Association between Psychological Symptoms, Participation in Core Activities and Health-Related Quality of Life among Spinal Cord Injury Survivors in Selected Counties, in Kenya

Abstract

Globally, rehabilitated spinal cord injury survivors in the communities continue to experience psycho-social challenges that impede their return to pre-injury lifestyle and/or achieve optimal functional independence. Therefore, the main purpose of the study was to determine the association between psychological symptoms and participation in core-activities as well as in health-related quality of life amongst spinal cord injury survivors in Nairobi, Machakos and Nakuru Counties in Kenya.A cross-sectional study utilizing quantitative methods was conducted on a sample of 186 spinal cord injured survivors in Nairobi, Nakuru and Machakos counties. Potential participants were identified from the databases of National Spinal Injury Hospital in Nairobi, Nakuru level 5 Hospital, Naivasha county referral Hospital and Machakos level 5 hospital. In addition, purposive sampling technique was employed to recruit participants identified in the databases. Data was collected using a combination of the Participation Scale (P-scale), Depression, Anxiety, Stress Scale version 21 (DASS21) and World Health Organization Quality of Life questionnaire (WHOQOL-BREF). Data was entered into two separate MS Excel sheets and later imported into Statistical Package for Social Sciences version 25 (SPSS 25). Data was re-entered from the questionnaires where discrepancy was noted and corrected. Thereafter, descriptive statistics were calculated and presented in frequency tables. Further one-way analysis of variance (ANOVA) was done to test the influence of the participation in core activities variables and health-related quality of life HRQol variables by psychological symptoms. The level of significance was set at < 0.05. Ethical clearance was sought from JKUAT- Ethical Review Committee while authority to conduct the study was secured from the NACOSTI (Ref no. NACOSTI/P/19/63727/30278; Date. 21st May, 2019). In addition, permission to conduct the study was sought from the County commissioners, Ministry of education, Ministry of health and participating hospitals ERCs. A 72% (n=134) prevalence of psychological symptoms was recorded amongst the 186 participants. Noteworthy, lowly educated males aged <45 years, and earning less than USA $500 (Kshs. 50,000) annually were the most affected by SCI. At least 53.8% of the sample (n=100) had depression although anxiety was the most prevalent symptom, that is, 65.6% (n=122) among the three psychological symptoms measured. Concerning HRQoL, the environmental domain had the lowest mean (44.71% SD 15.07%) percentage reported. This implies that most SCI survivors felt that the environmental domain affected their HRQoL compared to other domains. Regarding participants’ involvement in core activities, majority, 119 (64%) reported to experience severe participation restriction in all domains. There was a significant association between County of residence and having or not having psychological symptoms (P=.003). Further, there was a statistically significant association between self-care (domain of participation) and psychological symptoms (P=.000). In addition, there was a statistically significant association between psychological symptoms and HRQoL physical health domain (P=.008). In conclusion, 3 out of 4 SCI patients in the study sample suffer from psychological symptoms and 1 out of 2 have depression. These are lowly educated poor young male adults. Although integrated and living in the community after rehabilitation, SCI patients do experience poor HRQoL in their environments and self-care problems mostly. The study further shows that psychological symptoms status may influence SCI survivors’ physical, HRQoL and self-care activity. The results of this study form baseline data for future research and policy pertaining to SCI patients’ wellbeing.