Social Integration Scores Research Articles

The effect of social integration on outcomes after major lower extremity amputation

Major lower extremity (MLE) amputation is a common procedure that results in a profound change in a patient's life. We sought to determine the association between social support and outcomes after amputation. We hypothesized that patients with greater social support will have better post amputation outcomes. From November 2011 to May 2013, we conducted a cross-sectional, observational, multicenter study. Social integration was measured by the social integration subset of the Short Form Craig Handicap Assessment and Reporting Technique. Systemic social support was assessed by comparing a United States and Tanzanian population. Walking function was measured using the 6-minute walk test and quality of life (QoL) was measured using the EuroQol-5D. We recruited 102 MLE amputees. Sixty-three patients were enrolled in the United States with a mean age of 58.0. Forty-two (67%) were male. Patients with low social integration were more likely to be unable to ambulate (no walk 39% vs slow walk 23% vs fast walk 10%; P = .01) and those with high social integration were more likely to be fast walkers (no walk 10% vs slow walk 59% vs fast walk 74%; P = .01). This relationship persisted in a multivariable analysis. Increasing social integration scores were also positively associated with increasing QoL scores in a multivariable analysis (β, .002; standard error, 0.0008; P = .02). In comparing the United States population with the Tanzanian cohort (39 subjects), there were no differences between functional or QoL outcomes in the systemic social support analysis. In the United States population, increased social integration is associated with both improved function and QoL outcomes among MLE amputees. Systemic social support, as measured by comparing the United States population with a Tanzanian population, was not associated with improved function or QoL outcomes. In the United States, steps should be taken to identify and aid amputees with poor social integration.

Social Integration, Social Support and Mortality in the US National Health Interview Survey

Social relationship quantity and quality are associated with mortality, but it is unclear whether each relationship dimension is equally important for longevity and whether these associations are sensitive to baseline health status. This study examined the individual and joint associations of relationship quantity (measured using a social integration score) and quality (measured by perceived social support) with mortality in a representative US sample (n = 30,574). The study also evaluated whether these associations were consistent across individuals with and without diagnosed chronic illness and whether they were independent of socioeconomic status (SES; education, income, employment, and wealth). Baseline data were collected in 2001 and were linked to vital status records 5 years later (1836 deaths). Both social integration and social support were individually related to mortality (hazard ratios [HRs] = 0.83 [95% confidence interval {CI} = 0.80-0.85] and HR = 0.94 [95% CI = 0.89-0.98], respectively). However, in multivariate models including demographic and SES variables, social integration (HR = 0.86, 95% CI = 0.83-0.89) but not social support (HR = 1.03, 95% CI = 0.98-1.08) was associated with mortality. The social integration association was linear and consistent across baseline health status and men and women. Social integration but not social support was independently associated with mortality in the US sample. This association was consistent across baseline health status and not accounted for by SES.

Relation Between Inpatient and Postdischarge Services and Outcomes 1 Year Postinjury in People With Traumatic Spinal Cord Injury

ObjectiveTo examine the association between inpatient and postdischarge rehabilitation services and function, life satisfaction, and community participation 1 year after spinal cord injury (SCI). DesignProspective, observational. SettingSix rehabilitation facilities. ParticipantsPatients with SCI (N=1376). InterventionsNone. Main Outcome MeasuresSatisfaction with Life Scale (SWLS), Craig Handicap Assessment and Reporting Technique (CHART), motor FIM (mFIM), and return to work/school at 1 year post-SCI. ResultsDemographic and injury characteristics explained 49% of the variance in mFIM and 9% to 25% of the variance in SWLS and CHART social integration, mobility, and occupation scores. Inpatient rehabilitation services explained an additional 2% of the variance for mFIM and 1% to 3% of the variance for SWLS and CHART scores. More time in inpatient physical therapy (PT) was associated with higher mFIM scores; more time in inpatient therapeutic recreation (TR) and social work and more postdischarge nursing (NSG) were associated with lower mFIM scores. More inpatient PT and TR and more postdischarge PT were associated with higher mobility scores; more inpatient psychology (PSY) was associated with lower mobility scores. More postdischarge TR was associated with higher SWLS; more postdischarge PSY services was associated with lower SWLS. Inpatient TR was positively associated with social integration scores; postdischarge PSY was negatively associated with social integration scores. More postdischarge vocational counseling was associated with higher occupation scores. Differences between centers did not explain additional variability in the outcomes studied. ConclusionsInpatient and postdischarge rehabilitation services are weakly associated with life satisfaction and societal participation 1 year after SCI. Further study of the type and intensity of postdischarge services, and the association with outcomes, is needed to ascertain the most effective use of therapy services after SCI.

Academic and social integration of Master students: a cross-institutional comparison between Dutch and international students

In Europe there is a growing concern among educators and policy makers that students are not well-prepared to start a Master programme. This study draws on longitudinal research conducted at four universities in the Netherlands and a follow-up exploratory purposively chosen from one of the study sites. In Study 1, differences in academic performance between 146 Dutch and 215 international students were identified by focussing on their levels of academic and social integration. Afterwards, students from 53 countries were clustered into ten geographical clusters using Hofstede culture difference scores. In Study 2, a questionnaire about perceived transitional barriers was completed by 159 Master students at one of the four institutes. The results of Study 1 indicate that academic and social integration scores of Western European and domestic students were comparable. Eastern European, non-European and in particular Southern Asian and Confucian Asian Master students had significantly lower academic and social integration scores. Follow-up regressions showed that academic adjustment is the main predictor of study- performance, irrespective of cultural differences. Study 2 indicates that half of the Master students experienced a substantial change in their learning strategies, language and research methods. We encourage UK higher educational institutes to conduct more research on whether the specific needs of international Master students are sufficiently supported.

Outcomes of social work and case management services during inpatient spinal cord injury rehabilitation: The SCIRehab project

ObjectiveTo investigate associations of social work/case management (SW/CM) services during inpatient rehabilitation following spinal cord injury (SCI) and patient characteristics with outcomes.DesignProspective observational cohort of individuals with SCI receiving inpatient rehabilitation.SettingSix inpatient rehabilitation centers.Participants1032 individuals with traumatic SCI.InterventionsNot applicable.Main outcome measure(s)Type of residence at the time of rehabilitation discharge. Employment/school status, presence of a pressure ulcer, Patient History Questionnaire, Satisfaction with Life Scale, Craig Handicap Assessment and Reporting Technique (CHART) subscales, and rehospitalization at 1-year post-injury.ResultsThe intensity of specific SW/CM services is associated with multiple outcomes examined. More sessions dedicated to discharge planning for a home discharge and financial planning were associated positively with more discharge to home, while more sessions focused on planning for discharge to a location other than home, e.g. nursing home or long-term acute care facilities, have negative associations with societal participation outcomes (CHART Social Integration, Occupation, and Mobility scores) as well as with residing at home at the time of the 1-year injury anniversary.Conclusion(s)The intensity and type of SW/CM services are associated with outcomes at rehabilitation discharge and at 1-year post-injury. Discharge to home may require assistance from SW/CM in the area of discharge planning and financial planning, while discharge to non-home residence demands directed SW/CM services for such placement.NoteThis is the eighth of nine articles of this SCIRehab series.

The Effect of Social Integration on Self-rated Health for Elderly Japanese People: A Longitudinal Study

The current study used the 1999 wave of the Nihon University Japanese Longitudinal Study of Aging to measure intrafamilial and extrafamilial social integration scores for people aged 65-plus, and their self-ranked health reported in follow-up interviews in 2001. An innovation was the usage of ordinal logit regressions of this ordinally-measured dependent variable on the two dimensions of social integration. Higher scores on each dimension of social integration in 1999 predicted more favorable rankings on self-rated health scores in 2001. The five conclusions of this study are: (1) the relationship between social integration and self-rated health did not vanish during the “lost decade” of the 1990s; (2) the relationship is causal; (3) both intrafamilial and extrafamilial dimensions of social integration cause more favorable rankings of self-perceived health; (4) extrafamilial roles have a stronger effect than intrafamilial roles, and (5) the roleenhancement perspective is more useful than the role-strain perspective in understanding the relationship of social integration to health.

Social relationships and inflammatory markers: An analysis of Taiwan and the U.S.

We evaluated the association between two aspects of social relationships and six inflammatory markers in Taiwan and the U.S. These two countries share similar levels of current life expectancy, but exhibit important differences in social structure. The data comprised population based samples from Taiwan (aged 53+; n=962) and the U.S. (aged 35–86; n=990) collected between 2003 and 2009. Circulating levels of interleukin-6 (IL-6), C-reactive protein (CRP), fibrinogen, and soluble forms of intercellular adhesion molecule 1, E-selectin, and IL-6 receptor (sIL-6R) were measured in fasting blood samples. A social integration score was based on marital status, contact with family and friends, church attendance, and other social participation. A perceived social support index was based on questions regarding the availability of care and support from family and friends. Linear regression models tested the association between these two measures and each inflammatory marker controlling for sociodemographic characteristics, obesity, medication use, and baseline health status. After adjusting for potential confounders, social integration had a significant but weak inverse association with CRP in Taiwan. Perceived social support was significant in two of 12 models, and the coefficient was positive (i.e., higher support was associated with higher CRP and sIL-6R in the U.S.). We found no evidence that the coefficients for social relationship measures varied by sex or age. Our results yielded limited evidence of a weak association between two dimensions of social relationships and six inflammatory markers in Taiwan and the U.S. Given that the literature suggests a strong link between social relationships and mortality, and that inflammation plays an important role in the leading causes of death, we had expected to find consistent and moderately strong associations between social relationships and inflammatory markers. The small effect sizes and lack of robustness across markers were surprising.

P03-596 - SWN (subjective well-being under neuroleptics) in clinical practice

ObjectivesTo assess the use of SWN in the acute phase of psychiatric disease as a predictor of clinical outcome.MethodsThis study started in June 2009 and at the moment we have recruited 150 patients. The patients were divided into 4 groups according to their psychiatric diagnosis (schizophrenic psychosis, mood disorders, personality disorders, acute stress reaction) and each diagnostic group into three subgroups according to length of stay (T1< 7 days, T2 = 7–14 days, T3> 14 days). The subjective well-being indicators (subscales SWN: emotional regulation; self-control; mental functioning; social integration and physical functioning) and the severity of illness (CGI-S) were evaluated at admission and discharge.ResultsAt discharge there is a statistically significant difference in the SWN subgroups among the four diagnostic groups except for social integration and total score with equal CGI-S scores. Schizophrenic patients and personality disorders show a subjective improvement at T2; mood disorders at T3; acute stress reactions T1 = T2. CGI shows a statistically improvement regardless of the length of stay.ConclusionsPreliminary data suggest that SWN represents a predictor of clinical outcome and remission and together with the clinical evaluation it can help clinician to settle therapeutic programs.

Cell Telephone Ownership and Social Integration in Persons With Spinal Cord Injury

Roach MJ, Harrington A, Powell H, Nemunaitis G. Cell telephone ownership and social integration in persons with spinal cord injury. Objectives To describe the prevalence and demographic characteristics associated with cell telephone ownership and to investigate whether cell telephone ownership has a positive relationship with social integration. Design Cross-sectional. Setting Spinal Cord Injury (SCI) Model Systems. Participants Participants (N=7696) with traumatic SCI who were entered into the National SCI Database and completed a follow-up interview from April 2004 through April 2009. Interventions None. Main Outcome Measures Cell telephone ownership; Craig Handicap Assessment Reporting Technique Social Integration subscale. Results A total of 73% of participants owned a cell telephone. Persons who were younger, employed, achieved education beyond grade school, and had computer and e-mail access were more likely to own cell telephones. Not owning a cell telephone decreased the likelihood of belonging to the high-social-integration group compared with the low-integration group (odds ratio, .509; 95% confidence interval, .396–.654). Persons with low or medium social integration scores were less likely to own a cell telephone than those who had high social integration scores. Conclusion In this study, most participants owned a cell telephone, although 27% did not compared with 13% nonowners in the general population. Owning a cell telephone increased the likelihood of being more socially integrated compared with non–cell telephone ownership.

Mechanical Ventilation, Health, and Quality of Life Following Spinal Cord Injury

Charlifue S, Apple D, Burns SP, Chen D, Cuthbert JP, Donovan WH, Lammertse DP, Meade MA, Pretz CR. Mechanical ventilation, health, and quality of life following spinal cord injury. Objective To examine differences in perceived quality of life (QOL) at 1 year postinjury between people with tetraplegia who required mechanical ventilation assistance at discharge from rehabilitation and those who did not. Design Prospective cross-sectional examination of people with spinal cord injury (SCI) drawn from the SCI Model Systems National Database. Setting Community. Participants People with tetraplegia (N=1635) who sustained traumatic SCI between January 1, 1994, and September 30, 2008, who completed a 1-year follow-up interview, including 79 people who required at least some use of a ventilator at discharge from rehabilitation. Interventions Not applicable. Main Outcome Measures Satisfaction With Life Scale (SWLS); Craig Handicap Assessment and Reporting Technique (CHART)-Short Form Physical Independence, Mobility, Social Integration, and Occupation subscales; Patient Health Questionnaire-9 (PHQ-9), Medical Outcomes Study 36-Item Short-Form Health Survey self-perceived health status. Results Significant differences were found between the ventilator-user (VU) group and non–ventilator-user (NVU) group for cause of trauma, proportion with complete injury, neurologic impairment level, and number of rehospitalizations. The NVU group had significantly higher SWLS and CHART Social Integration scores than the VU group after controlling for selected covariates. The NVU group also had more positive perceived health status compared with a year previously and a lower incidence of depression assessed by using the PHQ-9 than the VU group. There were no significant differences between groups for perceived current health status. Conclusions People in this study who did not require mechanical ventilation at discharge from rehabilitation post-SCI reported generally better health and improved QOL compared with those who required ventilator assistance at 1 year postinjury. Nonetheless, the literature suggests that perceptions of QOL improve as people live in the community for longer periods.

Social Integration and Health Behavioral Change in San Luis, Honduras

This study explores the effects of social integration on behavioral change in the course of an intensive, community-based public health intervention. The intervention trained volunteers and mobilized local organizations to promote 16 key family health practices in rural San Luis, Honduras, during 2004 to 2006. A mixed methods approach is used. Standard household sample surveys were performed in 22 villages before and after the intervention. Eight villages were then resurveyed. A household survey, focus groups, and key informant interviews measured health behaviors and several social structural and psychosocial variables. The villages were then ranked on their mean behavioral and social integration scores. The quantitative and qualitative rankings were in close agreement (Kendall's coefficient of concordance = .707, p < .001). Behaviors changed most markedly in the villages where respondents participated in local organizations, observed that others performed those behaviors, and depended on their neighbors for support. The results show that social integration conditions health behavioral change. Health interventions can be made more effective by analyzing these features a priori.

Mothers' depression and health‐related quality of life in neuromuscular diseases: Role of functional independence level of the children

In the literature there have been studies about quality of life of parents who have children with chronic diseases. Most of these studies have focused on the stress of parents of children with neuromuscular disease (NMD), and there was no evidence to support hypothesized relationships between caregiving demands and health-related quality of life (HRQOL). The aim of the present study was therefore to evaluate the relations between maternal depression and HRQOL and functional limitations of the children with NMD. Forty children with a diagnosis of NMD and their mothers were included in the study. HRQOL of the mothers was assessed on the Turkish version of the Nottingham Health Profile (NHP); potential cases of depressive illness were identified on Beck Depression Inventory (BDI); and Wee-Functional Independence Measure (Wee-FIM) was used to evaluate of functional independence level of the children. It was found that mean total NHP score of the mothers was moderately correlated with the total FIM score and sphincter control of the child, and weakly correlated with the locomotion of the child (P < 0.001). There was moderate correlation between mothers' social isolation and children's sphincter control, social integration and total Wee-FIM score and a weak correlation between mobility and communication scores (P < 0.001). In contrast there was no correlation between BDI scores of mothers and Wee-FIM scores of children (P > 0.05). The functional level of children with NMD is one of the factors that affect the quality of life of mothers.

Mobility, Assistive Technology Use, and Social Integration Among Adults with Spina Bifida

Many individuals with spina bifida have impairments that limit mobility and functional independence. Sedentary lifestyles and social isolation are very prevalent. This study evaluated the association between the use of mobility devices and degree of socialization. A retrospective chart review was performed on 208 adults with spina bifida attending a university-based clinic. Data collected included the Craig Handicap Assessment Reporting Technique-Short Form, Beck Depression Inventory, and data on wheelchair and other assistive technology use. We hypothesized that community and home mobility and social integration, as measured by the Craig Handicap Assessment Reporting Technique-Short Form, would be lower for manual and power wheelchair users than for ambulators, regardless of depression scores or shunt history. We found that individuals with spina bifida who used both manual and power wheelchairs do have lower daily home and community activity levels compared with ambulators, but that most individuals with spina bifida have low social integration and economic self-sufficiency scores, regardless of whether they can ambulate or use wheelchairs. These findings were not explained by wheelchair quality because most were prescribed high-quality devices. A high prevalence of depression was also found. Special considerations for wheelchair provision are discussed. Additional research is needed to identify other barriers to social integration.

Community integration following moderate to severe traumatic brain injury: A longitudinal investigation

To evaluate the course and identify determinants of community integration for up to 3 years following moderate to severe traumatic brain injury. Prospective cohort study. A total of 119 moderate to severe traumatic brain injury patients aged 16-67 years. The Community Integration Questionnaire was completed at 3, 6, 12, 18, 24 and 36 months post-injury. Repeated measures analysis of variance was performed to determine changes over time in the Community Integration Questionnaire and its subscales. Bivariate and multivariate regression analyses were used to identify determinants of community integration 36 months post-injury. Compared with pre-injury, mean home integration, social integration, productivity, and total questionnaire scores decreased 3 months post-injury. Patient scores showed maximal improvement during the first year post--injury. Mean home integration, productivity, and total scores increased to a lesser extent during years 1-3 post-injury. Age, Barthel Index scores, hospital discharge destination, and pre-injury community integration scores were the major determinants of community integration 36 months post-injury (R2 = 60%). After an initial decline, mean community integration scores gradually improve following moderate to severe traumatic brain injury. Understanding the course and determinants of community integration is necessary in order to determine functional prognosis following traumatic brain injury.

Elements and degrees of SI: A case study of Nikkei Brazilian immigrants in Japan

This article provides an overview of the recent immigrant phenomenon in Japan and explains the complexity of the social integration (SI) of Nikkei Brazilians. Through the research, factors that explain the degree of social integration (SI) of Nikkei Brazilians are identified. Basic data include triangulated results from a survey of 80 people and interviews with 8 individuals. This mixed method case study presents a formula for assessing the degree of SI (SI score), empirically tests and questions several key hypotheses derived from previous literature, and explores the possibility of developing a new non-conventional theory to explain this phenomenon.

EFFECTIVENESS OF A COMPREHENSIVE DAY TREATMENT PROGRAM FOR REHABILITATION OF PATIENTS WITH ACQUIRED BRAIN INJURY IN JAPAN

To assess the effectiveness of a day treatment program with a comprehensive team approach for treating outpatients with acquired brain injury, which is offered by the Kanagawa Rehabilitation Hospital. Non-randomized controlled study. Twenty-five program graduates and 12 control patients with acquired brain injury. A prospective study using 25 brain-injured patients with cognitive dysfunction who were provided with a comprehensive day treatment program at Kanagawa Rehabilitation Hospital. The 25 enrolled patients had treatment sessions lasting 2-4 hours for 2 days a week over a 3-6-month period. Functional Independence Measure/Functional Assessment Measure (FIM/FAM) and the Community Integration Questionnaire (CIQ) were administered before and after the program to compare outcomes between the 25 program participants and the 12 control patients who did not receive the day treatment program. Significant improvements in speech intelligibility, problem solving, memory, attention and social integration scores in the FIM/FAM and scores in social integration and productive activity in the CIQ were evident in the enrolled subjects. In addition, 9 of the 25 patients returned to work or school. These results demonstrate the effectiveness of this program in helping to rehabilitate patients with acquired brain injury.

Social Integration Is Associated With Fibrinogen Concentration in Elderly Men

The objective of this study was to determine whether social integration is associated with plasma concentrations of fibrinogen in an elderly population. Participants (ages 70-79; n = 375 men and 425 women) were part of the MacArthur Successful Aging Study, a longitudinal study from three community-based cohorts in the United States, who have relatively high physical and cognitive functioning. Social integration was measured using a social integration score, which assessed marital status, number of contacts with family and friends, frequency of religious service attendance, and participation in voluntary organizations. Fibrinogen concentrations were measured in plasma using an automated clot-rate assay. Cross-sectional multivariate logistic regression analyses were performed. Social integration was significantly associated with elevated concentrations of fibrinogen (>336 mg/dL) in men after adjusting for smoking, alcohol consumption, physical activity, body mass index, comorbidity, physical functioning, depression, age, race, and education (odds ratio [OR] = 2.29, 95% confidence interval [CI] = 1.07-4.89, p = .03 for having elevated fibrinogen in the least integrated quartile versus the most integrated quartile). There was no significant association between social integration and fibrinogen in women (multivariate-adjusted OR = 0.57, 95% CI = 0.27-1.21, p = .15). Social integration is associated with fibrinogen concentrations in elderly men. This provides evidence of a biologic mechanism that may help explain the observed associations between social integration and mortality in men. There may be gender differences in the physiological pathways by which social integration influences health.

Patterns of internet use by persons with spinal cord injuries and relationship to health-related quality of life

Drainoni M-L, Houlihan B, Williams S, Vedrani M, Esch D, Lee-Hood E, Weiner C. Patterns of Internet use by persons with spinal cord injuries and relationship to health-related quality of life. Arch Phys Med Rehabil 2004;85:1872–9. Objectives To examine patterns of computer and Internet use among persons with spinal cord injuries (SCI) and to assess the relationship between Internet use and health-related quality of life (HRQOL). Design Cross-sectional survey design. Setting National Model Spinal Cord Injury Systems. Participants People with SCI enrolled in a national database. Interventions Not applicable. Main outcome measures Patterns of Internet use and relationship to HRQOL indicators: self-perceived health status, health status compared with 1 year ago, severity of depression, social integration score, occupation score, contacts with friends, business contacts, and satisfaction with life. Results Most subjects owned computers, had Internet access, and used the Internet regularly—primarily for email, disability and health information, and shopping. Bivariate analysis revealed significant differences in Internet access based on sociodemographics, particularly among subjects with less education and among African Americans and Hispanics. In initial univariate analysis, most HRQOL indicators were significantly better for Internet users; once sociodemographic factors were included, 4 indicators remained significant. Conclusions Complex factors contribute to Internet access among people with SCI, with more barriers among specific subgroups. A significant HRQOL benefit from Internet use is suggested. Targeted interventions and studies of usage patterns are recommended.

Race, employment, and spinal cord injury

Meade MA, Lewis A, Jackson N, Hess DW. Race, employment, and spinal cord injury. Arch Phys Med Rehabil 2004;85:1782-92. Objectives To examine issues of employment and race for persons with spinal cord injury (SCI), by assessing the type of work that was being done before and after injury and by placing this in the context of patterns for the general population. Design Retrospective, cross-sectional analysis. Setting Centers funded as part of the federally sponsored Model Spinal Cord Injury Systems (MSCIS) Project. Participants Two samples: 5925 African Americans and whites with SCI who are part of the MSCIS and a subset of 577 people with SCI. Interventions Not applicable. Main outcome measures Demographic information, occupational status, employment rate, job census codes, Craig Hospital Assessment and Reporting Technique-Short Form, and Satisfaction With Life Scale. Results Racial disparities were found in employment rates before injury and at 1, 5, 10, 15, and 20 years after SCI. Differences were also found in the types of jobs that were held before SCI with patterns for participants similar to those of African Americans and whites in the general population. No differences were found in the types of jobs held by African Americans and whites with SCI at 1 year after injury. After injury, African Americans had lower economic self-sufficiency scores, regardless of employment status, and lower social integration scores among those who were not employed. Conclusions Racial disparities found in employment patterns among persons with SCI mirrored patterns among the general population.

Poster 20: Community integration after traumatic brain injury

Objective: To determine the level of community integration after traumatic brain injury (TBI) and its association with clinical inpatient outcome measures. Design: The Community Integration Questionnaire (CIQ) was used to conduct telephone interviews with either the patient or a proxy who lived with the patient. Setting: Community. Participants: 77 patients with TBI who were 5 to 34 months postdischarge from an acute rehabilitation hospital. Interventions: Not applicable. Main Outcome Measure: The CIQ. Results: The CIQ total score had an inverse correlation with age ( r=−.300, P<.008) and length of stay ( r=−.290, P<.011). There were low but statistically significant correlations with discharge cognitive skills on the FIM™ instrument ( r=.451, P<.0001), discharge FIM total score ( r=.366, P<.001), and FIM efficiency ( r=.367, P<.001). There were significant differences between subjects who were not currently working or attending school versus those who were. The latter group scored higher on home integration (5.6±3.0 vs 3.6±2.9), social integration (8.9±2.1 vs 6.6±2.8), productivity (5.4±0.8 vs 1.5±1.1), and CIQ total scores (20.0±3.7 vs 11.8±5.8). Conclusion: Consistent with previous findings, community integration correlated with functional outcome at discharge from rehabilitation. Patients who return to work or school exhibit better social and home integration.