Impact of a photovoice intervention on fall-related psychological variables, participation levels and quality of life in chronic spinal cord injury.

CONTEXT: Falling is common after spinal cord injury (SCI). Falls can cause a fear of falling and reduced participation in activities. Interventions that target falls self-efficacy may change fall-related behaviors, such as reduced participation.

OBJECTIVE

The primary objective was to investigate the impact of a photovoice intervention on falls self-efficacy in individuals with chronic SCI. The secondary objectives were to examine the effects of photovoice on participation, quality of life, fear of falling and falls.

METHODS

Convergent mixed methods study with 34 adults with chronic SCI; 17 used a wheelchair (WC) and 17 ambulated (AM). The six-week, virtual photovoice intervention focused on fall prevention and consisted of photo-assignments, individual interviews and group meetings facilitated by a peer mentor. The primary measures were questionnaires of falls self-efficacy and falling concern. The secondary measures included questionnaires of participation, quality of life and fear of falling, and number of falls. Quantitative data were compared over time for WC and AM groups separately with a repeated measures ANOVA or Friedman's test. Semi-structured interviews and thematic analysis were used to collect and analyze qualitative data. A joint display merged quantitative and qualitative findings.

RESULTS

Scores did not change over time for both groups (p≥0.109) with the exception of participation. The AM group's participation scores were significantly improved three months post-intervention (p≤0.028). Overall, divergence between quantitative and qualitative data was observed, with some participants describing improvements in self-efficacy and quality of life.

CONCLUSIONS

A photovoice intervention focused on fall prevention may benefit ambulatory individuals with chronic SCI.Trial registration: ClinicalTrials.gov identifier: NCT04864262.