Detecting subgroups in social participation among individuals living with spinal cord injury: a longitudinal analysis of community survey data

Functioning performance trajectory and its associated factors for people with disability-A 4-year national study

BACKGROUND

Humans experience functioning difficulties in daily life, which are dependent on the interaction between health conditions and barriers in life. In general, functioning is an umbrella term and a dynamic concept. Thus, identifying the factors associated with long-term functioning would be beneficial to the development of specific health policies and quality of life for people with disabilities. However, previous studies are mainly cross-sectional ones, and fewer studies focus on the long-term effect of changes in functioning for people with disabilities. The current study aims to examine functioning performance trajectory and the associated factors for people with disabilities.

METHODS

A longitudinal study was conducted over four years, for which data were retrieved from the National Disability Eligibility Determination System in Taiwan. The assessment methods used are as follows: activity and participation rated using the WHO Disability Assessment Schedule 2.0 (with high scores indicating increased limitations in daily life), personal factors, body function and structure, and environmental factors. Statistical analysis was conducted using latent growth curve models.

RESULTS

We recruited 3,720 people with disabilities. We found that females, people with moderate and severe disability level, and those who were employed were associated with rapid increases in functioning scores every year. Conversely, improved social participation was linked to relatively slow increases in functioning scores regardless of the type of disability (p <.05).

CONCLUSIONS

Determining the factors associated with long-term functioning can serve as a reference for the development of health policies and improvement of quality of life for people with disabilities.

Community integration after spinal cord injury rehabilitation: Predictors and causal mediators

CONTEXT/OBJECTIVE

Community integration (CI) is a crucial rehabilitation goal after spinal cord injury (SCI). There is a pressing need to enhance our understanding of the factors associated with CI for individuals with traumatic or non-traumatic etiologies, with the latter being notably understudied. Accordingly, our research explores the associations and potential mediators influencing CI across these populations.

SETTING

Specialized neurological rehabilitation center.

PARTICIPANTS

Community-dwelling individuals who were admitted as inpatients within 3 months post-injury (n = 431, 51.9% traumatic, 48.1% non-traumatic), assessed in relation to community integration within 1-3 years after discharge.

OUTCOME MEASURE

Community Integration Questionnaire (CIQ). Covariates: American Spinal Injury Association Impairment Scale (AIS), Functional Independence Measure (FIM) and Hospital Anxiety and Depression Scale (HADS).

RESULTS

Multiple linear regression yielded age, B AIS grade, educational level (< 6 years and <12 years), time since injury to admission, length of stay, HADS-depression at discharge, total FIM at discharge and three social work interventions (support in financial, legal and transportation services) as significant predictors of total CIQ score (Adjusted R2 = 41.4). Multiple logistic regression identified age, traumatic etiology, educational level (< 6 years and <12 years), length of stay, HADS depression at discharge, total FIM at discharge and one social work intervention (transportation support) as significant predictors of good community integration, AUC (95% CI): 0.82 (0.75-0.89), Sensitivity:0.76, Specificity:0.73. We identified motor FIM at discharge and motor FIM efficiency as causal mediators of total CIQ.

CONCLUSIONS

We identified modifiable factors during rehabilitation-functional independence, depression, and social work interventions-that are associated with CI.

Pain, pain interference, social and school/work functioning in youth with spinal cord injury: A mediation analysis

CONTEXT/OBJECTIVE

The objective of the present study was to investigate the effects of pain severity, pain interference and social functioning in a serial multiple mediator model predicting school/work functioning in youth with spinal cord injury (SCI) from their perspective.

DESIGN

Explanatory or mechanistic study.

SETTING

Pediatric specialty hospital.

PARTICIPANTS

125 youth with SCI ages 8-24.

OUTCOME MEASURES

The Pain Severity Item and Pain Interference Scale from the PedsQL™ Spinal Cord Injury Module, and the Social Functioning and School/Work Functioning Scales from the PedsQL™ 4.0 Generic Core Scales Short Form SF15 were completed.

RESULTS

Hierarchical multiple regression and serial multiple mediator model analyses were conducted to test the percent variability accounted for and the mediating effects of pain interference and social functioning in the association between pain severity and school/work functioning. Pain predictive effects on school/work functioning were serially mediated by pain interference and social functioning. In a predictive analytics model conducted with hierarchical multiple regression analysis, age, sex, pain, pain interference and social functioning accounted for 45% of the variance in youth-reported school/work functioning (P < 0.001), demonstrating a large effect size.

CONCLUSION

The mechanisms of the predictive effects of pain severity on school/work functioning in youth with SCI are explained in part by the serial multiple mediator effects of pain interference and social functioning. Identifying the multiple mediators of SCI pain on school/work functioning from the perspective of youth with SCI may facilitate future clinical research and practice to ameliorate impaired daily functioning and improve overall well-being.

Is Spending Nights Away From Home Associated With Participation and Life Satisfaction After Spinal Cord Injury? A Longitudinal Perspective

Background

Community reintegration after SCI rehabilitation consists of readjustment not only to the home setting but also to the social and occupational spheres, which often require people to spend nights away from home. Because community reintegration contributes to life satisfaction after SCI, it is necessary to investigate how travel participation is related to occupational and social participation and life satisfaction. Additionally, better management of the long-term effects of SCI requires better understanding of the changes in participation and life satisfaction over time.

Objectives

To examine how participation and life satisfaction change over time following SCI, and to investigate whether spending nights away from home is associated with occupational and social participation and life satisfaction over time.

Methods

This is a longitudinal analysis of data extracted from the publicly available database of Spinal Cord Model Systems from 1996 to 2016. A generalized linear mixed model was developed to examine the changes of outcome variables over time while controlling demographic variables.

Results

Travel and social participation declined while life satisfaction increased as people lived longer with SCI, controlling for confounders. No significant change was identified in occupational participation. Spending nights away from home was significantly and positively associated with social and occupational participation and life satisfaction over time. Although travel participation of people with SCI declined over time, its association with social participation strengthened as the number of postinjury years increased.

Conclusion

Travel participation plays an important role in successful community reintegration. Rehabilitation services and travel services should provide training and resources on travel after SCI for improved participation and life satisfaction.

Bladder and bowel function effects on emotional functioning in youth with spinal cord injury: a serial multiple mediator analysis

STUDY DESIGN

Preliminary explanatory or mechanistic cross-sectional study.

OBJECTIVES

This preliminary cross-sectional study investigates the hypothesized serial mediating effects of bladder/bowel worry, social worry, and social participation in the relationship between bladder function or bowel function and emotional functioning in youth with spinal cord injury (SCI) from their perspective.

METHODS

The Bladder Function, Bowel Function, Worry Bladder Bowel, Worry Social, and Social Participation Scales from the PedsQL™ Spinal Cord Injury Module and the Emotional Functioning Scale from the PedsQL™ 4.0 Generic Core Scales Short Form SF15 were completed by 127 youth with SCI ages 8-24. Serial multiple mediator model analyses were conducted to test the hypothesized sequential mediating effects of bladder/bowel worry, social worry, and social participation as intervening variables separately for the cross-sectional association between bladder function or bowel function and emotional functioning.

RESULTS

The separate cross-sectional negative association of bladder function and bowel function with emotional functioning were serially mediated by bladder/bowel worry, social worry and social participation, accounting for 28% and 31%, respectively, of the variance in youth-reported emotional functioning (p < 0.001), representing large effect sizes.

CONCLUSIONS

In this preliminary study, bladder/bowel worry, social worry, and social participation explain in part the cross-sectional negative association of bladder function and bowel function with emotional functioning in youth with SCI from the youth perspective. Identifying the hypothesized associations of bladder function and bowel function, bladder/bowel worry, social worry, and social participation with emotional functioning may help inform future clinical research and practice for youth with SCI.

Needs and Research Priorities for Young People with Spinal Cord Lesion or Spina Bifida and Their Caregivers: A National Survey in Switzerland within the PEPSCI Collaboration

The aim of this study was to describe the needs and research priorities of Swiss children/adolescents and young adults (from here, “young people”) with spinal cord injury/disorder (SCI/D) or spina bifida (SB) and their parents in the health and life domains as part of the international Pan-European Pediatric Spinal Cord Injury (PEPSCI) collaboration. Surveys included queries about the satisfaction, importance, research priorities, quality of life (QoL), and characteristics of the young people. Fifty-three surveys with corresponding parent-proxy reports were collected between April and November 2019. The self-report QoL sum scores from young people with SCI/D and SB were 77% and 73%, respectively. Parent-proxy report QoL sum scores were lower, with 70% scores for parents of young people with SCI/D and 64% scores for parents of young people with SB. “Having fun”, “relation to family members”, and “physical functioning” were found to be highly important for all young people. “Physical functioning”, “prevention of pressure injuries”, “general health”, and “bowel management” received the highest scores for research priority in at least one of the subgroups. As parents tend to underestimate the QoL of their children and young people prioritized research topics differently, both young peoples’ and caregivers’ perspectives should be included in the selection of research topics.

The presence of pain in community-dwelling South African manual wheelchair users with spinal cord injury

Background

Pain after spinal cord injury (SCI) is common and is likely to continue throughout life with varying levels of severity.

Objective

To determine the presence of pain, the sociodemographic and injury profile of community-dwelling manual wheelchair users.

Method

This quantitative correlational study used a sociodemographic and injury profile sheet and the Douleur Neuropathique 4 Questions (DN4) questionnaire to document demographic, SCI profiles as well as pain characteristics. Pain severity was determined using the Numeric Rating Scale. Data were analysed using the Statistical Package for the Social Sciences (SPSS) v27 at 0.05 level of significance.

Results

The pain rate was 104; 85% of 122 participants and mainly in those with complete SCI (77.9%). Neuropathic pain was more common (76; 62.5%) and significantly associated (p < 0.05) with higher pain severity. Pain was mainly in one area of the body (59; 48.4%) but occurring in up to five areas. The most painful area had a mean severity of 6.7/10; was more common in the lower limbs below the injury level (48; 39.4%); and was burning in nature (40; 32.7%).

Conclusions

Pain after SCI is as problematic in the South African context as it is globally. With the rising SCI prevalence in the country, understanding pain and its presentation is important for holistic management of a person with SCI.

Clinical implications

In-depth assessment of pain should be conducted and appropriate management interventions for specific pain types be prescribed to effectively reduce pain.

Identification and relationship of quality of life and self-care ability among Chinese patients with traumatic spinal cord injuries: a cross-sectional analysis

Improving the quality of life of patients with complete spinal cord injuries is an urgent objective of the Chinese Department of Health. For better management of spinal cord injuries, it is necessary to understand the background of the patients. A total of 392 patients aged ≥18 years with traumatic spinal cord injuries (≥1 year of history) were attending the rehabilitation center of the Institutes. A total of 7 (2%) patients reported low quality of life, 200 (51%) patients reported moderate quality of life, 181 (46%) patients reported good quality of life, and 4 (1%) patients reported excellent quality of life. Male patients (P=0.042), patients with college or more education (P=0.039), incomplete spinal cord injuries (P=0.045), paraplegia (P=0.046), and absence of pressure injury (P=0.047) were associated with higher quality of life. A total of 81 (21%) patients were dependent on the caregiver, 85 (22%) patients were highly dependent on the caregiver, 155 (40%) patients were moderately dependent on the caregiver, 60 (15%) patients were mildly dependent on the caregiver, and 11 (2%) patients were independent for activities of daily living. An incomplete spinal cord injury (P=0.045) and paraplegia (P=0.041) were associated with higher independence in activities of daily living of patients. The independence in activities of daily living and quality of life of the Chinese population with complete spinal cord injury and tetraplegia are poor (Level of Evidence: IV; Technical Efficacy Stage: 5).

Self-care in spinal cord injuries inventory (SC-SCII) and self-care self-efficacy scale in spinal cord injuries (SCSES-SCI): development and psychometric properties

STUDY DESIGN

Validation cross-sectional study.

OBJECTIVES

To develop and assess the psychometric properties of two instruments based on the middle-range theory of self-care in chronic illness: the Self-Care in Spinal Cord Injuries Inventory (SC-SCII) and the Self-Care Self-Efficacy Scale in Spinal Cord Injuries (SCSES-SCI).

SETTING

Multicenter study in five spinal units across Italy and Ireland.

METHODS

Instrument development was based on self-care behaviours identified in the scientific literature. Behaviours were grouped into four dimensions during a consensus conference: self-care maintenance, self-care monitoring, self-care management and self-care self-efficacy. Sixty-seven items were subsequently generated based on these dimensions. A multidisciplinary group of 40 experts evaluated content validity. Dimensionality of the final items was tested by confirmatory factor analyses (CFA) with a sample of 318 participants. Internal consistency and test-retest reliability were evaluated for each dimension. Construct validity was assessed using correlations between items and scoring differences amongst participants with more severe conditions and secondary complications.

RESULTS

Content validity of the SC-SCII and SCSES-SCI was satisfactory for thirty-five of the previously generated items, which were further refined. CFA showed comparative fit indexes ranging from 0.94 to 0.97 and root mean square errors of approximation from 0.03 to 0.07. Internal consistency ranged from 0.71 to 0.85, and intraclass correlation coefficients were higher than 0.70. Correlations among dimensions were moderate, and the theoretical hypotheses formulated when designing the instruments were largely confirmed.

CONCLUSIONS

The SC-SCII and the SCSES-SCI represent valid and reliable theoretically-grounded instruments to assess self-care in people with spinal cord injury.