A Structural Analysis of Health Outcomes After Spinal Cord Injury

Abstract

Objective: To develop and validate a latent model of health outcomes among persons with spinal cord injury. Methods: Survey data were collected at a large specialty hospital in the southeastern USA from 1,388 adult participants with traumatic spinal cord injury of at least 1 year's duration. Multiple indicators of health outcomes were used, including general health ratings, days adversely affected by poor health and poor mental health, treatments and hospitalizations, depressive symptoms, symptoms of illness or infection (eg, sweats, chills, fever), and multiple individual conditions (eg, pressure ulcers, subsequent injuries, fractures, contractures). Results: We performed exploratory factor analysis on half of the sample and confirmatory factor analysis on the other. A 6-factor solution was the best overall solution, because there was an excellent fit with the exploratory factor analysis (root mean square error of approximation 5 0.042) and acceptable fit with the confirmatory factor analysis (root mean square error of approximation 5 0.065). Four of the factors were types of secondary conditions, including symptoms of illness or infection, orthopedic conditions, pressure ulcers, and subsequent injuries. The 2 remaining factors reflected global health and treatment. Gender, race-ethnicity, age, injury severity, and years of education were all significantly related to at least 1 factor dimension, indicating variations in health outcomes related to these characteristics. Conclusion: Identification of the 6 factors represents an improvement over the utilization of multiple individual indicators, because composite scores generated from multiple individual indicators provide more informative and stable outcome scores than utilization of single indicators.

Health Care Utilization in Persons with Traumatic Spinal Cord Injury: The Importance of Multimorbidity and the Impact on Patient Outcomes

“…Important factors include the number of SHCs, gender, time since injury, living situation, type of SCI and age, many of which have already been identified in other studies. 21 These factors are easily measured during routine clinical visits and could form the basis of a screening tool to identify who requires specialized health care services to prevent a potential inappropriate HCU such as hospital re-admission in the future. As mentioned previously, most individuals visit their general practitioner yearly but only 15.8% (n = 103) visit a physiatrist and 7.5% (n = 49) have SCI peer support, which may not be enough based on results of this study.…”

Secondary health conditions in individuals aging with SCI: Terminology, concepts and analytic approaches

“…A recent study using a factor analysis of selected health outcome measures yielded six health-outcome factors, supporting this possibility. 19 Three of the factors that emerged were clearly healthcondition factors reflecting (1) pressure sores, (2) illness/infections and (3) orthopedic conditions. In addition, a measure of emotional functioning (depression) was associated with a separate factor, providing support for a distinction between psychological and physical SHCs.…”

“…(3) Individual SHCs can be clustered into higher-order SHC constructs that may be useful for classifying and measuring these conditions in individuals with SCI, as well as other disabilities. 19 Despite the acknowledged importance of the secondary conditions concept as it relates to the lives of individuals living with long-term disabilities, there is no clear agreed-upon definition of the concept to guide research. Thus, it is not surprising that there is a lack of consistency in the way that these conditions are conceptualized and measured in the scientific literature.…”

The Relationship of Pressure Ulcers, Race, and Socioeconomic Conditions After Spinal Cord Injury

“…Therefore, all results in this study are referring to open PrUs. This measurement has been used in previous studies of people with SCI (17,19,20).…”

“…We used a subset of measures from a larger study of protective and risk factors associated with the onset of multiple types of adverse health outcomes and secondary conditions among a large sample of individuals with SCI (17). Specifically for this study, income, education, race, and PrUs were examined.…”