Perception and predictors of health locus of control at rehabilitation discharge and 1 year after traumatic spinal cord injury.

Abstract

This retrospective study examined the perception and predictors of health locus of control (LOC) in 71 individuals with a spinal cord injury (SCI) at discharge from inpatient rehabilitation (average age 39 years, 77% male, 54% black, 51% cervical SCI, 51% incomplete SCI and average time post-SCI 20 days). We also determined if health LOC beliefs and predictors change over the 1st year after SCI in a representative subsample of 36 individuals. The participants completed surveys regarding the health LOC, self-esteem and depression whereas demographic and SCI information were retrieved from medical records. At inpatient discharge, 55% of SCI individuals endorsed the doctor LOC category compared to internal (14%), other people (6%), chance (3%) or multiple LOC categories (22%). A similar pattern was found at 1-year postinjury (doctor LOC 44% and non-doctor LOC combined 56%). A backward stepwise regression revealed that white race (P = 0.093), >12 years of education (P = 0.001) and cervical level of SCI (P = 0.033) were significant predictors of the doctor LOC category at inpatient discharge (overall classification accuracy 76%). Similarly, >12 years of education (P = 0.055), cervical level of SCI at inpatient discharge (P = 0.033) and higher self-esteem at 1-year post-SCI (P = 0.113) were significant predictors of the doctor LOC category at 1-year post-SCI (overall classification accuracy 78%). We conclude that health LOC remains stable over the 1st year after SCI with the majority of individuals believing that the control over outcomes of their health is in the hands of doctors. These findings have implications for the provision of rehabilitation services after SCI.