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Projects and Funding

There are five integrating themes that link the three studies of this Center, including:

  1. Utilization of the theoretical risk model,
  2. Assessment of a core group of risk and protective factors,
  3. Focus on the prediction of secondary conditions as a prelude to prevention,
  4. Inclusion of underserved populations; and
  5. Commitment to long-term follow-up within the research design (i.e., either longitudinal data is collected, or it will be collected in future follow-ups).

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Risk and protective factors for secondary conditions: A 15-year longitudinal study

The purpose of this study is to identify risk and protective factors for future secondary conditions to increase knowledge that can be used to develop prevention strategies targeting factors most predictive of the greatest number of secondary conditions. This study builds upon the baseline data collection in 1997-1998 (n = 1386) and a 10-year follow-up conducted in 2007-2009. The majority of the same set of risk and protective measures were administered on both occasions along with a more detailed set of outcome measures that included pain, fatigue and spasticity (among others). The proposed study expands upon previous work by increasing the longitudinal interval to 15 years, identifying 5-year changes in predictors of secondary condition variables that were added during the last follow-up (i.e., those with no previous longitudinal data), and by using the augmented sample, including those who first participated in 2007-2009 (n = 1755).

Specific Aims:

  • Define the factor structure of both health behaviors and secondary conditions using newly collected data in order to establish a measurement model from which risk and protective behaviors may be linked to secondary health conditions.
  • Identify the stability of secondary conditions over five-year and 15-year intervals.
  • We will develop a latent model that links risk and protective factors from each level of the general theoretical risk model with future secondary conditions and health outcomes using five-year and 15-year longitudinal data as predictors.


Association of health services with secondary conditions: Use of a population-based cohort of persons with SCI in South Carolina.

This study will make two unique contributions including: (a) use of a population-based cohort and (b) analysis of the relationship of health services, including initial inpatient and outpatient rehabilitation. Population-based cohorts capture all acute SCIs in a given region and facilitate investigations among those who are in the most vulnerable positions, including those who have limited or no rehabilitative services after SCI onset. The second unique characteristic is the direct assessment of the role of health services in the development of secondary conditions, including direct comparisons of those receiving different types of rehabilitation (19% of a group surveyed from the surveillance system received neither inpatient nor outpatient rehabilitation).

Specific Aims:

  • Establish the underlying factor structure of the outcome measures.
  • Evaluate the association of rehabilitation services after SCI onset with race-ethnicity and secondary conditions, where rehabilitative services are defined as: (1) both inpatient and outpatient rehabilitation, (2) inpatient rehabilitation only, (3) outpatient rehabilitation only, (4) no organized rehabilitative services.
  • Test hypotheses regarding mediational relationships between race, access to services, and secondary conditions.


Risk of Metabolic Syndrome: A 17 year longitudinal study

Identification of risk factors for MetS and the relationship of MetS with other chronic secondary conditions is essential for preventing MetS after SCI. Because of the existing data on biomarkers on 845 participants, this study presents a unique opportunity to identify changes in MetS over a 17-year period.

Specific Aims:

  • Identify the magnitude of 17 year changes in biomarker indicators of MetS.
  • Identify the association of MetS with other secondary conditions, including those six factors identified in previous research (e.g., pressure ulcers, symptoms of infections), and in new areas included in the expanded data collection (e.g, pain, fatigue).
  • Identify the extent to which MetS is predicted by the risk and protective factors that have been associated with other secondary conditions as defined by the theoretical risk model.
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