1) A study examined biopsychosocial factors associated with social isolation among individuals with neurological disabilities. 2) Being single, having higher fatigue, depression, social barriers and less social support were associated with greater social isolation. 3) The study aims to identify appropriate rehabilitation interventions to minimize social isolation and improve participation in daily activities.

1. Findings Summary & Implications
 Being single, having higher fatigue, higher depression, more
social environment barriers, less social environment
facilitators, and lower emotional support were associated
with higher likelihood of being social isolated ((F(8, 495)) =
79.8, with an Adj. R2= 55.6%, p <0.001).
 The specific associations between sleep disturbance and
social isolation, as well as between anxiety and social
isolation were not significant when variables in other
domains were added into the final model.
 Biopsychosocial measures were significantly related to
social isolation among individuals with neurological
disabilities.
 Barriers and supports in the environment influence
participation involvement, choice and control.
 Outcomes, such as social isolation, are the ultimate
validation of the effectiveness and quality of medical care.
Measures and Results, continued
Measures and Results
 Subpopulation characteristics:
 CVA: 34.9%, TBI: 30.5, SCI: 34.6%
 White: 59%, Black: 32%, Hispanic: 7%,
Other: 10%
 Male: 64%
 Married/Partner: 31%
 Age, mean (SD): 47.2 (16.1)
 Education: <HS: 10%, HS/GED: 22%,
HS/GED>:68%
 Years since injury, mean (SD): 7 (8)
 Cause of Injury:
Research Goals
1. Determine the biopsychosocial
characteristics associated with social
isolation among individuals with
neurological disabilities (CVA , TBI, and
SCI).
2. Explore relationships among biological
factors, psychological factors, socio-
environmental factors, and social isolation.
3. Recognize public health implications
underlying health disparities and
participation inequalities.
 Social Isolation is defined as one aspect of
participation.
 Burgeoning evidence has acknowledged that
biological, psychological, and socio-
environmental factors are important
determinants of social participation.
 Neurological disabilities affect an individual’s
functioning, limit activity participation, which
may lead to social isolation.
 Limited research has substantially examined
the relationship of biological, psychological,
and socio-environmental determinants in
predicting participation outcomes.
Background
 Utilized the data from Rehabilitation Research
Training Center (RRTC) 2009 to 2014 including
a convenience sample of 604 persons with CVA,
TBI, and SCI.
 Community-dwelling individuals with
neurological disabilities completed the Patient
Reported Outcomes Measurement Information
System (PROMIS) and Environmental Factor
Item Banks (EFIB) in three rehabilitation facilities
 Analyzed the RRTC data using SPSS 23.
 A modified variable reduction technique was
employed due a possibility of a large number of
potential confounding factors relative to the
sample size.
Univariate regression was conducted for 31
potential contributing variables.
 A variable that reached a significance of p<0.05
in relation to the outcome measure was retained
for the final entry into the stepwise multivariate
regression.
Independent variables: Married/Partner vs all
others, PROMIS-29 Fatigue, PROMIS-29
Sleep Disturbance, PROMIS-29 Anxiety,
PROMIS-29 Depression, SSA Barriers, SSA
Facilitators, PROMIS 2.0 Emotional Support.
Dependent variable: PROMIS 2.0 Social
Isolation
Methods
Contact Information
Contact: Matthew R. Frank, matthew.frank@wustl.edu
Note: The work presented here was done for the purposes
of a course and is not my thesis or dissertation.
The overall goal of this project is to identify appropriate biopsychosocial components for rehabilitation and health services interventions
to minimize social isolation for individuals with neurological disabilities.
Participation, accomplishment of daily activities and social roles, in major life activities performed in one’s lived
environment is linked to improvements in social health and quality of life. Despite these benefits, evidence suggests
that participation of persons with disabilities has been significantly restricted due to their functional limitations.
Biopsychosocial Effects of Social Isolation among
Individuals with Neurological Disabilities
Matthew R. Frank, MSW/MPH ‘16, Brown School
Fig 1. The Biopsychosocial Model of Health
TBI
N=184
SCI
N=209
MVA 54% 46%
Fall 28% 14%
Sports related 3% 10%
Gunshot Wound /Violence 11% 3%
Other 4% 22%
Table 1. Summary of Stepwise Regression for Variables Predicting Social
Isolation
Variables B SE B β 95% CI
Step 1: Demographic Factors
Married/Partner vs all others -0.232 0.079 -0.130 (-0.388, -0.077)
Adj R² = 0.017*
Step 2: Biological Factors
PROMIS-29 Fatigue 0.036 0.004 0.401 (0.028, 0.044)
PROMIS-29 Sleep Disturbance 0.016 0.003 0.184 (0.009, 0.024)
Adj R² = 0.281*
Adj R² change =
0.266*
Step 3: Psychological
(Emotional) Factors
PROMIS-29 Anxiety 0.015 0.005 0.151 (0.004, 0.026)
PROMIS-29 Depression 0.034 0.005 0.351 (0.023, 0.045)
Adj R² = 0.411*
Adj R² change=
0.130*
Step 4: Socio-Environmental
Factors
Social Environment Barriers -0.020 0.003 -0.240 (-0.026, -0.014)
Social Environment Facilitators -0.016 0.003 -0.188 (-0.022, -0.009)
PROMIS 2.0 Emotional Support -0.013 0.003 -0.136 (-0.019, -0.007)
Adj R² = 0.556*
Adj R² change =
0.145*
*p<0.05
Table 2. Variables in Final Model
Variables B SE B β 95% CI P-value
Constant -0.070 0.350 -- (-0.758, -0.617) 0.841
Married/Partner vs all others -0.122 0.054 -0.068 (-0.228, -0.016) 0.024
PROMIS-29 Fatigue 0.014 0.004 0.153 (0.006, 0.021) <0.001
PROMIS-29 Sleep Disturbance -0.002 0.003 -0.019 (-0.008, 0.005) 0.596
PROMIS-29 Anxiety 0.009 0.005 0.091 (0.000, 0.018) 0.063
PROMIS-29 Depression 0.025 0.005 0.255 (0.015, 0.034) <0.001
SSA Barriers -0.020 0.003 -0.240 (-0.026, -0.014) <0.001
SSA Facilitators -0.016 0.003 -0.188 (-0.022, -0.009) <0.001
PROMIS 2.0 Emotional Support -0.013 0.003 -0.136 (-0.019, -0.007) <0.001
Acknowledgments:
This study is supported by grants from
the NIDILRR (#H133B090024; PI: Allen
Heinemann) and the Craig H. Neilsen
Foundation (#290474; PI: Alex Wong)
Transdisciplinary Considerations
 Epidemiology & Biostatistics: Use of regression models may
contribute to the prevalence and timing of biopsychosocial
determinants of health and treatment effects.
 Health Behavior: Provides an ecological perspective and
incorporates clinical outcomes research theory and
methods.
 Environmental Health: Examines the dynamic transactions
between persons and their environment that influence
activity performance and participation in home and
community.
 Health Policy & Services: Development of translating public
health and rehabilitation science data for dissemination and
use by policymakers.
 Rehabilitation Science: Assists in developing and evaluating
theoretically informed rehabilitation interventions aimed at
minimizing disability and optimizing functioning and
participation in daily life activities among persons with or at
risk of disability.

2. Socio-
environmental
PsychologyBiology
Social Supports
Family background
Culture
Socioeconomic status
Physical ability
Mobility
Fatigue
Pain
Sleep
Gender
Stress
Learning/memory
Attitudes/beliefs
Personality
Emotions
Coping skills
Trauma
Health