The objective of this study is to examine the interdependent associations between
ICF domains and their relationship with environmental factors with regard to quality
of life (QoL) in individuals with spinal cord injury (SCI).
Survey, cross-sectional study, and model testing using structural equation modeling.
Two inpatient and outpatient SCI rehabilitation units, Sheba Medical Center and Loewenstein
Convenience sample of 156 individuals with SCI.
Main Outcomes Measures
QoL assessed by the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF).
Neurological impairment following SCI reflected by lesion completeness and neurological
level of injury as measured by the International Standards for Neurological Classification
of SCI (ISNCSCI)
The Spinal Cord Independence Measure (SCIM) to assess SCI related task performance.
ICF brief Core Sets composition scores to assess impairment in body structure and
function domains; limitations in activities, restriction in participation constructs
and the impact of environmental factors within the ICF model.
Level of spinal cord injury and ICF brief Core Sets composite score relating to activities
and participation construct demonstrated a direct significant association with QoL.
Moreover, a significant indirect association with QoL was found between the composite
scores in ICF body structure and function, and environmental factors, level of spinal
cord injury, time since injury onset and gender. Since the SCIM was not related to
QoL, we inferred that the categories related to instrumental activities of daily living
(IADL) and participation exert the most significant influence on QoL.
In order to optimize improvements in quality of life, current rehabilitation programs
should target limitations specifically related to IADL and participation restrictions.
It may serve as a focal point for further development of current therapeutic models
and analytic methods that optimize rehabilitation planning and decision-making among
both healthcare professionals and patients.