Predicting compliance with annual follow-up evaluations in persons with spinal cord injury

A prospective study was performed to determine why some persons with spinal cord injury (SCI) fail to return for scheduled evaluations in order to identify predictive factors that could be used to target those at greatest risk for noncompliance and facilitate interventions to improve rates of return. Sixty-one noncompliant subjects and 102 persons compliant with regularly scheduled annual examinations were paid to come to the clinic for evaluation. Each participant completed a psychological questionnaire comprised of theoretical and socioeconomic variables. There was no difference between the two groups according to gender, race, level or completeness of injury, education, etiology of injury, responses to questions from the Health Locus of Control Scale, Health Beliefs Model, inconvenience or discomfort. For noncompliant versus compliant persons, cost (P = 0.0002), distance (P = 0.0047), transportation (P = 0.0330), belief that follow-up was not necessary (P < 0.0001), availability of good local doctor (P = 0.0001) and time (P = 0.0209) were identified as obstacles to returning for follow-up. These data indicate a need to improve the education for newly injured persons as well as those persons residing in the community on the importance of regular urological follow-up, to maintain close contact post-discharge and to assist in identifying community resources to facilitate either compliance with planned evaluations or the development of acceptable alternatives.