Quality of life after spinal cord injury: a metaanalysis of the effects of disablement components

While objective measures of impairment, disability and handicap can serve as outcome measures for the providers of medical and vocational rehabilitation services, for persons with spinal cord injury (SCI) themselves the only relevant measure of quality of life (QOL) is their own judgment as to their well-being. Subjective QOL in persons with SCI has been measured as happiness, psychological well-being, morale and life satisfaction. Various studies have reported inconclusive or contradictory findings, likely due to small sample size, sample composition, measures used, and other methodological issues. A meta analysis was performed to try to resolve these apparent discrepancies. A total of 22 studies, with an average sample size of 102, was retrieved. Information on the relationship between QOL and impairment, disability, and handicap, if provided, was abstracted. Findings include the following: persons with SCI tend to report lower subjective well-being than non-disabled people; the relationship between impairment and QOL is weak (mean correlation: -0.05; 95% confidence interval: -0.12 to 0.02), and generally not found to be statistically significant; the association between disability and QOL is somewhat stronger (mean r: -0.21; confidence interval: -0.27 to -0.14), but not found consistently; the relationship between QOL and (aspects of) handicap is strongest (range for mean r: -0.17 to -0.48), and fairly consistently found. The number of studies available is too small to make analysis of factors that explain contradictory findings possible. Further use of subjective QOL measures in research on longterm outcomes of SCI is recommended, in order to properly reflect the perspective of the patients/clients themselves.