print this pageLife Satisfaction Among
Persons with Spinal Cord Injuries
Part Three
Results
Measurement scores, frequencies, means, and standard deviations were initially computed. The data were analyzed using multiple regression analysis. An alpha level for all statistical testing of significance was preset at the .05 level.
Of the seven independent variables, two (marital status and personal control) contributed to the variance explained by the analysis (see Table 1). Perceived control was the single largest predictor of life satisfaction in the regression analysis and was significant at the .01 level with ß = .26, t = 4.50, p < .01 (see Table 1), indicating that life satisfaction may be predicted by the amount of control a person perceives.
In addition, marital status also contributed to life satisfaction and was significant at the .01 level with ß = -1.98, t = -2.44, p < .02 (see Table 1). Because of the dummy coding of marital status, the meaning of this contribution was that married persons with spinal cord injury reported higher levels of life satisfaction than those participants who were not married at the time of the survey. Because of the correlation between the various measures, the strongest relationships were first accounted for in the multiple regression. The remainder of the independent variables failed to make a significant independent contribution to the variance explained.
In this study, the independent variables were moderately correlated with one another, and separately correlated with the life satisfaction (see Table 2.).
Years since injury r = .201, p < .05), control r = .597, p < .01), health (r = .184, p < .01), personal assistance satisfaction r = .366, p < .01), and handicap r = .414, p < .01) were all positively correlated with life satisfaction. Conversely, the variable communication skills (r = -.200, p < .05) was negatively correlated with life satisfaction. The negative correlation of communication skills with life satisfaction is a function of the coding schema. For the communications measure, a lower score indicates greater clarity and directness in the exchange of information. Therefore, the greater the clarity and directness of the participant, the greater the life satisfaction.
Other Findings
Using a five-point scale, persons with a spinal cord injury indicated that they were more
satisfied with the quality of personal assistance services from other sources (x = 3.80) than they were with services from home
health care agencies (x = 2.92).
Persons with paraplegia were found to be more effective communicators, perceived themselves as having more control, and encountered fewer limitations than did persons with quadriplegia. That persons with paraplegia encountered fewer obstacles than persons with quadriplegia supports the findings reported by Whiteneck et al., (1992). However, it is important to note that there were no significant group differences in life satisfaction based upon injury level. This result supports the findings by Woodrich and Patterson (1983). Persons with quadriplegia can be empowered by allowing them to exercise greater choice in self directing their assistance services and home life by removing barriers that obstruct the opportunity to participate in community life.
Sixty-five percent of participants (n = 103) identified themselves as being responsible for directing their own personal assistance services. There was a wide range in the hourly amount of personal assistance services received in a typical 24-hour period depending on who provided the service: spouse (n = 47, x = 3.27, married respondents only), recruited (n = 75, x = 2.88), agency (n = 74, x = 2.81), parent (n = 66, x = 1.94), relative (n = 59, x =.67), and friend (n = 60, x = .89). As severity of the disability decreased so too did the use of personal assistance services.
The questionnaire allowed for more than one source of personal assistance services, The frequency with which each source was selected indicated that persons with a spinal cord injury received assistance from family members (spouse, parent, relative) at a higher rate than any other single category. The per hour rate of pay for personal assistance services decreased when family members provided assistance (spouse = $.40, parent = $.76, other relative = $.57) as compared to agency-provided assistance ($7.14). Medicare, Medicaid, private insurance, or a combination of these three were identified by 27% of the respondents as contributing to the payment for personal assistance services. One hundred and fifteen respondents (73%) reported annual out of pocket medical expenses of $5,000 or less.
Discussion
The findings from this study especially apply to persons with a spinal cord injury and their families. Others who might benefit from this information are health care providers, rehabilitation professionals, law makers, and educators. Understanding the components that are important to life satisfaction of persons with a spinal cord injury is the first step in making it a reality.
Persons with a spinal cord injury who took sole responsibility for instructing or directing their personal assistance services were found to perceive more control over their lives. They report ed greater satisfaction with personal assistance services and greater life satisfaction. They also reported better physical health. Furthermore, the respondents were found to encounter fewer social handicaps.
Because most persons with a spinal cord injury need assistance in a variety of important tasks for independent living, it is critical that more attention be given to teaching them the skills to direct the services of personal assistants. It is important to note that persons with a spinal cord injury were significantly more satisfied with personal assistance from family members than home health agencies. Moreover, persons with spinal cord injuries who had not been hospitalized during the past year were more satisfied with their personal assistance and reported better physical health. Given these findings, policy makers and health care providers may need to rethink their philosophy on service delivery and allow the consumer more control in service provision. The need for allowing persons with a spinal cord injury to assume more control over personal assistance services is an essential component to a much needed transformation of the national health care system (English, 1994).
The positive influence of employment on life satisfaction has been previously reported (Crewe & Krause, 1990; Krause, 1990; Mehnert et al., 1990). Similarly, this study found that persons employed at least part time were found to perceive more control, experience less handicap, and perceive more satisfaction with life. Economically, the availability of more disposable income, as compared to nonworkers, provides the financial resources to reduce or remove barriers. Psychologically, work well done and relationships with co-workers are validating and contribute to self-esteem. It is important for law makers to take this information into account when deciding what benefits are available to persons with disabilities. Employment incentives, such as tax deductions, would allow these persons, who may earn little above the poverty line, to return to school. Higher education provides greater employment opportunities. Persons in this study with a higher level of education perceived greater control and encountered fewer handicaps.
Better social skills fit closely with greater social opportunities, more effective personal assistance management practices, and closer relationships including marriage. Participants in this study who were married had claimed to have greater communication skills and higher life satisfaction. Married persons with a spinal cord injury reported greater life satisfaction than did unmarried persons. Married persons also reported being more effective verbal communicators and experienced fewer obstacles than did unmarried persons. Because effective communication and social skills are important in the development and maintenance of interpersonal relationships, persons with a spinal cord injury should be offered skill training in communication and human relations. Future research seems appropriate as culture continues to place greater emphasis on personal satisfaction with everyday life. Such research should emphasize all major life activities, including leisure, and all main life domains (physical, mental, psycho-social, and spiritual).
The participants in this study cannot be considered representative of the population of persons with spinal cord injuries for several reasons. This study provided an opportunity for persons with a spinal cord injury to participate in the process by making the survey instruments available in multiple forms, including, paper and pencil, web based forms, e-mail based forms, and telephone interviews. As was described earlier, a disproportionate number of persons with quadriplegia (73%) responded to the opportunity. It is unclear to what extent this predominant response to the web-based forms by persons with quadriplegia reflects a perceived new opportunity for these persons to express their opinions. This phenomenon needs to be examined further. Based on our review of the literature we also limited the number of possible independent variables that might contribute to life satisfaction. We recognize that important aspects of adult life, such as marital satisfaction and access to leisure activities, need to be examined for their contribution to the life satisfaction of persons with spinal cord injuries. Finally, persons with quadriplegia are more likely to make use of personal assistance than persons with paraplegia. As a result, about one third of the persons who participated in the study did not complete the measure on satisfaction with personal assistance, most of those who did not complete that measure were either married or had paraplegia. This study does, however, point to important issues that need to be addressed in the next wave of research.
In summary, the major independent variables of perceived control, handicap, marital status, verbal communication, and satisfaction with personal assistance services were found to be significantly related to life satisfaction. The regression analysis showed that perceived personal control and marital status are especially significant predictors of life satisfaction in the regression analysis. Substantial or significant disability is recognized as a stressor that reduces independence and influence in one's life, at least in the early stages of adjustment (English, 1995). In turn, many persons, often with the best of intentions, act in an overly controlling or protective manner that reduces self-direction and reinforces dependency (English, 1994). Overall, the findings of this study support the idea that persons with a spinal cord injury should attempt to maximize constructive self-control, while minimizing unwanted intrusive behavior by others.
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Article reprinted with permission from the Journal of Rehabilitation, July/August/September 2000, published by the National Rehabilitation Association