Background: To successfully prevent secondary health conditions (SHCs) and promote longevity after spinal cord injury (SCI), we must first understand the risk factors precipitating their occurrence and develop strategies to address these risk factors. Conceptual models may aid in identifying the nature of SHCs and guide research, clinical practice, and the development of prevention strategies. Objective: Our purpose is to review and refine an existing theoretical risk and prevention model (TRPM) as a means of classifying risk and protective factors for SHCs and mortality after SCI and for identifying points of intervention. Methods: We describe conceptual work within the field of SCI research and SHCs, including a description of the TRPM, a review of research using the TRPM, and conceptual enhancements to the TRPM based on previous research. Conclusions: The enhanced TRPM directs research to the timing and chronicity of the SHCs and their relationship with overall health and physiologic decline. Future research should identify differences in the nature of SHCs, the extent to which they relate to risk and protective factors, and the degree to which they may be prevented with appropriate research-based strategies.
Krause JS. Secondary conditions and spinal cord injury: a model for prediction and prevention. Top Spinal Cord Inj Rehabil. 1996;2(2):217–227.
,
Secondary conditions and spinal cord injury: a model for prediction and prevention
, Top Spinal Cord Inj Rehabil.
, vol. 2
(pg. 217
-227
) Jensen MP, Molton IR, Groah SL, et al. Secondary health conditions in individuals aging with SCI: terminology, concepts and analytic approaches. Spinal Cord. 2012;50(5):373–378.
,
Secondary health conditions in individuals aging with SCI: terminology, concepts and analytic approaches
, Spinal Cord.
, vol. 50
(pg. 373
-378
) Rimmer JH, Chen MD, Hsieh K. A conceptual model for identifying, preventing, and managinrg secondary conditions in people with disabilities. Phys Ther. 2011;91(12):1728–1739.
,
A conceptual model for identifying, preventing, and managinrg secondary conditions in people with disabilities
, Phys Ther.
, vol. 91
(pg. 1728
-1739
) Krause JS, Vines CL, Farley TL, Sniezek J, Coker J. An exploratory study of pressure ulcers after spinal cord injury: relationship to protective behaviors and risk factors. Arch Phys Med Rehabil. 2001;82(1):107–113.
,
An exploratory study of pressure ulcers after spinal cord injury: relationship to protective behaviors and risk factors
, Arch Phys Med Rehabil.
, vol. 82
(pg. 107
-113
) Gelis A, Dupeyron A, Legros P, Benaim C, Pelissier J, Fattal C. Pressure ulcer risk factors in persons with spinal cord injury part 2: the chronic stage. Spinal Cord. 2009;47(9):651–661.
,
Pressure ulcer risk factors in persons with spinal cord injury part 2: the chronic stage
, Spinal Cord.
, vol. 47
(pg. 651
-661
) Krause JS, Zhai Y, Saunders LL, Carter RE. Risk of mortality after spinal cord injury: an 8-year prospective study. Arch Phys Med Rehabil. 2009;90(10):1708–1715.
,
Risk of mortality after spinal cord injury: an 8-year prospective study
, Arch Phys Med Rehabil.
, vol. 90
(pg. 1708
-1715
) Krause JS, Carter RE, Pickelsimer E, Wilson D. A prospective study of health and risk of mortality after spinal cord injury. Arch Phys Med Rehabil. 2008;89(8):1482–1491.
,
A prospective study of health and risk of mortality after spinal cord injury
, Arch Phys Med Rehabil.
, vol. 89
(pg. 1482
-1491
) Thein HH, Gomes T, Krahn MD, Wodchis WP. Health status utilities and the impact of pressure ulcers in long-term care residents in Ontario. Qual Life Res. 2010;19(1):81–89.
,
Health status utilities and the impact of pressure ulcers in long-term care residents in Ontario
, Qual Life Res.
, vol. 19
(pg. 81
-89
) Paker N, Soy D, Kesiktas N, et al. Reasons for rehospitalization in patients with spinal cord injury: 5 years’ experience. Int J Rehabil Res. 2006;29(1):71–76.
,
Reasons for rehospitalization in patients with spinal cord injury: 5 years’ experience
, Int J Rehabil Res.
, vol. 29
(pg. 71
-76
) Javitz HS, Ward MM, Martens L. Major costs associated with pressure sores. J Wound Care. 1998;7(6):286–290.
,
Major costs associated with pressure sores
, J Wound Care.
, vol. 7
(pg. 286
-290
) Hayward MD, Crimmins EM, Miles TP, Yu Y. The significance of socioeconomic status in explaining the racial gap in chronic health conditions. Amer Sociol Rev. 2000;65(6):910–930.
,
The significance of socioeconomic status in explaining the racial gap in chronic health conditions
, Amer Sociol Rev.
, vol. 65
(pg. 910
-930
) House JS, Williams DR. Understanding and reducing socioeconomic and racial/ethnic disparities in health. In: Smedley BD, Syme SL, eds. Promoting Health: Intervention Strategies From Social and Behavioral Research. Washington, DC: National Academy Press; 2000:81–125.
,
Understanding and reducing socioeconomic and racial/ethnic disparities in health. In
, Promoting Health: Intervention Strategies From Social and Behavioral Research.
(pg. 81
-125
) Fiscella K, Franks P, Gold MR, Clancy CM. Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care. JAMA. 2000;283(19):2579–2584.
,
Inequality in quality: addressing socioeconomic, racial, and ethnic disparities in health care
, JAMA.
, vol. 283
(pg. 2579
-2584
) Lantz PM, Golberstein E, House JS, Morenoff J. Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of U.S. adults. Soc Sci Med. 2010;70(10):1558–1566.
,
Socioeconomic and behavioral risk factors for mortality in a national 19-year prospective study of U.S. adults
, Soc Sci Med.
, vol. 70
(pg. 1558
-1566
) Lantz PM, Lynch JW, House JS, et al. Socioeconomic disparities in health change in a longitudinal study of US adults: the role of health-risk behaviors. Soc Sci Med. 2001;53:29–40.
,
Socioeconomic disparities in health change in a longitudinal study of US adults: the role of health-risk behaviors
, Soc Sci Med.
, vol. 53
(pg. 29
-40
) Stringhini S, Dugravot A, Shipley M, et al. Health behaviours, socioeconomic status, and mortality: further analyses of the British Whitehall II and the French GAZEL prospective cohorts. PLoS Med. 2011;8(2):e1000419.
,
Health behaviours, socioeconomic status, and mortality: further analyses of the British Whitehall II and the French GAZEL prospective cohorts
, vol. 8
Stringhini S, Sabia S, Shipley M, et al. Association of socioeconomic position with health behaviors and mortality. JAMA. 2010;303(12):1159–1166.
,
Association of socioeconomic position with health behaviors and mortality
, JAMA.
, vol. 303
(pg. 1159
-1166
) Krause JS, Saunders LL. Risk and protective factors for secondary conditions: a 15-year longitudinal study. Top Spinal Cord Inj Rehabil. 2010;16(2):22–29.
,
Risk and protective factors for secondary conditions: a 15-year longitudinal study
, Top Spinal Cord Inj Rehabil.
, vol. 16
(pg. 22
-29
) Saunders LL, Krause JS, Selassie AW. Association of health services with secondary conditions: use of a population-based cohort of persons with SCI in South Carolina. Top Spinal Cord Inj Rehabil. 2010;16(2):30–39.
,
Association of health services with secondary conditions: use of a population-based cohort of persons with SCI in South Carolina
, Top Spinal Cord Inj Rehabil.
, vol. 16
(pg. 30
-39
) Jackson AB, Dijkers M, Devivo MJ, Poczatek RB. A demographic profile of new traumatic spinal cord injuries: change and stability over 30 years. Arch Phys Med Rehabil. 2004;85(11):1740–1748.
,
A demographic profile of new traumatic spinal cord injuries: change and stability over 30 years
, Arch Phys Med Rehabil.
, vol. 85
(pg. 1740
-1748
) Ho CH, Wuermser LA, Priebe MM, Chiodo AE, Scelza WM, Kirshblum SC. Spinal cord injury medicine. 1. Epidemiology and classification. Arch Phys Med Rehabil. 2007;88(3 Suppl 1):S49–54.
,
Spinal cord injury medicine. 1. Epidemiology and classification
, Arch Phys Med Rehabil.
, vol. 88
(pg. S49
-54
) Chen Y, Tang Y, Vogel L, DeVivo MJ. Causes of spinal cord injury. Top Spinal Cord Inj Rehabil. 2013;19(1):1–8.
,
Causes of spinal cord injury
, Top Spinal Cord Inj Rehabil.
, vol. 19
(pg. 1
-8
) Krause JS. Factors associated with risk for subsequent injuries after the onset of traumatic spinal cord injury. Arch Phys Med Rehabil. 2004;85:1503–1508.
,
Factors associated with risk for subsequent injuries after the onset of traumatic spinal cord injury
, Arch Phys Med Rehabil.
, vol. 85
(pg. 1503
-1508
) Krause JS, Broderick L. Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset. Arch Phys Med Rehabil. 2004;85:1257–1264.
,
Patterns of recurrent pressure ulcers after spinal cord injury: identification of risk and protective factors 5 or more years after onset
, Arch Phys Med Rehabil.
, vol. 85
(pg. 1257
-1264
) Krause JS, McArdle JJ, Pickelsimer E, Reed KS. A latent variable structural path model of health behaviors after spinal cord injury. J Spinal Cord Med. 2009;32:162–174.
,
A latent variable structural path model of health behaviors after spinal cord injury
, J Spinal Cord Med.
, vol. 32
(pg. 162
-174
) Krause JS, Carter R, Zhai Y, Reed K. Psychologic factors and risk of mortality after spinal cord injury. Arch Phys Med Rehabil. 2009;90(4):628–633.
,
Psychologic factors and risk of mortality after spinal cord injury
, Arch Phys Med Rehabil.
, vol. 90
(pg. 628
-633
) Krause JS, Carter RE. Risk of mortality after spinal cord injury: relationship with social support, education, and income. Spinal Cord. 2009;47(8):592–596.
,
Risk of mortality after spinal cord injury: relationship with social support, education, and income
, Spinal Cord.
, vol. 47
(pg. 592
-596
) Krause JS, Carter RE, Pickelsimer E. Behavioral risk factors of mortality after spinal cord injury. Arch Phys Med Rehabil. 2009;90(1):95–101.
,
Behavioral risk factors of mortality after spinal cord injury
, Arch Phys Med Rehabil.
, vol. 90
(pg. 95
-101
) Crumbaugh JC, Maholick LT. Manual of Instructions for the Purpose in Life Test. Saratoga, CA: Institute of Logotherapy;1981.
,
Manual of Instructions for the Purpose in Life Test.
Krause JS, Saunders LL. Socioeconomic and behavioral risk factors for mortality: Do risk factors observed after spinal cord injury parallel those from the general USA population?Spinal Cord. 2012;50(8):609–613.
,
Socioeconomic and behavioral risk factors for mortality: Do risk factors observed after spinal cord injury parallel those from the general USA population?
, Spinal Cord.
, vol. 50
(pg. 609
-613
) Link BG, Phelan J. Social conditions as fundamental causes of disease. J Health Soc Behav. 1995;35(extra issue):80-94.
,
Social conditions as fundamental causes of disease
, J Health Soc Behav.
Krause JS, DeVivo MJ, Jackson AB. Health status, community integration, and economic risk factors for mortality after spinal cord injury. Arch Phys Med Rehabil. 2004;85(11):1764–1773.
,
Health status, community integration, and economic risk factors for mortality after spinal cord injury
, Arch Phys Med Rehabil.
, vol. 85
(pg. 1764
-1773
) Krause JS, Saunders LL, DeVivo MJ. Income and risk of mortality after spinal cord injury. Arch Phys Med Rehabil. 2011;92(3):339–345.
,
Income and risk of mortality after spinal cord injury
, Arch Phys Med Rehabil.
, vol. 92
(pg. 339
-345
) Krause JS, Saunders LL, Acuna J. Gainful employment and risk of mortality after spinal cord injury: effects beyondthatofdemographic,injuryandsocioeconomic factors. Spinal Cord. 2012;50(10):784–788.
,
Gainful employment and risk of mortality after spinal cord injury: effects beyondthatofdemographic,injuryandsocioeconomic factors
, Spinal Cord.
, vol. 50
(pg. 784
-788
) Krause JS, Saunders LL. Life expectancy estimates in the life care plan: accounting for economic factors. J Life Care Plan. 2010;9(2):15–28.
,
Life expectancy estimates in the life care plan: accounting for economic factors
, J Life Care Plan.
, vol. 9
(pg. 15
-28
) Krause JS, Newman S. Clinical outcomes after spinal cord injury. In: Lajtha A, ed. Handbook of Neurochemistry and Molecular Neurobiology: Central Nervous System Injuries and Disorders (Vol 24, 3rd ed). New York: Springer; 2009:615–632.
,
Clinical outcomes after spinal cord injury. In
, Handbook of Neurochemistry and Molecular Neurobiology: Central Nervous System Injuries and Disorders (Vol 24, 3rd ed).
(pg. 615
-632
) Krause JS, Reed KS, McArdle JJ. A structural analysis of health outcomes after spinal cord injury. J Spinal Cord Med. 2010;33(1):522–32.
,
A structural analysis of health outcomes after spinal cord injury
, J Spinal Cord Med.
, vol. 33
(pg. 522
-32
) Krause JS. Intercorrelations between secondary conditions and life adjustment among people with spinal cord injuries. SCI Psychosocial Process. 1998;11:3–7.
,
Intercorrelations between secondary conditions and life adjustment among people with spinal cord injuries
, SCI Psychosocial Process.
, vol. 11
(pg. 3
-7
) Krause JS, Newman S, Brotherton S. Clinical considerations in translational research with chronic spinal cord injury: intervention readiness and intervention impact. In: Lajtha A, ed. Handbook of Neurochemistry and Molecular Neurobiology: Central Nervous System Injuries and Disorders (Vol 24, 3rd ed). New York: Springer; 2009:563–580.
,
Clinical considerations in translational research with chronic spinal cord injury: intervention readiness and intervention impact. In
, Handbook of Neurochemistry and Molecular Neurobiology: Central Nervous System Injuries and Disorders (Vol 24, 3rd ed).
(pg. 563
-580
) McEwen BS. Protective and damaging effects of stress mediators. N Engl J Med. 1998; 338(3): 171–179.
,
Protective and damaging effects of stress mediators
, N Engl J Med.
, vol. 338
(pg. 171
-179
) Seeman TE, Singer BH, Rowe JW, Horwitz RI, McEwen BS. Price of adaptation–allostatic load and its health consequences. MacArthur studies of successful aging. Arch Intern Med. 1997;157(19):2259–2268.
,
Price of adaptation–allostatic load and its health consequences. MacArthur studies of successful aging
, Arch Intern Med.
, vol. 157
(pg. 2259
-2268
) Seeman TE, McEwen BS, Rowe JW, Singer BH. Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging. Proc Natl Acad Sci USA. 2001;98(8):4770–4775.
,
Allostatic load as a marker of cumulative biological risk: MacArthur studies of successful aging
, Proc Natl Acad Sci USA.
, vol. 98
(pg. 4770
-4775
) Karlamangla AS, Singer BH, Seeman TE. Reduction in allostatic load in older adults is associated with lower all-cause mortality risk: MacArthur studies of successful aging. Psychosom Med. 2006;68(3):500–507.
,
Reduction in allostatic load in older adults is associated with lower all-cause mortality risk: MacArthur studies of successful aging
, Psychosom Med.
, vol. 68
(pg. 500
-507
) Blackburn EH. Structure and function of telomeres. Nature. 1991;350(6319):569–573.
,
Structure and function of telomeres
, Nature.
, vol. 350
(pg. 569
-573
) Calado RT, Young NS. Telomere diseases. N Engl J Med. 2009;361(24):2353–2365.
,
Telomere diseases
, N Engl J Med.
, vol. 361
(pg. 2353
-2365
) Cawthon RM, Smith KR, O’Brien E, Sivatchenko A, Kerber RA. Association between telomere length in blood and mortality in people aged 60 years or older. Lancet. 2003;361(9355):393–395.
,
Association between telomere length in blood and mortality in people aged 60 years or older
, Lancet.
, vol. 361
(pg. 393
-395
) Risques RA, Arbeev KG, Yashin AI, et al. Leukocyte telomere length is associated with disability in older U.S. population. J Am Geriatr Soc. 2010;58(7):1289–1298.
,
Leukocyte telomere length is associated with disability in older U.S. population
, J Am Geriatr Soc.
, vol. 58
(pg. 1289
-1298
)
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