Quality of life and adaptation in people with spinal cord injury: Response shift effects from one to five years’ post-injury

Publication date: Available online 2 March 2018
Source:Archives of Physical Medicine and Rehabilitation
Author(s): Carolyn E. Schwartz, Brian Stucky, Carly S. Rivers, Vanessa K. Noonan, Joel A. Finkelstein
ObjectiveTo investigate response shift effects in spinal cord injury (SCI) over five years' post-injury.DesignProspective cohort study observed at one-, two- and five-years post-SCI.Setting31 specialized Canadian SCI centersParticipantsSample included 1125, 760, and 219 at one-, two-, and five-years post-SCI.InterventionsNAMain Outcome MeasuresPatient-reported outcomes included the Short-Form 36v2, and the Life Satisfaction-11. Participant latent variable scores were adjusted for: (1) potential attrition bias; and (2) propensity scores reflecting risk of worse outcomes. Oort's Structural Equation Modeling approach for detecting and accounting for response shift effects was used to test the hypothesis that people with SCI would undergo response-shifts over follow-up.ResultsThe study sample was 79% male; 39% were motor/sensory complete (mean age 44.6, sd 18.3). The study data comprised the time after Functional Independence Measure (FIM) scores, an objective measure of motor and cognitive function, had improved and stabilized. Three latent variables (Physical, Mental, and Symptoms) were modeled over time. The response-shift model indicated uniform recalibration and reconceptualization response shift effects over time. When adjusted for these response-shift effects, Physical showed small 'true change' improvements at two- and five-year follow-ups, despite FIM stability.ConclusionsWe detected recalibration and reconceptualization response shift effects in one to five-year follow-up of people with SCI. Despite stable motor and cognitive function, people with SCI are adapting to their condition. This adaptation reflects a progressive disconnection between symptoms and physical or mental health, and a real improvement in the Physical latent variable.



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