Study design: Longitudinal and cross-sectional. Objective: To determine whether, for studies of ageing with a spinal cord injury, the crosssectional di erences in outcomes across both age and years post injury (YPI) di er from the longitudinal change. Setting: Two SCI centres in England: the National Spinal Injuries Centre in Aylesbury, and the Regional Spinal Injuries Centre in Southport. Methods: A total of 315 people who sustained spinal cord injuries prior to 1971 underwent comprehensive health and psychosocial status interviews at one or more of the study assessments (1990, 1993, 1996, and 1999). A range of continuous and dichotomous outcomes was analyzed to detect both cross-sectional di erences by age and average individual changes over multiple measurements. Results: Frequently, outcomes changed longitudinally without showing any cross-sectional di erences. Cross-sectional age was more commonly associated with the worsening of a condition while cross-sectional YPI was commonly associated with improvement. After controlling for cross-sectional e ects, psychological measures generally showed minor deterioration, measures of community integration both improved and deteriorated, upper extremity pain increased, lower enxtremity pain decreased, and participants tended to quit smoking. Conclusion: Using longitudinal ®ndings that control for cross-sectional di erences produces a more complete description of ageing with a spinal cord injury.

Study Design: Longitudinal. Objectives: To characterize long-injured SCI persons with high reported stress; to assess the relationship between severity of disability and perceived stress; to identify correlates of future stress and outcomes of previous stress. Setting: Two SCI centres in England: Stoke Mandeville Hospital in Aylesbury, and the District General Hospital in Southport. Methods: In 1990, 1993 187 persons who sustained spinal cord injuries prior to 1971 underwent comprehensive physical evaluations and health status interviews and completed a battery of tests to measure psychosocial functioning. Using mean scores on the Perceived Stress Scale (PSS) as the reference, a range of outcomes were analyzed to identify concurrent, previous, and future variables that were signi®cantly correlated with perceived stress. Results: No associations were found between stress and any of the proxy variables that represented injury severity. Such common SCI-related medical conditions as pressure sores and upper extremity pain were not related to stress; not even fatigue was signi®cantly associated with stress in both time periods studied. However, depressive symptoms, poorer life satisfaction, and poorer perceived well being were associated with future stress and were outcomes that appeared to be related to earlier stress. Conclusion: Perceived stress in long-term SCI is not closely related to the severity of the disability or physical independence. It is, however, related to scores on several measures of adjustment and coping. Though mean stress scores in this sample did not appear to dier substantially from scores in the general nondisabled population, further controlled study is needed to de®nitively answer the question: Do SCI survivors report more stress than their nondisabled counterparts? Sponsorship: