• Carly S Rivers, Nader Fallah, Vanessa K Noonan, David G Whitehurst, Carolyn E Schwartz, Joel A Finkelstein, B Catharine Craven, Karen Ethans, Colleen O'Connell, B Catherine Truchon, Chester Ho, A Gary Linassi, Christine Short, Eve Tsai, Brian Drew, Henry Ahn, Marcel F Dvorak, Jérôme Paquet, Michael G Fehlings, Luc Noreau, and RHSCIR Network.
• Rick Hansen Institute, Vancouver, BC, Canada. Electronic address: crivers@rickhanseninstitute.org.
• Arch Phys Med Rehabil. 2018 Mar 1; 99 (3): 443-451.

ObjectiveTo analyze relations among injury, demographic, and environmental factors on function, health-related quality of life (HRQoL), and life satisfaction in individuals with traumatic spinal cord injury (SCI).DesignProspective observational registry cohort study.SettingSpecialized acute and rehabilitation SCI centers.ParticipantsParticipants (N=340) from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) who were prospectively recruited from 2004 to 2014 were included. The model cohort participants were 79.1% men, with a mean age of 41.6±17.3 years. Of the participants, 34.7% were motor/sensory complete (ASIA Impairment Scale [AIS] grade A).InterventionsNone.Main Outcome MeasuresPath analysis was used to determine relations among SCI severity (AIS grade and anatomic level [cervical/thoracolumbar]), age at injury, education, number of health conditions, functional independence (FIM motor score), HRQoL (Medical Outcomes Study 36-Item Short-Form Health Survey [Version 2] Physical Component Score [PCS] and Mental Component Score [MCS]), and life satisfaction (Life Satisfaction-11 [LiSat-11]). Model fit was assessed using recommended published indices.ResultsGoodness of fit of the model was supported by all indices, indicating the model results closely matched the RHSCIR data. Higher age, higher severity injuries, cervical injuries, and more health conditions negatively affected FIM motor score, whereas employment had a positive effect. Higher age, less education, more severe injuries (AIS grades A-C), and more health conditions negatively correlated with PCS (worse physical health). More health conditions were negatively correlated with a lower MCS (worse mental health), however were positively associated with reduced function. Being married and having higher function positively affected Lisat-11, but more health conditions had a negative effect.ConclusionsComplex interactions and enduring effects of health conditions after SCI have a negative effect on function, HRQoL, and life satisfaction. Modeling relations among these types of concepts will inform clinicians how to positively effect outcomes after SCI (eg, development of screening tools and protocols for managing individuals with traumatic SCI who have multiple health conditions).Copyright © 2017 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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