Dunn et al. (2000) reported that veterans approaching 20 years post SCI with access to medical follow-up through a specialty comprehensive outpatient program reported better health, independence, and less depression than a demographically similar (civilian) group without access to follow-up care. Neither group reported “depression” with sufficient frequency to earn it a top ten ranking from a list of 40 possible complications. However, those without access to medical follow-up who did endorse depression considered it of sufficient intensity to rank it among the ten most severe problems. While the types of secondary complications were similar, these were less frequent and less severe in those receiving health care. Noting a variety of methodological concerns that limit conclusions and generalizability, the authors reported that their findings were consistent with those in other studies (involving SCI and other patient groups).
Zemper et al. (2003) examined a holistic wellness program for SCI patients. The intervention in this RCT study involved six group workshop sessions focused upon lifestyle management (including sexual health and stress management), physical activity, nutrition, and preventing secondary complications. It also included individual coaching sessions and follow-up phone calls. Assessments were completed at three times: prior to the series, two weeks following completion and four months later. Results of this study pointed to improvements in awareness and behavior in areas of health practices, nutrition, and stress. Also secondary conditions were fewer and less serious. Reports of depression intensity decreased but did not reach significance. Self-reports indicated improvements in physical activity, while more objective tests showed no improvement in physical fitness.
With a university clinic group of 20 outpatients with quadriplegic injuries, Diego et al. (2002) compared the effects of a 5-week massage therapy program to those of an independently performed exercise routine conducted over a similar period. Subjects were stratified according to range of motion and then assigned to either of the two treatment groups. While both groups averaged pretreatment depression scores approaching the clinically depressed range, only the massage therapy group showed a decrease in reported post treatment depression symptoms. The massage therapy group also reported lower anxiety immediately after treatment on the first and last days of the protocol. The authors suggested that the significant gains in upper limb muscle strength and wrist range of motion demonstrated by the massage therapy group may have contributed to their reported reduction in subjective distress.
One RCT (Defrin et al. 2007) evaluated the effectiveness of transmagnetic stimulation (TMS) in reducing pain post-SCI. This study found a significant decrease in depression in individuals treated with transmagnetic stimulation compared to those in the control group at time of follow-up 2-6 weeks post treatment.
- There is level 2 evidence (from one randomized controlled trial; Zemper et al. 2003) that a wellness and health promotion program does not significantly decrease intensity of depressive symptoms.
There is level 2 evidence (from one prospective controlled trial; Dunn et al. 2000) that access to medical follow-up for individuals with SCI results in better health, independence, less depression and fewer secondary complications.
There is level 1b evidence (from one randomized controlled trial; Diego et al. 2002) that massage therapy can reduce depressive symptoms.
There is level 1b evidence (from one randomized controlled trial; Defrin et al. 2007) for the effectiveness of transcutaneous magnetic stimulation in reducing depressive symptoms.
- Several non-traditional approaches to SCI appear to offer improved health practices and a reduction in reported secondary conditions including depression.