title: The impact of social support at home on health-related quality of life among veterans with spinal cord injury participating in a supported employment program.
abstract: OBJECTIVE
  To investigate the impact of social support at home on health-related quality of life (HRQOL) as measured by the VR-6D utility index for spinal cord injury (SCI) veterans participating in a program of supported employment (SE).
  
  
  METHODS
  We calculated a preference-based utility index called the VR-6D from the responses from a 36-item instrument called the VR-36. We estimated a growth curve model to examine the change in the VR-6D utility index over time adjusting for social support status, demographics, and chronic comorbidities.
  
  
  RESULTS
  Study participants experienced an increase in HRQOL over time. The initial level and the rate of increase in HRQOL varied by groups based on their support status. The rate of increase in HRQOL diminished over time. Participants reporting no support at home experienced lower initial HRQOL but reached the same level of those who reported having support at home by the ninth month of follow-up. Quality-adjusted life-years, as measured by the area under the curves, were approximately the same for both groups after 2 years.
  
  
  CONCLUSIONS
  Differences in the rate of change in HRQOL by support status have important implications for evaluations of SE programs. Participants in this program of SE experienced improvement in HRQOL beyond 12 months and extending to 2 years. Follow-up times for evaluations should extend beyond 12 months to assess complete improvements in HRQOL. Future comparison groups in comparative effectiveness evaluations of SE need to be balanced carefully on support status in addition to other factors.
authors.affiliation: Health Services Research and Development/Rehabilitation Research and Development, Center of Innovation on Disability and Rehabilitation Research, Veterans Integrated Systems Network 8, James A. Haley Hospital, 8900 Grand Oak Circle (151R), Tampa, FL, 33637-1022, USA, Bryce.Sutton@va.gov.
authors.forename: Bryce S
authors.initials: BS
authors.lastname: Sutton
authors.forename: Lisa
authors.initials: L
authors.lastname: Ottomanelli
authors.forename: Eni
authors.initials: E
authors.lastname: Njoh
authors.forename: Scott D
authors.initials: SD
authors.lastname: Barnett
authors.forename: Lance L
authors.initials: LL
authors.lastname: Goetz
mesh_terms: D000328:Adult; D016832:Employment, Supported; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D011788:Quality of Life / Q000523:psychology*; D019057:Quality-Adjusted Life Years; D012944:Social Support; D013119:Spinal Cord Injuries / Q000523:psychology* / Q000534:rehabilitation; D014728:Veterans / Q000523:psychology*