title: Functioning and disability in people living with spinal cord injury in high- and low-resourced countries: a comparative analysis of 14 countries.
abstract: OBJECTIVE
  We examined whether persons with spinal cord injury (SCI) from countries with differential resources and resource distribution differ in the level and structure of functioning and disability.
  
  
  METHODS
  We analysed cross-sectional data of 1,048 persons with SCI from 14 countries based on the International Classification of Functioning, Disability and Health (ICF). We used penalized logistic regression to identify ICF categories distinguishing lower- and higher-resourced countries. Hierarchical linear models were employed to predict the number of problems in functioning. The association structure of ICF categories was compared between higher- and lower-resourced countries using graphical models.
  
  
  RESULTS
  A total of 96 ICF categories separated lower- and higher-resourced countries. Differences were not univocal. Lower resources and unequal distribution were predictive of more functional problems in persons with higher age or tetraplegia. In the graphical models, few associations between ICF categories persisted across countries.
  
  
  CONCLUSIONS
  Higher-resourced countries do not score higher in all ICF categories. Countries' economic resources and their distribution are significant predictors of disability in vulnerable groups such as tetraplegics and the elderly. Functioning is multi-dimensional and structures of association suggest that country-specific pathways towards disability exist.
authors.affiliation: Swiss Paraplegic Research (SPF), 6207 Nottwil, Switzerland. jan.reinhardt@paranet.ch
authors.forename: Jan D
authors.initials: JD
authors.lastname: Reinhardt
authors.forename: Ulrich
authors.initials: U
authors.lastname: Mansmann
authors.forename: Bernd A G
authors.initials: BA
authors.lastname: Fellinghauer
authors.forename: Ralf
authors.initials: R
authors.lastname: Strobl
authors.forename: Eva
authors.initials: E
authors.lastname: Grill
authors.forename: Erik
authors.initials: E
authors.lastname: von Elm
authors.forename: Gerold
authors.initials: G
authors.lastname: Stucki
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D019049:Developed Countries; D003906:Developing Countries; D004185:Disability Evaluation; D004777:Environment; D005260:Female; D006295:Health Resources; D006801:Humans; D008297:Male; D008875:Middle Aged; D013119:Spinal Cord Injuries / Q000191:economics / Q000503:physiopathology*