Promoting factors and barriers to participation in working life for people with spinal cord injury

Background!#!It is still difficult for people with physical impairments to be and remain equally integrated into the labour market. For this reason, the question of occupational activity has explicitly been examined by the German Spinal Cord Injury Survey (GerSCI) in order to identify barriers and facilitators for labour market participation.!##!Methods!#!Cross-sectional explorative observational study. The GerSCI survey is the German part of the International Spinal Cord Injury Survey (InSCI). Using survey data from persons recruited at eight specialised SCI-centres in Germany.!##!Participants!#!1.479 persons with Spinal Cord Injury (SCI) aged 18 years and older.!##!Results!#!In a self-disclosure questionnaire, persons with SCI show themselves as a professionally well-educated and highly motivated group with most of them aiming at gainful employment and considering themselves fit for work. Many changeable and non-changeable factors have been found, which showed a high correlation with the return to work after acquired SCI.!##!Conclusion!#!Education and pain belong to the most critical factors and thereby possible approaches to increase the level of employment, which is essential and highly relevant not only for earning money but also for self-confidence and social integration. SCI has many dimensions in itself; support also should be multidimensional. Study results might help to improve participation

DataSheet3_Socioeconomic Status, the Countries’ Socioeconomic Development and Mental Health: Observational Evidence for Persons with Spinal Cord Injury from 22 Countries.DOCX

Objectives: Evidence on social inequalities in mental health of persons with physical impairments is limited. We therefore investigate associations of individual-level socioeconomic status (SES) and the country-level socioeconomic development (SED) with mental health in persons with spinal cord injury (SCI).Methods: We analyzed data from 12,588 participants of the International SCI Community Survey from 22 countries. To investigate individual-level inequalities, SES indicators (education, income, financial hardship, subjective status) were regressed on the SF-36 mental health index (MHI-5), stratified by countries. Country-level inequalities were analyzed with empirical Bayes estimates of random intercepts derived from linear mixed-models adjusting for individual-level SES.Results: Financial hardship and subjective status consistently predicted individual-level mental health inequalities. Country-level SED was inconsistently related to mental health when adjusting for individual-level SES. It however appeared that higher SED was associated with better mental health within higher-resourced countries.Conclusion: Reducing impoverishment and marginalization may present valuable strategies to reduce mental health inequalities in SCI populations. Investigations of country-level determinants of mental health in persons with SCI should consider influences beyond country-level SED, such as cultural factors.</p

DataSheet2_Socioeconomic Status, the Countries’ Socioeconomic Development and Mental Health: Observational Evidence for Persons with Spinal Cord Injury from 22 Countries.DOCX

Objectives: Evidence on social inequalities in mental health of persons with physical impairments is limited. We therefore investigate associations of individual-level socioeconomic status (SES) and the country-level socioeconomic development (SED) with mental health in persons with spinal cord injury (SCI).Methods: We analyzed data from 12,588 participants of the International SCI Community Survey from 22 countries. To investigate individual-level inequalities, SES indicators (education, income, financial hardship, subjective status) were regressed on the SF-36 mental health index (MHI-5), stratified by countries. Country-level inequalities were analyzed with empirical Bayes estimates of random intercepts derived from linear mixed-models adjusting for individual-level SES.Results: Financial hardship and subjective status consistently predicted individual-level mental health inequalities. Country-level SED was inconsistently related to mental health when adjusting for individual-level SES. It however appeared that higher SED was associated with better mental health within higher-resourced countries.Conclusion: Reducing impoverishment and marginalization may present valuable strategies to reduce mental health inequalities in SCI populations. Investigations of country-level determinants of mental health in persons with SCI should consider influences beyond country-level SED, such as cultural factors.</p

Which factors have an association to the Quality of Life (QoL) of people with acquired Spinal Cord Injury (SCI)? A cross-sectional explorative observational study

Study design!#!Cross-sectional explorative observational study.!##!Objectives!#!To identify factors which have an association to the self-perceived Quality of Life (QoL) for persons with acquired spinal cord injury (SCI).!##!Setting!#!Eight specialized SCI-centers in Germany. The GerSCI survey is the German part of the International Spinal Cord Injury Survey (InSCI).!##!Methods!#!Self-disclosure questionnaire, created from the InSCI group, translated and adapted for Germany. The questionnaire collects a very broad range of data and, and due to its design as a self-report, is particularly suitable for the analysis on QoL. Because of the content, which is binding for all participating states, it allows a direct comparability of the results. Included in Germany were 1479 persons with acquired SCI aged 18 years and older.!##!Results!#!Various factors were identified with high associations to QoL, including changeable and unchangeable ones, such as those of particular importance: pain, sleep problems, sexual dysfunction, age, and time since onset of SCI. Some results confirmed reports of previous studies, others were surprising.!##!Conclusion!#!this study provides an important basis for the planned analysis of the InSCI participating countries in the 6 WHO regions. Germany was able to contribute the largest study population. The concrete study design of InSCI allows us to directly compare data and helps us to improve ourselves within the framework of a 'learning health system'. Medical measures can be orientated towards the found results, in order to ensure the best possible care and support by the therapeutic team, individually adapted to the person, place of residence and impairment

DataSheet1_Socioeconomic Status, the Countries’ Socioeconomic Development and Mental Health: Observational Evidence for Persons with Spinal Cord Injury from 22 Countries.DOCX

Objectives: Evidence on social inequalities in mental health of persons with physical impairments is limited. We therefore investigate associations of individual-level socioeconomic status (SES) and the country-level socioeconomic development (SED) with mental health in persons with spinal cord injury (SCI).Methods: We analyzed data from 12,588 participants of the International SCI Community Survey from 22 countries. To investigate individual-level inequalities, SES indicators (education, income, financial hardship, subjective status) were regressed on the SF-36 mental health index (MHI-5), stratified by countries. Country-level inequalities were analyzed with empirical Bayes estimates of random intercepts derived from linear mixed-models adjusting for individual-level SES.Results: Financial hardship and subjective status consistently predicted individual-level mental health inequalities. Country-level SED was inconsistently related to mental health when adjusting for individual-level SES. It however appeared that higher SED was associated with better mental health within higher-resourced countries.Conclusion: Reducing impoverishment and marginalization may present valuable strategies to reduce mental health inequalities in SCI populations. Investigations of country-level determinants of mental health in persons with SCI should consider influences beyond country-level SED, such as cultural factors.</p

Ageing, functioning patterns and their environmental determinants in the spinal cord injury (SCI) population: A comparative analysis across eleven European countries implementing the International Spinal Cord Injury Community Survey.

BackgroundAs the European population with Spinal Cord Injury (SCI) is expected to become older, a better understanding of ageing with SCI using functioning, the health indicator used to model healthy ageing trajectories, is needed. We aimed to describe patterns of functioning in SCI by chronological age, age at injury and time since injury across eleven European countries using a common functioning metric, and to identify country-specific environmental determinants of functioning.MethodsData from 6'635 participants of the International Spinal Cord Injury Community Survey was used. The hierarchical version of Generalized Partial Credit Model, casted in a Bayesian framework, was used to create a common functioning metric and overall scores. For each country, linear regression was used to investigate associations between functioning, chronological age, age at SCI or time since injury for persons with para- and tetraplegia. Multiple linear regression and the proportional marginal variance decomposition technique were used to identify environmental determinants.ResultsIn countries with representative samples older chronological age was consistently associated with a decline in functioning for paraplegia but not for tetraplegia. Age at injury and functioning level were associated, but patterns differed across countries. An association between time since injury and functioning was not observed in most countries, neither for paraplegia nor for tetraplegia. Problems with the accessibility of homes of friends and relatives, access to public places and long-distance transportation were consistently key determinants of functioning.ConclusionsFunctioning is a key health indicator and the fundament of ageing research. Enhancing methods traditionally used to develop metrics with Bayesian approach, we were able to create a common metric of functioning with cardinal properties and to estimate overall scores comparable across countries. Focusing on functioning, our study complements epidemiological evidence on SCI-specific mortality and morbidity in Europe and identify initial targets for evidence-informed policy-making

Fig 4 -

a. Trends of functioning scores by type since injury groups and type of injury in countries with representative samples. For each group, the mean (marked with a green x) and its 95% Confidence Interval (the box around the mean) of functioning scores are displayed. The coefficient of the regression with functioning score as outcome (y) and continuous chronological age variable as predictor (x), their correspondent p-value and used number of cases are displayed for each country and lesion level (tetraplegia in blue versus paraplegia in brown). The groups where only mean is displayed have a sample of 1 person. b. Trends of functioning scores by time since injury groups and type of injury in countries with convenience samples. For each group, the mean (marked with a green x) and its 95% Confidence Interval (the box around the mean) of functioning scores are displayed. The coefficient of the regression with functioning score as outcome (y) and continuous chronological age variable as predictor (x), their correspondent p-value and used number of cases are displayed for each country and lesion level (tetraplegia in blue versus paraplegia in brown).</p

Fig 5 -

a. Relative importance of each environmental factors in explaining the total variation of functioning scores in countries with representative samples, when controlling for chronological age and type of injury. For each country, the full model variation when considering EFs and chronological age and type since injury as predictors is indicated in each country figure’s title. b. Relative importance of each environmental factors in explaining the total variation of functioning scores countries with convenience samples, when controlling for chronological age and type of injury. For each country, the full model variation when considering EFs and chronological age and type since injury as predictors is indicated in each country figure’s title.</p

Fig 2 -

a. Trends of functioning scores by chronological age groups and type of injury in countries with representative samples. For each group, the mean (marked with a green x) and its 95% Confidence Interval (the box around the mean) of functioning scores are displayed. The coefficient of the regression with functioning score as outcome (y) and continuous chronological age variable as predictor (x), their correspondent p-value and used number of cases are displayed for each country and lesion level (tetraplegia in blue versus paraplegia in brown). The groups where only mean is displayed have a sample of one person. b. Trends of functioning scores by chronological age groups and type of injury in countries with convenience samples. For each group, the mean (marked with a green x) and its 95% Confidence Interval (the box around the mean) of functioning scores are displayed. The coefficient of the regression with functioning score as outcome (y) and continuous chronological age variable as predictor (x), their correspondent p-value and used number of cases are displayed for each country and lesion level (tetraplegia in blue versus paraplegia in brown). The groups where only mean is displayed have a sample of 1 person.</p

Basic sociodemographic and lesion characteristics of European country study participants by collaborating country.

Basic sociodemographic and lesion characteristics of European country study participants by collaborating country.</p