Spinal Cord Injury: Outcomes
Rehabilitation Research and Training Center (RRTC) on Secondary Conditions in Individuals with SCI
Sponsor: United States Department of Education/NIDRR | PI: James Krause, Subproject "A" and "C"; PI: Lee Saunders, Subproject "B"
The purpose of the study is to increase our knowledge and ability to predict and prevent a wide array of secondary conditions, with an emphasis on factors from a theoretical risk model specifically developed for the prediction of morbidity and mortality after spinal cord injury. This, coupled with education and training, dissemination, and technical assistance will directly result in a network of well-informed professionals to apply their skills to diminish the likelihood of secondary conditions and increase longevity after spinal cord injury.
A. Subproject: Risk and Protective Factors for Secondary Conditions: A 15-year Longitudinal Study
This study will establish a foundation for the development of prevention strategies that target predictive factors that have the strongest association with the greatest number of secondary conditions (preliminary research identified six clusters). The new knowledge to be gained from the study will allow for the development of intervention strategies that focus on individual or classes of risk factors that may decrease the likelihood of multiple secondary conditions, rather than a single condition.
B. Subproject: Association of Health Services with Secondary Conditions: Use of a Population-based Cohort of Persons with SCI in South Carolina.
This component will make two critical and unique contributions to our understanding of secondary conditions. First, because of this population-based, it does not have the same set of biases that are inherent to identification of cohorts through rehabilitation hospitals and other clinical facilities. A second contribution of this component is the direct assessment of the role of health services in the development of secondary conditions and disparities in secondary conditions as a function of race ethnicity (up to 40% of the surveillance system is African-American). This will allow for the direct comparison of individuals who received different types of rehabilitation after SCI onset, including inpatient, outpatient, and no rehabilitation services. These analyses address the fundamental limitation in the Model SCI System related to outcomes research – the inability to compare outcomes than those who received Model System care with those who received either other rehabilitation services or no services at all.
C. Subproject: Risk of Metabolic Syndrome: A 17 Year Longitudinal Study
This component adds a unique focus on metabolic syndrome and cardiovascular disease, which requires collection of specimens to identify biomarkers and both of which require longitudinal methods for thorough investigation. Metabolic syndrome has not received the attention it deserves in the literature, given the potential prelude to cardiovascular disease and the disproportionate deaths after SCI associated with cardiovascular syndrome and lay the foundation for prevention strategies for cardiovascular disease. Second, the cohort itself is rather unique by virtue of including substantial portion of Hispanic participants (as well as a smaller, relatively large cohort of African Americans) that will average about 25 years post injury time of the second assessment. Lastly, although not a primary objective of this component, we will evaluate the elevated risk for mortality associated with metabolic syndrome, as this speaks directly to the consequences of secondary conditions.
Center on Health Outcomes Research and Capacity Building for Underserved Populations with Spinal Cord Injury and Traumatic Brain Injury (CHORCUP)
Sponsor: United States Department of Education | PI: James Krause
This project builds the capacity of institutions addressing the needs of underserved populations by: (a) conducting two studies to generate new knowledge on the health of three underserved racial-ethnic groups with traumatic neurologic injuries; (b) providing capacity building through collaboration with a historic Black university, specialized instruction of undergraduate and graduate students, and widespread training to institutions and organizations representing underserved populations; and (c) providing technical assistance to a wide array of target audiences to enhance the capacity to meet the needs of underserved populations.
Ambulation and Secondary Complications: Participants with Chronic Spinal Cord Injury
Sponsor: United States Department of Education/NIDRR | PI: James Krause
The purpose of this study is to identify variations in ambulation after SCI based on utilization of assistive devices and orthoses, reliance on people for assistance, functionality (distances, primary mode of locomotion), and association with secondary conditions.
Risk for Adverse Outcomes after Spinal Cord Injury: A Longitudinal Study
Sponsor: National Institutes of Health/National Institute of Neurological Disorders and Stroke | PI: James Krause
The purpose of this study is to identify risk and protective factors for three types of health outcomes after SCI by testing two empirical models for risk of adverse outcomes.
Measuring Outcomes after Spinal Cord Injury Throughout South Carolina: A System of Tracking, Research and Referral
Sponsor: South Carolina Spinal Cord Injury Research Fund | PI: James Krause
The purpose of this study is to gain a more comprehensive understanding of the outcomes of people with spinal cord injury in South Carolina, their access to health services, and the interrelationships between access to services and clinical outcomes by developing a statewide outcomes database, analyzing and disseminating the results, and building a resource for use by diverse investigators in South Carolina. All newly injured individuals that come into the surveillance system will be routinely assessed for risk and protective factors, access to and utilization of services, and outcomes. In addition to the routine collection among new individuals, follow-up assessments will be conducted at regular intervals.
Participation, Subjective Well Being, Health, and Spinal Cord Injury: A 40-Year Longitudinal Study
Sponsor: United States Department of Education/National Institute on Disability and Rehabilitation Research | PI: James Krause
Our purpose builds upon a 40 year ongoing longitudinal study of spinal cord injury to help us better understand the natural course of aging and to lay the foundation for intervention strategies to improve outcomes. This study was initiated in 1973 using a revolving panel longitudinal design with routine follow-ups every 5 years, and the intermittent addition of new participant samples to counter attrition (this will be the eighth stage of data collection). Study enhancements include identification of age-related changes, factors predicting change and the roles of resiliency in buffering individuals from age-related declines.
A Longitudinal Study of Gainful Employment 10 Years after Spinal Cord Injury Onset: Comparisons of Those Who Do Not Return to the Pre-Injury Employer
Sponsor: United States Department of Education/ National Institute on Disability and Rehabilitation Research; Prime - Shepard Center, Atlanta Georgia; MUSC Sub-Contractor | PI: James Krause
The purpose of this study has four objectives: identify the timing of starting a post-injury employee (PE) and how this differs depending on whether the individual returns to the pre-injury employer as opposed to finding new employment after spinal cord injury; identify how vocational interests measured by the Strong Interest Inventory have changed from the baseline assessment through 10 years post-injury and their relationship with sex, race, and injury severity; develop 10-year predictive models using variables from the time of injury (baseline inpatient hospitalization) so as to maximize the predictive value of assessments during inpatient rehabilitation; and develop 10-year explanatory predictive models using a combination of significant predictors assessed during inpatient rehabilitation and additional key constructs measured at follow-up including vocational interest change and environmental barriers and facilitators to employment.
Center for Interdisciplinary Spinal Cord Injury Research Fund
Sponsor: South Carolina Spinal Cord Injury Research Fund | PI: James Krause
The mission of this Center is to facilitate interdisciplinary research in spinal cord injury in the state of South Carolina by virtue of enhancing the core capacity of researchers to perform interdisciplinary research, providing leadership to guide research efforts, and pulling together resources from existing entities.