The unfairness of it all | The role of injustice appraisals in rehabilitation outcomes


Monden, K. R., Trost, Z., Scott, W., Bogart, K. R., & Driver, S. (2016). The unfairness of it all: Exploring the role of injustice appraisals in rehabilitation outcomes. Rehabilitation Psychology, 61(1), 44.


Rehabilitation psychology research and practice are guided by several foundational principles that help to conceptualize the person-environment interaction. Growing evidence suggests that (in)justice-related appraisals of injury and disability are fundamental appraisal processes in adjustment to disability, affecting rehabilitation outcomes. The authors review social and rehabilitation theory as underscoring the relevance of injustice appraisals and critically examines the existing literature on the impact of perceived injustice (and related constructs) on adjustment to disability. Lewin’s Field Theory and Just World Theory are described to highlight the influence of assumptions on an individual’s injustice perception. Current findings demonstrate associations between the spectrum of perceived injustice and physical and psychological outcomes (self-reported pain intensity and disability, depressive symptomology, likelihood to return to work) amongst various rehabilitation populations. Injustice is conceptualized as the cognitive antecedent to anger, which was associated with worse psychological adjustment in individuals with SCI, MS, amputees and a variety of traumatic injuries. Traumatic injury and pain populations show poorer mental and physical health outcomes amongst those who ascribed external blame. Just world beliefs (JWB) appear to buffer the impact of disability on psychological distress, a finding that is explored within Beatrice Wright’s model of coping vs. succumbing. Injustice appraisals may be heavily influenced by environmental factors, however, the authors point out that the impact of social processes requires a systematic review.

Such lack of contextualization may problematically (and incorrectly) characterize perceived injustice as an immutable characteristic that arises from within the person, rather than emerges from interaction with environmental stimuli, thus countering a fundamental view of rehabilitation psychology.”

The authors provide a call to action for rehabilitation professionals to expand the discourse on injustice perception through recognition of the diversity of disability experience, as well as several new avenues of inquiry. They also provide recommendations and rationale for clinical research and practice using interventions to address promising mechanisms of action underlying injustice appraisals.

I PICKED THIS ARTICLE BECAUSE injustice appraisals can influence adjustment across rehabilitation populations, and this review highlights a unique opportunity for the specialty area of rehabilitation psychology to further explore research and clinical inquiry. I think that the authors were exemplary in providing contemporary empirical data to support the intersection of foundational social and rehabilitation psychology theory. They also provide a powerful call to action which is informed by thoughtful suggestions for potential interventions.

This month's rehabilitation science spotlight was chosen by Evan L. Smith, Rehabilitation Psychology Post-doctoral Fellow, Johns Hopkins University Department of Physical Medicine and Rehabilitation; Chair of the Division 22 Science Committee.