title: Objective and subjective handicap following spinal cord injury: interrelationships and predictors.
abstract: OBJECTIVE
  To investigate the relationship between objective and subjective indicators of handicap or community participation among people with spinal cord injury (SCI) 1 year postinjury.
  
  
  METHODS
  Longitudinal correlational study of quality of life indicators linked to Northern New Jersey SCI System database.
  
  
  METHODS
  A total of 126 (80% male) participants was assessed at 1 year post-SCI. Age ranged from 14-83 years (median age = 34 years); 47% had tetraplegia, and 53% had paraplegia.
  
  
  METHODS
  Objective (or normative) handicap was measured using the Craig Handicap Assessment and Reporting Technique and the Community Integration Questionnaire. Subjective feelings about each area of handicap or community participation were assessed using the Andrews Delighted-Terrible scale.
  
  
  RESULTS
  Significant correlations were found between objective and subjective indicators of handicap in work life, social life, mobility, and economic status. Subjective handicap also correlated modestly with severity of impairment and length of hospitalization. These correlations were, however, weak or inconsistent across individuals. Subjective quality of life was not related to preinjury economic or social handicap. Some participants spontaneously reported dissatisfaction with items outside of the standard outcomes scales used (eg, sexuality and personal relationships).
  
  
  CONCLUSIONS
  The weakness and inconsistency of relationships between objective and subjective appraisals of areas of community participation is a challenge to outcomes measurement and has implications for the targeting of interventions. More research is needed to understand relationships between objective indicators of community participation and subjective appraisals of these areas.
authors.affiliation: Kessler Medical Rehabilitation Research and Education Corporation, West Orange, New Jersey 07052, USA. mjohnston@kmrrec.org
authors.forename: Mark
authors.initials: M
authors.lastname: Johnston
authors.forename: Elizabeth N
authors.initials: EN
authors.lastname: Nissim
authors.forename: Kenneth
authors.initials: K
authors.lastname: Wood
authors.forename: Karen
authors.initials: K
authors.lastname: Hwang
authors.forename: David
authors.initials: D
authors.lastname: Tulsky
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003256:Community Participation; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011788:Quality of Life; D013119:Spinal Cord Injuries / Q000150:complications* / Q000534:rehabilitation*; D013997:Time Factors; D015599:Trauma Severity Indices