• Claudio Peter, Rachel Müller, Marcel W M Post, Christel M C van Leeuwen, Christina S Werner, Szilvia Geyh, and SwiSCI Study Group.
• Swiss Paraplegic Research (SPF), Nottwil, Switzerland; Unit for Biopsychosocial Health, Chair for Public Health and Health Care Research, Department of Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-University, Munich, Germany. Electronic address: claudio.peter@paraplegie.ch.
• Arch Phys Med Rehabil. 2014 Sep 1; 95 (9): 1662-71.

ObjectiveTo test the Spinal Cord Injury Adjustment Model and gain a better understanding about whether and how the psychological resources general self-efficacy (SE), purpose in life (PIL), appraisals, and coping influence participation in persons with spinal cord injury (SCI).DesignCross-sectional data collection within the Swiss Spinal Cord Injury Cohort.SettingCommunity setting.ParticipantsPersons with SCI (N=516) who are ≥ 16 years old and living in the community in Switzerland.InterventionsNot applicable.Main Outcome MeasuresParticipation was measured with the restrictions subscale of the Utrecht Scale for Evaluation of Rehabilitation-Participation, General SE with the General Self-Efficacy Scale, PIL with the Purpose in Life Test-Short Form, appraisals with the Appraisal of Life Events Scale, and coping with the Brief COPE.ResultsGeneral SE (r=.32) and PIL (r=.23) were associated with less participation restrictions. The initial model yielded a poor model fit. The modified final model had an acceptable fit (χ(2)11=36.2; P<.01; root mean square error of approximation=.067 [90% confidence interval: .045-.09]; comparative fit index=.98). A total of 15% of the variance of participation was explained. In the final model, general SE had a moderate direct effect (β=.24) and mediated effects via threat appraisal and challenge appraisal and humor on participation, indicating a partial mediation effect. The association between PIL and participation was indirect: challenge appraisal and humor acted as mediators.ConclusionsThe results only partly support the double-mediating effect as suggested in the SCI adjustment model because both direct and indirect effects on participation were observed. Individuals with higher general SE and PIL perceive less participation restrictions. General SE seems an appropriate target to enhance participation. Longitudinal studies are needed to support our findings.Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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