Community integration after spinal cord injury rehabilitation: Predictors and causal mediators.

ABSTRACT

CONTEXT/OBJECTIVE: Community integration (CI) is a crucial rehabilitation goal after spinal cord injury (SCI). There is a pressing need to enhance our understanding of the factors associated with CI for individuals with traumatic or non-traumatic etiologies, with the latter being notably understudied. Accordingly, our research explores the associations and potential mediators influencing CI across these populations. SETTING: Specialized neurological rehabilitation center. PARTICIPANTS: Community-dwelling individuals who were admitted as inpatients within 3 months post-injury (n = 431, 51.9% traumatic, 48.1% non-traumatic), assessed in relation to community integration within 1-3 years after discharge. OUTCOME MEASURE: Community Integration Questionnaire (CIQ). Covariates American Spinal Injury Association Impairment Scale (AIS), Functional Independence Measure (FIM) and Hospital Anxiety and Depression Scale (HADS). RESULTS: Multiple linear regression yielded age, B AIS grade, educational level (< 6 years and <12 years), time since injury to admission, length of stay, HADS-depression at discharge, total FIM at discharge and three social work interventions (support in financial, legal and transportation services) as significant predictors of total CIQ score (Adjusted R2 = 41.4). Multiple logistic regression identified age, traumatic etiology, educational level (< 6 years and <12 years), length of stay, HADS depression at discharge, total FIM at discharge and one social work intervention (transportation support) as significant predictors of good community integration, AUC (95% CI) 0.82 (0.75-0.89), Sensitivity0.76, Specificity0.73. We identified motor FIM at discharge and motor FIM efficiency as causal mediators of total CIQ. CONCLUSIONS: We identified modifiable factors during rehabilitation-functional independence, depression, and social work interventions-that are associated with CI.