Abstract
Objective
To understand the role of cultural and psychosocial factors in the outcomes of veteran
wheelchair users with spinal cord injury (SCI) to help clinicians identify unique
factors faced by their patients and help researchers identify target variables for
interventions to reduce disparities in outcomes.
Design
Cross-sectional cohort study.
Setting
Three urban Veterans Affairs medical centers affiliated with academic medical centers.
Participants
Of the patients (N=516) who were eligible to participate, 482 completed the interview
and 439 had SCI. Because of small numbers in other race groups, analyses were restricted
to white and African American participants, resulting in a final sample of 422.
Intervention
Not applicable.
Main Outcome Measures
Quality of life (QOL, Veterans RAND 12-Item Health Survey); satisfaction (Client Satisfaction
Questionnaire); and participation (Craig Handicap Assessment and Reporting Technique
Short Form).
Results
African American Veterans reported poorer physical QOL but better mental QOL than
did white Veterans. No other significant race differences were found in unadjusted
analyses. Multivariable analyses showed that psychosocial factors were predominantly
associated with patients' QOL outcomes and satisfaction with service, but demographic
and medical factors were predominantly associated with participation outcomes. Interaction
analyses showed that there was a stronger negative association between anxiety and
mental QOL for African Americans than for whites, and a positive association between
higher self-esteem and social integration for whites but not African Americans.
Conclusions
Findings suggest that attempts to improve the outcomes of Veterans with SCI should
focus on a tailored approach that emphasizes patients' demographic, medical, and psychosocial
assets (eg, building their sense of self-esteem or increasing their feelings of mastery),
while providing services targeted to their specific limitations (eg, reducing depression
and anxiety).
Keywords
List of abbreviations:
CHART-SF (Craig Handicap Assessment and Reporting Technique Short Form), QOL (quality of life), SCI (spinal cord injury), VA (Veterans Affairs)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: January 24, 2017
Footnotes
Supported in part by the VA Rehabilitation Research and Development Department (grant no. B7148I). The contents do not represent the views of the Department of Veterans Affairs or the United States Government.
Clinical Trials Registration No.: NCT01236170.
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
