A structural analysis of health outcomes after spinal cord injury.
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.
Krause
James S
JS
College of Health Professions, Medical University of South Carolina, 77 President St, Suite 117, PO Box 250700, Charleston, SC 29425, USA. krause@musc.edu
Reed
Karla S
KS
McArdle
John J
JJ
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
Clin Rehabil. 2004 Mar;18(2):164-71
15053125
J Spinal Cord Med. 2007;30 Suppl 1:S76-82
17874691
Phys Ther. 1999 May;79(5):495-502
10331753
Milbank Q. 2002;80(2):393-421
12101878
Arch Phys Med Rehabil. 2004 Nov;85(11):1848-53
15520980
Med Care. 2005 Jan;43(1):68-78
15626936
J Geriatr Psychiatry Neurol. 1995 Jul;8(3):162-7
7576040
Neuroepidemiology. 2005;25(2):55-61
15947491
Clin Rehabil. 2003 Dec;17(8):879-84
14682560
Arch Phys Med Rehabil. 2004 Sep;85(9):1503-8
15375825
Arch Phys Med Rehabil. 1998 Aug;79(8):900-9
9710160
Arch Phys Med Rehabil. 2000 Mar;81(3):359-63
10724083
NeuroRehabilitation. 2004;19(2):91-101
15201468
Int J Rehabil Res. 1996 Mar;19(1):55-66
8730544
J Spinal Cord Med. 2007;30(3):243-50
17684890
Spinal Cord. 2007 Jan;45(1):37-40
16491105
Spinal Cord. 2000 Feb;38(2):77-83
10762179
NeuroRehabilitation. 2009;24(1):57-66
19208958
BMJ. 1992 Jul 18;305(6846):160-4
1285753
J Spinal Cord Med. 2009;32(3):237-48
19810625
Exp Aging Res. 1992 Autumn-Winter;18(3-4):87-115
1459166
J Spinal Cord Med. 2009;32(2):162-74
19569464
Spinal Cord. 2007 Jun;45(6):404-10
17102809
Arch Phys Med Rehabil. 2000 Oct;81(10):1380-7
11030504
Arch Phys Med Rehabil. 2004 Aug;85(8):1257-64
15295750
Arch Phys Med Rehabil. 2002 Dec;83(12 Suppl 2):S18-25
12474168
Arch Phys Med Rehabil. 1999 Nov;80(11):1435-40
10569438
Phys Occup Ther Pediatr. 2001;21(4):49-68
12043172
Am J Epidemiol. 1995 Jun 1;141(11):1097-105
7771444
Arch Phys Med Rehabil. 2008 Aug;89(8):1482-91
18674984
Assist Technol. 1999;11(2):105-22
11010061
Disabil Rehabil. 1999 May-Jun;21(5-6):241-9
10381236
Spinal Cord. 2008 Sep;46(9):622-6
18392039
Spinal Cord. 2004 Mar;42(3):177-84
14758351
Arch Phys Med Rehabil. 2004 Nov;85(11):1757-63
15520970
Arch Phys Med Rehabil. 2000 Aug;81(8):1099-109
10943762
Arch Phys Med Rehabil. 1999 Nov;80(11):1402-10
10569434
Disabil Rehabil. 2007 Aug 15;29(15):1229-37
17653997
Spinal Cord. 2001 Apr;39(4):208-14
11420736
Arch Phys Med Rehabil. 2001 Jan;82(1):107-13
11239295
J Community Health. 2008 Oct;33(5):293-6
18473152
J Spinal Cord Med. 1997 Oct;20(4):384-90
9360217
Arch Phys Med Rehabil. 1996 Aug;77(8):816-23
8702378