Harper, Alexandra Elizabeth
(2022)
Identifying Variations in Stakeholder-Prioritized Outcomes during Traumatic Spinal Cord Injury Rehabilitation.
Doctoral Dissertation, University of Pittsburgh.
(Unpublished)
Abstract
Some individuals with a newly acquired traumatic spinal cord injury (SCI) will experience one or more poor clinical outcomes, including pressure injuries and suboptimal functional outcomes (i.e., independence in self-care and mobility). Variations in these two stakeholder-prioritized outcomes may be due to characteristics related to who receives care, the people who deliver care, the places in which care is delivered, and what happens during care delivery. Yet, no research has synthesized the sources of variation that have been studied to inform opportunities for future research and clinical practices. Identifying characteristics driving variations in stakeholder-prioritized outcomes during the first-year post-SCI is critical because this is the optimal window for neurological recovery in conjunction with rehabilitation.
The focus of this dissertation was twofold. First, we described characteristics associated with stakeholder-prioritized clinical outcomes (i.e., pressure injuries and functional outcomes) during inpatient rehabilitation and at 1-year post-SCI. Individual-sociodemographic and individual-clinical characteristics were examined more frequently than characteristics related to individual-behavior, who delivers care, where care is delivered, and what happens during care delivery. Significance and directionality of findings varied based on stratification of analyses by age and SCI severity as well as by provider and process of care characteristics included in analyses.
Second, we conducted two secondary analyses to probe our understanding of understudied individual characteristics. We found that severity of the SCI but not severity of the hospital-acquired pressure injuries was associated with increased risk of additional pressure injuries during rehabilitation. We also found that among individuals who reported low pain severity, those with a history of substance use achieved less change in functional outcomes during rehabilitation than those without a history of substance use.
Overall, this dissertation leveraged a novel conceptual model to inform future directions. Future research can explore understudied sources of variation in stakeholder-prioritized outcomes, adopt principles of precision medicine to guide those investigations, and develop tailored clinical practice guidelines that promote the delivery of safe, effective, patient-centered care. These efforts may help to guide providers in delivering the right care to the right patient at the right time in the right setting to optimize stakeholder-prioritized outcomes.
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Details
| Item Type: |
University of Pittsburgh ETD
|
| Status: |
Unpublished |
| Creators/Authors: |
|
| ETD Committee: |
|
| Date: |
9 September 2022 |
| Date Type: |
Publication |
| Defense Date: |
27 July 2022 |
| Approval Date: |
9 September 2022 |
| Submission Date: |
6 July 2022 |
| Access Restriction: |
2 year -- Restrict access to University of Pittsburgh for a period of 2 years. |
| Number of Pages: |
172 |
| Institution: |
University of Pittsburgh |
| Schools and Programs: |
School of Health and Rehabilitation Sciences > Health and Rehabilitation Sciences |
| Degree: |
PhD - Doctor of Philosophy |
| Thesis Type: |
Doctoral Dissertation |
| Refereed: |
Yes |
| Uncontrolled Keywords: |
spinal cord injury; rehabilitation; pressure injuries; function; outcomes |
| Date Deposited: |
09 Sep 2022 15:14 |
| Last Modified: |
09 Sep 2022 15:14 |
| URI: |
http://d-scholarship.pitt.edu/id/eprint/43268 |
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