Overview of the Spinal Cord Injury-Functional Index (SCI-FI): Structure and Recent Advances

Factors enabling comorbidities and secondary conditions in older adults with spinal cord injury

OBJECTIVE

To examine the role of personal, social, and environmental factors predicting comorbidities and secondary conditions among older adults with spinal cord injury (SCI).

DESIGN

Cross-sectional study utilizing survey methods were used to collect the data analyzed with two distinct general linear models.

SETTING

Community-dwelling participants who resided in rural and urban areas.

PARTICIPANTS

One hundred and eighty-three (183) participants with SCI ages 45 and over at least five years post injury.

INTERVENTIONS

Not applicable.

MEASURES

Spinal Cord Injury Secondary Conditions Scale (SCI-SCS); Comorbidities Questionnaire; Spinal Cord Injury Functional Index Assistive Technology (SCI-FI/AT) Basic - Mobility; Spinal Cord Injury Quality of Life (SCI-QOL) Satisfaction with Social Roles and Activities Scale (SSRA); Cohen's Social Network-Social Integration Index, the Medical Outcomes Study (MOS) Social Support Emotional/Informational Support Scale, and the Facilitators and Barriers Survey for Mobility (FABS-Mv2). Questions were also asked from the Behavioral Risk Factor Surveillance System (BRFSS).

RESULTS

Common predictors of comorbidities and secondary conditions included age, basic mobility, primary health care payer and parking limitations. An interaction between parking and neurological classification was observed for comorbidities. Neurological classification and employment were significantly associated with comorbidities while for secondary conditions, sex, years since injury, education, satisfaction with social roles and the home environment were critical factors.

CONCLUSIONS

Our study shows the effects of demographic and injury factors, physical functioning, satisfaction with social roles, access to home environment adaptations and health resources in predicting comorbidities and secondary conditions among older adults with SCI.

Therapeutic Lifestyle Intervention Targeting Enhanced Cardiometabolic Health and Function for Persons with Chronic Spinal Cord Injury in Caregiver/Care-Receiver Co-Treatment: A Study Protocol of a Multisite Randomized Controlled Trial

BACKGROUND

Chronic spinal cord injury (SCI) significantly accelerates morbidity and mortality, partly due to the increased risk of cardiometabolic diseases (CMD), including neurogenic obesity, dyslipidemia, and impaired glucose metabolism. While exercise and dietary interventions have shown some transient benefits in reducing CMD risk, they often fail to improve clinically relevant disease markers and cardiovascular events. Moreover, SCI also places caregiving demands on their caregivers, who themselves experience health and functional decline. This underscores the need for more substantial interventions that incorporate appropriate physical activity, heart-healthy nutrition, and behavioral support tailored to the SCI population.

OBJECTIVES

This randomized clinical trial (RCT) protocol will (1) assess the health and functional effects, user acceptance, and satisfaction of a 6-month comprehensive therapeutic lifestyle intervention (TLI) adapted from the National Diabetes Prevention Program (DPP) for individuals with chronic SCI and (2) examine the impact of a complementary caregiver program on the health and function of SCI caregivers and evaluate user acceptance and satisfaction. Caregivers (linked with their partners) will be randomized to 'behavioral support' or 'control condition'.

METHODS

Dyadic couples comprise individuals with SCI (18-65 years, >1-year post-injury, ASIA Impairment Scale A-C, injury levels C5-L1) and non-disabled SCI caregivers (18-65 years). Both groups undergo lock-step circuit resistance training, a calorie-restricted Mediterranean-style diet, and 16 educational sessions focused on diet/exercise goals, self-monitoring, psychological and social challenges, cognitive behavioral therapy, and motivational interviewing. The outcome measures encompass the cardiometabolic risks, cardiorespiratory fitness, inflammatory stress, multidimensional function, pain, life quality, independence, self-efficacy, program acceptance, and life satisfaction for SCI participants. The caregiver outcomes include multidimensional function, pain, quality of life, independence, and perceived caregiver burden.

DISCUSSION/CONCLUSIONS

This study evaluates the effects and durability of a structured, multi-modal intervention on health and function. The results and intervention material will be disseminated to professionals and consumers for broader implementation.

TRIAL REGISTRATION

ClinicalTrials.gov, ID: NCT02853149 Registered 2 August 2016.

Outcomes of Patients with Cervical Spinal Cord Injury Treated by Surgery and Their Prognostic Factors

Objective

To investigate the outcomes of patients with cervical spinal cord injury treated by surgery and their prognostic factors.

Methods

We retrospectively analyzed 139 patients with cervical spinal cord injury treated by surgery at our hospital, who were admitted between January 2017 and December 2018. Depending on the Barthel index at last follow-up, the patients were divided into the recovery group (n = 60, Barthel index > 45) and the nonrecovery group (n = 79, Barthel index ≤ 45). General information of patients in the two groups was compared. The significant factors were further introduced into the logistic regression model. The poor prognostic factors of cervical spinal cord injury treated by surgery were analyzed, and specific nursing measures were taken.

Results

There were significant differences in the duration of injury before admission, duration of injury before surgery, transportation and protection before admission, spinal canal invasion rate, and hormonal therapy within 8 h after injury between the patients achieving good postoperative recovery and those not (P < 0.05). Logistic regression analysis showed that all the factors above were prognostic factors for cervical spinal cord injury treated surgically.

Conclusion

The duration of injury before admission, duration of injury before surgery, transportation and protection before admission, spinal canal invasion rate, and hormonal therapy within 8 h after injury were prognostic factors of patients with cervical spinal cord injury treated by surgery. The following factors should be considered for favorable outcomes: spinal protection during transportation to hospital, timely hormonal shock therapy to delay injury progression, and timely surgery to relieve pain. The spine is composed of cervical, thoracic, lumbar, sacral, and caudal vertebrae.

Validation of the Spinal Cord Injury Functional Index for Use in Community-Dwelling Individuals With SCI

OBJECTIVE

To evaluate the psychometric properties of the Spinal Cord Injury Functional Index (SCI-FI) instruments in a community-dwelling sample.

DESIGN

Cross-sectional study.

SETTING

Community setting.

PARTICIPANTS

Individuals (N=269) recruited from 6 SCI Model Systems sites.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants completed computer adaptive test and short form versions of 4 SCI-FI/Capacity (C) banks (ie, Ambulation, Basic Mobility, Fine Motor, Self-Care) and 1 SCI-FI/Assistive Technology (AT) bank (Wheelchair Mobility) at baseline and after 2 weeks. The Self-Report Functional Measure (SRFM) and the clinician-rated motor FIM were used to evaluate evidence of convergent validity.

RESULTS

Pearson correlations, intraclass correlation coefficients, minimal detectable change, and Bland-Altman plots supported the test-retest reliability of the SCI-FI instruments. Correlations were large with the SRFM (.69-.89) and moderate-to-large for the FIM instrument (.44-.64), supporting convergent validity. Known-groups validity was demonstrated by a significant main effect of injury level on all instruments and a main effect of injury completeness on the SCI-FI/C instruments. A ceiling effect was detected for individuals with incomplete paraplegia on the Fine Motor/C and Self-Care/C Short Forms.

CONCLUSION

Findings support the test-retest reliability, convergent validity, and known-groups validity of the SCI-FI/C instruments and the SCI-FI/AT Wheelchair Mobility instruments for use by community-dwelling individuals.