Examining the complexity of functioning in persons with spinal cord injury attending ﬁrst rehabilitation in Switzerland using structural equation modelling

Spinal Cord, 2020 · DOI: https://doi.org/10.1038/s41393-020-0428-4 · Published: February 13, 2020

Spinal Cord Injury Participation Rehabilitation

Simple Explanation

This study explores the complex factors affecting how well people with spinal cord injuries (SCI) can function during their initial rehabilitation in Switzerland. It looks at how body functions, mental health, and daily activities are interconnected, using a model called the International Classiﬁcation of Functioning, Disability and Health (ICF). The goal is to better understand these connections so that rehabilitation programs can be designed to meet the specific needs of individuals with SCI.

Study Duration

Not specified

Participants

390 participants with newly acquired SCI

Evidence Level

Cross-sectional study

Key Findings

1
Pain significantly affects independence in daily activities through its relationship with depression, optimism, and self-esteem.
2
Direct effects on independence in performing ADL were mainly influenced by the level of injury and complications related to urinary, bowel, and skin functions.
3
Differences in aetiology groups were found for the structural model about anxiety, indicating that the cause of SCI may influence anxiety levels.

Research Summary

This study examined the associations between activities, body structures and functions, and their relationship with aetiology, age and sex in persons with spinal cord injury (SCI) at discharge from ﬁrst rehabilitation. Using structural equation modelling (SEM), indirect effects of body structures and functions on independence in performing ADL through mental functions were tested for each mental function separately. Using an ICF-based modelling approach, this study presents an attempt towards a more comprehensive understanding of functioning in ﬁrst rehabilitation of persons with SCI, which might be fundamental for rehabilitation planning.

Practical Implications

Rehabilitation Planning

The study highlights the importance of considering mental functions, especially pain, in rehabilitation planning for individuals with SCI.

Targeted Interventions

Interventions should focus on managing pain and promoting optimism and self-esteem to improve independence in daily activities.

Aetiology-Specific Approaches

Rehabilitation strategies may need to be tailored based on the cause of SCI to address specific mental health concerns like anxiety.

Study Limitations

1
The measurement models for anxiety, depression and self-esteem are lacking good ﬁt in terms of the P value of the χ2 test statistic which is leading to unknown bias in the corresponding structural models
2
The results of this study are not generalisable and should be cross-validated.
3
The cross-sectional design of the study does not allow for causal conclusions.

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