Rehabilitation Practices

Socioeconomic Status

Very little research exists examining the effect of socioeconomic status (SES) on rehabilitation outcomes in SCI. However, those with a greater SES may experience enhanced well-being, participation, and employment (Botticello et al. 2011; Botticello et al. 2012). As discussed previously, SES may have more of an impact on rehabilitation outcomes in relation to education and income than race. In this sense, understanding the role of SES in access to continuing care is important to improve rehabilitation outcomes and inform health policy within SCI populations, particularly for individuals with low SES.

Table 9. Effect of Socioeconomic Status on Rehabilitation Outcomes

Author Year; Country Research Design PEDro Score Total Sample Size	Methods	Outcome
Chhabra & Bhalla, 2015; India Observational NInitial=150, NFinal=150	Population: Below poverty line (BPL, n=30): mean age=30.6±10.7yr; Gender: male=30, female=0; Level of SCI: tetraplegic (T)=15, paraplegic (P)=15. Upper-lower (n=16): mean age=24.75±5.2yr; Gender: male=16, female=0; Level of SCI: T=5, p=11. Lower-middle (n=26): mean age=30.75±9.8yr; Gender: male=24, female=2; Level of SCI: T=18, p=8. Upper-middle (n=38): mean age=29.58±10.4yr; Gender: male=22, female=16; Level of SCI: T=9, p=29. Upper (n=40): mean age=31.98±12.1yr; Gender: male=28, female=12; Level of SCI: T=25, p=15. Intervention: No intervention given. Those with SCI admitted to a SCI centre were classified by socioeconomic status (SES) using the Kuppuswamy scale and completed a custom questionnaire. Outcome Measures: Questionnaire determining difficulties in accessing SCI care, Community Integration Questionnaire (CIQ).	CIQ scores were significantly greater in upper to upper middle SES groups (p<0.05). A statistically significant difference in level of difficulty accessing SCI management perceived by the patient between different SES groups (p<0.05). Severe difficulties due to financial constraints were reported by unaided upper lower, lower middle, and most of the upper middle SES groups. Upper SES group were the only to report no difficulty in accessing SCI care.
Gupta et al. 2008; India Case Control NInitial=76, NFinal=76	Population: Traumatic (n=38): Mean age=32.86yr; Gender: males=34, females=4. Non-traumatic (n=38): Mean age=31.10; Gender: males=16, females=22 Intervention: Admission/discharge data from all surviving non-traumatic and traumatic spinal cord lesion (SCL) patients in a neurological rehabilitation facility was assessed over a 2yr period. Outcome Measures: LOS, BI, AIS collected at admission and discharge.	The traumatic SCL group was not significantly different in age, marriage, education or socioeconomic factors.

Discussion

Gupta et al. (2008) compared socioeconomic status among individuals with traumatic and non- traumatic SCI. They found no significant differences in SES between groups, suggesting that type of injury is independent of SES. Although, type of injury may be independent of SES, Chhabra and Bhalla (2015) found that financial constraints affect all components of SCI management across all SES groups except for those with the highest SES. However, the generalizability of this study to populations outside of India needs to be investigated in further studies. Despite this, SES is an important factor to consider when determining management strategies beyond outpatient rehabilitation.

Conclusions

There is level 3 evidence (from one case control study: Gupta et al. 2008) that socioeconomic status has no effect on type of injury.

There is level 5 evidence (from one observational study: Chhabra & Bhalla 2015) that financial constraints experienced by patients affect access to SCI care in all socioeconomic status groups, except those with the greatest socioeconomic status.

Low socioeconomic status may affect access to comprehensive SCI care and in turn, rehabilitation outcomes.