title: A structural analysis of health outcomes after spinal cord injury.
abstract: OBJECTIVE
  To develop and validate a latent model of health outcomes among persons with spinal cord injury.
  
  
  METHODS
  Survey data were collected at a large specialty hospital in the southeastern USA from 1,388 adult participants with traumatic spinal cord injury of at least 1 year's duration. Multiple indicators of health outcomes were used, including general health ratings, days adversely affected by poor health and poor mental health, treatments and hospitalizations, depressive symptoms, symptoms of illness or infection (eg, sweats, chills, fever), and multiple individual conditions (eg, pressure ulcers, subsequent injuries, fractures, contractures).
  
  
  RESULTS
  We performed exploratory factor analysis on half of the sample and confirmatory factor analysis on the other. A 6-factor solution was the best overall solution, because there was an excellent fit with the exploratory factor analysis (root mean square error of approximation = 0.042) and acceptable fit with the confirmatory factor analysis (root mean square error of approximation = 0.065). Four of the factors were types of secondary conditions, including symptoms of illness or infection, orthopedic conditions, pressure ulcers, and subsequent injuries. The 2 remaining factors reflected global health and treatment. Gender, race-ethnicity, age, injury severity, and years of education were all significantly related to at least 1 factor dimension, indicating variations in health outcomes related to these characteristics.
  
  
  CONCLUSIONS
  Identification of the 6 factors represents an improvement over the utilization of multiple individual indicators, because composite scores generated from multiple individual indicators provide more informative and stable outcome scores than utilization of single indicators.
authors.affiliation: College of Health Professions, Medical University of South Carolina, 77 President St, Suite 117, PO Box 250700, Charleston, SC 29425, USA. krause@musc.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Krause
authors.forename: Karla S
authors.initials: KS
authors.lastname: Reed
authors.forename: John J
authors.initials: JJ
authors.lastname: McArdle
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D004522:Educational Status; D005163:Factor Analysis, Statistical; D005260:Female; D006304:Health Status; D006306:Health Surveys; D006801:Humans; D008297:Male; D008960:Models, Psychological; D017063:Outcome Assessment, Health Care / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D013119:Spinal Cord Injuries / Q000453:epidemiology / Q000503:physiopathology / Q000534:rehabilitation; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
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