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Determinants of quality of life in individuals with spinal cord injury using structural equation modelling

  • Dr. Manuel Zwecker
    Correspondence
    Corresponding author: Manuel Zwecker, MD, Department of Neurological Rehabilitation, Division of Rehabilitation, The Integrated Rehabilitation Hospital, Sheba Medical Center, Tel HaShomer, Israel, Sackler School of Medicine, Tel-Aviv University, Tel Aviv, Israel. Tel: +972 526666524.
    Affiliations
    Department of Neurological Rehabilitation, Division of Rehabilitation, The Integrated Rehabilitation Hospital, Sheba Medical Center, Tel HaShomer, Israel

    Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Dr. Eyal Heled
    Affiliations
    Department of Neurological Rehabilitation, Division of Rehabilitation, The Integrated Rehabilitation Hospital, Sheba Medical Center, Tel HaShomer, Israel

    Department of Behavioral Sciences, Ariel University, Ariel, Israel
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  • Dr. Moshe Bondi
    Affiliations
    Department of Neurological Rehabilitation, Division of Rehabilitation, The Integrated Rehabilitation Hospital, Sheba Medical Center, Tel HaShomer, Israel

    Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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  • Prof. Gabi Zeilig
    Affiliations
    Department of Neurological Rehabilitation, Division of Rehabilitation, The Integrated Rehabilitation Hospital, Sheba Medical Center, Tel HaShomer, Israel

    Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    School of Health Professions, Ono Academic College, Kiryat Ono, Israel
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  • Dr. Vadim Bluvstein
    Affiliations
    Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana, Israel
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  • Prof. Amiram Catz
    Affiliations
    Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Department of Spinal Rehabilitation, Loewenstein Hospital, Raanana, Israel
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  • Prof. Israel Dudkiewicz
    Affiliations
    Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel

    Division of Rehabilitation, The Integrated Rehabilitation Hospital, Sheba Medical Center, Tel HaShomer, Israel
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      Abstract

      Objective

      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).

      Design

      Survey, cross-sectional study, and model testing using structural equation modeling.

      Setting

      Two inpatient and outpatient SCI rehabilitation units, Sheba Medical Center and Loewenstein Hospital, Israel.

      Participants

      Convenience sample of 156 individuals with SCI.

      Interventions

      Not applicable.

      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.

      Results

      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.

      Conclusions

      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.

      Keywords

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