Disability Trajectories And Its Influence Factors With Patients Of Spinal Cord Injury

Objective: We conducted a longitudinal investigation on the degree of disability of patients with spinal cord injury at three different time points,such as the stable period after acute admission of hospital,3 months after discharge,and 6 months after discharge.Then we used a latent category growth model to fit the development track of disability of patients with spinal cord injury,analyzed the characteristics of disability development of patients with spinal cord injury,and analyzed the influencing factors of different types of disability development track,and explored the predictive factors of different types of disability development track of SCI patients from acute admission to 6 months after discharge.Method: This study is a longitudinal study,which a convenient sampling method was conducted to select 210 patients with spinal cord injury in three Grade A hospitals in Anhui Province from January 2021 to August 2022.We used several scales to investigate the patients with acute spinal cord injury after stable hospitalization(T1)such as a general data questionnaire,the World Health Organization Disability Rating Scale(WHO DAS2.0),the Hamilton Depression Scale(HAMD),the Post-traumatic Stress Disorder Scale(PTSD),the Hope Scale(HHI)and the Social Support Rating Scale(SSRS).And The World Health Organization Disability Assessment Project(WHO DAS2.0)was used again to investigate the patients who were discharged for 3 months and 6 months.Then we used Epi Data3.1 software to entry the data acquired,and repeated the measurement of variance to analyze the overall change trend of patients’ disability.Then a potential category growth model was used to fit the potential category of the disability development track and a best fitting model is finally determined according to the fitting results.A single factor analysis method was used to screen out the socio-demographic factors,the disease characteristics and the related variables of socio-psychological that affect the development of disability in patients with spinal cord injury.Finally,multivariate logistic regression was used to analyze the influencing factors of different disability development tracks in patients with spinal cord injury.Results: 1.The disability scores of patients with spinal cord injury at three time points were(93.04 ± 19.55),(47.61 ± 29.85)and(37.88 ± 33.57)respectively.Apparently it is at a high level during the acute hospitalization and then gradually decreases with time.The test we conducted based on the fitting results of the potential category growth model indicators that LMR and BLRT have significantly statistical differences in the two potential categories(P<0.05),in which the number of samples in different categories is more than 5%.And finally,two potential tracks were selected,which were named as high starting point rapid development type and low starting point stable type according to the respective characteristics of the two groups of disability development tracks,accounting for 93.3% and 6.7% of the total research object respectively.2.The results of single factor analysis showed that the indicators in general demographic data,disease-related data and socio-psychological factors that had an impact on the 6-month disability development track of patients after discharge included: occupation,ASIA injury grade,T1 hope score,T1 social support score,T1 depression score,and T1 PTSD score.Multivariate logistic regression results showed that compared with the patients in the low starting point stable group,the depression score was an indicator to predict the high starting point continuous decline group,with the impact effect about 7.30 times higher than the former group(OR=1.28;95% CI: 1.05-1.56).Conclusions:1.The fitting results of the latent category growth model showed that the disability development track of SCI patients from the acute stage to 6 months after discharge showed two distinct types,namely,the high starting point continuous decline group and the low starting point stable group.The disability level of patients at the initial stage of SCI was high,but then gradually declined over time.2.The results of single factor analysis and multivariate logistic regression analysis showed that,the influencing factors of different disability development tracks of SCI patients included occupation,ASIA injury grade,hope level,social support,depression and PTSD,which would affect the disability development tracks of SCI patients.Therefore,the quantitative study of these factors would provide a corresponding reference basis for constructing the development track of SCI patients’ disability under the long-term care vision.