Long-term trajectories of community integration after spinal cord injury in a Mediterranean setting: identification, characterisation and trajectory predictors

Abstract

Meaningful participation in occupations or employment and/or the ability to engage in societal roles holds significant implications for one's wellbeing and is internationally recognised as a fundamental right for all persons, nowadays representing an emerging policy-making goal. We aimed to identify novel classes of individuals with chronic spinal cord injury (SCI) having similar long-term trajectories of community integration and relate them to their demographic and clinical features using a retrospective observational design. Community Integration Questionnaire (CIQ) follow-up assessments, motor Functional Independence Measure (mFIM) categorised as poor, fair or good, and Hospital Anxiety and Depression Scale (HADS) were analysed. Growth mixture models (GMM) were fitted to identify individuals with similar CIQ trajectories, classes' predictors were identified using multivariate logistic regression. GMM identified three classes of trajectories of community-dwelling adults with SCI (n=238) living in Catalonia, Spain assessed in-person (between 2002 and 2022) up to 19 years post-injury: Class 1 (n=46, 19.3 per cent): male (56.5 per cent), aged 53.5 (16.6) years at injury, mFIM (poor 39.1 per cent, fair 23.9 per cent, good 37.0 per cent), mean total CIQ=9.9 (3.4), depressive (21.7 per cent), tetraplegia (39.1 per cent). Class 2 (n=41, 17.3 per cent): male (56.1 per cent), 57.4 (14.8) years at injury, mFIM (poor 26.8 per cent, fair 12.2 per cent, good 61.0 per cent), CIQ=9.3 (3.8), depressive (7.3 per cent), paraplegia (65.9 per cent). Class 3 (n=151, 63.4 per cent): male (68.9 per cent), 43.6 (15.9) years at injury, mFIM (poor 11.9 per cent, fair 13.9 per cent, good 74.2 per cent), CIQ=17.7 (3.3), depressive (4.0 per cent), paraplegia (74.2 per cent). Admission age, higher education (university), mFIM and HADS depression predict good community integration, AUC: 0.82 (0.73-0.91). Our results suggest possible course of action focusing on specific aspects to promote community integration.

Keywords: chronic disease; community integration; disability; latent class analysis; spinal cord injury.