Longitudinal Impact of Time and Negative Health Events on Physical Independence and Social Participation After Spinal Cord Injury.

BACKGROUND

Many individuals aging with spinal cord injury (SCI) experience health complications that threaten independence and participation. However, little is known about how negative health events (NHEs) and time since injury shape long-term functional and psychosocial outcomes for individuals with SCI.

METHODS

Participants were from a national longitudinal dataset of over 13,000 participants from the SCI Model Systems. Participants had 2 or more follow-up assessments of functional and psychosocial outcomes (CHART-SF and SWLS) and NHEs (composite of pain interference, rehospitalization, perceived health decline, and poor self-rated health). Multilevel modeling assessed the effects of time since injury, NHEs, and their interactions on functional and psychosocial outcomes. Latent profile analysis (LPA) was used to identify functional and psychosocial profiles under differing NHE burden.

RESULTS

Greater NHE burden predicted significant declines across all CHART-SF domains and SWLS (P < .001), whereas time since injury showed small or nonsignificant effects once NHEs were accounted for. Although NHEs adversely affected all groups, baseline functioning and the magnitude of decline varied by demographic and injury characteristics. LPA identified a 4-class solution, including a subgroup (11%) showing high functioning and life satisfaction despite elevated NHE burden, reflecting adaptive stability.

CONCLUSION

NHEs-not aging alone -are key drivers of decline. However, a meaningful subgroup demonstrates adaptive stability despite significant health adversity, which is characteristic of resilience. Understanding and facilitating mechanisms that foster such adaptive capacity (e.g., psychosocial coping, support, behavioral adaptations) may inform individualized approaches for successful aging with SCI.