Determinants of Quality of Life in Individuals With Spinal Cord Injury Using Structural Equation Modeling |
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| Institution: | 1. Department of Neurological Rehabilitation, Division of Rehabilitation, The Integrated Rehabilitation Hospital, Sheba Medical Center, Tel HaShomer;2. Sackler School of Medicine, Tel Aviv University, Tel Aviv;3. Department of Behavioral Sciences, Ariel University, Ariel;4. School of Health Professions, Ono Academic College, Kiryat Ono;5. Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana;6. Division of Rehabilitation, The Integrated Rehabilitation Hospital, Sheba Medical Center, Tel HaShomer, Israel;1. Department of Occupational Therapy, Western Michigan University, Kalamazoo, MI;2. Hennepin Healthcare System, Minneapolis, MN;3. Clinical Education, Quantum Rehab, Pride Mobility Products Corporation, Duryea, PA;4. Clinical Education, Permobil, Inc, Lebanon, TN;1. College of Health Professions, Medical University of South Carolina, Charleston, SC;2. Health Economics Resource Center, VA Palo Alto, Menlo Park, CA;3. University of Kentucky, Lexington, KY;4. Spartanburg Methodist College, Spartanburg, SC;5. Shepherd Center, Atlanta, GA;1. Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama;2. Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama;3. Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, Pennsylvania;4. School of Health Professions, University of Texas Medical Branch, Galveston, Texas;5. Department of Kinesiology and Applied Physiology, University of Delaware, Newark, Delaware;1. Division of Palliative Care and Geriatric Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA;2. Center for Aging and Serious Illness, Mongan Institute, Massachusetts General Hospital, Boston, MA;3. Department of Health Services, Policy & Practice, Brown University, School of Public Health, Providence, RI;4. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN;5. Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN;1. School of Physical and Occupational Therapy, McGill University, Montréal, Quebec;3. Clinical Epidemiology, McGill University Health Center, Montréal, Quebec;4. Institute of Health Sciences Education, McGill University, Montréal, Quebec, Canada |
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| Abstract: | ObjectiveThe objective of this study is to examine the interdependent associations between International Classification of Functioning, Disability and Health (ICF) domains and their relationship with environmental factors with regard to quality of life (QoL) in individuals with spinal cord injury (SCI).DesignSurvey, cross-sectional study, and model testing using structural equation modeling.SettingTwo inpatient and outpatient SCI rehabilitation units, Sheba Medical Center and Loewenstein Hospital, Israel.ParticipantsConvenience sample of 156 individuals with SCI (N=156).InterventionsNot applicable.Main Outcome MeasuresQoL assessed by the World Health Organization Quality of Life Assessment-BREF.Neurological impairment after SCI reflected by lesion completeness and neurologic level of injury as measured by the International Standards for Neurological Classification of Spinal Cord Injury.The Spinal Cord Independence Measure to assess SCI-related task performance.ICF Brief Core Sets composition scores to assess impairment in body structure and function domains, limitations in activities, restriction in participation constructs, and the effect of environmental factors within the ICF model.ResultsLevel of spinal cord injury and ICF Brief Core Sets composite score relating to activities and participation construct demonstrated a direct significant association with QoL. Moreover, a significant indirect association with QoL was found between the composite scores in ICF body structure and function and environmental factors, level of spinal cord injury, time since injury onset, and sex. Because the Spinal Cord Independence Measure was not related to QoL, we inferred that the categories related to instrumental activities of daily living and participation exert the most significant influence on QoL.ConclusionsIn order to optimize improvements in quality of life, current rehabilitation programs should target limitations specifically related to instrumental activities of daily living and participation restrictions. It may serve as a focal point for further development of current therapeutic models and analytical methods that optimize rehabilitation planning and decision making among both health care professionals and patients. |
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