Multi-Level Factors Associated with Social Participation among Stroke Survivors: China's Health and Retirement Longitudinal Study (2011-2015)

Longitudinal relationship between social participation, depressive symptoms, and activity impairment among older patients with arthritis: a moderated mediation analysis

BACKGROUND

Arthritis primarily affects older people and is a prominent cause of their activity impairment. This study aimed to examine the mediating role of depressive symptoms in the relationship between social participation and activity impairment, as well as to determine whether sex moderated the mediating effect.

METHODS

A total of 2247 older patients with arthritis were included from the China Health and Retirement Longitudinal Study between 2015 and 2018. We first examined a simple mediation model where depressive symptoms were a mediator between social participation and activity impairment. Furthermore, sex was systematically integrated into the model as a moderator. The mediation model and moderated mediation model were analyzed using PROCESS macro.

RESULTS

Mediation analysis revealed that the association between social participation and activity impairment was partially mediated by depressive symptoms (B = -0.10, 95% CI = [-0.14, -0.06]) with intermediary effect of 28.6%. Moderated mediation analysis indicated that mediation model was moderated by sex. The indirect effect of social participation on activity impairment among female patients (B = -0.15, 95% CI = [-0.21, -0.09]) was stronger than male patients (B = -0.04, 95% CI = [-0.09, -0.01]).

CONCLUSION

Social participation was the key protective factor associated with depressive symptoms and activity impairment among arthritis patients. Encouraging arthritis patients to social participation and improving the depressive symptoms might avoid activity impairment, especially for female patients.

A predictive model for social participation of middle-aged and older adult stroke survivors: the China Health and Retirement Longitudinal Study

Objective

This study aims to develop and validate a prediction model for evaluating the social participation in the community middle-aged and older adult stroke survivors.

Methods

The predictive model is based on data from the China Health and Retirement Longitudinal Study (CHARLS), which focused on individuals aged 45 years or older. The study utilized subjects from the CHARLS 2015 and 2018 wave, eighteen factors including socio-demographic variables, behavioral and health status, mental health parameters, were analyzed in this study. To ensure the reliability of the model, the study cohort was randomly split into a training set (70%) and a validation set (30%). The Least Absolute Shrinkage and Selection Operator (LASSO) regression analysis was used to identify the most effective predictors of the model through a 10-fold cross-validation. The logistic regression model was employed to investigate the factors associated with social participation in stroke patients. A nomogram was constructed to develop a prediction model. Calibration curves were used to assess the accuracy of the nomogram model. The model's performance was evaluated using the area under the curve (AUC) and decision curve analysis (DCA).

Result

A total of 1,239 subjects with stroke from the CHARLS database collected in 2013 and 2015 wave were eligible in the final analysis. Out of these, 539 (43.5%) subjects had social participation. The model considered nineteen factors, the LASSO regression selected eleven factors, including age, gender, residence type, education level, pension, insurance, financial dependence, physical function (PF), self-reported healthy,cognition and satisfaction in the prediction model. These factors were used to construct the nomogram model, which showed a certain extent good concordance and accuracy. The AUC values of training and internal validation sets were 0.669 (95%CI 0.631-0.707) and 0.635 (95% CI 0.573-0.698), respectively. Hosmer-Lemeshow test values were p = 0.588 and p = 0.563. Calibration curves showed agreement between the nomogram model and actual observations. ROC and DCA indicated that the nomogram had predictive performance.

Conclusion

The nomogram constructed in this study can be used to evaluate the probability of social participation in middle-aged individuals and identify those who may have low social participation after experiencing a stroke.

The factors associated with the deterioration of activities of daily life in stroke patients: A retrospective cohort study

BACKGROUND

The activities of daily life (ADL) of stroke patients generally improves after rehabilitation. However, some patients remain at risk of ADL deterioration in the future. So far, there have been few studies on the factors related to ADL deterioration in stroke patients.

OBJECTIVE

To identify the factors related to ADL deterioration in stroke patients with independent mobility after discharge.

METHODS

We assessed 336 stroke patients with independent mobility who were discharged from the rehabilitation center between January 2016 and December 2018. The primary outcome was ADL deterioration, defined as that ADL assessed at 2 years after discharge decreased more than 15 points compared with that assessed at discharge. Univariate and multivariate statistical analyses were conducted to screen for factors related to ADL deterioration.

RESULTS

Overall, 62 (18.4%) patients exhibited ADL deterioration at 2 years after discharge.Age (OR = 1.114, 95%CI = 1.045-1.188, p = 0.001), vascular risk factors>3 (OR = 3.269, 95%CI = 1.189-8.986, p = 0.022) and with post-stroke depression (OR = 2.486, 95%CI = 1.011-6.114, p = 0.047) were risk factors for ADL deterioration in stroke patients. In contrast, elevated Berg Balance Scale (BBS) scores at discharge was a protective factor for ADL deterioration (OR = 0.484, 95%CI = 0.386-0.606, p < 0.001).

CONCLUSIONS

Nearly 1 in 5 stroke patients with independent mobility experienced ADL deterioration at 2 years after discharge. Aging, vascular risk factors>3, BBS at discharge, and post-stroke depression (PSD) were identified as factors associated with ADL deterioration.

Effects of multicomponent exercise on quality of life, depression and anxiety among stroke survivors: A systematic review and meta-analysis

BACKGROUND

Current guidelines stress the importance of exercise, especially multicomponent exercise to older adults with chronic conditions.

AIM

To critically synthesise evidence that evaluates the effects of multicomponent exercise on quality of life, depression and anxiety after stroke.

DESIGN

Systematic review and meta-analysis followed the PRISMA 2020 statement.

METHODS

A systematic search of PubMed, Embase, Web of Science, Cochrane Library, CINAHL and PsycINFO from inception to 12 June 2023 was performed. Risk of bias was assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2). Meta-analyses were conducted using Review Manager 5.4 and narrative syntheses were adopted whenever meta-analysis was inappropriate. The overall certainty of the evidence was rated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.

RESULTS

Of 15,351 records identified, nine were eligible and data were available for seven randomised controlled trials, three of which were identified as having a high risk of bias, one as low risk, and five as having some concerns. Subgroup pooled analyses indicated that multicomponent exercise engaged in longer exercise sessions (>60 min) was effective in improving quality of life immediately post-intervention and through 3-6 months post-intervention. However, multicomponent exercise did not significantly affect depression and anxiety.

CONCLUSIONS

Multicomponent exercise with longer duration of exercise sessions has promising effects on both short- to medium-term quality of life among stroke survivors.

PATIENT OR PUBLIC CONTRIBUTION

This does not apply to our work as it is a review paper.

RELEVANCE TO CLINICAL PRACTICE

Healthcare providers could consider encouraging the patients to participate in multicomponent exercise sessions for more than 60 min. It is important to note that stroke survivors should be supervised by trained personnel at the beginning of the training.

REGISTRATION

The protocol was registered on PROSPERO.

Life satisfaction and its influencing factors for bedridden patients with stroke

OBJECTIVES

This study aimed to evaluate the life satisfaction of bedridden patients with stroke and explore its relationship with demographic, social, and medical factors.

MATERIAL AND METHODS

This multicenter cross-sectional study was conducted in two steps. The Longshi scale was used to select the study population and assess patients' ability to perform activities of daily living. Subsequently, a multidimensional questionnaire was used to obtain the participants' information and evaluate their level of life satisfaction. The chi-squared test and binary logistic regression methods were employed to analyze the factors influencing the life satisfaction of bedridden patients with stroke.

RESULTS

A total of 3,639 bedridden patients with stroke were included in this study, of them, only 27.2% reported satisfaction with their current lives. Factors associated with higher life satisfaction include female sex, older age, and primary school education or lower (P<0.05). Patients who had experienced a single stroke episode had chronic diseases, and rated their health as good were more satisfied with their lives than those who did not. The results of the binary logistic regression confirmed that age, education, religion, household income, cohabitation, social participation, number of chronic diseases, self-rated health status, and disability level significantly influenced the life satisfaction of bedridden patients with stroke (P<0.05).

CONCLUSION

Our study showed that the overall life satisfaction of bedridden patients with stroke was low, with several factors influencing their life satisfaction. Therefore, effective measures should be implemented to improve life satisfaction and quality of life.

Childhood abuse and association with adult depressive symptoms among people with cardiovascular disease

Background

To study the association between the total/different types of childhood abuse and adult depressive symptoms in people with cardiovascular disease (CVD).

Methods

The subjects were people with CVD who continuously participated in the China Health and Retirement Longitudinal Study (CHARLS) life history survey and the 2018 wave of the CHARLS national baseline Survey. Multi-level logistic regression models were used to analyze the relationship between emotional neglect, physical neglect, physical abuse and adult depressive symptoms.

Results

A total of 4,823 respondents were included in this study. The incidence of childhood abuse (existed emotional neglect, physical neglect or physical abuse) was 43.58% among people over 45 years old with CVD, which was higher than that of the general population (36.62%, p < 0.05). Adjusted model showed that overall childhood abuse was associated with adult depressive symptoms (OR = 1.230, 95%CI:1.094-1.383). Among different types of childhood abuse, only physical abuse was associated with depressive symptoms in adulthood (OR = 1.345, 95%CI:1.184-1.528).

Conclusion

Compared with that of the general population, the incidence of childhood abuse in CVD population is higher. Physical abuse in childhood increased the risk of depressive symptoms in adulthood. It suggested that the occurrence of depressive symptoms was the result of related factors in the whole life course. In order to prevent the depressive symptoms, childhood abuse also needs to be considered. It is very important to identify and prevent the continuation of childhood abuse in time.

Tooth loss, body mass index and cognitive function among middle-aged and older adults in China: Does gender matter?

BACKGROUND

Previous studies have shown a longitudinal association between tooth loss and cognitive function. Body mass index (BMI) is an essential applicable indicator of health status screening. However, the underlying mechanism among these factors remains unclear. This study aimed to determine the mediating role of BMI in the tooth loss-cognition relationship by gender among Chinese middle-aged and older adults.

METHODS

This is a prospective and cohort study. We used three waves of follow-up data (2011, 2013, and 2015) from the China Health and Retirement Longitudinal Survey, including 10,013 participants aged 45 years or above. Cognitive function was evaluated by Telephone Interview of Cognitive Status, words recall, and figure drawing. The cross-lagged panel model was applied to test the hypothesized model.

RESULTS

Tooth loss is associated with higher BMI and lower level of cognitive function. We found significant total effects (B = -0.017, P = 0.008), direct effect (B = -0.015, P = 0.022) and indirect effects (B = -0.002, P = 0.010) of tooth loss on cognition mediated through BMI only among middle-aged and older men. For middle-aged and older women, the total effect (B = -0.010, P = 0.125) and direct effect (B = -0.007, P = 0.249) were no more significant.

CONCLUSIONS

The longitudinal association between tooth loss and cognition was primarily indirect through BMI among middle-aged Chinese males but not women. Public health authorities should remind middle-aged and older males with tooth loss and high BMI to participate in timely medical checkups for improving cognition.

Impact of community-based rehabilitation on the physical functioning and activity of daily living of stroke patients: a systematic review and meta-analysis

PURPOSE

This study aimed at establishing the impact of community-based rehabilitation (CBR) on the physical functioning and activity of daily living (ADL) of patients with stroke (PWS).

MATERIALS AND METHODS

Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, an electronic search was conducted in five databases, including PubMed, OVID Embase, OVID Medline, Cochrane Library, and Web of Science between May 2010 and 2020. Meta-analysis was performed using the Comprehensive Meta-Analysis Version 2 software to establish whether the studies were sufficiently homogenous.

RESULTS

Twenty studies out of 828 publications were included in the present systematic review. A significant difference between CBR intervention and control groups was identified about the physical functional capacity in mobility, 6-metre walk test (6MWT) (g = 0.351, 95% CI (0.110, 0.592)), community walking test (g= -0.473, 95% CI (-0.926, -0.020)) and on the other hand a significant improvement in ADL was found (g = 0.138, 95% CI(0.051, 0.224)).

CONCLUSIONS

CBR is revealed to be effective in improving the physical functioning and ADL for PWS and is drawn based on eligible studies which were conducted in high-income countries (HICs). This highlights a gap between developed and less-resourced countries as far as CBR for PWS is concerned and calls for a further study. Protocol Registration: CRD42020159683Implication for rehabilitationCommunity-based rehabilitation (CBR) is recommended as one of the best programme for treating stroke patients with stroke (PWS) after they are discharged from hospitals.CBR is effective in improving the physical functioning and activity of daily living of PWS.Further research should be carried out to compare between CBR and institution-based rehabilitation for PWS, especially the less-resourced settings which are grappling with a challenge of limited skilled rehabilitation professionals.

Association between participation self-efficacy and participation in stroke survivors

BACKGROUND

Most stroke survivors face restrictions in functional disability and social participation, which can impede their recovery and community reintegration. Participation self-efficacy refers to survivors' confidence in using strategies to manage participation in areas including community living and work engagement. This study aimed to assess the association between participation self-efficacy and participation among stroke survivors.

METHODS

This study adopted a cross-sectional correlational design with a convenience sample of 336 stroke survivors recruited from five hospitals in China. Participation self-efficacy was measured using the Chinese version of the Participation Strategies Self-Efficacy Scale (PS-SES-C) and participation measured using the Chinese version of the Reintegration to Normal Living Index (RNLI-C). The association between participation self-efficacy and participation was examined using multiple regression analysis with adjustment for potential confounders.

RESULTS

Participants had a mean age of 69.9 ± 11.5 years, with most (81.6%) having an ischaemic stroke, and more than half (61.6%) a first-ever stroke. After adjustment for potential confounders, every 10-point increase in the PS-SES-C total score was significantly associated with an average 1.3-point increase in the RNLI-C total score (B = 1.313, SE = 0.196, p < 0.001).

CONCLUSIONS

This study demonstrates that participation self-efficacy is significantly associated with participation among Chinese community-dwelling survivors of a mild or moderate stroke. This suggests that rehabilitation programmes for stroke survivors may be more effective if they incorporate participation-focused strategies designed to enhance self-efficacy. (229 words).

Life satisfaction and its influencing factors of middle-aged and elderly stroke patients in China: a national cross-sectional survey

OBJECTIVES

This study reports the life satisfaction of middle-aged and elderly patients who had a stroke in China, and explores its association with patients' sociodemographic characteristics, health status, lifestyles and family relationship.

DESIGN

Cross-sectional survey.

SETTING AND PARTICIPANTS

The samples of this study were selected from the data of China Health and Retirement Longitudinal Study (CHARLS) in 2018, which covered 28 provinces, 150 countries/districts and 450 village/urban communities. 1154 patients who had a stroke aged 45 and over were included in this study as qualified samples.

OUTCOME MEASURES

Descriptive analysis was used to report sociodemographic characteristics, health status, lifestyles, family relationship and life satisfaction of middle-aged and elderly patients who had a stroke. χ² analysis and binary logistic regression were used to analyse the factors influencing the life satisfaction of the patients who had a stroke.

RESULTS

Overall, 83.1% of patients who had a stroke were satisfied with their lives, although only 8.7% rated their own health as being good. Patients who had a stroke who were male, elderly, married, living with their spouses and having a pension were more likely to report satisfaction with life (p<0.05). Self-rated health, health satisfaction, chronic lung disease, fall, pain, ability to work and family relationships were also significantly associated with life satisfaction (p<0.05). Patients who drank alcohol (86.8% vs 81.7%, p=0.041), had physical activity (84.4% vs 75.6%, p=0.004) and had social activity (85.3% vs 80.8%, p=0.041) were more satisfied with their lives than those who did not. Multivariable analysis confirmed that age, health satisfaction, physical pain, working ability, relationships with spouse and with children had significant effects on life satisfaction of patients who had a stroke (p<0.05).

CONCLUSIONS

Our study indicates the importance of improving the overall health of patients who had a stroke and mediating factors, such as pain management, and work ability, spouse and children relationship in improving the life satisfaction of patients in the poststroke rehabilitation.

Factors of Functional Disability in the Social Participation of Older Adults Living Alone With Fall Experience

The fall experiences of older adults living alone lead to restrictions in their social participation. This study aimed to examine the factors that influence functional disability in social participation (FSP) among older adults who live alone and have experienced falls. This study used secondary data of 493 older adults living alone who experienced a fall, which were collected from the 2017 National Survey of Older Koreans. Multiple linear regression analyses were performed. Factors, such as old age, sex, economic status, frequency of drinking, and number of acquaintances, significantly related to functional disability in terms of social participation. In addition, poor muscle strength, depression, and cognitive decline comprised predictors of FSP. The findings of this study revealed that it is important to comprehensively evaluate the social participation of older adults who live alone and have experienced falls.

The Application of the Omaha System in Community Rehabilitation Nursing for Patients With Stroke and Previous Falls

Objective

This study aimed to explore the use of the Omaha System in rehabilitation and nursing methods and the effects on patients within the community who had experienced stroke and previous falls.

Methods

This study enrolled 42 patients who had experienced stroke and previous falls and had returned to the community after being discharged from the Department of Neurology and Rehabilitation of the Affiliated Hospital of Nanchang University from January to July 2018. The patients were randomly divided into two groups: an experimental group (n = 21) and a control group (n = 21). Patients in the control group received routine community rehabilitation care, and patients in the experimental group received community rehabilitation care on the basis of the Omaha System. Intervention lasted for 1 year. The Omaha outcome score, the ability to perform activities of daily living (ADL) (measured via the Modified Barthel Index [MBI]), and the incidence of falls for each group were compared before and after the intervention.

Results

After 1 year of intervention, the Omaha outcome score and MBI of both groups were higher than before; the Omaha outcome score and MBI of the experimental group were higher than those of the control group; the differences were statistically significant (P &lt; 0.05). No fall occurred in either of the two groups.

Conclusion

The Omaha System can comprehensively evaluate the health problems of patients, guide nursing intervention, and quantitatively evaluate the effect of nursing intervention; it is therefore worthy of promotion.

Longitudinal trajectories of physical functioning among Chinese older adults: the role of depressive symptoms, cognitive functioning and subjective memory

BACKGROUND AND OBJECTIVE

Maintaining physical functioning (i.e. mobility, activities of daily living [ADLs], instrumental activities of daily living [IADLs]) in older adults is essential for independent living. However, little is known about how longitudinal trajectories of physical functioning differ by varying levels of depressive symptoms, subjective memory impairment and cognitive functioning. We aimed to examine whether, and to what degree, the rate of change in physical functioning over time was associated with depressive symptoms, subjective memory and cognitive functioning.

DESIGN

A correlational longitudinal design.

METHODS

The sample included 5,519 older adults (mean age = 68.13 years) from the China Health and Retirement Longitudinal Study (three waves: 2011-15) who self-reported their depressive symptoms, subjective memory impairment and physical functioning. Cognitive functioning was assessed through interview-based tests.

RESULTS

There were significant increases in mobility impairment (β = 0.27, P < 0.001), ADLs impairment (β = 0.05, P < 0.001) and IADLs impairment (β = 0.03, P = 0.006) over time. Compared with the mean score at baseline in 2011, the mobility, ADLs and IADLs impairment increased by 13.32, 10.57 and 4.34% for every 2 years, respectively. Those with high depressive symptoms had accelerated rates of mobility (β = 0.212, P < 0.001), ADLs (β = 0.104, P < 0.001) and IADLs impairment (β = 0.076, P = 0.002). Those with poorer cognitive functioning had more rapid rates of mobility impairment. In contrast, those with differing levels of subjective memory impairment did not experience different physical functioning trajectories.

CONCLUSIONS

High depressive symptoms and poor cognitive functioning may be precursors to rapid declines in physical functioning. Proactive screening for these precursors may attenuate physical decline among Chinese older adults.

Stroke outcome assessment: Optimizing cutoff scores for the Longshi Scale, modified Rankin Scale and Barthel Index

The Longshi Scale, a visual-based scale, is reliable and valid in activity assessment, but lacks cutoff definition corresponding to classical scales such as the modified Rankin Scale and Barthel Index. Therefore, this study aimed to investigate the relationships of the Longshi Scale with the modified Rankin Scale and Barthel Index and optimize cutoff scores of these scales in stroke outcomes assessment. This is a cross-sectional study. Stroke patients were measured concurrently by the Longshi scale, modified Rankin Scale and Barthel Index. Kruskal-Wallis test and Spearman correlation analysis were used to analyze the differences and associations among the three scales. The receiver operating characteristic curve was performed to determine the optimal cutoff scores. A total of 5475 stroke patients (67.3% ischemic) were included in this study. There are close relationships of the Longshi Scale with adjusted modified Rankin Scale and Barthel Index (r = -0.861, 0.922; p<0.001, <0.001; respectively). The activity levels assessed by adjusted modified Rankin Scale and Barthel Index among different Longshi scale grades were significantly different (χ2:4217.27, 4676.55; p<0.001, <0.001; respectively). The optimal cutoff scores were adjusted modified Rankin Scale 4, 3, 3, 3, 2 for Longshi scale grade 2 to 6 (sensitivity%: 96.12, 70.24, 89.10, 96.80, 86.23, specificity%: 72.72, 98.29, 93.81, 79.82, 92.89, respectively), and Barthel Index 15, 45, 60, 75, 80 for Longshi scale grade 2 to 6 (sensitivity%: 92.54, 89.28, 91.32, 90.30, 95.65, specificity%: 95.48, 89.51, 94.02, 90.41, 90.62, respectively). In conclusion, the classification of Longshi Scale is consistent with those of modified Rankin Scale and Barthel Index. We recommend the Longshi Scale as an effective supplement for modified Rankin Scale and Barthel Index in assessing the outcome in acute stroke patients.

Effectiveness of post-stroke social rehabilitation in patients with moderate impairments

The importance of post-stroke rehabilitation cannot be overestimated. The aim of this study was to assess the effectiveness of a standardized post-stroke rehabilitation program for patients with moderate impairments. A total of 122 stroke survivors participated in the study. Group 1 (the comparison group) consisted of 59 patients undergoing standard rehabilitation. Group 2 (the main group) consisted of 63 patients participating in a specially designed social rehabilitation program. The functional, cognitive, psychological and emotional states and the level of social activity were monitored for 6 months. Group 2 demonstrated more pronounced improvement than group 1 after 6 months of follow-up, confirmed by higher Rivermead (p = 0.011) and SS-QOL (p < 0.05) scores and lower DASH and Beck scores (p = 0.015 and p < 0.001, respectively). In both groups, MMSE (cognitive function) scores slightly increased, but the differences between the groups were insignificant. The proposed post-stroke rehabilitation program is effective in helping patients regain their independence and improve social adaptation. The scales and scores used in the study, especially DASH and SS-QOL, are sensitive to changes in the functional state of stroke survivors with moderate impairments.

Daily Time Use by Activity of Community-Dwelling Older Koreans: Focus on Health Management

This study aimed to examine the daily time use by activity and identified factors related to health management time (HMT) use among 195 older adults (mean age = 77.5, SD = 6.28 years; 70.8% women) attending a Korean senior center. Descriptive statistics were analyzed and gamma regression analyses were performed. Participants used the most time on rest, followed by leisure, health management, daily living activities, and work. The mean duration of HMT was 205.38 min/day. The mean score for the subjective evaluation of health management (SEHM) was 13.62 and the importance score for SEHM was 4.72. Factors influencing HMT included exercise, number of chronic conditions, fasting blood sugar level, low density lipoprotein level, and cognitive function. HMT and frailty significantly predicted SEHM. HMT interventions focus on promoting exercise and acquiring health information to improve health outcomes among older adults in senior centers.

Comparing Activity and Participation between Acquired Brain Injury and Spinal-Cord Injury in Community-Dwelling People with Severe Disability Using WHODAS 2.0

Central-nervous-system (CNS) injuries constitute a significant cause of morbidity (often resulting in long-term disability) and mortality. This cross-sectional study compared the activity and participation of community-dwelling people with severe disability from acquired brain injuries (ABI) (n = 322) and spinal-cord injuries (SCI) (n = 183) to identify risk factors related to disability. Data were collected through a questionnaire survey of community-dwelling people with severe disability attending 65 healthcare centers. The survey included the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) and sociodemographic factors. We categorized a registered grade of disability of 1 or 2 as severe disability. WHODAS 2.0 domain and summary scores were compared between the ABI and SCI groups, and risk factors associated with disability were identified through regression analysis. ABI participants had significantly higher disability in cognition and relationships, whereas patients with SCI had higher disability in mobility (p < 0.05). Onset duration was negatively correlated with cognition, relationships, participation, and summary scores in ABI participants (p < 0.05). Neither group’s socioeconomic factors were associated with WHODA 2.0 scores. Understanding the different patterns of disability between SCI and ABI in community-dwelling people with severe disability helps establish future plans for the management of health resources.