Associations Between Cognitive Factors and Quality of Life in Individuals with Spinal Cord Injury: A Meta-Analysis

Objective: Both cognitive impairment and lower quality of life (QoL) are highly prevalent in individuals with spinal cord injury (SCI) compared to healthy controls. Despite a growing interest into understanding the association between cognitive impairment and QoL in SCI patients, the results of studies conducted to date are conflicting. Therefore, we conducted a meta-analysis to have a better understanding of this association in SCI patients. Data sources: EMBASE, PubMed, and PsychInfo were systematically searched for all eligible articles with a cut-off date of March 21st, 2023. Study selection: Studies describing SCI patients, in which an association between cognitive factors and QoL was measured using validated questionnaires. Data Synthesis: Of 1824 studies, eight met inclusion criteria, reporting on 39 individual correlations and involving total sample size of 1142 SCI patients. Given the limited number of studies examining the association between cognitive factors and overall...Show moreObjective: Both cognitive impairment and lower quality of life (QoL) are highly prevalent in individuals with spinal cord injury (SCI) compared to healthy controls. Despite a growing interest into understanding the association between cognitive impairment and QoL in SCI patients, the results of studies conducted to date are conflicting. Therefore, we conducted a meta-analysis to have a better understanding of this association in SCI patients. Data sources: EMBASE, PubMed, and PsychInfo were systematically searched for all eligible articles with a cut-off date of March 21st, 2023. Study selection: Studies describing SCI patients, in which an association between cognitive factors and QoL was measured using validated questionnaires. Data Synthesis: Of 1824 studies, eight met inclusion criteria, reporting on 39 individual correlations and involving total sample size of 1142 SCI patients. Given the limited number of studies examining the association between cognitive factors and overall QoL, our meta-analysis focused on emotional QoL, specifically depression and anxiety. The random-effects meta-analysis for the association between cognitive factors and depression, included seven studies and 24 correlations, and the association between cognitive factors and anxiety, included four studies and 15 correlations. Results: Overall cognitive impairment was not associated with increased depression (𝑟 = -.095; 95% CI = -.214, .024; p = .142). However, cognitive impairment was significantly associated with increased anxiety (𝑟 = -.239; 95% CI = -.360, -.119; p < .001). Subgroup meta-analysis revealed an association between impaired perceptual-motor function and increased depression (-.171; 95% CI = -.192, -.151; p = .006). Impaired executive function (-.209; 95% CI = -.415, -.003; p = .047) and language (-.510; 95% CI = -.639, -.381; p < .001) were associated with increased anxiety. Conclusions: While depression was generally not associated with cognitive factors, subgroup analyses revealed that there was an association with impaired perceptual-motor functions. For anxiety, a more general negative association was found. In more specific analysis, only impaired language and executive functions associated with anxiety. The results need to be interpreted with caution due to limitations such as high heterogeneity. Follow-up longitudinal research could explore the causality between cognitive factors and QoL in SCI patients.Show less

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Associations Between Cognitive Factors and Quality of Life in Individuals with Spinal Cord Injury: A Meta-Analysis