Latent Structural Analysis of Health Outcomes in People Living With Spinal Cord Injury

Abstract

ObjectiveTo develop a latent structural model of health outcomes in people with spinal cord injury (SCI) that accounts for the measurement of underlying factors and their association with demographic and injury-related exogenous variables. DesignCross-sectional study. SettingSpecialty hospital and medical university. ParticipantsParticipants with traumatic SCI (N=1871) of at least 1-year duration. InterventionsNot applicable. Main Outcome MeasuresExploratory factor analysis was used to identify latent health outcome structures. Several key exogenous variables were also linked with the latent health outcome factors. ResultsSix latent health outcome factors were identified by the exploratory factor analysis with excellent model fit (root mean square error of approximation=.040). These latent factors included (1) global health problems; (2) chronic disease; (3) acute treatments; (4) symptoms of SCI complications, (5) pressure ulcers; and (6) subsequent injuries. Sex, race/ethnicity, age, years since injury, and injury severity were all significantly associated with at least 1 latent health outcome factor, which indicates that these latent health outcomes varied as a function of the exogenous variables. ConclusionsThis study improved our understanding of the structure of health outcomes, and utilization of latent health outcome factors provides more stable and comprehensive composite scores than does utilization of a single observed health outcome indicator.