Health Literacy During Inpatient Rehabilitation and its Association With 1-Year Health and Functional Outcomes in Individuals With Traumatic Spinal Cord Injury.

OBJECTIVE

Evaluate the prevalence of limited health literacy (HL) of patients with a traumatic spinal cord injury (SCI) during inpatient rehabilitation and determine which factors are associated with limited HL. Also examine whether limited HL during inpatient rehabilitation was associated with poorer health and functional outcomes 1-year after injury.

DESIGN

Cohort study.

SETTING

SCI Model System centers.

PARTICIPANTS

Individuals (N=3943) 18 years of age or older enrolled in an SCI Model System center between 2016 and 2025 who had data for the Single-Item Literacy Screener during inpatient rehabilitation and completed the 1-year follow-up interview.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Urinary tract infections, pressure injury, rehospitalizations, days hospitalized, bowel incontinence episodes, and Spinal Cord Injury Functional Index/Assistive Technology (SCI-FI/AT) scores.

RESULTS

A total of 30.7% of participants met criteria for limited HL. Limited HL was associated with male sex (odds ratio [OR]=1.52, P<.01), lower education (OR=1.85, P<.01), and lower income (OR=1.59, P<.01). Among participants with greater than high school education, limited HL was linked to increased odds of ≥1 rehospitalizations (OR=1.49, P=.01), hospitalization ≥14 days (OR=1.74, P=.02), and ≥1 monthly bowel incontinence episodes (OR=1.51, P=.02), along with lower ability (lower SCI-FI/AT scores) for basic mobility (-3.70, P<0.01), self-care (-3.53, P<.01), fine motor function (-3.43 P<.01), and manual wheelchair mobility (-3.99, P<.01) at 1 year postinjury. Among individuals with lower education, limited HL was associated with lower ability (lower SCI-FI/AT scores) for basic mobility (-1.53, P<.01), self-care (-2.56, P<.01), fine motor function (-1.75, P<.01), manual wheelchair mobility (-0.97, P=.02), and power wheelchair mobility (-2.57, P<.01) at 1 year postinjury.

CONCLUSION

Limited HL during inpatient SCI rehabilitation was common and related to multiple sociodemographic factors. HL may be associated with postdischarge health and functional outcomes. Routine screening for HL, universal HL precautions, and targeted transition supports should be adopted by inpatient rehabilitation clinicians.