Predictors of disability trajectories in individuals with spinal cord injury in mainland China

Abstract Study Design: Observational cohort study. Objectives: To identify classes of disability trajectories from spinal-cord injury to 6 months after discharge and to investigate whether psychosocial resources and disease factors can predict disability trajectory. Setting: Spinal surgery in three Class III hospitals. Hospitals in China are divided into three classes (Class I, II and III). Class III hospitals are the highest-level hospitals in China. Methods: All the participants were submitted to WHO Disability Assessment Schedule (WHO-DAS 2.0) at three times；and personal data anamnesis, hope, PTSD, social support were recorded at first time. All the data collected by the master's students who participated in this study. Results: Two disability trajectories were identified using the latent class growth model: the continuous high disability group (N=196, 93.3%) and the low starting point stabilization group (N=14, 6.7%). Participants with higher American Spinal Injury Association (ASIA) (β=1.26; 95% confidence interval [CI] 1.00-12.21) and more depression (β=0.249; 95% CI 1.05-1.56) in the stable condition after SCI surgery were more likely to be classified as having higher disability than those with a lower disability trajectory. Occupation, annual family income, hope, social support, and Post-traumatic Stress Disorder (PTSD) cannot predict individuals belonging to trajectory classes. Conclusion: These findings emphasize the importance of ASIA and depression in the early recovery stage after SCI and support the opinion that strengthening psychological nursing and rehabilitation management at an early stage after SCI will benefit individuals with a lower disability trajectory.