Behavioral Factors and Unintentional Injuries After Spinal Cord Injury

Relations Between Self-Reported Prescription Hydrocodone, Oxycodone, and Tramadol Use and Unintentional Injuries Among Those With Spinal Cord Injury

OBJECTIVE

To identify the relations of 3 frequently used prescription opioids (hydrocodone, oxycodone, tramadol) with unintentional injuries, including fall-related and non-fall-related injuries among adults with chronic, traumatic spinal cord injury (SCI).

DESIGN

Cross-sectional cohort study.

SETTING

Community setting; Southeastern United States.

PARTICIPANTS

Adult participants (N=918) with chronic traumatic SCI were identified from a specialty hospital and state population-based registry and completed a self-report assessment.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Self-reported fall-related and non-fall-related unintentional injuries serious enough to receive medical care in a clinic, emergency room, or hospital within the previous 12 months.

RESULTS

Just over 20% of participants reported ≥1 unintentional injury in the past year, with an average of 2.16 among those with ≥1. Overall, 9.6% reported fall-related injuries. Only hydrocodone was associated with any past-year unintentional injuries. Hydrocodone taken occasionally (no more than monthly) or regularly (weekly or daily) was related to 2.63 (95% confidence interval [CI], 1.52-4.56) or 2.03 (95% CI, 1.15-3.60) greater odds of having ≥1 unintentional injury in the past year, respectively. Hydrocodone taken occasionally was also associated with past-year non-fall-related injuries (OR, 2.20; 95% CI, 1.12-4.31). Each of the 3 opioids was significantly related to fall-related injuries. Taking hydrocodone occasionally was associated with 2.39 greater odds of fall-related injuries, and regular use was associated with 2.31 greater odds. Regular use of oxycodone was associated with 2.44 odds of a fall-related injury (95% CI, 1.20-4.98), and regular use of tramadol was associated with 2.59 greater odds of fall-related injury (95% CI, 1.13-5.90).

CONCLUSIONS

Injury prevention efforts must consider the potential effect of opioid use, particularly hydrocodone. For preventing fall-related injuries, each of the 3 opioids must be considered.

Staying Pressure Injury Free: The Role of Modifiable Behaviors

OBJECTIVE

To investigate the association of behavioral factors with retrospective reports of staying free from pressure injuries (PIs) during a 12-month period for people with chronic spinal cord injury (SCI).

DESIGN

Cross-sectional survey.

SETTING

Data collection was completed at an academic medical center in the Southeastern United States in collaboration with a specialized treatment center and 2 public health registries that use population-based approaches to identify all incident cases of SCI within the state.

PARTICIPANTS

The participant cohort was composed of 3817 adults (N=3817) with traumatic SCI of at least 1-year duration.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Self-reported recall of staying PI-free for 12 months vs having 1 or more PIs.

RESULTS

Among the 3817 participants, 74% were male, 76% were non-Hispanic White, and mean age was 48 years, with an average of 12 years post SCI. Based on self-report assessment, 67% reported being PI-free in the past year. After controlling for the demographic and injury characteristics, we found that those in the clinical cohort and those who reported healthy diets and planned exercise at least once a week were more likely to be PI-free; being underweight and high frequency of prescription medication use for spasticity, pain, and depression were negatively associated with being PI-free. Smoking, alcohol use, nonmedical substance use, and prescription medication misuse were not statistically significant in the multivariate model.

CONCLUSIONS

There are several significant behavioral predictors of being PI-free, and consideration of these factors may be used to develop tailored strategies to promote healthy skin maintenance and the prevention of multiple, severe, and recurrent PI.

Psychoactive Substance Use Among Individuals With Chronic Spinal Cord Injury: Patterns and Characteristics

OBJECTIVE

To identify the patterns of nonprescription psychoactive substance (PAS) use among persons with spinal cord injury (SCI) and the relationships with demographic and injury characteristics.

DESIGN

Cross-sectional, self-report assessment (SRA).

SETTING

A medical university in the southeastern United States.

PARTICIPANTS

The participants (N=4670) were identified through a specialty hospital and 2 state-based surveillance registries.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants completed SRAs and reported the past 3 months' use of the following substances for which they did not have a prescription: cannabis, cocaine, amphetamine-type stimulants, inhalants, sedatives/hypnotics and sleeping pills, hallucinogens, and opioids. PAS use was grouped into 4 categories: none, cannabis use only, use of cannabis and other PAS, and use of other PAS only.

RESULTS

Of the 4577 participants who responded to the PAS use questions, 24.1% reported using at least 1 PAS without a prescription. Cannabis was the most frequently reported substance (16.4%), followed by sedatives or sleeping pills (8.0%). By PAS use group, 12.1% reported use of cannabis use only, followed by use of other PAS only (7.7%) and use of cannabis and other PAS (4.3%). There were significant differences among the groups of use by nearly all personal characteristics.

CONCLUSIONS

The use of nonprescription PASs is prevalent among adults with chronic SCI, and there are clear differences in patterns and characteristics of use.

Assistive devices and future fall-related injuries among ambulatory adults with spinal cord injury: a prospective cohort study

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.

The association between secondary health conditions and indirect costs after spinal cord injury

STUDY DESIGN

Cross-sectional.

OBJECTIVE

Identify the association between secondary health conditions (SHC) and the indirect costs of traumatic spinal cord injury (SCI) based on the pre-injury and post-injury changes in employment and earnings.

SETTING

Medical university in the southeastern United States (US).

METHODS

A population-based cohort of 304 participants met the following eligibility criteria: received treatment for acute SCI within the state, residual effects resulting from traumatic SCI, at least 1-year post injury, age between 23 and 64 years at the time of injury onset, and younger than 65 years at the time of study measurement. The indirect costs estimate was measured by the annual forgone earnings and fringe benefits calculated as the difference in the sum of earnings and benefits between before injury and after injury adjusting for inflation in 2019 US dollars. We considered seven SHC in this study: bowel accidents, urine accidents, urinary tract infections, pressure sores, unintentional injury, severe pain, and depressive disorder. We used multivariate ordinary least squares regression models to examine their relationship controlling for age, sex, race/ethnicity, marital status, years of education, injury level, and ambulatory status.

RESULTS

The indirect costs were significantly associated with the total number of SHC and with the individual conditions of bowel accidents, urine accidents, pressure sores, and depressive disorder after controlling for age, sex, race/ethnicity, marital status, years of education, injury level, and ambulatory status.

CONCLUSIONS

Preventing SHC relates to better economic consequences for individuals, their families, and society, even after accounting for differences in severity of SCI.