A latent structural equation model of risk behaviors and pressure ulcer outcomes among people with spinal cord injury

Study Design: Cross-sectional. Objective: Our purpose was to develop a latent structural model to demonstrate the relationship between factor structures of risk health behaviors and pressure ulcer (PrU) outcomes among participants with spinal cord injury (SCI). Setting: Data were collected at a large specialty hospital and analyzed at a medical university in the Southeastern USA. Methods: In total, 1871 participants with traumatic SCI of at least 1-year duration were recruited. Four latent risk behavior indicators were developed and further linked with a higher dimension which is classified as the risk dimension. A latent PrU variable was created and measured by four observable PrU-related outcomes. Latent structural equation modeling was performed to assess the relationship between the latent risk behavior and the latent PrU outcome. Several exogenous variables were also included in the structural equation model. Results: The risk behavior dimension had a significant direct effect on the latent PrU (direct effect=0.323, P<0.01). All direct relationships between the risk behavior dimension and risk behaviors were also significant (r(smoking)=0.436, r(prescription) (compliance)= 0.351 and r(specific) (prescription misuse)=0.502), except alcohol consumption (r(alcohol consumption)=0.087). Participants who were African American, had higher injury levels and longer time since SCI were more likely to have worse PrU outcomes. Conclusions: The overall findings of this study suggest the need to reduce risk behaviors to prevent adverse PrU outcomes. The risk of PrU outcomes is especially high among people who are African American, have higher level of SCI and have longer time since SCI.