• Arch Phys Med Rehabil · Aug 2018

    Quality of Life and Adaptation in People With Spinal Cord Injury: Response Shift Effects From 1 to 5 Years Postinjury.

    • Carolyn E Schwartz, Brian Stucky, Carly S Rivers, Vanessa K Noonan, Joel A Finkelstein, and RHSCIR Network.
    • DeltaQuest Foundation Inc, Concord, MA; Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, Boston, MA. Electronic address: carolyn.schwartz@deltaquest.org.
    • Arch Phys Med Rehabil. 2018 Aug 1; 99 (8): 1599-1608.e1.

    ObjectiveTo investigate response shift effects in spinal cord injury (SCI) over 5 years postinjury.DesignProspective cohort study observed at 1, 2, and 5 years post-SCI.SettingSpecialized SCI centers.ParticipantsSample included 1125, 760, and 219 participants at 1, 2, and 5 years post-SCI (N = 2104). The study sample was 79% men; 39% were motor/sensory complete (mean age, 44.6±18.3y).InterventionsNot applicable.Main Outcome MeasuresPatient-reported outcomes included the Medical Outcomes Study 36-Item Short-Form Health Survey version 2 and the Life Satisfaction-11 Questionnaire. Participant latent variable scores were adjusted for (1) potential attrition bias and (2) propensity scores reflecting risk of worse outcomes. The Oort structural equation modeling approach for detecting and accounting for response shift effects was used to test the hypothesis that people with SCI would undergo response shifts over follow-up.ResultsThe study data comprised the time after FIM scores, an objective measure of motor and cognitive function, had improved and stabilized. Three latent variables (Physical, Mental, and Symptoms) were modeled over time. The response shift model indicated uniform recalibration and reconceptualization response shift effects over time. When adjusted for these response shift effects, Physical showed small true change improvements at 2- and 5-year follow-up, despite FIM stability.ConclusionsWe detected recalibration and reconceptualization response shift effects in 1- to 5-year follow-up of people with SCI. Despite stable motor and cognitive function, people with SCI are adapting to their condition. This adaptation reflects a progressive disconnection between symptoms and physical or mental health, and a real improvement in the Physical latent variable.Copyright © 2018 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

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