Health Literacy During Inpatient Rehabilitation and Its Association with One-Year Health and Functional Outcomes in Individuals with Traumatic Spinal Cord Injury.

Abstract

Evaluate the prevalence of limited health literacy (HL) of patients with a traumatic spinal cord injury (SCI) during inpatient rehabilitation and determine which factors are associated with limited HL. Also examine whether limited HL during inpatient rehabilitation was associated with poorer health and functional outcomes one-year following injury. Cohort study. SCI Model System centers. Individuals (N=3,943) 18 years of age or older enrolled in a SCI Model System center between 2016 to 2025 who had data for the Single Item Literacy Screener (SILS) during inpatient rehabilitation and completed the one-year follow-up interview. Not applicable. Urinary tract infections (UTIs), pressure injury, rehospitalizations, days hospitalized, bowel incontinence episodes, and Spinal Cord Injury Functional Index/Assistive Technology (SCI-FI/AT) scores. 30.7% of participants met criteria for limited HL. Limited HL was associated with male sex (odds ratio [OR]=1.52, p<0.01), lower education (OR=1.85, p<0.01), and lower income (OR=1.59, p<0.01). Among participants with greater than high school education, limited HL was linked to increased odds of ≥1 rehospitalizations (OR=1.49, p=0.01), hospitalization ≥14 days (OR=1.74, p=0.02), and ≥1 monthly bowel incontinence episodes (OR=1.51, p=0.02), along with lower ability (lower SCI-FI/AT scores) for basic mobility (-3.70, p<0.01), self-care (-3.53, p<0.01), fine motor function (-3.43 p<0.01), and manual wheelchair mobility (-3.99, p<0.01) at one-year post-injury. Among individuals with lower education, limited HL was associated with lower ability (lower SCI-FI/AT scores) for basic mobility (-1.53, p<0.01), self-care (-2.56, p<0.01), fine motor function (-1.75, p<0.01), manual wheelchair mobility (-0.97, p=0.02), and power wheelchair mobility (-2.57, p<0.01) one-year post-injury. Limited HL during inpatient SCI rehabilitation was common and related to multiple sociodemographic factors. HL may be associated with post-discharge health and functional outcomes. Routine screening for HL, universal HL precautions, and targeted transition supports should be adopted by inpatient rehabilitation clinicians.