A Comparison Between People with Spinal Cord Injuries

Published: February 16, 2000  |  Source: findarticles.com
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Spinal cord injury (SCI) is a severe traumatic Disability that occurs suddenly and affects both sensory and Motor functions. According to the National Spinal Cord Injury Statistical Center 1999), there are about 203,000 persons in the U.S. who have sustained a spinal cord injury and approximately 10,000 new injuries occurr each year. Although medical advances have increased the life expectancies of people with SCI, there has been a limited amount of research addressing life satisfaction in people with SCI (Krause, 1992).

Life satisfaction, an individual’s cognitive evaluation of his or her life, is considered an important Rehabilitation goal of people with SCI by many rehabilitation professionals (Boswell, Dawson, & Heininger, 1998; Christopher, 1999; Krause, 1992). Previous studies in the U.S. on life satisfaction have found positive relationships between employment status, age at the onset of disability, marital status, educational attainment, social support, and life satisfaction (Boschen, 1996; Decker & Schulz, 1985; Krause & Dawis, 1992; Mehnert, Krauss, Nadler, & Boyd, 1990). On the other hand, the severity of the injury did not appear to be associated with life satisfaction (Cushman & Hassett, 1992; Schulz & Decker, 1985).

Researchers also point out that individuals’ cognitive evaluation of their lives is influenced by their salient values and that these values are learned through socialization in their culture (Diener & Diener, 1995; Keith, Heal, & Schalock, 1996; Oishi, Diener, Suh, & Lucas, 1999). When studying life satisfaction, one needs to take both culture and value perspectives into consideration (Krause & Dawis, 1992). However, culture is a difficult construct to define (Triandis et al., 1986). The majority of culture-related studies have focused on the individualism- collectivism dimension of cultures (Hofstede, 1980; Schaller, Parker, Garcia, 1998; Thompson, 1997; Triandis et al., 1986). It was found that people in individualistic cultures tend to give priority to the goals of individuals, feel personally responsible for their successes and failures, and experience some separation and distance from their ingroups. In contrast, people in collectivistic cultures tend to give priority to the goals of collectives, share both successes and failures with others, and have close relationships with members of their ingroups (Triandis et al., 1986).

Further, social psychologists found that culturally different nations have demonstrated notable variations in reported life satisfaction (Diener, Sandvik, Seidlitz, & Diener, 1993; Veenhoven, 1991). Poorer countries tend to possess lower life satisfaction than richer ones. For instance, Leelakulthanit and Day (1993) investigated the differences in lite satisfaction between Americans and Thais. They reported that Americans were more satisfied with their lives than Thais. Similarly, Diener, Suh, Smith, and Shao (1995) conducted a survey of life satisfaction among American, Korean, and Chinese college students. They found that Chinese and Korean college students scored much lower than Americans on both life satisfaction and positive feelings after other influential factors (e.g., income and wealth of the countries) were controlled. In a study of the cross-cultural correlates of life satisfaction, Diener and Diener (1995) found that four variables (satisfaction with self, family, friends, and finances) were related to life satisfaction for all participants in 31 nations. However, the size of the correlation between life satisfaction and satisfaction with the self was higher in individualistic countries (e.g., the United States) and lower in collectivistic countries (e.g., Korea). We were not able to locate any cross-cultural study on life satisfaction of people with disabilities in the rehabilitation literature, indicating a need for future investigations in this area.

Diener et al. (1995) suggested that the cultural differences between these countries might be responsible for the differences in reported life satisfaction. In the American culture, individual happiness and satisfaction are considered very important in one’s life and people are socialized to attend to their own needs and satisfaction. In contrast, the Chinese and Korean are socialized to fit into the community and life satisfaction is related to fulfilling one’s responsibilities to his or her family, community, and country (Diener et al., 1995). However, empirical investigations are needed to examine this hypothesis. It should be noted that, in Diener et al.’s study, the participants were college students. If one wants to examine influences of culture and values on life satisfaction of rehabilitation clients cross culturally, one should recruit adults with disabilities in these explorations.

In addition, researchers pointed out that the life satisfaction of women with SCI is a much neglected but critically needed area of research (Krause & Anson, 1997; Trieschmann, 1992). In a national survey of the general public, Gurin, Veroff, and Feld (1960) found that American women had more emotional problems than men. Campbell (1981) reported that American women were more dissatisfied with their lives than men. However, recent studies indicated that American women did not differ from men on most of the general measures of happiness, although they scored much higher on both negative and positive measures of emotions (Fujita, Diener, & Sandvik, 1991). For example, Diener and Diener (1995) reported that the levels of life satisfaction of female college students from 31 countries were similar to the levels of male students and the correlational patterns between life satisfaction and the predictors (satisfaction with self, family, friends, and finances) were similar for men and women across nations.

Further, the few studies which explore the life satisfaction of women with SCI have reported inconsistent findings. Fuhrer, Rintala, Jart, Clearman, and Young (1993) found that women were more likely to have negative feelings and were more at risk for serious Depression than men following SCI. Krause and Anson (1997) indicated that minority women with SCI appeared to experience greater emotional distress than minority men, Caucasian men, and Caucasian women with SCI. On the other hand, minority men with SCI tended to experience less emotional distress than either of the other three groups (Krause & Anson, 1997). These studies contradicted the findings of earlier study by Woodrich and Patterson (1983) which reported that female participants with SCI were more likely to accept their disabilities than male participants.

It appears that gender is an important but less understood factor in life satisfaction of people with SCI. The limited studies on the relationship between gender and life satisfaction, however, do merit further explorations in this area. Moreover, previous investigations indicated that self-efficacy – a person’s beliefs about his or her abilities to cope with life’s exigencies – had an influence on life satisfaction. For instance, Waltz and Bandura (1988) reported that the life satisfaction of cardiac male patients appeared to be influenced by a sense of efficacy, subjective health perceptions, and relatively stable socio-environmental conditions. Arns and Linney (1993) found that a change in vocational status had an impact on self-efficacy which then affected life satisfaction through its influence on self-esteem. In a qualitative study of life satisfaction and psychological well-being in Chinese with SCI, Hampton (1998) reported that self-efficacy was an important predictor of life satisfaction in the Chinese people with SCI. However, more investigations are needed to explore the influence of self-efficacy on life satisfaction in people with SCI.

In summary, although previous research implies that culture and values may have an impact on life satisfaction, no empirical work has directly addressed these issues in people with SCI. Further, the impact of gender and self-efficacy beliefs on life satisfaction of people with SCI is not clear. Accordingly, the purposes of this study were to examine value differences between Americans and Chinese people with SCI, to assess culture and gender effects on life satisfaction, and to explore patterns of correlates of life satisfaction in the two groups.

Continued from page 1. The U. S. and China were chosen for this comparison study because Americans scored particularly high on individualism and Chinese scored particularly low on individualism but high on collectivism when assessed with instruments which measured the individualism-collectivism construct (Triandis et al., 1986). A study of people from these two countries may provide insight about the roles of culture and values in life satisfaction. In addition, as we become more globally linked by travel, communication, and advancing technology, we must learn more about each other in order to communicate effectively and work well together to build a better world in which people with SCI can have a good quality of life.

Method

Participants

Two hundred and sixty-three individuals with SCI participated in the study. Of them, 133 were Americans and 130 were Chinese. The criteria for the participant recruitment included: (a) the person had a traumatic SCI but did not have any cognitive Impairment, (b) the injury duration was at least two years at the time of the study, and (c) the participant was at least 18 years of age at the time of the study. These criteria were consistent with those of previous studies (Hampton, 2000; Krause, 1992) done in the U.S. and China.

In the American group, 64% were males. The majority of the participants were Whites (87%), followed by African Americans (10%) and Hispanic Americans (3%). Of the participants, 37% were single, 40% were married, 19% were divorced or separated, and 4% were cohabitating. Their ages ranged from 20 to 69 years, with a mean age of 43 (SD = 10.92) years. The age at the time of injury ranged from 10 to 64 years, with a mean age of 29 (SD = 11.49) years. The educational levels ranged from 8 to 24 years with a mean of 16 years (SD = 3.05). Ninety-three percent of the participants lived in private non-institutional residences. Among them, 3% lived with friends, 5% lived with an attendant, 22% lived alone, and 62% lived with a spouse or parents. The remaining 7% of the participants lived in nursing homes. Of the participants, 43% were unemployed, 18% held part-time positions, and 39% held full-time positions. The income ranged from below $7,500 to more than $50,000 with a median of $35,001 (SD=I 8,720). The causes and levels of injury are listed in Table 1.

In the Chinese group, 60% were males; 27% were single, 70% were married, 2% were separated, and 1% was widowed. Their ages ranged from 18 to 58 years, with a mean age of 35 (SD = 9.08) years. The age at the time of injury ranged from 13 to 56 years, with a mean age of 31(SD = 8.59) years. The educational levels ranged from 6 to 18 years with a mean of 12 years (SD = 2.98). All participants lived in a non-institutional residence; 3% of them lived alone, 4% lived with their friends, 13% lived with an attendant, and 80% lived with a spouse or parents. Of the participants, 34% were unemployed, 18% held part-time positions, and 48% held full-time positions. Ninety-three percent of the participants were Han (the ethnic majority group in China) and 7% ,of them were descendants of other ethnic groups. The annual income ranged from 2,400 ($300) to 60,000 ($7,500) Chinese yuan with a median of 12,000 yuan ($1,500; SD = 861.88 yuan = $107.74.). The causes of the injury and the severity of the Disability are listed in Table 1.

Table 1

Causes and Severity of Disability In Americans and Chinese with Spinal Cord Injuries

Injury Americans (%) Chinese (%)

Causes

Diving 20 0
Fall 29 10
Gunshot 11 1
Job-related 3 39
Natural disaster 0 4
Vehicle 37 46

Levels

Cervical 59 23
Thoracic 34 51
Lumbar 7 26

Types

Complete 39 58
Incomplete 56 41
Missing 5 1

Instruments

The Life Situation Survey (LSS; Chubon, 1995) was used to assess life satisfaction. The LSS contains 20 items (Chubon, 1995; Clayton & Chubon, 1994). Participants are asked to indicate their agreement on a seven-point Likert scale ranging from “Agree Very Strongly” to “Disagree Very Strongly.’ High scores reflect a higher level of life satisfaction. The LSS has been applied to people with SCI in both the U.S. and China (Clayton & Chubon, 1994; Hampton, 2000). In this study, the Cronbach alpha reliability coefficient of the LSS was .85.

The Individualism-Collectivism scale (Trandis et al., 1986) was used to measure the values of individualism-collectivism. The scale contains 21 items answered on a six-point scale (Extremely Agree to Extremely Disagree). A factor analysis indicated that the scale contained four factors: (a) self-reliance, (b) interdependence, (c) family integrity, and (d) separation from ingroups. Originally, family integrity and interdependence were designed to be the indicators of collectivism; self-reliance and separation from ingroups were indicators of individualism. However, previous studies indicated that (a) collectivism was best described by family integrity but not by interdependence, and (b) individualism was well-described by separation from ingroups but not by self-reliance (Triandis et al., 1993; Triandis, McCusker, & Hui, 1990).

The General Self-Efficacy Scale (GSES) was used to measure an individual’s fundamental beliefs about his or her ability to cope with life’s exigencies (Sherer, Maddux, Mercandante, PrenticeDunn, Jacobs, & Rogers, 1982). It consists of 17 items. Higher scores correspond with higher self-efficacy expectations. The Cronbach reliability of the GSES in this study was .79.

The Self-Rated Health Status scale (SRHS; Lawton, Moss, Fucomer, & Kleban, 1982) was used to measure perceived health. According to Lawton et al. (1982), the Cronbach alpha internal consistency of the scale was .76. The concurrent validity of the scale was supported by a moderate correlation (r = .63) between the scale and clinicians’ rating of health status. The Cronbach reliability of the SRHS in this study was .75.

A demographic: information sheet containing the participants’ age, age at the onset of disability, sex, educational level, marital and employment statuses, income, and injury level was developed. All instruments were translated into Chinese using a back translation method (English-Chinese-English) by a bilingual counseling psychology graduate student and a bilingual counseling psychologist. The Chinese versions of the instruments had been tested in a study of 40 people with SCI in China and the results indicated that the instruments were reliable (Hampton, 1998).

Procedures

The information regarding the study was published in the Newsletters of the National Spinal Cord Injury Association (NSCIA) in the U. S. Thirty local Chapters of the NSCIA across the U. S. were contacted by the phone. Fifteen Chapters agreed to participate in the study. Three hundred and eighty questionnaires in self-stamped envelopes were mailed to the coordinators of the local Chapters. The coordinators then distributed the questionnaires to members who met the recruitment criteria for participants. One hundred and thirty-three questionnaires were returned. The return rate was 35%. Meanwhile, the president and the chief psychologist of a Rehabilitation center for people with spinal cord injuries in Beijing, China were contacted. Because this center was the only rehabilitation facility that specialized in spinal cord injuries in China, its patients came from different geographic areas across China. Two hundred questionnaires were sent to outpatients of the center. One hundred and thirty questionnaires were returned with a return rate of 65%. All participants received $5.00 or 40 Chinese yuan.

Results

A preliminary analysis was conducted to examine variations in values and life satisfaction between majority and minority group members within each country. No significant difference was found. Thus, we decided not to conduct separate analysis for race or ethnicity within each country.

Differences in Values between Americans and Chinese

Continued from page 2. Table 2 reports the means and standard deviations of variables for the groups of Americans and Chinese and for men and women. A multivariate analysis of the variance (MANOVA) was conducted. Four value variables were used as the dependent variables to examine the effect of culture (country affiliation) on individualism-collectivism. There was a significant difference in values between Americans and Chinese; F (4, 249) = 32.86, p [is less than] .0001. Univariate analyses indicated that Americans had significantly higher scores on separation from the ingroup [F(1,252) = 30.07, 12 [is less than] .0001] but significantly lower scores on family integrity [F(1,252) = 66.05, P [is less than] .0001] and self-reliance [F(1,252) = 55.09, 12 [is less than] .0001] than Chinese. The difference in the scores on interdependence was insignificant; F(1,252) = .81,12 [is greater than] .05.

Table 2 Means and Standard Deviations of Perceived Health, Self-Efficacy, Values. and Life Satisfaction

USA
Variable Male Female Total
m SD m SD m SD

Health 9.4 1.8 8.7 1.9 9.1 1.8
Efficacy 135.8 22.9 126.9 27.5 132.6 24.9
Reliance 34.3 11.1 29.6 11.6 32.6 11.5
SFI 11.2 2.2 11.3 2.0 11.2 2.1
FI 6.1 2.9 5.3 2.9 5.8 2.9
ITDPNDT 12.3 2.5 12.0 2.2 12.2 2.4
LSS 99.4 18.5 93.4 20.2 97.2 19.3

China
Variable Male Female Total
m SD m SD m SD

Health 5.5 1.5 6.6 1.6 5.9 1.5
Efficacy 110.1 25.2 114.2 26.2 111.7 25.6
Reliance 43.4 8.3 39.8 8.7 42.0 8.6
SFI 8.7 3.5 10.1 3.0 9.3 3.4
FI 8.6 2.8 8.9 2.8 8.7 2.8
ITDPNDT 12.3 2.4 12.9 2.1 12.5 2.3
LSS 71.0 17.7 75.6 21.2 72.8 19.2

Note. SFI = separation from ingroups; FI = family integrity; ITDPNDT = interdependence;

LSS = life satisfaction.

Culture, Gender and Life Satisfaction

The effects of culture and gender and the interaction effect between these two variables were examined using a univariate analysis of the variance. Values and income were used as covariate variables. The effects of the covariate variables were assessed first. The effect of income was significant; F(1,234) = 5.88, 12 [is greater than] .05. The effect of values, however, was small and insignificant (the F values ranged from .05 to .81,12 [is greater than] .05). Then, the effects of culture and gender were determined after statistically controlling for group difference in values and income. Culture had a strong effect on life satisfaction; F(1,242) = 7.76, 12 [is less than] .001. Americans had much higher life satisfaction than Chinese. However, the effect of gender was not significant; F(1,242) = .17, 12 [is greater than] .05. Males and females with SCI had a similar level of life satisfaction. The interaction effect between culture and gender was significant; F(1,242) = 6.98, 12 [is less than] .01. Chinese males had lower life satisfaction scores (m = 71.0) than Chinese females (m = 75.6) and American males (m = 99.5) and females (m = 94.5).

Correlates of Life Satisfaction in the Two Groups

Multiple linear regression analyses were performed for each of the groups separately. Life satisfaction was used as the dependent variable. Values, gender, and self-efficacy were used as the independent variables. Because the literature indicated that age, age at the time of injury, marital status, educational level, perceived health status, and income were the major contributors to life satisfaction in people with SCI (Krause & Dawis, 1992; Schulz & Decker, 1985); these variables were also included as independent variables. Prior to the regression analyses, gender and marital status were recoded using a dummy coding method. Females and individuals who were divorced, separated, widowed, or single were assigned a value of `0′; males and married individuals were assigned a value of `1.’

Because the entry order of the independent variables could affect results, a stepwise regression procedure was chosen to examine relationships between the independent variables and life satisfaction. It is important to note that, in a stepwise regression procedure, variables enter the equation according to their potency in contributing to the prediction. No hierarchy for inclusion of variables is preestablished; therefore, the results of a stepwise regression procedure reflect the predicative utility of the variables (Pedhazur, 1982).

As can be seen in Table 3, for Americans, perceived health status was the strongest predictor and entered the equation first, followed by self-efficacy, self-reliance, and marital status. The combination of the four predictors accounted for 50% of the variance in life satisfaction, F (4, 121) = 28.79, 12 [is less than] .001. Gender, separation from ingroups, family integrity, interdependence, and other demographic variables did not significantly contribute to life satisfaction when other variables in the model were controlled.

Table 3

Summary of Stepwise Regression Analysis for Gender, Values, Self-Efficacy, and Demographic Variables Predicting Life Satisfaction in Americans with SCI

Variable B SE B [Beta]

Step 1
Health 5.79 .75 .58(***)

Step 2
Health 4.39 .76 .44(***)
Efficacy .26 .06 .34(***)

Step 3
Health 4.39 .73 .44(***)
Efficacy .28 .06 .37(***)
Reliance -.37 .11 -.22(**)

Step 4
Health 4.47 .72 .44(***)
Efficacy .27 .05 .36(***)
Reliance -.38 .11 -.23(**)
Marital status 3.72 1.78 .14(*)

Note. [R.sup.2] = .33 for step 1 (p<.001); [Delta] [R.sup.2] = .43 for Step 2 (p<.001); [Delta] [R.sup.2] = .47 for Step 3 (p<.001); [Delta] [R.sup.2] = .50 for Step 4 (p<.001); (*) p<.05; (**) p<.01; (***) p<.001. For Chinese, self-efficacy was the strongest predictor and entered the equation first, followed by perceived health status. The combination of the two predictors accounted for 39% of the variance in life satisfaction, F (2, 112) = 33.83, p [is less than] .0001. Gender, the four value variables, and other demographic variables did not significantly contribute to life satisfaction when the influences of other independent variables in the model were controlled (Table 4). Table 4 Summary of Stepwise Regression Analysis for Gender, Values, Self-Efficacy, and Demographic Variables Predicting Life Satisfaction in Chinese with SCI Variable B SE B [Beta] Step 1 Efficacy .35 .06 .49(***) Step 2 Efficacy .28 .05 .40(***) Health 4.69 .93 .39(***) Note. [R.sup.2] = .24 for Step 1 (p<.001); [Delta] [R.sup.2] = .39 for Step 2 (p<.001); (***) p<.001. A one way analysis of the variance was conducted to examine the influence of employment status on life satisfaction. For the American group, the means of the LSS of individuals who were unemployed, employed part-time, or employed full-time were 95.94, 96.83 and 99.30, respectively. For the Chinese group, the means of the LSS were: 70.86 (unemployed), 73.05 (part-time), and 74.50 (full-time), respectively. Although participants who were employed were more satisfied with their lives than those who were unemployed, the differences were not significant at the .05 level. In addition, a one way analysis of the variance was conducted to examine differences in life satisfaction between participants with different levels of injuries. No significant difference was found for either Americans or Chinese. Discussions This study focused on value differences between Americans and Chinese people with SCI. the influences of culture and gender on life satisfaction, and the correlates of life satisfaction. It should be noted that all instruments used in this study were developed in the U.S. Although these instruments had been pretested with the Chinese people who had SCI, the constructs measured may have different meanings in the two cultures. Hence, the results of this study must be interpreted with caution. Nevertheless, the results of the study indicated that the values of Americans and Chinese with SCI differed significantly and reflected the differences between individualistic cultures and collectivistic cultures. Americans tended to value keeping distance from their ingroups. On the other hand, the Chinese valued a close family relationship. It is worthwhile to note that Americans scored much lower than Chinese on self-reliance. This finding was consistent with previous studies on individualism-collectivism with college students in the U.S., Hong Kong, and China (Triandis, McCusker, Hui, 1990). Triandis et al. suggested that the higher scores of Chinese students on self-reliance might reflect the pressures of modernization in both China and Hong Kong. Additionally, Triandis et al. (1990) pointed out that self-reliance might have different meanings for individualists and collectivists. For Americans, self-reliance may be linked to individual competition; for Chinese, it may be linked to avoidance of being a burden on the ingroup. Thus, self-reliance may not be a good measure of individualism. Further, Americans with SCI were more satisfied with their lives than their Chinese counterparts. This finding was consistent with previous research in social psychology that also found a discrepancy in the life satisfaction experienced by American and Chinese college students (Diener & Diener, 1995). However, two culture-related values (separation from ingroups and family integrity) did not appear to have an influence on life satisfaction when other influential variables were controlled. Perhaps these two values were too narrow. They focus on living arrangement within a family (e.g., Aging parents should live at home with their children) and distance from one's ingroups (e.g., Children should not feel honored even if the father were highly praised and given an award by a government official for his contributions and services to the community). They might not represent values that influence people's perceptions of life satisfaction in the two cultures. Unlike the culture factor, gender was not consistently related to life satisfaction. Although American men with SCI scored higher on life satisfaction than American women with SCI, the difference was not statistically significant. On the other hand, Chinese men with SCI had the lowest life satisfaction mean score compared with Chinese women and American men and women. These findings are consistent with some of previous studies (e.g., Diener & Diener, 1995) but contrary to others (e.g., Campbell, 1981; Krause & Anson, 1997), suggesting the need for further explorations of gender differences in life satisfaction. In addition, Americans differed from Chinese in the patterns of the correlates of life satisfaction. Significantly correlated with life satisfaction in the American group were four variables: perceived health status, self-efficacy, self-reliance, and marital status were. The correlations mean that individuals who were married and perceived themselves as having good health, high self-efficacy beliefs, and low self-reliance were more satisfied with their lives than those who were not married and perceived themselves as having poor health, low self-efficacy, and high self-reliance beliefs. On the other hand, in the Chinese group, only self-efficacy and perceived health status significantly related to life satisfaction. Thus, it is not surprising that the model of life satisfaction adopted in this study can explain 50% of the variance in life satisfaction of Americans and only 39% of the variance in life satisfaction of Chinese. In other words, a much larger variance is still unexplained for the life satisfaction of Chinese. This largely unexplained variance suggests that further explorations of correlates of life satisfaction for Chinese are needed. The finding that Americans with a stronger belief in self-reliance were less satisfied with their lives than those with a weaker belief is difficult to explain. Perhaps, individuals who placed a higher value on their autonomy were more impacted by their physical limitations than those who placed a lower value on autonomy. Another way to look at this issue is that individuals with higher self-reliance beliefs might hesitate to seek support from others which, in turn, would reduce the persons' opportunities to receive social support. The lack of social support would have a negative impact on the individuals' life satisfaction as indicated by Schulz and Decker (1985). Of course, the above statements are speculative and need to be examined in future studies. It is worthwhile to note that this study found demographic variables to be relatively unimportant correlates of life satisfaction. This finding offers support to Krause and Dawis' (1992) statement that demographic variables might hold little promise for predicting life satisfaction. Also, we failed to find statistically significant differences between people who were employed and those who were unemployed although employed individuals had higher life satisfaction scores. Implications for Rehabilitation Practitioners The results of this study have several implications for rehabilitation practitioners in both the U.S. and China. First, the findings of this study signify the importance of self-efficacy beliefs to life satisfaction in Americans and Chinese people with SCI. To assist people with SCI in living a happy and productive life, rehabilitation practitioners should help them enhance their beliefs about their abilities to cope with life's exigencies. This enhancement can be achieved through building successful coping experiences for the client, providing positive reinforcement and accurate feedback, using role models, and providing appropriate counseling to reduce their anxiety level (Strauser, 1995). Bandura (1993) suggests that environments which construe ability as an acquirable skill, de-emphasize competitive social comparisons, and highlight self-comparison of progress and personal accomplishments are well suited for building a sense of efficacy. From this perspective, rehabilitation practitioners should create an Environment which emphasizes the acquirable nature of coping skills and encourages clients' self-comparison of rehabilitation progress. Second, the results of this study indicate that life satisfaction may be predicted by a subjective interpretation of health. As Diener et al. (1999) pointed out, perceived health status reflected not only one's actual physical condition but also one's emotional adjustment level. Thus, rehabilitation professionals in both the U.S. and China should continue to address not only health-related issues but also negative emotion that influences their clients' life satisfaction. Third, the findings of this study suggested that Chinese people with SCI in China placed a high value on family integrity. When working with people with SCI, Chinese rehabilitation professionals need to take this issue into consideration. Family members and community should be involved in developing and carrying out rehabilitation plans. Limitations There several limitations of the present study. First, the afore-mentioned findings are derived from a purposive convenience sampling process, therefore, the generalizability of the findings is limited. Second, this study used the LSS developed in the U.S. to assess life satisfaction of Chinese individuals with SCI. Although the constructs measured by the instrument reflect the values that represent three universal requirements of human existence (meeting biological needs, coordinated social interaction, and the survival and welfare needs of groups; Schwartz, 1994), the instruments may not cover the components that are unique to life satisfaction of Chinese people. Finally, this study did not include social support - an important correlate of life satisfaction. Future investigations should include this variable and explore relationships among social support, self-reliance, and other value variables. Also, the joint contributions of self-efficacy, values, and social support to life satisfaction should be examined. Acknowledgement This work was supported by the Joseph P. Healey Grant from University of Massachusetts-Boston. The opinions expressed are those of the authors and do not reflect the position of the agency. 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