Predicting health preference in chronic spinal cord injury

• Published in: The journal of spinal cord medicine 2014-09, Vol.37 (5), p.548-555
• Main Authors: Mittmann, Nicole, Hitzig, Sander L., Catharine Craven, B.
• Format: Article
• Language: English
• Subjects: Adult; Age Distribution; Aged; Aged, 80 and over; Chronic Disease; Diagnostic Self Evaluation; Female; Health preference; Health Status; Health-related quality of life; Humans; ICF; International Classification of Functioning, Disability and Health; Male; Middle Aged; Ontario - epidemiology; Patient Preference - psychology; Patient Preference - statistics & numerical data; Prevalence; Prognosis; Quality of Life - psychology; Reproducibility of Results; Risk Factors; Secondary health conditions; Sensitivity and Specificity; Sex Distribution; Spinal cord independence measure; Spinal cord injuries; Spinal Cord Injuries - diagnosis; Spinal Cord Injuries - epidemiology; Spinal Cord Injuries - psychology; Surveys and Questionnaires; Trauma Severity Indices; Young Adult
• ISSN: 1079-0268; 2045-7723
• DOI: 10.1179/2045772314Y.0000000249

Context/Objective Health preference values relate to a person's state of well-being, and is a single metric anchored at 0 (death) and 1 (perfect health). Health preference plays a key role in health economics and health policy, particularly in interpreting the results of cost-effectiveness studies, and supports the allocation of healthcare resources. The current study used elements of the International Classification of Functioning, Disability and Health (ICF) framework to predict health preference in persons with spinal cord injury (SCI). Methods Data were collected by telephone survey on (1) demographics, (2) impairment (etiology, neurological level of injury, and ASIA impairment scale), (3) secondary health conditions (SHCs) using the SCI-Secondary Conditions Scale-Modified, (4) functional abilities using the Spinal Cord Independence Measure (SCIM), and (5) health preference using the Health Utilities Index-Mark III (HUI-Mark III) among adults with chronic SCI. Variables were categorized according to ICF headings and hierarchical regression analyses were used to predict HUI-Mark III scores. Results Adults with chronic traumatic or non-traumatic SCI (N = 357) reported a mean health preference score of 0.27 (±0.27). In predicting health preference, our model accounted for 55.1% of the variance with "body functions and structure", and "activity and participation", significantly contributing to the model (P < 0.0001). In particular, older age, being employed, and having higher SCIM scores were positively associated with health preference. Conversely, a higher SHC impact score was associated with poorer health preference. Conclusions Variables representative of "activity and participation" largely influence health preference among persons with chronic SCI, which may be amenable to intervention. These findings could be applied to advocate for health promotion and employment support programs to maximize well-being in persons aging with chronic SCI in the community.