Trajectories in the course of life satisfaction after spinal cord injury: identification and predictors

Abstract

Objective: To identify different life satisfaction trajectories in the period between the start of active spinal cord injury (SCI) rehabilitation and 5 years after discharge, and to find predictors for distinguishing between trajectories. The hypotheses were that different life satisfaction trajectories would be identified and that demographic, lesion, physical, and social characteristics would be predictors of life satisfaction trajectory membership.

Design: Multicenter prospective cohort study with measurements at the start of active rehabilitation, after 3 months, at discharge, and 1, 2, and 5 years after discharge.

Setting: Eight Dutch rehabilitation centers with specialized SCI units.

Participants: Persons (N=225) with recently acquired SCI between the ages of 18 and 65 years were included, and data from 206 persons were analyzed.

Interventions: Not applicable.

Main outcome measures: Life satisfaction was measured as the sum score of "current life satisfaction" and "current life satisfaction compared with life satisfaction before SCI" (range, 2-13).

Results: Five life satisfaction trajectories were identified by using latent class growth mixture modeling: (1) low median scores (3-5) at all time points (27%), (2) intermediate scores (6-7) at all time points (31%), (3) high scores (8-10.5) at all time points (17%), (4) improvements from 3 to 9 (23%), and (5) deterioration from 9 to 4 (2%). Logistic regression showed that predictors of the low versus high life satisfaction trajectory were functional independence and pain. Predictors of the low life satisfaction versus the recovery trajectory were sex and functional independence. These predictors explained only a small part of the total variance.

Conclusions: Life satisfaction in people with SCI follows distinct trajectories. Monitoring life satisfaction at the start of active rehabilitation and 3 months later might allow identification of persons at risk for poor long-term adjustment.