Abstract
Riggins MS, Kankipati P, Oyster ML, Cooper RA, Boninger ML. The relationship between
quality of life and change in mobility 1 year postinjury in individuals with spinal
cord injury.
Objective
To examine quality-of-life (QOL) factors and change in mobility in individuals with
traumatic spinal cord injury (SCI) 1 year after injury.
Design
Retrospective case study of National SCI Database data.
Setting
SCI Model Systems (SCIMS) sites (N=18).
Participants
Subjects (N=1826; age >18y) who presented to an SCIMS site after traumatic SCI between
June 2004 and July 2009 and returned for 1-year follow-up. All subjects had FIM mobility
data for both assessments.
Interventions
Not applicable.
Main Outcome Measures
Assessment of impairment based on Lower-Extremity Motor Score. Assessment of QOL based
on Craig Handicap Assessment and Reporting Technique, Patient Health Questionnaire,
Satisfaction With Life Scale, Self-perceived Health Status, and pain severity scores.
Results
Of the sample, 55 individuals transitioned from walking to wheelchair use within 1
year of discharge. This group had the highest number of individuals from minority
groups (52.8%) and the lowest employment rate (7.3%). Compared with individuals who
transitioned from wheelchair use to walking or maintained wheelchair use or ambulation,
the walking-to-wheelchair transition group had significantly lower QOL scores (P<.01), including higher depression (P<.01) and higher pain severity (P<.001).
Conclusions
Individuals with SCI who transitioned from walking at discharge to wheelchair use
within 1 year had low QOL factors, including high pain and depression scores. Rehabilitation
professionals should consider encouraging marginal ambulators to work toward functional
independence from a wheelchair, rather than primary ambulation during acute inpatient
rehabilitation.
Key Words
List of Abbreviations:
AA (ambulation to ambulation), AW (ambulation to wheelchair), CHART (Craig Handicap Assessment and Reporting Technique), CHART Mob (Craig Handicap Assessment and Reporting Technique Mobility subscale), CHART Occ (Craig Handicap Assessment and Reporting Technique Occupation subscale), CHART PI (Craig Handicap Assessment and Reporting Technique Physical Independence subscale), CHART SI (Craig Handicap Assessment and Reporting Technique Social Integration subscale), LEMS (Lower-Extremity Motor Score), MDS (major depressive syndrome), NSCID (National Spinal Cord Injury Database), QOL (quality of life), SCI (spinal cord injury), SCIMS (Spinal Cord Injury Model Systems), SDS (Severity of Depression Scale), SPHS (Self-perceived Health Status), SWLS (Satisfaction With Life Scale), WA (wheelchair to ambulation), WW (wheelchair to wheelchair)To read this article in full you will need to make a payment
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References
- Hope during the first months after acute spinal cord injury.J Adv Nurs. 2004; 47: 279-286
- Spinal cord injury: promising interventions and realistic goals.Am J Phys Med Rehabil. 2003; 82: S38-S49
- Spinal cord injury facts and figures at a glance.J Spinal Cord Med. 2010; 33: 439-440
- Walking after spinal cord injury: evaluation, treatment, and functional recovery.Arch Phys Med Rehabil. 1999; 80: 225-235
- Association of mode of locomotion and independence in locomotion with long-term outcomes after spinal cord injury.J Spinal Cord Med. 2009; 32: 237-248
- Physiological Cost Index (PCI) and walking performance in individuals with transfemoral prostheses compared to healthy controls.Disabil Rehabil. 2007; 29: 643-649
- Walking speed predicts health status and hospital costs for frail elderly male veterans.J Rehabil Res Dev. 2005; 42: 535-546
- Prediction of ambulatory performance based on motor scores derived from standards of the American Spinal Injury Association.Arch Phys Med Rehabil. 1994; 75: 756-760
- Physical activity is related to lower levels of pain, fatigue and depression in individuals with spinal-cord injury: a correlational study.Spinal Cord. 2009; 47: 301-306
- Pain following spinal cord injury: the impact on community reintegration.Spinal Cord. 2005; 43: 278-282
- Quality of life in spinal cord injured individuals and their caregivers during the initial 6 months following rehabilitation.Qual Life Res. 2004; 13: 97-110
- Quality of life after spinal cord injury.J Neurol Phys Ther. 2005; 29: 139-146
- Predictors of life satisfaction: a spinal cord injury cohort study.Arch Phys Med Rehabil. 2002; 83: 555-561
- Data collection syllabus for the National Spinal Cord Injury Database 2009.National Spinal Cord Injury Statistic Center, Birmingham2009
- Quantifying handicap: a new measure of long-term rehabilitation outcomes.Arch Phys Med Rehabil. 1992; 73: 519-526
- The Satisfaction With Life Scale.J Pers Assess. 1985; 49: 71-75
- Validation and utility of a self-report version of PRIME-MD: the PHQ Primary Care Study.JAMA. 1999; 282: 1737-1744
- Guide for use of the CHART Craig Handicap Assessment and Reporting Technique 1992.Craig Hospital, Englewood1992
- Scoring CHART: survey and sensitivity analysis.J Am Paraplegia Soc. 1991; 14: 85-86
- SF-36 Physical and Mental Health Summary Scales: a user's manual.The Health Institute, New England Medical Center, Boston1994
- Correlates of life satisfaction among persons with spinal cord injury.Arch Phys Med Rehabil. 1999; 80: 867-876
- Quality of life after spinal cord injury: a meta analysis of the effects of disablement components.Spinal Cord. 1997; 35: 829-840
- Spinal cord injuries: a shortened measure of function and mood.Spinal Cord. 1997; 35: 17-21
- Spinal cord injuries: clinical, functional, and emotional status.Spine. 1991; 16: 78-83
- The PHQ-9: validity of a brief depression severity measure.J Gen Intern Med. 2001; 16: 606-613
- A simple sequentially rejective multiple test procedure.Scand J Stat. 1979; 6: 65-70
- The psychological assessment of candidates for spinal cord stimulation for chronic pain management.Pain Practice. 2004; 4: 204-221
- Recovery of life satisfaction in persons with spinal cord injury during inpatient rehabilitation.Am J Phys Med Rehabil. 2009; 88: 887-895
- Factors associated with health-related quality of life in chronic spinal cord injury.Am J Phys Med Rehabil. 2007; 86: 387-396
- Disability status, perceived health, social support, self-efficacy, and quality of life among people with spinal cord injury in the People's Republic of China.Int J Rehabil Res. 2001; 24: 69-71
- The lived experience of moving forward for clients with spinal cord injury: a Parse Research Method Study.J Adv Nurs. 2010; 66: 1132-1141
- Equitable access to cancer services: a review of barriers to quality care.Cancer. 1999; 86: 2378-2390
- Time trends in late-stage diagnosis of cervical cancer.Med Care. 1997; 35: 1220-1224
- Racial differences in performance of invasive cardiac procedures in a Department of Veterans Affairs Medical Center.J Clin Epidemiol. 1997; 50: 899-901
- Racial and ethnic disparities in access to health insurance and health care.UCLA Center for Health Policy Research, Los Angeles2000
- Demographic and socioeconomic factors associated with disparity in wheelchair customizability among people with traumatic spinal cord injury.Arch Phys Med Rehabil. 2004; 85: 1859-1864
- Physical rehabilitation as an agent for recovery after spinal cord injury.Phys Med Rehabil Clin N Am. 2007; 18: 183-202
Article info
Footnotes
Supported by the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, U.S. Department of Education (grant nos. H133N000019, H133N060019).
This material is the result of work supported with resources and the use of facilities at the Human Engineering Research Laboratories, VA Pittsburgh Healthcare System, Pittsburgh, PA. The contents of this report do not represent the views of the Department of Veterans Affairs or the U.S. Government.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
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Copyright
© 2011 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Possible Deleterious Effects of Therapy Solely Directed at Neural Plasticity and Walking in People With Serious Spinal Cord InjuryArchives of Physical Medicine and RehabilitationVol. 92Issue 11
- PreviewWe read with interest the recent article by Riggins and colleagues.1 The authors highlight a contentious but important issue which needs to be openly addressed. At issue are the risks of focusing on neural plasticity and walking through locomotor training and recovery programs in patients with serious spinal cord injury and very little lower-limb strength. The authors provide some evidence that when walking is not achieved 1 year later, these patients have high levels of depression and pain, and a low quality of life.
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