Ageing, functioning patterns and their environmental determinants in the spinal cord injury (SCI) population: A comparative analysis across eleven European countries implementing the International Spinal Cord Injury Community Survey

PLoS ONE, 2023 · DOI: https://doi.org/10.1371/journal.pone.0284420 · Published: April 20, 2023

Simple Explanation

This study investigates how ageing affects people with Spinal Cord Injury (SCI) across eleven European countries. It looks at how their physical and social functioning changes with age, time since injury, and the environment they live in. The researchers used a common measure of functioning to compare people with SCI across different countries. They also looked at environmental factors, such as accessibility and support services, that affect how well people with SCI can function. The study found that older age is generally associated with a decline in functioning for people with SCI, especially those with paraplegia. The environment plays a significant role, with accessibility issues being a major barrier to functioning.

Study Duration

Not specified

Participants

6’635 participants with Spinal Cord Injury

Evidence Level

Cross-sectional study

Key Findings

1
Older chronological age was consistently associated with a decline in functioning for paraplegia but not for tetraplegia in countries with representative samples.
2
Age at injury and functioning level were associated, but patterns differed across countries, with lower functioning becoming more evident from a certain age at injury on.
3
Problems with the accessibility of homes of friends and relatives, access to public places and long-distance transportation were consistently key determinants of functioning.

Research Summary

This study describes functioning patterns of the SCI population in light of chronological age, age at the time of the injury, and time since injury as well as to identify environmental determinants of functioning. Enhancing methods traditionally used by WHO with machine learning techniques, we were able to create a common functioning metric with cardinal properties and to estimate corresponding overall scores of functioning comparable across the eleven countries. Focusing on functioning, our study complements epidemiological evidence on SCI-specific mortality and morbidity in Europe and identify initial targets for evidence-informed policy-making.

Practical Implications

Inform Policy-Making

The ranking of the impact of the environment on functioning is especially relevant for policy-makers to prioritize policies and public health actions.

Improve Accessibility

Promote or modify existing accessibility laws targeting infrastructure. House modifications or access to public spaces can have important benefits in the activity and participations of persons with SCI

Address Long-Term Care

Existing long-term care policies need to be adapted to cope with the increasing number of people in need of care. In the case of SCI, long-term care is even more relevant because requires some level of expertise

Study Limitations

1
Six countries used convenience sampling, leading to a high risk of bias.
2
The study has a cross-sectional design, limiting the ability to model functioning trajectories over time.
3
The analyses of contextual factors presented in this study is quite broad; a more in-depth analyses of environmental factors is recommended.

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