Associations Between Self-Efficacy and Secondary Health Conditions in People Living With Spinal Cord Injury: A Systematic Review and Meta-Analysis

Objective To describe the association between self-efficacy and secondary health conditions (SHCs) in people living with spinal cord injury (SCI). Data Sources PubMed, EMBASE, the Cochrane Library, and CINAHL were systematically searched from database inception to September 2016. Study Selection Studies describing patients living with SCI in which self-efficacy was measured by a standardized questionnaire and an association was made with somatic or psychological SHCs. Data Extraction An independent extraction by multiple observers was performed based on the Strengthening the Reporting of Observational Studies in Epidemiology statements checklist. A meta-analysis concerning the association between self-efficacy and SHCs in people with SCI was performed if a minimum of 4 comparable studies were available. Data Synthesis Of 670 unique articles screened, 22 met the inclusion criteria. Seven of these 22 studies investigated associations between self-efficacy and somatic SHCs. Only a trend toward an association between higher self-efficacy and less pain, fatigue, number of SHCs, and limitations caused by SHCs was found. Twenty-one studies described the association between self-efficacy and psychological SHCs. All correlations of higher self-efficacy with fewer depressive (18 studies) and anxiety symptoms (7 studies) were significant, and meta-analysis showed a strong negative correlation of −.536 (−.584 to −.484) and −.493 (−.577 to −.399), respectively. A small number of studies (2) showed a trend toward a positive correlation between self-efficacy and quality of life. Conclusions Self-efficacy is negatively associated with depressive and anxiety symptoms in SCI. Therefore, self-efficacy seems an important target in the rehabilitation of patients living with SCI. More research is necessary to clarify the associations between self-efficacy and somatic SHCs. Future research should also focus on different types of self-efficacy and their association with SHCs.