Racial and Ethnic Disparities in Functioning at Discharge and Follow-Up Among Patients With Motor Complete Spinal Cord Injury

Arch Phys Med Rehabil., 2014 · DOI: 10.1016/j.apmr.2014.07.398 · Published: November 1, 2014

Spinal Cord Injury Rehabilitation Public Health

Simple Explanation

This study looks at how race and ethnicity affect the recovery of self-care and mobility skills in people with complete spinal cord injuries after they leave the hospital. The study found that non-Hispanic Black patients with spinal cord injuries showed less improvement in self-care and mobility during their initial rehabilitation compared to non-Hispanic White and Hispanic patients. However, one year after discharge, these differences in self-care and mobility outcomes between racial and ethnic groups were no longer noticeable.

Study Duration

2000 to 2011

Participants

N=1766; Adults with traumatic, motor complete SCI (American Spinal Injury Association Impairment Scale grade A or B)

Evidence Level

Retrospective cohort study

Key Findings

1
At discharge, non-Hispanic black participants with tetraplegia and paraplegia had significantly poorer gains in FIM self-care and mobility scores relative to non-Hispanic white and Hispanic participants.
2
At 1-year follow-up, similar FIM self-care and mobility change scores were found across racial and ethnic groups within each neurologic category.
3
Hispanic participants with paraplegia demonstrated significantly smaller gains in self-care scores relative to non-Hispanic white participants at 1-year follow-up.

Research Summary

The study examined racial and ethnic differences in self-care and mobility outcomes at discharge and 1-year follow-up among patients with motor complete SCI. Non-Hispanic black participants with tetraplegia and paraplegia achieved significantly smaller gains in FIM self-care and mobility scores during inpatient rehabilitation in comparison to non-Hispanic white and Hispanic participants. Differential patterns of self-care and mobility outcomes among patients with motor complete SCI may emerge across racial and ethnic groups at discharge from inpatient rehabilitation; these differences were not evident at 1-year follow-up.

Practical Implications

Targeted Interventions

Develop culturally tailored rehabilitation programs to address the specific needs of non-Hispanic Black patients with SCI during inpatient rehabilitation.

Resource Allocation

Ensure equitable access to assistive devices and support services for minority groups post-discharge to promote sustained functional independence.

Further Research

Investigate the underlying factors contributing to racial and ethnic disparities in functional outcomes during inpatient rehabilitation, including socioeconomic status, healthcare access, and cultural beliefs.

Study Limitations

1
The continuity of rehabilitation centers included in the grant cycles of the SCIMS, which could vary the proportion of racial and ethnic groups included in the sample.
2
Socioeconomic indicators (eg, health insurance, income) were not assessed in the SCIMS database, making it difficult to ascertain the potential confounding role these socioeconomic factors could contribute to the findings.
3
The generalizability of results is limited since the SCIMS is a database of grantees from the National Institute on Disability and Rehabilitation Research that is not a nationally representative sample of the SCI population across the country, nor are the data weighted.

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