title: Quality of life after spinal cord injury: a comparison across six countries.
abstract: METHODS
  An international cross-sectional study.
  
  
  OBJECTIVE
  To examine the quality of life (QoL) of people with spinal cord injury (SCI) across six countries worldwide, controlling for socio-demographic and lesion-related sample characteristics and using a cross-culturally valid assessment.
  
  
  METHODS
  Data from 243 persons with SCI from Australia, Brazil, Canada, Israel, South Africa and the United States were analyzed. QoL was measured using five satisfaction items from the World Health Organization Quality of Life Assessment. Cross-culturally valid, Rasch-transformed scores were used for comparison.
  
  
  RESULTS
  Analysis of variance showed a significant difference in QoL between countries (F=3.938; df=5; P=0.002). Shorter time since injury, no paid employment and living in Brazil were significant predictors of lower QoL, explaining 13% of variance in linear regression. Using multilevel regression with country as higher-order variable, time since injury and paid employment remained significant predictors and explained 18% of variance in QoL. The intraclass correlation coefficient (0.05) indicates that 5% of the variability can be accounted for by country.
  
  
  CONCLUSIONS
  This study showed QoL differences between countries that could not be explained by differences in demographic and lesion-related characteristics. Results point to the relevance of reintegration of people with SCI into the workforce. Further international comparative research using larger samples is recommended.
authors.affiliation: Swiss Paraplegic Research, Nottwil, Switzerland. szilvia.geyh@paranet.ch
authors.forename: S
authors.initials: S
authors.lastname: Geyh
authors.forename: C
authors.initials: C
authors.lastname: Ballert
authors.forename: A
authors.initials: A
authors.lastname: Sinnott
authors.forename: S
authors.initials: S
authors.lastname: Charlifue
authors.forename: A
authors.initials: A
authors.lastname: Catz
authors.forename: J M
authors.initials: JM
authors.lastname: D'Andrea Greve
authors.forename: M W M
authors.initials: MW
authors.lastname: Post
mesh_terms: D000328:Adult; D003431:Cross-Cultural Comparison; D003430:Cross-Sectional Studies; D005260:Female; D014943:Global Health; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D011788:Quality of Life; D012189:Retrospective Studies; D013119:Spinal Cord Injuries / Q000453:epidemiology* / Q000523:psychology*