title: Racial and ethnic disparities in functioning at discharge and follow-up among patients with motor complete spinal cord injury.
abstract: OBJECTIVE
  To examine racial and ethnic differences in self-care and mobility outcomes for persons with a motor complete, traumatic spinal cord injury (SCI) at discharge and 1-year follow-up.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Sixteen rehabilitation centers contributing to the Spinal Cord Injury Model Systems (SCIMS) database.
  
  
  METHODS
  Adults with traumatic, motor complete SCI (N=1766; American Spinal Injury Association Impairment Scale grade A or B) enrolled in the SCIMS between 2000 and 2011. Selected cases had complete self-reported data on race and ethnicity (non-Hispanic white, non-Hispanic black, or Hispanic) and motor FIM scores assessed at inpatient rehabilitation admission, discharge, and 1-year follow-up.
  
  
  METHODS
  Not applicable.
  
  
  METHODS
  Functional outcomes were measured by FIM self-care and mobility scores on a 1 to 7 FIM scale, at discharge and 1-year follow-up.
  
  
  RESULTS
  Multiple regression models stratified by neurologic category and adjusted for sociodemographic and injury characteristics assessed racial and ethnic group differences in FIM self-care and mobility change scores at discharge and 1-year follow-up. At discharge, non-Hispanic black participants with tetraplegia and paraplegia had significantly poorer gains in FIM self-care and mobility scores relative to non-Hispanic white and Hispanic participants. At 1-year follow-up, similar FIM self-care and mobility change scores were found across racial and ethnic groups within each neurologic category.
  
  
  CONCLUSIONS
  Non-Hispanic white and Hispanic participants had comparatively more improvement in self-care and mobility during inpatient rehabilitation compared with non-Hispanic black participants. At 1-year follow-up, no differences in self-care and mobility outcomes were observed across racial and ethnic groups. Additional research is needed to identify potential modifiable factors that may contribute to racially and ethnically different patterns of functional outcomes observed during inpatient rehabilitation.
authors.affiliation: Kessler Foundation, West Orange, NJ; New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ. Electronic address: dfyffe@kesslerfoundation.org.
authors.forename: Denise C
authors.initials: DC
authors.lastname: Fyffe
authors.affiliation: Rehabilitation Institute of Chicago, Chicago, IL; Research Triangle Institute International, Research Triangle Park, NC.
authors.forename: Anne
authors.initials: A
authors.lastname: Deutsch
authors.affiliation: Kessler Foundation, West Orange, NJ; New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ.
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Botticello
authors.affiliation: Kessler Foundation, West Orange, NJ; New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, NJ; Kessler Institute for Rehabilitation, West Orange, NJ.
authors.forename: Steven
authors.initials: S
authors.lastname: Kirshblum
authors.affiliation: University of Texas Medical Branch, Galveston, TX.
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ottenbacher
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D002574:Cervical Vertebrae; D005260:Female; D005500:Follow-Up Studies; D054624:Health Status Disparities; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D051346:Mobility Limitation; D010264:Paraplegia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D010351:Patient Discharge; D011782:Quadriplegia / Q000209:etiology / Q000503:physiopathology / Q000534:rehabilitation; D012189:Retrospective Studies; D012648:Self Care; D013119:Spinal Cord Injuries / Q000208:ethnology* / Q000503:physiopathology* / Q000534:rehabilitation; D013904:Thoracic Vertebrae; D015599:Trauma Severity Indices; D014481:United States; D044465:White People / Q000706:statistics & numerical data; D055815:Young Adult
keywords: Activities of daily living; Health status disparities; Motor activity; Rehabilitation; Spinal cord injuries
references.citation: NeuroRehabilitation. 2009;24(1):57-66
references.pmid: 19208958
references.citation: Spinal Cord. 2003 Nov;41(11):629-35
references.pmid: 14569264
references.citation: Arch Phys Med Rehabil. 2004 Nov;85(11):1859-64
references.pmid: 15520982
references.citation: Arch Phys Med Rehabil. 2011 Mar;92(3):441-8
references.pmid: 21353826
references.citation: Ann Thorac Surg. 2003 Oct;76(4):S1377-81
references.pmid: 14530068
references.citation: Ann N Y Acad Sci. 2001 Dec;954:140-74
references.pmid: 11797855
references.citation: Arch Phys Med Rehabil. 2011 Apr;92(4):626-31
references.pmid: 21440709
references.citation: Med Care. 2004 Jan;42(1 Suppl):I62-72
references.pmid: 14707756
references.citation: Arch Phys Med Rehabil. 2011 Mar;92(3):329-31
references.pmid: 21353816
references.citation: J Rehabil Res Dev. 2007;44(5):693-701
references.pmid: 17943681
references.citation: NeuroRehabilitation. 2002;17(3):187-94
references.pmid: 12237498
references.citation: PM R. 2010 Oct;2(10):901-10
references.pmid: 20970759
references.citation: J Spinal Cord Med. 2012 Nov;35(6):527-46
references.pmid: 23318035
references.citation: Arch Phys Med Rehabil. 2009 Aug;90(8):1371-8
references.pmid: 19651271
references.citation: Arch Phys Med Rehabil. 2005 Jun;86(6):1208-13
references.pmid: 15954061
references.citation: NeuroRehabilitation. 2009;24(1):47-56
references.pmid: 19208957
references.citation: Arch Phys Med Rehabil. 2011 Mar;92(3):339-45
references.pmid: 21353818
references.citation: Arch Phys Med Rehabil. 2013 Apr;94(4 Suppl):S154-64.e1-4
references.pmid: 23527771
references.citation: Arch Phys Med Rehabil. 2001 Jul;82(7):949-54
references.pmid: 11441384
references.citation: Top Spinal Cord Inj Rehabil. 2011 Fall;17(2):1-9
references.pmid: 23966760
references.citation: J Spinal Cord Med. 2004;27(3):241-51
references.pmid: 15478527
references.citation: Arch Phys Med Rehabil. 2004 Nov;85(11):1774-81
references.pmid: 15520972
references.citation: J Neurol Phys Ther. 2005 Sep;29(3):139-46
references.pmid: 16398946
references.citation: Am J Phys Med Rehabil. 2012 Apr;91(4):289-99
references.pmid: 22407160
references.citation: Med Care. 1989 Mar;27(3 Suppl):S178-89
references.pmid: 2646488
references.citation: J Spinal Cord Med. 2006;29(1):17-25
references.pmid: 16572561
references.citation: Arch Phys Med Rehabil. 2011 Mar;92(3):332-8
references.pmid: 21353817
references.citation: Arch Phys Med Rehabil. 2002 Nov;83(11):1603-11
references.pmid: 12422333
references.citation: Arch Phys Med Rehabil. 2006 Oct;87(10):1318-26
references.pmid: 17023240
references.citation: J Neurol Phys Ther. 2008 Mar;32(1):2-7
references.pmid: 18463549
references.citation: Am J Phys Med Rehabil. 2001 May;80(5):366-70; quiz 371-3, 387
references.pmid: 11327559
references.citation: J Rehabil Res Dev. 2005 May-Jun;42(3 Suppl 1):87-110
references.pmid: 16195966
references.citation: Ethn Dis. 2001 Autumn;11(3):496-518
references.pmid: 11572416
references.citation: Arch Phys Med Rehabil. 2004 Nov;85(11):1740-8
references.pmid: 15520968
references.citation: J Neurotrauma. 2013 Mar 15;30(6):492-7
references.pmid: 23113561
references.citation: Disabil Rehabil. 1999 May-Jun;21(5-6):241-9
references.pmid: 10381236
references.citation: J Neurotrauma. 2011 Aug;28(8):1413-30
references.pmid: 20367251
references.citation: Arch Phys Med Rehabil. 2004 Mar;85(3):368-75
references.pmid: 15031819
references.citation: Health Technol Assess. 1998;2(14):i-iv, 1-74
references.pmid: 9812244
references.citation: Phys Med Rehabil Clin N Am. 2000 Feb;11(1):1-27, vii
references.pmid: 10680155
references.citation: Spinal Cord. 2012 May;50(5):365-72
references.pmid: 22270188
references.citation: J Neurol Phys Ther. 2005 Sep;29(3):147-56
references.pmid: 16398947
references.citation: J Spinal Cord Med. 2000 Winter;23(4):289-316
references.pmid: 17536300
references.citation: Arch Phys Med Rehabil. 2000 Aug;81(8):1099-109
references.pmid: 10943762
references.citation: J Spinal Cord Med. 2003 Spring;26 Suppl 1:S50-6
references.pmid: 16296564
references.citation: J Spinal Cord Med. 2010;33(4):379-86
references.pmid: 21061897
references.citation: Neurorehabil Neural Repair. 2008 Mar-Apr;22(2):145-53
references.pmid: 17761810
references.citation: Arch Phys Med Rehabil. 1999 Nov;80(11):1471-6
references.pmid: 10569443
references.citation: J Spinal Cord Med. 2004;27 Suppl 1:S4-10
references.pmid: 15503696
references.citation: Arch Phys Med Rehabil. 2004 Nov;85(11):1782-92
references.pmid: 15520973
references.citation: J Spinal Cord Med. 2008;31(2):133-44
references.pmid: 18581660
references.citation: Arch Phys Med Rehabil. 1996 Nov;77(11):1101-8
references.pmid: 8931518
references.citation: Arch Phys Med Rehabil. 1997 Jun;78(6):636-43
references.pmid: 9196472
references.citation: J Spinal Cord Med. 2012 Nov;35(6):503-26
references.pmid: 23318034
references.citation: Arch Phys Med Rehabil. 2004 Nov;85(11):1811-7
references.pmid: 15520976
references.citation: J Neurotrauma. 2006 Nov;23(11):1621-31
references.pmid: 17115909
references.citation: Arch Phys Med Rehabil. 1993 Nov;74(11):1172-7
references.pmid: 8239957