Functioning and disability in people living with spinal cord injury in high- and low-resourced countries: a comparative analysis of 14 countries

Abstract

Objectives We examined whether persons with spinal cord injury (SCI) from countries with differential resources and resource distribution differ in the level and structure of functioning and disability. Methods We analysed cross-sectional data of 1,048 persons with SCI from 14 countries based on the International Classification of Functioning, Disability and Health (ICF). We used penalized logistic regression to identify ICF categories distinguishing lower-and higher-resourced countries. Hierarchical linear models were employed to predict the number of problems in functioning. The association structure of ICF categories was compared between higher-and lower-resourced countries using graphical models.Results A total of 96 ICF categories separated lower-and higher-resourced countries. Differences were not univocal. Lower resources and unequal distribution were predictive of more functional problems in persons with higher age or tetraplegia. In the graphical models, few associations between ICF categories persisted across countries. Conclusion Higher-resourced countries do not score higher in all ICF categories. Countries' economic resources and their distribution are significant predictors of disability in vulnerable groups such as tetraplegics and the elderly. Functioning is multi-dimensional and structures of association suggest that country-specific pathways towards disability exist.

Pressure ulcers in people with spinal cord injury in developing nations

“…8 Finally, care providers, and especially international aid organizations, need to understand and operate within the context of their patients' lives. In a comparative analysis of people living with SCI in 14 countries representing all WHO world regions (Thailand, India, Vietnam, Malaysia, Denmark, Germany, Switzerland, New Zealand, Australia, Israel, USA, Canada, Brazil and South Africa), Reinhardt et al 72 noted, 'health professionals know only little about the environment of their patient,' a situation likely to breed unrealistic expectations of how one is to care for oneself once living at home. Indeed, even if 'first-world' care is provided to a patient in the hospital, these efforts will go to waste if the necessary care cannot be continued after discharge.…”

Study Protocol of the International Spinal Cord Injury (InSCI) Community Survey

“…1 Yet, data about health system performance and economic resources of a country are of particular importance to understanding the societal response and may point to possible inequalities between countries. 40 To determine the societal response to the lived experience of persons with SCI, variables on the health care and rehabilitation system as well as economic resource variables of the 28 participating countries have been collected and will be integrated into the statistical modeling to determine the influence of the health system on the lived experience of SCI within and between countries. 24 Finally, it is important to mention that insights gained from InSCI alone will not be a complete guide to reforming practice, research, and policy in the field of disability and rehabilitation.…”

“…First, the perceived lived experience of people with SCI (the person's perspective) will be analyzed with regard to items of the InSCI questionnaire, which will then be contrasted to variables of the health system to determine the influence of the countries' health systems on the lived experience (the societal perspective). 40 To achieve this, the analysis plan will analyze both the person's perspective and the societal perspective separately, as follows: 1) Data analysis plan for the lived experience and participation in the society-the person's perspective First, functioning profiles across all functioning domains based on the prevalence of functioning problems among the population with SCI will be created. Heat graphs 41 will be used to visualize the extent of functioning problems in both, SCI samples and SCI subgroups identified as meaningful for comparing information across different countries, namely, SCI type (tetraplegia, paraplegia), etiology (traumatic and nontraumatic), SCI degree (complete/ incomplete), age (16-30 years, 31-45 years, 46-60 years, 61-75 years, and 76 years or older), and sex (male, female).…”

“…However, as comprehensive registries on persons with SCI are lacking in many countries, such random samples are hard to obtain; and this limits the representativeness of the sampling frames. 40 To guarantee feasibility and best possible adjustment to local conditions, national study groups develop country-specific strategies regarding sampling frames and sampling modes within the given InSCI guidelines. This flexibility ensures that the targeted minimal sample size of 200 eligible participants per country can be reached.…”

Determining the Most Robust Dimensional Structure of Categories from the International Classification of Functioning, Disability and Health Across Subgroups of Persons With Spinal Cord Injury to Build the Basis for Future Clinical Measures

“…Country resources were defined according to their gross domestic product and their Gini index in 2007. 17 Twenty seven participants dropped out from the age group analysis because their ages were unknown.…”