psychology researchers from diverse backgrounds and their colleagues; thus, authors should be given the freedom to choose if and how to include a positionality statement in their work. (PsycInfo Database Record (c) 2025 APA, all rights reserved)

Rehabilitation Psychology - Vol 70, Iss 1