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Desai RH, Hollingsworth H, Stark S, Putnam M, Eyler A, Wehmeier A, Morgan K. Social participation of adults aging with long-term physical disabilities: A cross-sectional study investigating the role of transportation mode and urban vs rural living. Disabil Health J 2023; 16:101503. [PMID: 37455234 PMCID: PMC10686629 DOI: 10.1016/j.dhjo.2023.101503] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Revised: 06/13/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND Adults aging with long-term physical disabilities (AAwPDs) experience barriers in the built environment that can hinder their participation in meaningful social roles and activities. However, interventions addressing built environment barriers to participation for AAwPD are limited. OBJECTIVE The purpose of this study was to examine how the built environment and other socioenvironmental factors influence the social participation of AAwPD to inform future interventions and service provision. We hypothesized that social participation would be significantly different between AAwPD using private versus public transportation and living in urban versus rural areas. METHODS This cross-sectional study of 331 Missouri-dwelling AAwPD reports findings on relationships among transportation mode, urban versus rural residence, and ability to participate in social roles and activities using PROMIS measures. A multivariate analysis of covariance (MANCOVA) explored differences in social participation across transportation mode and residential location. Linear regression examined associations among socioenvironmental factors, individual factors, and social participation. RESULTS The MANCOVA demonstrated significant differences in social participation across transportation mode and urban versus rural residential location. Specifically, AAwPD using paratransit and living in urban areas reported significantly higher social participation than rural-dwelling individuals and private transportation users (p < .001). The linear regression revealed that individual factors served a larger role in predicting social participation than built or social environmental factors. CONCLUSIONS Our findings suggest that transportation mode plays a significant role in shaping social participation outcomes for AAwPD. However, compared to built and social environmental factors, individual factors (i.e., physical function, 'aging-with-disability' symptoms) may restrict social participation more.
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Affiliation(s)
- Rachel Heeb Desai
- Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Ave., St. Louis, MO, USA.
| | - Holly Hollingsworth
- Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Ave., St. Louis, MO, USA
| | - Susy Stark
- Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Ave., St. Louis, MO, USA
| | - Michelle Putnam
- Simmons University, School of Social Work, 300 the Fenway, Boston, MA, USA
| | - Amy Eyler
- Washington University in St. Louis, One Brookings Dr., Brown School of Public Health, St. Louis, MO, USA
| | - Aimee Wehmeier
- Paraquad Center for Independent Living, 5240 Oakland Ave., St. Louis, MO, USA
| | - Kerri Morgan
- Washington University School of Medicine, Program in Occupational Therapy, 4444 Forest Park Ave., St. Louis, MO, USA
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Kelly-Hedrik M, Abd-El-Barr MM, Aarabi B, Curt A, Howley SP, Harrop JS, Kirshblum S, Neal CJ, Noonan V, Park C, Ugiliweneza B, Tator C, Toups EG, Fehlings MG, Williamson T, Guest JD. Importance of Prospective Registries and Clinical Research Networks in the Evolution of Spinal Cord Injury Care. J Neurotrauma 2023; 40:1834-1848. [PMID: 36576020 DOI: 10.1089/neu.2022.0450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Only 100 years ago, traumatic spinal cord injury (SCI) was commonly lethal. Today, most people who sustain SCI survive with continual efforts to improve their quality of life and neurological outcomes. SCI epidemiology is changing as preventative interventions reduce injuries in younger individuals, and there is an increased incidence of incomplete injuries in aging populations. Early treatment has become more intensive with decompressive surgery and proactive interventions to improve spinal cord perfusion. Accurate data, including specialized outcome measures, are crucial to understanding the impact of epidemiological and treatment trends. Dedicated SCI clinical research and data networks and registries have been established in the United States, Canada, Europe, and several other countries. We review four registry networks: the North American Clinical Trials Network (NACTN) SCI Registry, the National Spinal Cord Injury Model Systems (SCIMS) Database, the Rick Hansen SCI Registry (RHSCIR), and the European Multi-Center Study about Spinal Cord Injury (EMSCI). We compare the registries' focuses, data platforms, advanced analytics use, and impacts. We also describe how registries' data can be combined with electronic health records (EHRs) or shared using federated analysis to protect registrants' identities. These registries have identified changes in epidemiology, recovery patterns, complication incidence, and the impact of practice changes such as early decompression. They've also revealed latent disease-modifying factors, helped develop clinical trial stratification models, and served as matched control groups in clinical trials. Advancing SCI clinical science for personalized medicine requires advanced analytical techniques, including machine learning, counterfactual analysis, and the creation of digital twins. Registries and other data sources help drive innovation in SCI clinical science.
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Affiliation(s)
| | | | - Bizhan Aarabi
- University of Maryland School of Medicine, Maryland, USA
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland
| | - Susan P Howley
- Christopher & Dana Reeve Foundation, Short Hills, New Jersey, USA
| | - James S Harrop
- Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Steven Kirshblum
- Rutgers New Jersey Medical School, Newark, New Jersey, USA
- Kessler Institute for Rehabilitation, West Orange, New Jersey, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - Christopher J Neal
- Division of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, Maryland, USA
| | - Vanessa Noonan
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Christine Park
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Charles Tator
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth G Toups
- Department of Neurosurgery, Houston Methodist Hospital, Houston, Texas, USA
| | - Michael G Fehlings
- Division of Neurosurgery and Spine Program, Department of Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Theresa Williamson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James D Guest
- Neurological Surgery and The Miami Project to Cure Paralysis, University of Miami, Miami, USA
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Whelan A, McVeigh S, Barker P, Glennie A, Wang D, Chen M, Cheng CL, Humphreys S, O'Connell C, Attabib N, Engelbrecht A, Christie S. The effect of rurality and distance from care on health outcomes, environmental barriers, and healthcare utilization patterns in persons with traumatic spinal cord injury. Spinal Cord 2023; 61:399-408. [PMID: 37169867 PMCID: PMC10173934 DOI: 10.1038/s41393-023-00898-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 03/21/2023] [Accepted: 04/03/2023] [Indexed: 05/13/2023]
Abstract
STUDY DESIGN Cohort study. OBJECTIVES To evaluate the association between residential living location and health outcomes, environmental barriers, quality of life, and healthcare utilization patterns after traumatic spinal cord injury (tSCI). SETTING Community setting, Atlantic Canada. METHODS An ambispective study of data collected on a subset of individuals enrolled in the Rick Hansen Spinal Cord Injury Registry (RHSCIR) from 2012 to 2018. Outcomes were analyzed using two measures of rurality: postal codes at community follow-up (rural versus urban) and residential travel distance to the nearest RHSCIR facility (>100 km versus ≤100 km). Outcomes studied included the Craig Hospital Inventory of Environmental Factors-Short Form (CHIEF-SF), Short Form-36 Version 2 (SF36v2), Life Satisfaction Questionnaire (LISAT-11), Spinal Cord Independence Measure (SCIM), secondary health complications and healthcare utilization patterns. Outcomes were assessed 9 to 24 months post-discharge from initial hospitalization. RESULTS 104 participants were studied, 21 rural and 83 urban based on postal codes at community follow-up. 59 participants lived more than 100 km away from the nearest RHSCIR facility, while 45 participants lived within 100 km. Individuals from urban area codes reported a greater magnitude of perceived barriers on the policies and work/school subscales of the CHIEF-SF. No differences in function, quality of life, and healthcare utilization patterns according to the measures of rurality were observed. Individuals living >100 km from the nearest RHSCIR facility reported greater rates of sexual dysfunction. CONCLUSIONS Despite differences in environmental barriers, individuals from urban and rural locations in Eastern Canada reported similar health outcomes and quality of life after tSCI.
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Affiliation(s)
- Alexander Whelan
- Department of Medicine (Physical Medicine and Rehabilitation), Dalhousie University, Halifax, NS, Canada
| | - Sonja McVeigh
- Department of Medicine (Physical Medicine and Rehabilitation), Dalhousie University, Halifax, NS, Canada
| | - Paula Barker
- Faculty of Medicine, Memorial University of Newfoundland, Corner Brook, NF, Canada
| | - Andrew Glennie
- Department of Surgery (Orthopaedics), Dalhousie University, Halifax, NS, Canada
| | - Di Wang
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
| | - Melody Chen
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
| | | | | | - Colleen O'Connell
- Division of Physical Medicine and Rehabilitation, Dalhousie Medicine New Brunswick, Fredericton, NB, Canada
| | - Najmedden Attabib
- Division of Neurosurgery, Dalhousie University, Saint John, NB, Canada
| | - Andre Engelbrecht
- Division of Neurosurgery, Memorial University of Newfoundland, St. John's, NF, Canada
| | - Sean Christie
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada.
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Akhavan Amjadi M, Simbar M, Hoseini SA, Zayeri F. Evaluation of sexual reproductive health needs of women with spinal cord injury in Tehran, Iran. SEXUALITY AND DISABILITY 2021. [DOI: 10.1007/s11195-021-09717-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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D'Arcy J, Haines K, Paul E, Doherty Z, Goodwin A, Bailey M, Barrett J, Bellomo R, Bucknall T, Gabbe BJ, Higgins AM, Iwashyna TJ, Murray LJ, Myles PS, Ponsford J, Pilcher D, Udy AA, Walker C, Young M, Cooper DJJ, Hodgson CL. The impact of distance on post-ICU disability. Aust Crit Care 2021; 35:355-361. [PMID: 34321180 DOI: 10.1016/j.aucc.2021.05.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 05/01/2021] [Accepted: 05/17/2021] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Nonurban residential living is associated with adverse outcomes for a number of chronic health conditions. However, it is unclear what effect it has amongst survivors of critical illness. OBJECTIVES The purpose of this study is to determine whether patients living greater than 50 km from the treating intensive care unit (ICU) have disability outcomes at 6 months that differ from people living within 50 km. METHODS This was a multicentre, prospective cohort study conducted in five metropolitan ICUs. Participants were adults admitted to the ICU, who received >24 h of mechanical ventilation and survived to hospital discharge. In a secondary analysis of these data, the cohort was dichotomised based on residential distance from the treating ICU: <50 km and ≥50 km. The primary outcome was patient-reported disability using the 12-item World Health Organization's Disability Assessment Schedule (WHODAS 2.0). This was recorded at 6 months after ICU admission by telephone interview. Secondary outcomes included health status as measured by EQ-5D-5L return to work and psychological function as measured by the Hospital Anxiety and Depression Scale (HADS). Multivariable logistic regression was used to assess the association between distance from the ICU and moderate to severe disability, adjusted for potential confounders. Variables included in the multivariable model were deemed to be clinically relevant and had baseline imbalance between groups (p < 0.10). These included marital status and hours of mechanical ventilation. Sensitivity analysis was also conducted using distance in kilometres as a continuous variable. RESULTS A total of 262 patients were enrolled, and 169 (65%) lived within 50 km of the treating ICU and 93 (35%) lived ≥50 km from the treating ICU (interquartile range [IQR] 10-664 km). There was no difference in patient-reported disability at 6 months between patients living <50 km and those living ≥50 km (WHODAS total disability % [IQR] 10.4 [2.08-25] v 14.6 [2.08-20.8], P = 0.74). There was also no difference between groups for the six major life domains of the WHODAS. There was no difference in rates of anxiety or depression as measured by HADS score (HADS anxiety median [IQR] 4 [1-7] v 3 [1-7], P = 0.60) (HADS depression median [IQR] 3 [1-6] v 3 [1-6], P = 0.62); health status as measured by EQ-5D (mean [SD] 66.7 [20] v 69.8 [22.2], P = 0.24); or health-related unemployment (% (N) 39 [26] v 25 [29.1], P = 0.61). After adjusting for confounders, living ≥50 km from the treating ICU was not associated with increased disability (odds ratio 0.61, 95% confidence interval: 0.33-1.16; P = 0.13) CONCLUSIONS: Survivors of intensive care in Victoria, Australia, who live at least 50 km from the treating ICU did not have greater disability than people living less than 50 km at 6 months after discharge. Living 50 km or more from the treating ICU was not associated with disability, nor was it associated with anxiety or depression, health status, or unemployment due to health.
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Affiliation(s)
| | | | - Eldho Paul
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia
| | - Zakary Doherty
- School of Public Health & Preventative Medicine, Monash University, Australia
| | - Andrew Goodwin
- Faculty of Engineering & Information Technologies, The University of Sydney, Australia
| | - Michael Bailey
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; Department of Medicine and Radiology, University of Melbourne, Melbourne, Australia
| | - Jonathan Barrett
- Monash Partners Academic Health Science Centre, Australia; Epworth Hospital, Melbourne, Australia
| | - Rinaldo Bellomo
- Austin Health, Melbourne, Australia; Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia
| | - Tracey Bucknall
- The Alfred Hospital, Melbourne, Australia; Deakin University, Melbourne, Geelong, Australia
| | - Belinda J Gabbe
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; Health Data Research UK, Swansea University Medical School, Swansea University, UK
| | - Alisa M Higgins
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia
| | - Theodore J Iwashyna
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; University of Michigan, Michigan, USA
| | - Lynne J Murray
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia
| | - Paul S Myles
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia
| | - Jennie Ponsford
- Monash Partners Academic Health Science Centre, Australia; School of Psychological Sciences, Monash University, Melbourne, Australia
| | - David Pilcher
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia
| | - Andrew A Udy
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia
| | | | - Meredith Young
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia
| | - D J Jamie Cooper
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia
| | - Carol L Hodgson
- Australian and New Zealand Intensive Care Research Centre, Melbourne, Australia; The Alfred Hospital, Melbourne, Australia; Monash Partners Academic Health Science Centre, Australia.
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Botticello AL, Murphy L, Bogner J, Boninger M, Bryce TN, Chen Y, Heinemann AW, Roach MJ. Who Moves After SCI? Individual, Health, and Neighborhood Predictors of Residential Mobility Among Participants in the National Spinal Cord Injury Model Systems Database. Arch Phys Med Rehabil 2021; 103:822-831. [PMID: 34004163 DOI: 10.1016/j.apmr.2021.03.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 03/11/2021] [Accepted: 03/19/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To investigate residential mobility among community-living adults with spinal cord injury (SCI) and the individual, health, and neighborhood factors associated with the propensity to relocate. DESIGN Retrospective analysis of data from the National SCI Model Systems (SCIMS) Database collected between 2006 and 2018 and linked with the American Community Survey 5-year estimates. SETTING Community. INTERVENTIONS Not applicable. PARTICIPANTS People with traumatic SCI (N=4599) who participated in 2 waves of follow-up and had residential geographic identifiers at the census tract level. MAIN OUTCOME MEASURES Moving was a binary measure reflecting change in residential locations over a 5-year interval. Move distance distinguished nonmovers from local movers (different tracts within the same county) and long-distance movers (to different county or state). Move quality included 4 categories: stayed/low poverty tract, stayed/high poverty tract, moved/low poverty tract, and moved/high poverty tract. RESULTS One in 4 people moved within a 5-year interval (n=1175). Of the movers, 55% relocated to a different census tract within the same county and 45% relocated to a different county or state. Thirty-five percent of all movers relocated to a high poverty census tract. Racial and ethnic minorities, people from low-income households, and younger adults were more likely to move, move locally, and relocate to a high poverty neighborhood. High poverty and racial/ethnic segregation in the origin neighborhood predicted an increased risk for remaining in or moving to a high poverty neighborhood. CONCLUSIONS Although people with SCI relocated at a lower rate than has been reported in the general population, moving was a frequent occurrence postinjury. People from vulnerable groups were more likely to remain in or relocate to socioeconomically disadvantaged neighborhoods, thus increasing the risk for health disparities and poorer long-term outcomes among minorities and people from low-income households. These findings inform policy makers' considerations of housing, health care, and employment initiatives for individuals with SCI and other chronic disabilities.
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Affiliation(s)
- Amanda L Botticello
- Kessler Foundation, West Orange, NJ; Rutgers New Jersey Medical School, Rutgers University, Newark, NJ.
| | - Lauren Murphy
- Kessler Foundation, West Orange, NJ; Rutgers New Jersey Medical School, Rutgers University, Newark, NJ
| | - Jennifer Bogner
- Department of Physical Medicine and Rehabilitation, The Ohio State University, Columbus, OH
| | - Michael Boninger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - Thomas N Bryce
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Yuying Chen
- University of Alabama at Birmingham, Birmingham, AL
| | - Allen W Heinemann
- Shirley Ryan AbilityLab and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Mary Joan Roach
- Case Western Reserve University, Cleveland, OH; MetroHealth System, Cleveland, OH
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Rigot SK, Boninger ML, Ding D, McKernan G, Field-Fote EC, Hoffman J, Hibbs R, Worobey LA. Toward Improving the Prediction of Functional Ambulation After Spinal Cord Injury Though the Inclusion of Limb Accelerations During Sleep and Personal Factors. Arch Phys Med Rehabil 2021; 103:676-687.e6. [PMID: 33839107 DOI: 10.1016/j.apmr.2021.02.029] [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: 10/10/2020] [Revised: 01/21/2021] [Accepted: 02/07/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To determine if functional measures of ambulation can be accurately classified using clinical measures; demographics; personal, psychosocial, and environmental factors; and limb accelerations (LAs) obtained during sleep among individuals with chronic, motor incomplete spinal cord injury (SCI) in an effort to guide future, longitudinal predictions models. DESIGN Cross-sectional, 1-5 days of data collection. SETTING Community-based data collection. PARTICIPANTS Adults with chronic (>1 year), motor incomplete SCI (N=27). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Ambulatory ability based on the 10-m walk test (10MWT) or 6-minute walk test (6MWT) categorized as nonambulatory, household ambulator (0.01-0.44 m/s, 1-204 m), or community ambulator (>0.44 m/s, >204 m). A random forest model classified ambulatory ability using input features including clinical measures of strength, sensation, and spasticity; demographics; personal, psychosocial, and environmental factors including pain, environmental factors, health, social support, self-efficacy, resilience, and sleep quality; and LAs measured during sleep. Machine learning methods were used explicitly to avoid overfitting and minimize the possibility of biased results. RESULTS The combination of LA, clinical, and demographic features resulted in the highest classification accuracies for both functional ambulation outcomes (10MWT=70.4%, 6MWT=81.5%). Adding LAs, personal, psychosocial, and environmental factors, or both increased the accuracy of classification compared with the clinical/demographic features alone. Clinical measures of strength and sensation (especially knee flexion strength), LA measures of movement smoothness, and presence of pain and comorbidities were among the most important features selected for the models. CONCLUSIONS The addition of LA and personal, psychosocial, and environmental features increased functional ambulation classification accuracy in a population with incomplete SCI for whom improved prognosis for mobility outcomes is needed. These findings provide support for future longitudinal studies that use LA; personal, psychosocial, and environmental factors; and advanced analyses to improve clinical prediction rules for functional mobility outcomes.
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Affiliation(s)
- Stephanie K Rigot
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
| | - Michael L Boninger
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA; Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Dan Ding
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
| | - Gina McKernan
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
| | - Edelle C Field-Fote
- Crawford Research Institute, Shepherd Center, Atlanta, GA; Division of Physical Therapy, Department of Rehabilitation Medicine, Emory University School of Medicine, Atlanta, GA; Program in Applied Physiology, School of Biological Sciences, Georgia Institute of Technology, Atlanta, GA
| | - Jeanne Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Rachel Hibbs
- Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Physical Therapy, University of Pittsburgh, Pittsburgh, PA
| | - Lynn A Worobey
- Rehab Neural Engineering Labs, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA; Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA; Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA; Physical Therapy, University of Pittsburgh, Pittsburgh, PA.
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Simpson B, Villeneuve M, Clifton S. The experience and perspective of people with spinal cord injury about well-being interventions: a systematic review of qualitative studies. Disabil Rehabil 2020; 44:3349-3363. [PMID: 33377801 DOI: 10.1080/09638288.2020.1864668] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE Promoting well-being is a key aim of rehabilitation. The intentional design of interventions to address well-being requires an understanding of the factors that affect this complex phenomenon. A growing body of qualitative literature has identified determinants that people with SCI report affect their well-being. It is unclear whether or how rehabilitation interventions can influence these well-being determinants. This study sought to explore the experience and perspective of people with SCI about interventions that target their well-being. METHOD Systematic search of seven databases. Deductive analysis to categorize findings related to well-being determinants, and further inductive coding to identify sub-themes, relationships and additional findings. RESULTS Twenty studies were selected, involving a wide range of interventions. Each intervention influenced a number of well-being determinants, which were inter-related. People with SCI reported improvements in both subjective and psychological well-being. However, well-being was not always well defined in the studies and people with SCI reported lack of priority for, and opportunity to engage in, well-being interventions in the current rehabilitation system. CONCLUSIONS Rehabilitation interventions can influence well-being determinants. These determinants form a useful framework for the intentional design of well-being interventions, which should be informed by a broad understanding of well-being.IMPLICATIONS FOR REHABILITATIONWell-being can be influenced by rehabilitation interventions, and a more explicit focus on well-being in intervention design and evaluation is recommended.Conceptual frameworks used to define and measure well-being should adopt a broad understanding of well-being.Well-being interventions should address the determinants identified by people with SCI (engaging in occupation, responsibility, values and perspectives, self-worth, self-continuity, relationships and the environment).People with SCI want a greater priority placed on well-being interventions, and more opportunities to engage in these interventions, especially in the community.
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Affiliation(s)
- Bronwyn Simpson
- Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Shane Clifton
- Centre for Disability Research, The University of Sydney, Sydney, Australia.,Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, Sydney, Australia
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Riedman E, Scott H, Clarke P, Meade M, Forchheimer M, Tate D. "Earth angels" and parking spots: qualitative perspectives on healthy aging with spinal cord injury. Disabil Rehabil 2020; 44:1399-1408. [PMID: 32924639 DOI: 10.1080/09638288.2020.1817987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE People aging with spinal cord injury (SCI) can experience the premature onset of comorbid conditions, as well as the development and progression of secondary health conditions. The aim of this study was to understand the subjective experiences of persons aging with SCI in relation to their surrounding social and physical environments, including the impact of barriers and facilitators.Material/Methods: Eleven individuals who had an SCI for more than ten years and were 45 years or older participated in a semi-structured phone interview about their experiences with healthy aging, social participation, social supports, and community barriers. RESULTS Four main themes emerged in the qualitative data that captured the subjective experience of aging with SCI. These were: (1) Maintaining Physical Independence; (2) Importance of Resources and Special Equipment; (3) Planning Ahead; and (4) Finding Ways to Adapt. CONCLUSIONS The findings from this study highlight the importance of looking beyond individual factors to consider the social and environmental factors that support continued independence and participation in society as people living with long term SCI experience their aging process. Qualitative research that delves further into the dynamics behind this process is needed to fully anticipate the needs of this growing population.IMPLICATIONS FOR REHABILITATIONPeople aging with spinal cord injury (SCI) who are engaged in their social and physical environments have become increasingly adaptive when faced with accelerating and secondary comorbidities.Programs and facilities should ensure universal access to prevention and self-management programs that target physical activity and health habits when considered in the context of a patient's socio-environmental constraints and resources.Clinical healthcare providers need to engage with their patients to develop an early intervention approach to preserve functional capacity while navigating potential future health problems.Clinicians should act as advocates for ongoing policy changes that help promote an environment more inclusive towards people aging with SCI.
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Affiliation(s)
- Elizabeth Riedman
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Haley Scott
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Philippa Clarke
- Institute of Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Michelle Meade
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Martin Forchheimer
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Denise Tate
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
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Clarke P, Twardzik E, Meade MA, Peterson MD, Tate D. Social Participation Among Adults Aging With Long-Term Physical Disability: The Role of Socioenvironmental Factors. J Aging Health 2020; 31:145S-168S. [PMID: 31718412 DOI: 10.1177/0898264318822238] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Objective: This study examined the environmental barriers and facilitators that hinder or promote participation among adults aging with physical disabilities. Method: Data come from an ongoing study of 1,331 individuals aging with long-term physical disability (M = 65 years). Linear regression examined the association between individual and socioenvironmental factors and participation restrictions in work, leisure, and social activities. Results: Pain, fatigue, and physical functional limitations were significant barriers to participation for individuals aging with physical disability. Barriers in the built environment also reduced participation, net of health and functioning. Poor access to buildings was especially problematic for participation among individuals not using any mobility aid to get around. But for those using wheel or walking aids, environmental barriers had no adverse effect on participation. Discussion: These findings highlight the importance of disentangling the role of different environmental factors by distinguishing between assistive technology for mobility and the physical built environment, including their interactive effects.
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Wen H, Botticello AL, Bae S, Heinemann AW, Boninger M, Houlihan BV, Chen Y. Racial and Ethnic Differences in Obesity in People With Spinal Cord Injury: The Effects of Disadvantaged Neighborhood. Arch Phys Med Rehabil 2019; 100:1599-1606. [PMID: 30922881 DOI: 10.1016/j.apmr.2019.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 01/11/2019] [Accepted: 02/15/2019] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To examine the role of neighborhood in the relation between race and obesity in people with spinal cord injury (SCI). DESIGN A cross-sectional analysis of survey data from National SCI Database linked with neighborhood data from American Community Survey by census tract. SETTING A total of 17 SCI Model Systems centers. PARTICIPANTS Individuals (N=3385; 2251 non-Hispanic whites, 760 non-Hispanic blacks, 374 Hispanics) who completed a follow-up assessment during 2006-2017 (mean duration of injury, 8.3±9.9y) and resided in 2934 census tracts. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Body mass index (BMI) (kg/m2). RESULTS The overall prevalence of obesity was 52.9% (BMI≥25.0) and 23.3% (BMI≥30.0). Hispanics were 67.0% more likely to be obese (BMI≥30.0 kg/m2) relative to non-Hispanic whites (odds ratio, 1.67; 95% confidence interval, 1.27-2.18), after controlling for demographic and injury-related characteristics. Most of the non-Hispanic blacks (66.8%) were living in neighborhoods with high concentrated disadvantaged index (CDI), compared to 35.0% of Hispanics and 9.2% of non-Hispanic whites living in this similar neighborhood status (P<.0001). After accounting for CDI, the odds of being obese in Hispanics decreased (odds ratio, 1.51; 95% confidence interval, 1.15-1.99). Regardless of race and ethnicity, people with SCI from disadvantaged neighborhoods were 42.0%-70.0% more likely to be obese than those from minimal CDI neighborhoods. CONCLUSIONS Neighborhood characteristics partially diminish racial differences in obesity. Weight management for the SCI population should target those who are Hispanic and living in the disadvantaged neighborhoods.
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Affiliation(s)
- Huacong Wen
- Department of Physical Therapy, School of Health Professionals, University of Alabama at Birmingham, Birmingham, AL, the United States; Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, the United States
| | - Amanda L Botticello
- Kessler Foundation, West Orange, NJ, the United States; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, the United States
| | - Sejong Bae
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, the United States
| | - Allen W Heinemann
- Shirley Ryan AbilityLab, Chicago, IL, the United States; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, the United States
| | - Mike Boninger
- Departments of Physical Medicine and Rehabilitation, Bioengineering, and Rehabilitation Science and Technology, University of Pittsburgh School of Medicine, Pittsburgh, PA, the United States
| | - Bethlyn Vergo Houlihan
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, the United States; Spaulding Rehabilitation Hospital, Boston, MA, the United States
| | - Yuying Chen
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, AL, the United States.
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Lakhani A, Norwood M, Watling DP, Zeeman H, Kendall E. Using the natural environment to address the psychosocial impact of neurological disability: A systematic review. Health Place 2018; 55:188-201. [PMID: 30583914 DOI: 10.1016/j.healthplace.2018.12.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 08/17/2018] [Accepted: 12/03/2018] [Indexed: 12/15/2022]
Abstract
Engaging with the natural environment contributes to favourable psychosocial health outcomes. A systematic review of research published before June 2017 was conducted to establish how engaging with natural environments impact the psychosocial health of people with a neurological disability. Identified studies included populations with dementia (n=14), brain injury (n=2), and stroke (n=2). Evidence suggests that engaging with gardens, and gardening, can favourably impact the emotional and social health of people with dementia and, an explanatory theoretical model is proposed. Considerable research gaps exist and further research investigating the psychosocial impact of engaging with natural environments for people with different neurological conditions (for example spinal cord injury or stroke) is warranted.
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Affiliation(s)
- Ali Lakhani
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia.
| | - Michael Norwood
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia
| | - David P Watling
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia
| | - Heidi Zeeman
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia
| | - Elizabeth Kendall
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, University Drive, Meadowbrook, Queensland 4131, Australia
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Silveira SL, Ledoux TA, Johnston CA, Kalpakjian C, O'Connor DP, Cottingham M, McGrath R, Tate D. Well on wheels intervention: Satisfaction with life and health for adults with spinal cord injuries. J Spinal Cord Med 2018; 43:60-68. [PMID: 30557093 PMCID: PMC7006815 DOI: 10.1080/10790268.2018.1554333] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Objective/Background: To examine how demographic and injury characteristics identify satisfaction with life (SWL), and assess the differential effects of a wellness intervention by baseline SWL groups.Design: Baseline and longitudinal analysis of a randomized controlled pilot intervention using decision tree regression and linear mixed models.Setting: Community based.Participants: Seventy-two individuals with spinal cord injury (SCI) were randomized to an intervention group (n = 39) or control group (n = 33). Participants were aged 44.1 ± 13.0 years and 13.1 ± 10.6 years post-injury. Most participants were male (n = 50; 69.4%) and had paraplegia (n = 38; 52.7%). Participants were classified as high versus low SWL at baseline using a cutoff score of 20.Interventions: The intervention aimed to increase self-efficacy, and in turn, increase engagement in health-promoting behaviors related to SWL. Six 4-hour in-person workshops were conducted over a 3-month period led by experts and peer-mentors who were available for support.Outcome measure(s): Self-efficacy for health practices, secondary condition severity, health-promoting behaviors, perceived stress, and SWL.Results: At baseline, participants with low SWL were recently injured (<4.5 years), while persons with high SWL were married and younger (<49 years old). Intervention participants with low SWL at baseline significantly improved SWL over time compared to those with high SWL (P = 0.02).Conclusion: Certain injury and demographic characteristics were associated with SWL, and intervention participants with low SWL at baseline improved their SWL over 2 years. Healthcare providers should consider time post-injury, marital status, and age in identifying individuals at risk for low SWL that may benefit from wellness interventions.
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Affiliation(s)
- Stephanie L. Silveira
- Department of Health and Human Performance, University of Houston, Houston, Texas, USA,Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, Alabama, USA,Correspondence to: Stephanie L. Silveira, Department of Physical Therapy, University of Alabama at Birmingham, 1720 2nd Avenue South, SHPB 360X, Birmingham, Alabama 35294-1212, USA; Ph: 205-975-9321.
| | - Tracey A. Ledoux
- Department of Health and Human Performance, University of Houston, Houston, Texas, USA
| | - Craig A. Johnston
- Department of Health and Human Performance, University of Houston, Houston, Texas, USA
| | - Claire Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Daniel P. O'Connor
- Department of Health and Human Performance, University of Houston, Houston, Texas, USA
| | - Michael Cottingham
- Department of Health and Human Performance, University of Houston, Houston, Texas, USA
| | - Ryan McGrath
- Department of Health, Nutrition, and Exercise Sciences, North Dakota State University, Fargo, North Dakota, USA
| | - Denise Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
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Depressive mood in individuals with spinal cord injury (SCI) living in Greece. Spinal Cord 2018; 56:883-889. [PMID: 29581518 DOI: 10.1038/s41393-018-0093-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/27/2018] [Accepted: 03/01/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To provide data on depressive symptoms rates in the Greek SCI population and to investigate their association with demographic and clinical variables. SETTING Greek territory. METHODS One hundred and sixty-four individuals with SCI living in the community for at least 1 year after the completion of the primary inpatient rehabilitation program were included in the study. Our group of participants were enrolled from multiple rehabilitation centers throughout Greece and were evaluated for probable depression according to the Patient Health Questionnaire (PHQ-9). Univariable and multiple linear regression analyses were performed to assess the possible association of risk factors with the occurrence of depression. We had also examined the correlation between PHQ-9 and scales measuring social reintegration (Craig Handicap Assessment and Reporting Technique (CHART)), quality of life (World Health Organization Quality of Life BREF (WHOQOL-BREF)), and independence (Spinal Cord Independence Measure (SCIM)). RESULTS It was found that 18.2% of the sample had probable depression. The mean (SD) PHQ-9 score was 5.7 (4.9). The multiple linear regression analysis showed that high pain scores (P = 0.001) and suffering from both nociceptive and neuropathic pain (P = 0.005) were associated with depressive mood, while pressure ulcers had a significant effect (P = 0.049) only in the univariable analysis. Participant's PHQ-9 scores had also a negative correlation with almost all CHART, WHOQOL-BREF, and SCIM subscales' scores. CONCLUSIONS This study documents relatively low rates of probable depression among individuals with SCI in Greece. Severe pain and pressure ulcers were the main identified predictors of depressive mood.
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Gecht J, Mainz V, Boecker M, Clusmann H, Geiger MF, Tingart M, Quack V, Gauggel S, Heinemann AW, Müller CA. Development of a short scale for assessing economic environmental aspects in patients with spinal diseases using Rasch analysis. Health Qual Life Outcomes 2017; 15:196. [PMID: 29017570 PMCID: PMC5634831 DOI: 10.1186/s12955-017-0767-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 09/26/2017] [Indexed: 11/17/2022] Open
Abstract
Background Economic environmental factors represent important barriers to participation and have deleterious effects on quality of life (QOL) in persons with spinal diseases (SpD). While economic factors are anchored in the International Classification of Functioning, Disability and Health, their influence on QOL and participation from patients’ perspectives is an infrequent focus of research. The aim of the present research is to calibrate a culturally adapted Rasch-based questionnaire assessing economic QOL in patients with SpD. Methods The 11-items of the German economic-QOL-scale were answered by 325 patients with SpD on a four-point Likert-scale. Fit to the Rasch measurement model was investigated by testing for stochastic ordering of the items, unidimensionality, local independence, and differential item functioning (DIF). Results After adjusting for local dependency, fit to the Rasch model was achieved with a non-significant item-trait interaction (chi-squaredf = 20 = 34.8, p = 0.021). The person separation reliability equaled 0.88, the scale was free from age- or gender-related DIF, and unidimensionality could be verified. Conclusions The Rasch-based German version of the economic-QOL-scale represents a suitable instrument to investigate the influences of economic factors on patients’ QOL at a group and individual level. It can be easily applied in research and practice and may be administered quickly in combination with other instruments. The short test duration implies a low test burden for patients and a minimum of time expenditure by clinicians when evaluating the results.
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Affiliation(s)
- Judith Gecht
- Department of Medical Psychology and Medical Sociology, RWTH Aachen University, Pauwelsstr. 19, 52074, Aachen, Germany
| | - Verena Mainz
- Department of Medical Psychology and Medical Sociology, RWTH Aachen University, Pauwelsstr. 19, 52074, Aachen, Germany.
| | - Maren Boecker
- Department of Medical Psychology and Medical Sociology, RWTH Aachen University, Pauwelsstr. 19, 52074, Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | | | - Markus Tingart
- Department of Orthopedic Surgery, RWTH Aachen University, Aachen, Germany
| | - Valentin Quack
- Department of Orthopedic Surgery, RWTH Aachen University, Aachen, Germany
| | - Siegfried Gauggel
- Department of Medical Psychology and Medical Sociology, RWTH Aachen University, Pauwelsstr. 19, 52074, Aachen, Germany
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL, USA
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Frier A, Barnett F, Devine S, Barker R. Understanding disability and the 'social determinants of health': how does disability affect peoples' social determinants of health? Disabil Rehabil 2016; 40:538-547. [PMID: 27927028 DOI: 10.1080/09638288.2016.1258090] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to investigate how an individual's social determinants of health are affected by the acquisition of physical disability in adulthood. The secondary aim was to report the described facilitators and barriers to living with a disability. METHOD This qualitative study used an exploratory, descriptive approach. Nine individuals with a neurologically derived disability were purposively recruited from a rehabilitation center in northern Queensland. Participation in the study involved semi-structured interviews. QSR NVivo was used for the data analysis process. RESULTS Changes to social determinants of health resulting from the acquisition of disability had substantial flow-on consequences in all aspects of life for the individual and those close to them. Income had the greatest influence over the other social determinant of health. Following the acquisition of disability, the reduced inflow and increased outflow of finances had subsequent negative effects on housing, transport and social interactions, and also personal relationships. CONCLUSIONS When considering changes to the social determinants of health resulting from disability acquisition, it is impractical to view these changes and those affected in isolation. Consideration of this multidimensional effect on life associated with the acquisition of disability will be useful in disability research, advocacy and support services. Implications for Rehabilitation Social determinants of health are known to have a direct influence on health status. As social determinants of health decrease, morbidity and mortality rates increase. Following the acquisition of disability, there is a decline in social determinants of health. This decline affects quality of life for individuals' with a disability, and those closest to them. The effects of declining social determinants of health may inhibit the rehabilitation process. Thus, it is important to acknowledge the multifaceted impact the acquisition of disability has on peoples' lives, and the consequences this may have for their rehabilitation.
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Affiliation(s)
- Amanda Frier
- a College of Public Health, Medical and Veterinary Sciences , James Cook University , Townsville , Australia
| | - Fiona Barnett
- b College of Healthcare Sciences , James Cook University , Townsville , Australia
| | - Sue Devine
- a College of Public Health, Medical and Veterinary Sciences , James Cook University , Townsville , Australia
| | - Ruth Barker
- c College of Healthcare Sciences , James Cook University , Cairns , Australia
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Machado WCA, Silva VMD, Silva RAD, Ramos RL, Figueiredo NMAD, Branco EMDSC, Rezende LK, Carreiro MDA. Hospital discharge of patients with disabling neurological injury: necessary referrals to rehabilitation. CIENCIA & SAUDE COLETIVA 2016; 21:3161-3170. [PMID: 27783789 DOI: 10.1590/1413-812320152110.17232016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 06/27/2016] [Indexed: 11/22/2022] Open
Abstract
The present qualitative study was conducted in the second semester of 2014 via interviews with 12 doctors and 13 nurses working as managers at a large hospital that serves as a reference center for urgent and emergent care in the Zona da Mata region of Minas Gerais State, Brazil. The study sought to identify the criteria that doctors and nurses use to discharge individuals with disabling neurological injury with instructions related to accessing physical rehabilitation programs. Thematic content analysis was used to examine data. The results show that the participating hospital managers still have difficulties providing adequate referrals to specialized rehabilitation services and that their patients' autonomy and independence for self-care are impaired as a result. We concluded that in addition to involving relatives and other caregivers in the discharge of patients with a neurological injury that impairs their self-care abilities, managers should assess the accessibility of the patient's home and make adequate referrals to rehabilitation services in the community in light of the poor dispersal of information about what is available within the Care for People with Disability Network.
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Affiliation(s)
- Wiliam César Alves Machado
- Escola de Enfermagem Alfredo Pinto, Centro de Ciências Biológicas e da Saúde, Universidade Federal do Estado do Rio de Janeiro. R. Doutor Xavier Sigaud, Urca. 22290-180 Rio de Janeiro RJ Brasil.
| | - Vera Maria da Silva
- Escola de Enfermagem Alfredo Pinto, Centro de Ciências Biológicas e da Saúde, Universidade Federal do Estado do Rio de Janeiro. R. Doutor Xavier Sigaud, Urca. 22290-180 Rio de Janeiro RJ Brasil.
| | - Rafael André da Silva
- Escola de Enfermagem Alfredo Pinto, Centro de Ciências Biológicas e da Saúde, Universidade Federal do Estado do Rio de Janeiro. R. Doutor Xavier Sigaud, Urca. 22290-180 Rio de Janeiro RJ Brasil.
| | | | - Nébia Maria Almeida de Figueiredo
- Escola de Enfermagem Alfredo Pinto, Centro de Ciências Biológicas e da Saúde, Universidade Federal do Estado do Rio de Janeiro. R. Doutor Xavier Sigaud, Urca. 22290-180 Rio de Janeiro RJ Brasil.
| | | | - Luciana Krauss Rezende
- Escola de Enfermagem Aurora Afonso Costa, Universidade Federal Fluminense. Niterói RJ Brasil
| | - Mônica de Almeida Carreiro
- Escola de Enfermagem Alfredo Pinto, Centro de Ciências Biológicas e da Saúde, Universidade Federal do Estado do Rio de Janeiro. R. Doutor Xavier Sigaud, Urca. 22290-180 Rio de Janeiro RJ Brasil.
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Botticello AL, Boninger M, Charlifue S, Chen Y, Fyffe D, Heinemann A, Hoffman JM, Jette A, Kalpakjian C, Rohrbach T. To What Extent Do Neighborhood Differences Mediate Racial Disparities in Participation After Spinal Cord Injury? Arch Phys Med Rehabil 2016; 97:1735-44. [DOI: 10.1016/j.apmr.2016.04.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Revised: 04/05/2016] [Accepted: 04/10/2016] [Indexed: 10/21/2022]
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Frier A, Barnett F, Devine S. The relationship between social determinants of health, and rehabilitation of neurological conditions: a systematic literature review. Disabil Rehabil 2016; 39:941-948. [DOI: 10.3109/09638288.2016.1172672] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Amanda Frier
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
| | - Fiona Barnett
- College of Healthcare Sciences, James Cook University, Townsville, Australia
| | - Sue Devine
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Australia
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Botticello AL, Rohrbach T, Cobbold N. Differences in the Community Built Environment Influence Poor Perceived Health Among Persons With Spinal Cord Injury. Arch Phys Med Rehabil 2015; 96:1583-90. [PMID: 25998221 PMCID: PMC4554841 DOI: 10.1016/j.apmr.2015.04.025] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 04/30/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To assess the association between characteristics of the built environment and differences in perceived health among persons with spinal cord injury (SCI) using objective measures of the local community derived from Geographic Information Systems data. DESIGN Secondary analysis of cross-sectional survey data. SETTING Community. PARTICIPANTS Persons with chronic SCI enrolled in the Spinal Cord Injury Model Systems database (N=503). All cases were residents of New Jersey, completed an interview during the years 2000 through 2012, had a complete residential address, and were community living at the time of follow-up. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Perceived health. RESULTS Bivariate tests indicated that persons with SCI residing in communities with more (vs less) mixed land use and small (vs large) amounts of open space were more likely to report poor perceived health. No associations were found between perceived health and differences in the residential or destination density of the community. Adjusting for variation in demographic, impairment, quality of life, and community socioeconomic characteristics accounted for the gap in the odds of reporting poor health between persons living in areas with large versus small amounts of open space (odds ratio [OR], 0.54; 95% confidence interval [CI], 0.28-1.02). However, even after accounting for individual background differences, persons living in communities characterized by more heterogeneous land use were twice as likely to report poor health compared with persons living in less mixed areas (OR, 2.14; 95% CI, 1.12-4.08). CONCLUSIONS Differences in the built characteristics of communities may be important to the long-term health and well-being of persons with SCI who may have greater exposure to the features of their local area because of limited mobility. The results of this study suggest living in a community with more heterogeneous land use was not beneficial to the perceived health of persons with chronic SCI living in New Jersey. Further investigation is needed to assess if the relationships observed in this analysis are influenced by differences in infrastructure and resources across communities. Further research is also needed to investigate the role built environment plays in the long-term health and well-being of persons with SCI in other geographic locales.
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Affiliation(s)
- Amanda L Botticello
- Spinal Cord Injury and Outcomes and Assessment Research, Kessler Foundation, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ.
| | - Tanya Rohrbach
- Department of Science and Engineering, Raritan Valley Community College, Branchburg, NJ
| | - Nicolette Cobbold
- Quantitative Methods Division, Penn Graduate School of Education, Philadelphia, PA
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Botticello AL, Rohrbach T, Cobbold N. Disability and the built environment: an investigation of community and neighborhood land uses and participation for physically impaired adults. Ann Epidemiol 2014; 24:545-50. [PMID: 24935467 DOI: 10.1016/j.annepidem.2014.05.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 04/21/2014] [Accepted: 05/06/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE There is a need for empirical support of the association between the built environment and disability-related outcomes. This study explores the associations between community and neighborhood land uses and community participation among adults with acquired physical disability. METHODS Cross-sectional data from 508 community-living chronically disabled adults in New Jersey were obtained from among participants in national Spinal Cord Injury Model Systems database. Participants' residential addresses were geocoded to link individual survey data with Geographic Information Systems data on land use and destinations. The influence of residential density, land use mix, destination counts, and open space on four domains of participation were modeled at two geographic scales-the neighborhood (i.e., half mile buffer) and community (i.e., five mile) using multivariate logistic regression. All analyses were adjusted for demographic- and impairment-related differences. RESULTS Living in communities with greater land use mix and more destinations was associated with a decreased likelihood of reporting optimum social and physical activity. Conversely, living in neighborhoods with large portions of open space was positively associated with the likelihood of reporting full physical, occupational, and social participation. CONCLUSIONS These findings suggest that the overall living conditions of the built environment may be relevant to social inclusion for persons with physical disabilities.
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Affiliation(s)
- Amanda L Botticello
- Outcomes and Assessment Department, Kessler Foundation Research Center, West Orange, NJ; Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark.
| | - Tanya Rohrbach
- Department of Science and Engineering, Raritan Valley Community College, Branchburg, NJ
| | - Nicolette Cobbold
- Outcomes and Assessment Department, Kessler Foundation Research Center, West Orange, NJ
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Maldonado Bouchard S, Hook MA. Psychological stress as a modulator of functional recovery following spinal cord injury. Front Neurol 2014; 5:44. [PMID: 24782818 PMCID: PMC3988397 DOI: 10.3389/fneur.2014.00044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Accepted: 03/23/2014] [Indexed: 12/28/2022] Open
Abstract
There is strong evidence indicating that the social environment triggers changes to the psychological stress response and glucocorticoid receptor function. Considerable literature links the subsequent changes in stress resiliency to physical health. Here, converging evidence for the modulatory role of chronic psychological stress in the recovery process following spinal cord injury (SCI) is presented. Despite the considerable advances in SCI research, we are still unable to identify the causes of variability in patients' recovery following injury. We propose that individuals' past and present life experiences (in the form of stress exposure) may significantly modulate patients' outcome post-SCI. We propose a theoretical model to explain the negative impact of chronic psychological stress on physical and psychological recovery. The stress experienced in life prior to SCI and also as a result of the traumatic injury, could compromise glucocorticoid receptor sensitivity and function, and contribute to high levels of inflammation and apoptosis post-SCI, decreasing the tissue remaining at the injury site and undermining recovery of function. Both stress-induced glucocorticoid resistance and stress-induced epigenetic changes to the glucocorticoid receptor can modulate the nuclear factor-kappa B regulated inflammatory pathways and the Bcl-2 regulated apoptosis pathways. This model not only contributes to the theoretical understanding of the recovery process following injury, but also provides concrete testable hypotheses for future studies.
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Affiliation(s)
- Sioui Maldonado Bouchard
- Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center, Texas A&M Institute for Neuroscience, College of Medicine , College Station, TX , USA
| | - Michelle A Hook
- Department of Neuroscience and Experimental Therapeutics, Texas A&M Health Science Center, Texas A&M Institute for Neuroscience, College of Medicine , College Station, TX , USA
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Fekete C, Wahrendorf M, Reinhardt JD, Post MWM, Siegrist J. Work stress and quality of life in persons with disabilities from four European countries: the case of spinal cord injury. Qual Life Res 2014; 23:1661-71. [PMID: 24384737 DOI: 10.1007/s11136-013-0610-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND Evidence on the adverse effects of work stress on quality of life (QoL) is largely derived from general populations, while respective information is lacking for people with disabilities. We investigated associations between work stress and QoL and the potentially moderating role of socioeconomic circumstances in employed persons with spinal cord injury (SCI). METHODS Cross-sectional data from 386 employed men and women with SCI (≥18 work h/week) from the Netherlands, Switzerland, Denmark, and Norway were analyzed. Work stress was assessed with the 'effort-reward imbalance' (ERI) model and the control component of the 'demand/control' model. QoL was operationalized with five WHOQoL BREF items. Socioeconomic circumstances were measured by years of formal education and perception of financial hardship. We applied ordinal and linear regressions to predict QoL and introduced interaction terms to assess a potential moderation of socioeconomic circumstances. RESULTS Multivariate analyses showed consistent associations between increased ERI and decreased overall QoL (coefficient -1.55, p < 0.001), domain-specific life satisfaction (health -1.32, p < 0.001; activities of daily living -1.28, p < 0.001; relationships -0.84, p = 0.004; living conditions -1.05, p < 0.001), and the QoL sum score (-2.40, p < 0.001). Low job control was linked to decreased general QoL (0.13, p = 0.015), satisfaction with relationships (0.15, p = 0.004), and QoL sum score (0.15, p = 0.029). None of the tested interaction terms were significant. CONCLUSION ERI was consistently related to all indicators of QoL, while associations with job control were less consistent. Our results do not support the notion that unfavorable socioeconomic circumstances moderate the association between work stress and QoL among persons with SCI.
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Pyatak EA, Blanche EI, Garber SL, Diaz J, Blanchard J, Florindez L, Clark FA. Conducting intervention research among underserved populations: lessons learned and recommendations for researchers. Arch Phys Med Rehabil 2012; 94:1190-8. [PMID: 23262157 DOI: 10.1016/j.apmr.2012.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 11/15/2012] [Accepted: 12/05/2012] [Indexed: 11/17/2022]
Abstract
Randomized controlled trials (RCTs) are considered the criterion standard in research design for establishing treatment efficacy. However, the rigorous and highly controlled conditions of RCTs can be difficult to attain when conducting research among individuals living with a confluence of disability, low socioeconomic status, and being a member of a racial/ethnic minority group, who may be more likely to have unstable life circumstances. Research on effective interventions for these groups is urgently needed, because evidence regarding approaches to reduce health disparities and improve health outcomes is lacking. In this methodologic article, we discuss the challenges and lessons learned in implementing the Lifestyle Redesign for Pressure Ulcer Prevention in Spinal Cord Injury study among a highly disadvantaged population. These issues are discussed in terms of strategies to enhance recruitment, retention, and intervention relevance to the target population. Recommendations for researchers seeking to conduct RCTs among socioeconomically disadvantaged, ethnically diverse populations are provided.
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Affiliation(s)
- Elizabeth A Pyatak
- Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA.
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Botticello AL, Chen Y, Tulsky DS. Geographic variation in participation for physically disabled adults: the contribution of area economic factors to employment after spinal cord injury. Soc Sci Med 2012; 75:1505-13. [PMID: 22818491 PMCID: PMC3416922 DOI: 10.1016/j.socscimed.2012.06.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 05/09/2012] [Accepted: 06/22/2012] [Indexed: 10/28/2022]
Abstract
This study investigates the role of area economic characteristics in predicting employment-a key aspect of social participation for adults with physical disabilities-using data from a national registry of persons with spinal cord injury (SCI). SCI results in chronic impairment and most commonly occurs during young adulthood when working is a key aspect of the adult social role. Geocoded data were collected from two of the 14 SCI Model Systems (SCIMS) centers involved in the National SCIMS database and used to link individual-level data with area-level measures extracted from the 2000 US Census. The analysis included participants of working-age (18-64 years) and living in the community (N=1013). Hierarchical generalized linear modeling was used to estimate area-level variation in participation and the relative contribution of area-level economic indicators, adjusted for individual-level health, functioning, and background characteristics. The likelihood of employment for adults with SCI varied by area and was associated with area SES and urbanicity, but not area unemployment. These findings suggest that variation in area economic conditions may affect the feasibility of employment for persons who experience chronic physical disability during adulthood, thus limiting full participation in society.
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Shim RS, Ye J, Baltrus P, Fry-Johnson Y, Daniels E, Rust G. Racial/ethnic disparities, social support, and depression: examining a social determinant of mental health. Ethn Dis 2012; 22:15-20. [PMID: 22774304 PMCID: PMC4039297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023] Open
Abstract
OBJECTIVE We examined the risk of depression as it relates to social support among individuals from African American, Caribbean black, and non-Hispanic White backgrounds. METHODS 6,082 individuals participated in the national survey of American life (NSAL), a nationally representative, psychiatric epidemiological, cross-sectional survey of household populations. The survey is designed to explore racial and ethnic differences in mental disorders. NSAL survey questions were used as a proxy for social support. Logistic regression analysis was used to examine the correlates between having a DSM-IV diagnosis of major depressive disorder in the past year, demographic variables, and social support. RESULTS African American race/ethnicity was associated with decreased odds of depression when compared to non-Hispanic whites, even when controlling for social support variables and demographics (OR = 0.51, 95% CI = 0.43-0.60). We found a three-fold increase in risk of depression among individuals who reported feeling "not very close at all" with family members compared to those who reported feeling "very close" to family (OR = 3.35, 95% CI = 1.81-6.19). CONCLUSIONS These findings reinforce previous research documenting the important relationship between social support and depression, and perhaps should lead us to reexamine the individualistic models of treatment that are most evaluated in United States. The lack of evidence-based data on support groups, peer counseling, family therapy, or other social support interventions may reflect a majority-culture bias toward individualism, which belies the extensive body of research on social support deficits as a major risk factor for depression.
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Affiliation(s)
- Ruth S Shim
- National Center for Primary Care, Morehouse School of Medicine, Atlanta, Georgia, USA.
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Chen Y. COMMENTARY. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2011. [DOI: 10.12968/ijtr.2011.18.10.556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Yuying Chen
- Department of Physical Medicine and Rehabilitation University of Alabama at Birmingham Alabama, USA
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Current research outcomes from the spinal cord injury model systems. Arch Phys Med Rehabil 2011; 92:329-31. [PMID: 21353816 DOI: 10.1016/j.apmr.2010.12.011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Accepted: 12/06/2010] [Indexed: 11/21/2022]
Abstract
This article serves as an introduction to this issue of the Archives of Physical Medicine and Rehabilitation that is devoted to current research findings of the Spinal Cord Injury Model Systems (SCIMS) program. The SCIMS program began in 1970, with funding from the National Institute on Disability and Rehabilitation Research in the U.S. Department of Education, to demonstrate a comprehensive care system for spinal cord injury (SCI) and also to conduct research to improve the health and quality of life of persons with SCI. Over the last 20 years, similar collaborative efforts for the dissemination of SCIMS research outcomes have produced conference proceedings in 1990, a book in 1995, and dedicated journal issues in 1999 and 2004. The collection of 24 articles in this issue shows the depth and breadth of work being carried out by the SCIMS investigators, from descriptive epidemiology to a randomized controlled trial, from neurologic recovery to community reintegration, and from health services utilization to assistive technology for mobility. Herein, we provide a brief overview of the SCIMS program, highlight the research initiatives currently underway, and describe the important findings of the original research articles contained in this issue.
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Fyffe DC, Botticello AL, Myaskovsky L. Vulnerable Groups Living with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2011; 17:1-9. [PMID: 23966760 PMCID: PMC3746335 DOI: 10.1310/sci1702-01] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
There is considerable variation in rehabilitation outcomes within the population of spinal cord-injured individuals across racial and socioeconomic groups. This suggests that the long-term health following spinal cord injury (SCI) is determined, at least in part, by group differences in exposure to advantages and disadvantages among persons living in the community. This article conceptualizes the nature of vulnerability and how increased vulnerability leads to disparities in SCI outcomes. Demographic, socioeconomic, and geographic determinants of adverse outcomes among vulnerable groups are discussed. Finally, a research model that outlines potential processes that elicit vulnerability following SCI and clinical implications is reviewed.
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Affiliation(s)
- Denise C Fyffe
- Kessler Foundation Research Center, West Orange, New Jersey ; University of Medicine and Dentistry of New Jersey - New Jersey Medical School, Newark, New Jersey
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