Article
Outcomes after spinal cord injury: comparisons as a function of gender and race and ethnicity 1☆,

https://doi.org/10.1016/S0003-9993(03)00615-4Get rights and content

Abstract

Krause JS, Broderick L. Outcomes after spinal cord injury: comparisons as a function of gender and race and ethnicity. Arch Phys Med Rehabil 2004;85:355–62.

Objective

To identify gender and racial and ethnic differences in subjective well-being (SWB), participation, and general health ratings in participants with spinal cord injury (SCI).

Design

A multisite, cross-sectional study that used stratified sampling to identify and maximize participation among groups of people traditionally underrepresented in SCI research.

Setting

Four Model Spinal Cord Injury Systems participated in the data collection. The primary site was a large southeastern specialty hospital; the other 3 were in the western and mountain regions of the United States.

Participants

A total of 512 participants, 475 of whom were included in the analysis. This group included relatively equal portions of whites, African Americans, American Indians, and Hispanics. Approximately 40% of the sample was women.

Interventions

Not applicable.

Main outcome measures

The primary outcome measures included 2 measures of SWB (Life Situation Questionnaire-Revised, Older Adult Health and Mood Questionnaire), 1 measure of participation (Craig Handicap Assessment and Reporting Technique), and several items from the Behavioral Risk Factor Surveillance System.

Results

The majority of racial and ethnic differences in SWB related to specific life areas (eg, economics, employment), rather than more global outcomes (eg, engagement, health), with whites generally reporting the best outcomes, followed by African Americans. American Indians, and whites generally reported the highest participation scores, whereas limited differences were noted between the racial and ethnic groups on health indicators. Women reported lower satisfaction with health, more poor mental health days, and lower SWB related to home life, but higher SWB related to interpersonal relations.

Conclusions

There are racial and ethnic differences in outcomes after SCI focused primarily on subjective outcomes in areas in which racial and ethnic minorities have traditionally been disadvantaged. The results of this study direct rehabilitation professionals to the outcomes that need to be targeted for intervention to eliminate inequities in outcomes for all persons with SCI.

Section snippets

Subjective well-being

On returning to community settings, people with SCI face many difficult issues, including the need to maintain health, to avoid secondary conditions, and to maximize quality of life (QOL). Fuhrer6 has outlined 2 key aspects of QOL: participation and subjective well-being (SWB). The first component of QOL, participation in community activities, may be objectively measured by identifying an individual’s actions—what an individual does or how the individual spends his/her time. It is essentially

Summary of research

It is clear that our understanding of the role of race-ethnicity and gender and SCI outcomes is restricted by virtue of the limited number of outcome studies with these populations. There has been a lack of systematic investigation of outcomes as a function of gender and race and ethnicity, with most studies of racial and ethnic minorities focusing solely on African-American participants. What are most clearly absent are investigations that compare outcomes among multiple racial and ethnic

Purpose

The purpose of this study was to generate data on 3 sets of community outcomes after SCI to compare outcomes as a function of gender and race and ethnicity. The 3 types of outcomes were SWB, community integration, and self-reported health. Unlike previous research, we compared 4 racial and ethnic groups in the same study (white, African American, Hispanic, American Indian). We also compared multiple outcomes in a single study; this represents a significant enhancement over previous research.

Participants

This study was specifically designed to identify similar percentages of participants from a diverse range of characteristics. A stratified sampling procedure was used to oversample groups generally underrepresented in SCI research, with the highest priority for race and ethnicity, followed by gender, and then age. In other words, attempts were made to maximize participation among diverse racial and ethnic minorities. If a sufficient pool of prospective participants was available within a

Subjective well-being

The results of the MANOVA (table 2) indicated that both main effects and the interaction effects were significant using Wilks’ λ (gender: F9,334=3.263, P=.001; race: F27,976=3.935, P<.000; interaction: F27,976=1.961, P<.01). Univariate tests with post hoc contrasts helped to identify the nature of the differences on the SWB outcomes (table 3).

Of the 7 SWB scales, 6 were significantly related to race and ethnicity (except for health problems), whereas only 2 were significantly related to gender

Discussion

Our study was designed to identify outcomes across a diversity of groups, including those typically underrepresented in SCI research (ie, women and racial and ethnic minorities). As such, this study generated basic comparative data on gender and racial and ethnic differences that may lay a foundation for enhancing our understanding of why these differences occur and the development of interventions that target areas in which outcomes are particularly poor.

The 4 study hypotheses were all

Conclusions

Although this study lays a solid foundation for our beginning to understand differences in outcomes among underrepresented groups, clearly more research needs to be conducted. Future research would benefit from the longitudinal design that tracks outcomes over time among each cohort of participants to determine how their outcomes change with environmental changes. It would also be beneficial to investigate specific environmental or cultural factors that may be associated with differential

Acknowledgements

We thank the following people, without whose contributions completion of this article would not have been possible: Glenn Allen, Marc Downes, Minna Hong, Samuel Jones, Sarah Lottes, and Christopher Spankovich from the Shepherd Center.

References (31)

  • M.J. Fuhrer

    The subjective well-being of people with spinal cord injuryrelationships to impairment, disability and handicap

    Top Spinal Cord Inj Rehabil

    (1996)
  • J.S. Krause

    Changes in adjustment after spinal cord injurya 20-year longitudinal study

    Rehabil Psychol

    (1998)
  • M. Davis et al.

    Self-concept as an outcome of spinal cord injurythe relation of race, hardiness and locus of control

    SCI Psychosoc Process

    (1995)
  • F.Z. Belgrave

    Psychosocial predictors of adjustment to disability in African-Americans

    J Rehabil

    (1991)
  • M.J. Fuhrer et al.

    Depressive symptomatology in persons with spinal cord injury who reside in the community

    Arch Phys Med Rehabil

    (1993)

    • Cited by (0)

    ☆

    Supported by the National Institute for Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, US Department of Education (grant no. H133G20200-93).

    1

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

    View full text
    Copyright © 2004 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.