Latent Structural Analysis of Health Outcomes in People Living With Spinal Cord Injury

Abstract

Objective: To develop a latent structural model of health outcomes in people with spinal cord injury (SCI) that accounts for the measurement of underlying factors and their association with demographic and injury-related exogenous variables.

Design: Cross-sectional study.

Setting: Specialty hospital and medical university.

Participants: Participants with traumatic SCI (N=1871) of at least 1-year duration.

Interventions: Not applicable.

Main outcome measures: Exploratory factor analysis was used to identify latent health outcome structures. Several key exogenous variables were also linked with the latent health outcome factors.

Results: Six latent health outcome factors were identified by the exploratory factor analysis with excellent model fit (root mean square error of approximation=.040). These latent factors included (1) global health problems; (2) chronic disease; (3) acute treatments; (4) symptoms of SCI complications, (5) pressure ulcers; and (6) subsequent injuries. Sex, race/ethnicity, age, years since injury, and injury severity were all significantly associated with at least 1 latent health outcome factor, which indicates that these latent health outcomes varied as a function of the exogenous variables.

Conclusions: This study improved our understanding of the structure of health outcomes, and utilization of latent health outcome factors provides more stable and comprehensive composite scores than does utilization of a single observed health outcome indicator.

Keywords: Health; Models, structural; Rehabilitation; Spinal cord injuries.