Effect of a mindfulness and motivational interviewing-oriented physical-psychological integrative intervention for community-dwelling spinal cord injury survivors : a mixed-methods randomized controlled trial

Abstract

Objective: To evaluate the feasibility, acceptability, and efficacy of a mindfulness and motivational interviewing-oriented physical-psychological integrated intervention in community-dwelling spinal cord injury (SCI) survivors. Design: A mixed-methods randomized controlled trial. Setting: Local organizations of handicapped in Hong Kong. Participants: Community-dwelling adults with SCI (N = 72). Interventions: Participants in the intervention group (n = 36) received video-guided exercise for daily practice and online group psychological (mindfulness and motivational interviewing-oriented) weekly sessions for eight weeks. Participants in the control group (n = 36) received an eight-week online group didactic education on lifestyle discussions and general health suggestions. Main Outcomes Measures: Primary outcomes included quality of life, physical activity, depression, and chronic pain. Secondary outcomes included exercise self-efficacy and mindfulness. Outcomes were measured at baseline, post-intervention, and three-month follow-up. Focus-group interviews were conducted post-intervention. Results: The recruitment, retention, and adherence rates were 84.7%, 100%, and 98.6%, respectively. The intervention showed significant positive effects on preventing declines in quality of life at three-month follow-up [Cohen's d = 0.70 (0.22, 1.18)]. Positive trends manifested in physical activity, depression, chronic pain, and exercise self-efficacy. Three qualitative categories were identified: subjective improvements in exercise, physical, and social well-being; perceived changes in mindfulness and mental well-being; and intervention facilitators and barriers. Conclusions: The mindfulness and motivational interviewing-oriented physical-psychological integrated intervention is feasible and acceptable. The significant prolonged effect in maintaining quality of life and positive impacts on physical and psychosocial well-being indicate its value to address major health challenges of community-dwelling SCI survivors.