Exploring self-efficacy – associations with secondary health conditions in the finnish spinal cord injury population: a national registry-based cross-sectional study

STUDY DESIGN: Registry-based cross-sectional survey. OBJECTIVES: To assess self-efficacy (SE) for managing symptoms and examine the association between SE and secondary health conditions (SHCs) among individuals with spinal cord injury (SCI) in Finland. SETTING: Three specialized SCI outpatient clinics providing lifelong follow-up care. METHODS: Data were drawn from the Finnish Spinal Cord Injury Study (FinSCI). Participants (n = 884; response rate 50%) met the following criteria: age ≥16 years, ASIA Impairment Scale grades A-D. SE was measured using an adapted version of the PROMIS Short Form v1.0 - Self-Efficacy for Managing Symptoms 8a; SHCs were assessed with the Spinal Cord Injury Secondary Condition Scale (SCI-SCS). T-scores were calculated via the HealthMeasures Scoring Service. Group differences and SE-SHC associations were analyzed using non-parametric tests and multivariable regression. RESULTS: Respondents (mean age 60.7 years; mean time since injury 11.4 years) had a mean SE score of 27.11 (T-score = 48.3; range, 5-35). Highest confidence was reported in managing symptoms at home and during personal care; lowest in work-related tasks and information-seeking. SE was higher among participants aged 31 to 45 years and those with ≥16 years since injury. SE was inversely correlated with SHC burden (r = -0.421, p < 0.001), particularly with contractures, bowel dysfunction, and chronic pain. In multivariable analysis, SE remained independently associated with SHC burden (β = -0.507, 95% CI, -0.588 to -0.427, p < 0.001). CONCLUSIONS: As SE was associated with SHCs, interventions to strengthen SE could be explored in future studies, but causal relationships cannot be inferred from the present cross-sectional data.