Secondary health conditions and disability among people with spinal cord injury: A prospective cohort study

Abstract

Objective: To examine how secondary health conditions (SHCs) that develop early after a spinal cord injury (SCI) are related to disability over time.

Design: Prospective cohort study.

Setting: Two spinal units in New Zealand (Burwood Spinal Unit and Auckland Spinal Rehabilitation Unit).

Participants: Between 2007 and 2009, 91 people participated in three telephone interviews approximately 6, 18, and 30 months after the occurrence of a SCI.

Outcome measures: SHCs were measured using 14 items derived from the Secondary Complications Survey. Disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0. Linear regression analyses were performed to investigate associations between SHCs at 6 months and disability at each assessment point.

Results: The most prevalent SHCs were leg spasms, constipation, back pain, pain below the level of SCI, and shoulder pain. Constipation, urinary tract infection, and headaches at 6 months post-SCI were associated with significantly higher levels of disability at each subsequent follow-up, independent of age, sex and SCI impairment. Back pain, and pain below the SCI, at 6 months were associated with significantly greater disability at 18 months, and difficulty coughing at 6 months was associated with significantly greater disability at 30 months.

Conclusion: The experience of specific SHCs in the first 6 months after an SCI is related to greater long-term disability. In order to reduce the disability burden of people with SCI, efforts should be directed toward early prevention of these SHCs.

Keywords:

• Disability
• Secondary health conditions
• Spinal cord injury

Acknowledgements

We are very grateful to all those who participated in this study. We thank the past and present management team and staff at the Burwood Academy of Independent Living and the two spinal units, particularly the research nurses for the recruitment and clinical data collection, and the study interviewers.

Disclaimer statements

Contributors AR led the preparation of the manuscript; AS, MS and SD all contributed to interpreting the results and to revisions of the manuscript, and approved the final version. All authors are accountable for the accuracy and integrity of the article. MS and SD designed the study that collected the data. SD, as corresponding author, has full access to the data in the study and final responsibility for the decision to submit for publication.

Conflicts of interest The authors declare no conflict of interest.

Additional information

Funding

This study was funded by the Health Research Council of New Zealand (HRC 07/302). The views and conclusions expressed herein are the authors’ and may not reflect those of the funders.