Date Presented 4/1/2017
While all persons with spinal cord injury (SCI) decreased in their activity of daily living function over 20 yr, those with C1–C4 SCI decreased the most compared with C5–C7 and T1–S5. Based on these findings, long-term occupational therapy intervention may be beneficial, especially for individuals with C1–C4 SCI.
Primary Author and Speaker: Chih-Ying (Cynthia) Li
Additional Authors and Speakers: Craig Velozo, Ickpyo Hong, Jill Newman
PURPOSE: It is crucial to offer continuous care to restore or maintain comprehensive daily function for persons with spinal cord injury (SCI) since SCI could have a longitudinal and chronic impact on different areas of life (Ullrich et al., 2012). For an SCI population, the duration of mobility activities and the intensity of everyday activity dropped dramatically after discharge from the hospital, although a similar activity level was retained 1 yr after discharge (van den Berg-Emons et al., 2008). Despite the fact that it is important to understand changes in activities of daily living (ADLs) after SCI across the lifespan, studies of this kind have been limited. Thus, this study aims to investigate longitudinal changes in ADLs for individuals who survive 20 years after the first SCI incidence.
DESIGN: We conducted secondary data analysis of 20-yr longitudinal data from a larger 40-yr prospective research project. All participants lived in the community at the time of enrollment. We categorized participants into three groups based on their injury level: C1–C4 (cervical), C5–C7 (cervical), and T1–S5 (thoracic, lumbar, and sacral). We first examined factor structure and item-level psychometrics of the developed SCI ADL scale and then investigated changes in ADL function from 1993 to 2013.
METHOD: Mplus 7.1 (Los Angeles) was used for exploratory factor analysis and residual correlation matrix. Winsteps 3.91 (Chicago) was used for principal component analysis of Rasch residuals and Rasch analysis (rating scale model) after one factor structure was validated. We examined fit statistics, rating scale diagnoses (e.g., monotonicity), and precision (person strata and person reliability). SAS 9.4 (SAS Institute, Cary, NC) was used to conduct descriptive analyses, general linear models, linear mixed model, and post hoc analyses to identify significant differences and main effects between and within groups across time.
RESULTS: Twenty-nine individuals with C1–C4, 161 individuals with C5–C7, and 181 individuals with T1–S5 SCI survived after 20 yr (total N = 371). The mean age of this sample in 1993 was 36.9 years (SD = 10.7), and the majority were male (67.7%), White (79.8%), non-Hispanic (91.1%), and married (41.2%) and had cervical injury (51.2%). The SCI ADL scale was essential unidimensional (comparative fit index = 0.996, Tucker–Lewis Index = 0.994, root mean square error of approximation = 0.104; all factor loadings >0.64; Rasch dimension explained 74.1% variance, and eigenvalue of first contrast was 1.95), with person strata of 3.45 and person reliability of 0.85. No violation of rating scale criteria was noticed. Three items misfit the Rasch model (walking, transferring, and driving) but were retained for psychometric and clinical purposes. There was a significant interaction effect between group and time (p < .05). All groups showed significant drops in self-reported ADL scale scores over time. T1–S5 had the highest mean ADL score, followed by C5–C7, and C1–C4 had the lowest mean ADL score at both time points. All groups had significantly different ADL person measures from each other across time, except C1–C4 and C5–C7 at the time point of 1993.
CONCLUSION: Understanding functional patterns of SCI across time, especially the ability to perform daily activities, is an essential first step to predict, monitor, and improve long-term recovery for individuals with SCI.
IMPACT STATEMENT: This study found that the SCI ADL scale could be used to detect ADL changes over 20 yr for the SCI population. Based on these findings, long-term occupational therapy intervention and consultation may be beneficial, especially for individuals with C1–C4 SCI.
References
Ullrich, P. M., Spungen, A. M., Atkinson, D., Bombardier, C. H., Chen, Y., Erosa, N. A., & Tulsky, D. S. (2012). Activity and participation after spinal cord injury: State-of-the-art report. Journal of Rehabilitation Research and Development, 49, 155–174. https://doi.org/10.1682/JRRD.2010.06.0108
van den Berg-Emons, R. J., Bussmann, J. B., Haisma, J. A., Sluis, T. A., van der Woude, L. H., Bergen, M. P., & Stam, H. J. (2008). A prospective study on physical activity levels after spinal cord injury during inpatient rehabilitation and the year after discharge. Archives of Physical Medicine and Rehabilitation, 89, 2094–2101. https://doi.org/10.1016/j.apmr.2008.04.024
