Erosa Norma A, Berry Jack W, Elliott Timothy R, Underhill Andrea T, Fine Philip R
Texas A&M University, College Station, Texas, USA.
Br J Health Psychol. 2014 Nov;19(4):688-700. doi: 10.1111/bjhp.12063. Epub 2013 Aug 9.
This study tested an a priori contextual model of the mediating effects of participation on the predictive relationships of functional impairment, family satisfaction, and pain to quality of life (QoL) following traumatic spinal cord injury (SCI).
A longitudinal design was used to study 144 persons following discharge for traumatic SCI. Predictor variables included functional impairment and family satisfaction (at 12 months post-discharge) and the presence of pain (at 24 months), and mediating variables were two indicators of participation (assessed 48 months post-discharge). Life satisfaction and self-rated health status at 60 months post-discharge were the outcome variables.
A path model tested hypothesized prospective effects of functional impairment, family satisfaction and pain on participation and the subsequent effects of participation on the QoL variables.
Greater functional impairment and pain were predictive of less participation, and participation significantly predicted both indicators of QoL. The two participation variables mediated the relationship of functional impairment and pain to life satisfaction over time. Family satisfaction had an indirect effect on QoL through its association with social integration.
Participation appears to mediate the prospective influence of functional impairment, family satisfaction, and pain on QoL in the years following SCI. These findings provide insight into factors that can predict QoL post-SCI and support the use of contextual models to understand the temporal influence of disability and psychological variables on participation and subsequent QoL.
What is already known on this subject? Life satisfaction and self-rated health status are important aspects of quality of life following traumatic spinal cord injury. Functional impairment has been inconsistently predictive of these variables over time. Prospective research to date has not examined the mediating effects of participation in predicting quality of life. What does this study add? The results indicate that greater functional impairment and pain are prospectively predictive of lower participation. Greater participation, in turn, is prospectively predictive of greater quality of life. Participation appears to mediate the prospective influence of functional impairment, family satisfaction, and pain to quality of life.
本研究检验了一个预先设定的情境模型，该模型探讨了创伤性脊髓损伤（SCI）后参与度在功能障碍、家庭满意度和疼痛与生活质量（QoL）的预测关系中所起的中介作用。
采用纵向设计对144例创伤性SCI出院患者进行研究。预测变量包括功能障碍和家庭满意度（出院后12个月时）以及疼痛情况（出院后24个月时），中介变量为参与度的两个指标（出院后48个月时评估）。出院后60个月时的生活满意度和自评健康状况为结果变量。
采用路径模型检验功能障碍、家庭满意度和疼痛对参与度的假设性前瞻性影响，以及参与度对生活质量变量的后续影响。
功能障碍和疼痛程度越高，参与度越低，且参与度显著预测了生活质量的两个指标。随着时间推移，两个参与度变量介导了功能障碍和疼痛与生活满意度之间的关系。家庭满意度通过与社会融合的关联对生活质量产生间接影响。
在脊髓损伤后的数年中，参与度似乎介导了功能障碍、家庭满意度和疼痛对生活质量的前瞻性影响。这些发现为预测脊髓损伤后生活质量的因素提供了见解，并支持使用情境模型来理解残疾和心理变量对参与度及随后生活质量的时间影响。
关于该主题已知的内容有哪些？生活满意度和自评健康状况是创伤性脊髓损伤后生活质量的重要方面。随着时间推移，功能障碍对这些变量的预测并不一致。迄今为止的前瞻性研究尚未考察参与度在预测生活质量方面的中介作用。本研究增加了什么内容？结果表明，功能障碍和疼痛程度越高，前瞻性地预测参与度越低。反过来，参与度越高，前瞻性地预测生活质量越高。参与度似乎介导了功能障碍、家庭满意度和疼痛对生活质量的前瞻性影响。
