Quality of Life and the Health System: A 22-Country Comparison of the Situation of People With Spinal Cord Injury

Objective To analyze and compare how performance indicators of the health system are linked to the self-reported quality of life (QoL) of people with spinal cord injury (SCI) in 22 countries participating in the International Spinal Cord (InSCI) community survey. Design Cross-sectional survey. Setting 22 countries representing all six WHO regions, community setting. Participants A total of 12,591 (N) persons with traumatic or non-traumatic SCI aged ≥18 years. Interventions n/a MAIN OUTCOMES: Self-reported satisfaction with health; performance of daily activities; oneself; personal relationships and living conditions. A total score of quality of life (QoL) was calculated using these five definitions. Results The most important health system indicators for self-reported QoL of persons with SCI were social attitudes and access to health care services, followed by nursing care, access to public spaces, the provision of vocational rehabilitation, transportation, medication and assistive devices. In general, persons with SCI living in higher-income countries reported a higher QoL than people in lower-income countries, with some exceptions. In the InSCI sample, the top performing country was The Netherlands with an estimated median QoL of 66% (on a 0%-100% scale) CONCLUSIONS: The living situation of people with SCI is highly influenced by the performance of their health system. Measuring and comparing the performance of the health system gives accountability to a country's citizens, but it also helps to determine areas for improvement.