Changes in Hospitalization, Physician Visits, and Self-Reported Fitness After Spinal Cord Injury: A Cross-Sequential Analysis of Age, Years Since Injury, and Age at Injury Onset

Abstract

ObjectiveTo identify changes in hospitalizations, days hospitalized, nonroutine physician visits, and self-reported fitness over 4 measurements separated by 4- to 5-year intervals among participants with spinal cord injury (SCI), while testing for the effects of age, time since injury, and age at injury onset. DesignA mixed model was used to analyze the cross-sequential data that include cross-sectional and longitudinal elements. The data were collected in 1993, 1998, 2003, and 2008. SettingData were collected at 2 Midwestern hospitals and a Southeastern specialty hospital in the United States. ParticipantsAdult participants (N=1032) with SCI of at least 1-year duration who participated during at least 1 of 4 times of measurement dating back to 1993. Of these, 463 participated on all 4 occasions. InterventionsNot applicable. Main Outcome MeasuresThe outcome measures were 3 indicators of medical treatments—hospitalization, days hospitalized, and nonroutine physician visits. A fourth outcome was self-reported fitness. ResultsResults of the growth model indicated some limited cohort effects for chronologic age, years since injury, and age at injury onset at baseline. However, significant time effects were observed for each of the health indices, with hospitalizations and physician visits increasing and self-reported fitness decreasing. Significant cohort by time interactions were observed for both number of hospitalizations and days hospitalized with years postinjury and chronologic age. ConclusionsThe natural course of change in the health indices was in the direction of a greater need for treatment and reduced fitness over time. Aging effects, as defined by cohort by time interactions, indicated the greater need for hospitalization increased over time at a greater rate for those with more years postinjury and of older ages.