PSYCHOLOGICAL SUPPORT AS A FACTOR IN IMPROVING THE EFFECTIVENESS OF REHABILITATION IN PATIENTS WITH SPINAL CORD INJURY: A PROSPECTIVE CONTROLLED STUDY

Abstract

Relevance: Spinal cord injury (SCI) is a life-changing event accompanied not only by severe physical but also by profound psychological consequences. The incidence of depression and anxiety disorders in this category of patients reaches 30-40%, which substantially reduces motivation for treatment and negatively affects rehabilitation outcomes. Aim of the study: To assess the influence of structured multimodal psychological support on the dynamics of functional recovery, the psycho-emotional state and the quality of life of patients who have sustained a spinal cord injury. Materials and methods: The prospective controlled study involved 100 patients (mean age 36.7 ± 11.2 years) with SCI, divided into two groups: the main group (n=50), which received a standard rehabilitation programme in combination with comprehensive psychological support (cognitive behavioural therapy, group therapy, family counselling), and the control group (n=50), which received standard rehabilitation only. The follow-up period was 6 months. The psycho-emotional state was assessed with the Beck Depression Inventory (BDI-II) and the Hospital Anxiety and Depression Scale (HADS). Quality of life was measured with the SF-36 questionnaire. Functional status was assessed with the ASIA (motor score) and FIM (functional independence) scales. Results: After 6 months a statistically significant reduction in the level of depression was observed in the main group (mean BDI-II score decreased from 24.1 to 11.5; p < 0.001) and of anxiety in comparison with the control group (BDI-II decreased from 23.8 to 19.6; p > 0.05). The gain in functional independence on the FIM scale in the main group averaged 28.4 points, which was significantly higher than in the control group (17.2 points; p < 0.01). A higher increase in the ASIA motor score was also noted in the main group (p < 0.05). Quality-of-life indicators on the SF-36 questionnaire, especially on the mental health and social activity subscales, were significantly higher in the group with psychological support. Conclusion: The integration of structured psychological support into standard rehabilitation protocols for patients with SCI is a critically important factor that increases their effectiveness. Psychological intervention not only improves the psycho-emotional state but also indirectly contributes to more substantial functional improvements, increasing adherence to therapy and the overall motivation of patients.