Influence of Race/Ethnicity on Divorce/Separation 1, 2, and 5 Years Post Spinal Cord Injury

Arango-Lasprilla JC, Ketchum JM, Francis K, Premuda P, Stejskal T, Kreutzer J. Influence of race/ethnicity on divorce/separation 1, 2, and 5 years post spinal cord injury.

Objectives

(1) To compare the proportions of divorce/separation between races/ethnicities at 1, 2, and 5 years post spinal cord injury (SCI); (2) to examine changes in proportions of divorce/separation over time within each race/ethnicity group; and (3) to compare the changes in proportions of divorce/separation over time between races/ethnicities.

Design

Retrospective study.

Setting

Model Spinal Cord Injury Systems.

Participants

A sample of participants married preinjury (N=1528; 1108 whites, 258 blacks, 162 Hispanics) was selected from the National Spinal Cord Injury Statistical Center database from 1988 to 1998.

Interventions

Not applicable.

Main Outcome Measures

Proportion of separation/divorce at 1, 2, and 5 years postinjury for each race/ethnic group.

Results

At all postinjury years (1, 2, 5y), blacks had significantly greater odds of divorce/separation versus staying married than Hispanics. In addition, whites had significantly greater odds of divorce/separation versus staying married compared with Hispanics at 1 and 2 years postinjury. People with SCI of all races/ethnicities showed significantly greater increases in the odds of divorce/separation versus staying married over time (1–2, 2–5, 1–5y postinjury). Although there was evidence that the races/ethnicities were significantly different at each postinjury year, and that each race/ethnicity showed significant increases in the proportion of divorce/separation over time, there was no indication that the increases in the divorce/separation over time were significantly different among the race/ethnic groups.

Conclusions

Family therapists and rehabilitation professionals should work together to reduce the separation and divorce rates in all subjects with SCI, with special attention paid to meeting the specific needs of those with minority backgrounds.     

Longitudinal Analysis of Hospitalization After Spinal Cord Injury: Variation Based on Race and Ethnicity

Objective

To examine the longitudinal effects of race/ethnicity on hospitalization among adults with spinal cord injury (SCI) in the 10-year period after initial injury.

Design

Retrospective analysis of postinjury hospitalizations among non-Hispanic white, non-Hispanic African American, and Hispanic adults with SCI.

Setting

Community. Data were extracted from the 2011 National Spinal Cord Injury Model Systems database.

Participants

Patients with traumatic SCI (N= 5146; white, 3175; African American, 1396; Hispanic, 575) who received rehabilitation at one of the relevant SCI Model Systems.

Interventions

Not applicable.

Main Outcome Measures

Hospitalization, including rate of hospitalization, number of hospitalizations, and number of days hospitalized during the 12 months before the first-, fifth-, and tenth-year follow-up interviews for the SCI Model Systems.

Results

Significant differences were found in rates of hospitalization at 1 and 5 years postinjury, with participants from Hispanic backgrounds reporting lower rates than either whites or African Americans. At 10 years postinjury, no differences were noted in the rate of hospitalization between racial/ethnic groups; however, compared with whites (P=.011) and Hispanics (P=.051), African Americans with SCI had 13 and 16 more days of hospitalization, respectively. Compared with the first year postinjury, the rate of hospitalization declined over time among whites, African Americans, and Hispanics; however, for African Americans, the number of days hospitalized increased by 12 days (P=.036) at 10 years versus 5 years postinjury.

Conclusions

Racial/ethnic variation appears to exist in postinjury hospitalization for individuals with SCI, with Hispanics showing the lowest rates of hospitalization at 1 and 5 years postinjury and African Americans having a significantly higher number of days hospitalized at 10 years postinjury. Potential explanations for these variations are discussed, and recommendations are made for potential changes to policy and clinical care.     

Employment Trajectories After Spinal Cord Injury: Results From a 5-Year Prospective Cohort Study

Objectives

To identify different employment trajectories in individuals with spinal cord injury (SCI) after discharge from initial rehabilitation and to determine predictors of different trajectories from demographic, injury, functional, and psychological characteristics.

Design

Prospective cohort study with baseline measurement at the start of active rehabilitation, a measurement at discharge, and follow-up measurements at 1, 2, and 5 years after discharge.

Setting

Eight rehabilitation centers with SCI units in The Netherlands.

Participants

People with acute SCI (N=176), aged between 18 and 60 years at baseline, who completed at least 2 follow-up measurements.

Interventions

Not applicable.

Main Outcome Measure

Employment was defined as having paid work for ≥12h/wk.

Results

Using latent class growth mixture modeling, 3 distinct employment trajectories were identified: (1) no employment group (22.2%), that is, participants without employment pre-SCI and during 5-year follow-up; (2) low employment group (56.3%), that is, participants with pre-SCI employment and a low, slightly increasing probability of employment during 5-year follow-up; and (3) steady employment group (21.6%), that is, participants with continuous employment pre-SCI and within 5-year follow-up. Predictors of steady employment versus low employment were having secondary education (odds ratio, 4.32; 95% confidence interval, 1.69–11.02) and a higher FIM motor score (odds ratio, 1.04; 95% confidence interval, 1.01–1.06) at discharge.

Conclusions

Distinct employment trajectories after SCI were identified. More than half of the individuals with SCI had a low employment trajectory, and only one-fifth of the individuals with SCI had a steady employment trajectory. Secondary education and higher functional independence level predicted steady employment.     

Effectiveness of Supported Employment for Veterans With Spinal Cord Injury: 2-Year Results

Objective

To examine if supported employment (SE) remains more effective than treatment as usual (TAU) in returning veterans to competitive employment after spinal cord injury (SCI) at 2-year follow-up.

Design

Prospective, randomized, controlled, multisite trial of SE versus TAU with 24 months of follow-up.

Setting

SCI centers.

Participants

Subjects (N=201) were enrolled and completed baseline interviews. At interventional sites, subjects were randomized to SE (n=81) or TAU (n=76). At observational sites, 44 subjects were enrolled in a nonrandomized TAU condition.

Intervention

The intervention was a SE program called the SCI Vocational Integration Program, which followed the principles of the individual placement and support model of SE for persons with mental illness.

Main Outcome Measures

Competitive employment in the community within 2 years.

Results

For the entire 2-year follow-up period, SE subjects were significantly more likely to achieve employment (30.8%; 95% confidence interval [CI], 21.8–41.6) than either the TAU subjects at the intervention sites (10.5%; 95% CI, 5.2–19.7; P<.001) or the TAU subjects at the observational sites (2.3%; 95% CI, 0.0–12.9; P<.002). Most subjects who obtained competitive employment did so in year 1, and the average time to first employment was about 17 weeks.

Conclusions

SE was better than usual practices in improving employment outcomes for veterans with SCI across a 2-year follow-up period. Although SE continued to be superior to traditional practices over the entire study, the first year of participation in SE may represent a critical window for achieving employment after SCI.