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. 2020 May;58(5):570-580.
doi: 10.1038/s41393-020-0428-4. Epub 2020 Feb 13.

Examining the complexity of functioning in persons with spinal cord injury attending first rehabilitation in Switzerland using structural equation modelling

Jsabel Hodel  1   2 , Cristina Ehrmann  3   4 , Gerold Stucki  3   4 , Jerome E Bickenbach  3   4 , Birgit Prodinger  3   4   5 ; and the SwiSCI Study Group
Affiliations

Examining the complexity of functioning in persons with spinal cord injury attending first rehabilitation in Switzerland using structural equation modelling

Jsabel Hodel et al. Spinal Cord. 2020 May.

Erratum in

Abstract

Study design: Cross-sectional.

Objectives: To examine the associations between activities, body structures and functions, and their relationship with aetiology, age and sex in persons with spinal cord injury (SCI) at discharge from first rehabilitation.

Setting: Swiss SCI Cohort Study (SwiSCI).

Methods: The study included 390 participants with newly acquired SCI and the International Classification of Functioning, Disability and Health (ICF) as conceptual frame of reference. Body structures were represented by injury level and severity; body functions by cardiovascular, pulmonary, skin, bowel and urinary functions and pain; mental functions by anxiety, depression, optimism and self-esteem; and activities by independence in performing activities of daily living (ADL). Using structural equation modelling (SEM), indirect effects of body structures and functions on independence in performing ADL through mental functions were tested for each mental function separately. For each structural model, fit was assessed using several indices and differences in aetiology, age and sex groups were explored.

Results: The structural model about optimism showed good fit in all indices; the models about anxiety, depression and self-esteem showed conflicting fit indices, respectively. Within all models, effects on independence in performing ADL were mainly direct. Pain showed significant (P < 0.05) indirect effects on independence in performing ADL within the depression, optimism and self-esteem models. The model about anxiety showed differences in aetiology groups.

Conclusions: Using an ICF-based modelling approach, this study presents an attempt towards a more comprehensive understanding of functioning in first rehabilitation of persons with SCI, which might be fundamental for rehabilitation planning.

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Conflict of interest statement

The authors declare that they have no conflict of interest.

Figures

Fig. 1
Fig. 1. Structural models showing the relationships of body structures and functions with activities of daily living.
a Completely standardised parameter estimates of the structural model about anxiety (N = 390). b Completely standardised parameter estimates of the structural model about depression (N = 390). c Completely standardised parameter estimates of the structural model about optimism (N = 390). d Completely standardised parameter estimates of the structural model about self-esteem (N = 390). ADL activities of daily living, Ref reference response option of binary variables. Squares indicate observable variables including the independence in performing activities of daily living (ADL) specified by the interval sum score of the Spinal Cord Independence Measure version III (SCIM III); ellipses indicate latent factors; single-headed arrows indicate direct effects including measurement errors; double-headed arrows indicate correlations; correlations among and measurement errors of independent observable variables are omitted; *P < 0.05; **P < 0.01.
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