Disability prevention is a key priority for both the fields of medical rehabilitation and public health. The role of environmental factors is emphasized in models of the disablement process, but understudied, particularly for medical rehabilitation populations. For persons with spinal cord injury (SCI), community characteristics such as socioeconomic disadvantage, resource deprivation, segregation, and physical inaccessibility are likely to threaten the physical, psychological, and social functioning gains achieved during rehabilitation. The purpose of this research is to identify the community-level factors that increase the risk for disability and health problems following SCI. Specifically, the mentored phase of this project aims to: 1) demonstrate the feasibility of using geographic identifiers to link individual outcomes data to community-level information from several administrative data sources;2) develop several scales that measure the physical, social, and economic dimensions of the environment from the raw community-level data;and 3) identify whether persons with SCI who live in aversive environments are at increased risk for functional decline and poor health using multilevel analysis.
These research aims will be attained using data from the National Spinal Cord Injury Database, an existing registry of over 25,000 persons with traumatic SCI in the US. This unique dataset combines clinical data with longitudinal follow-up information;the proposed research activities include the construction of a relational database using individual health information gathered for the NSCID and a combination of geographic information systems (GIS) analysis and multilevel modeling. The concurrent career development plan for the Candidate includes the acquisition of the skills needed to understand clinical rehabilitation for SCI and medical rehabilitation research combined with advanced conceptual and methodological training in public health research in disability and the application of advanced biostatistical and GIS techniques. The Candidate will draw upon the wealth of experience of three exceptional mentors in the areas of patient-orientated outcomes research, medical rehabilitation, and public health as well as the rich training environments of the Kessler Foundation Research Center and the Kessler Institute for Rehabilitation in New Jersey and the Health Research and Disability Institute at Boston University to obtain the necessary training to pursue an academic career that addresses problems in both medical rehabilitation and public health. These activities will launch a larger program of research that examines the threats posed by disadvantaged communities to the long-term success of rehabilitation for traumatic injuries and the prevention of functional decline for persons with acquired disabilities.
This investigation will increase our understanding of environmental risk factors for disability and health problems following traumatic injury. This research extends the focus of rehabilitation research to involve community factors and will identify areas of disability prevention that can be addressed through public policy.
