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Health Conditions: Effect on Function,Health-Related Quality of Life,and Life Satisfaction After Traumatic Spinal Cord Injury. A Prospective Observational Registry Cohort Study
Authors:Carly S. Rivers,Nader Fallah,Vanessa K. Noonan,David G. Whitehurst,Carolyn E. Schwartz,Joel A. Finkelstein,B. Catharine Craven,Karen Ethans,Colleen O&#x  Connell,B. Catherine Truchon,Chester Ho,A. Gary Linassi,Christine Short,Eve Tsai,Brian Drew,Henry Ahn,Marcel F. Dvorak,Jér?me Paquet,Luc Noreau
Affiliation:1. Rick Hansen Institute, Vancouver, BC, Canada;2. University of British Columbia, Vancouver, BC, Canada;3. Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada;4. DeltaQuest Foundation Inc, Concord, MA;5. Sunnybrook Health Sciences Centre, Toronto, ON, Canada;6. Division of PM&R, Department of Medicine, University of Toronto, Toronto, ON, Canada;g. Department of Medicine, University of Manitoba, Winnipeg, MB, Canada;h. Physical Medicine & Rehabilitation, Faculty of Medicine, Dalhousie University, Fredericton, NB, Canada;i. Institut national d''excellence en santé et en services sociaux, Québec, QC, Canada;j. Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Calgary, AB, Canada;k. Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, SK, Canada;l. Department of Medicine, Dalhousie University, Nova Scotia Rehabilitation Centre, Halifax, NS, Canada;m. Division of Surgery, Department of Surgery, University of Ottawa, Ottawa, ON, Canada;n. Department of Orthopaedic Surgery, McMaster University, Hamilton, ON, Canada;o. Department of Surgery, University of Toronto Spine Program, Toronto, ON, Canada;p. Université Laval, Québec, QC, Canada;q. Département de réadaptation, Faculté de médecine, Université Laval, Québec, QC, Canada
Abstract:

Objective

To analyze relations among injury, demographic, and environmental factors on function, health-related quality of life (HRQoL), and life satisfaction in individuals with traumatic spinal cord injury (SCI).

Design

Prospective observational registry cohort study.

Setting

Specialized acute and rehabilitation SCI centers.

Participants

Participants (N=340) from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) who were prospectively recruited from 2004 to 2014 were included. The model cohort participants were 79.1% men, with a mean age of 41.6±17.3 years. Of the participants, 34.7% were motor/sensory complete (ASIA Impairment Scale [AIS] grade A).

Interventions

None.

Main Outcome Measures

Path analysis was used to determine relations among SCI severity (AIS grade and anatomic level [cervical/thoracolumbar]), age at injury, education, number of health conditions, functional independence (FIM motor score), HRQoL (Medical Outcomes Study 36-Item Short-Form Health Survey [Version 2] Physical Component Score [PCS] and Mental Component Score [MCS]), and life satisfaction (Life Satisfaction-11 [LiSat-11]). Model fit was assessed using recommended published indices.

Results

Goodness of fit of the model was supported by all indices, indicating the model results closely matched the RHSCIR data. Higher age, higher severity injuries, cervical injuries, and more health conditions negatively affected FIM motor score, whereas employment had a positive effect. Higher age, less education, more severe injuries (AIS grades A–C), and more health conditions negatively correlated with PCS (worse physical health). More health conditions were negatively correlated with a lower MCS (worse mental health), however were positively associated with reduced function. Being married and having higher function positively affected Lisat-11, but more health conditions had a negative effect.

Conclusions

Complex interactions and enduring effects of health conditions after SCI have a negative effect on function, HRQoL, and life satisfaction. Modeling relations among these types of concepts will inform clinicians how to positively effect outcomes after SCI (eg, development of screening tools and protocols for managing individuals with traumatic SCI who have multiple health conditions).
Keywords:Health-related  Multiple chronic conditions  Quality of life  Rehabilitation  Spinal cord injuries  AIS  ASIA Impairment Scale  BMI  body mass index  HRQoL  health-related quality of life  ICF  LiSat-11  Life Satisfaction 11  MCS  Mental Component Score  PCS  Physical Component Score  RHSCIR  Rick Hansen Spinal Cord Injury Registry  SCI  spinal cord injury  SF-36V2  Medical Outcomes Study 36-Item Short-Form Health Survey (Version 2)
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