Myaskovsky Larissa, Gao Shasha, Hausmann Leslie R M, Bornemann Kellee R, Burkitt Kelly H, Switzer Galen E, Fine Michael J, Phillips Samuel L, Gater David, Spungen Ann M, Boninger Michael L
Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Division of General Internal Medicine, Department of Medicine, University of Pittsburgh, School of Medicine, Pittsburgh, PA.
Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
Arch Phys Med Rehabil. 2017 Sep;98(9):1812-1820.e3. doi: 10.1016/j.apmr.2016.12.015. Epub 2017 Jan 25.
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.
Cross-sectional cohort study.
Three urban Veterans Affairs medical centers affiliated with academic medical centers.
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.
Not applicable.
Quality of life (QOL, Veterans RAND 12-Item Health Survey); satisfaction (Client Satisfaction Questionnaire); and participation (Craig Handicap Assessment and Reporting Technique Short Form).
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.
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).
了解文化和心理社会因素在脊髓损伤（SCI）退伍军人轮椅使用者预后中的作用，以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的目标变量，以减少预后差异。
横断面队列研究。
隶属于学术医疗中心的三家城市退伍军人事务医疗中心。
在符合参与条件的患者（N = 516）中，482人完成了访谈，439人患有脊髓损伤。由于其他种族组人数较少，分析仅限于白人和非裔美国参与者，最终样本为422人。
不适用。
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）；以及参与度（克雷格残疾评估和报告技术简表）。
非裔美国退伍军人报告的身体生活质量较差，但心理生活质量优于白人退伍军人。在未调整的分析中未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局和服务满意度相关，但人口统计学和医学因素主要与参与结局相关。交互分析表明，非裔美国人焦虑与心理生活质量之间的负相关比白人更强，白人自尊较高与社会融合之间存在正相关，而非裔美国人则不存在。
研究结果表明，改善脊髓损伤退伍军人预后的尝试应侧重于采用量身定制的方法，强调患者的人口统计学、医学和心理社会资产（例如，建立他们的自尊感或增强他们的掌控感），同时提供针对其特定局限性的服务（例如，减少抑郁和焦虑）。
