Abstract
Background
Spinal cord injury (SCI) can result in partial or complete loss of function below the level of the injury. In New Zealand (NZ) approximately 160 people experience a SCI each year, with high rates among Māori and Pacific people.
International research has found SCI can have potentially major consequences on people’s lives, including changes in life satisfaction. Life satisfaction post-SCI is an important research topic as satisfaction with life has been identified as a strong predictor of long-term survival post-SCI. Previous international research has found varying associations between SCI and life satisfaction, with few studies looking at long-term life satisfaction outcomes. Also, there appears to be no previous NZ research focused on life satisfaction outcomes after SCI.
Aim
The research presented in this thesis aims to examine 18-month and 10-year life satisfaction outcomes, and factors associated with life satisfaction, following SCI in NZ.
Methods
This research analysed data previously collected from 118 participants in the prospective ‘Longitudinal study of the life histories of people with spinal cord injury’. Interviews for the study were conducted at 6-months, 18-months, and 10 years post-SCI, gathering data about a range of sociodemographic, physical, and psychosocial characteristics. For the research presented in this thesis, 6-month characteristics were quantitatively analysed using univariable and multivariable methods to assess their association with life satisfaction outcomes at 18-months and 10 years post-SCI. Additionally, thematic analysis was used to qualitatively interpret free-text-responses to participants lives being ‘back on track’ 10 years post-SCI.
Results
People were asked to recall their life satisfaction pre-SCI. Pre-SCI, 90% of participants reported being satisfied, compared to 67% reporting satisfaction at 18-months and 78% at 10 years post-SCI.
Multivariable analyses found participants who reported (6-months post-SCI): never or sometimes using a wheelchair, no problems with self-care, no problems with anxiety or depression, no/lesser disability, or fewer secondary health conditions, were significantly more likely to be satisfied 18-months post-SCI (p<0.05), compared to those without these 6-month characteristics.
The 10-year multivariable analyses found only disability was significantly associated with life satisfaction 10 years post-SCI. Participants experiencing no/lesser disability 6-months post-SCI had a 22% increased likelihood of being satisfied 10 years post-SCI compared to those experiencing considerable disability (p=0.028).
Qualitative analyses of free-text data collected 10 years post-SCI found participants reported physical, psychosocial, societal/environmental, and Māori perspectives as key aspects affecting their lives after SCI.
Conclusions
A higher proportion of participants were satisfied at both 18-months and 10-years post-SCI than not satisfied. Encouragingly, a greater proportion were satisfied at 10 years post-SCI compared to 18-months. Disability was the only factor significantly associated with both 18-month and 10-year life satisfaction, after adjusting for other factors.
Limited sample size means that further research is required, particularly to investigate Māori life satisfaction and health outcomes post-SCI. Further development of disability models seems warranted – particularly for NZ, to ensure concepts of importance to Māori are adequately addressed. The research also indicates the need for a less ‘disabling society’ and reduction in disability stigmas and stereotypes.