Modeling self-reported health of persons with spinal cord injury

Measures of self-reported health are used increasingly with persons with disabilities, but their meaning and usefulness for this group are not well understood. This relates, in part, to previous conceptual entanglement in the meaning and measurement of “health”, “disability” and “function”. The present study tested a conceptual model of self-reported health that included measures differing in their degree of subjectivity: presence/severity of physical secondary conditions, four domains of health status from the SF-36, and a single item on self-rated health. Data from a US sample of 270 adults with spinal cord injury (SCI) were analyzed using path analysis. The self-rated health of the SCI sample was lower than that of a population-based non-disabled sample, but higher than that of a population-based cross-disability sample. Findings indicate that 36% of variance in self-rated health was accounted for by physical secondary conditions and the health status domains of Role Physical and Vitality. Importantly, the domain of Physical Function as measured by the SF-36 was statistically unrelated to self-rated health. Its inclusion in measures of health-related quality of life for disability populations should be discouraged.