Assessment of physical function and secondary complications after complete spinal cord injury

Abstract

Purpose: Two physical function questions on the widely used SF-12 Health Related Quality of Life questionnaire appear less than optimal for people with complete spinal cord injury (SCI). Physical function questions typically receive the lowest score unless the individual is ambulatory. Additionally, the influence of secondary complications of SCI on quality of life is largely unknown. The purposes of this report are: (1) to determine whether two SF-12 physical function follow-up questions provide increased information in subjects with complete SCI; and (2) to describe the secondary complications of SCI in this group.

Method: Ten subjects with complete SCI completed two survey instruments (the SF-12 and a Secondary Complications survey) every 3 months. The SF-12 included two physical function follow-up questions designed to improve the sensitivity and appropriateness of the SF-12 for a population with complete SCI.

Results: The SF-12 follow-up questions revealed differences in physical function that did not appear with the original SF-12 items. With the new questions, subject scores approximated population normative values. The most common secondary complications (back pain, shoulder pain, leg spasms, leg joint stiffness, and difficulty coughing) were the most likely to be rated as moderately or greatly bothersome.

Conclusion: We advocate the use of follow-up questions for the SF-12 in complete SCI populations that are not ambulating to better discriminate changes in physical function. Secondly, we advocate further investigations to better understand the incidence and the severity of secondary complications after SCI.

Figure 1

Mean SF-12 subscale scores for 10 subjects. Each subject contributed between 1 and 10 survey samples to the population mean values (see Table II). Dotted lines indicate US population norms. The black bar in the second column indicates the Physical Function score when computed with the standard SF-12 questions, rather than the SCI-specific version. GH, general health; PF, physical function; RP, role physical; RE, role emotional; BP, bodily pain; MH, mental health; VT, vitality; ?SF, social function.

Figure 2

Mean SF-12 subscale scores for four subjects who entered the study during the acute phase of SCI. Results are presented for the first year after SCI. Surveys 1, 2, and 3 occurred at the following mean times post-SCI: 0.4123, 0.6582, and 0.9103 years following injury. Population normative data for males appear as the black bar. PF scores were obtained with the SCI-specific follow-up questions. GH, general health; PF, physical function; RP, role physical; RE, role emotional; BP, bodily pain; MH, mental health; VT, vitality; SF, social function.