Expectations of independence and life satisfaction among ageing spinal cord injured adults

Life satisfaction 18 months and 10 years following spinal cord injury: results from a New Zealand prospective cohort study

PURPOSE

To examine the life satisfaction outcomes after spinal cord injury (SCI) and to identify the factors associated with life satisfaction at 18 months and 10 years post-SCI in New Zealand (NZ).

METHODS

Adults (16-64 years) were recruited between 2007 and 2009 from NZ's two spinal units following first admission for SCI. Interviews at 6 months, 18 months, and 10 years post-SCI examined demographic, physical, psychosocial, economic, and environmental characteristics. Multivariable regression models were used to identify predictors of life satisfaction at each timepoint.

RESULTS

Overall, 118 people participated at 6 months, 103 at 18 months, and 63 at 10 years post-SCI. Pre-SCI, 90% of participants were satisfied with life, 67% were satisfied at 18 months, and 78% at 10 years. At 18 months post-SCI, participants who reported: never or sometimes using a wheelchair, no problems with self-care, no problems with anxiety or depression, no/lesser disability, or fewer secondary health conditions (SHCs) at 6 months post-SCI were more likely to be satisfied (p < 0.05), compared to those without these characteristics. Participants who experienced considerable disability at 6 months post-SCI were 22% less likely to be satisfied 10 years post-SCI compared to those experiencing no/lesser disability (p = 0.028).

CONCLUSIONS

A higher proportion of participants were satisfied at both 18 months and 10 years post-SCI than not satisfied. To improve the likelihood of satisfaction with life, increased focus on reducing disability and providing supports for those using wheelchairs, experiencing anxiety/depression or problems with self-care, and effects of SHCs are promising for future potential interventions.

Empirical Validity of a Generic, Preference-Based Capability Wellbeing Instrument (ICECAP-A) in the Context of Spinal Cord Injury

BACKGROUND

Assessing the validity of generic instruments across different clinical contexts is an important area of methodological research in economic evaluation and outcomes measurement.

OBJECTIVE

Our objective was to examine the empirical validity of a generic, preference-based capability wellbeing instrument (ICECAP-A) in the context of spinal cord injury.

METHODS

This study consisted of a secondary analysis of data collected using an online cross-sectional survey. The survey included questions regarding demographics, injury classifications and characteristics, secondary health conditions, quality of life and wellbeing, and functioning in activities of daily living. Analysis comprised the descriptive assessment of Spearman's rank correlations between item-/dimension-level data for the ICECAP-A and four preference-based health-related quality of life (HRQoL) instruments, and discriminant and convergent validity approaches to examine 21 evidence-informed or theoretically derived constructs. Constructs were defined using participant and injury characteristics and responses to a range of health, wellbeing and functioning outcomes.

RESULTS

Three hundred sixty-four individuals completed the survey. Mean index score for the ICECAP-A was 0.761; 12 (3%) individuals reported full capability (upper anchor; score = 1), and there were no reports of zero capabilities (lower anchor; score = 0). The strongest correlations were dominated by items and dimensions on the comparator (HRQoL) instruments that are non-health aspects of quality of life, such as happiness and control over one's life (including self-care). Of 21 hypothesised constructs, 19 were confirmed in statistical tests, the exceptions being the exploratory hypotheses regarding education and age at injury.

CONCLUSION

The ICECAP-A is an empirically valid outcome measure for assessing capability wellbeing in people with spinal cord injury living in a community setting. The extent to which the ICECAP-A provides complementary information to preference-based HRQoL instruments is dependent on the comparator.

"Earth angels" and parking spots: qualitative perspectives on healthy aging with spinal cord injury

PURPOSE

People aging with spinal cord injury (SCI) can experience the premature onset of comorbid conditions, as well as the development and progression of secondary health conditions. The aim of this study was to understand the subjective experiences of persons aging with SCI in relation to their surrounding social and physical environments, including the impact of barriers and facilitators.Material/Methods: Eleven individuals who had an SCI for more than ten years and were 45 years or older participated in a semi-structured phone interview about their experiences with healthy aging, social participation, social supports, and community barriers.

RESULTS

Four main themes emerged in the qualitative data that captured the subjective experience of aging with SCI. These were: (1) Maintaining Physical Independence; (2) Importance of Resources and Special Equipment; (3) Planning Ahead; and (4) Finding Ways to Adapt.

CONCLUSIONS

The findings from this study highlight the importance of looking beyond individual factors to consider the social and environmental factors that support continued independence and participation in society as people living with long term SCI experience their aging process. Qualitative research that delves further into the dynamics behind this process is needed to fully anticipate the needs of this growing population.IMPLICATIONS FOR REHABILITATIONPeople aging with spinal cord injury (SCI) who are engaged in their social and physical environments have become increasingly adaptive when faced with accelerating and secondary comorbidities.Programs and facilities should ensure universal access to prevention and self-management programs that target physical activity and health habits when considered in the context of a patient's socio-environmental constraints and resources.Clinical healthcare providers need to engage with their patients to develop an early intervention approach to preserve functional capacity while navigating potential future health problems.Clinicians should act as advocates for ongoing policy changes that help promote an environment more inclusive towards people aging with SCI.

Naturalistic Assessment using a Simulated Environment: Cognitive Correlates and Relationship to Functional Status in Individuals with Neurologic Conditions

Objective

Research has shown that neurologic conditions, such as traumatic brain injury and multiple sclerosis, result in a number of cognitive and functional deficits. However, little is known about the relationship between various cognitive domains and ability to perform everyday activities. The Community Shopping Task (CST), a naturalistic assessment task conducted in a simulated environment, was used to examine functional abilities and cognitive correlates of everyday functioning in individuals with neurologic conditions.

Method

Thirty-four participants with neurologic conditions and 34 healthy controls completed the CST as well as traditional paper-pencil measures of cognition. In addition, all participants completed a questionnaire assessing instrumental activities of daily living (IADLs).

Results

The results indicated that participants with neurologic conditions required significantly more cues and time to complete the CST compared to control participants and that immediate memory and executive functioning were important predictors of CST performance. Furthermore, time to complete the CST accounted for a significant amount of variance in IADL performance, over and beyond the traditional measures of cognition.

Conclusions

These results provide evidence that a naturalistic task completed in an everyday environment can enhance our understanding of how daily functioning is impacted in individuals with neurologic conditions and subsequently inform rehabilitation strategies.

Returning to Work After the Onset of Illness

Experiences of right hemisphere stroke survivors in their attempts to return to work after the onset of stroke were explored through an interdisciplinary qualitative investigation. Key findings indicate that (a) participants experienced an array of functional limitations that precipitated employment changes; (b) employment changes had a substantial psychosocial impact on both the stroke survivor and the primary caregiver; and (c) successful integration into employment was associated with both internal resources (e.g., patience, determination, sense of humor) and external resources (e.g., emotional support and encouragement from caregivers, family, and friends; emotional and instrumental support from healthcare professionals; employer willingness to provide reasonable accommodations). The findings support the use of an ecological approach to facilitate successful return to work for this population.

Paraplegia from Spinal Cord Injury: Self-Esteem, Loneliness, and Life Satisfaction

With advances in health care sciences, people with spinal cord injuries can now live to old age. Rehabilitation of the disabled is a dynamic process and should include not only attaining maximum function, but also receiving satisfaction with life in one's environment. Life satisfaction is thought to be the subjective part of quality of life, i.e., the feelings of the persons concerned about their functioning and circumstances. However, these feelings are influenced by self-esteem, the positive or negative attitude toward oneself, as well as life satisfaction and the effect of loneliness on self-esteem. Forty community-living adults with paraplegia from spinal cord injury from the metropolitan area of Athens responded to the Rosenberg's Self-Esteem Scale, the Revised UCLA Loneliness Scale, and the Life Satisfaction Index. As expected, statistically significant correlations were obtained among self-esteem, life satisfaction, and loneliness. More specifically, the higher an individual's self-esteem: a) the higher the life satisfaction and b) the lower the feelings of loneliness experienced. Furthermore, there was a statistically negative relationship between loneliness and life satisfaction. Community mobility, architectural adaptations, and social support, as it is reflected through marital status and frequency of received visits, proved to be important factors in understanding loneliness, self-esteem, and life satisfaction. Implications for rehabilitation of individuals with spinal cord injuries are discussed.

Household income and subjective well-being after spinal cord injury: a longitudinal study

BACKGROUND

Studies regarding subjective well-being (SWB) after spinal cord injury (SCI) are increasing in recent years, but little has been contributed to the relationship between income and SWB.

OBJECTIVE

By using longitudinal data, we want to identify (1) the overall trend in SWB over a 10-year period; (2) the association between household income and SWB at baseline; (3) the variation of the trajectory of SWB over 10 years among different household income groups; and (4) the variation of change rates of SWB over 10 years among different household income groups.

METHODS

We conducted a cohort study, including 434 participants who completed 3 measurements in 1998, 2003, and 2008. They were identified from outpatient records of 2 midwestern hospitals and a southeastern specialty hospital.

RESULTS

People with lower household income experienced more life problems and less life satisfaction at the baseline measurement. During the 10-year period, their health problems and environmental barriers significantly increased compared to persons with higher income. Increasing vocational satisfaction was the only favorable change for the lower income group.

CONCLUSIONS

There were consistent disparities in SWB related to income, and these typically persisted over time. Therefore, with the exception of vocational satisfaction, few changes may be anticipated in SWB that would narrow the gap between high and low income.

Recovery of life satisfaction in persons with spinal cord injury during inpatient rehabilitation

OBJECTIVE

To determine the course of life satisfaction of persons with spinal cord injury and its determinants during inpatient rehabilitation and up to 1 yr after discharge.

DESIGN

Prospective cohort study of 222 persons with spinal cord injury. Measurements at the start of active rehabilitation, after 3 mos, at discharge, and 1 yr after discharge. Questions about current life satisfaction and current life satisfaction compared with life satisfaction before spinal cord injury were asked and analyzed, and the sum score Life Satisfaction Total of these questions was analyzed using a multilevel regression analysis. Person and injury characteristics and secondary impairments at each measurement were analyzed as possible determinants of the Life Satisfaction Total score.

RESULTS

Estimated Life Satisfaction Total scores improved from 5.3 (SE, 0.16) at the start of active rehabilitation up to 6.5 (0.17) at discharge and remained stable (6.5; 0.16) during the first year after discharge. Significant determinants of a positive course of life satisfaction were less pain, fewer secondary impairments, and better functional status.

CONCLUSIONS

Life satisfaction already improves during inpatient rehabilitation. Functional status, pain, and secondary impairments must be treated adequately in multidisciplinary rehabilitation.

Psychometric validation of a subjective well-being measure for people with spinal cord injuries

PURPOSE

The researchers examined the factorial validity and the concurrent validity of the Sense of Well-Being Inventory (SWBI) based on a sample of Canadians with spinal cord injuries (SCI) in the community.

METHOD

One hundred thirty-two participants were recruited from the Alberta, Saskatchewan, Nova Scotia, and Manitoba chapters of the Canadian Paraplegic Association. Mean age of participants was 45.82 years (SD=15.67), and 77% were men. The participants were asked to complete a research packet containing a demographic questionnaire, the SWBI, and the brief version of the World Health Organization Quality of Life questionnaire (WHOQOL-BREF).

RESULTS

Factor analysis yield four factors (Psychological Well-Being, Financial Well-Being, Social and Family Well-Being, and Physical Well-Being) similar to the original SWBI. In addition, the SWBI factors in the present study correlated moderately well with the corresponding factors in the WHOQOL-BREF and with demographic variables appropriate to the respective subscale.

CONCLUSIONS

The factorial validity and the concurrent validity of the SWBI were generally supported. The SWBI, as a subjective well-being measure developed specifically to relate to disability and rehabilitation, appears useful for use with people with SCI in the community.

Differences in Affect, Life Satisfaction, and Depression Between Successfully and Unsuccessfully Rehabilitated Persons With Spinal Cord Injuries

This study assessed whether persons with spinal cord injuries who were successfully rehabilitated differed from those who were not with regard to positive and negative affect, life satisfaction, and depression. An ex post facto research design compared persons with spinal cord injuries who were previously employed with persons with spinal cord injuries who were not employed after receiving services from a southeastern state Division of Vocational Rehabilitation Services program. There were no significant differences between the two groups based on age, gender, race, current level of education, and time employed prior to their injury.The unsuccessfully rehabilitated had lower positive affect and higher negative affect, were less satisfied with life and more depressed, and had a higher percentage of cervical and lumbar injuries than the successfully rehabilitated. Positive psychotherapy techniques are recommended to see if they can decrease depression and improve satisfaction with life and positive affect, while decreasing negative affect.

Changes and determinants of life satisfaction after spinal cord injury: a cohort study in the Netherlands

OBJECTIVE

To determine the impact of spinal cord injury (SCI) on life satisfaction of persons with SCI 1 year after discharge of inpatient rehabilitation.

DESIGN

A cohort study. Life satisfaction before SCI was retrospectively measured at the start of active rehabilitation. One year after discharge from inpatient rehabilitation, current life satisfaction was measured.

SETTING

Eight rehabilitation centers in The Netherlands.

PARTICIPANTS

Persons (N=147) aged 18 to 65 and wheelchair-dependent at least for long distances.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

The Life Satisfaction Questionnaire.

RESULTS

Mean satisfaction with life +/- SD as a whole was 5.3+/-0 before SCI and 4.3+/-1.3 one year after inpatient rehabilitation. Sexual life, self-care, and vocational situation showed the largest impact of SCI (P<.05), whereas the social relationships domains appeared to be the least affected. Decrease of life satisfaction after SCI was larger when using the retrospective ratings than when using general population scores. Significant determinants of life satisfaction after SCI were high lesion level (beta=.31, P<.05), pain (beta=.19, P<.05), and secondary impairments (beta=.22, P<.05).

CONCLUSIONS

Life satisfaction decreased in persons with SCI. Level of lesion and suffering secondary impairments or pain were associated with low life satisfaction 1 year after discharge from inpatient rehabilitation.

Confirmatory Factor Analysis of the World Health Organization Quality of Life Questionnaire—Brief Version for Individuals With Spinal Cord Injury

This study examined the factorial structure of the World Health Organization Quality of Life Questionnaire—Brief Version in a community sample of Canadians with spinal cord injuries. A confirmatory factor analysis provides evidence that the instrument is a multidimensional measure of quality of life. Additionally, the questionnaire is correlated in the predicted directions with education, income, time since injury, self-esteem, and acceptance of disability. Implications of its use in rehabilitation counseling practice and research are discussed.

Predicting life satisfaction after spinal cord injury in a Canadian sample

STUDY DESIGN

Cross-sectional, survey.

OBJECTIVES

To extend current theoretical models predicting life satisfaction post-spinal cord injury (SCI). Our primary model predicting life satisfaction as measured by the Satisfaction with Life Scale (SWLS) examined demographic characteristics, elements of the International Classification of Functioning and subjective and objective measures of health. A second model was developed to examine factors that are associated with successful community participation as measured by the Reintegration to Normal Living Index (RNL). In addition, the effects of psychological distress and chronic pain on life satisfaction and community participation were examined.

SETTING

Toronto Rehabilitation Institute, Spinal Cord Rehabilitation Program, Lyndhurst Centre.

METHODS

Prospective data collection via semi-structured telephone interview on an established SCI Canadian sample.

RESULTS

In predicting life satisfaction, our model accounted for 35.3% of the variance with demographic characteristics, objective and subjective health, and community participation significantly contributing to the model. In particular, psychological complications, current health rating and community participation were the only variables that made significant contributions in predicting life satisfaction. With regards to community participation, the presence of psychological complications and number of medical complications were associated with decreased reintegration. Increased time since injury onset, higher health ratings and being employed were positively related to RNL.

CONCLUSION

It would appear that factors involving functional decline and aging are associated with lower participation but not life satisfaction. Further, models predicting quality of life should incorporate measures of psychological functioning.

Evaluation of an occupational therapy program for patients with spinal cord injury

STUDY DESIGN

Clinical controlled trial.

OBJECTIVES

To evaluate the effectiveness of an occupational therapy (OT) program combined with neuromotor rehabilitation, by assessing the degree of functional independence reached by patients with spinal cord injuries at first hospitalization.

SETTINGS

Subjects selected from the Spinal Cord Unit of the Rehabilitation Institute of Montecatone (Imola, Italy).

PARTICIPANTS

Thirty-six male patients below age 60, with complete paraplegia (ASIA-A) in thoracic-lumbar level, at first hospitalization.

METHODS

Patients were divided into experimental and control groups. Subjects in the experimental group underwent neuromotor rehabilitation coupled with an OT program, whereas those in the control group followed neuromotor rehabilitation only. Increase in functional independence at discharge was evaluated by the Valutazione Funzionale Mielolesi (VFM) assessment scale.

RESULTS

Patients in the experimental group showed a significant increase in the total VFM score, and in domains concerning transfers and wheelchair use. A significant improvement was observed in unmarried patients as compared to married ones.

CONCLUSION

An OT service within a Spinal Cord Unit allows us to achieve a higher level of functional independence.

Impact of the timing, type and severity of disability on the subjective well-being of individuals with disabilities

Despite the existence of a large volume of literature on subjective well-being (SWB) of the general population, very few studies have focused on individuals with disabilities. The present study uses data on 24,036 Canadians with disabilities to investigate factors affecting their SWB. It found that SWB, measured here by level of happiness, decreases with severity of disability but is independent of the type of physical disability. Those born with a disability are likely to be happier as compared to those disabled later on in life. Per capita family income has no effect on happiness. However, unemployment decreases happiness. Happiness is found to be U shaped in age, bottoming out around 40 years of age. Some of these results vary when the sample is split according to the timing, type or severity of disability.

Aging with a spinal cord injury: factors associated with the need for more help with activities of daily living

OBJECTIVES

To determine (1) the frequency of the need for more help with activities of daily living (ADLs), (2) the frequency of medical complications, and (3) the association between medical, injury-related, and sociodemographic factors and the need for more help with ADLs among those aging with spinal cord injury (SCI).

DESIGN

Cross-sectional survey.

SETTING

General community, international.

PARTICIPANTS

Volunteers (N=352) with SCI for more than 20 years.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

The need for more help with ADLs.

RESULTS

The need for more help with ADLs during the last 3 years was reported by 32.1% of participants. At least 1 medical complication was reported by 85%. Constipation (47.9%), diarrhea/bowel accidents (41.8%), and pressure ulcers (38.7%) were common. Constipation, pressure ulcers, female gender, and years postinjury were associated with needing more help with ADLs. Constipation and pressure ulcers were associated with a 97% and a 76% increase, respectively, in the likelihood of needing more help with ADLs during a 3-year time period. Female gender was associated with a 96% increased odds of needing more help with ADLs. There was a 42% increased odds of needing more help with ADLs per decade after SCI.

CONCLUSIONS

People aging with SCI are vulnerable to medical complications, and additional help is required to function. Knowledge of the effect of these factors, particularly the tetrad of constipation, pressure ulcers, female gender, and number of years postinjury, should increase awareness that more help with ADLs may be needed over time.

Exploring quality of life following high spinal cord injury: a review and critique

STUDY DESIGN

Review.

OBJECTIVES

To explore the concept of quality of life (QOL), critique the practice and problems of assessing QOL following spinal cord injury (SCI) and to review the findings of studies into QOL for people with SCI both below and above the level of C4.

METHODS

Relevant articles were identified from the Medline and CINAHL databases for approximately the period 1990-2003, cross-indexing 'spinal cord injury' or 'quadriplegia/tetraplegia' with 'quality of life', 'life satisfaction', 'social adjustment' or 'psychological adaptation'. This search was augmented through papers identified in reference lists. Articles were excluded if they were designed solely to examine the impact of a specific intervention upon QOL; or if they examined satisfaction with various life domains without explicitly linking these to perceptions of QOL. Papers were also accessed that addressed the philosophical and epistemological issues involved in QOL conceptions and assessment.

RESULTS

Review of the literature highlights the philosophical and methodological difficulties associated with the quantitative measurement of a qualitative experience; and with the assessment of life domains chosen by researchers. Analysis of QOL research undertaken among people with all levels of SCI demonstrates that dissatisfaction with life following injury arises primarily from social disadvantage. However, little research has been conducted specifically to ascertain perceptions of QOL among people with high SCI.

CONCLUSIONS

Ensuring the relevance of future research into QOL following high SCI requires qualitative methodology and mixed methods. Further research is needed to determine how rehabilitation professionals can act on the findings of their QOL assessments and enhance the QOL experienced by people with spinal cord injury in the context of their environments.

SPONSORSHIP

The early phase of this study was supported by: University of British Columbia Graduate Fellowship; Rick Hansen Man in Motion Foundation (studentship); Social Sciences and Humanities Research Council of Canada: doctoral fellowship.

Vieillissement chez les blessés médullaires

OBJECTIVE

Literature review of the data on aging with spinal cord injury.

METHOD

Interrogation on Medline using the following keywords: aging, spinal cord injuries, paraplegia, quadriplegia, mortality, morbidity, quality of life, survival, health status.

RESULTS

The expectation of life of the spinal cord injury patients improved even though it remains even lower than that of the general population. The effects of aging add to the specific complications which are numerous and alter almost every function. Respiratory complications became the first cause of death especially for tetraplegics. Urinary and cutaneous complications remain important as well as osteo-articular pathologies (particular upper limbs) whose consequences can be serious on the functional capacities. Studies on the quality of life show that adaptation to the handicap is done in a continuous way and a long time after the initial phase of rehabilitation. They underline the importance of professional resources, psychological reactions and previous experiences of the spinal cord injury patients in appreciating the quality of life after the traumatism.

CONCLUSION

The specificities of the aging of the spinal cord injury patients require to be well known and underline the importance and the necessity of an adequate and specific follow-up. On a more general plan, they imply a reflection on the strategies of initial rehabilitation, not to compromise the future of these spinal cord injury patients.

Death anxiety as a predictor of future time orientation among individuals with spinal cord injuries

PURPOSE

The purpose of this study was to examine the relationship between death anxiety and future time orientation among individuals who sustained spinal cord injuries (SCI).

METHODS

Participants were 317 individuals with SCI, of whom 57.4% were US veterans. Data were obtained by means of mailed questionnaires and included responses to the Death Anxiety Scale (DAS), the Future Time Orientation (FTOS) measure, as well as information on participants' personal and disability-related characteristics.

RESULTS

A hierarchical multiple regression analysis was conducted to examine the influence of a set of demographic variables, followed by a set of disability-related variables, and finally two factorially-derived measures of death anxiety (denial of death and distressed awareness of death) on future time orientation. Two disability-related variables (pain level and existence of pressure ulcers) and one of the two death anxiety measures (distressed awareness of death) significantly predicted future time orientation. A post-hoc analysis, adding depression as a predictor, was also significant, indicating that an increased level of depression uniquely contributed to a truncated future time orientation.

CONCLUSIONS

Distressed anxiety and depression may be important factors affecting goals and plans of people with SCI. Future research should attempt to clarify the intricate relationships among negative affectivity, future time orientation, and psychosocial adaptation to SCI.

Quality of life issues in individuals with spinal cord injury

Assessments of quality of life (QOL) are increasingly used in rehabilitation, embracing a number of conceptual approaches and measurement tools. Very few studies on QOL have addressed the specific needs of persons with spinal cord injury (SCI). Literature reviewed here describes 2 meta-analytical studies on SCI as well as several individual studies that focus on predictors and correlates of QOL applied to SCI. Results from a unique study on QOL after SCI using a qualitative methodology are also discussed. In addition, we describe the findings from another study, which used the Medical Outcomes Study 12-Item Short-Form Health Survey to assess QOL and relate it to the concept of being disabled.

Women with spinal cord injury and the impact of aging

OBJECTIVES

The objectives of this study were to describe what women with longstanding spinal cord injury (SCI) feel they are experiencing as they age, how they are coping and what they require in order to ensure their continued social and economic participation in society. STUDY DESIGN, METHODS AND SETTING: :A naturalistic approach was taken, incorporating three focus groups (n=10) and key informant interviews (n=19) of women with SCI ranging in age from 31 to 70 years and living in rural and urban communities in Ontario, Canada.

RESULTS

The women feel isolated and sense many of their key concerns are ignored or dismissed by health care and service providers. The common physical changes and concerns were gynecological/sexual and bowel and bladder issues. Socio-emotional changes with age included impact of their age-related changes on important relationships and re-evaluation of personal priorities. They articulated worries including declining health, increasing dependency and financial stresses. Additional resources they need to age successfully include improved environmental accessibility, assistive devices, more flexible and responsive attendant and household support, access to recreation and fitness opportunities and peer and psychological support.

CONCLUSIONS

Many of the issues raised by the women were consistent with the authors' previous examination of aging in men with SCI and women with disabilities. The most striking difference was their profound sense of isolation and perceptions that health care and service providers were unprepared or unwilling to address the unique issues they face as women living and now aging with SCI.

Predictors of life satisfaction: a spinal cord injury cohort study

OBJECTIVE

To determine unique demographic, medical, perceived health, and handicap predictors of life satisfaction 2 years after spinal cord injury (SCI), as well as the predictors of change in life satisfaction from year 1 to year 2.

DESIGN

Prospective predictive study performed by using longitudinal data from 18 Spinal Cord Injury Model Systems.

SETTING

University physical medicine and rehabilitation department.

PARTICIPANTS

Adults with traumatic onset SCI (N = 940) evaluated at 1 and 2 years' postinjury.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Satisfaction with Life Scale (SWLS) 2 years post-SCI.

PREDICTOR VARIABLES

demographic characteristics, impairment and disability classifications, and 1 year post-SCI measures of life satisfaction (SWLS), medical complications, self-perceived health (Medical Outcomes Study 12-Item Short-Form Health Survey), and extent of handicap (Craig Handicap Assessment and Reporting Technique).

RESULTS

The factors uniquely associated with an increased risk of lower self-reported life satisfaction at year 2 post-SCI included being male and unemployed, with poor perceived health, decreased mobility, and decreased social integration. After controlling for year 1 estimates of life satisfaction (ie, examining change in life satisfaction), only mobility and perceived health were uniquely related to life satisfaction 2 years post-SCI.

CONCLUSION

Mobility and perceived health appear to be the consistent predictors of life satisfaction at year 2 post-SCI, as well as change in satisfaction from year 1 to year 2. Because both factors are amenable to change, they are reasonable targets of intervention programs. Identifying specific mechanisms of perceived health and mobility associated with life satisfaction should be an important area of continued research.

Functional ability, perceived exertion and employment of the individuals with spinal cord lesion in Taiwan

STUDY DESIGN

A survey on functional ability, perceived exertion, and employment was mailed to 190 individuals with spinal cord lesion. Analysis is based on the 91 completed replies.

OBJECTIVES

To establish a database of individuals with spinal cord lesions and to assess the effectiveness of training programs designed to improve life quality and employment chances among the individuals with spinal cord lesion.

SETTINGS

Subjects selected from the Spinal Cord Injury Association of the Republic of China (SCIAROC) and from the Asylum Center Spinal Cord Injury (ASCCI) in Taiwan.

METHODS

Information was obtained from a survey sent to the subjects who are chosen randomly from the SCIAROC and from all the subjects through ACSCI training program.

RESULTS

Respondents in ACSCI had a higher functional activity level and lower perceived exertion during activities than those in SCIAROC. The employment status is related to the functional independence and level of injury.

CONCLUSION

The database provides information on functional and employment status of individuals with spinal cord lesion. The present study also demonstrates the efficacy of a vocational training program for individuals with spinal cord lesion in Taiwan.

Chronic pain after spinal injury: interference with sleep and daily activities

OBJECTIVES

To determine how chronic pain after spinal cord injury (SCI) interfered with sleep, exercise, work, household chores, and other daily activities and to define which clinical aspects of pain and psychosocial factors best predicted the extent of interference.

DESIGN

Postal survey; follow-up to a previous survey conducted 6 months earlier.

SETTING

General community.

PARTICIPANTS

Individuals (n = 217) with traumatic SCI and chronic pain.

INTERVENTION

Subjects answered questions regarding frequency of interference caused by pain on 5 activities: sleep, work, exercise, household chores, and other daily activities. Asked to self-report sadness, fatigue, or anxiety; and to describe location, quality, and intensity of pain.

MAIN OUTCOME MEASURES

Demographic data (gender, age, level of injury); sociodemographic data (education, employment); self-reported psychosocial outlook; clinical characteristics of pain: location (drawing), quality (descriptors), and intensity (2 numeric rating scales). Regression analysis.

RESULTS

The questionnaire was returned by 65.8% of the sample (217/330). A large number of the participants (77.3%) reported frequent interference caused by pain, ie, "often" to "always" in 1 or more of the 5 activities. The combination of high pain intensity and the use of multiple pain descriptors was significantly associated with frequent interference with falling asleep. Frequent sleep interruption was significantly associated with high pain intensity, male gender, anxiety, and higher age at time of injury. In working individuals, frequent interference due to pain was significantly associated with multiple pain descriptors, anxiety, low level of education, and being older at time of injury.

CONCLUSION

Reported extent of pain interference in various areas of activity is related to clinical symptoms of pain as well as to psychologic and psychosocial factors rather than level of injury. The relationship between frequent interference, pain intensity, and multiple descriptors indicate that individuals experiencing several types of pain of high intensity are more likely than others to experience frequent interference with a variety of daily activities including sleep.

Expectations of health, independence, and quality of life among aging spinal cord-injured adults

While our understanding of aging and mortality in spinal cord injury is evolving, precise estimates are still not available to assist people with spinal cord injuries in knowing what to expect as they grow older. The work of a number of authors suggests that the life expectancy of those with spinal cord injuries is improving. However, little is known about the conditions in which individuals may expect to spend their remaining years of life. This study used information from a 50-year database on spinal cord injury, in combination with national mortality statistics and new survey information, to estimate the number of remaining years that individuals could expect to spend in a variety of states of health, independence, and quality of life. The study showed that expectations of health are similar to those found in the general population. Regardless of total life expectancy, individuals could expect to spend about six of their remaining years in poor health, presumably near the end of life. Expectations of independence varied depending on lesion level. Those with paraplegia became less independent over time, moving from complete to modified independence. Those with quadriplegia appeared to have a greater expectation of independence over time; however, in actuality, only those who were most independent survived to report outcomes at older ages. Expectations of quality of life remained high until the fifth decade postinjury.