Original article| Volume 95, ISSUE 6, P1114-1126, June 2014

Download started.


Health Care Utilization and Barriers Experienced by Individuals With Spinal Cord Injury

Published:February 24, 2014DOI:



      To identify from whom individuals with spinal cord injury (SCI) seek health care, the percentage who receive preventative care screenings, and the frequency and types of barriers they encounter when accessing primary and specialty care services; and to examine how sociodemographic factors affect access to care and receipt of preventative screenings.


      Cross-sectional, observational study using an Internet-based survey.


      Internet based.


      Adults (N=108) with SCI who use a wheelchair as their primary means of mobility in the community.


      Not applicable.

      Main Outcome Measures

      Health care utilization during the past year, barriers encountered when accessing health care facilities, and receipt of routine care and preventative screenings.


      All but 1 participant had visited a primary care provider within the past 12 months, and 85% had had ≥1 visit to specialty care providers. Accessibility barriers were encountered during both primary care (91.1%) and specialty care (80.2%) visits; most barriers were clustered in the examination room. The most prevalent barriers were inaccessible examination tables (primary care=76.9%; specialty care=51.4%) and lack of transfer aids (primary care=69.4%; specialty care=60.8%). Most participants had not been weighed during their visit (89%) and had remained seated in their wheelchair during their examinations (85.2%). Over one third of individuals aged ≥50 years had not received a screening colonoscopy, 60% of women aged ≥50 years had not had a mammogram within the past year, 39.58% of women had not received a Papanicolaou smear within the previous 3 years, and only 45.37% of respondents had ever received bone density testing.


      Individuals with SCI face remediable obstacles to care and receive fewer preventative care screenings than their nondisabled counterparts. We recommend that clinics conduct Americans with Disabilities Act self-assessments, ensure that their clinical staff are properly trained in assisting individuals with mobility disabilities, and take a proactive approach in discussing preventative care screenings with their patients who have SCI.


      List of abbreviations:

      ADA (Americans with Disabilities Act), Pap (Papanicolaou), PCP (primary care physician), SCI (spinal cord injury)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Archives of Physical Medicine and Rehabilitation
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Morrison E.H.
        • George V.
        • Mosqueda L.
        Primary care for adults with physical disabilities: perceptions from consumer and provider focus groups.
        Fam Med. 2008; 40: 645-651
        • Veltman A.
        • Stewart D.
        • Tardif G.
        • Branigan M.
        Perceptions of primary healthcare services among people with physical disabilities - part 1: access issues.
        MedGenMed. 2001; 3: 18
        • Grabois E.
        • Nosek M.
        • Rossi D.
        Accessibility of primary care physicians' offices for people with disabilities.
        Arch Fam Med. 1999; 8: 44-51
        • Sanchez J.
        • Byfield G.
        • Brown T.
        • LaFavor K.
        • Murphy D.
        • Laud P.
        Perceived accessibility versus actual physical accessibility of healthcare facilities.
        Rehabil Nurs. 2000; 25: 6-9
        • Winters J.M.
        • Story M.F.
        • Barnekow K.
        • et al.
        Results on a national survey on accessibility of medical instrumentation for consumers. In: Winters JM, Story MF, editors. Medical instrumentation, accessibility and usability considerations.
        CRC Pr, Boca Raton2007: 13-26
        • Chan L.
        • Doctor J.N.
        • MacLehose R.R.
        • et al.
        Do Medicare patients with disabilities receive preventive services? A population-based study.
        Arch Phys Med Rehabil. 1999; 80: 642-646
        • Ramirez A.
        • Farmer G.
        • Grant D.
        • Papachristou T.
        Disability and preventive cancer screening: results from the 2001 California Health Interview Survey.
        Am J Public Health. 2005; 95: 2057-2064
      1. U.S. Department of Health and Human Services, Agency for Healthcare Research and Quality. Defining disability: developing quality of care measures for people with disabilities: summary of expert meeting. 2010. Available at: Accessed January 20, 2014.

        • Donnelly C.
        • McColl M.A.
        • Charlifue S.
        • et al.
        Utilization, access and satisfaction with primary care among people with spinal cord injuries: a comparison of three countries.
        Spinal Cord. 2007; 45: 25-36
        • Lavela S.
        • Weaver F.
        • Smith B.
        • Chen K.
        Disease prevalence and use of preventive services: comparison of female veterans in general and those with spinal cord injuries and disorders.
        J Womens Health. 2006; 15: 301-311
        • Johnston M.V.
        • Diab M.
        • Chu B.
        • Kirshblum S.
        Preventive services and health behaviors among people with spinal cord injury.
        J Spinal Cord Med. 2005; 28: 43-54
        • Bockenek W.L.
        Primary care for persons with disabilities. A fragmented model of care for persons with spinal cord injuries.
        Am J Phys Med Rehabil. 1997; 76: S43-S46
        • Francisco G.E.
        • Chae J.
        • DeLisa J.
        Physiatry as a primary care specialty.
        Am J Phys Med Rehabil. 1995; 74: 186-192
      2. Department of Justice. 2010 ADA Standards for Accessible Design. 2010. Available at: Accessed December 20, 2012.

      3. U.S. Department of Justice and U.S. Department of Health and Human Services. Americans with Disabilities Act: access to medical care for individuals with mobility disabilities. 2010. Available at: Accessed September 14, 2012.

        • Moyer V.A.
        • U.S. Preventive Services Task Force
        Screening for cervical cancer: U.S. Preventive Services Task Force recommendation statement.
        Ann Intern Med. 2012; 156: 880-891
        • Nelson H.D.
        • Tyne K.
        • Naik A.
        • et al.
        Screening for breast cancer; an update for the U.S. Preventive Services Task Force.
        Ann Intern Med. 2009; 151: 727-737
        • American College of Obstetrician-Gynecologists
        Practice bulletin no. 122: breast cancer screening.
        Obstet Gynecol. 2011; 118: 372-382
        • Rex D.
        • Johnson D.A.
        • Anderson J.C.
        • et al.
        American College of Gastroenterology guidelines for colorectal cancer screening 2009.
        Am J Gastroenterol. 2009; 104: 739-750
        • O'Hara B.
        • Caswell K.
        Health status, health insurance, and medical services utilization: 2010.
        U.S. Census Bureau, Washington (DC)2012 (Report No. P70-133)
      4. National Center for Health Statistics. Healthy people 2010 final review. 2012. Available at Accessed December 20, 2012.

        • Garshick E.
        • Kelley A.
        • Cohen S.A.
        • et al.
        A prospective assessment of mortality in chronic spinal cord injury.
        Spinal Cord. 2005; 43: 408-416
        • Rabadi M.H.
        • Mayanna S.K.
        • Vincent A.S.
        Predictors of mortality in veterans with traumatic spinal cord injury.
        Spinal Cord. 2013; 51: 784-788
      5. Centers for Disease Control and Prevention. Morbidity and mortality weekly report (MMWR). Vital signs: colorectal cancer screening test use—United States, 2012. Available at: Accessed March 17, 2014.

      6. Centers for Disease Control and Prevention. Prevalence and trends data. Nationwide (states, DC and territories)–2012 women's health data. Women aged 18+ who have had a pap test within the past three years. Available at: Accessed March 17, 2014.

      7. Centers for Disease Control and Prevention. Prevalence and trends data. Nationwide (states, DC and territories)–2012 women's health data. Women aged 50+ who have had a mammogram within the past two years. Available at: Accessed March 17, 2014.

      8. National Spinal Cord Injury Statistical Center. Spinal Cord Injury Model Systems 2012 annual statistical report - complete public version. 2013. Available at: Accessed November 14, 2013.

      9. Christopher and Dana Reeve Foundation. One degree of separation: paralysis and spinal cord injury in the United States. 2009. Available at: Accessed June 26, 2012.