Journal of Rehabilitation Medicine 51-1CompleteIssue | Page 46

Disability in spinal cord injury 43 Table IV. Spearman Correlations of patient-rated World Health Organization Disability Assessment Schedule (WHODAS) domains with spinal cord injury severity (AIS grade), level, walking ability, working status, and physician-rated functioning Variable Lesion level tetraplegia Any walking ability AIS grade D (n  = 89) (n  = 71) vs paraplegia (n  = 100) vs seated vs grades A–C (n  = 53) (n  = 71) (n  = 42) Current employment (n  = 19) Generic set sum (n  = 142) Cognition Mobility Self-care Getting along Life activities Participation WHODAS sum score Generic set sum score 0.15 –0.52**** –0.24** –0.04 –0.04 0.07 –0.16* –0.33**** 0.09 0.34**** 0.26** 0.11 0.24** 0.13 0.27*** 0.33**** 0.08 0.56**** 0.39**** 0.26** 0.40**** 0.27*** 0.49**** 1.00 –0.04 0.09 –0.30*** –0.19* –0.27** –0.18* –0.24** 0.02 0.21* –0.52**** –0.25** –0.01 –0.06 0.19* –0.15 –0.41**** *p  < 0.05, **p  < 0.01, ***p  < 0.001, ****p  < 0.0001. AIS: ASIA (American Spinal Cord Injury Association) Impairment Scale. found in household activities and self-care. When the ratings of those with a complete lesion (AIS A–B) were compared with those with a partial lesion (AIS C–D), a complete lesion was associated with more difficulties in getting around and self-care, and a partial lesion with participation difficulties. The Spearman correlations of the 6 patient-rated WHODAS domains with SCI severity (AIS grade), lesion level, walking ability, current working status, and physician-rated functioning (generic set sum score) are shown in Table IV. The correlation between the patient-rated WHODAS sum score and the physician- rated generic set sum score was moderate in all other patient groups, except for a strong correlation in the group with AIS D tetraplegia. The generic set sum score was correlated with all other WHODAS domains (0.26–0.56) except cognition. The correlation coefficient between patient and proxy WHODAS sum scores was very strong (0.89) with strong to very strong correlations in single items except for the item “dealing with strangers” with only a moderate correlation. The significant others rated both the total disability (sum score) and the items learning, emotions and dressing as slightly more impaired than did the patients themselves. Cronbach’s alpha value for reliability of the WHODAS patient sum was 0.86, the WHODAS significant other 0.86 and the minimal generic set sum 0.75. DISCUSSION These results support the utility of both generic measu- res WHODAS 2.0 and the WHO minimal generic set in assessing functioning of patients with SCI. The degree of perceived impairment (WHODAS sum score) was found to increase from incomplete paraplegia through complete paraplegia and partial tetraplegia to complete tetraplegia, respectively. In our study population, participants typically had hardly any problems in cognition, emotions or rela- tionships. The most severe impairments were found in getting around and life activities, followed by self- care, these results being largely in line with previous studies in SCI (15–17, 31, 32). Participation, on the other hand, was rated less severely impaired among our participants, the restriction being only mild in all other groups except those with a partial tetraplegia. Obviously, the ratings do not strictly measure the level of functional capacity, but evaluate the level of actual performance in real-life situations and also reflect environmental factors, e.g. the amount of assistance and aids, support and services the patients receive in the community, as in previous studies (13). Unexpec- tedly, those with an incomplete SCI lesion were found to experience more difficulties in community life than those with a complete lesion. Our hypothesis is that, if people with a complete lesion and more severe symp- toms get daily help from trained caregivers, those with a milder injury with no such aid may experience more restricted participation than those with a more severe or complete injury. The groups with a partial lesion were also 7–9 years older than the other 2 groups with a complete lesion, which could have some influence on the results even if the age difference was not sta- tistically significant. These results show that participants with a cervical lesion (partial or complete tetraplegia) experience more impairments in self-care and life activities, including the ability to work, than those with a lower lesion, which is in agreement with previous studies (18, 33–35). It is natural that, when those with a com- plete motor lesion were compared with those with an incomplete lesion, a complete lesion was associated with more difficulties in getting around and self-care. In our study, inability to walk was correlated with other impairments (getting around, self-care, participation and cognition) as in previous studies, which found wheelchair-dependency (36, 37) and mobility restric- tions (17) to increase difficulties in other domains of participation (17, 37) and to decrease quality of life (36). Also, current employment was found to be asso- ciated with other domains (mobility, self-care, and life J Rehabil Med 51, 2019