Self-care independence after spinal cord injury: patient and therapist expectations and real life performance.
OBJECTIVE
To evaluate changes in self-care performance between rehabilitation discharge and 1 year follow-up and to compare patients' and therapists' expectations of self-care independence with actual self-care performance after discharge.


METHODS
Prospective study of 55 patients with tetraplegia (21 complete and 34 incomplete) after spinal cord injury (SCI) consecutively admitted to a large urban rehabilitation hospital [injury levels: C4 (5), C5 (33), C6 (9), C7 (4), and C8 (4)]. Data were collected using structured patient interviews, occupational therapists' predictions of patients' self care, and Functional Independence Measure ratings by rehabilitation staff.


RESULTS
Analysis showed that for all skills, expectations of patients (mainly African American men) were higher than therapists' predictions, and for 3 of these skills, the differences were statistically significant: eating (Z = -4.47, P < .001 ); bathing (Z = -3.67, P < .001 ); and dressing (Z = -3.16, P = .002). Occupational therapists were better predictors of patients' actual self-care performance at discharge than were patients, although both tended to overestimate patients' performance. There was no evidence that self-care capability declined between discharge and 12 months follow-up, but routine self-care performance varied widely across patient and personal circumstances.


CONCLUSIONS
Differential attrition reduced the study sample to 25 SCI patients who were primarily more severely injured African American men. Results showed that these patients maintained their self-care performance 1 year after discharge, but more innovative strategies must be developed to customize self-care retraining to address the unique needs of this patient population.
Lysack
C L
CL
Institute of Gerontology and Department of Occupational Therapy, Wayne State University, Detroit, Michigan 48202, USA. c.lysack@wayne.edu
Zafonte
C A
CA
Neufeld
S W
SW
Dijkers
M P
MP
D000328:Adult; D001741:Black or African American / Q000523:psychology; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009788:Occupational Therapy / Q000523:psychology; D011369:Professional-Patient Relations; D011379:Prognosis; D011782:Quadriplegia / Q000523:psychology / Q000534:rehabilitation; D012648:Self Care / Q000523:psychology*; D012803:Sick Role; D013119:Spinal Cord Injuries / Q000523:psychology / Q000534:rehabilitation*