Sutton Bryce S, Ottomanelli Lisa, Njoh Eni, Barnett Scott D, Goetz Lance L
Health Services Research and Development/Rehabilitation Research and Development, Center of Innovation on Disability and Rehabilitation Research, Veterans Integrated Systems Network 8, James A. Haley Hospital, 8900 Grand Oak Circle (151R), Tampa, FL, 33637-1022, USA,
Qual Life Res. 2015 Jul;24(7):1741-7. doi: 10.1007/s11136-014-0912-4. Epub 2015 Jan 11.
To investigate the impact of social support at home on health-related quality of life (HRQOL) as measured by the VR-6D utility index for spinal cord injury (SCI) veterans participating in a program of supported employment (SE).
We calculated a preference-based utility index called the VR-6D from the responses from a 36-item instrument called the VR-36. We estimated a growth curve model to examine the change in the VR-6D utility index over time adjusting for social support status, demographics, and chronic comorbidities.
Study participants experienced an increase in HRQOL over time. The initial level and the rate of increase in HRQOL varied by groups based on their support status. The rate of increase in HRQOL diminished over time. Participants reporting no support at home experienced lower initial HRQOL but reached the same level of those who reported having support at home by the ninth month of follow-up. Quality-adjusted life-years, as measured by the area under the curves, were approximately the same for both groups after 2 years.
Differences in the rate of change in HRQOL by support status have important implications for evaluations of SE programs. Participants in this program of SE experienced improvement in HRQOL beyond 12 months and extending to 2 years. Follow-up times for evaluations should extend beyond 12 months to assess complete improvements in HRQOL. Future comparison groups in comparative effectiveness evaluations of SE need to be balanced carefully on support status in addition to other factors.
通过脊髓损伤（SCI）退伍军人参与支持性就业（SE）计划的VR-6D效用指数来研究家庭社会支持对健康相关生活质量（HRQOL）的影响。
我们从一个名为VR-36的36项工具的回答中计算出一个基于偏好的效用指数，即VR-6D。我们估计了一个增长曲线模型，以检验VR-6D效用指数随时间的变化，并对社会支持状况、人口统计学和慢性合并症进行调整。
研究参与者的HRQOL随时间增加。HRQOL的初始水平和增加率因支持状况不同而在各组之间有所差异。HRQOL的增加率随时间而降低。报告在家中没有得到支持的参与者初始HRQOL较低，但在随访的第九个月时达到了与报告在家中得到支持的参与者相同的水平。通过曲线下面积测量的质量调整生命年在两年后两组大致相同。
支持状况导致的HRQOL变化率差异对SE计划的评估具有重要意义。参与该SE计划的参与者在12个月后至2年期间HRQOL有所改善。评估的随访时间应延长至12个月以上，以评估HRQOL的完全改善情况。未来在SE的比较效果评估中除其他因素外，比较组还需要在支持状况方面仔细平衡。
