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The exclusion criterion was the diagnosis of SB occulta. Sixty\u2010three eligible adults were enrolled, and all completed the study.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The survey via questionnaire was performed in person or over the telephone.<\/jats:p><\/jats:sec><jats:sec><jats:title>Main Outcome Measurements<\/jats:title><jats:p>Data collected included the World Health Organization's Medical Outcomes Study 26\u2010item Short Form, Economic Self\u2010Sufficiency from the Craig Handicap Assessment and Reporting Technique Short Form, virtual socializing habits, and number of friends. Three linear regression models were performed, each with a unique dependent variable: number of friends, psychological QOL, or social QOL. The following independent variables were included in all models: age, gender, ethnicity, economic self\u2010sufficiency, marital status, education level, lesion level, health status, user group, collection method, and time spent virtually socializing. In addition, each regression model included the dependent variables from the other 2 models in its independent variables.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Increased degree of virtual socialization (VS) was associated with a greater number of friends (<jats:italic>P<\/jats:italic> = .003, <jats:italic>r<\/jats:italic> = .684). Mean (standard deviation) numbers of friends by VS groups were the following: users, n = 4.9 \u00b1 2.7; semi\u2010users, n = 3.8 \u00b1 2.7; and nonusers, n = 2.1 \u00b1 2.3, which represent a 2.3 times greater number of friends between the users and nonusers. The effect of virtual socialization on QOL was also positive, however, not statistically significant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>People with chronic physical disabilities, such as SB, are at high risk for peer rejection and long\u2010term social avoidance. Users of the most immersive forms of virtual socialization, have more real world friends than both semi\u2010users and nonusers. Any form of VS, whether immersive or real time, may improve the opportunity for meaningful social encounters. Prospective intervention studies are needed to elucidate whether a causal positive relationship between virtual socialization and friendships exists. Further research is needed to clarify virtual socialization's impact on QOL; however, the upward trend in all 4 domains of QOL across user groups suggests similar potential benefits.<\/jats:p><\/jats:sec>","DOI":"10.1016\/j.pmrj.2010.12.002","type":"journal-article","created":{"date-parts":[[2011,3,13]],"date-time":"2011-03-13T08:21:38Z","timestamp":1300004498000},"page":"219-225","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Virtual Socialization in Adults With Spina Bifida"],"prefix":"10.1002","volume":"3","author":[{"given":"Wendy M.","family":"Chan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Brad E.","family":"Dicianno","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2011,3,12]]},"reference":[{"key":"e_1_2_6_2_2","doi-asserted-by":"publisher","DOI":"10.1136\/adc.77.4.350"},{"key":"e_1_2_6_3_2","first-page":"2452","volume-title":"Nelson Textbook of Pediatrics","author":"Kinsman S.L.","year":"2007"},{"key":"e_1_2_6_4_2","doi-asserted-by":"publisher","DOI":"10.1007\/BF00334666"},{"key":"e_1_2_6_5_2","first-page":"280","article-title":"Family and peer issues among adolescents with spina bifida and cerebral palsy","volume":"88","author":"Blum R.W.","year":"1991","journal-title":"Pediatrics"},{"key":"e_1_2_6_6_2","doi-asserted-by":"publisher","DOI":"10.1097\/PHM.0b013e3181aa41d4"},{"key":"e_1_2_6_7_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2003.tb00896.x"},{"key":"e_1_2_6_8_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1651-2227.2008.00747.x"},{"key":"e_1_2_6_9_2","volume-title":"Psychological Appraisal of Children with Cerebral Defects","author":"Taylor E.M.","year":"1961"},{"key":"e_1_2_6_10_2","doi-asserted-by":"publisher","DOI":"10.3109\/13682827909011349"},{"key":"e_1_2_6_11_2","doi-asserted-by":"publisher","DOI":"10.1080\/03634528609388359"},{"key":"e_1_2_6_12_2","first-page":"115","article-title":"Integration of children with developmental disabilities in social activities","volume":"10","author":"Solish A.","year":"2003","journal-title":"J on Dev Disabilities"},{"key":"e_1_2_6_13_2","doi-asserted-by":"publisher","DOI":"10.1037\/a0019599"},{"key":"e_1_2_6_14_2","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1037\/0033-2909.102.3.357","article-title":"Peer relations and later personal adjustment: are low\u2010accepted children at risk?","volume":"102","author":"Asher S.R.","year":"1987","journal-title":"Psychol Bull"},{"key":"e_1_2_6_15_2","first-page":"40","article-title":"Sociometric choices and teacher ratings as predictors of school dropout","volume":"4","author":"Barclay J.R.","year":"1966","journal-title":"J Soc Psychol"},{"key":"e_1_2_6_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/PHM.0b013e3181aa41d4"},{"key":"e_1_2_6_17_2","doi-asserted-by":"publisher","DOI":"10.1093\/jpepsy\/jsl002"},{"key":"e_1_2_6_18_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2002.tb00818.x"},{"key":"e_1_2_6_19_2","doi-asserted-by":"publisher","DOI":"10.1136\/adc.83.4.293"},{"key":"e_1_2_6_20_2","doi-asserted-by":"publisher","DOI":"10.1177\/089801010202000307"},{"key":"e_1_2_6_21_2","unstructured":"Blizzard Entertainment.What is WoWhttp:\/\/www.worldofwarcraft.com\/info\/basics\/guide.html Accessed June 16 2010"},{"key":"e_1_2_6_22_2","unstructured":"Linden Labs.What is Second Life?http:\/\/secondlife.com\/whatis\/ Accessed June 16 2010"},{"key":"e_1_2_6_23_2","doi-asserted-by":"publisher","DOI":"10.1353\/anq.0.0110"},{"key":"e_1_2_6_24_2","doi-asserted-by":"publisher","DOI":"10.1162\/itgg.2007.2.3.62"},{"key":"e_1_2_6_25_2","first-page":"26","article-title":"Virtual worlds turn therapeutic for autistic disorders","volume":"54","author":"Mangan K.","year":"2008","journal-title":"Chronical High Educ"},{"key":"e_1_2_6_26_2","doi-asserted-by":"publisher","DOI":"10.1076\/digc.13.1.11.3208"},{"key":"e_1_2_6_27_2","first-page":"1","volume-title":"MacArthur Foundation Series on Digital Learning\u2014Youth, Identity, and Digital Media Volume","author":"Boyd D.","year":"2007"},{"key":"e_1_2_6_28_2","unstructured":"S.Shankland.Facebook Opens Chat and AIM Plugshttp:\/\/news.cnet.com\/8301\u201030685_3\u201020000060\u2010264.html Accessed June 21 2010"},{"key":"e_1_2_6_29_2","doi-asserted-by":"publisher","DOI":"10.1159\/000086559"},{"key":"e_1_2_6_30_2","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1207\/S15327965PLI1202_01","article-title":"Personality development across the life course: the argument for change and continuity","volume":"12","author":"Capsi A.","year":"2001","journal-title":"Psychol Inq"},{"key":"e_1_2_6_31_2","author":"Mellick D.","journal-title":"The Craig Handicap Assessment and Reporting Technique. 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