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Oña A, Strøm V, Lee BS, Le Fort M, Middleton J, Gutenbrunner C, Pacheco Barzallo D. Health inequalities and income for people with spinal cord injury. A comparison between and within countries. SSM Popul Health 2021; 15:100854. [PMID: 34258374 PMCID: PMC8259327 DOI: 10.1016/j.ssmph.2021.100854] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Income and health are related in a bi-directional manner, whereby level of income affects health and vice versa. People in poorer households tend to experience worse health status and higher mortality rates than people in wealthier households, and, at the same time, having poor health could restrict workability leading to less income. This gap exists in almost every country, and it is more pronounced in more unequal countries and in vulnerable populations, such as people experiencing disability. The goal of this paper is to estimate the health-income gap in people with a Spinal Cord Injury (SCI), which is a chronic health condition often associated with multiple comorbidities that leads to disability. As data on mortality is inexistent, to estimate the health-income gap for persons with SCI, this paper uses two health outcomes: the number of years a person has lived with the injury, and a comorbidity index. Data was obtained from the International Spinal Cord Injury survey (InSCI), which is the first worldwide survey on community-dwelling persons with SCI. To compare across countries, the health outcomes were adjusted through hierarchical models, accounting for country fixed-effects, individual characteristics such as age and gender, and injury characteristics (cause, type and degree). Our results suggest that for the years living with SCI, the gap varies from 1 to 6 years between the lowest and the highest income groups. The main driver of such a difference is the cause of injury, where injuries caused by work accidents showed the biggest gap. Similarly, for the comorbidity index, persons with SCI in poorer deciles reported significantly more comorbidities, forty times more, than people in richer deciles.
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Affiliation(s)
- Ana Oña
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Vegard Strøm
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | | | - Marc Le Fort
- Universitaire de Médecine Physique et Réadaptation, France
| | - James Middleton
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Australia
- Sydney Medical School - Northern, Faculty of Medicine and Health, The University of Sydney, Australia
| | | | - Diana Pacheco Barzallo
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Hossain MS, Harvey LA, Islam MS, Rahman MA, Muldoon S, Biering-Sorensen F, Jan S, Liu H, Li Q, Cameron ID, Taylor V, Lindley RI, Billot L, Herbert RD. A community-based intervention to prevent serious complications and death 2 years after discharge in people with spinal cord injury in Bangladesh (CIVIC): a randomised trial. Spinal Cord 2021; 59:649-658. [PMID: 32917948 PMCID: PMC8189918 DOI: 10.1038/s41393-020-00546-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022]
Abstract
STUDY DESIGN Randomised controlled trial. OBJECTIVES To determine the effectiveness of a sustainable community-based intervention designed to prevent serious complications and death 2 years after discharge in people with spinal cord injury in Bangladesh. SETTING Bangladesh. METHODS A pragmatic randomised controlled trial was undertaken. People who had sustained a spinal cord injury in the preceding 2 years, were wheelchair-dependent, and were about to be discharged from hospital in Bangladesh were recruited and randomised to an Intervention or Control group using a concealed allocation procedure stratified by level of lesion (tetraplegia/paraplegia). Participants in the Intervention group received 36 phone calls and three home visits over the first 2 years following discharge. All participants received usual post-discharge care. Survival status and date of death were determined by blinded assessors 2 years after randomisation. RESULTS Between July 2015 and March 2018, 410 participants were randomised (204 to Intervention, 206 to Control). There was no loss to follow up. At 2 years, 15 (7.4%) participants in the Intervention group and 16 (7.8%) participants in the Control group had died (hazard ratio from unadjusted Cox model = 0.93 [95% CI, 0.46 to 1.89]; p from log rank test 0.85). There were no clinically important or statistically significant average causal effects of intervention on the incidence or severity of complications. CONCLUSION A program of community-based care for people with recent spinal cord injury in Bangladesh involving frequent phone contact and occasional in-person contact with a health professional after discharge from hospital is no better at preventing death at 2 years than usual care.
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Affiliation(s)
- Mohammad Sohrab Hossain
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia.
| | - Md Shofiqul Islam
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
| | - Md Akhlasur Rahman
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
| | - Stephen Muldoon
- Muldoon Rehabilitation, 72 Liscreevin Road, Lisnarick, Co Fermanagh, BT94 1PZ, Northern Ireland
| | - Fin Biering-Sorensen
- Department for Spinal Cord Injuries, University of Copenhagen, Havnevej 25, DK-3100, Hornbæk, Denmark
| | - Stephen Jan
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Hueiming Liu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Qiang Li
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
| | - Valerie Taylor
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
| | - Richard I Lindley
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Laurent Billot
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Barker Street, Randwick, 2031, NSW, Australia
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Kesarwani A, Nagpal PS, Chhabra H. Experimental animal modelling for pressure injury: A systematic review. J Clin Orthop Trauma 2021; 17:273-279. [PMID: 33987077 PMCID: PMC8082114 DOI: 10.1016/j.jcot.2021.04.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/23/2021] [Accepted: 04/02/2021] [Indexed: 01/02/2023] Open
Abstract
INTRODUCTION Pressure injury (PI) is a potentially serious condition that is often a consequence of other medical illnesses. It remains a challenge for the clinicians and the researcher to fully understand and develop a technique for comprehending pathogenicity, prevention and treatment. Several animal models have been created to understand the multifaceted cellular and biochemical processes of PI. There are numerous known intrinsic and extrinsic factors influencing the recovery of PI. Some of the important factors are friction, spinal cord injury, diabetes, nutrition, aging, infection, medication, obesity and vascular diseases. The dearth of optimal, pre-clinical animal models capable of mimicking the human PI remains a major challenge for its cure. An ideal animal model must endeavour the reproducibility, clinical significance, and most importantly effective translation into clinical use. METHODS In this current systematic review, a methodological literature review was conducted on the PRISMA guidelines. PubMed/Medline, Research Scholar and Science Direct databases were searched. We conferred the animal models like mice, rats, pigs and dogs used in the PI experiments between January 1980 to January 2021. Typically, methods like Ischemia-reperfusion (IR), monoplegia pressure sore and mechanical non-invasive have been discussed. These were used to generate pressure injuries in small and large animal models. RESULTS AND CONCLUSION Different animal models (mouse, rat, pig, dog) were evaluated based on ease of handling, availability for research, their size, skin type and the technical skills required. Studies suggest that mice and rats are the best-suited animals as their skin healing by contraction resembles the skin healing in humans. In most of the studies with mice and rats, the time taken for the recovery was between 1 and 3 weeks. Further, various techniques discussed in the current systematics review, supports the statement that the Ischemia-reperfusion (IR) method is the most suited method to study pressure injury. It is a controlled method that can develop different stages of PI and does not require any specialized setup for the application.
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Affiliation(s)
- Ashwani Kesarwani
- Department of Basic Research, Indian Spinal Injuries Centre, New Delhi, India
| | - Puja S. Nagpal
- Department of Basic Research, Indian Spinal Injuries Centre, New Delhi, India
| | - H.S. Chhabra
- Medical Director and Chief of Spine Unit, Indian Spinal Injuries Centre, New Delhi, India
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Sengupta D, Bindra A, Kumar N, Goyal K, Singh PK, Chaturvedi A, Malhotra R, Mishra AK. Respiratory morbidity and mortality of traumatic cervical spinal cord injury at a level I trauma center in India. Spinal Cord Ser Cases 2021; 7:36. [PMID: 33986249 PMCID: PMC8117130 DOI: 10.1038/s41394-020-00371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/09/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022] Open
Abstract
STUDY DESIGN Descriptive retrospective. OBJECTIVES To evaluate the burden of respiratory morbidity in terms of ventilator dependence (VD) days and length of stay in neurotrauma ICU (NICU) and hospital, and to determine mortality in patients with traumatic cervical spinal cord injury (CSCI) in a low middle-income country (LMIC). SETTING Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India. METHODS A total of 135 patients admitted with CSCI in the NICU between January 2017 to December 2018 were screened. Information regarding age, gender, American Spinal Injury Association (ASIA) impairment scale (AIS), level of injury, duration of VD, length of NICU, hospital stay, and outcome in terms of mortality or discharge from the hospital were obtained from the medical records. RESULTS A total of 106 CSCI patients were analyzed. The mean (SD) age of patients was 40 (±16) years and male: female ratio was 5:1. The duration of VD, duration of NICU, and hospital stay was a median of 8 days (IQR 1127), 6 days (IQR 1118), and 15 days (IQR 3127) respectively. Mortality was 19% (20/106). The mortality was significantly associated with poorer AIS score, VD, and duration of ICU and hospital stay. All patients were discharged to home only after they became ventilator-free. CONCLUSIONS The ventilator burden, hospital stay, and mortality are high in patients with CSCI in LMICs. Poor AIS scores, prolonged VD, ICU and hospital stay are associated with mortality. There is a need for comprehensive CSCI rehabilitation programs in LMICs to improve outcome.
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Affiliation(s)
- Deep Sengupta
- Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Bindra
- Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
| | - Niraj Kumar
- Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Keshav Goyal
- Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Kumar Singh
- Neurosurgey, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Chaturvedi
- Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Ashwani Kumar Mishra
- Biostatistics, National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India
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Baron RB, Neifert SN, Martini ML, Maragkos GA, McNeill IT, Lamb C, Rasouli JJ, Caridi JM. A Comparison of Outcomes for Spinal Trauma Patients at Level I and Level II Centers. Clin Spine Surg 2021; 34:153-157. [PMID: 33044272 DOI: 10.1097/bsd.0000000000001074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 07/24/2020] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Retrospective analysis of a national database. OBJECTIVE To characterize the spine trauma population, describe trauma center (TC) resources, and compare rates of outcomes between the American College of Surgeons (ACS) level I and level II centers. SUMMARY OF BACKGROUND DATA Each year, thousands of patients are treated for spinal trauma in the United States. Although prior analyses have explored postsurgical outcomes for patients with trauma, no study has evaluated these metrics for spinal trauma at level I and level II TCs. MATERIALS AND METHODS The ACS Trauma Quality Improvement Program was queried for all spinal trauma cases between 2013 and 2015, excluding polytrauma cases, patients discharged within 24 hours, data from TCs without a designated level, and patients transferred for treatment. RESULTS Although there were similar rates of severe spine traumas (Abbreviated Injury Scale≥3) at ACS level I and level II centers (P=0.7), a greater proportion of level I patients required mechanical ventilation upon emergency department arrival (P=0.0002). Patients at level I centers suffered from higher rates of infectious complications, including severe sepsis (0.58% vs. 0.31%, P=0.02) and urinary tract infections (3.26% vs. 2.34%, P=0.0009). Intensive care unit time (1.90 vs. 1.65 days, P=0.005) and overall length of stay (8.37 days vs. 7.44 days, P<0.0001) was higher at level I TCs. Multivariate regression revealed higher adjusted overall complication rates at level II centers (odds ratio, 1.15, 95% confidence interval, 1.06-1.24; P<0.001), but no difference in mortality (odds ratio, 1.18; 95% confidence interval, 0.92-1.52; P>0.10). CONCLUSIONS ACS level I TCs possess larger surgical staff and are more likely to be academic centers. Patients treated at level I centers experience fewer overall complications but have a greater incidence of infectious complications. Mortality rates are not statistically different.
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Affiliation(s)
- Rebecca B Baron
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY
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Hu H, Jian X. The protective mechanism of action of plantamajoside on a rat model of acute spinal cord injury. Exp Ther Med 2021; 21:378. [PMID: 33680100 PMCID: PMC7918247 DOI: 10.3892/etm.2021.9809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Accepted: 05/22/2020] [Indexed: 12/29/2022] Open
Abstract
Acute spinal cord injury (ASCI) is a severe traumatic disease of the central nervous system, characterized by a high incidence and high morbidity, for which there are no effective drug therapies in the clinic. A rat model of ASCI was established to study the effects of plantamajoside (PMS) treatment on the expression of apoptotic factors, including caspase-3, caspase-9, poly (ADP-ribose) polymerase (PARP), Bax and Bcl-2. The Allen's weight hit rat ASCI model was used for the present study, and the rats were treated with various concentrations of PMS. The behavior of rats was assessed using the Basso-Beattle-Bresnahan locomotor rating scale (BBB), the histopathologic changes of spinal cord tissue were observed by hematoxylin and eosin staining, the survival of neurons was assessed by TUNEL staining and the expression levels of apoptotic proteins such as caspase-3, caspase-9, PARP, Bcl-2 and Bax was measured using western blot assays and RT-qPCR. It was observed that PMS could reverse the decrease in the BBB score after ASCI, improve the morphological characteristics of the spinal cord, reduce the degree apoptosis and affect the expression of caspase-3, caspase-9, PARP, Bax and Bcl-2 in a concentration dependent manner. In conclusion, PMS protected ASCI rats by inhibiting apoptosis; therefore PMS may be a potential candidate for ASCI therapy.
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Affiliation(s)
- Hua Hu
- Department of Orthopedics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Jiangan, Wuhan, Hubei 430014, P.R. China
| | - Xiaofei Jian
- Department of Orthopedics, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Jiangan, Wuhan, Hubei 430014, P.R. China
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Kriz J, Sediva K, Maly M. Causes of death after spinal cord injury in the Czech Republic. Spinal Cord 2021; 59:814-820. [PMID: 33446932 DOI: 10.1038/s41393-020-00593-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 01/02/2023]
Abstract
STUDY DESIGN A retrospective cohort study OBJECTIVES: To determine the causes of death in people with spinal cord injury (SCI) admitted to the Spinal Cord Unit (SCU) of the University Hospital Motol from 2004 to 2018. SETTING University Hospital Motol, Prague METHODS: From a cohort of people admitted to the SCU between 2004 and 2018, all deaths were identified based on the database of health insurance companies. The causes of death (ICD-10) were obtained from the Institute of Health Information and Statistics. The standardized mortality ratio (SMR) was calculated for most frequent causes of death. RESULTS During the study period, 990 patients with acute SCI were admitted to the SCU, out of which 183 (18.5%) died. Thirty-five people who had SCI due to cancer were excluded from the study. The leading cause of death in the remaining 148 people was pneumonia, followed by cardiac complications, pulmonary embolism, suicide, and urinary tract infection (UTI). In the group of the individuals who died within 1 year after SCI (N = 41), the main causes of death were pneumonia and pulmonary embolism (17.1% each). Among individuals who survived up to1 year after SCI (N = 107), the most common causes of death were pneumonia (14%) and pressure injuries (12.1%). The cause-specific SMRs were significantly increased for UTI, embolism, pneumonia, and suicide. CONCLUSION The frequent causes of death in our study group were pressure injuries and suicides. These findings are fundamental to the development and implementation of preventive programs to reduce mortality and increase life expectancy.
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Affiliation(s)
- Jiri Kriz
- Spinal Cord Unit, University Hospital Motol, Prague, Czech Republic.
| | - Kristyna Sediva
- Department of Rehabilitation and Sports Medicine, University Hospital Motol, Prague, Czech Republic
| | - Marek Maly
- Department of Biostatistics, National Institute of Public Health, Prague, Czech Republic
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Kamp O, Jansen O, Lefering R, Aach M, Waydhas C, Dudda M, Schildhauer TA, Hamsen U. Survival among patients with severe high cervical spine injuries - a TraumaRegister DGU® database study. Scand J Trauma Resusc Emerg Med 2021; 29:1. [PMID: 33407690 PMCID: PMC7786887 DOI: 10.1186/s13049-020-00820-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/24/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Trauma is a significant cause of death and impairment. The Abbreviated Injury Scale (AIS) differentiates the severity of trauma and is the basis for different trauma scores and prediction models. While the majority of patients do not survive injuries which are coded with an AIS 6, there are several patients with a severe high cervical spinal cord injury that could be discharged from hospital despite the prognosis of trauma scores. We estimate that the trauma scores and prediction models miscalculate these injuries. For this reason, we evaluated these findings in a larger control group. METHODS In a retrospective, multi-centre study, we used the data recorded in the TraumaRegister DGU® (TR-DGU) to select patients with a severe cervical spinal cord injury and an AIS of 3 to 6 between 2002 to 2015. We compared the estimated mortality rate according to the Revised Injury Severity Classification II (RISC II) score against the actual mortality rate for this group. RESULTS Six hundred and twelve patients (0.6%) sustained a severe cervical spinal cord injury with an AIS of 6. The mean age was 57.8 ± 21.8 years and 441 (72.3%) were male. 580 (98.6%) suffered a blunt trauma, 301 patients were injured in a car accident and 29 through attempted suicide. Out of the 612 patients, 391 (63.9%) died from their injury and 170 during the first 24 h. The group had a predicted mortality rate of 81.4%, but we observed an actual mortality rate of 63.9%. CONCLUSIONS An AIS of 6 with a complete cord syndrome above C3 as documented in the TR-DGU is survivable if patients get to the hospital alive, at which point they show a survival rate of more than 35%. Compared to the mortality prognosis based on the RISC II score, they survived much more often than expected.
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Affiliation(s)
- O Kamp
- Department of Trauma, University Hospital Essen, Hand and Reconstructive, Surgery, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany.
| | - O Jansen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - R Lefering
- Institute for Research in Operative Medicine (IFOM), University Witten/Herdecke, Cologne, Germany
| | - M Aach
- Department of Spinal Cord Injury, BG University Hospital Bergmannsheil, Bochum, Germany
| | - C Waydhas
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany.,Medical Faculty, University of Duisburg-Essen, Duisburg, Germany
| | - M Dudda
- Department of Trauma, University Hospital Essen, Hand and Reconstructive, Surgery, University of Duisburg-Essen, Hufelandstraße 55, 45147, Essen, Germany
| | - T A Schildhauer
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - U Hamsen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
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Epidemiological characteristics of traumatic spinal cord injury in Xi'an, China. Spinal Cord 2020; 59:804-813. [PMID: 33268825 DOI: 10.1038/s41393-020-00592-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/06/2020] [Accepted: 11/09/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN A hospital-based retrospective epidemiological study. OBJECTIVE To describe the demographic and epidemiological characteristics of patients with traumatic spinal cord injury (TSCI) in Xi'an to help health-related institutions formulate corresponding measures. SETTING People with TSCI, all spine centres and orthopaedic centres in Xi'an, China. METHODS We retrospectively reviewed the medical records of the all spine centers or orthopedic centers in Xi'an according to the International Classification of Disease Version 10 (ICD-10) and diagnostic code of TSCI. Variables included gender, age, medical insurance, etiology, occupation, level of injury, and severity of injury, multiple injury, complication, treatment, and so on. RESULTS The study included the medical records of 1730 patients with TSCI from 2014 to 2018. The estimated annual incidence rate increased from 39.0 cases (95% CI, 34.7-43.3 cases) per 1 million persons in 2014 to 43.2 cases (95% CI, 39.0-47.5 cases) per 1 million persons in 2018. The leading cause of TSCI was high falls (35.5%, 614 cases). The most common injury site was the cervical spinal cord, accounting for 55.7% (963 cases). The degree of injury severity with the highest proportion was incomplete tetraplegia (47.2%, 816 cases). In addition, 71.4% (1236 cases) of TSCI cases had spinal fracture or dislocation. CONCLUSIONS There are specific epidemiological characteristics of TSCI patients in Xi'an, and preventive measures are suggested to be based on the characteristics of the different types of patients with TSCI and focused on high-risk groups.
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Abstract
Objective: Identify the association of personality and purpose in life with competing risks of multiple causes of death after spinal cord injury (SCI), using data from the SCI Longitudinal Health Study. Design: Prospective cohort study with data collected in 1997-1998 and 2007-2009. Mortality status determined as of December 31, 2016. Setting: Specialty hospital in the Southeastern United States. Participants: 3070 adults with chronic (>1-year), traumatic SCI. Interventions: N/A. Outcome Measures: We examined 6 psychological factors (Purpose in Life and 5 scales of the Zuckerman-Kuhlman Personality Questionnaire) and risk of mortality due to 6 specific causes of death, building on published analyses of behavioral and health/clinical risk and protective factors. Results: There were 803 deaths. Four of the 6 psychological factors were predictive of all-cause mortality. All except 1 personality scale were related to cause-specific mortality. Psychological factors were most predictive of unintentional injury deaths. Purpose in life was protective of death due to pneumonia; whereas, Activity was protective of death due to diseases of heart and blood vessels and to unintentional injury. Sociability, Impulsive-Sensation Seeking, and Neuroticism-Anxiety were risk factors for death due to unintentional injury. Neuroticism-Anxiety was related to death due to septicemia. There were no significant psychological predictors of cancer. Conclusions: Rehabilitation professionals have a central role in promoting purpose in life as a means of increasing longevity. By assessing personality factors predictive of specific causes of mortality, those at risk may be targeted for cause-specific prevention strategies.
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Affiliation(s)
- James S. Krause
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA,Correspondence to: James S. Krause, College of Health Professions, Medical University of South Carolina, 151-B Rutledge Ave, MSC 962, Charleston, SC29425, USA; Ph: 843-792-1337.
| | - Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Nicole DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
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McRae J, Smith C, Emmanuel A, Beeke S. The experiences of individuals with cervical spinal cord injury and their family during post-injury care in non-specialised and specialised units in UK. BMC Health Serv Res 2020; 20:783. [PMID: 32831066 PMCID: PMC7443811 DOI: 10.1186/s12913-020-05659-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 08/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with acute cervical spinal cord injury require specialised interventions to ensure optimal clinical outcomes especially for respiratory, swallowing and communication impairments. This study explores the experiences of post-injury care for individuals with cervical spinal cord injury and their family members during admissions in specialised and non-specialised units in the United Kingdom. METHODS Semi-structured interviews were undertaken with individuals with a cervical spinal cord injury and their family member, focussing on the experience of care across units. Eight people with spinal cord injury levels from C2 to C6, were interviewed in their current care settings. Six participants had family members present to support them. Interviews were audio-recorded and transcribed with data inputted into NVivo for thematic analysis. RESULTS The study identified six themes from the participant interviews that highlighted different experiences of care in non-specialised and specialised settings. A number of these were related to challenges with the system, whilst others were about the personal journey of recovery. The themes were titled as: adjustment, transitions, "the golden opportunity", "when you can't eat", communication, and "in the hands of the nurses and doctors". CONCLUSIONS Whilst participants reported being well cared for in non-specialised units, they felt that they did not receive specialist care and this delayed their rehabilitation. Participants were dependent on healthcare professionals for information and care and at times lost hope for recovery. Staff in non-specialised units require training and guidance to help provide support for those with dysphagia and communication difficulties, as well as reassurance to patients and families whilst they wait for transfer to specialised units.
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Affiliation(s)
- Jackie McRae
- Faculty of Health, Social Care and Education, Kingston and St Georges University of London, London, UK
| | - Christina Smith
- Division of Psychology and Language Science, University College London, London, WC1N 1PF UK
| | - Anton Emmanuel
- Division of Medicine, University College London, London, WC1E 6JF UK
| | - Suzanne Beeke
- Division of Psychology and Language Science, University College London, London, WC1N 1PF UK
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Chamberlain JD, Eriks-Hoogland IE, Hug K, Jordan X, Schubert M, Brinkhof MWG. Attrition from specialised rehabilitation associated with an elevated mortality risk: results from a vital status tracing study in Swiss spinal cord injured patients. BMJ Open 2020; 10:e035752. [PMID: 32647022 PMCID: PMC7351285 DOI: 10.1136/bmjopen-2019-035752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Study drop-out and attrition from treating clinics is common among persons with chronic health conditions. However, if attrition is associated with adverse health outcomes, it may bias or mislead inferences for health policy and resource allocation. METHODS This retrospective cohort study uses data attained through the Swiss Spinal Cord Injury (SwiSCI) cohort study on persons with spinal cord injury (SCI). Vital status (VS) was ascertained either through clinic medical records (MRs) or through municipalities in a secondary tracing effort. Flexible parametric survival models were used to investigate risk factors for going lost to clinic (LTC) and the association of LTC with subsequent risk of mortality. RESULTS 1924 individuals were included in the tracing study; for 1608 of these cases, contemporary VS was initially checked in the MRs. VS was ascertained for 704 cases of the 1608 cases initially checked in MRs; of the remaining cases (n=904), nearly 90% were identified in municipalities (n=804). LTC was associated with a nearly fourfold higher risk of mortality (HR=3.62; 95% CI 2.18 to 6.02) among persons with traumatic SCI. Extended driving time (ie, less than 30 min compared with 30 min and longer to reach the nearest specialised rehabilitation facility) was associated with an increased risk of mortality (HR=1.51, 95% CI 1.02 to 2.22) for individuals with non-traumatic SCI. CONCLUSION The differential risk of LTC according to sociodemographic and SCI lesion characteristics underscores the importance of accounting for attrition in cohort studies on chronic disease populations requiring long-term care. In addition, given the associated risk of mortality, LTC is an issue of concern to clinicians and policy makers aiming to optimise the long-term survival of community-dwelling individuals with traumatic SCI. Future studies are necessary to verify whether it is possible to improve survival prospects of individuals LTC through more persistent outreach and targeted care.
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Affiliation(s)
- Jonviea D Chamberlain
- Swiss Paraplegic Research, Nottwil, Switzerland
- Centre INSERM U1219, CIC 1401-EC, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux School of Public Health, University of Bordeaux, Bordeaux, France
| | | | | | | | | | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
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Fekete C, Brach M, Ehrmann C, Post MWM, Stucki G. Cohort Profile of the International Spinal Cord Injury Community Survey Implemented in 22 Countries. Arch Phys Med Rehabil 2020; 101:2103-2111. [PMID: 32533933 DOI: 10.1016/j.apmr.2020.01.022] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVES To detail the methodological features of the first International Spinal Cord Injury (InSCI) Community Survey by describing recruitment and data collection procedures, and to report on the recruitment results and basic characteristics of participants by country and income setting. DESIGN Cross-sectional survey. SETTING Community setting in 22 countries representing all 6 World Health Organization regions. PARTICIPANTS Individuals (N=12,591) with traumatic or non-traumatic spinal cord injury (SCI) aged over 18 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Recruitment and data collection procedures, recruitment results, and basic sociodemographic and lesion characteristics of participants. RESULTS Eight countries used predefined sampling frames and 14 countries applied convenience sampling for recruitment. Most countries recruited participants through specialized rehabilitation facilities, patient organizations, or acute and general hospitals. Modes of approaching potential participants depended on the sampling strategy and multiple response modes were offered to maximize participation. Contact rates ranged from 33% to 98%, cooperation rates ranged from 29% to 90%, and response rates ranged from 23% to 54%. The majority of participants were men (73%), the median age was 52 years (interquartile range, 40-63y), 60% had a partner, 8% reported that they were born in another country than where they were currently residing, and the median length of education was 12 years (interquartile range, 9-15y). Paraplegia was the main diagnosis (63%), traumatic etiologies were the major cause of injury (81%), and the median time since injury (TSI) was 9 years (interquartile range, 4-19y). Compared with participants from lower income settings, participants from higher income settings were over-represented and, in general, were older, more often diagnosed with tetraplegia, had a longer TSI, higher education, and were more often born in a country different than their current residence country. CONCLUSIONS The successful implementation of the InSCI survey enables the comparison of the situation of individuals with SCI around the world and constitutes a crucial starting point for an international learning experience.
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Affiliation(s)
- Christine Fekete
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
| | - Mirjam Brach
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Cristina Ehrmann
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Marcel W M Post
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland; University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Center for Rehabilitation, Groningen, the Netherlands; Center of Excellence for Rehabilitation Medicine, UMC Utrecht Brain Center, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | | | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; ICF Research Branch, Swiss Paraplegic Research, Nottwil, Switzerland
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Kee KM, Mohamad NZ, Koh PPW, Yeo JPT, Ng YS, Kam JC, Asano M. Return to work after spinal cord injury: a Singaporean pilot community-based rehabilitation program. Spinal Cord 2020; 58:1096-1103. [PMID: 32273565 DOI: 10.1038/s41393-020-0459-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/20/2020] [Accepted: 03/20/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective analysis of data collected as part of a pilot program. OBJECTIVES The primary objective of our study was to document the return-to-work rate of individuals with SCI who participated in a community-based interdisciplinary vocational rehabilitation program. The secondary objectives were to assess changes in their levels of community integration and functional independence. SETTING A community-based rehabilitation center in Singapore. METHODS Participants were individuals with SCI between 21 and 55 years. They identified return to work as a rehabilitation goal, and were certified fit to undergo rehabilitation by their physicians. Primary outcome was the return-to-work rate at discharge from the program. Secondary outcomes were community integration and functional independence, measured by the Community Integration Questionnaire (CIQ) and the Spinal Cord Independence Measure III (SCIM-III), respectively. We summarized participants' clinical and socio-demographic characteristics descriptively, and used inferential statistics to compare pre- and postprogram scores for secondary outcome measures. RESULTS Thirty-nine participants were included for this study. Thirty-two completed the program, of which 84% (n = 27) reported returning to work. Participants who completed the program had mean change in total CIQ and SCIM-III scores of 7 (95% CI, 5-8) and 11 (95% CI, 7-15), respectively. There were differences (p < 0.05) between pre- and postprogram scores for both secondary outcome measures. CONCLUSIONS Our findings suggest that our vocational rehabilitation program facilitated participants with SCI in Singapore to return to work and was beneficial to enhance their levels of community integration and functional independence. Future interventional studies are recommended to estimate the efficacy of such programs.
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Affiliation(s)
- Kalya M Kee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
| | - Nizar Z Mohamad
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
| | | | - Joanna P T Yeo
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,National University Health System, Singapore, Singapore
| | - Yee Sien Ng
- Department of Rehabilitation Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Miho Asano
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. .,National University Health System, Singapore, Singapore.
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Utilization of Outpatient Physical and Occupational Therapy in People With Spinal Cord Injury in Germany: Results of the German Spinal Cord Injury Survey. Am J Phys Med Rehabil 2020; 99:532-539. [PMID: 32167958 DOI: 10.1097/phm.0000000000001366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of the study was to assess factors determining the utilization of physical and occupational therapy in people with spinal cord injury. DESIGN Data from the German Spinal Cord Injury study conducted in 2017 were analyzed. The 12-mo prevalence of physical therapy and occupational therapy utilization was determined. To identify underlying determinants, multivariable logistic regression was used. RESULTS Of 1479 participants (response = 26.4%), 72.9% were male, with a mean (SD) age of 55.3 (14.6) yrs and a mean (SD) time since injury of 14.0 (12.0) yrs; 51.2% were people with paraplegia and 66.3% had an incomplete spinal cord injury. In the past 12 mos, 78.1% received physical and 29.3% occupational therapy. Physical therapy and occupational therapy were significantly associated with time since spinal cord injury occurrence, participation in lifelong care programs, and electric wheelchair dependency. Spinal cord injury characteristics, level of impairment, and time since spinal cord injury had a greater impact on occupational therapy than on physical therapy utilization. CONCLUSIONS The use of physical therapy and occupational therapy is much higher in Germans with spinal cord injury than in the general population and in people with similar neurological conditions. Further research should focus on the frequency of use and the types of interventions. Guidelines for lifelong care should include recommendations on physical therapy and occupational therapy.
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McCaughey EJ, Butler JE, McBain RA, Boswell-Ruys CL, Hudson AL, Gandevia SC, Lee BB. Abdominal Functional Electrical Stimulation to Augment Respiratory Function in Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2019; 25:105-111. [PMID: 31068742 DOI: 10.1310/sci2502-105] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Functional electrical stimulation (FES) is the application of electrical pulses to a nerve to achieve a functional muscle contraction. Surface electrical stimulation of the nerves that innervate the abdominal muscles, termed abdominal FES, can cause the abdominal muscles to contract, even when paralysed after spinal cord injury. As the abdominal muscles are the major expiratory muscles, and commonly partially or completely paralysed in tetraplegia, abdominal FES offers a promising method of improving respiratory function for this patient group. Objective: The aim of the article is to provide readers with a better understanding of how abdominal FES can be used to improve the health of the spinal cord-injured population. Methods: A narrative review of the abdominal FES literature was performed. Results: Abdominal FES can achieve an immediate effective cough in patients with tetraplegia, while the repeated application over 6 weeks of abdominal FES can improve unassisted respiratory function. Ventilator duration and tracheostomy cannulation time can also be reduced with repeated abdominal FES. Conclusion: Abdominal FES is a noninvasive method to achieve functional improvements in cough and respiratory function in acute and chronically injured people with tetraplegia. Potential practical outcomes of this include reduced ventilation duration, assisted tracheostomy decannulation, and a reduction in respiratory complications. All of these outcomes can contribute to reduced morbidity and mortality, improved quality of life, and significant potential cost savings for local health care providers.
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Affiliation(s)
- E J McCaughey
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia
| | - J E Butler
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia
| | - R A McBain
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia.,Prince of Wales Hospital, Randwick, Australia
| | - C L Boswell-Ruys
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia.,Prince of Wales Hospital, Randwick, Australia
| | - A L Hudson
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia
| | - S C Gandevia
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia.,Prince of Wales Hospital, Randwick, Australia
| | - B B Lee
- Neuroscience Research Australia, Randwick, Australia.,School of Medical Sciences, University of New South Wales, Kensington, Australia.,Prince of Wales Hospital, Randwick, Australia
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Dorjbal D, Zanini C, Tsegmid N, Stucki G, Rubinelli S. Toward an optimization of rehabilitation services for persons with spinal cord injury in Mongolia: the perspective of medical doctors. Disabil Rehabil 2019; 43:2200-2212. [PMID: 31790290 DOI: 10.1080/09638288.2019.1696415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To explore medical doctors' views on what are barriers in providing rehabilitation services for persons with SCI in Mongolia. METHODS A qualitative study with semi-structured interviews was conducted with 12 medical doctors. Participants were purposely sampled. The World Health Organization (WHO)'s report International Perspectives on Spinal Cord Injury was chosen as a guide to structure the interviews. The study used inductive thematic analysis. RESULTS Five barriers in the provision of rehabilitation services were identified: low awareness and limited knowledge regarding SCI and rehabilitation issues, inadequate rehabilitation policies, deficiencies in infrastructure, deficiencies in equipment and medication, and a shortage of well-prepared rehabilitation workforce. CONCLUSIONS Based on WHO recommendations "Rehabilitation in health systems", this study provides suggestions on how to strengthen rehabilitation services in Mongolia to better respond to the needs of the SCI population. Our findings highlight that a core issue is the lack of awareness among policymakers regarding rehabilitation and its benefits at the micro, meso and macro levels of the health system. Actions are needed at the level of health policies to ensure, for instance, adequate financing and access to the services. Also, synergies between the Ministries of Education and Health can improve the training of the workforce.Implications for rehabilitationEvidence that rehabilitation services contribute to improving health outcomes and cost-effectiveness could raise awareness among Mongolian policymakers and inform their decisions on funding schemes.Health policies in Mongolia should be reformed to remove barriers in the provision of rehabilitation services for persons with complex and chronic health conditions.Rehabilitation services need to be included into the Mongolian health insurance scheme in order to improve the quality and accessibility of rehabilitation services.Synergies between the Ministry of Education and the Ministry of Health in Mongolia are needed to develop training standards for rehabilitation professionals.
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Affiliation(s)
- Delgerjargal Dorjbal
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Claudia Zanini
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Narantsetseg Tsegmid
- Department of Rehabilitation Medicine, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Gerold Stucki
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Sara Rubinelli
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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68
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Validation and psychometric evaluation of the Italian version of the Spinal Cord Injury Secondary Conditions Scale. Spinal Cord 2019; 58:496-503. [DOI: 10.1038/s41393-019-0384-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/15/2019] [Accepted: 11/04/2019] [Indexed: 11/08/2022]
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69
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Jiang F, Jaja BNR, Kurpad SN, Badhiwala JH, Aarabi B, Grossman RG, Harrop JS, Guest JD, Schär RT, Shaffrey CI, Boakye M, Toups EG, Wilson JR, Fehlings MG. Acute Adverse Events After Spinal Cord Injury and Their Relationship to Long-term Neurologic and Functional Outcomes: Analysis From the North American Clinical Trials Network for Spinal Cord Injury. Crit Care Med 2019; 47:e854-e862. [PMID: 31389834 DOI: 10.1097/ccm.0000000000003937] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There are few contemporary, prospective multicenter series on the spectrum of acute adverse events and their relationship to long-term outcomes after traumatic spinal cord injury. The goal of this study is to assess the prevalence of adverse events after traumatic spinal cord injury and to evaluate the effects on long-term clinical outcome. DESIGN Multicenter prospective registry. SETTING Consortium of 11 university-affiliated medical centers in the North American Clinical Trials Network. PATIENTS Eight-hundred one spinal cord injury patients enrolled by participating centers. INTERVENTIONS Appropriate spinal cord injury treatment at individual centers. MEASUREMENTS AND MAIN RESULTS A total of 2,303 adverse events were recorded for 502 patients (63%). Penalized maximum logistic regression models were fitted to estimate the likelihood of neurologic recovery (ASIA Impairment Scale improvement ≥ 1 grade point) and functional outcomes in subjects who developed adverse events at 6 months postinjury. After accounting for potential confounders, the group that developed adverse events showed less neurologic recovery (odds ratio, 0.55; 95% CI, 0.32-0.96) and was more likely to require assisted breathing (odds ratio, 6.55; 95% CI, 1.17-36.67); dependent ambulation (odds ratio, 7.38; 95% CI, 4.35-13.06) and have impaired bladder (odds ratio, 9.63; 95% CI, 5.19-17.87) or bowel function (odds ratio, 7.86; 95% CI, 4.31-14.32) measured using the Spinal Cord Independence Measure subscores. CONCLUSIONS Results from this contemporary series demonstrate that acute adverse events are common and are associated with worsened long-term outcomes after traumatic spinal cord injury.
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Affiliation(s)
- Fan Jiang
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
- Division of Orthopaedic Surgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Blessing N R Jaja
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Shekar N Kurpad
- Division of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI
| | - Jetan H Badhiwala
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
| | - Bizhan Aarabi
- Division of Neurosurgery, Shock Trauma, University of Maryland, Baltimore, MD
| | | | - James S Harrop
- Division of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA
| | - Jim D Guest
- Division of Neurosurgery, University of Miami, Miami, FL
| | - Ralph T Schär
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Chris I Shaffrey
- Division of Neurosurgery, University of Virginia, Chalottesville, VA
| | - Max Boakye
- Division of Neurosurgery, University of Louisville, Louisville, KY
| | | | - Jefferson R Wilson
- Division of Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Toronto Western Hospital, University of Toronto, Toronto, ON, Canada
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Buzzell A, Chamberlain JD, Eriks-Hoogland I, Hug K, Jordan X, Schubert M, Zwahlen M, Brinkhof MWG. All-cause and cause-specific mortality following non-traumatic spinal cord injury: evidence from a population-based cohort study in Switzerland. Spinal Cord 2019; 58:157-164. [PMID: 31591462 PMCID: PMC7007408 DOI: 10.1038/s41393-019-0361-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 09/16/2019] [Indexed: 12/20/2022]
Abstract
Study design Observational cohort study. Objective To benchmark all-cause and cause-specific mortality following NTSCI to the general population (GP). Setting Specialized rehabilitation centers in Switzerland. Methods Longitudinal data from the Swiss Spinal Cord Injury (SwiSCI) Medical Record study were probabilistically linked with cause of death (CoD) information from the Swiss National Cohort. Standardized mortality ratios (SMRs) were estimated for all-cause and cause-specific mortality. Competing risk frameworks were used to estimate the probability of death due to specific CoD. Results One thousand five hundred and one individuals were admitted for first rehabilitation with NTSCI between 1990–2011; CoD information was available for 454 individuals of the 525 individuals that died. Overall, the mortality rate for persons with NTSCI was 1.6 times greater than that of the GP. Deaths due to cardiovascular disease (39.8%), neoplasms (22%), and infection (9.9%) were most often reported. Individuals with an SCI due to a vascular etiology indicated the greatest burden of mortality from infection compared with the GP (SMR 5.4; 95% CI, 3.1 to 9.2). Conclusions Cause-specific SMRs varied according to etiology. This supports the need for targeted clinical care and follow-up. Cardiovascular disease, neoplasms, and infection, emerged as main causes of death following NTSCI and should thus be targets for future research and differential clinical management approaches.
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Affiliation(s)
- A Buzzell
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - J D Chamberlain
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.,Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | | | - K Hug
- REHAB Basel, Basel, Switzerland
| | - X Jordan
- Clinique Romand de Réadaption, Sion, Switzerland
| | - M Schubert
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - M Zwahlen
- Institute of Social and Preventative Medicine, University of Bern, Bern, Switzerland
| | - M W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland. .,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland.
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Paulus-Mokgachane TMM, Visagie SJ, Mji G. Access to primary care for persons with spinal cord injuries in the greater Gaborone area, Botswana. Afr J Disabil 2019; 8:539. [PMID: 31616623 PMCID: PMC6779981 DOI: 10.4102/ajod.v8i0.539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 06/05/2019] [Indexed: 12/02/2022] Open
Abstract
Background People with spinal cord injury (SCI) often have great need for healthcare services, but they report access challenges. Primary care access to people with SCI has not been explored in Botswana. Objective This study aimed to identify barriers and facilitators that users with spinal cord injuries experience in accessing primary care services in the greater Gaborone area, Botswana. Methods A quantitative, cross-sectional, observational study was conducted. Data were collected with a structured questionnaire from 57 participants with traumatic and non-traumatic SCI. Descriptive and inferential analysis was performed. Results The male to female ratio was 2.8:1. The mean age of participants was 40 years (standard deviation 9.59). Road traffic crashes caused 85% of the injuries. Most participants visited primary care facilities between 2 and 10 times in the 6 months before the study. Participants were satisfied with the services (63%) and felt that facilities were clean (95%) and well maintained (73.5%). Preferential treatment, respect, short waiting times and convenient hours facilitated satisfaction with services. Availability was hampered by insufficient provider knowledge on SCI as indicated by 71.9% of participants, and shortage of consumables (80.7%). Structural challenges (42.1% could not enter the facility by themselves and 56.5% could not use the bathroom) and lack of height-adjustable examining couches (66.7%) impeded accessibility. Cost was incurred when participants (64.9%) utilised private health services where public services failed to address their needs. Conclusion Primary care services were mostly affordable and adequate. Availability, acceptability and accessibility aspects created barriers.
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Affiliation(s)
- Thato M M Paulus-Mokgachane
- Spinal cord injury rehabilitation Unit, Princess Marina Hospital, University of Botswana, Gaborone, Botswana
| | - Surona J Visagie
- Centre for Rehabilitation Studies, Stellenbosch University, Cape Town, South Africa
| | - Gubela Mji
- Centre for Rehabilitation Studies, Stellenbosch University, Cape Town, South Africa
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Poor adherence to influenza vaccination guidelines in spinal cord injury: results from a community-based survey in Switzerland. Spinal Cord 2019; 58:18-24. [PMID: 31371803 DOI: 10.1038/s41393-019-0333-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVES To evaluate the annual influenza vaccination coverage rate (IVCR) among community-dwelling individuals with spinal cord injury (SCI). SETTING SCI community in Switzerland. METHODS Participants were responders to the influenza vaccination question (n = 492) in the 2012 community survey of the Swiss Spinal Cord Injury (SwiSCI) cohort study. IVCR of SwiSCI participants were compared to the normative Swiss population, sampled in the Swiss Health Survey of 2012 using direct standardization, logistic regression standardization, and a genetic matching approach to control for differences in age, sex, and quarterly period of survey response. RESULTS Individuals with SCI showed higher crude (26%, 95% confidence interval (CI): 22-30%) and age- and sex-standardized (24%, CI: 23-24%) IVCR than observed in the general population (15% CI, 14-15%). The adjustment for age and sex as well as quarterly period of survey response showed that the standardized IVCR of individuals with SCI (17%; CI: 12-23%) approached that of the general population. Low IVCR of about 10% were found among individuals with SCI younger than 45 years. IVCR were similar between men and women and between individuals with incomplete and complete paraplegia and tetraplegia. CONCLUSION The IVCR in individuals with chronic SCI was not higher than in the general population and much lower than guidelines recommend. The improvement of the IVCR is an important target of health policy in SCI in Switzerland as to reduce the evidenced excess burden in respiratory-disease related morbidity and mortality.
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A prospective study of health behaviors and risk of all-cause and cause-specific mortality after spinal cord injury. Spinal Cord 2019; 57:933-941. [DOI: 10.1038/s41393-019-0298-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 04/02/2019] [Accepted: 04/18/2019] [Indexed: 01/18/2023]
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Understanding and modelling the economic impact of spinal cord injuries in the United Kingdom. Spinal Cord 2019; 57:778-788. [PMID: 31086273 PMCID: PMC6760568 DOI: 10.1038/s41393-019-0285-1] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Revised: 04/22/2019] [Accepted: 04/23/2019] [Indexed: 12/17/2022]
Abstract
STUDY DESIGN Economic modelling analysis. OBJECTIVES To determine lifetime direct and indirect costs from initial hospitalisation of all expected new traumatic and non-traumatic spinal cord injuries (SCI) over 12 months. SETTING United Kingdom (UK). METHODS Incidence-based approach to assessing costs from a societal perspective, including immediate and ongoing health, rehabilitation and long-term care directly attributable to SCI, as well as aids and adaptations, unpaid informal care and participation in employment. The model accounts for differences in injury severity, gender, age at onset and life expectancy. RESULTS Lifetime costs for an expected 1270 new cases of SCI per annum conservatively estimated as £1.43 billion (2016 prices). This equates to a mean £1.12 million (median £0.72 million) per SCI case, ranging from £0.47 million (median £0.40 million) for an AIS grade D injury to £1.87 million (median £1.95 million) for tetraplegia AIS A-C grade injuries. Seventy-one percent of lifetime costs potentially are paid by the public purse with remaining costs due to reduced employment and carer time. CONCLUSIONS Despite the magnitude of costs, and being comparable with international estimates, this first analysis of SCI costs in the UK is likely to be conservative. Findings are particularly sensitive to the level and costs of long-term home and residential care. The analysis demonstrates how modelling can be used to highlight economic impacts of SCI rapidly to policymakers, illustrate how changes in future patterns of injury influence costs and help inform future economic evaluations of actions to prevent and/or reduce the impact of SCIs.
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75
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Nightingale TE, Walhin JP, Thompson D, Bilzon JLJ. Biomarkers of cardiometabolic health are associated with body composition characteristics but not physical activity in persons with spinal cord injury. J Spinal Cord Med 2019; 42:328-337. [PMID: 28901220 PMCID: PMC6522924 DOI: 10.1080/10790268.2017.1368203] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
OBJECTIVE To examine (i) the associations between physical activity dimensions, cardiorespiratory fitness and body composition and, (ii) the associations between physical activity dimensions, cardiorespiratory fitness, body composition and biomarkers of cardiometabolic health in persons with spinal cord injury (SCI). METHODS A cross-sectional prospective cohort study with 7-day follow-up was conducted. Body composition, cardiorespiratory fitness and biomarkers of cardiometabolic health were measured in thirty-three participants with SCI (> 1 year post injury). Physical activity dimensions were objectively assessed over 7-days. RESULTS Activity energy expenditure (r =.43), physical activity level (r =.39), and moderate-to-vigorous physical activity (MVPA) (r =.48) were significantly (P < 0.001) associated with absolute (L/min) peak oxygen uptake (⩒O2 peak). ⩒O2 peak was significantly higher in persons performing ≥150 MVPA minutes/week compared to <40 minutes/week (P = 0.003). Individual physical activity dimensions were not significantly associated with biomarkers of cardiometabolic health. However, body composition characteristics (BMI, waist and hip circumference) showed significant (P < 0.04), moderate (r >.30) associations with parameters of metabolic regulation, lipid profiles and inflammatory biomarkers. Relative ⩒O2 peak (ml/kg/min) was moderately associated with only insulin sensitivity (r = 0.37, P = 0.03). CONCLUSIONS Physical activity dimensions are associated with cardiorespiratory fitness; however, stronger and more consistent associations suggest that poor cardiometabolic health is associated with higher body fat content. Given these findings, the regulation of energy balance should be an important consideration for researchers and clinicians looking to improve cardiometabolic health in persons with SCI.
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Affiliation(s)
- Tom E Nightingale
- Department for Health, University of Bath, Bath, BA2 7AY, UK,Spinal Cord Injury and Disorders, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, US,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, US
| | | | - Dylan Thompson
- Department for Health, University of Bath, Bath, BA2 7AY, UK
| | - James LJ Bilzon
- Department for Health, University of Bath, Bath, BA2 7AY, UK,Correspondence to: Professor James LJ Bilzon, Department for Health, University of Bath, Bath, BA2 7AY, UK.
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76
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Gross-Hemmi MH, Post MWM, Bienert S, Chamberlain JD, Hug K, Jordan X, Scheel-Sailer A, Weiss A, Brinkhof MWG. Participation in People Living With Spinal Cord Injury in Switzerland: Degree and Associated Factors. Arch Phys Med Rehabil 2019; 100:1894-1906. [PMID: 31026462 DOI: 10.1016/j.apmr.2019.03.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 03/05/2019] [Accepted: 03/17/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe different domains of participation such as productive, leisure and social activities and describe sociodemographic and spinal cord injury (SCI)-related characteristics that are associated with participation in these domains in a large sample of community-dwelling individuals with SCI in Switzerland. DESIGN Cross-sectional population-based survey within the Swiss Spinal Cord Injury Cohort Study. Participation in major life domains was measured by the Utrecht Scale for Evaluation of Rehabilitation-Participation (USER-Participation). Univariable unconditional analysis and unbiased recursive partitioning were used to identify the predominant associations of sociodemographic and SCI-related characteristics with multiple dimensions of participation. SETTING Community. PARTICIPANTS Swiss residents aged 16 years or older and living with traumatic or nontraumatic SCI (N=1549). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The USER-Participation, a 32-item self-report questionnaire with 3 scales (Frequency, Restrictions, and Satisfaction) to assess key domains of participation (productive, leisure, social). RESULTS Frequency (median 34.5 out of 100) in productive, outdoor leisure, and social activities was reduced with distinctive perceived restrictions in work and education, sports, and partner relationships. Domestic leisure activities (65.4%) and maintaining social relationships (76.1%) were those activities most often performed and with least perceived restrictions. Participants were generally satisfied with their current daily life activities. Lower scores across all participation scales were associated with more severe SCI, higher age, being female, not having a partner, and lower level of education. CONCLUSIONS This study provides a thorough analysis of participation in major life domains of individuals with SCI in Switzerland. Different risk groups for reduced levels in participation in productive, leisure, and social activities were identified. This population-based evidence is instrumental to the better targeting of rehabilitation and policy interventions that aim to improve community participation.
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Affiliation(s)
| | - Marcel W M Post
- University of Groningen, University Medical Center Groningen, Department of Rehabilitation Medicine, Groningen, the Netherlands; Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Stefanie Bienert
- Swiss Paraplegic Research, Nottwil, Switzerland; Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Jonviea D Chamberlain
- Swiss Paraplegic Research, Nottwil, Switzerland; Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | | | | | | | - Annette Weiss
- Swiss Paraplegic Research, Nottwil, Switzerland; Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland; Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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Health factors and spinal cord injury: a prospective study of risk of cause-specific mortality. Spinal Cord 2019; 57:594-602. [PMID: 30804424 DOI: 10.1038/s41393-019-0264-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/08/2019] [Accepted: 02/08/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVES Identify the risk and protective factors of all-cause and cause-specific mortality among persons with traumatic spinal cord injury (SCI). SETTING Rehabilitation specialty hospital in the Southeastern United States. METHODS A prospective cohort study was conducted with 3070 adults with traumatic SCI who were a minimum of 1 year post-injury at assessment. Prospective data were collected in 1997-1998 and 2007-2010, with mortality determined as of 31 December, 2016. The deceased were classified into six categories based on underlying cause of death: septicemia, pneumonia and influenza, cancer, heart and blood vessel diseases, unintentional injuries, and all other causes. The competing risk analysis strategy applied to each of the specific causes. RESULTS There were a total of 803 observed deaths among the 2979 final study sample. After controlling for demographic and injury characteristics, general health, pressure ulcer history, and symptoms of infections were significantly associated with all-cause mortality. Except for cancer, they were also related with at least one of the specific causes of death, whereas orthopedic complications and subsequent injuries were unrelated to any cause. CONCLUSIONS Three health domains, global health, pressure ulcers, and symptoms of illness or infection, were significantly associated with mortality after SCI, and the patterns of association varied as a function of specific cause of death.
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Survival in 222 Patients With Severe CSCI: An 8-Year Epidemiologic Survey in Western China. Arch Phys Med Rehabil 2019; 100:1872-1880. [PMID: 30684486 DOI: 10.1016/j.apmr.2018.12.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Revised: 12/03/2018] [Accepted: 12/10/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To assess the survival and the predictors of mortality in patients with severe cervical spinal cord injuries (CSCI). DESIGN Retrospective study. PARTICIPANTS From January 1, 2010, to May 31, 2018, patients who suffered from severe CSCIs in Western China were enrolled in this study (N=222). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Survival rates and mortality risk factors. Measures were calculated by the product-limit method (Kaplan-Meier) and the Cox model. RESULTS The overall 1-year, 3-year, 5-year, and 8-year postoperative mortalities were 24.4%, 30.6%, 33.3%, 36.2%, and 39.0%, respectively. Most deaths occurred within 36 months after the injury. According to the Cox proportional hazards model, the significant predictors of survival were as follows: (1) age; (2) neurologic level; (3) treatment options (surgical or conservative); (4) ventilator support (P<.05). The 8-year mortality for older patients (>50y) was 50.2%, which was significantly higher than that for younger patients (32.4%, <50y). The risk of death was 2.053 times higher in higher levels of injury (C1-C4) than in lower levels of injury (C5-C8) (P<.05). Compared with conservative treatment, patients who received surgical treatment (either anterior or posterior decompression) had a lower risk of death (P<.05). No significant difference was detected in the risk of death between early surgery (<3d) and mid-term surgery (3-7d) (P>.05). However, patients who received late-term surgery (>7d) had a higher mortality risk (P<.05). The overall 8-year mortality risk of patients who needed ventilator support was much higher than those who did not need ventilator support (P<.05). CONCLUSIONS Age, neurologic level, ventilator dependence, treatment options, and timing to surgery were main risk factors for mortality in patients with severe CSCIs. Better understanding of the predictors for survival could possibly contribute to the improvement of survival rates.
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Ageing, Disability, and Spinal Cord Injury: Some Issues of Analysis. Curr Gerontol Geriatr Res 2018; 2018:4017858. [PMID: 30581466 PMCID: PMC6276527 DOI: 10.1155/2018/4017858] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/06/2018] [Indexed: 01/10/2023] Open
Abstract
Spinal cord injury is a disabling disorder, worldwide spread, with important consequences on functioning and health conditions and impacts on physical, psychological, and social well-being. The consequences are related to the lesion itself and to other complications related to the lesion. In the last decades, there have been an increasing of the mean ages of onset and also an increase in life expectancy after the lesion. So, differently from the past, people with spinal cord injury can age after the lesion. Taking into account the need to share data and information about specific disabling conditions and their relationship with ageing, this paper aims to discuss some issues from recent literature on the relationship between aging and disability in the spinal cord injury, according to a narrative review approach. A narrative review of the literature on ageing and spinal cord injury was undertaken. Search was based on the following electronic databases: PubMed/Medline and Ovid/PsychINFO. A combination of the following keywords was used: (1) “ageing” or “aging” and (2) “spinal cord injury” or “spinal cord lesion” and (3) disability. Data on consequences of the lesion in the life of aging people, secondary health conditions, life expectancy, participation, and quality of life are discussed. Then, a brief discussion of clinical issues and the role of interventions aimed to promote wellbeing, health, quality of life, and participation of people with spinal cord injury is proposed.
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80
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Survival after non-traumatic spinal cord injury: evidence from a population-based rehabilitation cohort in Switzerland. Spinal Cord 2018; 57:267-275. [DOI: 10.1038/s41393-018-0212-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Revised: 10/05/2018] [Accepted: 10/10/2018] [Indexed: 02/07/2023]
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81
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Hossain MS, Harvey LA, Islam MS, Rahman MA, Glinsky JV, Herbert RD. A prediction model to identify people with spinal cord injury who are at high risk of dying within 5 years of discharge from hospital in Bangladesh. Spinal Cord 2018; 57:198-205. [DOI: 10.1038/s41393-018-0211-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2018] [Revised: 10/03/2018] [Accepted: 10/08/2018] [Indexed: 11/09/2022]
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The Global Spine Care Initiative: public health and prevention interventions for common spine disorders in low- and middle-income communities. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 27:838-850. [DOI: 10.1007/s00586-018-5635-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/13/2018] [Indexed: 12/11/2022]
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83
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Post-discharge mortality in patients with traumatic spinal cord injury in a Brazilian hospital: a retrospective cohort. Spinal Cord 2018; 57:134-140. [PMID: 30089892 DOI: 10.1038/s41393-018-0183-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/24/2018] [Accepted: 07/03/2018] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To evaluate the survival outcomes in patients with traumatic spinal cord injury (TSCI). SETTING A teaching hospital in Brazil. METHODS A total of 434 patients diagnosed with TSCI (2004-2014) were included. Overall survival, standardized mortality ratios (SMR), and causes of death were assessed by Student's t-test, χ2 test, Kaplan-Meier analysis, and Cox proportional-hazards regression. RESULTS The mean follow-up was 4.8 years (±3.3 years). Individuals with tetraplegia had a median survival of 11 years, with participants in the paraplegia group not reaching median survival. The overall mortality rate was 37 per 1000 person-years. Age-adjusted SMR was 28.8 (95% CI: 22.8-36). There were 77 deaths with 56 defined causes, of which pneumonia was the most frequent (35.7%). Combined infectious etiologies caused 55.3% of deaths. Multivariate analysis revealed higher mortality among individuals with tetraplegia vs. paraplegia in the first 2 years post injury (HR = 8.28, 95% CI: 2.76-24.80), after 2 years post injury (HR = 2.35, 95% CI: 1.31-4.24), and in all years combined (HR = 3.36, 95% CI: 2.04-5.52). CONCLUSION Mortality among patients with TSCI was 28.8 times higher than in the reference population. In more than half of the cases, the cause of death was linked to infectious diseases. Pneumonia caused two times more deaths in individuals with tetraplegia than in individuals with paraplegia, with a higher impact in the first 2 years post injury. Reported findings indicate the need for a surveillance and prevention program with emphasis on vaccination and respiratory rehabilitation.
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84
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Hossain MS, Harvey LA, Liu H, Islam MS, Rahman MA, Muldoon S, Biering-Sorensen F, Cameron ID, Chhabra HS, Lindley RI, Jan S. Protocol for process evaluation of CIVIC randomised controlled trial: Community-based InterVentions to prevent serIous Complications following spinal cord injury in Bangladesh. BMJ Open 2018; 8:e024226. [PMID: 30012798 PMCID: PMC6082451 DOI: 10.1136/bmjopen-2018-024226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 06/14/2018] [Accepted: 06/25/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION People with spinal cord injuries in low-income and middle-income countries are highly vulnerable to life-threatening complications in the period immediately after discharge from hospital. We are conducting a randomised controlled trial in Bangladesh to determine whether all-cause mortality at 2 years can be reduced if health professionals regularly ring and visit participants in their homes following discharge. We will conduct a process evaluation alongside the trial to explain the trial results and determine the feasibility of scaling this intervention up in low-income and middle-income countries if it is found to be effective. METHODS AND ANALYSIS Our process evaluation is based on the Realist and Reach, Effectiveness, Adoption, Implementation and Maintenance frameworks. We will use a mixed methods approach that uses both qualitative and quantitative data. For example, we will audit a sample of telephone interactions between intervention participants and the healthcare professionals, and we will conduct semistructured interviews with people reflective of various interest groups. Quantitative data will also be collected to determine the number and length of interactions between the healthcare professionals and participants, the types of issues identified during each interaction and the nature of the support and advice provided by the healthcare professionals. All quantitative and qualitative data will be analysed iteratively before the final analysis of the trial results. These data will then be triangulated with the final results of the primary outcome. ETHICS AND DISSEMINATION Ethics approval was obtained from the institutional ethics committee at the site in Bangladesh and from the University of Sydney, Australia. The study will be conducted in compliance with all stipulations of its protocol, the conditions of ethics committee approval and the relevant regulatory bodies. The results of the trial will be disseminated through publications in peer-reviewed scientific journals and presentations at scientific conferences. TRIAL REGISTRATION NUMBER ACTRN12615000630516.
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Affiliation(s)
- Mohammad Sohrab Hossain
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School/Northern, University of Sydney, Sydney, New South Wales, Australia
- George Institute for Global Health, Sydney, New South Wales, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School/Northern, University of Sydney, Sydney, New South Wales, Australia
- George Institute for Global Health, Sydney, New South Wales, Australia
| | - Hueiming Liu
- George Institute for Global Health, Sydney, New South Wales, Australia
| | | | | | | | | | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School/Northern, University of Sydney, Sydney, New South Wales, Australia
- George Institute for Global Health, Sydney, New South Wales, Australia
| | | | - Richard I Lindley
- George Institute for Global Health, Sydney, New South Wales, Australia
| | - Stephen Jan
- George Institute for Global Health, Sydney, New South Wales, Australia
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Franz CK, Dalamagkas K, Jordan LA, Spill GR. Soft tissue sarcoma affecting the right shoulder of a man with paraplegia from a remote traumatic spinal cord injury: a case report. Spinal Cord Ser Cases 2018; 4:55. [PMID: 29951280 PMCID: PMC6018767 DOI: 10.1038/s41394-018-0081-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/07/2018] [Accepted: 04/08/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction People with spinal cord injury (SCI) are getting older due to a combination of increased life expectancy and older age at the time of injury. This trend makes it more likely for these patients to have other chronic health conditions including cancer. Inevitably relatively rare cancers such as soft tissue sarcomas (STS), which are more common with advancing age, will occur in some SCI patients. The present case represents the first report of a limb STS in a patient with chronic paraplegia from a traumatic SCI. Case presentation We report a case of a 50-year-old right handed male with a T6 chronic, complete SCI (American Spinal Injury Association Impairment Scale A) who presented with a large mass involving his right shoulder musculature that was determined to be a high grade spindle cell sarcoma. The patient was followed closely by Physiatry over an approximately 6-month time course including prior to his tumor diagnosis, during the pre-radiation and pre-surgical planning phase, and then post-operatively for his acute inpatient rehabilitation. He was successfully discharged home to live alone in his accessible apartment complex. Discussion This case is the first ever reported case of a person living with a traumatic SCI who subsequently developed a limb STS. In addition to its novelty, this case illustrates how health conditions such as rare cancers are presenting more often as the chronic SCI population is getting older, which creates both unique diagnostic and management challenges for cancer rehabilitation specialists.
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Affiliation(s)
- Colin K Franz
- 1Biologics Laboratory, Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago), Chicago, IL USA.,2Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL USA.,3The Ken & Ruth Davee Department of Neurology, Division of Neuromuscular Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL USA
| | - Kyriakos Dalamagkas
- 4The Institute for Rehabilitation and Research, Memorial Hermann Texas Medical Center, Houston, TX USA
| | - Lewis A Jordan
- 1Biologics Laboratory, Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago), Chicago, IL USA
| | - Gayle R Spill
- 2Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL USA.,5Cancer Rehabilitation Program, Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago), Chicago, IL USA
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Conradsson D, Rhoda A, Mlenzana N, Nilsson Wikmar L, Wahman K, Hultling C, Joseph C. Strengthening Health Systems for Persons With Traumatic Spinal Cord Injury in South Africa and Sweden: A Protocol for a Longitudinal Study of Processes and Outcomes. Front Neurol 2018; 9:453. [PMID: 29963007 PMCID: PMC6011127 DOI: 10.3389/fneur.2018.00453] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Accepted: 05/29/2018] [Indexed: 11/24/2022] Open
Abstract
Background: The provision of specialized care in a time-sensitive manner has shown to be crucial for survival and recovery of functioning after a traumatic spinal cord injury (TSCI). However, little is known about the provision of TSCI care in different international contexts; information which is required for strengthening policy and practice. Aims: The overarching aim of this study will be to explore health care processes and outcomes of TSCI care in South Africa and Sweden. Specific aims will be to: (1) describe acute processes of TSCI care, (2) determine acute- and long-term outcomes of TSCI care, and (3) identify predictors for survival, secondary complications, and functioning 12 months post-injury. Methods: A prospective (regional), population-based cohort study where adults with an acute TSCI will be recruited over at least a 1-year period from the City of Cape Town, South Africa, and Stockholm, Sweden. The anticipated sample size inclusive of both international contexts will be 200 participants—based on a power calculation for detecting differences in mortality. Information on the nature and timing of processes of acute care (e.g., transfer logistics, spinal surgery, and specialized SCI care) will be collected on acute care admission and discharge using a standardized form. Survival status, secondary complications, neurological symptoms, functional status, activity, and participation as well as health-related quality of life will be collected at discharge from SCI acute care and at 12-months post-injury. Secondary complications and functioning will be compared between South Africa and Sweden using inferential statistics. To address mortality specifically, the indirect standardization method for differences in mortality between contexts will be used whereby Stockholm will serve as standard for specialize care. For the assessment of factors related to mortality and other outcomes (e.g., neurological and secondary health conditions) multivariate regression analyses will be used to determine independent risk factors. Conclusion: This study offers a unique investigation of the relationship between health care processes and outcomes of TSCI care with the aim of strengthening management guidelines for SCI in South Africa and Sweden.
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Affiliation(s)
- David Conradsson
- Function Area Occupational Therapy and Physiotherapy, Allied Health Professionals Function, Karolinska University Hospital, Stockholm, Sweden.,Physiotherapy Division, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anthea Rhoda
- Physiotherapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Nondwe Mlenzana
- Physiotherapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Lena Nilsson Wikmar
- Physiotherapy Division, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Kerstin Wahman
- Section Neurorehabilitation, Division of Neurodegeneration, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,Spinalis Research and Development Unit, Rehab Station Stockholm, Stockholm, Sweden
| | - Claes Hultling
- Section Neurorehabilitation, Division of Neurodegeneration, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden.,Spinalis Foundation, Stockholm, Sweden
| | - Conran Joseph
- Physiotherapy Division, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.,Physiotherapy Department, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
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87
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Differential survival after traumatic spinal cord injury: evidence from a multi-center longitudinal cohort study in Switzerland. Spinal Cord 2018; 56:920-930. [DOI: 10.1038/s41393-018-0163-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/17/2018] [Accepted: 05/17/2018] [Indexed: 11/08/2022]
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88
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Welk B, Schneider MP, Thavaseelan J, Traini LR, Curt A, Kessler TM. Early urological care of patients with spinal cord injury. World J Urol 2018; 36:1537-1544. [DOI: 10.1007/s00345-018-2367-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 06/04/2018] [Indexed: 10/14/2022] Open
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89
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Green BN, Johnson CD, Haldeman S, Griffith E, Clay MB, Kane EJ, Castellote JM, Rajasekaran S, Smuck M, Hurwitz EL, Randhawa K, Yu H, Nordin M. A scoping review of biopsychosocial risk factors and co-morbidities for common spinal disorders. PLoS One 2018; 13:e0197987. [PMID: 29856783 PMCID: PMC5983449 DOI: 10.1371/journal.pone.0197987] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Accepted: 05/11/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The purpose of this review was to identify risk factors, prognostic factors, and comorbidities associated with common spinal disorders. METHODS A scoping review of the literature of common spinal disorders was performed through September 2016. To identify search terms, we developed 3 terminology groups for case definitions: 1) spinal pain of unknown origin, 2) spinal syndromes, and 3) spinal pathology. We used a comprehensive strategy to search PubMed for meta-analyses and systematic reviews of case-control studies, cohort studies, and randomized controlled trials for risk and prognostic factors and cross-sectional studies describing associations and comorbidities. RESULTS Of 3,453 candidate papers, 145 met study criteria and were included in this review. Risk factors were reported for group 1: non-specific low back pain (smoking, overweight/obesity, negative recovery expectations), non-specific neck pain (high job demands, monotonous work); group 2: degenerative spinal disease (workers' compensation claim, degenerative scoliosis), and group 3: spinal tuberculosis (age, imprisonment, previous history of tuberculosis), spinal cord injury (age, accidental injury), vertebral fracture from osteoporosis (type 1 diabetes, certain medications, smoking), and neural tube defects (folic acid deficit, anti-convulsant medications, chlorine, influenza, maternal obesity). A range of comorbidities was identified for spinal disorders. CONCLUSION Many associated factors for common spinal disorders identified in this study are modifiable. The most common spinal disorders are co-morbid with general health conditions, but there is a lack of clarity in the literature differentiating which conditions are merely comorbid versus ones that are risk factors. Modifiable risk factors present opportunities for policy, research, and public health prevention efforts on both the individual patient and community levels. Further research into prevention interventions for spinal disorders is needed to address this gap in the literature.
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Affiliation(s)
- Bart N. Green
- Qualcomm Health Center, Stanford Health Care, San Diego, California, United States of America
- Publications Department, National University of Health Sciences, Lombard, Illinois, United States of America
| | - Claire D. Johnson
- Publications Department, National University of Health Sciences, Lombard, Illinois, United States of America
| | - Scott Haldeman
- Department of Neurology, University of California, Irvine, California, United States of America
- Department of Epidemiology, School of Public Health, University of California, Los Angeles, California, United States of America
- World Spine Care, Santa Ana, California, United States of America
| | - Erin Griffith
- Emergency Medicine, Carlsbad, California, United States of America
| | - Michael B. Clay
- Rehabilitation Care Line, Physical Medicine and Rehabilitation, Cincinnati Veterans Affairs Medical Center, Cincinnati, Ohio, United States of America
| | - Edward J. Kane
- College of Rehabilitative Sciences, Doctor of Physical Therapy Program, University of St. Augustine for Health Sciences, San Marcos, California, United States of America
| | - Juan M. Castellote
- National School of Occupational Medicine, Carlos III Institute of Health, Complutense University of Madrid, Madrid, Spain
| | | | - Matthew Smuck
- Section of Physical Medicine and Rehabilitation and Department of Orthopaedic Surgery, Stanford University, Redwood City, California, United States of America
| | - Eric L. Hurwitz
- Office of Public Health Studies, University of Hawai`i, Mānoa, Honolulu, Hawaii, United States of America
| | - Kristi Randhawa
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Toronto, Ontario, Canada
- Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | - Hainan Yu
- UOIT-CMCC Centre for Disability Prevention and Rehabilitation, University of Ontario Institute of Technology, Toronto, Ontario, Canada
| | - Margareta Nordin
- World Spine Care, Santa Ana, California, United States of America
- Department of Orthopedic Surgery, New York University, New York, New York, United States of America
- Department of Environmental Medicine, New York University, New York, New York, United States of America
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90
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Azarhomayoun A, Aghasi M, Mousavi N, Shokraneh F, Vaccaro AR, Haj Mirzaian A, Derakhshan P, Rahimi-Movaghar V. Mortality Rate and Predicting Factors of Traumatic Thoracolumbar Spinal Cord Injury; A Systematic Review and Meta-Analysis. Bull Emerg Trauma 2018; 6:181-194. [PMID: 30090812 PMCID: PMC6078479 DOI: 10.29252/beat-060301] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Objective To estimate the summation of mortality rate and the contributing factors in patients with traumatic thoracolumbar spinal cord injuries (TLSCI). Methods A systematic search of observational studies that evaluated the mortality associated with TLSCI in MEDLINE and EMBASE was conducted. The study quality was evaluated using a modified quality assessment tool previously designed for observational studies. Results Twenty-four observational studies involving 11,205 patients were included, published between January 1, 1997, and February 6, 2016. Ten studies were of high quality, thirteen were of moderate quality, and one study was of low quality. Seventeen reports described risk factors for mortality and eleven of these studies used a multiple regression models to adjust for confounders. The reported mortality rate ranged from 0 to 37.7% overall and between 0 and 10.4% in-hospital. The sum of mortality for in-hospital, 6-month, and 12-month were 5.2%, 26.12%, 4.3%, respectively. The mortality at 7.7 years follow-up was 10.07% and for 14 years follow-up reports ranged from 13.47% to 21.46%. Associated data such as age at injury, male to female ratio, pre-existing comorbidities, concomitant injuries, duration of follow-up, and cause of death have been underreported in studies investigating the mortality rate after TLSCI. Conclusion There is no study was found that accurately assessed mortality in the thoracolumbar spine, while there is general agreement that traumatic thoracolumbar spinal cord injuries are important.
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Affiliation(s)
- Amir Azarhomayoun
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Aghasi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Najmeh Mousavi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Shokraneh
- Division of Psychiatry and Clinical Psychology, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Alexander R Vaccaro
- Departments of Orthopaedic Surgery and Neurological Surgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, PA, USA
| | - Arvin Haj Mirzaian
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Pegah Derakhshan
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.,Student Research Committee, Faculty of Medicine, Iran University of Medical Science, Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
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91
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Falavigna A, Quadros FW, Teles AR, Wong CC, Barbagallo G, Brodke D, Al-Mutair A, Riew KD. Worldwide Steroid Prescription for Acute Spinal Cord Injury. Global Spine J 2018; 8:303-310. [PMID: 29796379 PMCID: PMC5958488 DOI: 10.1177/2192568217735804] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To continue the line of a previous publication using steroid for acute spinal cord injury (SCI) by spine surgeons from Latin America (LA) and assess the current status of methylprednisolone (MP) prescription in Europe (EU), Asia Pacific (AP), North America (NA), and Middle East (ME) to determine targets for educational activities suitable for each region. METHODS The English version of a previously published questionnaire was used to evaluate opinions about MP administration in acute SCI in LA, EU, AP, NA, and ME. This Internet-based survey was conducted by members of AOSpine. The questionnaire asked about demographic features, background with management of spine trauma patients, routine administration of MP in acute SCI, and reasons for MP administration. RESULTS A total of 2659 responses were obtained for the electronic questionnaire from LA, EU, AP, NA, and ME. The number of spine surgeons that treat SCI was 2206 (83%). The steroid was used by 1198 (52.9%) surgeons. The uses of MP were based predominantly on the National Acute Spinal Cord Injury Study III study (n = 595, 50%). The answers were most frequently given by spine surgeons from AP, ME, and LA. These regions presented a statistically significant difference from North America (P < .001). The number of SCI patients treated per year inversely influenced the use of MP. The higher the number of patients treated, the lower the administration rates of MP observed. CONCLUSIONS The study identified potential targets for educational campaigns, aiming to reduce inappropriate practices of MP administration.
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Affiliation(s)
- Asdrubal Falavigna
- Universidade de Caxias do Sul, Caxias do Sul, Rio Grande do Sul, Brazil,Asdrubal Falavigna, Universidade de Caxias do Sul, Rua General Arcy da Rocha Nóbrega, 401/602 Caxias do Sul, RS, Brazil.
| | | | | | | | | | | | - Abdulaziz Al-Mutair
- Alrazi Hospital, Ministry of Health & Kuwait Institute for Medical Specialization, Adailiya, Kuwait
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Perspectives From Family Caregivers of Persons With Spinal Cord Injury in Hospital Versus Rehabilitation: A Pilot Study. Rehabil Nurs 2018; 44:311-318. [PMID: 29613875 DOI: 10.1097/rnj.0000000000000143] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The study aims to assess differences in family preferences for involvement in the ongoing care of a hospitalized family member with spinal cord injury based on whether the patient was hospitalized for initial rehabilitation (Group R) or hospitalized to treat secondary complications (Group C). DESIGN Explorative cross-sectional design. METHOD Family members rated the importance and experience of involvement on five subscales of the Patient Participation in Rehabilitation Questionnaire. Differences among the importance and experience scores between the groups were tested using the Mann-Whitney U test. FINDINGS Group C scored the importance to be involved significantly higher than Group R (M = 3.17 vs. M = 4.04, p =.01). No other significant differences between groups were detected. CONCLUSION Family members of patients hospitalized for secondary complications want greater involvement in care compared to those hospitalized for rehabilitation. CLINICAL RELEVANCE Results indicate the need for tailored interventions using a family-centered approach and ongoing needs assessment.
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93
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Collagen-Binding Hepatocyte Growth Factor (HGF) alone or with a Gelatin- furfurylamine Hydrogel Enhances Functional Recovery in Mice after Spinal Cord Injury. Sci Rep 2018; 8:917. [PMID: 29343699 PMCID: PMC5772669 DOI: 10.1038/s41598-018-19316-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 12/29/2017] [Indexed: 12/14/2022] Open
Abstract
The treatment of spinal cord injury (SCI) is currently a significant challenge. Hepatocyte growth factor (HGF) is a multipotent neurotrophic and neuroregenerative factor that can be beneficial for the treatment of SCI. However, immobilized HGF targeted to extracellular matrix may be more effective than diffusible, unmodified HGF. In this study, we evaluated the neurorestorative effects of an engineered HGF with a collagen biding domain (CBD-HGF). CBD-HGF remained in the spinal cord for 7 days after a single administration, while unmodified HGF was barely seen at 1 day. When a gelatin-furfurylamine (FA) hydrogel was applied on damaged spinal cord as a scaffold, CBD-HGF was retained in gelatin-FA hydrogel for 7 days, whereas HGF had faded by 1 day. A single administration of CBD-HGF enhanced recovery from spinal cord compression injury compared with HGF, as determined by motor recovery, and electrophysiological and immunohistochemical analyses. CBD-HGF alone failed to improve recovery from a complete transection injury, however CBD-HGF combined with gelatin-FA hydrogel promoted endogenous repair and recovery more effectively than HGF with hydrogel. These results suggest that engineered CBD-HGF has superior therapeutic effects than naïve HGF. CBD-HGF combined with hydrogel scaffold may be promising for the treatment of serious SCI.
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Li C, DiPiro ND, Krause JS. A latent structural analysis of health behaviors among people living with spinal cord injury. Spinal Cord 2017; 56:265-273. [DOI: 10.1038/s41393-017-0027-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Revised: 09/21/2017] [Accepted: 10/01/2017] [Indexed: 02/06/2023]
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95
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Majdan M, Plancikova D, Nemcovska E, Krajcovicova L, Brazinova A, Rusnak M. Mortality due to traumatic spinal cord injuries in Europe: a cross-sectional and pooled analysis of population-wide data from 22 countries. Scand J Trauma Resusc Emerg Med 2017; 25:64. [PMID: 28673315 PMCID: PMC5496373 DOI: 10.1186/s13049-017-0410-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 06/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Traumatic spinal cord injuries (TSCI) pose a significant burden globally, while existing epidemiological data-especially on population mortality-are limited. The aim of this study was to calculate the age-standardized population mortality rates attributable to TSCI in 22 European countries, along with the pooled age-standardized mortality rate attributable to TSCI in Europe. METHODS A descriptive cross-sectional epidemiological study was conducted. Crude and age-standardized mortality rates attributable to TSCI for the year 2012 for 22 European countries were compared using data from death certificates provided by Eurostat. Pooled age-standardized mortality rates were calculated using the random effects model, and overall number of cases were estimated by extrapolating our findings to the populations of EU and Europe (48 countries), in 2012. RESULTS A total of 1840 TSCI-related deaths were identified, of which 1084 (59%) were males. The pooled age-standardized TSCI-related mortality rate of 6.7 per million (95% CI: 5.2 to 8.2) overall, 9.4 (95% CI: 7.3 to 11.5) for males, and 4.5 (95% CI: 3.4 to 5.6) for females. Extrapolating our results, 3152 (95% CI: 2441 to 3915) deaths would occur in 2012 in the EU-28 and 4570 (95% CI: 3538 to 5675) deaths in the whole Europe. TSCI-related deaths contributed by 2% (95% CI: 1.8% to 2.2%) to the overall injury related mortality. 61% of fatal TSCI were located in the cervical spine area. CONCLUSION To our knowledge, this is the largest study that reports TSCI-related population-based mortalities to date which brings valuable information that can inform further research or prevention strategies. Our study presents a comprehensive and large-scale overview of TSCI-related population mortality in Europe. With an estimated toll of nearly five thousand lives that could be potentially saved by prevention, our findings confirm TSCI as an important cause of injury related deaths in Europe. Further action towards harmonization of case ascertainment and towards prevention strategies targeted mainly on the elderly is warranted.
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Affiliation(s)
- Marek Majdan
- Faculty of Health Sciences and Social Work, Department of Public Health, Trnava University, Univerzitne namestie 1, 91701 Trnava, Slovakia
- International Neurotrauma Research Organization, Moelkergasse 4, Vienna, Austria
| | - Dominika Plancikova
- Faculty of Health Sciences and Social Work, Department of Public Health, Trnava University, Univerzitne namestie 1, 91701 Trnava, Slovakia
| | - Eva Nemcovska
- Faculty of Health Sciences and Social Work, Department of Public Health, Trnava University, Univerzitne namestie 1, 91701 Trnava, Slovakia
| | - Lenka Krajcovicova
- Faculty of Health Sciences and Social Work, Department of Public Health, Trnava University, Univerzitne namestie 1, 91701 Trnava, Slovakia
| | - Alexandra Brazinova
- Faculty of Health Sciences and Social Work, Department of Public Health, Trnava University, Univerzitne namestie 1, 91701 Trnava, Slovakia
- International Neurotrauma Research Organization, Moelkergasse 4, Vienna, Austria
| | - Martin Rusnak
- Faculty of Health Sciences and Social Work, Department of Public Health, Trnava University, Univerzitne namestie 1, 91701 Trnava, Slovakia
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96
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Lu CW, Hsiao JK, Liu HM, Wu CH. Characterization of an iron oxide nanoparticle labelling and MRI-based protocol for inducing human mesenchymal stem cells into neural-like cells. Sci Rep 2017; 7:3587. [PMID: 28620162 PMCID: PMC5472606 DOI: 10.1038/s41598-017-03863-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 05/04/2017] [Indexed: 12/13/2022] Open
Abstract
The aim of the current study was to develop an iron oxide nanoparticle (ION) labelling and magnetic resonance imaging (MRI)-based protocol to allow visualization of the differentiation process of mesenchymal stem cells (MSCs) into neural-like cells (NCs) in vitro. Ferucarbotran, a clinically available ION, which can be visualized under MRI, is used for tracking cells implanted in vivo. The NCs were verified morphologically and histologically by light microscopy, and their functions were verified by measuring their action potentials. Conformational conversion of axon-like structures was observed under light microscopy. These NCs exhibited frequent, active action potentials compared with cells that did not undergo neural differentiation. The labelling of ION had no influence on the morphological and functional differentiation capacity of the MSCs. We conclude that the MSCs that were differentiated into NCs exhibited in vitro activity potential firing and may be used to replace damaged neurons.
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Affiliation(s)
- Chen-Wen Lu
- Department of Life Science, National Taiwan Normal University, Taipei, 10677, Taiwan.,Department of Medical Imaging, Taipei TzuChi Hospital, The Buddhist TzuChi Medical Foundation, New Taipei City, 23142, Taiwan
| | - Jong-Kai Hsiao
- Department of Medical Imaging, Taipei TzuChi Hospital, The Buddhist TzuChi Medical Foundation, New Taipei City, 23142, Taiwan
| | - Hon-Man Liu
- Department of Medical Imaging, National Taiwan University Hospital, Taipei, 10048, Taiwan.
| | - Chung-Hsin Wu
- Department of Life Science, National Taiwan Normal University, Taipei, 10677, Taiwan.
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97
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Abstract
OBJECTIVE The Learning Health System for Spinal Cord Injury (LHS-SCI) is an initiative embedded in the World Health Organization's (WHO's) Global Disability Plan and requires the statistical collection of data on the lived experience of persons with SCI to consequently formulate recommendations and policies. The International Spinal Cord Injury (InSCI) community survey has been developed as an initial step to gain information about the lived experience of persons with SCI within and across diverse nations. DESIGN InSCI is a multinational community survey based on the International Classification of Functioning, Disability and Health Core Sets for SCI and involves 28 countries from all six WHO regions. The study will be implemented in 2017. Overall aims, guiding principles on sampling strategies, data collection modes, and reminder management are described. CONCLUSIONS InSCI will be the first survey to be conducted simultaneously in many countries and in all six WHO world regions that identifies the factors associated with functioning, health, and well-being of persons living with SCI. Expected results of the survey will be used for the basis of conducting stakeholder dialogs for policy reforms designed to improve the functioning, health maintenance, and well-being of persons with SCI.
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98
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Haque A, Capone M, Matzelle D, Cox A, Banik NL. Targeting Enolase in Reducing Secondary Damage in Acute Spinal Cord Injury in Rats. Neurochem Res 2017; 42:2777-2787. [PMID: 28508172 DOI: 10.1007/s11064-017-2291-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2017] [Revised: 04/24/2017] [Accepted: 05/06/2017] [Indexed: 12/12/2022]
Abstract
Spinal cord injury (SCI) is a complex debilitating condition leading to permanent life-long neurological deficits. The complexity of SCI suggests that a concerted multi-targeted therapeutic approach is warranted to optimally improve function. Damage to spinal cord is complicated by an increased detrimental response from secondary injury factors mediated by activated glial cells and infiltrating macrophages. While elevation of enolase especially neuron specific enolase (NSE) in glial and neuronal cells is believed to trigger inflammatory cascades in acute SCI, alteration of NSE and its subsequent effects in acute SCI remains unknown. This study measured NSE expression levels and key inflammatory mediators after acute SCI and investigated the role of ENOblock, a novel small molecule inhibitor of enolase, in a male Sprague-Dawley (SD) rat SCI model. Serum NSE levels as well as cytokines/chemokines and metabolic factors were evaluated in injured animals following treatment with vehicle alone or ENOblock using Discovery assay. Spinal cord samples were also analyzed for NSE and MMPs 2 and 9 as well as glial markers by Western blotting. The results indicated a significant decrease in serum inflammatory cytokines/chemokines and NSE, alterations of metabolic factors and expression of MMPs in spinal cord tissues after treatment with ENOblock (100 µg/kg, twice). These results support the hypothesis that activation of glial cells and inflammation status can be modulated by regulation of NSE expression and activity. Analysis of SCI tissue samples by immunohistochemistry confirmed that ENOblock decreased gliosis which may have occurred through reduction of elevated NSE in rats. Overall, elevation of NSE is deleterious as it promotes extracellular degradation and production of inflammatory cytokines/chemokines and metabolic factors which activates glia and damages neurons. Thus, reduction of NSE by ENOblock may have potential therapeutic implications in acute SCI.
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Affiliation(s)
- Azizul Haque
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, BSB-201, Charleston, SC, 29425, USA.
| | - Mollie Capone
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, BSB-201, Charleston, SC, 29425, USA
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - Denise Matzelle
- Department of Neurosurgery, Medical University of South Carolina, Charleston, USA
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
| | - April Cox
- FirstString Research, Mt. Pleasant, SC, USA
| | - Naren L Banik
- Department of Microbiology and Immunology, Medical University of South Carolina, 173 Ashley Avenue, BSB-201, Charleston, SC, 29425, USA
- Department of Neurosurgery, Medical University of South Carolina, Charleston, USA
- Ralph H. Johnson Veterans Administration Medical Center, Charleston, SC, USA
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99
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Thongprayoon C, Cheungpasitporn W, Kittanamongkolchai W, Harrison AM, Kashani K. Prognostic Importance of Low Admission Serum Creatinine Concentration for Mortality in Hospitalized Patients. Am J Med 2017; 130:545-554.e1. [PMID: 27998681 DOI: 10.1016/j.amjmed.2016.11.020] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2016] [Revised: 10/30/2016] [Accepted: 11/04/2016] [Indexed: 11/17/2022]
Abstract
OBJECTIVE The study objective was to assess the association between low serum creatinine value at admission and in-hospital mortality in hospitalized patients. METHODS This was a retrospective single-center cohort study conducted at a tertiary referral hospital. All hospitalized adult patients between 2011 and 2013 who had an admission creatinine value available were identified for inclusion in this study. Admission creatinine value was categorized into 7 groups: ≤0.4, 0.5 to 0.6, 0.7 to 0.8, 0.9 to 1.0, 1.1 to 1.2, 1.3 to 1.4, and ≥1.5 mg/dL. The primary outcome was in-hospital mortality. Logistic regression analysis was performed to obtain the odds ratio of in-hospital mortality for the various admission creatinine levels, using a creatinine value of 0.7 to 0.8 mg/dL as the reference group in the analysis of all patients and female patients and of 0.9 to 1.0 mg/dL in the analysis of male patients because it was associated with the lowest in-hospital mortality. RESULTS Of 73,994 included patients, 973 (1.3%) died in the hospital. The association between different categories of admission creatinine value and in-hospital mortality assumed a U-shaped distribution, with both low and high creatinine values associated with higher in-hospital mortality. After adjustment for age, sex, ethnicity, principal diagnosis, and comorbid conditions, very low creatinine value (≤0.4 mg/dL) was significantly associated with increased mortality (odds ratio, 3.29; 95% confidence interval, 2.08-5.00), exceeding the risk related to a markedly increased creatinine value of ≥1.5 mg/dL (odds ratio, 2.56; 95% confidence interval, 2.07-3.17). The association remained significant in the subgroup analysis of male and female patients. CONCLUSIONS Low creatinine value at admission is independently associated with increased in-hospital mortality in hospitalized patients.
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Affiliation(s)
| | | | | | - Andrew M Harrison
- Mayo Medical School, Mayo Clinic College of Medicine, Rochester, Minn
| | - Kianoush Kashani
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, Minn; Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, Minn.
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100
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