Department of Physical Medicine and Rehabilitation, University of Pittsburgh, School of Medicine, Pittsburgh, PA; Center of Excellence in Wheelchairs and Associated Rehabilitation Engineering, VA Pittsburgh Healthcare System, Pittsburgh, PA.
OBJECTIVE: To 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.
DESIGN: Cross-sectional cohort study SETTING: Three urban VA Medical Centers affiliated with academic medical centers. PARTICIPANTS: Of 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. INTERVENTION: NA MAIN OUTCOME MEASURES: Quality 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) RESULTS: AA 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.
CONCLUSIONS: Findings 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).