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  • The Effect of Health Service Use, Unmet Need, and Service Obstacles on Quality of Life and Psychological Well-Being in the First Year After Discharge From Spinal Cord Injury Rehabilitation

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    Accepted Manuscript (AM)
    Author(s)
    Borg, David N
    Foster, Michele M
    Legg, Melissa
    Jones, Rachel
    Kendall, Elizabeth
    Fleming, Jennifer
    Geraghty, Timothy J
    Griffith University Author(s)
    Kendall, Elizabeth
    Foster, Michele M.
    Borg, David
    Legg, Melissa A.
    Jones, Rachel
    Geraghty, Tim
    Year published
    2020
    Metadata
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    Abstract
    Objective: This study examined the effects of health and rehabilitation service use, unmet need for services, and service obstacles on health-related quality of life (HR QoL) and psychological well-being after discharge from spinal cord injury (SCI) rehabilitation. Design: Prospective cohort study, with participants followed up at 6 and/or 12 months after discharge from SCI inpatient rehabilitation. Setting: Community setting. Participants: People with SCI (N=55; mean age 51y; 76.4% men; 61.8% traumatic injury; mean length of stay 137d). Interventions: Not applicable. Main Outcome Measures: Service Usage Scale, Service ...
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    Objective: This study examined the effects of health and rehabilitation service use, unmet need for services, and service obstacles on health-related quality of life (HR QoL) and psychological well-being after discharge from spinal cord injury (SCI) rehabilitation. Design: Prospective cohort study, with participants followed up at 6 and/or 12 months after discharge from SCI inpatient rehabilitation. Setting: Community setting. Participants: People with SCI (N=55; mean age 51y; 76.4% men; 61.8% traumatic injury; mean length of stay 137d). Interventions: Not applicable. Main Outcome Measures: Service Usage Scale, Service Obstacles Scale, the EuroQol-5D, and the Depression Anxiety and Stress Scale short form. Eight predictors of outcome were considered: service use (ie, use of general practitioner, medical specialist, nursing, and allied health, and rehospitalization), unmet need, and service obstacles (ie, finances and transport). Possibly important predictors of each outcome were identified via penalized regression, and a final model was fit using Bayesian hierarchical regression with a Gaussian or zero-inflated Poisson response distribution. Results: Financial obstacles were associated with a poorer HR QoL (β [95% credible interval]= −0.095 [−0.166 to −0.027]) and higher anxiety (odds ratio, OR [95% credible interval]=1.63 [1.16-2.23]). Rehospitalization was associated with a lower EuroQol visual analog scale (β= −11.2 [−19.7 to −2.5]) and, interestingly, lower anxiety (OR=1.63 [1.16-2.23]). Use of allied health was associated with higher anxiety (OR=2.48 [1.42-4.44]). Conclusion: The varying degrees of financial hardship experienced after injury with complex rehabilitation needs requires investigation, as does the interactive effects of service use, unmet need, and service obstacles on outcomes like QoL and psychological well-being.
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    Journal Title
    Archives of Physical Medicine and Rehabilitation
    Volume
    101
    Issue
    7
    DOI
    https://doi.org/10.1016/j.apmr.2020.02.008
    Copyright Statement
    © 2020 The American Congress of Rehabilitation Medicine. Published by Elsevier Ltd. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International Licence (http://creativecommons.org/licenses/by-nc-nd/4.0/) which permits unrestricted, non-commercial use, distribution and reproduction in any medium, providing that the work is properly cited.
    Subject
    Clinical sciences
    Sports science and exercise
    Health services and systems
    Public health
    Rehabilitation
    Publication URI
    http://hdl.handle.net/10072/395407
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    • Journal articles

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