Today, research on quality of life and health status are quantified by standard instruments in difficult domains of human life. It is assumed that caring for people with chronic spinal cord injury may affect the primary caregivers` health and this point should be greatly considered as long as the injury exists and the caregiver provides care [16, 17].
In agreement with the finding of Rahimi-Movaghar et al. who found a high burden for SCI, we assumed a lower quality of life among the caregivers of SCI individuals due to the high work load. The results of our study confirmed this hypothesis by demonstrating lower SF-36 scores among caregiver wives comparing to normal Iranian women. This finding also has been confirmed by other researchers [1, 9, 12, 18, 19].
Naturally, when the people become older they will experience a decline in their physical function . Likewise, we found that with the increase of the caregivers’ age there was a reduction in the physical component (PF) of the quality of life . However, when the level of education of the participants increased, it resulted a rise in the level of the quality of life (better PF and VT). We had also expected that a higher education and better knowledge of different life circumstances would bring about a better life situation for them. Conversely, other factors such as having more children, being employed, and a longer duration of caregiving, all of which intensifies the caregiver’s work load and burden, can be a contributing factor of lower physical function and quality of life.
Another influencing factor which can negatively affect the physical function is the duration of caregiving . The duty of caring for a patient with a chronic disease can increase one’s levels of fatigue and result in a lower QOL . A possible explanation for this is that the pressure of the burden can impact the physical health of the caregivers and cause problems like mechanical back pain and knee osteoarthritis as well as having a lower general health condition. These problems can cause limitations for the caregivers and we can anticipate a decline in the quality of the care given by them. Shimoyama et al. after assessing patients and their caregivers discovered that a lower level of physical ability in caregivers can be due to various factors including being less healthy due to physical and mental issues . According to this, we can infer that a lower level of physical function in the participants of our survey can be the result of physical problems such as chronic back pain or knee osteoarthritis. Apart from these, the emotional problems which they have encountered during the period of caregiving can be another contributing factor.
Considering that most of the time spouses play the roles of the caregivers [5–7] we can infer that chronic diseases like Alzheimer or spinal cord injury can cause a heavy burden for caregiver spouses and in order for the caregiver to continue to provide care a strong emotional tie with the SCI patient is needed. In our study we observed this, as caregivers expressed their powerful connection to their patients to be the main reason of continuing their duty. Moreover, they believed that their religious beliefs have had a positive impact in their thinking which leads them to be optimistic.
As psychological issues play an important role in such a situation , investigations have been done to evaluate the frequency of depression and anxiety and their effects on caregivers. Chan et al.  as well as Hadrys et al.  investigated the frequency of psychological problems in the caregivers of patients with SCI and mental disorders respectively. [1–3] They reported that caregiving can have a negative effect on the mental health of these persons and claim that depression and anxiety are highly prevalent among them. Correspondingly, we discovered a lower rank in the wives' mental components (VT, SF, RE, MH) of the SF-36 health survey. Although this finding can be representative of lower mood function in the spouses of veterans with chronic spinal cord injury, their psychological health can be evaluated by more specific instruments like Hospital Anxiety and Depression Scale (HADS) or Patient Health Questionnaire (PHQ-9) for a more precise result.
From the results of the study we can conclude that determinants of negative effects on the quality of life of the caregivers are higher age, a higher number of children, and long duration of caregiving, and having diseases like knee osteoarthritis or mechanical back pain. Also, by conducting a more detailed study regarding their psychological health and burden of caregiving by using a specific questionnaire such as the Zarit Burden Interview , which has been shown to be a competent instrument in different countries, we will be able to quantify the amount of burden in caregivers of individuals with chronic diseases like SCI. Furthermore, comparison of the quality of life between caregivers and patients will enable us to explore the effect of different factors bilaterally. In this study, one of our limitations was not being able to evaluate the problems which both encounter outside their residential place, which will give us valuable information regarding environmental issues in order to find better strategies and remove any possible obstacles.
To sum up, various items can influence the QOL among the caregivers or spouses of patients with a chronic disease like spinal cord injury. The chronicity of the problem can negatively affect the life of these caregivers as well as their QOL. However, with better support and more education, and generally by modifying the contributing factors, we can anticipate a better quality of life for the caregiver spouses and as a result improved care of spinal cord injured veterans. As it has been suggested by Devins et al and Hadrys et al that by instructing caregivers and organizing patient education programs and family interventions, quality of life can be improved for both caregiver spouses and their disabled husbands [10, 21]. Therefore, we can facilitate the management of a disabling condition such as SCI and improve the psychosocial life for both the caregivers and their patients.