Relationships of self-reported opioid and benzodiazepine use with health-related quality of life among adults with spinal cord injury.

BACKGROUND: There is limited understanding of the relationships between prescription opioid and benzodiazepine use and indices of health-related quality of life (HRQOL) among those with spinal cord injuries (SCI). OBJECTIVE: To identify the relationships between self-reported prescription opioid and benzodiazepine use and two indicators of HRQOL, number of days in poor physical health and poor mental health in the past 30 days among adults with SCI. METHODS: A cross-sectional cohort study of 918 adults with chronic (>1 year), traumatic SCI living in the Southeastern United States was conducted. Participants completed a self-report assessment (SRA). RESULTS: In the preliminary model, both opioid and benzodiazepine use were associated with a greater number of days in poor physical health and poor mental health in the past month. After controlling for health conditions (pain intensity, spasticity, anxiety and perceived sleep insufficiency), opioid use was associated with 2.04 (CI = 0.69; 3.39) additional poor physical health days in the past 30 days, and benzodiazepine use was associated with 2.18 (CI = 0.70; 3.64) additional days of poor mental health. Age was associated with greater number of poor physical health days and fewer poor mental health days. Lower income was associated with poor mental health days. Most of the health conditions were significantly related to the number of past month poor physical and mental health days. CONCLUSIONS: Opioid and benzodiazepine use are associated with poor physical and mental HRQOL, even after controlling for health conditions. Treatment strategies should consider potential unanticipated negative consequences of pharmacological interventions.

All day in bed, all night in the wheelchair: Unmet attendant care needs of people with spinal cord injury.

CONTEXT: Having dependable attendant care is essential to the health and well-being of those most severely impacted by a spinal cord injury (SCI). Our objective was to identify how often people with SCI who require assistance for transfers either spend a full day in bed or all night in a wheelchair because they do not have paid or unpaid assistance. FINDINGS: Of the 918 respondents, 319 (34.7%) indicated they needed someone's help for basic activities of daily living and 229 (24.9%) relied on someone's assistance for wheelchair-to-bed transfers. Nearly a quarter of participants (22.2%) reported staying in bed all day for at least one once on during the past year, with a median of 10 times among those with at least one day. Men reported a higher rate than women (25.6%, 13.6%) and nonwhites-Hispanics (33.3%) reported a higher percentage than non-Hispanic whites (18.6%). Just over one in every 20 participants (5.3%) reported staying in the wheelchair at least one night because they did not have attendant care, with a median of 2.5 times among those with at least one night. Over one in 10 (11.7%) nonwhites and Hispanics reported at least one overnight in the wheelchair compared with only (3.1%) for non-Hispanic whites. CONCLUSION/CLINICAL RELEVANCE: Staying in bed all day and staying in the chair all night due to lack of attendant care represents a breakdown in the attendant care system and a threat to the well-being of those with SCI, particularly nonwhites and Hispanics, and men.

Longitudinal Comparisons in Health, Participation, Life Satisfaction, and Depressive Symptoms From Pre- to Post-COVID-19 Pandemic Among People With Spinal Cord Injuries.

OBJECTIVE: To identify changes in health, health care utilization, participation, life satisfaction, and depressive symptoms from before the coronavirus disease 2019 pandemic to after among ambulatory and nonambulatory participants with spinal cord injury. DESIGN: Longitudinal study with the first measurement taken within 3 months prior to pandemic restrictions and 2 follow-ups at approximately 1-year intervals. SETTING: Medical university. PARTICIPANTS: Adult participants (N=219) with spinal cord injury, including ambulatory (n=155) and nonambulatory (n=64). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-report assessment of health outcomes from the Behavioral Risk Factor Surveillance System; health service utilization including physician visits, emergency department visits, and hospitalizations; items from the Craig Handicap Assessment Reporting Technique; 3 life satisfaction scales from the Life Situation Questionnaire; and the brief version of the Patient Health Questionnaire. RESULTS: After using a z score correction for nonnormality, none of the time effects or interaction effects of time by ambulatory status were significant. Six comparisons between ambulatory and nonambulatory were statistically significant. Ambulatory participants reported 3 more days in poor physical health (P=.02; statistically significant) and 2 more days feeling worried, tense, or anxious in the last 30 days (P=.03). They visited the emergency department on 0.3 fewer occasions (P=.02) while reporting leaving the house 1 more day every week (P=.02), 2 hours more of sitting tolerance (P<.01), and 1 higher score of vocational satisfaction (P=.03). CONCLUSIONS: The absence of statistically significant changes from before to after the pandemic and the absence of time by ambulatory status interactions suggest stability of outcomes, even in the presence of pandemic challenges.

Relations Between Self-Reported Prescription Hydrocodone, Oxycodone, and Tramadol Use and Unintentional Injuries Among Those With Spinal Cord Injury.

OBJECTIVE: To identify the relations of 3 frequently used prescription opioids (hydrocodone, oxycodone, tramadol) with unintentional injuries, including fall-related and non-fall-related injuries among adults with chronic, traumatic spinal cord injury (SCI). DESIGN: Cross-sectional cohort study. SETTING: Community setting; Southeastern United States. PARTICIPANTS: Adult participants (N=918) with chronic traumatic SCI were identified from a specialty hospital and state population-based registry and completed a self-report assessment. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Self-reported fall-related and non-fall-related unintentional injuries serious enough to receive medical care in a clinic, emergency room, or hospital within the previous 12 months. RESULTS: Just over 20% of participants reported ≥1 unintentional injury in the past year, with an average of 2.16 among those with ≥1. Overall, 9.6% reported fall-related injuries. Only hydrocodone was associated with any past-year unintentional injuries. Hydrocodone taken occasionally (no more than monthly) or regularly (weekly or daily) was related to 2.63 (95% confidence interval [CI], 1.52-4.56) or 2.03 (95% CI, 1.15-3.60) greater odds of having ≥1 unintentional injury in the past year, respectively. Hydrocodone taken occasionally was also associated with past-year non-fall-related injuries (OR, 2.20; 95% CI, 1.12-4.31). Each of the 3 opioids was significantly related to fall-related injuries. Taking hydrocodone occasionally was associated with 2.39 greater odds of fall-related injuries, and regular use was associated with 2.31 greater odds. Regular use of oxycodone was associated with 2.44 odds of a fall-related injury (95% CI, 1.20-4.98), and regular use of tramadol was associated with 2.59 greater odds of fall-related injury (95% CI, 1.13-5.90). CONCLUSIONS: Injury prevention efforts must consider the potential effect of opioid use, particularly hydrocodone. For preventing fall-related injuries, each of the 3 opioids must be considered.

Self-Reported Prescription Opioid Use Among Participants with Chronic Spinal Cord Injury.

Background: Individuals with spinal cord injuries (SCI) experience high rates of prescription opioid use, yet there is limited data on frequency of opioid use and specific medications being taken. Objectives: To examine the frequency of self-reported prescription opioid use among participants with SCI and the relationship with demographic, injury, and socioeconomic characteristics. Methods: A cohort study of 918 adults with SCI of at least 1-year duration completed a self-report assessment (SRA) that indicated frequency of specific prescription opioid use based on the National Survey on Drug Use and Health (NSDUH). Results: Forty-seven percent of the participants used at least one prescription opioid over the last year; the most frequently used was hydrocodone (22.1%). Nearly 30% used a minimum of one opioid at least weekly. Lower odds of use of at least one opioid over the past year was observed for Veterans (odds ratio [OR] = 0.60, 95% CI = 0.38, 0.96) and those with a bachelor's degree or higher (OR = 0.63, 95% CI = 0.44, 0.91). When restricting the analysis to use of at least one substance daily or weekly, lower odds of use was observed for those with a bachelor's degree or higher and those with income ranging from $25,000 to $75,000+. None of the demographic or SCI variables were significantly related to prescription opioid use. Conclusion: Despite the widely established risks, prescription opioids were used daily or weekly by more than 28% of the participants. Usage was only related to Veteran status and socioeconomic status indicators, which were protective of use. Alternative treatments are needed for those with the heaviest, most regular usage.

A 5-year longitudinal structural equation model of social isolation and probable major depression among participants with spinal cord injury.

OBJECTIVE: To develop longitudinal structural models of social isolation and probable major depression (PMD) over a 5-year interval among participants with spinal cord injury (SCI). DESIGN: Longitudinal structural equation modeling of self-report assessments collected during two follow-ups (2013 as Time 1, 2018 as Time 2) of a 45-year multicohort longitudinal study. Participants (n = 557) were identified from a specialty hospital in the Southeastern United States and two Midwestern hospitals and were initially enrolled in 1973-1974, 1984-1985, 1993-1994, or 2003-2004. PMD symptomology was measured by the Patient Health Questionnaire-9 (PHQ-9) and was defined by PHQ-9 scores ≥ 10. Social isolation was represented by two latent dimensions: social disconnectedness, objective component measured by activities, and perceived isolation, based on subjective appraisals. Structural equation modeling assessed the relationship among social disconnectedness and perceived isolation measured at Time 1 and PMD measured at Times 1 and 2. RESULTS: Both social disconnectedness and perceived isolation, measured at Time 1, were significantly related with PMD measured at Time 1 (rSD_Time 1 and PMD_Time 1 = .49, p < .001; rPI_Time 1 and PMD_Time 1 = .66, p < .001) and Time 2 (rSD_Time 1 and PMD_Time 2 = .37, p < .001; rPI_Time 1 and PMD_Time 2 = .54, p < .001), indicating participants with greater perceived isolation and social disconnectedness were more likely to have greater likelihood of PMD, both cross-sectionally and longitudinally. Perceived isolation was more strongly related to PMD compared with social disconnectedness. CONCLUSION: Social isolation was associated with both current and future depression symptoms. People with more years post-SCI were less likely to have PMD. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Relationships of Self-reported Opioid Use and Misuse and Pain Severity With Probable Major Depression Among Participants With Spinal Cord Injury.

OBJECTIVES: To examine the relations of pain intensity, opioid use, and opioid misuse with depressive symptom severity and probable major depression (PMD) among participants with spinal cord injuries (SCI), controlling for demographic, injury, and socioeconomic characteristics. STUDY DESIGN: Cohort study. SETTING: Medical University in the Southeastern United States (US). PARTICIPANTS: Participants (N=918) were identified from 1 of 2 sources including a specialty hospital and a state-based surveillance system in the Southeastern US. Participants were a minimum of 18 years old at enrollment and had SCI with non-complete recovery. Participants were on average 57.5 years old at the time of the study and an average of 24.4 years post SCI onset. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participants completed a self-report assessment that included frequency of prescription opioid use and misuse, based on the National Survey on Drug Use and Health (NSDUH), and the PHQ - 9 to measure depressive symptom severity and PMD. RESULTS: Opioid use, opioid misuse, and pain intensity were related to elevated depressive symptom severity and higher odds of PMD. Non-Hispanic Blacks had fewer depressive symptoms and lower odds of PMD, as did those with higher incomes. Veterans had lower risk of PMD, whereas ambulatory participants had a higher risk of PMD. Age at SCI onset had a mixed pattern of significance, whereas years of education and years since injury were not significant. CONCLUSIONS: The relation between pain intensity with depressive symptom severity and PMD was profound, consistent with the biopsychosocial model of pain. The greater risk of PMD and higher depressive symptom severity among those using opioids and misusing opioids raises further concern about long-term prescription opioid use. Alternative treatments are needed.

Validation of an eight-item resilience scale for inpatients with spinal cord injuries in a rehabilitation hospital: exploratory factor analyses and item response theory.

PURPOSE: People with spinal cord injury (PwSCI) can experience life changes, including impacts on their physical and mental health. PwSCI often report less life satisfaction and lower subjective well-being than peers without SCI. These challenges and adversities increase the demand on them to be more resilient. Healthcare providers need quick and valid instruments to assess adult patients' resilience in clinical settings. We aimed to validate the factor validity and discrimination ability of a resilience scale, CD-RISC-10, for clinical usage in adults with SCI during hospitalization. MATERIALS AND METHODS: 93 adults with SCI responded to the self-reported survey, including CD-RISC-10, the Patient Health Questionnaire-9 Scale (PHQ-9), the Satisfaction with Life Scale (SWLS), and the Intrinsic Spirituality Scale. We conducted descriptive statistics, exploratory factor analysis (EFA), and item response theory (IRT). RESULTS: Two items were deleted from CD-RISC-10 after EFA, forming CD-RISC-8. The item discriminations of the remaining eight items from the unconstrained IRT model ranged from a high of 3.071 to a relatively low 1.433. CD-RISC-8 is significantly related to PHQ-9 and SWLS. CONCLUSIONS: The factor validity of the CD-RISC-8 was improved. Significantly, the CD-RISC-8 has excellent potential for clinical usage due to its discriminant ability between low and intermediate resilience.

Spinal Cord InjuryPeople with spinal cord injury (PwSCI) experience unique challenges and adversities that can negatively affect physical, mental, social, and financial health and life satisfaction.PwSCI with higher resilience adapt to challenges quicker, and have better mental health outcomes and improved quality of life.The CD-RISC-8 is useful for screening PwSCI who need resilience intervention and it is sensitive enough to evaluate resilience improvement within two minutes.

Difficulty Obtaining Daily Necessities and Difficulty Obtaining SCI Services During the COVID-19 Pandemic Among People With Spinal Cord Injury.

OBJECTIVE: To describe the self-reported difficulties during the COVID-19 pandemic on the lives of persons with traumatic spinal cord injury (SCI), and to identify the factors measured prior the pandemic that predict the number of difficulties obtaining daily necessities and difficulties obtaining SCI services during the pandemic. DESIGN: Cohort study. SETTING: A state SCI outcomes follow-up database in the southeastern United States. PARTICIPANTS: 297 participants (N=297) met the following eligibility criteria: (1) ≥18 years of age, (2) traumatic SCI, (3) minimum of 1-year post-injury, and (4) having completed a longitudinal study questionnaire immediately prior to the pandemic (between 12/1/2019 and 03/11/2020). INTERVENTIONS: N/A. MAIN OUTCOME MEASURE(S): The outcome measures were the self-reported number of difficulties obtaining daily necessities (difficulties to get food, medication, and routine medical/dental care) and difficulties obtaining SCI services during the pandemic (difficulties to get treatment for SCI-related problems, to maintain regular SCI equipment, and to get SCI supplies). RESULTS: Among 297 eligible participants, 247 (83%) have completed the follow-up during the pandemic between December 2020 and December 2021. There were 22% participants having at least 1 difficulty obtaining daily necessities and 19% participants having at least 1 difficulty obtaining SCI services. Younger, ambulatory participants, cervical 1-4 injury level, lower household income, more health conditions, and no routine health care access prior to the pandemic were associated with greater number of difficulties obtaining daily necessities. Women, non-ambulatory participants, marital relation, having need for physical assistance, more health conditions, and no routine health care access prior to the pandemic related to greater number of difficulties obtaining SCI services. CONCLUSIONS: People with SCI have experienced living difficulties during the COVID-19 pandemic. Of particular importance, no routine health care access and more health conditions are related to more difficulties obtaining both daily necessities and SCI services after controlling the socio-demographics and injury characteristics.

Suicidal ideation among individuals aging with spinal cord injury.

OBJECTIVE: To identify the prevalence of suicidal ideation (SI) and its correlates among an aging cohort of people with spinal cord injury (SCI) with an average of more than three decades of having lived with SCI. RESEARCH METHOD: The study was a cross-sectional analysis of self-report assessment data. These data were collected from 2018 to 2019 during the most recent data collection period of the 45-year SCI Longitudinal Aging Study. Participants (n = 553) were identified from specialty and university hospitals in the southeastern and midwestern United States. The participants averaged 31 years since SCI onset, with an average age of 58 years. Participants were predominantly non-Hispanic, White (79%), male (70.1%), and had a cervical level SCI (51%). Approximately 23% of participants were ambulatory. SI was assessed using a nonzero response to the ninth item on the Patient Health Questionnaire-9. RESULTS: Over 14% of the sample endorsed experiencing recent SI. Bivariate analyses indicated that those with SI had greater pain severity, pain interference, depressive symptom severity, and frequency of anxiety. Having a cervical injury level, lower self-reported general health, instrumental social support, emotional social support, and fewer days spent outside the home were also associated with SI. Logistic regression analysis indicated that when all biopsychosocial variables were considered simultaneously, having a cervical-level injury and greater depressive symptom severity remained significantly associated with SI. CONCLUSION: The results of this study highlight the importance of continued assessment of depressive symptoms and SI as individuals age with SCI. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Pain interference and depressive symptom severity across 10 years in individuals with long-term spinal cord injury.

OBJECTIVE: To examine change in pain interference and depression over a 10-year time period in individuals with long-term traumatic spinal cord injury (SCI) and to identify the extent to which changes in pain interference over time predicts change in depressive symptoms. DESIGN: Longitudinal analyses of self-report assessment data. SETTING: Specialty and university hospitals in the Southeastern and Midwestern United States. PARTICIPANTS: Adults with a history of traumatic SCI (n = 504) who responded to the three most recent data collection periods of the SCI Longitudinal Aging Study (2008 [Time 1], 2013 [Time 2], and 2018 [Time 3]). The participants averaged 59 years of age and 32 years since injury onset at Time 3. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Patient Health Questionnaire (PHQ-9) assessed depressive symptom severity. The 7-item Pain Interference scale from the Brief Pain Inventory assessed pain interference. RESULTS: Over the three study timepoints, the sample averaged moderate levels of pain interference and mild depressive symptom severity. Unconditional linear growth models, reflecting changes in central tendency, indicated that pain interference significantly decreased and depressive symptom severity significantly increased over time. Multiple independent variables random coefficient modeling based on correlations suggested that change in pain interference was positively associated with change in depressive symptom severity over the 10-year study follow-up. CONCLUSION: Average depressive symptom severity worsened over time. Change in pain interference was positively associated with change in depressive symptom severity. These results point to the complexity of aging related changes in depressive symptoms and pain interference. They further support the need for continued assessment of mood and pain experiences, particularly among individuals reaching aging milestones with SCI.

Differences in personal characteristics and health outcomes between ambulatory and non-ambulatory adults with traumatic spinal cord injury.

OBJECTIVE: To identify differences in personal characteristics, health outcomes, and hospital utilization as a function of ambulatory status among adults with chronic SCI. DESIGN: Prospective cohort study linked to state administrative billing data. SETTING: Population-based SCI Registry from the Southeastern United States. PARTICIPANTS: 1,051 adults (>18 years old) with chronic (>1-year), traumatic SCI. OUTCOME MEASURES: The self-report assessment (SRA) included demographic, injury and disability characteristics, health status, psychological and behavioral factors, and participation and quality of life (QOL) variables. We linked cases to administrative billing data to assess hospital utilization, including Emergency Department (ED) visits and inpatient (IP) admissions (through the ED and direct IP) in non-federal state hospitals within the year following the SRA. RESULTS: There were 706 ambulatory and 345 non-ambulatory participants. We found significant differences across all sets of factors and significant differences in hospital utilization metrics. Ambulatory adults had fewer ED visits (36% vs 44%), IP admissions through the ED (11% vs 25%) and IP only admissions (9% vs 19%) and spent fewer days in the hospital for both admissions through the ED (0.9 vs 4.6 days) and IP only admissions (0.7 vs 3.1 days). They also reported having fewer past year ED visits (44% vs 62%) and IP admissions (34% vs 52%). CONCLUSIONS: We identified differences in personal characteristics, ED visits and IP admissions between ambulatory and non-ambulatory adults with SCI, providing a better understanding of the characteristics of those with SCI. The findings suggest the need for separate analyses based on ambulatory status when assessing long-term health outcomes including hospital utilization.

Feasibility and acceptability of a remote, hands-free cognitive battery for adults with traumatic spinal cord injury.

PURPOSE/OBJECTIVE: To evaluate the acceptability and feasibility of testing the cognitive abilities of adults with traumatic spinal cord injury (TSCI) via teleconference. RESEARCH DESIGN: Data were collected prospectively at two study sites from 75 adults living with TSCI. Participants completed a series of self-report measures via an online survey platform, in addition to a brief battery of cognitive testing administered via audio-video teleconference. Modifications were made to select measures to allow for hands-free administration of all tasks. RESULTS: Feasibility was demonstrated by a 97.4% completion rate among the 77 participants who began the cognitive testing and approximately normal distributions for nearly all cognitive testing variables examined. No ceiling or floor effects were observed across cognitive testing variables. Review of acceptability ratings indicated that participants found this approach to cognitive testing to be highly acceptable. CONCLUSION/IMPLICATIONS: Our findings provide evidence for the feasibility and acceptability of administering cognitive testing via teleconference to adults living with TSCI. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Assessment of high-risk opioid use metrics among individuals with spinal cord injury: A brief report.

OBJECTIVE: To examine high-risk opioid prescription metrics among individuals with chronic spinal cord injury (SCI) living in South Carolina. DESIGN: Cohort Study. SETTING: Two statewide population-based databases, an SCI Surveillance Registry and state prescription drug monitoring program (PDMP). PARTICIPANTS: Linked data was obtained for 503 individuals with chronic (>1year-post injury) SCI who were injured in 2013 or 2014 and who survived at least 3 years post-injury. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): Opioid prescription metrics were obtained from the PDMP. Fill data during the period between January 1, 2014 and December 31, 2017 were analyzed to assess high-risk opioid use. Outcomes included: percentage of individuals prescribed chronic opioids, high-dose chronic opioid therapy (daily morphine milligram equivalents (MME) ≥50 and ≥90), and chronic concurrent opioids and benzodiazepines, sedatives, or hypnotics (BSH). RESULTS: Over half (53%) of the individuals filled an opioid in years 2-3 after injury. Of those, 38% had a concurrent BSH fill during the study period, 76% of which were for benzodiazepines. In any given quarter over the two-year timeframe, over half of the opioid prescriptions were for 60 days or more (chronic opioid prescriptions). Of those, roughly 40% of the individuals had high-dose chronic opioid prescriptions ≥50 MME/d and 25% were ≥90 MME/d. Over 33% had a concurrent BSH prescription for ≥60 days. CONCLUSIONS: While the number of individuals receiving high-risk opioid prescriptions may not be large, it is a concerning number of prescriptions. The findings suggest a need for more cautious opioid prescribing and monitoring of high-risk use in adults with chronic SCI.

Perceived impact of the COVID-19 pandemic among people with spinal cord injury: A descriptive study.

Objective: To describe the self-reported impact of the COVID-19 pandemic on the lives of persons with spinal cord injury (SCI). Design: Cross sectional study. Participants: There were a total of 382 adult participants with traumatic SCI of at least one-year duration, all of whom were identified through a state-based surveillance registry in the Southeastern United States. The majority of participants were male (68.4%) and 72% were ambulatory. The average age at the time of the study was 57.7. Main Outcome Measures: Participants completed a self-report assessment (SRA) online or by mail on the impact of COVID-19 on quality-of-life, ability to get daily necessities, and access to healthcare. Results: Over half of the participants (58.9%) reported a negative impact of the pandemic in at least one of five life areas, with community participation being the primary area affected (51.4%). A small portion of individuals had trouble obtaining necessities, with approximately 12% reporting difficulties getting enough or quality food and 8.2% reporting difficulty getting prescription medications. However, 25% reported delaying healthcare procedures because of fear of catching COVID-19. Among those requiring personal assistance, 32% reported a decrease in quality of care and 51.9% relied more on family to assist with their care. Conclusions: The COVID-19 pandemic had multiple negative impacts. Of particular importance were reduced access to healthcare and declines in quality and stability of attendant care, with greater reliance on family. Fear of contracting COVID-19 when accessing routine medical procedures needs to be addressed in future outbreaks.

Longitudinal changes in employment, health, participation, and quality-of-life and the relationships with long-term survival after spinal cord injury.

STUDY DESIGN: Cohort study. OBJECTIVE: To identify five-year longitudinal changes in employment, health, participation, and quality-of-life outcomes (QOL) among participants with chronic spinal cord injury (SCI) and to compare the amount of change in these outcomes between those surviving and those not surviving until follow-up. METHODS: Participants were 1157 individuals from the SCI Longitudinal Aging Study, who have completed at least two self-report assessments separated by five-year intervals. The main outcome measures were 13 indicators related to employment, health, participation, and QOL/psychosocial indicators. Survival status measured at follow-up. RESULTS: Those who survived to follow up had a history indicating a greater likelihood of employment, better health, participation, and QOL/psychosocial indicators. Among survivors, longitudinal declines were limited to the percent employed and participation indicators, whereas those deceased by follow-up had significant undesirable changes in employment, participation, health, and QOL/psychosocial indicators. More specifically, compared to the survivors, those deceased by follow-up experienced a greater increase in hospitalizations, decreases in nights away from home, and declines in global satisfaction over the five-year interval. CONCLUSIONS: Longitudinal declines in employment and some aspects of participation are common among long-term survivors and may be part of the natural course of outcomes after SCI. However, more dramatic increases in hospitalizations, fewer nights away from home, and declining satisfaction may be red flags for declining longevity.

Life Satisfaction Trend and Mortality After Traumatic Spinal Cord Injury: A Cohort Study.

Background: Individuals with traumatic spinal cord injuries (SCIs) have lower subjective well-being and diminished longevity, yet there is a lack of research on how life satisfaction and changes in life satisfaction relate to longevity. Objectives: To identify the relationships between survival status and life satisfaction and its changing trend over a 10-year period. Methods: Data were taken from the SCI Longitudinal Aging Study. A cohort study of 676 adult participants with SCI completed three assessments separated by 5-year intervals. We applied the survival analyses by using person-year logistic regression models. Results: There were 135 participants (20%) who were deceased by the end of 2019. After controlling for demographic and injury factors, life satisfaction was significantly related to survival. In the final model, having an upward trend of life satisfaction was significantly associated with lower odds of mortality, whereas a downward trend in life satisfaction was not significant. Conclusion: Our findings demonstrate the importance of current life satisfaction and having a trend toward improving satisfaction to survival. The findings indicated the importance of psychosocial adaptation to life quality and longevity after SCI.

Characteristics Associated With Perceived Underemployment Among Participants With Spinal Cord Injury.

Objective: To identify job characteristics related to perceived underemployment among people with spinal cord injury (SCI), while controlling for demographic, injury, and educational factors. Design: Cross-sectional, logistic regression with predicted probabilities of underemployment. Setting: Medical University in the Southeastern United States. Participants: 952 were adults with traumatic SCI, all of whom were a minimum of 1-year post-injury and employed at the time of the study. They averaged 46.7 years of age, the majority were male (70.5%), and over half (52%) were ambulatory (N=952). Interventions: Not applicable. Main Outcome Measures: Perceived underemployment was defined and measured by a dichotomous variable (yes/no). Results: Demographic, injury, and educational factors explained only 4.8% of the variance in underemployment, whereas the full model explained 21.8%. Underemployment was significantly lower for women (odds ratio [OR]=0.66, 95% confidence interval [CI; .44, .98]), those who were either married or in a nonmarried couple (OR=0.63, 95% CI [.42, .93]), those with health benefits (OR=0.58, 95% CI [.37, .91]) and higher for those with lower earnings and occupations in the category of sales, professional/managerial. Postsecondary educational milestones, having received a promotion or recognition, and working full time were not identified as significant predictors in the multivariate model, although each was significantly related to a lower likelihood of underemployment when using a restricted model that controls only for demographics, SCI, and educational status (rather than all variables simultaneously). Age, years since injury, and injury severity were not significant. Conclusion: Underemployment is a concern among people with SCI and is more prevalent in low-paying jobs, without benefits, and opportunities for recognition and promotion. Vocational counseling strategies need to promote quality employment, including jobs with recognition and benefits.

The Relationship of Secondary and Chronic Health Conditions With Emergency Department Visits and Related Hospitalizations Among People With Traumatic Spinal Cord Injury.

OBJECTIVE: Identify the relationship of health conditions with self-reported emergency department (ED) visits and ED-related hospitalizations among people with traumatic spinal cord injury (SCI), while controlling for demographic, injury, and socioeconomic factors. DESIGN: Cross-sectional. SETTING: A regional SCI model system in the Southeastern United States. PARTICIPANTS: Participants (N=648) were adults with chronic traumatic SCI at least 1 year postinjury who were identified through their Form II annual follow-up within the SCI Model Systems. INTERVENTIONS: N/A. MAIN OUTCOME MEASURES: Self-reported ED visits and ED-related hospitalizations within the 12 months prior to the study. RESULTS: Several types of factors were significantly related to ED visits, with fewer related to ED hospitalizations. Men (odds ratio [OR]=1.58); those divorced, widowed, or separated (OR=1.57); and those with more severe SCI (C1-C4, or American Spinal Injury Association Impairment Scale A/B) had greater odds of having at least 1 ED visit; education and employment factors were not significant. Of health conditions, acute secondary health conditions including falls (OR=1.45), urinary tract infections (UTIs; OR=2.40), and pressure injuries (OR=1.58) were all associated with a greater odds of ED visits, whereas chronic health conditions were not. Being unemployed was associated with greater odds of an ED hospitalization (OR=1.79), as was having at least 1 UTI (OR=2.24) and at least 1 pressure injury (OR=2.37). CONCLUSIONS: The current findings suggest acute secondary health conditions, particularly UTIs and pressure injuries, were much more highly related to ED visits and related hospitalizations compared to chronic health conditions (eg, diabetes, hypertension). Greater attention needs to be paid to fall, UTI, and pressure injury prevention to reduce the ED burden related to SCI.

Job Retention Among Individuals With Multiple Sclerosis: Relationship With Prediagnostic Employment and Education; Demographic Characteristics; and Disease Course, Severity, and Complications.

OBJECTIVE: To identify how prediagnosis employment, education, demographic statuses, and disease factors relate to job retention among people with multiple sclerosis (MS). DESIGN: Cross-sectional logit model. SETTING: Data were collected at an academic Medical University and a specialty hospital, both in the Southeastern US. PARTICIPANTS: People with MS (N=1126) who were employed at the time of MS diagnosis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Job retention was measured by employment status at the time of follow-up assessment. RESULTS: Prediagnostic educational attainment was predictive of job retention. Among several prediagnostic employment characteristics, only working in production, transportation, and material moving was significantly related to a lower odds of job retention compared with those working in professional/managerial occupations. Aging factors were strongly related to job retention, with declines in job retention observed with increasing age and years since diagnosis. Non-Hispanic Black and Hispanic participants reported lower odds of job retention than non-Hispanic White participants, although there were no observed effects of sex. A significantly lower job retention rate was observed among those with progressive MS, compared with relapsing-remitting. Job retention was also less likely among people with greater MS severity and fatigue. CONCLUSIONS: Job retention strategies and interventions should target people with greater MS complications and severity, as well as non-Hispanic Black and Hispanic persons, because these characteristics are more highly related to job retention than our prediagnostic employment and vocational history.