Psychological or physiological

Published: July 16, 2007  |  Source: neurology.org
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Why are tetraplegic patients content?

Objective: To assess the effects of spinal cord injury (SCI) on perceived health-related quality of life (QOL).

Background: SCI is physically disabling, socially handicapping, and romantically limiting. Nevertheless, little is known about post-SCI neurocognitive and psychosocial life. Better understanding of the cognitive and emotional worlds of SCI patients is essential to better address and meet their needs and expectations.

Methods: Twenty subjects with high-cord (T6 and above) complete (American Spinal Injury Association [ASIA] A) SCI (High SCI) were compared with 10 subjects with low-cord (T7 and below) ASIA A SCI (Low SCI) and with 11 Able-Bodied control subjects. Satisfaction with Life and Short Form-36 instruments were used to assess physical and emotional aspects of QOL. Analyses of variance were used to assess potential differences across groups.

Results: Overall, satisfaction with life was the same among the groups. Expectedly, High SCI and Low SCI subjects reported lower physical functioning than Able-Bodied subjects (p < 0.0001). But, oddly, there were no differences in perceived physical role, physical health, or social functioning. Furthermore, High SCI subjects reported better perceived mental health than Able-Bodied control subjects (p = 0.004) and a trend over Low SCI subjects (p = 0.06), better perceived emotional role in society (p = 0.02), and greater vitality (p = 0.01) than Low SCI subjects and Able-Bodied subjects.
Conclusions: Despite severe physical Impairment and Disability and frequent medical complications, subjects with complete spinal cord injury at high anatomic levels report better than average quality of life, being overall content. Reasons for these findings are unclear. Psychological adaptive reactions are likely, but the possible role of physiologic and neurocognitive changes needs further exploration.

Fátima de N. Abrantes-Pais, MD, Joyce K. Friedman, PhD, William R. Lovallo, PhD and Elliott D. Ross, MD

From the Sections of Neurology and Rehabilitation (F.N.A.-P.), Psychiatry and Behavioral Sciences (W.R.L.), and Neurology and Rehabilitation (E.D.R.), Oklahoma City VA Medical Center, and Departments of Neurology (F.N.A.-P., J.K.F., E.D.R.) and Psychiatry and Behavioral Sciences (W.R.L.), University of Oklahoma Health Science Center, Oklahoma City.
Address correspondence and reprint requests to Dr. F. de N. Abrantes-Pais, Department of Neurology, OUHSC, 711 Stanton L. Young Blvd., Suite 209, Oklahoma City, OK, 73104; fatima-abrantes-pais@ouhsc.edu

E-Pub ahead of print on April 25, 2007, at www.neurology.org.

Supported fully by the Research Career Development Program, Rehabilitation Research and Development, Veterans Health Administration, and in part by NIH, National Center for Research Resources, General Clinical Research Center grant M01 RR-14467.

Disclosure: The authors report no conflicts of interest.
NEUROLOGY 2007;69:261-267
© 2007 American Academy of Neurology