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Cao Y, DiPiro N, Krause JS. Association of Secondary Health Conditions With Future Chronic Health Conditions Among Persons With Traumatic Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 26:283-289. [PMID: 33536734 DOI: 10.46292/sci20-00020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Secondary health conditions (SHC) are physical and mental health conditions that are causally related to disabilities. Studies have found that SHC increase risk of negative health outcomes among people with traumatic spinal cord injury (TSCI). However, little has been done to assess the association of SHC with the risk of chronic health conditions (CHC) after TSCI. Objectives To identify the prevalence of CHC in adults with TSCI, changes in CHC at follow-up, and the associations of baseline SHC with future CHC. Methods Participants included 501 adults with TSCI of at least 1-year duration, identified through a population-based surveillance system. Baseline and follow-up self-report assessments were completed. We measured seven SHC: fatigue, spasticity, pain, pressure ulcers, subsequent injury, fracture, and anxiety disorder, and measured seven CHC: diabetes, heart attack, coronary artery disease, stroke, cancer, hypertension, and high blood cholesterol. Control variables included gender, race/ethnicity, age at injury, years post injury, injury severity, smoking status, binge drinking, and taking prescription medication. We implemented a Poisson regression model for the multivariate analyses. Results The total number of CHC, the percentage of participants having at least one CHC, and prevalence of three individual CHC (diabetes, cancer, and high cholesterol) increased from baseline to follow-up. After controlling for demographic, injury characteristics, and behavioral factors, pain interference and anxiety disorder at baseline were associated with the total number of CHC at follow-up. Conclusion CHC are common among adults with TSCI and increase significantly over time. Pain and anxiety disorders appear to be risk factors for future CHC.
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Affiliation(s)
- Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Nicole DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
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Cao Y, DiPiro ND, Brotherton SS, Krause JS. Assistive devices and future fall-related injuries among ambulatory adults with spinal cord injury: a prospective cohort study. Spinal Cord 2020; 59:747-752. [PMID: 33130822 DOI: 10.1038/s41393-020-00572-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 10/19/2020] [Accepted: 10/21/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective cohort study with two times of measurement. OBJECTIVE To assess the relationship between use of assistive devices for walking (at baseline) and the number of annual fall-related injuries (at follow-up) among a cohort of ambulatory adults with spinal cord injury (SCI). SETTING Medical University in the Southeastern United States. METHODS There were 622 ambulatory adults who met the eligibility criteria, 317 of whom completed both baseline and follow-up assessments. The participants completed a mailed self-report assessment (SRA) that measured self-reported number of fall-related injuries in the previous year, and the use of orthopedic equipment (assistive devices) for walking, including cane(s), crutches, walker, and braces, was assessed at both baseline and follow-up. RESULTS The percentage of at least one self-reported fall-related injury decreased from 22% at baseline to 13% at the follow-up. Walker and cane use at baseline was significantly associated with fall-related injuries at follow-up. Participants using one walking device related to 194% greater number of fall injures, and using multiple device related to 730% greater number of fall injures than those who used no devices. We also found walker users were associated with 214% greater number of fall injures, while cane users were associated with 160% greater number of fall injures. CONCLUSIONS The probability of fall-related injury remained high among persons who are ambulatory after SCI. Health care professionals should be aware of the balance between the goal of ambulation and the potential increased risk of fall-related injuries associated with assistive device use.
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Affiliation(s)
- Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
| | - Nicole D DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - Sandra S Brotherton
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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Respiratory complications during initial rehabilitation and survival following spinal cord injury in Sweden: a retrospective study. Spinal Cord 2020; 59:659-664. [PMID: 32963363 PMCID: PMC7508239 DOI: 10.1038/s41393-020-00549-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/26/2020] [Accepted: 09/01/2020] [Indexed: 11/26/2022]
Abstract
Study design Retrospective study. Objectives To determine prevalence of respiratory complications in individuals with spinal cord injury (SCI) during the initial rehabilitation at the spinal cord injury unit (SCU) and to describe the subsequent effect on mortality. Setting The SCU at the university hospital in Gothenburg, Sweden. Methods We reviewed the medical charts of newly injured persons with SCI who were admitted to the SCU between 1/1/2010 and 12/31/2014. Outcome measures were time to death, length of stay, occurrence of respiratory complications, and the use of breathing aids. Results A total of 136 consecutive individuals were included; 53% with cervical SCI and 20% with lower SCI suffered from one or several respiratory complications during their initial rehabilitation in the SCU. At follow-up, 10/1/2018, 20% of the individuals were deceased. The most common cause of death was related to respiratory insufficiency. The individuals with respiratory complications during the initial rehabilitation in the SCU had particularly shortened survival compared with those without. The relative risk (RR) of dying if the person suffered from any respiratory complications during their initial rehabilitation in the SCU was 2.1 times higher than for those with no respiratory complications (RR, 2.1; 95% CI, 1.1–3.9). Conclusions Having respiratory complications at the SCU provides preliminary data to support the claim that respiratory complications predict premature mortality. Early diagnosis and prophylactic measures seem to be necessary to mitigate the adverse consequences of serious respiratory problems.
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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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Predictors of respiratory complications in patients with C5-T5 spinal cord injuries. Spinal Cord 2020; 58:1249-1254. [PMID: 32581306 PMCID: PMC7312109 DOI: 10.1038/s41393-020-0506-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/08/2022]
Abstract
Study design Retrospective chart audit. Objectives Describing the respiratory complications and their predictive factors in patients with acute traumatic spinal cord injuries at C5–T5 level during the initial hospitalization. Setting Hospital Vall d’Hebron, Barcelona. Methods Data from patients admitted in a reference unit with acute traumatic injuries involving levels C5–T5. Respiratory complications were defined as: acute respiratory failure, respiratory infection, atelectasis, non-hemothorax pleural effusion, pulmonary embolism or haemoptysis. Candidate predictors of these complications were demographic data, comorbidity, smoking, history of respiratory disease, the spinal cord injury characteristics (level and ASIA Impairment Scale) and thoracic trauma. A logistic regression model was created to determine associations between potential predictors and respiratory complications. Results We studied 174 patients with an age of 47.9 (19.7) years, mostly men (87%), with low comorbidity. Coexistent thoracic trauma was found in 24 (19%) patients with cervical and 35 (75%) with thoracic injuries (p < 0.001). Respiratory complications were frequent (53%) and were associated to longer hospital stay: 83.1 (61.3) and 45.3 (28.1) days in patients with and without respiratory complications (p < 0.001). The strongest predictors of respiratory complications were: previous respiratory disease (OR 5.4, 95% CI: 1.5–19.2), complete motor function impairment (AIS A–B) (OR 4.7, 95% CI: 2.4–9.5) and concurrent chest trauma (OR 3.73, 95% CI: 1.8–7.9). Conclusions Respiratory complications are common in traumatic spinal cord injuries between C5–T5. We identified previous respiratory disease, complete motor function impairment and the coexistence of thoracic trauma as predictors of respiratory complications. Identification of patients at risk might help clinicians to implement preventive strategies.
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Estimation of indirect costs based on employment and earnings changes after spinal cord injury: an observational study. Spinal Cord 2020; 58:908-913. [PMID: 32139887 DOI: 10.1038/s41393-020-0447-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 02/19/2020] [Accepted: 02/20/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES (1) Identify changes in employment status and earnings after spinal cord injury (SCI). (2) Estimate annual indirect costs and lifetime indirect costs due to lost earnings for various age and neurologic categories of those with SCI. (3) Compare our estimates with previous research. SETTING Medical university in southeastern United States. METHODS A population-based cohort of 307 participants met eligibility criteria of: (1) residual impairment resulting from traumatic SCI, (2) at least 1 year post injury, (3) between 23 and 64 years old at time of injury, (4) <65 years old at time of measurement, and (5) complete information on injury level, injury completeness, employment status, and earnings before and after injury. Main outcomes were employment status and earnings at the time of injury and post injury. Earnings were adjusted for inflation and the value of fringe benefits. RESULTS Employment rate decreased from 87% at the time of injury to 35% after injury. Average annual indirect costs were $29,354 in 2019 dollars. Lifetime indirect costs for persons injured at age 25 varied by severity of injury, ranging from 0.5 to 2.3 million dollars. Lifetime indirect costs for persons injured at age 50 ranged from 0.3 to 0.6 million dollars. CONCLUSIONS Our estimate of indirect costs is lower than the previously estimated number. However, the higher unemployment rate and decreased earnings after SCI still make a heavy economic burden. With improvements in employment outcomes after SCI, the indirect costs affecting individuals, their families, and society can be further reduced.
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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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Krause JS, Cao Y, DiPiro ND, Cuddy E. Personality, High-Risk Behaviors, and Elevated Risk of Unintentional Deaths Related to Drug Poisoning Among Individuals With Spinal Cord Injury. Arch Phys Med Rehabil 2018; 99:1941-1948. [DOI: 10.1016/j.apmr.2018.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 05/07/2018] [Accepted: 05/09/2018] [Indexed: 12/17/2022]
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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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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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Karapolat H, Akkoç Y, Eyigör S, Tanıgör G. Bladder-related quality of life in people with neurological disorders: reliability and validity of the Turkish version of the King's Health Questionnaire in people with spinal cord injury. Turk J Urol 2018; 44:411-417. [PMID: 29799397 DOI: 10.5152/tud.2018.45556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 01/05/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the validity and reliability of the Turkish version of the King's Health Questionnaire (KHQ) in patients with spinal cord injury (SCI) and to compare the bladder- related quality of life between patients with SCI and multiple sclerosis (MS). MATERIAL AND METHODS Thirty-five patients with SCI and 57 patients with multiple sclerosis (MS) were included in the study. For analysis of test-retest reliability, the Turkish version of the KHQ scale was developed using the back translation method, and it was administered on the day of admission and again one week later. The Qualiveen and SF-36 questionnaires were administered to the patients for validity analysis. Moreover, the results of KHQ that had been administered to 35 patients with SCI were compared with those of 57 patients with MS. RESULTS Both the internal consistency (Cronbach's alpha coefficient: 0.68-0.93) and the test-retest reliability (intraclass correlation coefficient: 0.69-0.94) of the KHQ in patients with SCI were found to be high. Although a weak correlation between the subscales of the KHQ and SF-36, a moderate correlation between the subscales of KHQ, and the Qualiveen questionnaire (0.34<r<0.76, p<0.05) were found. The comparison of patients with SCI and patients with MS in terms of KHQ revealed that patients with SCI had significantly higher scores in some of the subscales of KHQ (p<0.05). These higher scores represented the worst health state, and the uppermost limit was determined as 100 points. CONCLUSION The KHQ scale is an internally consistent, reliable, and valid scale for people with SCI. In addition, bladder-related quality of life was poorer in patients with SCI than in MS patients.
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Affiliation(s)
- Hale Karapolat
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, İzmir, Turkey
| | - Yeşim Akkoç
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, İzmir, Turkey
| | - Sibel Eyigör
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, İzmir, Turkey
| | - Göksel Tanıgör
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, İzmir, Turkey
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Gates TM, Baguley IJ, Simpson GK, Barden HLH, Nott MT. The impact of compensation on late mortality after traumatic brain injury: A multi-centre study. Brain Inj 2017; 31:1044-1049. [PMID: 28481650 DOI: 10.1080/02699052.2017.1298002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To determine the impact of financial compensation on long-term mortality in adults with severe traumatic brain injury (TBI). DESIGN, SETTING AND PARTICIPANTS An inception cohort of 2545 adults consecutively discharged from three metropolitan, post-acute inpatient rehabilitation services of the NSW Brain Injury Rehabilitation Programme from 1 July 1990 to 1 October 2007. MAIN OUTCOME MEASURE Survival status at 1 October 2009. RESULTS Compensation data were available for 1851 (73%) participants, with 826 (45%) receiving financial compensation. Yearly standardized mortality ratios remained elevated above general population norms for six to ten years for both groups. Compensation had a protective effect on mortality risk as a univariate predictor. However, when considered in multivariate Cox regression analysis, compensation had minimal effect on mortality risk when modelled with non-modifiable demographic factors and pre-existing medical history. Conversely, compensation trended towards a protective effect when modelled with post-injury variables. CONCLUSIONS Financial compensation had a protective effect against late mortality following rehabilitation for severe TBI through complex interactions with rehabilitation service variables but not with injury-related variables. This finding suggests that wider access to compensation (and hence rehabilitation) through recently implemented schemes (e.g., NSW Lifetime Care and Support) may further improve life expectancy for this clinical population.
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Affiliation(s)
- Thomas Munro Gates
- a Brain Injury Rehabilitation Service, Westmead Hospital , Westmead , Australia.,b Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research , Liverpool , Australia
| | - Ian James Baguley
- a Brain Injury Rehabilitation Service, Westmead Hospital , Westmead , Australia
| | - Grahame Kenneth Simpson
- b Brain Injury Rehabilitation Research Group, Ingham Institute of Applied Medical Research , Liverpool , Australia
| | | | - Melissa Therese Nott
- a Brain Injury Rehabilitation Service, Westmead Hospital , Westmead , Australia.,c School of Community Health , Charles Sturt University , Albury , Australia
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Galea MP, Panisset MG, El-Ansary D, Dunlop SA, Marshall R, Clark JM, Churilov L, Hurley M, Nunn A, Alexander J, Buchanan J, Nolan S, Atresh S, Pick V, Acland R, Nunnerley J. SCIPA Switch-On: A Randomized Controlled Trial Investigating the Efficacy and Safety of Functional Electrical Stimulation–Assisted Cycling and Passive Cycling Initiated Early After Traumatic Spinal Cord Injury. Neurorehabil Neural Repair 2017; 31:540-551. [DOI: 10.1177/1545968317697035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Background. Substantial skeletal muscle atrophy after spinal cord injury (SCI) carries significant repercussions for functional recovery and longer-term health. Objective. To compare the efficacy, safety, and feasibility of functional electrical stimulation–assisted cycling (FESC) and passive cycling (PC) to attenuate muscle atrophy after acute SCI. Methods. This multicenter, assessor-blinded phase I/II trial randomized participants at 4 weeks post-SCI to FESC or PC (4 sessions per week, 1 hour maximum per session, over 12 weeks). The primary outcome measure was mean maximum cross-sectional area (CSA) of thigh and calf muscles (magnetic resonance imaging), and secondary outcome measures comprised body composition (dual energy X-ray absorptiometry), anthropometry, quality of life, and adverse events (AEs). Results. Of 24 participants, 19 completed the 12-week trial (10 FESC, 9 PC, 18 male). Those participants completed >80% of training sessions (FESC, 83.5%; PC, 85.9%). No significant between-group difference in postintervention muscle CSA was found. No significant between-group difference was found for any other tissue, anthropometric parameter, or behavioral variable or AEs. Six participants experienced thigh hypertrophy (FESC = 3; PC = 3). Atrophy was attenuated (<30%) in 15 cases (FESC = 7; PC = 8). Conclusions. Both cycle ergometry regimens examined were safe, feasible, and well tolerated early after SCI. No conclusions regarding efficacy can be drawn from our data. Further investigation of both modalities early after SCI is required.
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Affiliation(s)
- Mary P. Galea
- The University of Melbourne, Parkville, VIC, Australia
| | | | - Doa El-Ansary
- The University of Melbourne, Parkville, VIC, Australia
| | - Sarah A. Dunlop
- The University of Western Australia, Crawley, Western Australia, Australia
| | - Ruth Marshall
- Hampstead Rehabilitation Centre, Northfield, South Australia, Australia
| | - Jillian M. Clark
- Hampstead Rehabilitation Centre, Northfield, South Australia, Australia
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Yarar-Fisher C, Heyn P, Zanca JM, Charlifue S, Hsieh J, Brienza DM. Early Identification of Cardiovascular Diseases in People With Spinal Cord Injury: Key Information for Primary Care Providers. Arch Phys Med Rehabil 2017; 98:1277-1279. [PMID: 28185637 DOI: 10.1016/j.apmr.2016.10.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/06/2016] [Indexed: 11/25/2022]
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Krause JS, Cao Y, DeVivo MJ, DiPiro ND. Risk and Protective Factors for Cause-Specific Mortality After Spinal Cord Injury. Arch Phys Med Rehabil 2016; 97:1669-78. [PMID: 27449321 DOI: 10.1016/j.apmr.2016.07.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To investigate the association of multiple sets of risk and protective factors (biographic and injury, socioeconomic, health) with cause-specific mortality after spinal cord injury (SCI). DESIGN Retrospective analysis of a prospectively created cohort. SETTING Spinal Cord Injury Model Systems facilities. PARTICIPANTS Adults (N=8157) with traumatic SCI who were enrolled in a model systems facility after 1973 and received follow-up evaluation that included all study covariates (between November 1, 1995 and October 31, 2006). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES All-cause mortality was determined using the Social Security Death Index as of January 1, 2014. Causes of death were obtained from the National Death Index and classified as infective and parasitic diseases, neoplasms, respiratory system diseases, heart and blood vessel diseases, external causes, and other causes. Competing risk analysis, with time-dependent covariates, was performed with hazard ratios (HRs) for each cause of death. RESULTS The HRs for injury severity indicators were highest for deaths due to respiratory system diseases (highest HR for injury level C1-4, 4.84) and infective and parasitic diseases (highest HR for American Spinal Injury Association Impairment Scale grade A, 5.70). In contrast, injury level and American Spinal Injury Association Impairment Scale grade were relatively unrelated to death due to neoplasms and external causes. Of the socioeconomic indicators, education and income were significantly predictive of a number of causes of death. Pressure ulcers were the only 1 of 4 secondary health condition indicators consistently related to cause of death. CONCLUSIONS Injury severity was related to mortality due to infective disease and respiratory complications, suggesting that those with the most severe SCI should be targeted for prevention of these causes. Socioeconomic and health factors were more broadly related to a number of causes of death. Intervention strategies that enhance socioeconomic status and health may also result in reduced mortality due to multiple causes.
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Affiliation(s)
| | - Yue Cao
- Medical University of South Carolina, Charleston, SC
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Callaway L, Barclay L, McDonald R, Farnworth L, Casey J. Secondary health conditions experienced by people with spinal cord injury within community living: implications for a National Disability Insurance Scheme. Aust Occup Ther J 2016; 62:246-54. [PMID: 26256853 DOI: 10.1111/1440-1630.12206] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2015] [Indexed: 11/28/2022]
Abstract
BACKGROUND Australia's National Disability Insurance Scheme (NDIS) provides supports for individuals, delivered through a personalised participant planning process, to influence choice and goal attainment. AIM This study aimed to use both quantitative and qualitative methods to examine the impact of secondary health conditions on the experiences of people with spinal cord injury (SCI) who have returned to community living, in the context of Australia's National Disability Strategy and recently launched NDIS. Exploration of lived experience of health conditions following SCI utilising this mixed methods approach may offer important insights for effective planning within an NDIS. METHODS A cross-sectional survey using the Spinal Cord Injury Secondary Conditions Scale (SCISCS), demographic questionnaire and in-depth interview was undertaken with 33 people with SCI living in the community. Demographic and SCISCS data were reported using descriptive statistics. Interviews were audio-taped, transcribed and analysed thematically. RESULTS Participants were on average 58.5 years of age and 20 years post-injury. Five key themes emerged relating to (i) spasm and pain; (ii) sexual dysfunction; (iii) pressure areas; (iv) fatigue; and (v) the impact of secondary health conditions on life role participation and choice of supports and equipment. CONCLUSION Secondary health conditions can significantly impact occupational participation following SCI. Appropriate intervention, including customised equipment and direct support, if delivered as part of an effective NDIS, may prevent or reduce the severity of these conditions and offer the potential to influence health and participation outcomes of people who have returned to community living.
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Affiliation(s)
- Libby Callaway
- Occupational Therapy Department, Monash University, Frankston, Victoria, Australia
| | - Linda Barclay
- Occupational Therapy Department, Monash University, Frankston, Victoria, Australia
| | - Rachael McDonald
- Occupational Therapy Department, Monash University, Frankston, Victoria, Australia
| | - Louise Farnworth
- Occupational Therapy Department, Monash University, Frankston, Victoria, Australia
| | - Jackie Casey
- Occupational Therapy Department, University of Ulster, Antrim, UK
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Zhang X, Plow E, Ranganthan V, Huang H, Schmitt M, Nemunaitis G, Kelly C, Frost F, Lin V. Functional Magnetic Stimulation of Inspiratory and Expiratory Muscles in Subjects With Tetraplegia. PM R 2016; 8:651-9. [PMID: 26968608 DOI: 10.1016/j.pmrj.2016.01.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Revised: 01/20/2016] [Accepted: 01/28/2016] [Indexed: 12/17/2022]
Abstract
BACKGROUND Respiratory complications are major causes of morbidity and mortality in persons with a spinal cord injury, partly because of respiratory muscle paralysis. Earlier investigation has demonstrated that functional magnetic stimulation (FMS) can be used as a noninvasive technology for activating expiratory muscles, thus producing useful expiratory functions (simulated cough) in subjects with spinal cord injury. OBJECTIVE To evaluate the effectiveness of FMS for conditioning inspiratory and expiratory muscles in persons with tetraplegia. DESIGN A prospective before and after trial. SETTING FMS Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH. PARTICIPANTS Six persons with tetraplegia. METHOD Each subject participated in a 6-week FMS protocol for conditioning the inspiratory and expiratory muscles. A magnetic stimulator was used with the center of a magnetic coil placed at the C7-T1 and T9-T10 spinous processes, respectively. Pulmonary function tests were performed before, during, and after the protocol. MAIN OUTCOME MEASUREMENTS Respiratory variables included maximal inspiratory pressure (MIP), inspiratory reserve volume (IRV), peak inspiratory flow (PIF), maximal expiratory pressure (MEP), expiratory reserve volume (ERV), and peak expiratory flow (PEF). RESULTS After 6 weeks of conditioning, the main outcome measurements (mean ± standard error) were as follows: MIP, 89.6 ± 7.3 cm H2O; IRV, 1.90 ± 0.34 L; PIF, 302.4 ± 36.3 L/min; MEP, 67.4 ± 11.1 cm H2O; ERV, 0.40 ± 0.06 L; and PEF, 372.4 ± 31.9 L/min. These values corresponded to 117%, 107%, 136%, 109%, 130%, and 124% of pre-FMS conditioning values, respectively. Significant improvements were observed in MIP (P = .022), PIF (P = .0001), and PEF (P = .0006), respectively. When FMS was discontinued for 4 weeks, these values showed decreases from their values at the end of the conditioning protocol, which suggests that continual FMS may be necessary to maintain improved respiratory functions. CONCLUSION FMS conditioning of the inspiratory and expiratory muscles improved voluntary inspiratory and expiratory functions. FMS may be a noninvasive technology for respiratory muscle training in persons with tetraplegia.
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Affiliation(s)
- Xiaoming Zhang
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Cleveland, OH(∗)
| | - Ela Plow
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH(†)
| | | | - Honglian Huang
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Cleveland, OH(¶)
| | - Melissa Schmitt
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH(§)
| | | | - Clay Kelly
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH(††)
| | - Frederick Frost
- Cleveland Clinic Lerner College of Medicine, Cleveland, OH(‡‡)
| | - Vernon Lin
- Louis Stokes Cleveland Veterans Affairs Medical Center, Cleveland, OH; Cleveland Clinic Lerner College of Medicine, Cleveland, OH(¶¶).
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Selassie A, Cao Y, Saunders LL. Epidemiology of Traumatic Spinal Cord Injury Among Persons Older Than 21 Years: A Population-Based Study in South Carolina, 1998-2012. Top Spinal Cord Inj Rehabil 2015; 21:333-44. [PMID: 26689698 PMCID: PMC4750818 DOI: 10.1310/sci2104-333] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
BACKGROUND A gap exists in the current knowledge regarding the epidemiology of traumatic spinal cord injury (TSCI) in a statewide population. OBJECTIVE To describe population-based epidemiology and trend of TSCI in persons 22 years and older in South Carolina over a 15-year period from 1998 through 2012. METHODS Data on patients with TSCI were obtained from ongoing statewide TSCI surveillance and follow-up registry. Deaths were ascertained by linking surveillance files and the multiple cause-of-death dataset. Descriptive analyses were completed, and incidence and mortality rates were calculated based on the civilian adult population of the state. RESULTS Over the 15 years, 3,365 persons with incident TSCI were discharged alive from acute care hospitalization, of whom 555 died during the period of observation. Age-standardized cumulative mortality rate was 14 per million, and the average incidence rate was estimated at 70.8 per million population per year. Age-standardized incidence rate of TSCI increased significantly from 66.9 in 1998 to 111.7 per million in 2012. Standardized incidence rates were significantly higher among non-Whites and males. Motor vehicle crashes and falls were the leading causes, accounting for nearly 70% of TSCI. CONCLUSIONS Standardized incidence and mortality rates of TSCI in South Carolina are higher than reported rates for the US population. Motor vehicle crashes and falls are the leading causes of TSCI. There was a significant increase in the overall trend of the incidence rates over the 15 years. A well-coordinated preventive strategy is needed to reduce incidence and improve survival of persons with TSCI.
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Affiliation(s)
- Anbesaw Selassie
- Department of Public Health Sciences, Medical University of South Carolina, Charleston
| | - Yue Cao
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston
| | - Lee L. Saunders
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston
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Selassie A, Cao Y, Saunders LL. Epidemiology of Traumatic Spinal Cord Injury Among Persons Older Than 21 Years: A Population-Based Study in South Carolina, 1998–2012. Top Spinal Cord Inj Rehabil 2015. [DOI: 10.1310/sci2015-313] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Chamberlain JD, Meier S, Mader L, von Groote PM, Brinkhof MWG. Mortality and longevity after a spinal cord injury: systematic review and meta-analysis. Neuroepidemiology 2015; 44:182-98. [PMID: 25997873 DOI: 10.1159/000382079] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Accepted: 03/26/2015] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND/AIMS Mortality and longevity studies of spinal cord injury (SCI) are essential for informing healthcare systems and policies. This review evaluates the current evidence among people with SCIs worldwide in relation to the WHO region and country income level; demographic and lesion characteristics; and in comparison with the general population. METHODS A systematic review of relevant databases for original studies. Pooled estimates were derived using random effects meta-analysis, restricted to traumatic SCI. RESULTS Seventy-four studies were included. In-hospital mortality varied, with pooled estimates of 24.1% (95% confidence interval (CI) 14.1-38.0), 7.6% (95% CI 6.3-9.0), 7.0% (95% CI 1.5-27.4), and 2.1% (95% CI 0.9-5.0) in the WHO regions of Africa, the Americas, Europe and Western Pacific. The combined estimate for low- and middle-income countries was nearly three times higher than for high-income countries. Pooled estimates of first-year survival were 86.5% (95% CI 75.3-93.1), 95.6% (95% CI 81.0-99.1), and 94.0% (95% CI 93.3-94.6) in the Americas, Europe and Western Pacific. Pooled estimates of standardized mortality ratios in tetraplegics were 2.53 (2.00-3.21) and 2.07 (1.47-2.92) in paraplegics. CONCLUSION This study found substantial variation in mortality and longevity within the SCI population, compared to the general population, and between WHO regions and country income level. Improved standardization and quality of reporting is needed to improve inferences regarding the extent to which mortality outcomes following an SCI are related to healthcare systems, services and policies.
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Lieberman J, Goff D, Hammond F, Schreiner P, James Norton H, Dulin M, Zhou X, Steffen L. Dietary intake relative to cardiovascular disease risk factors in individuals with chronic spinal cord injury: a pilot study. Top Spinal Cord Inj Rehabil 2014; 20:127-36. [PMID: 25477735 PMCID: PMC4252172 DOI: 10.1310/sci2002-127] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
BACKGROUND The relationship between cardiovascular disease (CVD) risk factors and dietary intake is unknown among individuals with spinal cord injury (SCI). OBJECTIVE To investigate the relationship between consumption of selected food groups (dairy, whole grains, fruits, vegetables, and meat) and CVD risk factors in individuals with chronic SCI. METHODS A cross-sectional substudy of individuals with SCI to assess CVD risk factors and dietary intake in comparison with age-, gender-, and race-matched able-bodied individuals enrolled in the Coronary Artery Risk Development in Young Adults (CARDIA) study. Dietary history, blood pressure, waist circumference (WC), fasting blood glucose, high-sensitivity C-reactive protein (hs-CRP), lipids, glucose, and insulin data were collected from 100 SCI participants who were 38 to 55 years old with SCI >1 year and compared to 100 matched control participants from the CARDIA study. RESULTS Statistically significant differences between SCI and CARDIA participants were identified in WC (39.2 vs 36.2 in.; P < .001) and high-density lipoprotein cholesterol (HDL-C; 39.2 vs 47.5 mg/dL; P < .001). Blood pressure, total cholesterol, triglycerides, glucose, insulin, and hs-CRP were similar between SCI and CARDIA participants. No significant relation between CVD risk factors and selected food groups was seen in the SCI participants. CONCLUSION SCI participants had adverse WC and HDL-C compared to controls. This study did not identify a relationship between consumption of selected food groups and CVD risk factors.
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Affiliation(s)
- Jesse Lieberman
- Department of Physical Medicine and Rehabilitation, Carolinas Medical Center, Charlotte, North Carolina
| | - David Goff
- Colorado School of Public Health, Denver, Colorado
| | - Flora Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana
| | - Pamela Schreiner
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
| | - H. James Norton
- Department of Biostatistics, Carolinas Medical Center, Charlotte, North Carolina
| | - Michael Dulin
- Department of Family Medicine, Carolinas Medical Center, Charlotte, North Carolina
| | - Xia Zhou
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
| | - Lyn Steffen
- University of Minnesota School of Public Health, Division of Epidemiology and Community Health, Minneapolis, Minnesota
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