Abstract
Objective
This study examined the effects of health and rehabilitation service use, unmet need
for services, and service obstacles on health-related quality of life (HR QoL) and
psychological well-being after discharge from spinal cord injury (SCI) rehabilitation.
Design
Prospective cohort study, with participants followed up at 6 and/or 12 months after
discharge from SCI inpatient rehabilitation.
Setting
Community setting.
Participants
People with SCI (N=55; mean age 51y; 76.4% men; 61.8% traumatic injury; mean length
of stay 137d).
Interventions
Not applicable.
Main Outcome Measures
Service Usage Scale, Service Obstacles Scale, the EuroQol-5D, and the Depression Anxiety
and Stress Scale short form. Eight predictors of outcome were considered: service
use (ie, use of general practitioner, medical specialist, nursing, and allied health,
and rehospitalization), unmet need, and service obstacles (ie, finances and transport).
Possibly important predictors of each outcome were identified via penalized regression,
and a final model was fit using Bayesian hierarchical regression with a Gaussian or
zero-inflated Poisson response distribution.
Results
Financial obstacles were associated with a poorer HR QoL (β [95% credible interval]=
−0.095 [−0.166 to −0.027]) and higher anxiety (odds ratio, OR [95% credible interval]=1.63
[1.16-2.23]). Rehospitalization was associated with a lower EuroQol visual analog
scale (β= −11.2 [−19.7 to −2.5]) and, interestingly, lower anxiety (OR=1.63 [1.16-2.23]).
Use of allied health was associated with higher anxiety (OR=2.48 [1.42-4.44]).
Conclusion
The varying degrees of financial hardship experienced after injury with complex rehabilitation
needs requires investigation, as does the interactive effects of service use, unmet
need, and service obstacles on outcomes like QoL and psychological well-being.
Keywords
List of abbreviations:
BF (Bayes factor), DASS-21 (Depression Anxiety Stress Scales 21-item short form), EQ-5D (EuroQol-5D), EQ-VAS (EuroQol visual analog scale), GP (general practitioner), HR QoL (health-related quality of life), Lasso (least absolute shrinkage and selection operator), LOS (length of stay), OR (odds ratio), SCI (spinal cord injury), SIU (Spinal Injuries Unit), ZIP (zero-inflated Poisson)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 04, 2020
Footnotes
Disclosures: none.
Identification
Copyright
© 2020 by the American Congress of Rehabilitation Medicine
