Mindfulness for pain, depression, anxiety, and quality of life in people with spinal cord injury: a systematic review

A systematic review of five studies found mixed support for mindfulness-based interventions in people with spinal cord injury. One study reported significant reductions in pain-related outcomes with moderate effect sizes, while four showed no change. Four studies described reductions in depressive symptoms and three reported reductions in anxiety. Only two studies assessed quality of life as an outcome, and neither reported improvements. The authors conclude that mindfulness may be particularly effective for depression and anxiety but highlight the need for larger, more rigorous randomized controlled trials with long-term follow-up.

Study at a glance

Abstract

Background Populations with reduced sensory and motor function, such as spinal cord injury (SCI) are at increased risk of depression, anxiety, pain, and poorer quality of life (QoL). Mindfulness-Based Interventions (MBIs) have been developed with the aim of improving outcomes for people with SCI. To understand the value of MBIs, a systematic review was conducted pertaining to the use of MBIs, and interventions including elements of mindfulness, with people with SCI. Methods Databases were reviewed from 1996 to October 2018 (updated January 2020). Eligibility criteria included the assessment of at least one of the common secondary consequences of SCI (i.e. risk of depression, anxiety, pain, and QoL), describe the use of mindfulness training as a component part of an intervention, or as the whole intervention. The Cochrane Collaboration Risk of Bias and The Effective Public Health Practice Project Quality Assessment Tools were utilised for quality appraisals. Two assessors appraised the studies and demonstrated good agreement (Cohen’s k = .848 , p < .001). Results Five papers met the inclusion criteria, and demonstrated a range of results of interventions delivered individually, in a group format, in person, and online. Only one study reported significant reductions in pain-related outcomes (with moderate effect sizes), with the remaining studies (n = 4 ) demonstrating no change. Four studies described reductions in depressive symptoms and three reported reductions in anxiety. Despite the importance of good QoL as a goal for people with SCI, few studies ( n = 2) assessed this as an outcome with no improvements reported. Study quality ranged from high to low/weak. Conclusions The findings in this review provide mixed support for the use of mindfulness to improve outcomes after SCI. In particular, findings indicate that mindfulness may be particularly effective for improving symptoms of depression and anxiety. This review highlights the requirement for more rigorous, high-quality research, particularly larger randomised-controlled trials with long-term follow-up, in this area. The small number of studies included in the present review mean that conclusions drawn are preliminary and thus reflects the paucity of the research in the area to date.