How are race, cultural, and psychosocial factors associated with outcomes in Veterans with spinal cord injury?

Publication date: Available online 25 January 2017
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Larissa Myaskovsky, Shasha Gao, Leslie RM. Hausmann, Kellee R. Bornemann, Kelly H. Burkitt, Galen E. Switzer, Michael J. Fine, Samuel L. Phillips, David Gater, Ann M. Spungen, Michael L. Boninger
ObjectiveTo understand the role of cultural and psychosocial factors in the outcomes of Veteran wheelchair users with spinal cord injury (SCI) to help clinicians identify unique factors faced by their patients and help researchers identify target variables for interventions to reduce disparities in outcomes.DesignCross-sectional cohort studySettingThree urban VA Medical Centers affiliated with academic medical centers.ParticipantsOf the 516 patients who were eligible to participate, 482 completed the interview and 439 had SCI. Due to small numbers in other race groups, analyses were restricted to white (WH) and African American (AA) participants, resulting in a final sample of 422.InterventionNAMain outcome measuresQuality of life (QOL, Veterans RAND 12 Item Health Survey); satisfaction (Client Satisfaction Questionnaire); and participation (Craig Handicap Assessment and Reporting Technique Short Form – CHART SF)ResultsAA Veterans reported poorer physical QOL, but better mental QOL than did WH. No other significant race differences were found in unadjusted analyses. Multivariable analyses showed that psychosocial factors were predominantly associated with patients' QOL outcomes and satisfaction with service, but demographic and medical factors were predominantly associated with participation outcomes. Interaction analyses showed that there was a stronger negative association between anxiety and mental QOL for AA than for WH, and a positive association between higher self-esteem and social integration for WH but not AA.ConclusionsFindings suggest that attempts to improve the outcomes of Veterans with SCI should focus on a tailored approach that emphasizes patients' demographic, medical, and psychosocial assets (e.g., building their sense of self-esteem or increasing their feelings of mastery), while providing services targeted to their specific limitations (e.g., reducing depression and anxiety).



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