(PS6-A16) Reciprocal Associations Between Quality of Life and Pain During Initial Rehabilitation After Spinal Cord Injury: A Random Intercept Cross-lagged Panel Model Study

Spinal cord injury (SCI) is a medical emergency that can result in severe functional impairment and increase risk for secondary health conditions. Chronic pain in particular is highly prevalent - approximately 70% of individual with SCI experience chronic pain, with more than a third reporting high levels of pain. Chronic pain can adversely affect mental health and restrict social participation, which is an important determinant of quality of life (QoL). While associations between pain and QoL are well documented in chronic SCI, little is known about the directionality of associations between pain and QoL in the acute inpatient stage. This is the first study to examine the longitudinal course of QoL and its reciprocal association with pain intensity in patients undergoing first rehabilitation after SCI. Longitudinal data, with three measurement time points (1 and 3 month(s) after SCI and at discharge) from the Inception Cohort of the Swiss Spinal Cord Injury Cohort Study were used. The dataset included 381 individuals aged ≥16 years with newly diagnosed traumatic or non-traumatic SCI admitted to initial rehabilitation between August 2015 and November 2021. QoL was assessed with the international SCI QoL Basic Data Set (QoL-BDS),(Charlifue et al., 2012), which has shown good validity and reliability in individuals with SCI. Random intercept cross-lagged panel models were conducted to examine the reciprocal association between total QoL, its three subscales (i.e. satisfaction with life, physical health, and psychological health), and pain intensity. Higher total QoL at 3-month post-injury was related to higher total QoL at discharge. Similarly, satisfaction with physical health measured at 3-months was associated with higher satisfaction with physical health at discharge. Pain intensity at 3-months was a robust predictor of pain at discharge. There were no significant cross-lagged associations between QoL and pain intensity across time points, indicating that a person's change in QoL was not related to a person's pain intensity at a previous time point, and vice versa. However, there was a trend for negative reciprocal associations between pain intensity and QoL (for both total and subscale scores). Results from sensitivity analysis and post-hoc analyses also showed no significant associations between pain and QoL. In contrast to studies of community-dwelling individuals with chronic SCI, pain and quality of life did not influence each other in individuals undergoing first rehabilitation after SCI. The small sample size precluded more complex analyses to examine the role of gender, pain type, and pain interference. Overall, the finding that pain at 3-months following SCI was a robust predictor of pain at discharge from inpatient rehabilitation highlights the importance of addressing pain early in treatment and calls for investigating compensatory mechanisms that mitigate the impact of pain on quality of life.