title: Impact of impairment and secondary health conditions on health preference among Canadians with chronic spinal cord injury.
abstract: OBJECTIVE
  To describe the relationships between secondary health conditions and health preference in a cohort of adults with chronic spinal cord injury (SCI).
  
  
  METHODS
  Cross-sectional telephone survey.
  
  
  METHODS
  Community.
  
  
  METHODS
  Community-dwelling adult men and women (N = 357) with chronic traumatic and non-traumatic SCI (C1-L3 AIS A-D) who were at least 1 year post-injury/onset.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Health Utilities Index-Mark III (HUI-Mark III) and SCI Secondary Conditions Scale-Modified (SCS-M).
  
  
  RESULTS
  SCS-M responses for different secondary health conditions were used to create "low impact = absent/mild" and "high impact = moderate/significant" secondary health condition groups. Analysis of covariance was used to examine differences in HUI-Mark III scores for different secondary health conditions while controlling for impairment. The mean HUI-Mark III was 0.24 (0.27, range, -0.28 to 1.00). HUI-Mark III scores were lower (P < 0.001) in high impact groups for spasms, bladder and bowel dysfunction, urinary tract infections, autonomic dysreflexia, circulatory problems, respiratory problems, chronic pain, joint pain, psychological distress, and depression compared with the low impact groups. As well, HUI-Mark III scores were lower (P < 0.05) in high impact groups for pressure sores, unintentional injuries, contractures, heterotopic bone ossification, sexual dysfunction, postural hypotension, cardiac problems, and neurological deterioration than low-impact groups.
  
  
  CONCLUSIONS
  High-impact secondary health conditions are negatively associated with health preference in persons with SCI. Although further work is required, the HUI-Mark III data may be a useful tool for calculating quality-adjusted life years, and advocating for additional resources where secondary health conditions have substantial adverse impact on health.
authors.affiliation: Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada. Cathy.craven@uhn.ca
authors.forename: Catharine
authors.initials: C
authors.lastname: Craven
authors.forename: Sander L
authors.initials: SL
authors.lastname: Hitzig
authors.forename: Nicole
authors.initials: N
authors.lastname: Mittmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010264:Paraplegia / Q000523:psychology / Q000534:rehabilitation; D057240:Patient Preference / Q000523:psychology*; D011782:Quadriplegia / Q000523:psychology / Q000534:rehabilitation; D019057:Quality-Adjusted Life Years; D013119:Spinal Cord Injuries / Q000523:psychology* / Q000534:rehabilitation*; D011795:Surveys and Questionnaires; D013689:Telephone; D055815:Young Adult