How Are Race, Cultural, and Psychosocial Factors Associated With Outcomes in Veterans With Spinal Cord Injury?
How Are Race, Cultural, and Psychosocial Factors Associated With Outcomes in Veterans With Spinal Cord Injury?
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DOI：
10.1016/j.apmr.2016.12.015
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发表时间：
2017-09-01
影响因子：
4.3
通讯作者：
Boninger, Michael L.
中科院分区：
文献类型：
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作者：
Myaskovsky, Larissa;Gao, Shasha;Boninger, Michael L.
目的：了解文化和心理社会因素在退伍军人轮椅使用者脊髓损伤(SCI)预后中的作用，帮助临床医生识别患者面临的独特因素，并帮助研究人员确定干预措施的目标变量，以减少结果差异。设计：横断面队列研究。地点：三个附属于学术医学中心的城市退伍军人事务医疗中心。参与者：符合条件的患者(N=516)中，482人完成访谈，439人患有脊髓损伤。由于在其他种族群体中人数较少，分析仅限于白人和非裔美国人参与者，最终样本为422人。干预：不适用。主要观察指标：生活质量(QOL，退伍军人兰德12项健康调查)；满意度(客户满意度问卷)；参与(克雷格残疾评估和报告技术简表)。结果：非裔美国退伍军人的身体生活质量低于白人退伍军人，但心理生活质量好于白人退伍军人。在未经调整的分析中，没有发现其他显著的种族差异。多变量分析表明，心理社会因素主要与患者的生活质量结果和服务满意度有关，但人口和医疗因素主要与参与结果有关。交互作用分析表明，与白人相比，非裔美国人的焦虑与心理生活质量之间存在更强的负相关关系，而白人更高的自尊与社会融合之间存在正相关关系。结论：研究结果表明，试图改善患有脊髓损伤的退伍军人的结局应侧重于一种量身定制的方法，强调患者的人口统计、医疗和心理社会资产(例如，建立他们的自尊感或增加他们的掌控感)，同时提供针对他们特定限制的服务(例如，减少抑郁和焦虑)。爱思唯尔公司代表美国康复医学大会出版
Objective: To understand the role of cultural and psychosocial factors in the outcomes of veteran wheelchair users with spinal cord injury (SCI) to help clinicians identify unique factors faced by their patients and help researchers identify target variables for interventions to reduce disparities in outcomes.Design: Cross-sectional cohort study.Setting: Three urban Veterans Affairs medical centers affiliated with academic medical centers.Participants: Of the patients (N=516) who were eligible to participate, 482 completed the interview and 439 had SCI. Because of small numbers in other race groups, analyses were restricted to white and African American participants, resulting in a final sample of 422.Intervention: Not applicable.Main Outcome Measures: Quality of life (QOL, Veterans RAND 12-Item Health Survey); satisfaction (Client Satisfaction Questionnaire); and participation (Craig Handicap Assessment and Reporting Technique Short Form).Results: African American Veterans reported poorer physical QOL but better mental QOL than did white Veterans. No other significant race differences were found in unadjusted analyses. Multivariable analyses showed that psychosocial factors were predominantly associated with patients' QOL outcomes and satisfaction with service, but demographic and medical factors were predominantly associated with participation outcomes. Interaction analyses showed that there was a stronger negative association between anxiety and mental QOL for African Americans than for whites, and a positive association between higher self-esteem and social integration for whites but not African Americans.Conclusions: Findings suggest that attempts to improve the outcomes of Veterans with SCI should focus on a tailored approach that emphasizes patients' demographic, medical, and psychosocial assets (eg, building their sense of self-esteem or increasing their feelings of mastery), while providing services targeted to their specific limitations (eg, reducing depression and anxiety). Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine