Original article
Changes and Determinants of Life Satisfaction After Spinal Cord Injury: A Cohort Study in The Netherlands

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Abstract

van Koppenhagen CF, Post MW, van der Woude LH, de Witte LP, van Asbeck FW, de Groot S, van den Heuvel W, Lindeman E. Changes and determinants of life satisfaction after spinal cord injury: a cohort study in The Netherlands.

Objective

To determine the impact of spinal cord injury (SCI) on life satisfaction of persons with SCI 1 year after discharge of inpatient rehabilitation.

Design

A cohort study. Life satisfaction before SCI was retrospectively measured at the start of active rehabilitation. One year after discharge from inpatient rehabilitation, current life satisfaction was measured.

Setting

Eight rehabilitation centers in The Netherlands.

Participants

Persons (N=147) aged 18 to 65 and wheelchair-dependent at least for long distances.

Interventions

Not applicable.

Main Outcome Measure

The Life Satisfaction Questionnaire.

Results

Mean satisfaction with life ± SD as a whole was 5.3±0 before SCI and 4.3±1.3 one year after inpatient rehabilitation. Sexual life, self-care, and vocational situation showed the largest impact of SCI (P<.05), whereas the social relationships domains appeared to be the least affected. Decrease of life satisfaction after SCI was larger when using the retrospective ratings than when using general population scores. Significant determinants of life satisfaction after SCI were high lesion level (β=.31, P<.05), pain (β=.19, P<.05), and secondary impairments (β=.22, P<.05).

Conclusions

Life satisfaction decreased in persons with SCI. Level of lesion and suffering secondary impairments or pain were associated with low life satisfaction 1 year after discharge from inpatient rehabilitation.

Section snippets

Participants

This study is part of the Dutch research program “Physical Strain, Work Capacity, and Mechanisms of Restoration of Mobility in the Rehabilitation of Persons With a SCI.” Eight rehabilitation centers with a specialty in SCI rehabilitation participated in the study. Subjects were eligible to enter the project if they had an acute SCI; were between 18 and 65 years of age; were classified as grade A, B, C, or D on the AIS; and were expected to remain wheelchair dependent (at least for long

Respondent Characteristics

Of the initial study group of 222 persons, 147 completed the measurements 1 year after discharge of inpatient rehabilitation. Dropout had different causes; 9 persons died, 12 persons were excluded from the study because they regained ability to walk for longer distances, and 19 refused to collaborate. Some other persons had moved, had developed a psychiatric condition after the first measurement, or could not be contacted at all.27 A comparison between participants and nonparticipants showed no

Discussion

The results of this study show a marked decrease in life satisfaction of persons with SCI at 1 year after discharge from inpatient rehabilitation compared with their life satisfaction before SCI, which was retrospectively reported early in inpatient rehabilitation. Decrease of life satisfaction was strongest for the domains sexual life, self-care, and vocational situation. Partner relations, family life, and contacts with friends and acquaintances appeared to be the least affected life domains.

Conclusions

Measurement of life satisfaction 1 year after discharge might be too early to reflect a more or less stable situation.6 A long-term follow-up is necessary to identify determinants that influence life satisfaction.2, 14, 34, 50 The use of the LiSat-9 facilitated comparisons with other studies and is recommended for further study. The addition of the SWLS, which is used commonly in the United States, would further improve the comparability of study results.51 In the current study, person and

Acknowledgments

We thank the research assistants for collecting all the data and the following participating Dutch rehabilitation centers: Rehabilitation Centre De Hoogstraat (Utrecht), Rehabilitation Centre Amsterdam, Rehabilitation Centre Het Roessingh (Enschede), Rehabilitation Centre Hoensbroeck, Sint Maartenskliniek (Nijmegen), Rehabilitation Centre Beatrixoord (Haren), Rehabilitation Centre Heliomare (Wijk aan Zee), and Rijndam Rehabilitation Centre (Rotterdam).

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    Supported by the Health Research and Development Council of the Netherlands (grant no. 1435.0003).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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