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Lafeuillee G, Desai M, Magni F, Knight S. Challenge or opportunity: Rehabilitation outcomes in patients with metastatic spinal cord compression - a UK single center experience. J Spinal Cord Med 2024; 47:432-439. [PMID: 36260004 PMCID: PMC11044739 DOI: 10.1080/10790268.2022.2097997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
CONTEXT /OBJECTIVE Metastatic Spinal Cord Compression (MSCC) is a devastating complication of cancer, affecting approximately 3000 patients per annum in England. However, access to rehabilitation services for MSCC patients is limited. The London Spinal Cord Injury Centre has set up a bespoke MSCC rehabilitation pathway from May 2013. This article aims to describe the clinical features and functional outcomes of patients with MSCC admitted to a Specialist Spinal Cord Injury Rehabilitation Centre between May 2013 and December 2021. DESIGN Retrospective analysis of medical records from a single specialist rehabilitation centre database. SETTING London Spinal Cord Injury Centre (LSCIC), Stanmore, United Kingdom. PARTICIPANTS Adult patients diagnosed with MSCC who were admitted to and discharged from LSCIC from May 2013 to December 2021. INTERVENTIONS Specialist Inpatient Spinal Cord Injury Rehabilitation Program. OUTCOME MEASURES Spinal Cord Independence Measure 19 (SCIM version III), Discharge Destination. RESULTS A total of 40 patients with MSCC were admitted - 32 male and 8 female patients. The average length of stay was 6 weeks. 17(42.5%) patients had primary prostate cancer. Most patients (34(85%)) had thoracic MSCC. There was an improvement in the Spinal Cord Independence Measure in all patients with an average significant improvement from 43.8 to 64.5 (P < 0.001). There was no significant difference in SCIM scores between patients under 65 and over 65. 28 (70%) patients required psychological input. 33(82.5%) patients were discharged home. CONCLUSION Patients with MSCC show improvement in SCIM outcome measures after a six-week inpatient Specialist Spinal Rehabilitation program.
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Affiliation(s)
- Gisele Lafeuillee
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, Stanmore, UK
| | - Manish Desai
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, Stanmore, UK
| | | | - Sarah Knight
- London Spinal Cord Injury Centre, Royal National Orthopaedic Hospital, Stanmore, UK
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Senthinathan A, Cimino S, Jaglal SB, Craven BC, Tu K, Guilcher S. The impact of the COVID-19 virus and pandemic on healthcare utilization, access, delivery, experiences, and outcomes in the spinal cord injuries/dysfunction population: A scoping review study. PLoS One 2024; 19:e0297384. [PMID: 38386642 PMCID: PMC10883570 DOI: 10.1371/journal.pone.0297384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 01/04/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Individuals with spinal cord injuries or disease (SCI/D) require frequent healthcare services. The COVID-19 pandemic may have impacted healthcare. Furthermore, due to secondary health conditions and comorbidities persons with SCI/D are at increased risk of experiencing severe symptoms or outcomes if infected with the COVID-19 virus. It is unclear to what extent research has investigated the pandemic and virus impacts on the SCI/D population. OBJECTIVE To identify and summarize what is reported in the literature on the impact the COVID-19 virus and pandemic had on healthcare, health outcomes, and experiences in the adult SCI/D population. METHODS Electronic databases and grey literature were searched for articles that included an adult population with a SCI/D and investigated the impact the COVID-19 virus and pandemic had on healthcare-related outcomes and experiences. Articles were double screened, and data were extracted, and synthesized to provide a descriptive summary of the findings. RESULTS Twenty-four studies were included in this review with eight qualitative, fifteen quantitative, and one mixed methods study. Sixteen studies investigated healthcare utilization/access; nine investigated care delivery, nine investigated patient outcomes, and eight investigated patient experiences, with multiple studies spanning different categories of investigation. The pandemic was detrimental to healthcare utilization, access, and outcomes, but no studies quantified these changes. Virtual care was well-received by the SCI/D population to maintain continuity of care. The SCI/D population had issues with maintaining caregiving support. It was unclear if the COVID-19 virus infection impacted individuals with SCI/D differently than the general population. CONCLUSIONS This scoping review found the pandemic negatively impacted multiple aspects of healthcare in individuals with SCI/D, however further investigation on health outcomes is required. More research, particularly large-scale quantitative studies, investigating healthcare access, utilization, and delivery, as well as patient outcomes and experiences is needed to improve care in the SCI/D population post-pandemic onset.
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Affiliation(s)
- Arrani Senthinathan
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Stephanie Cimino
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Susan B. Jaglal
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
| | - B. Catharine Craven
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Canada
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
- North York General Hospital, Toronto, Ontario, Canada
- Toronto Western Family Health Team, University Health Network, Toronto, Ontario, Canada
| | - Sara Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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Moran K, Barclay L, Lannin NA. Experiences of people with non-traumatic spinal cord injuries returning home after inpatient rehabilitation. Disabil Rehabil 2024; 46:362-368. [PMID: 36591728 DOI: 10.1080/09638288.2022.2162611] [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] [Received: 07/25/2022] [Accepted: 12/21/2022] [Indexed: 01/03/2023]
Abstract
PURPOSE The aim of this study was to explore the experience of people with non-traumatic spinal cord injuries who have recently returned home from inpatient rehabilitation. METHODS Semi-structured interviews were conducted with seven adults with non-traumatic spinal cord injuries who had been discharged from inpatient rehabilitation from an Australian rehabilitation hospital, within the last two years. RESULTS Three themes were identified: the practicalities of coming home; adjusting to "my altered home life"; pursuing recovery. When people felt prepared by their rehabilitation service, and had appropriate support from others, they had a more positive adjustment experience, although not one without challenges. Due to less independence and inability to participate in meaningful life roles, participants experienced a sense of lost or changed identity. Maintaining hope for physical recovery was very important and motivated participants to actively engage in rehabilitation efforts. CONCLUSIONS This study adds to the knowledge regarding the lived experience of people with non-traumatic spinal cord injury transitioning from rehabilitation to home. Facilitators for successful rehabilitation discharge included ensuring community services contacted patients immediately after they left hospital, and providing support for carers. Health care workers can positively influence the adjustment process of people with NTSCI by facilitating re-engagement in meaningful roles.IMPLICATIONS FOR REHABILITATIONThe transition home from inpatient rehabilitation after non-traumatic spinal cord injury (NTSCI) is facilitated by early discharge planning and follow-up from services after discharge.Establishing routines helped participants adjust to their new circumstances.The emotional and practical support of carers is vital for successful adjustment to living in the community with an NTSCI.Health care workers can positively influence the adjustment process of people with NTSCI by facilitating their re-engagement in meaningful roles.
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Affiliation(s)
- Kathryn Moran
- Department of Occupational Therapy, Monash University, Frankston, Vic, Australia
| | - Linda Barclay
- Department of Neuroscience, Monash University, Melbourne, Vic, Australia
| | - Natasha A Lannin
- Department of Neuroscience, Monash University, Melbourne, Vic, Australia
- Occupational Therapy Department, Alfred Health, Melbourne, Vic, Australia
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Dahl TS, Lindblom RPF. Intermediate outcomes following arch reconstruction with frozen elephant trunk, a single centre study. J Cardiothorac Surg 2023; 18:44. [PMID: 36683042 PMCID: PMC9869602 DOI: 10.1186/s13019-023-02140-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Accepted: 01/05/2023] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Surgery on the aortic arch and proximal descending thoracic aorta can be lifesaving but is also associated with significant morbidity, ranging from minor infections to severe neurological impairments as well as a substantial risk of mortality. The aim of this study is to clinically assess outcomes, with special regards to neurologic injury, as well as to seek to identify predictors of in-hospital mortality in two patient groups with different underlying aortic pathology, aneurysms and dissections, undergoing arch/descending aortic repair. METHODS 34 patients (17 aneurysms, 17 dissections) underwent surgery involving the arch and/or descending aorta, using the Thoraflex or E-Vita frozen elephant trunk graft. 40% were female. Subgroup analysis of aneurysms compared to dissections were performed. Mean follow-up time was 53.9 months and mean age 63.5 years. RESULTS In-hospital mortality was 18%. Survival was comparable between aneurysms and dissections. Incidence of spinal cord injury was 9% and stroke 9%. 67% suffered any form of neurological affection, when also cognitive afflictions were included. Perioperative reoperation rate was 29% (bleeding 21%, visceral ischemia 6%, infection 2%), the need for postoperative dialysis was 11% and a series of other minor complications such as atrial fibrillation and pleurocentesis were common. CONCLUSION Postoperative dialysis was found to be a predictor of in-hospital mortality, while both dialysis as well as reoperation due to bleeding and/or visceral ischemia increased the risk for overall mortality, irrespective of preoperative diagnosis. Previous or current smoking appeared to be associated with negative outcomes regarding both in-hospital and overall mortality during follow-up. Trial registration Retrospectively enrolled.
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Affiliation(s)
- Therese Schagerholm Dahl
- grid.8993.b0000 0004 1936 9457Department of Surgical Sciences, Section of Thoracic Surgery, Uppsala University, Uppsala, Sweden
| | - Rickard P. F. Lindblom
- grid.8993.b0000 0004 1936 9457Department of Surgical Sciences, Section of Thoracic Surgery, Uppsala University, Uppsala, Sweden ,grid.412354.50000 0001 2351 3333Department of Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, 751 85 Uppsala, Sweden
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Senthinathan A, Cronin SM, Ho C, New PW, Guilcher SJ, Noonan VK, Craven BC, Christie S, Wai EK, Tsai EC, Sreenivasan V, Wilson J, Fehlings MG, Welk B, Jaglal SB. Using Clinical Vignettes and a Modified Expert Delphi Panel to Determine Parameters for Identifying Non-Traumatic Spinal Cord Injury in Health Administrative and Electronic Medical Record Databases. Arch Phys Med Rehabil 2023; 104:63-73. [PMID: 36002056 DOI: 10.1016/j.apmr.2022.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/04/2022] [Accepted: 08/05/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To obtain expert consensus on the parameters and etiologic conditions required to retrospectively identify cases of non-traumatic spinal cord injury (NTSCI) in health administrative and electronic medical record (EMR) databases based on the rating of clinical vignettes. DESIGN A modified Delphi process included 2 survey rounds and 1 remote consensus panel. The surveys required the rating of clinical vignettes, developed after chart reviews and expert consultation. Experts who participated in survey rounds were invited to participate in the Delphi Consensus Panel. SETTING An international collaboration using an online meeting platform. PARTICIPANTS Thirty-one expert physicians and/or clinical researchers in the field of spinal cord injury (SCI). MAIN OUTCOME MEASURE(S) Agreement on clinical vignettes as NTSCI. Parameters to classify cases of NTSCI in health administrative and EMR databases. RESULTS In health administrative and EMR databases, cauda equina syndromes should be considered SCI and classified as a NTSCI or TSCI based on the mechanism of injury. A traumatic event needs to be listed for injury to be considered TSCI. To be classified as NTSCI, neurologic sufficient impairments (motor, sensory, bowel, and bladder) are required, in addition to an etiology. It is possible to have both a NTSCI and a TSCI, as well as a recovered NTSCI. If information is unavailable or missing in health administrative and EMR databases, the case may be listed as "unclassifiable" depending on the purpose of the research study. CONCLUSION The Delphi panel provided guidelines to appropriately classify cases of NTSCI in health administrative and EMR databases.
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Affiliation(s)
- Arrani Senthinathan
- From the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada; KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Canada.
| | - Shawna M Cronin
- From the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada; KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Chester Ho
- Division of Physical Medicine & Rehabilitation, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Peter W New
- Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Caulfield, Australia; Department of Medicine & Rehabilitation and Aged Services Program, Kingston Centre, Monash Health, Cheltenham, Australia; Epworth-Monash Rehabilitation Medicine Unit, Monash University, Richmond, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Prahran, Australia
| | - Sara Jt Guilcher
- From the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada; Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada; Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, Canada; International Collaboration on Repair Discoveries, Vancouver, Canada
| | - B Catherine Craven
- KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Canada; Department of Medicine, University of Toronto, Toronto, Canada; Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute - University Health Network, Toronto, Canada
| | - Sean Christie
- Division of Neurosurgery, Dalhousie University, Halifax, Canada
| | - Eugene K Wai
- Division of Orthopaedic Surgery and School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Eve C Tsai
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Canada; Division of Neurosurgery, University of Ottawa, The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Vidya Sreenivasan
- Physical Medicine and Rehabilitation, The Ottawa Hospital, Ottawa, Canada
| | - Jefferson Wilson
- Division of Neurosurgery, University of Toronto, Toronto, Canada; St. Michael's Hospital, Toronto, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, University of Toronto, Toronto, Canada; Department of Surgery and Epidemiology & Biostatistics, Western University, London, Canada
| | - Blayne Welk
- Division of Neurosurgery and Division of Genetics and Development, Krembil Neuroscience Centre, University Health Network, Toronto, Canada
| | - Susan B Jaglal
- From the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada; KITE (Knowledge Innovation Talent Everywhere), Toronto Rehabilitation Institute - University Health Network, Toronto, Canada; Rehabilitation Science Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada; Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Luo Y, Zhang W. WITHDRAWN: DNMT inhibitor (decitabine) attenuates tuberculosis-induced spine injury by modulating the expression of microRNA-155 and matrix metalloproteinase-13 via suppressing the hypermethylation of IDH mutant. Biochem Biophys Res Commun 2022. [DOI: 10.1016/j.bbrc.2022.03.081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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KPELAO E, DOLEAGBENOU AK, MOUMOUNI AEK, Hobli A, Améléké M, Dzidoula L, Komi E, BEKETI AK. Spinal cord compression in Togo: etiologies and management. World Neurosurg 2022; 162:e542-e545. [DOI: 10.1016/j.wneu.2022.03.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 03/14/2022] [Indexed: 10/18/2022]
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Ikbali Afsar S, Cosar SNS, Yemişçi OU, Bölük H. Inpatient rehabilitation outcomes in neoplastic spinal cord compression vs. traumatic spinal cord injury. J Spinal Cord Med 2022; 45:221-229. [PMID: 32701391 PMCID: PMC8986217 DOI: 10.1080/10790268.2020.1794713] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Objective: To compare neurological and functional outcomes, and complications of patients with neoplastic vs traumatic spinal cord injury (SCI) after in-patient rehabilitation.Design: This study is a retrospective analysis.Setting: In-patient rehabilitation unit of a tertiary research hospital.Participants: A total of 252 patients with a SCI were included; 43 with neoplastic SCI (mean age: 60.9 ± 15.7 years, 60.5% were males) and 209 with traumatic SCI (mean age: 43.1 ± 16.8 years, 71.3% were males).Outcome measures: Comparisons were made of demographic characteristics, etiology, American Spinal Injury Association (ASIA) impairment scale, functional independence measurement (FIM) and Functional Ambulation Categories (FAC) scores, length of stay (LOS), bladder independence, medical comorbidities and complications in both groups.Results: Patients with neoplastic SCI were significantly older than those with traumatic SCI (P < 0.01). No difference was present between the groups in terms of sex and lesion level (P > 0.05). Incomplete SCI was significantly higher in the neoplastic group when compared with the traumatic group (P < 0.01). The LOS was significantly shorter in the neoplastic group than traumatic group (34.8 ± 41.03 vs. 60.02 ± 53.1, P < 0.01). There were no differences in the admission FIM scores (69.3 ± 24.7 vs. 58.7 ± 18.9, P > 0.05), discharge FIM scores (82.1 ± 25.1 vs. 74.02 ± 23.3, P > 0.05) and FIM efficiencies (0.43 ± 0.72 vs. 0.36 ± 0.51, P > 0.05) for the neoplastic and traumatic groups, respectively. However, neoplastic SCI patients demonstrated lower FIM gains compared to traumatic patients (12.9 ± 11.9 vs. 15.4 ± 15.2, P < 0.05). During rehabilitation, urinary tract infection (48.4% vs. 69.4%) and decubitus ulcer (11.6% vs. 35.9%) were significantly more common in the traumatic group than the neoplastic group (P < 0.05).Conclusion: Neoplastic SCI patients who commonly present at rehabilitation units exhibit different characteristics from traumatic SCI patients but the rehabilitation results are similar. Similar functional development can be achieved in a shorter period of time with inpatient rehabilitation in the neoplastic SCI group.
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Affiliation(s)
- Sevgi Ikbali Afsar
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Sacide Nur Saraçgil Cosar
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Oya Umit Yemişçi
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Hüma Bölük
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Baskent University, Ankara, Turkey
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Smith É, Fitzpatrick P, Lyons F, Morris S, Synnott K. Epidemiology of non-traumatic spinal cord injury in Ireland - a prospective population-based study. J Spinal Cord Med 2022; 45:76-81. [PMID: 32406815 PMCID: PMC8890548 DOI: 10.1080/10790268.2020.1762829] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective: To carry out a study of non-traumatic spinal cord injury (NTSCI) epidemiology in IrelandDesign: Prospective study of all new incident cases of NTSCI during 2017Setting: Republic of IrelandParticipants: All persons with a newly acquired NTSCIInterventions: NoneOutcome measures: Crude and age/sex specific incidences; ISCoS core dataset and non-traumatic dataset; population denominator was 2016 national census figures, adjusted to 2017.Results: Overall crude incidence of NTSCI in the Republic of Ireland in 2017 was 26.9 per million per year. Mean age at onset was 56.6 (SD 17.7) years. Females accounted for 51.2% of cases. Most frequent grade of ASIA impairment scale (AIS) was AIS D. Most common etiology was degenerate conditions (48.8%) followed by neoplastic (26.4%). The most common pattern of onset (51.2%) was lengthy (greater than one month).Conclusions: Incidence of NTSCI is more than double that for traumatic SCI in the Republic of Ireland. This suggests that the delivery of rehabilitation services to patients with spinal cord injuries requires prompt review and expansion.
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Affiliation(s)
- Éimear Smith
- Spinal Cord System of Care, National Rehabilitation Hospital, Dún Laoghaire, Co. Dublin, Ireland,Department of Orthopaedic & Spine Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland,Correspondence to: Éimear Smith, Spinal Cord System of Care, National Rehabilitation Hospital, Rochestown Avenue, Dún Laoghaire, Co. Dublin, Ireland; Ph: 00353 1 2355528 00353 1 2854370.
| | - Patricia Fitzpatrick
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin 4, Ireland
| | - Frank Lyons
- Department of Orthopaedic & Spine Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Seamus Morris
- Spinal Cord System of Care, National Rehabilitation Hospital, Dún Laoghaire, Co. Dublin, Ireland,Department of Orthopaedic & Spine Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
| | - Keith Synnott
- Spinal Cord System of Care, National Rehabilitation Hospital, Dún Laoghaire, Co. Dublin, Ireland,Department of Orthopaedic & Spine Surgery, Mater Misericordiae University Hospital, Dublin 7, Ireland
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Teo CP, Cheng K, New PW. Retrospective study of functional outcomes and disability after non-ischaemic vascular causes of spinal cord dysfunction. J Spinal Cord Med 2021; 44:306-311. [PMID: 31403383 PMCID: PMC7952061 DOI: 10.1080/10790268.2019.1645405] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
Objective: Describe demographic characteristics, functional outcomes and disability following rehabilitation for non-ischemic vascular spinal cord dysfunction (SCDys).Design: Retrospective, open cohort, case series.Setting: Tertiary rehabilitation unit, Victoria, Australia.Participants: Patients with non-ischemic vascular SCDys admitted over a 21-year-period (01/01/1995-31/12/2015) were identified using International Classification of Diseases codes.Outcome Measures: Demographic characteristics, etiology, neurologic classification, length of stay (LOS), and complications. On admission and discharge, the following were collected: functional independence measure (FIM) motor subscale, details on bowel, bladder, mobility, living arrangement, and support services.Results: 36 patients (female 58%; mean age 69 ± 16 years) were identified. The main causes of non-ischemic vascular SCDys were epidural hematoma (39%), dural arteriovenous fistula (17%), and arteriovenous malformation (11%). 22 cases (61%) were iatrogenic. Most (86%) had incomplete paraplegia. Urinary tract infection was the most common complication (64%). Median LOS in rehabilitation was 68 days. Significant improvement in FIM motor scores was observed from admission (median 25, interquartile range [IQR] 20-38) to discharge (median 69, IQR 38-77) (P < 0.001). On discharge, 4 patients (11%) walked >100 m unaided, 6 (17%) walked >100 m with assistive device, 10 (28%) walked >10 m with assistive device, 15 (41%) were wheelchair dependent and 1 (3%) patient remained non-mobile. 20 patients (56%) were discharged home, 8 (22%) to nursing home, and 8 (22%) transferred to another hospital.Conclusion: Most patients returned home with significantly improved functional outcomes compared to rehabilitation admission, but with the majority having ongoing major disabilities based on FIM motor scores.
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Affiliation(s)
- Chiu Pin Teo
- Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia,Correspondence to: Chiu Pin Teo, Spinal Rehabilitation Service, Caulfield Hospital, 260 Kooyong Rd, Caulfield, Victoria3162, Australia; Ph: +613 9076 6000.
| | - Kevin Cheng
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Peter Wayne New
- Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Melbourne, Victoria, Australia,Epworth-Monash Rehabilitation Medicine Unit, Monash University, Melbourne, Victoria, Australia,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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Niemi-Nikkola V, Koskinen E, Väärälä E, Kauppila AM, Kallinen M, Vainionpää A. Incidence of Acquired Nontraumatic Spinal Cord Injury in Finland: A 4-Year Prospective Multicenter Study. Arch Phys Med Rehabil 2020; 102:44-49. [PMID: 33007307 DOI: 10.1016/j.apmr.2020.08.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/05/2020] [Accepted: 08/25/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To evaluate the incidence and epidemiologic characteristics of acquired nontraumatic spinal cord injury (NTSCI) in Finland. DESIGN Prospective 4-year epidemiologic multicenter study. SETTING Two of the 3 spinal cord injury (SCI) centers in Finland responsible for acute care, immediate rehabilitation, and lifelong follow-up for all SCI patients in a population of 3,073,052 (as of 2013). PARTICIPANTS All newly diagnosed NTSCI patients (N=430) admitted to Tampere University Hospital between 2012 and 2015 and Oulu University Hospital between 2013 and 2016 based on the evaluation of the designated rehabilitation teams. Patients with NTSCI resulting from congenital etiologies or progressive neurologic diseases were excluded. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Incidence and variables, according to the International SCI Core Data Set and the International Standards for Neurological Classification of SCI, including etiology and the severity of injury. RESULTS The incidence of NTSCI was 54.1 per million per year. NTSCI was more common in men (n=260, 60.5%) than women (n=170, 39.5%). The mean age was 62.0±14.6 years old. Degenerative causes were the most common etiology (n=219, 50.9%), followed by malignant (n=88, 20.5%) and benign (n=41, 9.5%) neoplasms. The injury resulted in tetraplegia in 177 patients (41.1%) and paraplegia in 249 patients (57.9%). American Spinal Injury Association Impairment Scale grade D injuries were common, with an incidence of 71% (n=304). Specialized inpatient rehabilitation was needed in 44% (n=189) of the cases. CONCLUSIONS There are no previous studies on the epidemiology of NTSCI in Finland, and international reporting has been limited. The incidence of NTSCI in our study was substantially higher than in most previous studies, which was likely owing to our study including individuals with less severe lesions who did not require inpatient rehabilitation.
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Affiliation(s)
- Ville Niemi-Nikkola
- Oulu University Hospital, Department of Medical Rehabilitation, Oulu, Finland.
| | - Eerika Koskinen
- Tampere University Hospital, Department of Neurosciences and Rehabilitation, Tampere, Finland
| | - Eija Väärälä
- Tampere University Hospital, Department of Neurosciences and Rehabilitation, Tampere, Finland
| | - Anna-Maija Kauppila
- Oulu University Hospital, Department of Medical Rehabilitation, Oulu, Finland
| | - Mauri Kallinen
- Central Finland Central Hospital, Rehabilitation Department, Jyväskylä, Finland; The Center for Life Course Health Research, University of Oulu, Oulu, Finland
| | - Aki Vainionpää
- Seinäjoki Central Hospital, Department of Rehabilitation, Seinäjoki, Finland
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New PW. A Narrative Review of Pediatric Nontraumatic Spinal Cord Dysfunction. Top Spinal Cord Inj Rehabil 2019; 25:112-120. [PMID: 31068743 DOI: 10.1310/sci2502-112] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
This article provides a narrative review of seven key issues relevant to pediatric onset of spinal cord damage not due to trauma, or spinal cord dysfunction (SCDys). The first topic discussed is terminology issues. There is no internationally accepted term for spinal cord damage not due to trauma. The implications of this terminology issue and an approach to addressing this are discussed. Second, a brief history of SCDys is presented, focusing on conditions relevant to pediatrics. Third, the classification of SCDys is outlined, based on the International Spinal Cord Injury Data Sets for Non-Traumatic Spinal Cord Injury. Following this, a summary is given of the epidemiology of pediatric SCDys, primarily focused on the incidence, prevalence, and etiology, with a comparison to traumatic spinal cord injury. Next, important clinical rehabilitation principles unique to children with SCDys are highlighted. Then important prevention opportunities for SCDys in children are discussed. Finally, trends, challenges, and opportunities regarding research in SCDys are mentioned.
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Affiliation(s)
- Peter Wayne New
- Spinal Rehabilitation Service, Department of Rehabilitation, Caulfield Hospital, Alfred Health, Victoria, Australia.,Epworth-Monash Rehabilitation Medicine Unit, Monash University, Melbourne, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Victoria, Australia
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Sturt R, Hill B, Holland A, New PW, Bevans C. Validation of a clinical prediction rule for ambulation outcome after non-traumatic spinal cord injury. Spinal Cord 2019; 58:609-615. [DOI: 10.1038/s41393-019-0386-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 10/20/2019] [Accepted: 11/03/2019] [Indexed: 11/09/2022]
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14
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Pataraia A, Crevenna R. Challenges in rehabilitation of patients with nontraumatic spinal cord dysfunction due to tumors : A narrative review. Wien Klin Wochenschr 2019; 131:608-613. [PMID: 31312916 PMCID: PMC6908546 DOI: 10.1007/s00508-019-1528-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Revised: 06/24/2019] [Accepted: 06/25/2019] [Indexed: 02/03/2023]
Abstract
The incidence of cancer-associated non-traumatic spinal cord dysfunction is rising due to population aging and better cancer treatment. The overall benefit of rehabilitation in specialized facilities for traumatic spinal cord dysfunction has been confirmed many times. Because of their fragility and multiple comorbidities cancer patients still face challenges to complete rehabilitation in the spinal rehabilitation facilities. In this narrative review we describe specific aspects, challenges in rehabilitation and opportunities to improve care. A literature search was performed in the PubMed database from 1 January 1978 to 30 November 2018. The focus was to find publications that discuss challenges and opportunities for rehabilitation of patients with non-traumatic spinal cord dysfunction due to a tumor. Most publications described the benefits of rehabilitation in specialized facilities. There were only few publications about survival and functional outcomes after rehabilitation for this patient population. Overall benefits including fewer complications associated with spinal cord dysfunction, less pain and depression, and better quality of life were shown. Within the past decades increasing number of publications revealed a growing interest for this group of patients. Despite major progress in cancer treatment, patients still have a limited vital prognosis and access to specialized rehabilitation units because of the concerns about the medical complexity. Patients with spinal cord tumors can benefit in areas of functionality, mood, quality of life, and survival from inpatient rehabilitation programs, in spite of the increased medical comorbidities.
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Affiliation(s)
- Anna Pataraia
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria.
| | - Richard Crevenna
- Department of Physical Medicine, Rehabilitation and Occupational Medicine, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
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Interaction between Nursing Staff and Residents with Aphasia in Long-Term Care: A Mixed Method Case Study. Nurs Res Pract 2018; 2018:9418692. [PMID: 30631596 PMCID: PMC6304643 DOI: 10.1155/2018/9418692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 10/22/2018] [Indexed: 12/18/2022] Open
Abstract
Introduction Thousands of individuals with communication disorders live in long-term residential care. Nursing staff are often their primary communication partners. The positive effects of social interaction and person-centred care have been recognised but there remains a paucity of research on the content and quality of communicative interaction between long-term care staff and residents with aphasia. This mixed method study investigates the discourse in interaction between nursing staff and residents with aphasia. Methods A routine care activity was explored in 26 video-recordings featuring four enrolled nurses and four elderly persons with severe aphasia. Factors such as goals and roles in the activity were mapped out and a qualitative discourse analysis was performed. Based on the findings a coding scheme was constructed and the amount of time spent in different interactional foci of discourse was explored. Results From the qualitative findings three broad, but distinct, foci in the nurse-initiated interaction could be distinguished: (1) a focus on getting the task done with minimum interaction; (2) topics related to the task, but not necessary to get the task done; and (3) personal topics related to themes beyond the caring task. The analysis of distribution of time revealed that although most of the interaction was focused on the main care activity, between 3 and 17% of the time was spent in either task-related or non task-related interaction. The distribution varied between dyads and could not be related to the residents' severity of aphasia nor the activity as such. Conclusions An endeavour to interact socially with the residents with aphasia influences the nurses' foci of interaction. Contextual and personal factors of the residents and nurses need to be considered in clinical work as well as research on how communication may be supported to facilitate social interaction and person-centredness in long-term care of people with aphasia.
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Lindblom RPF, Shen Q, Axén S, Landegren U, Kamali-Moghaddam M, Thelin S. Protein Profiling in Serum and Cerebrospinal Fluid Following Complex Surgery on the Thoracic Aorta Identifies Biological Markers of Neurologic Injury. J Cardiovasc Transl Res 2018; 11:503-516. [PMID: 30367354 PMCID: PMC6294830 DOI: 10.1007/s12265-018-9835-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/10/2018] [Indexed: 12/19/2022]
Abstract
Surgery on the arch or descending aorta is associated with significant risk of neurological complications. As a consequence of intubation and sedation, early neurologic injury may remain unnoticed. Biomarkers to aid in the initial diagnostics could prove of great value as immediate intervention is critical. Twenty-three patients operated in the thoracic aorta with significant risk of perioperative neurological injury were included. Cerebrospinal fluid (CSF) and serum were obtained preoperatively and in the first and second postoperative days and assessed with a panel of 92 neurological-related proteins. Three patients suffered spinal cord injury (SCI), eight delirium, and nine hallucinations. There were markers in both serum and CSF that differed between the affected and non-affected patients (SCI; IL6, GFAP, CSPG4, delirium; TR4, EZH2, hallucinations; NF1). The study identifies markers in serum and CSF that reflect the occurrence of neurologic insults following aortic surgery, which may aid in the care of these patients.
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Affiliation(s)
- Rickard P F Lindblom
- Department of Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, SE-751 85, Uppsala, Sweden. .,Department of Surgical Sciences, Section of Thoracic Surgery, Uppsala University, Uppsala, Sweden.
| | - Qiujin Shen
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Sofie Axén
- Department of Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, SE-751 85, Uppsala, Sweden
| | - Ulf Landegren
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Masood Kamali-Moghaddam
- Department of Immunology, Genetics and Pathology, Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Stefan Thelin
- Department of Cardiothoracic Surgery and Anesthesia, Uppsala University Hospital, SE-751 85, Uppsala, Sweden.,Department of Surgical Sciences, Section of Thoracic Surgery, Uppsala University, Uppsala, Sweden
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Guilcher SJT, Voth J, Ho C, Noonan VK, McKenzie N, Thorogood NP, Craven BC, Cronin S, Jaglal SB. Characteristics of Non-traumatic Spinal Cord Dysfunction in Canada Using Administrative Health Data. Top Spinal Cord Inj Rehabil 2018; 23:343-352. [PMID: 29339910 DOI: 10.1310/sci2304-343] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: There is a paucity of studies using administrative health data to examine the epidemiology, health care utilization, and outcomes for non-traumatic spinal cord dysfunction (NTSCD). Objective: The purpose of this study is to characterize discrete NTSCD cohorts using decision algorithms with Canadian health administrative databases. Method: Data were provided by the Canadian Institute for Health Information that included all acute care hospital, day surgery, ambulatory, and inpatient rehabilitation records of patients with neurological impairment between April 1, 2004 and March 31, 2011. Diagnostic codes for neurological impairment and NTSCD etiology were used to identify cases and classify 3 NTSCD groups (most likely, probable, and possible). Logistic regression identified factors related to inpatient rehabilitation admission within 7 days of discharge among the preferred group. Results: The most likely NTSCD group (n = 6,362) was significantly older and had a greater proportion of women and individuals with cauda equina lesions compared to the other 2 NTSCD groups (probable [n = 2,777] and possible [n = 11,179]; ps < .001). Factors associated with the likelihood of an inpatient rehabilitation admission included being older (odds ratio [OR], 1.01; 95% CI, 1.00-1.01), being female (OR, 1.18; 95% CI, 1.06-1.32), having paraplegia diagnosis compared to cauda equina (OR, 1.24; 95% CI, 1.09-1.41), residing in an urban area compared to a rural area (OR, 1.34; 95% CI, 1.13-1.58), having degenerative etiology compared to other (OR, 1.59; 95% CI, 1.41-1.80), and having an MRI on record compared to not (OR = 1.57; 95% CI, 1.39-1.76). Conclusion: Administrative data allow for ongoing surveillance of a population in a relatively cost-effective manner. Advancing our knowledge of NTSCD epidemiology, health outcomes, and system performance can inform policy and system planning.
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Affiliation(s)
- Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jennifer Voth
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada
| | - Chester Ho
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
| | | | - Nicole McKenzie
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | | | - B Catharine Craven
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Institute for Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Shawna Cronin
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Institute for Health Policy Management and Evaluation, Toronto, Ontario, Canada
| | - Susan B Jaglal
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario, Canada.,Institute for Health Policy Management and Evaluation, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Ontario, Canada
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New PW, Eriks-Hoogland I, Scivoletto G, Reeves RK, Townson A, Marshall R, Rathore FA. Important Clinical Rehabilitation Principles Unique to People with Non-traumatic Spinal Cord Dysfunction. Top Spinal Cord Inj Rehabil 2018; 23:299-312. [PMID: 29339906 DOI: 10.1310/sci2304-299] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Non-traumatic spinal cord dysfunction (SCDys) is caused by a large range of heterogeneous etiologies. Although most aspects of rehabilitation for traumatic spinal cord injury and SCDys are the same, people with SCDys have some unique rehabilitation issues. Purpose: This article presents an overview of important clinical rehabilitation principles unique to SCDys. Methods: Electronic literature search conducted (January 2017) using MEDLINE and Embase (1990-2016) databases for publications regarding SCDys. The focus of the literature search was on identifying publications that present suggestions regarding the clinical rehabilitation of SCDys. Results: The electronic search of MEDLINE and Embase identified no relevant publications, and the publications included were from the authors' libraries. A number of important clinical rehabilitation principles unique to people with SCDys were identified, including classification issues, general rehabilitation issues, etiology-specific issues, and a role for the rehabilitation physician as a diagnostic clinician. The classification issues were regarding the etiology of SCDys and the International Standards for Neurological Classification of Spinal Cord Injury. The general rehabilitation issues were predicting survival, improvement, and rehabilitation outcomes; admission to spinal rehabilitation units, including selection decision issues; participation in rehabilitation; and secondary health conditions. The etiology-specific issues were for SCDys due to spinal cord degeneration, tumors, and infections. Conclusions: Although there are special considerations regarding the rehabilitation of people with SCDys, such as the potential for progression of the underlying condition, functional improvement is typically significant with adequate planning of rehabilitation programs and special attention regarding the clinical condition of patients with SCDys.
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Affiliation(s)
- Peter Wayne New
- Spinal Rehabilitation Service, Department of Rehabilitation, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia.,Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, Monash University, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia
| | | | - Giorgio Scivoletto
- Spinal Unit, IRCCS Fondazione S. Lucia, Rome, Italy.,Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione S. Lucia, Rome, Italy
| | - Ronald K Reeves
- Department of Physical Medicine & Rehabilitation, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Andrea Townson
- GF Strong Rehab Centre, British Columbia, Vancouver, Canada.,University of British Columbia, Vancouver, Canada
| | - Ruth Marshall
- South Australian Spinal Cord Injury Service, Hampstead Rehabilitation Centre, Northfield, South Australia, Australia.,Discipline of Orthopaedics and Trauma, School of Medicine, Faculty of Health Science, University of Adelaide, South Australia, Australia
| | - Farooq A Rathore
- Department of Rehabilitation Medicine, PNS Shifa Hospital, Karachi, Pakistan.,Department of Rehabilitation Medicine, Bahria University Medical and Dental College, Bahria University, Karachi, Pakistan
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New PW, Guilcher SJT, Jaglal SB, Biering-Sørensen F, Noonan VK, Ho C. Trends, Challenges, and Opportunities Regarding Research in Non-traumatic Spinal Cord Dysfunction. Top Spinal Cord Inj Rehabil 2018; 23:313-323. [PMID: 29339907 DOI: 10.1310/sci2304-313] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background: Spinal cord dysfunction (SCDys) is caused by heterogeneous health conditions, and the incidence is increasing. Despite the growing interest in rehabilitation research for SCDys, research into SCDys faces many challenges. Objective: The objective of this project was to perform a clinical review of changes in SCDys research over the last 4 decades; identify challenges to conducting research in SCDys; and propose opportunities for improving research in SCDys. Methods: A triangulation approach was used for obtaining evidence: literature search (January 2017) using MEDLINE and Embase databases for publications in English (1974-2016) regarding SCDys; workshop discussions at the International Spinal Cord Society annual meeting, September 16, 2016, Vienna, Austria; and our collective expertise in SCDys clinical rehabilitation research. Results: There has been a substantial increase in publications on SCDys over the 4 decades, from 1,825 in 1974-1983 to 11,887 in the decade 2004-2013, along with an improvement in research methodology. Numerous challenges to research in SCDys rehabilitation were grouped into the following themes: (a) identification of cases; (b) study design and data collection; and (c) funding, preclinical, and international research. Opportunities for addressing these were identified. Conclusions: The increase in scientific publications on SCDys highlights the importance of this heterogeneous group among the research community. The overall lack of good quality epidemiological studies regarding incidence, prevalence, and survival in these patients serves as a benchmark for guiding improvements to inform evidence-based care and policy.
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Affiliation(s)
- Peter Wayne New
- Spinal Rehabilitation Service, Department of Rehabilitation, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia.,Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, Monash University, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing & Health Sciences, Monash University, Victoria, Australia
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Susan B Jaglal
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.,Department of Physical Therapy, University of Toronto, Toronto. Ontario, Canada.,Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | - Fin Biering-Sørensen
- Clinic for Spinal Cord Injuries, Neuroscience Center, Rigshospitalet, University of Copenhagen, Denmark
| | | | - Chester Ho
- Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta, Canada
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Robinson DM, Bazzi MS, Millis SR, Bitar AA. Predictors of readmission to acute care during inpatient rehabilitation for non-traumatic spinal cord injury. J Spinal Cord Med 2018; 41:444-449. [PMID: 29355465 PMCID: PMC6055975 DOI: 10.1080/10790268.2018.1426235] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
OBJECTIVES To investigate the frequency of and reasons for readmissions to acute care (RTAC) during inpatient rehabilitation (IPR) after non-traumatic spinal cord injury (NT-SCI). To develop a predictive model for RTAC using identified risk factors. DESIGN Retrospective case-control. SETTING Academic IPR hospital. PARTICIPANTS Individuals with NT-SCI admitted to an academic SCI rehabilitation unit from January 2014-December 2015. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Readmissions to acute care services from IPR. RESULTS Thirty-seven participants (20%) experienced a RTAC for a total of 39 episodes. Thirty-five experienced 1 RTAC, while two had 2. The most common medical reasons for RTAC were infection (27%), neurological (27%), and noninfectious respiratory (16%). Multivariable logistic regression was used to develop a model to predict RTAC. Paraplegia was associated with 3.2 times increase in the odds of RTAC (P = 0.03). For every unit increase in FIM-Motor, there was a 5% reduction in the odds of RTAC (P = 0.03) Body mass index less than 30 decreased odds of RTAC by 61% (P = 0.004). CONCLUSION RTACs were associated with body mass index greater than 30, decreased FIM-Motor subscore on admission, and paraplegia. Physiatrists caring for the non-traumatic SCI patient need be more circumspect of individuals with these parameters to potentially prevent the problems necessitating acute care transfer.
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Affiliation(s)
- David M. Robinson
- School of Medicine, Wayne State University, Detroit, Michigan, USA,Correspondence to: David M. Robinson, MD. 5420 Wessex Ct. Apt 106, Dearborn, MI 48126, USA.
| | - Moussa S. Bazzi
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan, Detroit, Michigan, USA
| | - Scott R. Millis
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan, Detroit, Michigan, USA
| | - Ali A. Bitar
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan, Detroit, Michigan, USA
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Le Fort M, Espagnacq M, Albert T, Lefèvre C, Perrouin-Verbe B, Ravaud JF. Risk of pressure ulcers in tetraplegic people: a French survey crossing regional experience with a long-term follow-up. Eur J Public Health 2018; 28:993-999. [DOI: 10.1093/eurpub/cky084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Marc Le Fort
- EHESP, High School of Public Health - MSSH, House of Social Sciences and Disability, Rennes Cedex, France
- Neurological Physical Medicine and Rehabilitation Department, University Hospital – Hôpital Saint-Jacques, Nantes Cedex 01, France
| | - Maude Espagnacq
- IRDES – Institute for Research and Documentation in Health Economics, Paris, France
| | | | - Chloë Lefèvre
- Neurological Physical Medicine and Rehabilitation Department, University Hospital – Hôpital Saint-Jacques, Nantes Cedex 01, France
| | - Brigitte Perrouin-Verbe
- Neurological Physical Medicine and Rehabilitation Department, University Hospital – Hôpital Saint-Jacques, Nantes Cedex 01, France
| | - Jean-François Ravaud
- EHESP, High School of Public Health - MSSH, House of Social Sciences and Disability, Rennes Cedex, France
- CERMES3, INSERM, CNRS, EHESS, Université Paris Descartes, Villejuif, France
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22
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Fu JB, Raj VS, Guo Y. A Guide to Inpatient Cancer Rehabilitation: Focusing on Patient Selection and Evidence-Based Outcomes. PM R 2017; 9:S324-S334. [PMID: 28942907 PMCID: PMC5736373 DOI: 10.1016/j.pmrj.2017.04.017] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 03/23/2017] [Accepted: 04/05/2017] [Indexed: 11/18/2022]
Abstract
Cancer inpatients commonly suffer from impairments that can prohibit safe discharge home from the acute care inpatient medical service and thus require transfer to a postacute inpatient rehabilitation facility. It has been demonstrated in multiple studies that cancer rehabilitation inpatients are able to make statistically significant functional improvements and at a similar pace as their noncancer counterparts. Medical fragility and reimbursement regulations are concerns that affect acceptance and triage of cancer rehabilitation inpatients. Strategies to rehabilitate these challenging patients include considering risk factors for medical complications, consult-based inpatient rehabilitation, and improved communication and coordination with oncology teams.
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Affiliation(s)
- Jack B Fu
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1414, Houston, TX 77030(∗).
| | - Vishwa S Raj
- Department of Physical Medicine & Rehabilitation, Carolinas Rehabilitation and Levine Cancer Institute, Charlotte, NC(†)
| | - Ying Guo
- Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, TX(‡)
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Spinal Cord Injury due to Tumour or Metastasis in Aragón, Northeastern Spain (1991-2008): Incidence, Time Trends, and Neurological Function. BIOMED RESEARCH INTERNATIONAL 2017; 2017:2478197. [PMID: 28812012 PMCID: PMC5547721 DOI: 10.1155/2017/2478197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Accepted: 06/21/2017] [Indexed: 12/02/2022]
Abstract
Purpose Understanding the presentation of spinal cord injury (SCI) due to tumours considering population distribution and temporal trends is key to managing SCI health services. This study quantified incidence rates, function scores, and trends of SCI due to tumour or metastasis over an 18-year time period in a defined region in Spain. Methods A retrospective cohort study included in-and outpatients with nontraumatic SCI due to tumour or metastasis admitted to a metropolitan hospital in Spain between 1991 and 2008. Main outcome measures were crude and age- and sex-adjusted incidence rates, tumour location and type, distribution by spinal level, neurological level of injury, and impairment ASIA scores. Results Primary tumour or metastasis accounted for 32.5% of nontraumatic SCI with an incidence rate of 4.1 per million population. Increasing rates with age and over time were observed. Major pathology groups were intradural-extramedullary masses from which meningiomas and neurinomas accounted for 40%. Lesions were mostly incomplete with predominant ASIA Grade D. Conclusions Increasing incidence rates of tumour-related SCI over time in the middle-aged and the elderly suggest a growing need for neurooncology health resources in the future.
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Understanding the Role of Rehabilitation Medicine in the Care of Patients with Tumor Causing Spinal Cord Dysfunction. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2017. [DOI: 10.1007/s40141-017-0142-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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New PW, Marshall R, Stubblefield MD, Scivoletto G. Rehabilitation of people with spinal cord damage due to tumor: literature review, international survey and practical recommendations for optimizing their rehabilitation. J Spinal Cord Med 2017; 40:213-221. [PMID: 27088581 PMCID: PMC5430479 DOI: 10.1080/10790268.2016.1173321] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVES People with spinal cord dysfunction (SCDys) due to tumor (benign and malignant) pose enormous rehabilitation challenges. Objectives were: conduct literature search regarding epidemiology, clinical features and outcomes for SCDys due to tumor following rehabilitation, the ideal setting for rehabilitation and practical considerations for rehabilitation; and propose framework and practical considerations for managing people with SCDys due to tumor in spinal rehabilitation units (SRUs). DESIGN Survey of rehabilitation health care professionals, consensus opinion from experts and literature search. SETTING Workshop at International Spinal Cord Society and American Spinal Injury Association combined annual meeting, May 16, 2015, Montréal, Canada. PARTICIPANTS Workshop attendees and experts in the rehabilitation of people with SCDys due to tumor. OUTCOMES MEASURES Reports of services offered to people with SCDys due to tumor, including whether those with benign and malignant tumors are admitted into rehabilitation, any admission criteria used and the rational for declining admission. RESULTS Most respondents (n = 33, 83%) reported that people with benign tumors were routinely admitted for rehabilitation but only 18 (45%) reported that people with malignant tumors were routinely admitted. A range of criteria and reasons for declining admission were given. Evidence from the literature and the opinion of experts support the admission of people with SCDys due to tumor into specialist SRUs. CONCLUSIONS A framework and practical considerations for managing people with SCDys due to tumor in SRUs are proposed. Patients with tumor causing SCDys should be given greater access to specialist SRU in order to achieve the best outcomes.
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Affiliation(s)
- Peter Wayne New
- Spinal Rehabilitation Unit, Caulfield Hospital, Alfred Health, Victoria, Australia,Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, Monash University, Victoria, Australia,Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia,Correspondence to: Peter Wayne New, Spinal Rehabilitation Service, Caulfield Hospital, 260 Kooyong Rd, Caulfield 3162, Victoria, Australia.
| | - Ruth Marshall
- South Australian Spinal Cord Injury Service, Hampstead Rehabilitation Centre, Northfield, South Australia, Australia,Discipline of Orthopaedics and Trauma, School of Medicine, Faculty of Health Sciences, University of Adelaide, South Australia, Australia
| | - Michael D. Stubblefield
- Select Medical Corporation, Mechanicsburgy, PA, USA,Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - Giorgio Scivoletto
- Spinal Cord Unit,Spinal Rehabilitation (SpiRe) laboratory, IRCCS Fondazione S. Lucia, Rome, Italy
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27
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Jaglal SB, Voth J, Guilcher SJ, Ho C, Noonan VK, McKenzie N, Cronin S, Thorogood NP, Craven BC. Creation of an Algorithm to Identify Non-traumatic Spinal Cord Dysfunction Patients in Canada Using Administrative Health Data. Top Spinal Cord Inj Rehabil 2017; 23:324-332. [PMID: 29339908 PMCID: PMC5667429 DOI: 10.1310/sci2304-324] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: The lack of consensus on the best methodology for identifying cases of non-traumatic spinal cord dysfunction (NTSCD) in administrative health data limits the ability to determine the burden of disease and provide evidence-informed services. Objective: The purpose of this study is to develop an algorithm for identifying cases of NTSCD with Canadian health administrative databases using a case-based approach. Method: Data were provided by the Canadian Institute for Health Information that included all acute care hospital and day surgery (Discharge Abstract Database), ambulatory (National Ambulatory Care Reporting System), and inpatient rehabilitation records (National Rehabilitation Reporting System) of patients with neurological impairment (paraplegia, tetraplegia, and cauda equina syndrome) between April 1, 2004 and March 31, 2011. The approach to identify cases of NTSCD involved using a combination of diagnostic codes for neurological impairment and NTSCD etiology. Results: Of the initial cohort of 23,703 patients with neurological impairment, we classified 6,362 as the "most likely NTSCD" group (had a most responsible diagnosis or pre-existing diagnosis of NTSCD and diagnosis of neurological impairment); 2,777 as "probable NTSCD" defined as having a secondary diagnosis of NTSCD, and 11,179 as "possible NTSCD" who had no NTSCD etiology diagnoses but neurological impairment codes. Conclusion: The proposed algorithm identifies an inpatient NTSCD cohort that is limited to patients with significant paralysis. This feasibility study is the first in a series of 3 that has the potential to inform future research initiatives to accurately determine the incidence and prevalence of NTSCD.
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Affiliation(s)
- Susan B. Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, Ontario
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario
- Institute for Clinical Evaluative Sciences, Toronto, Ontario
- Institute for Health Policy Management and Evaluation, Toronto, Ontario
| | - Jennifer Voth
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario
| | - Sara J.T. Guilcher
- Institute for Clinical Evaluative Sciences, Toronto, Ontario
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
- Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, Ontario
| | - Chester Ho
- Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
- Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta
| | | | - Nicole McKenzie
- Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta
| | - Shawna Cronin
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario
- Institute for Health Policy Management and Evaluation, Toronto, Ontario
| | | | - B. Cathy Craven
- Toronto Rehabilitation Institute-University Health Network, Toronto, Ontario
- Institute for Health Policy Management and Evaluation, Toronto, Ontario
- Department of Medicine, University of Toronto, Toronto, Ontario
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Sharma A, Chhabra HS, Chabra T, Mahajan R, Batra S, Sangondimath G. Demographics of tuberculosis of spine and factors affecting neurological improvement in patients suffering from tuberculosis of spine: a retrospective analysis of 312 cases. Spinal Cord 2016; 55:59-63. [PMID: 27241442 DOI: 10.1038/sc.2016.85] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Revised: 04/20/2016] [Accepted: 04/25/2016] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The purpose of the study was to study demographics of tuberculosis of spine and analyze factors that might affect neurological improvement in such patients. METHODS Of the 638 suspected cases of spinal tuberculosis, 312 cases with confirmed diagnosis with at least 1-year follow-up were selected for retrospective analysis. Two hundred cases who presented with neurological deficit were further divided into three groups-completely improved, partially improved and no improvement according to American Spinal Injury Association impairment scale (AIS) grading. All continuous variables and categorical variables were compared across groups. RESULTS A total of 209 (66.99%) patients had typical clinical presentation. A total of 264 (84.62%) had typical magnetic resonance imaging (MRI) presentation. Among 356 involved vertebrae, thoracic levels (T1-10) were most commonly affected in 163 (45.78%) followed by thoracolumbar (T11-L2) vertebrae in 98 (27.52%). In 250 patients (80.12%), disease was restricted to one or two adjoining vertebrae. At presentation, 112 (35.89%) patients were neurologically intact, whereas 97 (31%) were AIS D, 65 (20.83%) were AIS C, 8 (2.5%) were AIS B and 30 (9.61%) were AIS A. On statistical analysis, although three groups of patients with complete improvement, partial improvement and no improvement were similar in age, sex, radiological presentation, and co-morbidities and the presence of pulmonary tuberculosis, they were significantly different with regard to the levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration. CONCLUSIONS In management of patients suffering from tuberculosis of spine, levels of vertebral involvement, AIS grade at presentation, bladder and bowel involvement and its duration significantly affect the final neurological improvement.
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Affiliation(s)
- A Sharma
- Department of Spine Services, Indian Spinal Injuries Center, New Delhi, India.,Department of Orthopedic and Spine Surgery, Dr B R Ambedkar Central Railway Hospital, Mumbai, India
| | - H S Chhabra
- Department of Spine Services, Indian Spinal Injuries Center, New Delhi, India
| | - T Chabra
- Department of Spine Services, Indian Spinal Injuries Center, New Delhi, India
| | - R Mahajan
- Department of Spine Services, Indian Spinal Injuries Center, New Delhi, India
| | - S Batra
- Department of Spine Services, Indian Spinal Injuries Center, New Delhi, India
| | - G Sangondimath
- Department of Spine Services, Indian Spinal Injuries Center, New Delhi, India
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