Aging After Spinal Cord Injury: A 30-Year Longitudinal Study

Krause, James S.; Coker, Jennifer

doi:10.1080/10790268.2006.11753885

Cited by 61 publications

(43 citation statements)

References 14 publications

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“…12,13 There were several similarities with the earlier research over shorter intervals. [7][8][9] In addition to the aforementioned survivor effect, there was a combination of favorable and unfavorable changes. Participants were clearly less active socially and continue to report a greater number of health problems, with corresponding diminished satisfaction in related areas.…”

Section: Discussionmentioning

confidence: 99%

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Natural course of life changes after spinal cord injury: a 35-year longitudinal study

Krause

Bozard

2011

Spinal Cord

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Objectives: To identify the natural course of changes in participation, employment, health and subjective quality of life over a 35-year interval among participants with spinal cord injury (SCI). Methods: Participants were enrolled in 1973 from a specialty hospital in the Midwestern United States and assessed again approximately 35 years later. The inclusion criteria were the following: having traumatic SCI; being 18 years of age or older; and a minimum of 2 years having elapsed post injury. There were 64 participants who responded on both occasions. Average age at follow-up was 61.5 years, with 41.1 years having passed since SCI onset. The Life Situation Questionnaire was used to measure outcomes. Results: Attrition analyses indicated that those who participated at follow-up were younger and had better overall outcomes at baseline (1973) when compared with those who dropped out of the study. Longitudinal analyses indicated a mixed pattern of favorable and unfavorable changes over the 35 years. The overall social participation decreased over time, although the sitting tolerance and hours spent in gainful employment increased. Non-routine physician visits increased. Satisfaction with employment improved over time, whereas satisfaction with social life, sex life and health declined. Self-reported adjustment improved, but the prediction of future adjustment in 5 years declined. Conclusion: Our study suggests that the natural course of SCI is marked by a survivor effect, whereby those with better outcomes are more likely to survive to follow-up, and a mixed pattern of favorable and unfavorable changes. Rehabilitation professionals should work to promote favorable outcomes in areas of strength, as well as minimize the likelihood of adverse outcomes. Spinal Cord (2012) 50, 227-231; doi:10.1038/sc.2011.106; published online 27 September 2011Keywords: spinal cord injury; aging; social participation; employment; quality of life; adjustment INTRODUCTIONSpinal cord injury (SCI) results in immediate and generally permanent changes to all aspects of life. The rehabilitation process is heavily focused on the time shortly after injury, including inpatient rehabilitation and transition to the community. However, life typically continues for years and even decades after SCI onset. What is the natural course of life changes after SCI? Answering this relatively simple and straightforward question requires a longitudinal investigation of changes in multiple life areas over time.It is tempting to conceptualize the natural course of SCI entirely in terms of aging. As the years pass, an individual's chronological age increases, but so does the number of years after injury. 1 Broader environmental changes also take place, such as those related to rehabilitation practices, medical and technological innovations, and funding practices. Longitudinal studies document the natural course of changes in life outcomes over a particular period of time reflecting a combination of factors, which may not easily be parceled into separate effects.Seve...

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Section: Discussionmentioning

confidence: 99%

“…4 Several reports on a longitudinal cohort have been reported over a 30-year interval. [5][6][7][8][9] Changes in outcomes have evolved over time. There has been a mixed pattern of favorable and unfavorable changes, with general improvements in employment outcomes, overall adjustment, and satisfaction with employment and finances.…”

Section: Introductionmentioning

confidence: 99%

Natural course of life changes after spinal cord injury: a 35-year longitudinal study

Krause

Bozard

2011

Spinal Cord

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“…[2][3]5 We found that LMP increases up to 15 years after SCI onset, but plateaus at around 40 with more than 80% of persons with SCI working, and this percentage falls afterwards. 8,19 Rather surprising is the low LMP of persons between 45 and 54, and who sustained their SCI 1 to 10 years before this study. (Figure 1).…”

Section: Discussionmentioning

confidence: 99%

“…5 Frequently found factors associated with LMP in SCI are gender, marital status, education, disability severity, age, time since onset of SCI, social support, vocational counselling, perceived health and pain. 2,3,[5][6][7][8][9] However, the existing evidence on determinants of LMP in SCI is inconsistent. Although in some studies injury severity and gender are associated with LMP, others show the contrary.…”

Section: Introductionmentioning

confidence: 99%

To work or not to work: labour market participation of people with spinal cord injury living in Switzerland

et al. 2012

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Study design: Cross-sectional survey. Objectives: To establish labour market participation figures of persons with spinal cord injury (SCI) living in Switzerland and to investigate determinants and consequences of having paid work. Setting: Community. Methods: A survey among members of the Swiss Paraplegic Association was performed in 2008. Inclusion criteria were: SCI of traumatic or non-traumatic origin, minimum age of 18 years, and living in the community for at least 1 year. A total of 559 persons with SCI returned the questionnaire (response rate 27%), of which 495 (24%) fulfilled the eligibility criteria. Bivariate and logistic regression analyses were performed based on theoretical considerations and relevant determinants found in the literature. Results: Of the respondents of working age, 63.8% were involved in gainful employment. No significant difference between persons with para-and tetraplegia was observed. Logistic regression showed that employment was associated with age, time since onset of SCI, having worked at 2 years after initial rehabilitation, having received vocational counselling, having less pain, more years of education and more perceived importance of work. Working persons achieved a significantly higher total income. The most important reasons to work were not financial, but rather of social nature. Barriers to work were primarily health-related. Conclusions: We found a relatively high employment rate among the studied persons with SCI living in Switzerland. However, because of the low response, it is difficult to generalise this finding.

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“…The items were adapted from a checklist administered to unemployed participants in a previous study. 10 There is no data on test-retest reliability.…”

Section: Measurementioning

confidence: 99%

Barriers and facilitators to employment after spinal cord injury: underlying dimensions and their relationship to labor force participation

Krause

Reed

2010

Spinal Cord

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Study design: Cross-sectional survey. Objective: To identify barriers and facilitators to employment after spinal cord injury (SCI) and their relationship with labor force participation. Methods: Participants were initially identified through specialty hospitals in the Midwest and Southeastern United States of America. 781 adults with traumatic SCI, at least 1 year post-injury, and between the ages of 18-64, participated. A 30-item instrument on barriers and facilitators to employment was administered. Analyses included exploratory factor analysis (EFA), confirmatory factor analysis (CFA) and comparisons of scores as a function of employment status. Results: EFA indicated six primary themes (root mean square error of approximation (RMSEA) ¼ 0.040), including: (a) resources, (b) health status, (c) disability considerations, (d) lack of importance, (e) disincentives and (f) motivation. CFA indicated an acceptable fit (RMSEA ¼ 0.078). Univariate analyses indicated each item and factor was significantly different as a function of labor force participation. After controlling for biographical and injury factors, multinomial logistic regression indicated three factors significantly differentiated those never employed, those currently unemployed but had worked since injury and those currently employed. Those employed reported higher scores for resources and motivation and lower scores for lack of importance. Conclusions: Barriers and facilitators were consistently related to labor force participation, with facilitators more highly related to labor force participation than barriers. Although loss of financial and medical benefits (disincentives) as well as health status have been reported as barriers to employment, they were not as highly correlated with labor force participation as were other factors.

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Aging After Spinal Cord Injury: A 30-Year Longitudinal Study

Cited by 61 publications

References 14 publications

Natural course of life changes after spinal cord injury: a 35-year longitudinal study

Natural course of life changes after spinal cord injury: a 35-year longitudinal study

To work or not to work: labour market participation of people with spinal cord injury living in Switzerland

Barriers and facilitators to employment after spinal cord injury: underlying dimensions and their relationship to labor force participation

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