Enhancing Community Reintegration after Inpatient Rehabilitation for Persons with Spinal Cord Injury

This article describes factors associated with outcomes after hospital discharge into the community and evaluates an inpatient independent living (IL) program, the Hospital to Community program, for persons with spinal cord injury (SCI). A sample of 234 subjects whose injuries occurred between 1986 and 1995 were included in this study. Factors such as subjects' demographic, neurologic, and psychosocial characteristics were considered as potential predictors of successful community reintegration (defined by decreased experience of handicap in various areas of community living, increased personal control, and decreased level of distress 1 year after injury). Findings suggest that those who participated in the program showed increased knowledge about IL and community resources available to them and considered the program helpful. Those who most actively engaged in the program felt the strongest about its value as a component of rehabilitation that prepared them for community reentry. Although multivariate analyses suggested that the program did not affect long-term outcomes, several other factors did. Most noticeably, level of neurologic impairment influenced experience of handicap and personal control, with less impairment being associated with less handicap. Younger and more educated subjects at injury showed less handicap 1 year after injury, whereas those who were more active in work and school activities prior to injury reported greater feelings of personal control. Level of distress was related to one's insurance, with those insured by Medicaid experiencing greater distress after injury. When program participation was measured by change in knowledge of the material taught by the program, those who reported greater knowledge acquisition also reported a greater sense of personal control 1 year after injury. Implications for community reintegration are discussed based on these findings.