1
|
Bhattarai M, Shigemoto Y, Huang YC, Islam MT, Sorenson M. Mindfulness for health and wellbeing in adults with spinal cord injury: A scoping review. J Spinal Cord Med 2024:1-15. [PMID: 39007686 DOI: 10.1080/10790268.2024.2374130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/16/2024] Open
Abstract
CONTEXT Individuals with spinal cord injury (SCI) require resources to prevent or self-manage complications in order to maintain optimum functioning and well-being. Rehabilitation literature suggests that mindfulness as an internal psychological resource can play a crucial role in promoting self-management and improving health and well-being. OBJECTIVES We sought to identify and synthesize existing evidence on the role of mindfulness and mindfulness-based interventions in health and well-being outcomes among adults with SCI. METHODS We conducted a scoping review, searching evidence across four electronic databases, CINAHL, PubMed, PsycINFO, and Web of Science, for articles published between 2000 and 2023. Additional articles were searched from the reference list of identified articles. RESULTS Of 354 articles identified in the search, 20 were included in the scoping review. Thirteen studies were interventional in design, while the other seven included cross-sectional and qualitative designs. Some interventional studies examined mindfulness as the major component of the interventions, whereas other studies integrated mindfulness as one component of the intervention program. Overall, mindfulness and mindfulness-based interventions were associated with a range of health and well-being outcomes among individuals with SCI. CONCLUSIONS Mindfulness and mindfulness-based interventions appear to positively impact health and well-being in adults with SCI. However, mindfulness interventions were inconsistent in terms of content, delivery frequency, and duration. It is essential to develop multifaceted, tailored mindfulness interventions utilizing a consumer-based approach and established theories of mindfulness and mindfulness-based practices for adults with SCI.
Collapse
Affiliation(s)
- Muna Bhattarai
- College of Nursing, Texas A&M University, College Station, TX, USA
| | - Yuki Shigemoto
- Department of Psychology, Prairie View A&M University, Prairie View, TX, USA
| | - Ya-Ching Huang
- College of Nursing, Texas A&M University, College Station, TX, USA
| | | | - Matthew Sorenson
- College of Nursing, Texas A&M University, College Station, TX, USA
| |
Collapse
|
2
|
Liu W, Wang J, Chen C, Reinhardt JD. Health care needs and health services utilization of people with spinal cord injury living in Jiangsu and Sichuan provinces of China: a cross-sectional community survey. Disabil Rehabil 2024; 46:2282-2293. [PMID: 37280785 DOI: 10.1080/09638288.2023.2219903] [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: 11/29/2022] [Accepted: 05/25/2023] [Indexed: 06/08/2023]
Abstract
PURPOSE We aimed to investigate health care needs, health service utilization, and their socio-economic and health-related determinants in people with spinal cord injury (SCI) living in Jiangsu and Sichuan Provinces of China. MATERIALS AND METHODS A total of 1355 participants with SCI living in the community were recruited using a multi-stage stratified random sample and surveyed by telephone or online. Outcomes evaluated included the presence of health care needs, mode of health service utilization, and specific provider types seen within 12 months preceding the survey. RESULTS The prevalence of healthcare needs was 92%. Needs were higher in Sichuan (98%) as compared to Jiangsu (80%). Of those in need of health care, 38% reported not having utilized care, more in Sichuan (39%) than in Jiangsu (37%). In Jiangsu, inpatient care was more often used than in Sichuan (46% vs. 27%), while in Sichuan outpatient services were utilized more often (33% vs. 17%). On average, 1.6 provider types were seen, with Sichuan reporting fewer different provider types. CONCLUSIONS Considerable differences in the prevalence of health care needs and service utilization patterns were found between provinces, mostly in favour of the economically more developed Jiangsu Province.Implications for RehabilitationPeople with low income, particularly those below the World Bank poverty line for middle-income countries, had increased health care needs but utilized health care less often.Moreover, environmental barriers contributed significantly to unmet health care needs.This implies the necessity to provide better accessible and more affordable rehabilitation services for people with spinal cord injury (SCI) in China such as community-based rehabilitation programming.Policies for alleviation of poverty in the case of SCI including insurance for catastrophic health expenditure should also be reviewed and adapted where applicable.
Collapse
Affiliation(s)
- Wei Liu
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, P.R. China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, P.R. China
| | - Jiayue Wang
- Department of Rehabilitation Medicine, Jiangsu Province Hospital/Nanjing Medical University First Affiliated Hospital, Nanjing, P.R. China
| | - Chuandong Chen
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, P.R. China
- West China School of Public Health and West China Fourth Hospital, Sichuan University, Chengdu, P.R. China
| | - Jan D Reinhardt
- Institute for Disaster Management and Reconstruction, Sichuan University-The Hong Kong Polytechnic University, Chengdu, P.R. China
- Department of Rehabilitation Medicine, Jiangsu Province Hospital/Nanjing Medical University First Affiliated Hospital, Nanjing, P.R. China
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| |
Collapse
|
3
|
Kelly LC, Glinsky JV, Harvey LA. A case report of three people experiencing intractable autonomic dysreflexia following instillation of Uro-Tainer ® Polyhexanide 0.02. Spinal Cord Ser Cases 2024; 10:17. [PMID: 38580624 PMCID: PMC10997763 DOI: 10.1038/s41394-024-00626-5] [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: 04/29/2023] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Historically, bladder washouts were used to instil therapeutic reagents directly into the bladder. This practice has expanded to include instillation of solutions that deal with catheter issues such as encrustation or formation of bio-film. They appear to provide a promising strategy for people with long term catheters. These products are readily available to purchase, but there is concern that people are using these solutions without a complete understanding of the purpose for the rinse and without clinical guidance to monitor response to treatment. CASE PRESENTATION These case studies include three people living with spinal cord injury (SCI) who developed severe autonomic dysreflexia (AD) when a catheter rinse was carried out using a particular solution. Each of the cases developed immediate and, in some cases, intractable AD requiring further intervention to resolve symptoms. DISCUSSION Catheter-associated urinary tract infection is a significant cause of morbidity and mortality in people living with SCI. Long-term catheters provide a vector for opportunistic micro-organisms to form bio-film and create an environment that promotes formation of struvite calculi, thus increasing the risk of chronic catheter blockage and urinary tract infection. Whilst these solutions are used to reduce these risks, they also pose additional risks to people susceptible to AD. These cases highlight the need for judicious patient selection and clinical oversight and management of adverse events when using catheter rinse solutions in certain people living with SCI. This is supported by a decision-making algorithm and a response to AD algorithm. This case report was prepared following the CARE Guidelines (supplementary file 1).
Collapse
Affiliation(s)
- Louise C Kelly
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
- Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia.
- Northern Sydney Local Health District, Sydney, NSW, Australia.
| |
Collapse
|
4
|
Soegaard K, Sig JR, Nielsen C, Verhaeghe S, Beeckman D, Biering-Sørensen F, Sørensen JA. "I am just trying to live a life!" -a qualitative study of the lived experience of pressure ulcers in people with spinal cord injuries. J Tissue Viability 2024; 33:50-59. [PMID: 38044163 DOI: 10.1016/j.jtv.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/22/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Pressure ulcers (PUs) are frequently reported in people with spinal cord injuries (SCI). Wound management in people with SCI involves relieving pressure on the affected area by means of immobilisation and bed rest. The healing time of a PU can vary, but often takes several months or even years, causing people to stay in bed for prolonged periods of time. OBJECTIVE This study aims to explore the perspectives and lived experiences of people with SCI who are affected by PUs. DESIGN and method: This study is a qualitative explorative study that employs individual semi-structured in-depth interviews to obtain the narratives of people with SCI and a pressure ulcer. We used a phenomenological-hermeneutic approach that was inspired by Ricoeur's theory of interpretation. The analysis was performed in three levels: Naïve reading, structural analysis and critical interpretation and discussion. PARTICIPANTS and setting: Ten people with SCI who were being treated in the Danish healthcare system for their PU participated in this study: six participants had experienced a complete traumatic SCI, three had an incomplete traumatic SCI, and one had a non-traumatic complete SCI. The study included nine men and one woman, aged 49-81 years (mean 64). Nine had a PU in the seating area, while one had the ulcer on the leg. RESULTS The analysis revealed three themes: 1. Struggling to balance prevention with an active, meaningful life, 2. Challenges and consequences of pressure relief protocols and bed rest, 3. Experiencing prolonged and incoherent treatment with varying levels of staff engagement and competencies. CONCLUSIONS People with SCI and a PU have difficulty balancing their active, redefined lives when subjected to a strict pressure relief protocol. The consequences of immobility caused by pressure relief include reduced social and community participation and decreased quality of life. PU treatment is experienced as incoherent and unnecessarily lengthy, leading to a deterioration in the wounds. Improving PU treatment for people with SCI is of utmost importance and has the potential to benefit not only the people with SCI but also the healthcare system and the economy.
Collapse
Affiliation(s)
- Knaerke Soegaard
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark.
| | | | - Charlotte Nielsen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Belgium; Swedish Centre for Skin and Wound Research, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Fin Biering-Sørensen
- University of Copenhagen, Denmark; Department for Spinal Cord Injuries, NeuroScience Centre, Rigshospitalet, Denmark
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
5
|
Mashola MK, Korkie E, Mothabeng DJ. Pain medication misuse in the South African spinal cord injury context. Health SA 2024; 29:2377. [PMID: 38322368 PMCID: PMC10839206 DOI: 10.4102/hsag.v29i0.2377] [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: 03/02/2023] [Accepted: 10/31/2023] [Indexed: 02/08/2024] Open
Abstract
Background Pain after spinal cord injury (SCI) is debilitating and has been reported to be difficult to treat, despite pharmacological interventions. Pain medication misuse (PMM) and associated individual factors among people with spinal cord injury (PWSCI) are scarce. Aim To determine PMM and the associated factors in PWSCI. Setting Homes of community-dwelling manual wheelchair users with SCI in South Africa. Methods Community-dwelling PWSCI (n = 122) were consecutively sampled and the Pain Medication Questionnaire (PMQ) was used to determine PMM. Descriptive statistics, Fisher's exact test, independent t-tests, and simple linear regression tests were performed using SPSS v27. Testing was conducted at the 0.05 level of significance. Results Eighty-five per cent of the participants reported the presence of pain and 48.1% of them used pain medication. Forty-four percent of people who used pain medication scored ≥ 30, indicative of serious aberrant drug-taking behaviours. Opioids were mainly used for neuropathic pain and in combination with other types of medications such as anticonvulsants and non-steroidal anti-inflammatories (44.0%). Pain severity and the type of pain medication were found to be predictors of PMM (p < 0.01 respectively). Conclusion Pain relief after SCI remains difficult to achieve, with an evident high risk of PMM, which may lead to long-lasting side effects, dependency, or overdose. Contribution This study has shown the need for the assessment of the potential risk of dependency before prescribing pain medication, particularly opioids to PWSCI.
Collapse
Affiliation(s)
- Mokgadi K Mashola
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Elzette Korkie
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Diphale J Mothabeng
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
6
|
Conti A, Pradovera E, Luciani M, Tesio M, Casabona E, Sperlinga R, Campagna S. Experiences of people with spinal cord injuries readmitted for continence-related complications: a qualitative descriptive study. Spinal Cord 2024; 62:26-33. [PMID: 38062213 DOI: 10.1038/s41393-023-00943-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 11/22/2023] [Accepted: 11/27/2023] [Indexed: 01/13/2024]
Abstract
STUDY DESIGN Qualitative descriptive. OBJECTIVES To describe the experiences of people with Spinal Cord Injury (SCI) re-admitted to the hospital due to continence-related complications. SETTING Inpatient service of a large spinal unit in North-West of Italy. METHODS Semi-structured interviews were conducted on a purposive sample of people with SCI (n = 11; age range 22-66 years, n = 5 females, n = 6 with cervical injuries), audio-recorded, and transcribed verbatim (duration range 38-52 min). Data were analysed inductively using the thematic analysis approach as described by Braun and Clarke. RESULTS Three main themes were identified: (i) managing the frustration of continence-related complications; (ii) finding your way to deal with continence-related complications; (iii) identifying precise needs to deal with continence-related complications. Obtained findings highlighted the perceived emotional and physical burden suffered by people with SCI and their caregivers regarding the constant look for solutions and renounces to social participation, the different strategies implemented to address continence-related complications, and the unmet or partially met needs of people with SCI regarding support in transition to the community, infrastructure, and reliable information or education. CONCLUSIONS Continence-related complications have a significant impact on the lives of people with SCI and their families. Interventions using technological tools and peer participation could reduce the burden associated with continence-related complications. Specific instruments are needed to facilitate evaluation, goal setting, and promote discussion of continence to allow HCPs to support people with SCI. Structured follow-up for SCI survivors should also focus on their needs to improve knowledge, facilitate decision making, and promote preventive behaviours.
Collapse
Affiliation(s)
- Alessio Conti
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Elena Pradovera
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Michela Luciani
- Department of Medicine and Surgery, University of Milano Bicocca, Milan, Italy
| | | | - Elena Casabona
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy.
| | - Riccardo Sperlinga
- Department of Continuing Education and Training in the Health Professions, Mauriziano Hospital of Turin, Turin, Italy
| | - Sara Campagna
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| |
Collapse
|
7
|
Zeinaddini-Meymand A, Baigi V, Mousavi-Nasab MM, Shool S, Sadeghi-Naini M, Azadmanjir Z, Jazayeri SB, Berchi Kankam S, Dashtkoohi M, Shakeri A, Fakharian E, Kouchakinejad-Eramsadati L, Pirnejad H, Sadeghi-Bazargani H, Bagheri L, Pourandish Y, Amiri M, Pour-Rashidi A, Harrop J, Rahimi-Movaghar V. Pre-Hospital and Post-Hospital Quality of Care in Traumatic Spinal Column and Cord Injuries in Iran. Global Spine J 2023:21925682231202425. [PMID: 37732722 DOI: 10.1177/21925682231202425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/22/2023] Open
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES The quality of care (QoC) for spinal column/cord injury patients is a major health care concern. This study aimed to implement the QoC assessment tool (QoCAT) in the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to define the current state of pre- and post-hospital QoC of individuals with Traumatic Spinal Column and Spinal Cord Injuries (TSC/SCIs). METHODS The QoCAT, previously developed by our team to measure the QoC in patients with TSC/SCIs, was implemented in the NSCIR-IR. The pre-hospital QoC was evaluated through a retrospective analysis of NSCIR-IR registry data. Telephone interviews and follow-ups of patients with SCI evaluated the QoC in the post-hospital phase. RESULTS In the pre-hospital phase, cervical collars and immobilization were implemented in 46.4% and 48.5% of the cases, respectively. Transport time from the scene to the hospital was documented as <1 hour and <8 hours in 33.4% and 93.9% of the patients, respectively. Post-hospital indicators in patients with SCI revealed a first-year mortality rate of 12.5% (20/160), a high incidence of secondary complications, reduced access to electrical wheelchairs (4.2%) and modified cars (7.7%), and low employment rate (21.4%). CONCLUSION These findings revealed a significant delay in transport time to the first care facilities, low use of immobilization equipment indicating low pre-hospital QoC. Further, the high incidence of secondary complications, low employment rate, and low access to electrical wheelchairs and modified cars indicate lower post-hospital QoC in patients with SCI. These findings imply the need for further planning to improve the QoC for patients with TSC/SCIs.
Collapse
Affiliation(s)
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sina Shool
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Sadeghi-Naini
- Department of Neurosurgery, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Zahra Azadmanjir
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Behnam Jazayeri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Samuel Berchi Kankam
- International Neurosurgery Group (ING), Universal Scientific Education and Research Network (USERN), Tehran, Iran
| | - Mohammad Dashtkoohi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Students' Scientific Research Center (SSRC), Tehran University of Medical Sciences, Tehran, Iran
| | - Aidin Shakeri
- Department of Neurosurgery, Arak University of Medical Sciences, Arak, Iran
| | - Esmail Fakharian
- Trauma Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | | | - Habibollah Pirnejad
- Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
| | - Homayoun Sadeghi-Bazargani
- Research Center for Evidence Based Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
- Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Laleh Bagheri
- Shahid Rahnemoun Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Yasaman Pourandish
- Department of Nursing, School of Nursing, Arak University of Medical Sciences, Arak, Iran
| | - Malihe Amiri
- Department of Neurosurgery, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - James Harrop
- Department of Neurological and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran
| |
Collapse
|
8
|
King GK, Goodes LM, Hartshorn C, Thavaseelan J, Jonescu S, Watts A, Rawlins M, Woodland P, Synnott EL, Barrett T, Hayne D, Boan P, Dunlop SA. Intravesical hyaluronic acid with chondroitin sulphate to prevent urinary tract infection after spinal cord injury. J Spinal Cord Med 2023; 46:830-836. [PMID: 35792831 PMCID: PMC10446783 DOI: 10.1080/10790268.2022.2089816] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023] Open
Abstract
CONTEXT/OBJECTIVE Prevention of urinary tract infection (UTI) after spinal cord injury is an important goal. Intravesical hyaluronic acid with chondroitin sulphate (HA+CS) has been effective in preventing UTI in other settings. We aimed to demonstrate safety and feasibility of a standard treatment course of 7 intravesical HA+CS instillations over 12 weeks, in patients with acute (Arm A) and chronic (Arm B) spinal cord injury (SCI). DESIGN Follow-up of adverse events, quality of life bladder management difficulty (BMD) and bladder complication (BC) T-scores at baseline (Arm B only), 12 and 24 weeks, and symptomatic urinary tract infection (UTI). RESULTS Of 33 and 14 individuals screened, 2 and 8 participants were recruited to the study for Arm A and Arm B respectively. Of the 10 participants, 8 completed all 7 instillations. HA+CS commonly caused cloudy urine with urinary sediment which was mild and short-lived. In Arm B, a mean reduction in BMD and BC T-scores was observed from baseline (57.3 and 54.4 respectively), of 6.8 and 4.3 at 12 weeks and 1.6 and 2.8 at 24 weeks, respectively. Four participants with a history of frequent UTI in the prior 12 months did not have UTI in the 24 weeks of the study. CONCLUSIONS HA+CS was well tolerated. Recruitment was more difficult in early acute SCI; participants with chronic SCI were highly motivated to reduce UTI and manage self-administration without difficulty. Larger case-control or randomized controlled trials in patients with neurogenic bladder from SCI are warranted. TRIAL REGISTRATION ClinicalTrials.gov identifier: NCT03945110.
Collapse
Affiliation(s)
- Gabrielle K. King
- School of Biological Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Louise M. Goodes
- School of Biological Sciences, The University of Western Australia, Crawley, WA, Australia
| | | | - Jeffery Thavaseelan
- Perth Urology Clinic, Murdoch, WA, Australia
- Department of Urology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Sheryl Jonescu
- Department of Trauma, Royal Perth Hospital, Perth, WA, Australia
| | - Anne Watts
- State Rehabilitation Service, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Matthew Rawlins
- Department of Pharmacy, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Peter Woodland
- Department of Spinal Surgery, Royal Perth Hospital, Perth, WA, Australia
| | - Emma-Leigh Synnott
- State Rehabilitation Service, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Trent Barrett
- Department of Urology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Dickon Hayne
- Department of Urology, Fiona Stanley Hospital, Murdoch, WA, Australia
- UWA Medical School, The University of Western Australia, Crawley, WA, Australia
| | - Peter Boan
- Department of Infectious Diseases, Fiona Stanley Hospital, Murdoch, WA, Australia
- Department of Microbiology, Fiona Stanley Hospital, PathWest Laboratory Medicine WA, Murdoch, WA, Australia
| | - Sarah A. Dunlop
- School of Biological Sciences, The University of Western Australia, Crawley, WA, Australia
- Minderoo Foundation, Perth, WA, Australia
| |
Collapse
|
9
|
Furlan JC, Furlan DT, Marquez-Chin C. Progress Report on the Spinal Cord Rehabilitation Research Initiatives Based on Registered Clinical Studies From 2000 to 2022. Am J Phys Med Rehabil 2023; 102:755-763. [PMID: 36928768 DOI: 10.1097/phm.0000000000002207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to: (1) Identify the most common trends and features of research studies on spinal cord rehabilitation, which were registered in the ClinicalTrials.gov Website between 2000 and 2022; (2) Discuss the main limitations of research on spinal cord rehabilitation, based on the protocols published on the ClinicalTrials.gov Website; and (3) Recognize important knowledge gaps in clinical studies on spinal cord rehabilitation that were registered in the ClinicalTrials.gov Website. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Collapse
Affiliation(s)
- Julio C Furlan
- From the Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Canada (JCF); KITE Research Institute, University Health Network, Toronto, Canada (JCF, CM-C); Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada (JCF); Institute of Medical Science, University of Toronto, Toronto, Canada (JCF); Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada (JCF); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada (JCF); Faculty of Arts and Science, University of Toronto, Toronto, Canada (DTF); and Institute of Biomedical Engineering, University of Toronto, Toronto, Canada (CM-C)
| | | | | |
Collapse
|
10
|
Lee SB, Oh YT, Yang SW, Kim JB. Data-Driven Smart Living Lab to Promote Participation in Rehabilitation Exercises and Sports Programs for People with Disabilities in Local Communities. SENSORS (BASEL, SWITZERLAND) 2023; 23:2761. [PMID: 36904962 PMCID: PMC10006891 DOI: 10.3390/s23052761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Patients discharged from hospitals after an inpatient course of medical treatment for any ailment or traumatic injury that results in disabling conditions and are rendered mobility impaired require ongoing systematic sports and exercise programs to maintain healthy lifestyles. Under such circumstances, a rehabilitation exercise and sports center, accessible throughout local communities, is critical for promoting beneficial living and community participation for these individuals with disabilities. An innovative data-driven system equipped with state-of-the-art smart and digital equipment, set up in architecturally barrier-free infrastructures, is essential for these individuals to promote health maintenance and overcome secondary medical complications following an acute inpatient hospitalization or suboptimal rehabilitation. A federally funded collaborative research and development (R&D) program proposes to build a multi-ministerial data-driven system of exercise programs using a smart digital living lab as a platform to provide pilot services in physical education and counseling with exercise and sports programs for this patient population. We describe the social and critical aspects of rehabilitating such a population of patients by presenting a full study protocol. A modified sub-dataset of the previously generated 280-item full dataset is applied using a data-collecting system-"The Elephant"-as an example of how data acquisition will be achieved to assess the effects of lifestyle rehabilitative exercise programs for people with disabilities.
Collapse
Affiliation(s)
- Seung Bok Lee
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
| | - Yim Taek Oh
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
- Frontier Research Institute for Convergence Sports Science, Yonsei University, Seoul 03722, Republic of Korea
| | - Seung Wan Yang
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
| | - Jong Bae Kim
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
- Department of Occupational Therapy, College of Health Sciences, Yonsei University, Wonju 26493, Republic of Korea
| |
Collapse
|
11
|
Lee SB, Oh YT, Yang SW, Kim JB. Data-Driven Smart Living Lab to Promote Participation in Rehabilitation Exercises and Sports Programs for People with Disabilities in Local Communities. SENSORS 2023; 23:2761. [DOI: https:/doi.org/10.3390/s23052761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2023]
Abstract
Patients discharged from hospitals after an inpatient course of medical treatment for any ailment or traumatic injury that results in disabling conditions and are rendered mobility impaired require ongoing systematic sports and exercise programs to maintain healthy lifestyles. Under such circumstances, a rehabilitation exercise and sports center, accessible throughout local communities, is critical for promoting beneficial living and community participation for these individuals with disabilities. An innovative data-driven system equipped with state-of-the-art smart and digital equipment, set up in architecturally barrier-free infrastructures, is essential for these individuals to promote health maintenance and overcome secondary medical complications following an acute inpatient hospitalization or suboptimal rehabilitation. A federally funded collaborative research and development (R&D) program proposes to build a multi-ministerial data-driven system of exercise programs using a smart digital living lab as a platform to provide pilot services in physical education and counseling with exercise and sports programs for this patient population. We describe the social and critical aspects of rehabilitating such a population of patients by presenting a full study protocol. A modified sub-dataset of the previously generated 280-item full dataset is applied using a data-collecting system—“The Elephant”—as an example of how data acquisition will be achieved to assess the effects of lifestyle rehabilitative exercise programs for people with disabilities.
Collapse
Affiliation(s)
- Seung Bok Lee
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
| | - Yim Taek Oh
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
- Frontier Research Institute for Convergence Sports Science, Yonsei University, Seoul 03722, Republic of Korea
| | - Seung Wan Yang
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
| | - Jong Bae Kim
- Yonsei Enabling Science and Technology Research Center, Seoul 26493, Republic of Korea
- Korea Wheelchair Rugby Association, Seoul 05540, Republic of Korea
- Department of Occupational Therapy, College of Health Sciences, Yonsei University, Wonju 26493, Republic of Korea
| |
Collapse
|
12
|
Causes and length of stay of readmission among individuals with traumatic spinal cord injury: a prospective observational cohort study. Spinal Cord 2023:10.1038/s41393-023-00874-6. [PMID: 36841915 DOI: 10.1038/s41393-023-00874-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Secondary conditions may reduce function and participation in individuals with chronic Spinal Cord Injury (SCI). The knowledge of reasons for readmission to the hospital may be enlightening to prevent them and remodel the health services. STUDY DESIGN Multicenter prospective observational study of all consecutive readmissions of persons with SCI after rehabilitation completion. OBJECTIVES To explore the characteristics of individuals with SCI readmitted to the hospital, the reasons for readmissions and the burden on hospitalization in terms of length of stay (LoS) for different conditions. SETTING 31 Italian specialized SCI centers. METHODS Data on people with traumatic SCI readmitted to SCI centers were recorded about: age, sex, SCI level and severity group, geographical origin, readmission causes, clinical interventions during hospitalization, LoS and discharge destination. Linear and multiple logistic regression analyses were performed considering LoS (days) as dependent variable for correlations with independent variables. All tests were two-sided. RESULTS Among 1039 persons with traumatic SCI enrolled (mean age 46, males 85%, tetraplegia 43%), 59.09% of the readmissions were caused by urological problems, 39.74% by pressure injury and 35.41% by spasticity (68% readmitted for ≥2 causes, associated with longer LoS). The mean LoS was 48 days: pressure injury, rehabilitative needs, sexual, bowel, and pain problems were associated with longer and urological problems with shorter LoS. People from the South of the country were frequently (68%) readmitted to the northern centers. CONCLUSIONS Urological problems, pressure injury and spasticity were the most frequent causes of re-hospitalization in individuals with traumatic SCI. The migration trend seeking SCI-specific treatments suggests geographic areas to which health care organizations need to pay more attention.
Collapse
|
13
|
Unplanned hospital admissions due to secondary health conditions after spinal cord injury: a population-based description of determinants of length of stay. Spinal Cord 2023; 61:290-295. [PMID: 36782017 DOI: 10.1038/s41393-023-00880-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Abstract
STUDY DESIGN Population-based prospective study. OBJECTIVES To provide a population-based description of length of stay (LOS) and person-related risk factors following unplanned hospital admission due to a secondary health condition (SHC) in persons with spinal cord injury (SCI). SETTING Specialized SCI hospital and rehabilitation center in Switzerland. METHODS Descriptive analysis of LOS using routine clinical data of persons with SCI, who were acutely hospitalized between 01.01.2017-30.06.2018. Multivariable regression analysis was used to derive marginal predictions of LOS by acute SHCs and person characteristics. RESULTS The study included 183 persons, 83% were male, and the median age was 57 years (interquartile range, IQR, 49-67 years). SCI cause was traumatic in 160 (88.4%) cases, 92 (50.3%) were persons with tetraplegia, 147 (80.3%) were classified as motor complete lesions (American Spinal Injury Association Impairment Scale (AIS) A or B) and median time since injury (TSI) was 24 (IQR 13-34) years. Median LOS was 19 (IQR 9-39) days, varying from 74 (IQR 39-92) days for pressure ulcers, 13 (IQR 8-24) days for urinary tract infections (UTI), to 27 (IQR 18-47) days for fractures. LOS was prolonged in persons with multiple co-morbidities or those developing complications during hospitalization. Sex, SCI etiology and lesion level were not associated with LOS. CONCLUSIONS This population-based description identified substantial variation in LOS between acute SHCs and clinical complications as the main, potentially modifiable, person-related risk factors for extended hospital stay.
Collapse
|
14
|
Furlan JC, Loh E, Boulos MI. The potential effects of untreated sleep-related breathing disorders on neuropathic pain, spasticity, and cardiovascular dysfunction following spinal cord injury: A cross-sectional prospective study protocol. PLoS One 2023; 18:e0282860. [PMID: 37130111 PMCID: PMC10153696 DOI: 10.1371/journal.pone.0282860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 02/13/2023] [Indexed: 05/03/2023] Open
Abstract
INTRODUCTION Sleep-related breathing disorders (SRBDs), neuropathic pain, spasticity and cardiovascular autonomic dysfunction are common after spinal cord injury (SCI). Prior studies suggest that systemic inflammation following SCI may be implicated in the development of neuropathic pain, spasticity and cardiovascular dysfunction. Given that SRBDs also cause a systemic inflammatory response, we hypothesized that individuals with SCI who develop more severe SRBDs would experience more intense neuropathic pain, more severe spasticity and more significant cardiovascular autonomic dysfunction. METHODS This cross-sectional prospective study will explore the previously understudied hypothesis that SRBDs are associated with increased neuropathic pain, spasticity, and cardiovascular autonomic dysfunction in adult individuals with low-cervical/high-thoracic (injury level at C5 to T6), complete/incomplete (ASIA Impairment Scale A, B, C or D) SCI. DISCUSSION To our knowledge, no prior study has addressed this clinically relevant question on whether the degree of SRBDs affects the intensity of neuropathic pain, spasticity, and cardiovascular autonomic dysfunction in individuals with SCI. We anticipate that the results of this original study will provide key information for a future clinical trial on the use of continuous positive airway pressure (CPAP) therapy for moderate-to-severe SRBDs, which may better control neuropathic pain, spasticity, and cardiovascular autonomic dysfunction among individuals with SCI. TRIAL REGISTRATION The research protocol for this study was registered in the ClinicalTrials.gov website (NCT05687097). https://clinicaltrials.gov/ct2/show/NCT05687097.
Collapse
Affiliation(s)
- Julio Cesar Furlan
- Toronto Rehabilitation Institute, Lyndhurst Centre, University Health Network, Toronto, Ontario, Canada
- KITE Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Eldon Loh
- Department of Physical Medicine and Rehabilitation, University of Western Ontario, London, ON, Canada
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Mark Iskander Boulos
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Sunnybrook Research Institute and Sunnybrook Health Sciences Centre, Hurvitz Brain Sciences Research Program, Toronto, ON, Canada
- Department of Medicine, Division of Neurology, University of Toronto, Toronto, ON, Canada
| |
Collapse
|
15
|
Korkmaz N, Yardimci G, Ülgen E, Köroğlu Ö, Yilmaz B. Evaluation of secondary complication awareness among individuals with spinal cord injury. Int J Rehabil Res 2022; 45:311-318. [PMID: 36083580 DOI: 10.1097/mrr.0000000000000544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Secondary complications (SCs) are common and cause high morbidity and mortality in individuals with spinal cord injury (SCI). There is no information or a satisfactory scale of measurement for evaluating the opinions of individuals with SCI on whether they have sufficient knowledge about these complications. This study aimed to evaluate the opinions of individuals with SCI about whether they have sufficient information on SCI-related SCs. Demographic and clinical characteristics of 64 SCI individuals were recorded. A questionnaire was applied to evaluate the opinions of the participants and whether they have sufficient information about SCs before and after a multidisciplinary rehabilitation for SCI. A test was performed to measure the knowledge level at admission to the hospital and discharge. The mean value of the total questionnaire score, which was 6.2 at admission, increased to 7.91 at discharge ( P < 0.001). All subgroup scores of the questionnaire were higher at discharge than at admission (all P < 0.05). Total, neurogenic bladder, neurogenic bowel and spasticity test scores increased at discharge compared to admission (all P < 0.05). There is a relationship between the change in questionnaire scores and some demographic and injury characteristics. The opinions of the individuals with SCI on having sufficient information about SCs and their knowledge levels increased after a multidisciplinary rehabilitation program. Applying such a questionnaire and test at admission may have increased the awareness of the participants about SCs and contributed to a higher level of knowledge and opinion.
Collapse
Affiliation(s)
- Nurdan Korkmaz
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital and
| | - Gokhan Yardimci
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital and
| | - Esra Ülgen
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Gaziler Physical Medicine and Rehabilitation Training and Research Hospital and
| | - Özlem Köroğlu
- Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Gaziler Training and Research Hospital, Ankara, Turkey
| | - Bilge Yilmaz
- Department of Physical Medicine and Rehabilitation, Gulhane School of Medicine, University of Health Sciences, Gaziler Training and Research Hospital, Ankara, Turkey
| |
Collapse
|
16
|
Krause JS, Cao Y, DiPiro ND. The Relationship of Secondary and Chronic Health Conditions With Emergency Department Visits and Related Hospitalizations Among People With Traumatic Spinal Cord Injury. Arch Phys Med Rehabil 2022; 103:2338-2344. [PMID: 35644216 DOI: 10.1016/j.apmr.2022.05.004] [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: 03/30/2022] [Revised: 05/02/2022] [Accepted: 05/03/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Identify the relationship of health conditions with self-reported emergency department (ED) visits and ED-related hospitalizations among people with traumatic spinal cord injury (SCI), while controlling for demographic, injury, and socioeconomic factors. DESIGN Cross-sectional. SETTING A regional SCI model system in the Southeastern United States. PARTICIPANTS Participants (N=648) were adults with chronic traumatic SCI at least 1 year postinjury who were identified through their Form II annual follow-up within the SCI Model Systems. INTERVENTIONS N/A. MAIN OUTCOME MEASURES Self-reported ED visits and ED-related hospitalizations within the 12 months prior to the study. RESULTS Several types of factors were significantly related to ED visits, with fewer related to ED hospitalizations. Men (odds ratio [OR]=1.58); those divorced, widowed, or separated (OR=1.57); and those with more severe SCI (C1-C4, or American Spinal Injury Association Impairment Scale A/B) had greater odds of having at least 1 ED visit; education and employment factors were not significant. Of health conditions, acute secondary health conditions including falls (OR=1.45), urinary tract infections (UTIs; OR=2.40), and pressure injuries (OR=1.58) were all associated with a greater odds of ED visits, whereas chronic health conditions were not. Being unemployed was associated with greater odds of an ED hospitalization (OR=1.79), as was having at least 1 UTI (OR=2.24) and at least 1 pressure injury (OR=2.37). CONCLUSIONS The current findings suggest acute secondary health conditions, particularly UTIs and pressure injuries, were much more highly related to ED visits and related hospitalizations compared to chronic health conditions (eg, diabetes, hypertension). Greater attention needs to be paid to fall, UTI, and pressure injury prevention to reduce the ED burden related to SCI.
Collapse
Affiliation(s)
- James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC.
| | - Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Nicole D DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
17
|
Cao Y, DiPiro ND, Krause JS. The relationship between health behaviors and emergency department visits and hospitalizations after traumatic spinal cord injury. Spinal Cord 2022; 60:428-434. [PMID: 35322166 DOI: 10.1038/s41393-022-00791-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 03/08/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVE To identify demographic, injury, and behavioral predictors of emergency department (ED) visits and ED-related hospitalizations among individuals with chronic traumatic spinal cord injury (SCI). SETTING An academic medical center in the Southeastern United States. METHODS 4057 participants who were at least 18 years of age and 1 year post traumatic SCI with residual neurologic impairment were identified from three cohorts: a rehabilitation specialty hospital in the Southeastern USA and two SCI Surveillance System Registries, one in the Midwestern and one in the Southeastern USA. The participants completed a self-reported assessment on ED visits and ED hospitalizations (yes/no) in the past 12 months. Logistic regression models were used to examine the relationship between ED visits/hospitalizations and eight behavioral indicators, including body weight, healthy diet, drinking, smoking, non-medical substance usage, prescription medication usage, prescription medication misuse, and the planned exercise. RESULTS During the study period, 41% of participants reported having at least one ED visit and 21% participants reported hospitalization after ED visit in the past 12 months. High frequency of prescription medication usage, prescription medication misuse, and lack of planned exercise were associated with greater odds of at least one ED visit and at least one ED-related hospitalization, while smoking was only associated with ED visits. CONCLUSIONS Health care professionals should be aware that ED visit and related hospitalization prevalence remain high among people with chronic SCI, and there is significant need for intervention of managing risk behaviors and promoting healthy behaviors after SCI.
Collapse
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
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
18
|
Mashola MK, Korkie E, Mothabeng DJ. The presence of pain in community-dwelling South African manual wheelchair users with spinal cord injury. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2022; 78:1600. [PMID: 35281780 PMCID: PMC8905372 DOI: 10.4102/sajp.v78i1.1600] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/23/2021] [Indexed: 11/15/2022] Open
Abstract
Background Pain after spinal cord injury (SCI) is common and is likely to continue throughout life with varying levels of severity. Objective To determine the presence of pain, the sociodemographic and injury profile of community-dwelling manual wheelchair users. Method This quantitative correlational study used a sociodemographic and injury profile sheet and the Douleur Neuropathique 4 Questions (DN4) questionnaire to document demographic, SCI profiles as well as pain characteristics. Pain severity was determined using the Numeric Rating Scale. Data were analysed using the Statistical Package for the Social Sciences (SPSS) v27 at 0.05 level of significance. Results The pain rate was 104; 85% of 122 participants and mainly in those with complete SCI (77.9%). Neuropathic pain was more common (76; 62.5%) and significantly associated (p < 0.05) with higher pain severity. Pain was mainly in one area of the body (59; 48.4%) but occurring in up to five areas. The most painful area had a mean severity of 6.7/10; was more common in the lower limbs below the injury level (48; 39.4%); and was burning in nature (40; 32.7%). Conclusions Pain after SCI is as problematic in the South African context as it is globally. With the rising SCI prevalence in the country, understanding pain and its presentation is important for holistic management of a person with SCI. Clinical implications In-depth assessment of pain should be conducted and appropriate management interventions for specific pain types be prescribed to effectively reduce pain.
Collapse
Affiliation(s)
- Mokgadi K Mashola
- Department of Physiotherapy, Faculty of Health Science, University of the Witwatersrand, Johannesburg, South Africa
- Department of Physiotherapy, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
| | - Elzette Korkie
- Department of Physiotherapy, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
| | - Diphale J Mothabeng
- Department of Physiotherapy, Faculty of Health Science, University of Pretoria, Pretoria, South Africa
| |
Collapse
|
19
|
Furlan JC, Furlan DT, Marquez-Chin C. A Scoping Review of Registered Clinical Studies on Management of Individuals With Acute Spinal Cord Injury (2000-2020): Trends and Characteristics of the Research Initiatives. Am J Phys Med Rehabil 2022; 101:184-190. [PMID: 35026781 DOI: 10.1097/phm.0000000000001811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT This scoping review examined the current trends and characteristics of the clinical research initiatives on the management of acute spinal cord injury. This review included all clinical studies on the acute treatment of spinal cord injury that were registered in the ClinicalTrials.gov website from February 2000 to December 2020. The search strategy combined the terms "acute spinal cord injury" and "treatment." There has been a gradual increase in the number of registered clinical studies on acute treatment of spinal cord injury over the past two decades. Of the 116 studies, there were 103 interventional studies, 12 observational studies, and 1 registry. While 115 clinical studies recruited male and female participants, most of the registered clinical studies included only adults with an upper age limit after spinal cord injury. Most of the registered clinical studies were interventional studies led by single institutions in North America (n = 70), Europe (n = 29), and Asia (n = 15). Most of the research initiatives were interventional studies on new therapies for management of individuals with spinal cord injury (n = 91). In conclusion, the results of this scoping review suggest that although there has been an increase in the amount and diversity of the research initiatives on treatment of acute spinal cord injury over the past two decades, their generalizability remains relatively limited.
Collapse
Affiliation(s)
- Julio C Furlan
- From the Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada (JCF); KITE-Research Institute, University Health Network, Toronto, Ontario, Canada (JCF, DTF, CM-C); Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada (JCF); Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada (JCF); Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada (JCF); Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada (JCF); and Institute of Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada (CM-C)
| | | | | |
Collapse
|
20
|
Developing a consensus on the core educational content to be acquired by people with spinal cord injuries during rehabilitation: findings from a Delphi study followed by a Consensus Conference. Spinal Cord 2021; 59:1187-1199. [PMID: 34108615 DOI: 10.1038/s41393-021-00652-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/28/2021] [Accepted: 05/28/2021] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN Three-round Delphi study followed by a Consensus Conference with selected stakeholders. OBJECTIVES To identify a set of core educational content that people with spinal cord injury (SCI) need to acquire during rehabilitation. SETTING The Delphi study was performed electronically. The Consensus Conference was held at the Città della Salute e della Scienza University Hospital of Turin, Italy. METHODS A panel of 20 experts (healthcare professionals and SCI survivors) participated in a three-round Delphi study. In round 1, arguments for core educational content were solicited and reduced into items. In rounds 2 and 3, a five-point Likert scale was used to find consensus on and validate core educational content items (threshold for consensus and agreement: 60% and 80%, respectively). A Consensus Conference involving 32 stakeholders was held to discuss, modify (if appropriate) and approve the list of validated items. RESULTS The 171 arguments proposed in round 1 were reduced into 74 items; 67 were validated in round 3. The Consensus Conference approved a final list of 72 core educational content items, covering 16 categories, which were made into a checklist. CONCLUSIONS Consensus was achieved for a set of core educational content for people with SCI. The resultant checklist could serve as an assessment tool for both healthcare professionals and SCI survivors. It can also be used to support SCI survivors' education, streamline resource use and bridge the gap between information provided during rehabilitation and information SCI survivors need to function in the community.
Collapse
|
21
|
van Diemen T, Verberne DPJ, Koomen PSJ, Bongers-Janssen HMH, van Nes IJW. Interdisciplinary follow-up clinic for people with spinal cord injury: a retrospective study of a carousel model. Spinal Cord Ser Cases 2021; 7:86. [PMID: 34580276 DOI: 10.1038/s41394-021-00451-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Explorative retrospective cohort study. OBJECTIVE Secondary health conditions (SHCs) are common in people with spinal cord injury (SCI). To date, little is known about the effectiveness of long-term follow-up care in preventing SHCs. The objective of this study was to explore the therapeutic content of an interdisciplinary follow-up clinic by retrospective analyses of provided recommendations and collected data concerning SHCs. SETTING Rehabilitation center Sint Maartenskliniek, The Netherlands. METHODS All people with SCI, who visited one or more outpatient interdisciplinary follow-up clinics between January 2012 and October 2020 were included in this study. Treatment information was retrieved from their medical records. RESULTS The 264 participants of the follow-up clinic received, after their first visit, an average of 3.9 recommendations regarding SHCs. Most recommendations were preventive in nature (43%), and were related to physical SHCs (61%). Most recommendations were followed by the participants (34% out of 40% that could be determined) and half of the underlying problems were solved (31% out of 62%). The bodyweight and respiratory function remained stable over time. CONCLUSION Participants of the interdisciplinary follow-up clinics received extensive recommendations on a variety of subjects, which most likely, reflects the interdisciplinary approach. Recommendations were followed-up to a large extent, resulting in solving half of the underlying SHCs. This way, worse SHCs were prevented by the recommendations. This findings, together with the stability of respiratory function and bodyweight, suggests the added value of the interdisciplinary follow-up clinic to usual care. More prospective research is necessary to investigate the (cost-)effectiveness.
Collapse
Affiliation(s)
- Tijn van Diemen
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands.
| | - Daan P J Verberne
- Department of Neurorehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Patrick S J Koomen
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Ilse J W van Nes
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| |
Collapse
|
22
|
Self-care in spinal cord injuries inventory (SC-SCII) and self-care self-efficacy scale in spinal cord injuries (SCSES-SCI): development and psychometric properties. Spinal Cord 2021; 59:1240-1246. [PMID: 34455422 DOI: 10.1038/s41393-021-00702-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 08/18/2021] [Accepted: 08/20/2021] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Validation cross-sectional study. OBJECTIVES To develop and assess the psychometric properties of two instruments based on the middle-range theory of self-care in chronic illness: the Self-Care in Spinal Cord Injuries Inventory (SC-SCII) and the Self-Care Self-Efficacy Scale in Spinal Cord Injuries (SCSES-SCI). SETTING Multicenter study in five spinal units across Italy and Ireland. METHODS Instrument development was based on self-care behaviours identified in the scientific literature. Behaviours were grouped into four dimensions during a consensus conference: self-care maintenance, self-care monitoring, self-care management and self-care self-efficacy. Sixty-seven items were subsequently generated based on these dimensions. A multidisciplinary group of 40 experts evaluated content validity. Dimensionality of the final items was tested by confirmatory factor analyses (CFA) with a sample of 318 participants. Internal consistency and test-retest reliability were evaluated for each dimension. Construct validity was assessed using correlations between items and scoring differences amongst participants with more severe conditions and secondary complications. RESULTS Content validity of the SC-SCII and SCSES-SCI was satisfactory for thirty-five of the previously generated items, which were further refined. CFA showed comparative fit indexes ranging from 0.94 to 0.97 and root mean square errors of approximation from 0.03 to 0.07. Internal consistency ranged from 0.71 to 0.85, and intraclass correlation coefficients were higher than 0.70. Correlations among dimensions were moderate, and the theoretical hypotheses formulated when designing the instruments were largely confirmed. CONCLUSIONS The SC-SCII and the SCSES-SCI represent valid and reliable theoretically-grounded instruments to assess self-care in people with spinal cord injury.
Collapse
|
23
|
Cao Y, DiPiro ND, Field-Fote E, Krause JS. Emergency Department Visits, Related Hospitalizations, and Reasons for Emergency Department Utilization After Traumatic Spinal Cord Injury. Arch Phys Med Rehabil 2021; 103:722-728. [PMID: 34058155 DOI: 10.1016/j.apmr.2021.02.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Revised: 02/15/2021] [Accepted: 02/19/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify the self-reported frequency of emergency department (ED) visits, ED-related hospitalizations, and reasons for ED visits among people with traumatic spinal cord injury (SCI) and compare them with general population data from the same geographic area. DESIGN Cross-sectional. SETTING A specialty hospital in the Southeastern United States. PARTICIPANTS The participants (N=648) were community-dwelling adults (18 years and older) with a traumatic SCI, who were at least 1 year postinjury. A comparison group of 9728 individuals from the general population was retrieved from the 2017 National Health Interview Survey (NHIS). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants completed self-report assessments on ED visits, ED hospitalizations, and reasons for ED visits in the past 12 months using items from the NHIS. RESULTS A total of 37% of participants with SCI reported at least 1 ED visit, and 18% reported at least 1 ED hospitalization in the past 12 months. Among those having at least 1 ED visit, 49% were admitted to hospitals. After controlling for sex, age, and race/ethnicity, participants with SCI were 151% more likely to visit the ED (odds ratio [OR], 2.51) and 249% more likely to have at least 1 ED hospitalization than the NHIS sample (OR, 3.49). Persons with SCI had a higher percentage of ED visits because of severe health conditions, reported an ED was the closest provider, and were more likely to arrive by ambulance. NHIS participants were more likely to visit the ED because no other option was available. CONCLUSIONS Compared with those in the general population, individuals with SCI have substantially higher rates of ED visits, yet ED visits are not regularly assessed within the SCI Model Systems. ED visits may indicate the need for intervention beyond the acute condition leading directly to the ED visits and an opportunity to link individuals with resources needed to maintain function in the community.
Collapse
Affiliation(s)
- Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Nicole D DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | | | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC.
| |
Collapse
|
24
|
Goldstine J, Knox K, Beekman J, Cobussen-Boekhorst H, Conti A, Gray M, Inglese G, England A, Rodriguez G, Stanley J, Vaughn S, Howlett SE, Rockwood K. A Patient-Centric Tool to Facilitate Goal Attainment Scaling in Neurogenic Bladder and Bowel Dysfunction: Path to Individualization. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:413-420. [PMID: 33641776 DOI: 10.1016/j.jval.2020.10.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 09/30/2020] [Accepted: 10/30/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES People with neurogenic bladder and/or bowel dysfunction experience diverse challenges that can be difficult to evaluate with standardized outcome measures. Goal attainment scaling (GAS) is an individualized, patient-centric outcome measure that enables patients/caregivers to identify and track their own treatment goals. Because creating goals de novo can be cumbersome, we aimed to develop a neurogenic bladder/bowel dysfunction goal menu to facilitate goal attainment scaling uptake and use. METHODS We conducted a workshop with 6 expert clinicians to develop an initial menu. Individual interviews with 12 people living with neurogenic bladder and/or bowel dysfunction and 2 clinician panels with 5 additional experts aided us in refining the menu. A thematic framework analysis identified emergent themes for analysis and reporting. RESULTS Interview participants were adults (median = 36 years, range 25-58), most with spinal cord injury (75%; 9/12). Of 24 goals identified initially, 2 (8%) were not endorsed and were removed, and 3 goals were added. Most participants listed "Impact on Life" goals (eg, Exercise, Emotional Well-Being) among their 5 most important goals (58%; 35/60). Three main themes emerged: challenges posed by incontinence, limitations on everyday life, and need for personalized care. CONCLUSIONS We developed a clinical outcome assessment tool following a multistep process of representative stakeholder engagement. This patient-centric tool consists of 25 goals specific to people living with neurogenic bladder and/or bowel dysfunction. Asking people what matters most to them can identify important constructs that clinicians might have overlooked.
Collapse
Affiliation(s)
| | - Kari Knox
- DGI Clinical Inc, Halifax, NS, Canada
| | | | | | | | - Mikel Gray
- University of Virginia, Charlottesville, VA, USA
| | | | | | | | | | | | - Susan E Howlett
- DGI Clinical Inc, Halifax, NS, Canada; Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada; Department of Pharmacology, Dalhousie University, Halifax, NS, Canada
| | - Kenneth Rockwood
- DGI Clinical Inc, Halifax, NS, Canada; Division of Geriatric Medicine, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
25
|
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.
Collapse
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
| |
Collapse
|
26
|
Nunnerley JL, Martin RA, Aldridge M, Bourke JA, Simpson I. Access to community support workers during hospital admission for people with spinal cord injury: a pilot study. Spinal Cord Ser Cases 2021; 7:3. [PMID: 33468996 DOI: 10.1038/s41394-020-00370-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN A descriptive qualitative study. OBJECTIVES To evaluate a pilot project enabling people with spinal cord injury (SCI) to have their support workers accompany them into a non-SCI specialist/public hospital (excluding ICU) to perform selected care. SETTING The study was conducted in New Zealand. METHODS Interviews and focus groups with people with SCI, support workers, care agency staff, and hospital staff who participated in the pilot project. RESULTS Twenty-five individuals participated in the study. Two themes captured participants' experiences of the pilot: 'Maintaining individualised care' and 'Role, tasks and responsibilities. Support workers were described as knowledgeable about SCI care needs and being better positioned to provide individualised care for people with SCI than general nursing staff. Participants with SCI felt less anxious having a support worker with them, and perceived less risk of acquiring secondary health complications during the hospital admission. Good communications is important to ensure there is a shared understanding of the role and responsibilities of having an unregistered support worker in the hospital environment. CONCLUSIONS Having their regular support worker during admission to public hospital improved the SCI-specific care received. Support workers reduced the demand on hospital nursing staff who did not always have the time or specialist SCI knowledge to provide individualised care. People with SCI may be more likely to access medical assistance earlier and not defer hospital admissions if they can have support workers accompany them into hospital.
Collapse
Affiliation(s)
- Joanne L Nunnerley
- Burwood Academy of Independent Living, Christchurch, New Zealand. .,Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand.
| | - Rachelle A Martin
- Burwood Academy of Independent Living, Christchurch, New Zealand.,Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Matthew Aldridge
- Burwood Academy of Independent Living, Christchurch, New Zealand
| | - John A Bourke
- Burwood Academy of Independent Living, Christchurch, New Zealand.,Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia.,Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Ian Simpson
- Burwood Academy of Independent Living, Christchurch, New Zealand
| |
Collapse
|
27
|
Eysenbach G, Buis L, Scheel-Sailer A, Brach M, Rubinelli S. Opportunities and Challenges of a Self-Management App to Support People With Spinal Cord Injury in the Prevention of Pressure Injuries: Qualitative Study. JMIR Mhealth Uhealth 2020; 8:e22452. [PMID: 33295876 PMCID: PMC7758166 DOI: 10.2196/22452] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 08/14/2020] [Accepted: 10/09/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Mobile health applications can offer tailored self-management support to individuals living with chronic health conditions. However, there are several challenges to the adoption of these technologies in practice. Co-design is a promising approach to overcoming some of these challenges by enabling the development of solutions that meet the actual needs and preferences of the relevant stakeholder groups. OBJECTIVE Taking spinal cord injury as a case in point, the overall objectives of this study were to identify the perceived benefits of a co-designed self-management app that could promote its uptake and to explore the factors that may impede adoption. METHODS We adopted a qualitative research approach guided by the Technology Acceptance Model. Data were collected through semistructured interviews with individuals with spinal cord injury (n=15) and two focus groups with health care professionals specialized in spinal cord injury (n=7, n=5). Prior to the interviews and focus groups, study participants were given time to explore the app prototype. All interviews were transcribed verbatim and analyzed using inductive thematic analysis. RESULTS Findings of our analysis indicate that study participants perceived the app prototype as potentially useful for supporting individuals with spinal cord injury in preventing pressure injuries. In particular, we identified three concrete use cases highlighting the benefits of the app for different audiences: (1) a companion for newly injured individuals, (2) an emergency kit and motivational support, and 3) a guide for informal caregivers and family members. We also uncovered several challenges that might impede the adoption of the self-management app in practice, including (1) challenges in motivating individuals to use the app, (2) concerns about the misuse and abuse of the app, and (3) organizational and maintenance challenges. CONCLUSIONS This study adds to a growing body of research that investigates individuals' adoption and nonadoption behavior regarding mobile health solutions. Building on earlier work, we make recommendations on how to address the barriers to the adoption of mobile health solutions identified by this study. In particular, there is a need to foster trust in mobile health among prospective users, including both patients and health care professionals. Moreover, increasing personal relevance of mobile health solutions through personalization may be a promising approach to promote uptake. Last but not least, organizational support also plays an instrumental role in mobile health adoption. We conclude that even though co-design is promoted as a promising approach to develop self-management tools, co-design does not guarantee adoption. More research is needed to identify the most promising strategies to promote the adoption of evidence-based mobile health solutions in practice.
Collapse
Affiliation(s)
| | | | - Anke Scheel-Sailer
- Swiss Paraplegic Center, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Mirjam Brach
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Sara Rubinelli
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| |
Collapse
|
28
|
Eysenbach G, Fiordelli M, Brach M, Bertschy S, Scheel-Sailer A, Rubinelli S. Co-designing a Self-Management App Prototype to Support People With Spinal Cord Injury in the Prevention of Pressure Injuries: Mixed Methods Study. JMIR Mhealth Uhealth 2020; 8:e18018. [PMID: 32673241 PMCID: PMC7380902 DOI: 10.2196/18018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 04/03/2020] [Accepted: 04/19/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Spinal cord injury is a complex chronic health condition that requires individuals to actively self-manage. Therefore, an evidence-based, self-management app would be of value to support individuals with spinal cord injury in the prevention of pressure injuries. OBJECTIVE The main objectives of this study were to (1) establish a co-design approach for developing a high-fidelity prototype app for the self-management of individuals with spinal cord injury, (2) design the prototype that resulted from this process, and (3) conduct the first usability assessment of the prototype app. METHODS We adopted a co-design approach to develop an evidence-based app prototype. Starting from a preliminary content model (based on clinical guidelines for the prevention of pressure injuries) and three research-based user personas, we conducted an ideation workshop involving individuals with spinal cord injury and health care professionals. The ideation workshop formed the basis for two consecutive design sprints. The result of this co-design phase was an interactive app prototype. The prototype was evaluated in two rounds of usability testing (N=4 and N=15, respectively) using a combination of qualitative and quantitative methods. RESULTS The co-design process resulted in a high-fidelity prototype with two key components: a self-management component and a communication component. The final prototype included a combination of features to support individuals with spinal cord injury in the prevention of pressure injuries, namely a smart camera, pressure injury diary, expert consultation, reminders, and knowledge repository. Findings of the usability testing showed that most participants navigated the app fluently with little back and forth navigation and were able to successfully complete a set of assigned tasks. These positive results are supported by the average system usability score achieved (78.5/100; range 47.5-95.0) and our qualitative analysis of the semistructured interviews. Despite an overall positive evaluation of the app prototype, we identified areas for improvement (eg, inclusion of a search function). CONCLUSIONS Individuals with spinal cord injury often need to navigate competing interests and priorities, paired with uncertainty about the accuracy and relevance of clinical recommendations. Understanding what matters to individuals with spinal cord injury can help guide the design of behavioral interventions that are useful and acceptable to these individuals in their daily lives. This study shows that involving individuals with spinal cord injury and health care professionals in co-designing a self-management app can foster knowledge cocreation at the intersection of lived experience, medical expertise, and technical solutions.
Collapse
Affiliation(s)
| | - Maddalena Fiordelli
- Swiss Paraplegic Research, Nottwil, Switzerland.,Institute of Communication and Health, University of Lugano, Lugano, Switzerland
| | - Mirjam Brach
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne, Switzerland
| | - Sue Bertschy
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne, Switzerland
| | | | - Sara Rubinelli
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne and Swiss Paraplegic Research, Lucerne, Switzerland
| |
Collapse
|
29
|
Conti A, Clari M, Kangasniemi M, Martin B, Borraccino A, Campagna S. What self-care behaviours are essential for people with spinal cord injury? A systematic review and meta-synthesis. Disabil Rehabil 2020; 44:991-1006. [PMID: 32602384 DOI: 10.1080/09638288.2020.1783703] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To systematically identify, evaluate, and synthesise the qualitative literature on the self-care behaviours, skills, and strategies performed by individuals with spinal cord injury (SCI).Review methods: The Joanna Briggs Institute (JBI) meta-aggregation method was followed. The search was conducted on five databases and limited to papers published from January 2000 to March 2020. Two independent reviewers screened, extracted the data from, and assessed the methodological quality of selected papers using the JBI qualitative assessment and critical appraisal instrument.Results: Eleven qualitative papers were included. Three synthesised findings with a moderate level of confidence emerged from 90 findings: people with SCI perform self-directed or directed-by-other behaviours focused on their physical condition (i); and on their social life (ii); people with SCI perform self-directed behaviours focused on their emotional well-being (iii). Individuals with SCI are aware of their condition and incorporate self-care behaviours into their routine to maintain health and prevent complications.Conclusion: This meta-synthesis provides evidence on the self-care behaviours performed by people with SCI to prevent, control, and manage the physical, emotional, and social effects of their condition. These findings may help healthcare providers to understand the self-care process in SCI survivors and tailor educational programmes to their experiences.IMPLICATIONS FOR REHABILITATIONSCI survivors are directly responsible for their health and must reach their maximum level of independence by acquiring self-care behaviours and adjusting them over time.Self-care behaviours must be incorporated into SCI survivors' daily routine to maintain their condition, promote their social participation, and prevent complications.Caregiver contributions to self-care should be given more value, as these are fundamental to maintain SCI survivors' well-being and social participation.
Collapse
Affiliation(s)
- Alessio Conti
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Marco Clari
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Barbara Martin
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Alberto Borraccino
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Sara Campagna
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| |
Collapse
|
30
|
Conti A, Clari M, Nolan M, Wallace E, Tommasini M, Mozzone S, Campagna S. The Relationship Between Psychological and Physical Secondary Conditions and Family Caregiver Burden in Spinal Cord Injury: A Correlational Study. Top Spinal Cord Inj Rehabil 2020; 25:271-280. [PMID: 31844379 DOI: 10.1310/sci2504-271] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background: Caregiver burden (CB) is a consequence of providing care to people with spinal cord injury (SCI). However, there is a lack of clarity about the influence of secondary conditions of care recipients on family caregivers. Secondary conditions refer to the physical and psychological complications that can occur after SCI and lead to increased hospitalization and reduced functionality, quality of life, and social participation. Objective: To assess the impact of physical and psychological secondary conditions of people with SCI on the perceived burden of family caregivers. Methods: A multicenter, cross-sectional study of 56 dyads of family caregivers and individuals with SCI in two urban spinal units in Italy and Ireland. Care recipients completed a toolset consisting of demographic information and assessments of functional, physical, and psychological health. Caregivers completed a multidimensional measure of CB. Bivariate data analysis was used. Results: No significant differences between centers were identified. CB was found to be related to physical secondary conditions and functional independence but not to mental health of care recipients. Bladder dysfunction and urinary tract infections influenced all dimensions of CB, whereas pressure injuries influenced only the time-dependent dimension. Level and completeness of injury and duration of caregiving increased CB. Conclusion: Findings indicate the value of a reduction in secondary conditions not just for individuals with SCI but also for their family caregivers. To reduce the individual and family burden of secondary conditions, a two-pronged, multidimensional approach, focusing on self-management for care recipients and psychoeducational support for caregivers, is required.
Collapse
Affiliation(s)
- Alessio Conti
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Universita degli Studi di Torino, Torino, Italy
| | - Marco Clari
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Universita degli Studi di Torino, Torino, Italy
| | - Maeve Nolan
- The Spinal Cord System of Care Team, The National Rehabilitation Hospital, Dun Laoighire, County Dublin, Ireland
| | - Eva Wallace
- The Spinal Cord System of Care Team, The National Rehabilitation Hospital, Dun Laoighire, County Dublin, Ireland
| | - Marco Tommasini
- Spinal Unit, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Silvia Mozzone
- Spinal Unit, Città della Salute e della Scienza Hospital, Torino, Italy
| | - Sara Campagna
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Universita degli Studi di Torino, Torino, Italy
| |
Collapse
|
31
|
Beck B, Cameron PA, Braaf S, Nunn A, Fitzgerald MC, Judson RT, Teague WJ, Lennox A, Middleton JW, Harrison JE, Gabbe BJ. Traumatic spinal cord injury in Victoria, 2007-2016. Med J Aust 2020; 210:360-366. [PMID: 31055854 DOI: 10.5694/mja2.50143] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 11/26/2018] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To investigate trends in the incidence and causes of traumatic spinal cord injury (TSCI) in Victoria over a 10-year period. DESIGN, SETTING, PARTICIPANTS Retrospective cohort study: analysis of Victorian State Trauma Registry (VSTR) data for people who sustained TSCIs during 2007-2016. MAIN OUTCOMES AND MEASURES Temporal trends in population-based incidence rates of TSCI (injury to the spinal cord with an Abbreviated Injury Scale [AIS] score of 4 or more). RESULTS There were 706 cases of TSCI, most the result of transport events (269 cases, 38%) or low falls (197 cases, 28%). The overall crude incidence of TSCI was 1.26 cases per 100 000 population (95% CI, 1.17-1.36 per 100 000 population), and did not change over the study period (incidence rate ratio [IRR], 1.01; 95% CI, 0.99-1.04). However, the incidence of TSCI resulting from low falls increased by 9% per year (95% CI, 4-15%). The proportion of TSCI cases classified as incomplete tetraplegia increased from 41% in 2007 to 55% in 2016 (P < 0.001). Overall in-hospital mortality was 15% (104 deaths), and was highest among people aged 65 years or more (31%, 70 deaths). CONCLUSIONS Given the devastating consequences of TSCI, improved primary prevention strategies are needed, particularly as the incidence of TSCI did not decline over the study period. The epidemiologic profile of TSCI has shifted, with an increasing number of TSCI events in older adults. This change has implications for prevention, acute and post-discharge care, and support.
Collapse
Affiliation(s)
- Ben Beck
- Monash University, Melbourne, VIC
| | - Peter A Cameron
- Monash University, Melbourne, VIC.,The Alfred Hospital, Melbourne, VIC
| | | | - Andrew Nunn
- Monash University, Melbourne, VIC.,Victorian Spinal Cord Service, Austin Hospital, Melbourne, VIC
| | - Mark C Fitzgerald
- The Alfred Hospital, Melbourne, VIC.,National Trauma Research Institute, Melbourne, VIC
| | - Rodney T Judson
- Royal Melbourne Hospital, Melbourne, VIC.,University of Melbourne, Melbourne, VIC
| | - Warwick J Teague
- University of Melbourne, Melbourne, VIC.,Royal Children's Hospital, Melbourne, VIC.,Murdoch Children's Research Institute, Melbourne, VIC
| | | | - James W Middleton
- Kolling Institute, University of Sydney, Sydney, NSW.,Agency for Clinical Innovation, Sydney, NSW
| | - James E Harrison
- Research Centre for Injury Studies, Flinders University, Adelaide, SA
| | - Belinda J Gabbe
- Monash University, Melbourne, VIC.,Health Data Research UK, Swansea University Medical School, Swansea University, Swansea, United Kingdom
| |
Collapse
|
32
|
McIntyre A, Marrocco SL, McRae SA, Sleeth L, Hitzig S, Jaglal S, Linassi G, Munce S, Wolfe DL. A Scoping Review of Self-Management Interventions Following Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 26:36-63. [PMID: 32095066 PMCID: PMC7015175 DOI: 10.1310/sci2601-36] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To conduct a scoping review to identify what components of self-management are embedded in self-management interventions for spinal cord injury (SCI). Methods: In accordance with the approach and stages outlined by Arksey and O'Malley (2005), a comprehensive literature search was conducted using five databases. Study characteristics were extracted from included articles, and intervention descriptions were coded using Practical Reviews in Self-Management Support (PRISMS) (Pearce et al, 2016), Barlow et al (2002), and Lorig and Holman's (2003) taxonomy. Results: A total of 112 studies were included representing 102 unique self-management programs. The majority of the programs took an individual approach (52.0%) as opposed to a group (27.4%) or mixed approach (17.6%). While most of the programs covered general information, some provided specific symptom management. Peers were the most common tutor delivering the program material. The most common Barlow components included symptom management (n = 44; 43.1%), information about condition/treatment (n = 34; 33.3%), and coping (n = 33; 32.4%). The most common PRISMS components were information about condition and management (n = 85; 83.3%), training/rehearsal for psychological strategies (n = 52; 51.0%), and lifestyle advice and support (n = 52; 51.0%). The most common Lorig components were taking action (n = 62; 60.8%), resource utilization (n = 57; 55.9%), and self-tailoring (n = 55; 53.9%). Conclusion: Applying self-management concepts to complex conditions such as SCI is only in the earliest stages of development. Despite having studied the topic from a broad perspective, this review reflects an ongoing program of research that links to an initiative to continue refining and testing self-management interventions in SCI.
Collapse
Affiliation(s)
- Amanda McIntyre
- Lawson Health Research Institute, Parkwood Institute, Ontario, Canada
| | | | | | - Lindsay Sleeth
- Lawson Health Research Institute, Parkwood Institute, Ontario, Canada
| | - Sander Hitzig
- St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Ontario, Canada
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Gary Linassi
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatchewan, Canada
| | - Sarah Munce
- Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
- Department of Occupational Science and Occupational Therapy, University of Toronto
| | - Dalton L. Wolfe
- Lawson Health Research Institute, Parkwood Institute, Ontario, Canada
- Health Sciences, Western University, Ontario, Canada
| |
Collapse
|
33
|
Validation and psychometric evaluation of the Italian version of the Spinal Cord Injury Secondary Conditions Scale. Spinal Cord 2019; 58:496-503. [DOI: 10.1038/s41393-019-0384-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/15/2019] [Accepted: 11/04/2019] [Indexed: 11/08/2022]
|
34
|
Legg M, Foster M, Parekh S, Nielsen M, Jones R, Kendall E, Fleming J, Geraghty T. Trajectories of Rehabilitation across Complex Environments (TRaCE): design and baseline characteristics for a prospective cohort study on spinal cord injury and acquired brain injury. BMC Health Serv Res 2019; 19:700. [PMID: 31615532 PMCID: PMC6794776 DOI: 10.1186/s12913-019-4564-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 09/26/2019] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Trajectories of Rehabilitation across Complex Environments (TRaCE), a consented prospective cohort study, addresses a critical need to better understand access to the healthcare system after acute treatment and specialist inpatient rehabilitation for acquired disability. It is expected that this study will produce new knowledge on access to healthcare through the linkage of administrative, survey, and spatial datasets on the one cohort. This paper outlines the study design and baseline characteristics of the cohort. METHODS The TRaCE cohort is comprised of 165 inpatients who are currently being followed up for 12 months after discharge from specialist rehabilitation for acquired brain injury (ABI) and spinal cord injury (SCI). This project combines a data linkage framework on health service use with a prospective survey on psychosocial wellbeing, geographical information systems to examine spatial accessibility to services, and qualitative interviews with a sub-cohort on experiences of service access. CONCLUSION Ultimately, TRaCE will have strong translational impact on strategies for more targeted interventions to improve the healthcare system and support individuals with acquired disabilities in the long-term.
Collapse
Affiliation(s)
- Melissa Legg
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Michele Foster
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Sanjoti Parekh
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Mandy Nielsen
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Rachel Jones
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Elizabeth Kendall
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| |
Collapse
|
35
|
Dukes EM, Kirshblum S, Aimetti AA, Qin SS, Bornheimer RK, Oster G. Relationship of American Spinal Injury Association Impairment Scale Grade to Post-injury Hospitalization and Costs in Thoracic Spinal Cord Injury. Neurosurgery 2019; 83:445-451. [PMID: 28945855 PMCID: PMC6096161 DOI: 10.1093/neuros/nyx425] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 07/11/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The lifetime economic burden of thoracic spinal cord injury (SCI) is known to be high, but evidence of variability of costs in relation to the American Spinal Injury Association Impairment Scale (AIS) grade is limited. OBJECTIVE To estimate lifetime economic costs of hospitalization by AIS grade in thoracic SCI. METHODS Using SCI Model Systems data from January 2000 to March 2016 from the National Spinal Cord Injury Statistical Center, we estimated mean total annual days of all-cause hospitalization by AIS grade among persons with thoracic SCI, based on assessments 1, 5, and 10 yr post-injury. We combined this information with secondary cost data and projections of life expectancy to estimate lifetime economic costs of hospitalization by AIS grade in persons aged 35 yr at time of thoracic SCI. Future costs were discounted to present value at 3% annually. RESULTS One year post-injury, mean total annual days of hospitalization ranged from 2.1 for persons with AIS-D injuries to 5.9 for those who were AIS-A. Similar differences were noted 5 and 10 yr post-SCI. The estimated net present value of expected lifetime costs of hospitalization following thoracic SCI at age 35 yr was $321 534, $249 514, $188 989, and $68 120 (2015 US$) for AIS-A, AIS-B, AIS-C, and AIS-D injuries, respectively. CONCLUSION Persons with less severe thoracic SCI, as reflected in AIS grade, spend fewer days in hospital over their lifetimes, leading to lower costs of inpatient care. Therapies improving AIS grade following thoracic SCI may provide cost savings in addition to addressing substantial unmet need.
Collapse
Affiliation(s)
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersey.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, New Jersey
| | | | - Sarah S Qin
- Policy Analysis Inc (PAI), Brookline, Massachusetts
| | | | - Gerry Oster
- Policy Analysis Inc (PAI), Brookline, Massachusetts
| |
Collapse
|
36
|
Identifying Predictors of Higher Acute Care Costs for Patients With Traumatic Spinal Cord Injury and Modeling Acute Care Pathway Redesign: A Record Linkage Study. Spine (Phila Pa 1976) 2019; 44:E974-E983. [PMID: 30882757 DOI: 10.1097/brs.0000000000003021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Record linkage study using healthcare utilization and costs data. OBJECTIVE To identify predictors of higher acute-care treatment costs and length of stay for patients with traumatic spinal cord injury (TSCI). SUMMARY OF BACKGROUND DATA There are few current or population-based estimates of acute hospitalization costs, length of stay, and other outcomes for people with TSCI, on which to base future planning for specialist SCI health care services. METHODS Record linkage study using healthcare utilization and costs data; all patients aged more than or equal to 16 years with incident TSCI in the Australian state of New South Wales (June 2013-June 2016). Generalized Linear Model regression to identify predictors of higher acute care treatment costs for patients with TSCI. Scenario analysis quantified the proportionate cost impacts of patient pathway modification. RESULTS Five hundred thirty-four incident cases of TSCI (74% male). Total cost of all acute index episodes approximately AUD$40.5 (95% confidence interval [CI] ±4.5) million; median cost per patient was AUD$45,473 (Interquartile Range: $15,535-$94,612). Patient pathways varied; acute care was less costly for patients admitted directly to a specialist spinal cord injury unit (SCIU) compared with indirect transfer within 24 hours. Over half (53%) of all patients experienced at least one complication during acute admission; their care was less costly if they had been admitted directly to SCIU. Scenario analysis demonstrated that a reduction of indirect transfers to SCIU by 10% yielded overall cost savings of AUD$3.1 million; an average per patient saving of AUD$5,861. CONCLUSION Direct transfer to SCIU for patients with acute TSCI resulted in lower treatment costs, shorter length of stay, and less costly complications. Modeling showed that optimizing patient-care pathways can result in significant acute-care cost savings. Reducing potentially preventable complications would further reduce costs and improve longer-term patient outcomes. LEVEL OF EVIDENCE 3.
Collapse
|
37
|
Goodes LM, King GK, Rea A, Murray K, Boan P, Watts A, Bardsley J, Hartshorn C, Thavaseelan J, Rawlins M, Brock JA, Dunlop SA. Early urinary tract infection after spinal cord injury: a retrospective inpatient cohort study. Spinal Cord 2019; 58:25-34. [PMID: 31388122 DOI: 10.1038/s41393-019-0337-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 07/05/2019] [Accepted: 07/10/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective audit. OBJECTIVES Examine factors associated with urinary tract infection (UTI), UTI incidence and impact on hospital length of stay (LOS) in new, inpatient adult traumatic spinal cord injury (SCI). SETTING Western Australian Hospitals managing SCI patients. METHODS Data on UTIs, bladder management and LOS were obtained from hospital databases and medical records over 26 months. Adherence to staff-administered intermittent catheterisation (staff-IC) was determined from fluid balance charts. RESULTS Across the cohort (n = 70) UTI rate was 1.1 starts/100 days; UTI by multi-resistant organisms 0.1/100 days. Having ≥1 UTIs compared with none and longer duration of initial urethral indwelling catheterisation (IDC) were associated with longer LOS (p-values < 0.001). For patients with ≥1 UTIs (n = 43/70), longer duration of initial IDC was associated with shorter time to first UTI (1 standard deviation longer [SD, 45.0 days], hazard ratio (HR): 0.7, 95% confidence interval [CI] 0.5-1.0, p-value 0.044). In turn, shorter time to first UTI was associated with higher UTI rate (1 SD shorter [30.7 days], rate ratio (RR): 1.32, 95%CI 1.0-1.7, p-value 0.039). During staff-IC periods (n = 38/70), protocols were followed (85.7% ≤ 6 h apart, 96.1% < 8 h), but 26% of IC volumes exceeded 500 mL; occasional volumes > 800 mL and interruptions requiring temporary IDC were associated with higher UTI rates the following week (odds ratios (ORs): 1.6, 95%CI 1.1-2.3, p-value 0.009; and 3.9, 95%CI 2.6-5.9, p-value < 0.001 respectively). CONCLUSIONS Reducing initial IDC duration and limiting staff-IC volumes could be investigated to possibly reduce inpatient UTIs and LOS. SPONSORSHIP None.
Collapse
Affiliation(s)
- Louise M Goodes
- School of Biological Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Gabrielle K King
- School of Biological Sciences, The University of Western Australia, Crawley, WA, Australia
| | - Alethea Rea
- Centre for Applied Statistics, The University of Western Australia, Crawley, WA, Australia
| | - Kevin Murray
- School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
| | - Peter Boan
- Departments of Microbiology and Infectious Diseases, Fiona Stanley Hospital and PathWest Laboratory Medicine, Murdoch, WA, Australia
| | - Anne Watts
- State Rehabilitation Service, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Jen Bardsley
- State Rehabilitation Service, Fiona Stanley Hospital, Murdoch, WA, Australia
| | | | | | - Matthew Rawlins
- Department of Pharmacy, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - James A Brock
- Department of Anatomy and Neuroscience, University of Melbourne, Parkville, VIC, Australia
| | - Sarah A Dunlop
- School of Biological Sciences, The University of Western Australia, Crawley, WA, Australia.
| |
Collapse
|
38
|
Battalio SL, Jensen MP, Molton IR. Secondary health conditions and social role satisfaction in adults with long-term physical disability. Health Psychol 2019; 38:445-454. [PMID: 31045428 PMCID: PMC6501832 DOI: 10.1037/hea0000671] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Individuals living with physical disability due to early acquired or traumatic conditions often experience a range of psychological and physical health problems that are associated with their condition but are not directly caused by it. Known as "secondary health conditions," these problems can interact with existing functional limitations and other medical comorbidities to limit social participation. The current study assessed the concurrent and longitudinal associations between secondary health conditions, chronic medical comorbidities, and functional limitations, with a PROMIS® measure of social role participation. METHODS A longitudinal survey study of community-dwelling adults with one of four chronic physical conditions (multiple sclerosis, muscular dystrophy, spinal cord injury, postpoliomyelitis syndrome). The baseline survey (T1) was mailed to 2041 individuals, and1862 baseline surveys were completed and returned (91% response rate). The follow-up survey (T2) was mailed roughly three years later; 1594 completed and returned the T2 survey (86% of T1 survey completers). RESULTS Multiple linear regression analyses revealed that secondary health conditions, functional impairments, and chronic medical comorbidities accounted for 52% of the variance in satisfaction with social roles concurrently at T1. The amount of variance of change in satisfaction with social roles over the ∼3-year period accounted for by these variables was 3%. Functional limitations and more psychologically oriented secondary conditions were the strongest predictors of satisfaction with social roles. CONCLUSIONS Findings suggest that, for people with disabilities, addressing psychologically oriented secondary health conditions may be as important as functional impairment in predicting long-term social health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
Collapse
Affiliation(s)
- Samuel L. Battalio
- Department of Rehabilitation Medicine, University of Washington, WA, USA
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, WA, USA
| | - Ivan R. Molton
- Department of Rehabilitation Medicine, University of Washington, WA, USA
| |
Collapse
|
39
|
The Nature and Cost of Readmissions after Work-Related Traumatic Spinal Injuries in New South Wales, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16091509. [PMID: 31035444 PMCID: PMC6539456 DOI: 10.3390/ijerph16091509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 04/12/2019] [Accepted: 04/23/2019] [Indexed: 11/17/2022]
Abstract
This study aimed to measure the subsequent health and health service cost burden of a cohort of workers hospitalised after sustaining work-related traumatic spinal injuries (TSI) across New South Wales, Australia. A record-linkage study (June 2013–June 2016) of hospitalised cases of work-related spinal injury (ICD10-AM code U73.0 or workers compensation) was conducted. Of the 824 individuals injured during this time, 740 had sufficient follow-up data to analyse readmissions ≤90 days post-acute hospital discharge. Individuals with TSI were predominantly male (86.2%), mean age 46.6 years. Around 8% (n = 61) experienced 119 unplanned readmission episodes within 28 days from discharge, over half with the primary diagnosis being for care involving rehabilitation. Other readmissions involved device complications/infections (7.5%), genitourinary or respiratory infections (10%) or mental health needs (4.3%). The mean ± SD readmission cost was $6946 ± $14,532 per patient. Unplanned readmissions shortly post-discharge for TSI indicate unresolved issues within acute-care, or poor support services organisation in discharge planning. This study offers evidence of unmet needs after acute TSI and can assist trauma care-coordinators’ comprehensive assessments of these patients prior to discharge. Improved quantification of the ongoing personal and health service after work-related injury is a vital part of the information needed to improve recovery after major work-related trauma.
Collapse
|
40
|
White AR, Holmes GM. Investigating neurogenic bowel in experimental spinal cord injury: where to begin? Neural Regen Res 2019; 14:222-226. [PMID: 30531001 PMCID: PMC6301179 DOI: 10.4103/1673-5374.244779] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/04/2018] [Indexed: 12/11/2022] Open
Abstract
The devastating losses following traumatic spinal cord injury (SCI) encompass the motor, sensory and autonomic nervous systems. Neurogenic bowel is a slow transit colonic dysfunction marked by constipation, rectal evacuation difficulties, decreased anorectal sensation, fecal incontinence or some combination thereof. Furthermore, neurogenic bowel is one of the most prevalent comorbidities of SCI and is recognized by afflicted individuals and caregivers as a lifelong physical and psychological challenge that profoundly affects quality of life. The restoration of post-injury control of movement has received considerable scientific scrutiny yet the daily necessity of voiding the bowel and bladder remains critically under-investigated. Subsequently, physicians and caregivers are rarely presented with consistent, evidence-based strategies to successfully address the consequences of dysregulated voiding reflexes. Neurogenic bowel is commonly believed to result from the interruption of the supraspinal control of the spinal autonomic circuits regulating the colon. In this mini-review, we discuss the clinical challenges presented by neurogenic bowel and emerging pre-clinical evidence that is revealing that SCI also initiates functional remodeling of the colonic wall concurrent with a decrease in local enteric neurons. Since the enteric input to the colonic smooth muscle is the final common pathway for functional contractions of the colon, changes to the neuromuscular interface must first be understood in order to maximize the efficacy of therapeutic interventions targeting colonic dysfunction following SCI.
Collapse
Affiliation(s)
- Amanda R. White
- Department of Neural & Behavioral Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - Gregory M. Holmes
- Department of Neural & Behavioral Sciences, Penn State University College of Medicine, Hershey, PA, USA
| |
Collapse
|
41
|
Huang D, Slocum C, Silver JK, Morgan JW, Goldstein R, Zafonte R, Schneider JC. Functional status predicts acute care readmission in the traumatic spinal cord injury population. J Spinal Cord Med 2019; 42:20-31. [PMID: 29596035 PMCID: PMC6340280 DOI: 10.1080/10790268.2018.1453436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
CONTEXT/OBJECTIVE Acute care readmission has been identified as an important marker of healthcare quality. Most previous models assessing risk prediction of readmission incorporate variables for medical comorbidity. We hypothesized that functional status is a more robust predictor of readmission in the spinal cord injury population than medical comorbidities. DESIGN Retrospective cross-sectional analysis. SETTING Inpatient rehabilitation facilities, Uniform Data System for Medical Rehabilitation data from 2002 to 2012. PARTICIPANTS traumatic spinal cord injury patients. OUTCOME MEASURES A logistic regression model for predicting acute care readmission based on demographic variables and functional status (Functional Model) was compared with models incorporating demographics, functional status, and medical comorbidities (Functional-Plus) or models including demographics and medical comorbidities (Demographic-Comorbidity). The primary outcomes were 3- and 30-day readmission, and the primary measure of model performance was the c-statistic. RESULTS There were a total of 68,395 patients with 1,469 (2.15%) readmitted at 3 days and 7,081 (10.35%) readmitted at 30 days. The c-statistics for the Functional Model were 0.703 and 0.654 for 3 and 30 days. The Functional Model outperformed Demographic-Comorbidity models at 3 days (c-statistic difference: 0.066-0.096) and outperformed two of the three Demographic-Comorbidity models at 30 days (c-statistic difference: 0.029-0.056). The Functional-Plus models exhibited negligible improvements (0.002-0.010) in model performance compared to the Functional models. CONCLUSION Readmissions are used as a marker of hospital performance. Function-based readmission models in the spinal cord injury population outperform models incorporating medical comorbidities. Readmission risk models for this population would benefit from the inclusion of functional status.
Collapse
Affiliation(s)
- Donna Huang
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA,Correspondence to: Donna Huang, MD, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, 300 First Ave, Charlestown, MA02129, USA; Ph: 404-667-1138.
| | - Chloe Slocum
- Commonwealth Fund Mongan Fellow, Harvard Medical School, Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Massachusetts, USA
| | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - James W. Morgan
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| |
Collapse
|
42
|
Optimal Bladder Management Following Spinal Cord Injury: Evidence, Practice and a Cooperative Approach Driving Future Directions in Australia. Arch Phys Med Rehabil 2018; 99:2118-2121. [DOI: 10.1016/j.apmr.2018.04.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 11/20/2022]
|
43
|
Prevalence of chronic health conditions and hospital utilization in adults with spinal cord injury: an analysis of self-report and South Carolina administrative billing data. Spinal Cord 2018; 57:33-40. [DOI: 10.1038/s41393-018-0185-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 12/27/2022]
|
44
|
Lennox A, Gabbe B, Nunn A, Braaf S. Experiences With Navigating and Managing Information in the Community Following Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 24:315-324. [PMID: 30459494 DOI: 10.1310/sci17-00050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: People living with spinal cord injury (SCI) have reported difficulties managing information in the community, which can negatively impact their functional independence and ability to prevent secondary complications. Objective: This exploratory qualitative study aimed to describe the experiences of people living with SCI with navigating and managing information in the community from their perspective. Methods: Participants were recruited through the Australian Quadriplegic Association. Twenty-two semi-structured in-depth interviews were conducted with purposively selected participants to ensure representation of age, gender, SCI level, and compensation status. Data were thematically analyzed using a framework approach. Results: People living with SCI reported using multiple, complementary sources of information to prevent and manage secondary conditions. Over time, they learned to appraise the content, relevance, timing, and sources of information. Information delivered by health professionals in the rehabilitation setting was appraised as lacking personalization, but it acted as a springboard to search for more relevant information. Participants described the process of becoming experts about their condition to overcome the lack of knowledge of many general practitioners, guide their own care, and act as a source of information for others. Due to a lack of information provision, some participants missed health improvement opportunities and experienced frustration at the uncertainty of their future with SCI. Conclusion: Greater support is required for individuals with SCI to navigate information sources in the community. Rehabilitation is an opportune time to provide education related to finding and appraising information. Improved access to community health providers with SCI knowledge is also required.
Collapse
Affiliation(s)
- Alyse Lennox
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Melbourne, Victorian, Australia
| | - Sandra Braaf
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
45
|
White BA, Dea N, Street JT, Cheng CL, Rivers CS, Attabib N, Kwon BK, Fisher CG, Dvorak MF. The Economic Burden of Urinary Tract Infection and Pressure Ulceration in Acute Traumatic Spinal Cord Injury Admissions: Evidence for Comparative Economics and Decision Analytics from a Matched Case-Control Study. J Neurotrauma 2017; 34:2892-2900. [DOI: 10.1089/neu.2016.4934] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Nicolas Dea
- Service de Neurochirurgie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - John T. Street
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Najmedden Attabib
- Dalhousie University, Halifax, Nova Scotia; Horizon Health Network, Division of Neurosurgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G. Fisher
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel F. Dvorak
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
46
|
Skeels SE, Pernigotti D, Houlihan BV, Belliveau T, Brody M, Zazula J, Hasiotis S, Seetharama S, Rosenblum D, Jette A. SCI peer health coach influence on self-management with peers: a qualitative analysis. Spinal Cord 2017; 55:1016-1022. [PMID: 28994415 DOI: 10.1038/sc.2017.104] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/17/2017] [Accepted: 07/22/2017] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN A process evaluation of a clinical trial. OBJECTIVES To describe the roles fulfilled by peer health coaches (PHCs) with spinal cord injury (SCI) during a randomized controlled trial research study called 'My Care My Call', a novel telephone-based, peer-led self-management intervention for adults with chronic SCI 1+ years after injury. SETTING Connecticut and Greater Boston Area, MA, USA. METHODS Directed content analysis was used to qualitatively examine information from 504 tele-coaching calls, conducted with 42 participants with SCI, by two trained SCI PHCs. Self-management was the focus of each 6-month PHC-peer relationship. PHCs documented how and when they used the communication tools (CTs) and information delivery strategies (IDSs) they developed for the intervention. Interaction data were coded and analyzed to determine PHC roles in relation to CT and IDS utilization and application. RESULTS PHCs performed three principal roles: Role Model, Supporter, and Advisor. Role Model interactions included CTs and IDSs that allowed PHCs to share personal experiences of managing and living with an SCI, including sharing their opinions and advice when appropriate. As Supporters, PHCs used CTs and IDSs to build credible relationships based on dependability and reassuring encouragement. PHCs fulfilled the unique role of Advisor using CTs and IDSs to teach and strategize with peers about SCI self-management. CONCLUSION The SCI PHC performs a powerful, flexible role in promoting SCI self-management among peers. Analysis of PHC roles can inform the design of peer-led interventions and highlights the importance for the provision of peer mentor training.
Collapse
Affiliation(s)
- S E Skeels
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - D Pernigotti
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,Rehabilitation Services and Outpatient Services, Spinal Cord Injury Program, Gaylord Hospital, Wallingford, CT, USA
| | - B V Houlihan
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - T Belliveau
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,Hospital for Special Care, New Britain, CT, USA
| | - M Brody
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - J Zazula
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - S Hasiotis
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,Rehabilitation Services and Outpatient Services, Spinal Cord Injury Program, Gaylord Hospital, Wallingford, CT, USA
| | - S Seetharama
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,Hartford Hospital, Hartford, CT, USA
| | - D Rosenblum
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,Rehabilitation Services and Outpatient Services, Spinal Cord Injury Program, Gaylord Hospital, Wallingford, CT, USA
| | - A Jette
- Spaulding New England Regional Spinal Cord Injury Center Model Systems Network, Boston, MA, USA.,The Health and Disability Research Institute, Department of Health Policy and Management, Boston University School of Public Health, Boston, MA, USA
| |
Collapse
|
47
|
Li C, Clark JM, Krause JS. Latent Structural Analysis of Health Outcomes in People Living With Spinal Cord Injury. Arch Phys Med Rehabil 2017; 98:2457-2463. [PMID: 28583463 DOI: 10.1016/j.apmr.2017.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/12/2017] [Accepted: 04/29/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop a latent structural model of health outcomes in people with spinal cord injury (SCI) that accounts for the measurement of underlying factors and their association with demographic and injury-related exogenous variables. DESIGN Cross-sectional study. SETTING Specialty hospital and medical university. PARTICIPANTS Participants with traumatic SCI (N=1871) of at least 1-year duration. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Exploratory factor analysis was used to identify latent health outcome structures. Several key exogenous variables were also linked with the latent health outcome factors. RESULTS Six latent health outcome factors were identified by the exploratory factor analysis with excellent model fit (root mean square error of approximation=.040). These latent factors included (1) global health problems; (2) chronic disease; (3) acute treatments; (4) symptoms of SCI complications, (5) pressure ulcers; and (6) subsequent injuries. Sex, race/ethnicity, age, years since injury, and injury severity were all significantly associated with at least 1 latent health outcome factor, which indicates that these latent health outcomes varied as a function of the exogenous variables. CONCLUSIONS This study improved our understanding of the structure of health outcomes, and utilization of latent health outcome factors provides more stable and comprehensive composite scores than does utilization of a single observed health outcome indicator.
Collapse
Affiliation(s)
- Chao Li
- Medical University of South Carolina, Charleston, SC.
| | | | | |
Collapse
|
48
|
Braaf SC, Lennox A, Nunn A, Gabbe BJ. Experiences of hospital readmission and receiving formal carer services following spinal cord injury: a qualitative study to identify needs. Disabil Rehabil 2017; 40:1893-1899. [DOI: 10.1080/09638288.2017.1313910] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sandra C. Braaf
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alyse Lennox
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Hospital, Heidelberg, Victoria, Australia
| | - Belinda J. Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The Farr Institute, Swansea University Medical School, Swansea University, Singleton Park, Swansea, United Kingdom
| |
Collapse
|
49
|
Jordan SW, De la Garza M, Lewis VL. Two-stage treatment of ischial pressure ulcers in spinal cord injury patients: Technique and outcomes over 8 years. J Plast Reconstr Aesthet Surg 2017; 70:959-966. [PMID: 28285012 DOI: 10.1016/j.bjps.2017.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2015] [Revised: 11/29/2016] [Accepted: 01/05/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND Despite newly introduced techniques, reconstruction of ischial pressure ulcers remains a difficult problem with high-reported failure rates. METHODS A retrospective chart review was performed on all spinal cord injury patients who underwent ischial pressure ulcer reconstruction by the senior author (V.L.) between 2004 and 2012. The two-stage procedure consisted of debridement and bone biopsy, followed by bursectomy, partial ischiectomy, fascial release, and gluteus maximus and hamstring advancement flaps. Postoperative care included 2-week supine bed rest on an air-fluidized bed, sitting tolerance rehabilitation, and thorough behavioral training. RESULTS Sixty-five patients (74 flaps) were identified. A 45.9% had a previous attempt at reconstruction. The median follow-up period was 622 days. Overall, 67.6% of flaps were intact at the last follow-up. Superficial and deep dehiscence rates were 16.2 and 28.4%, respectively. Seven out of 35 flaps suffered late recurrence after being well healed for more than 1 year. History of previous reconstruction was found to be associated with increased odds of superficial (OR 6.02, 95% CI 1.55-23.3) and deep dehiscence (OR 12.3, 95% CI 1.99-76.9). CONCLUSIONS The evolution of the senior author's decades of practice has led to the development of a simpler repair, which relies on plane-by-plane release of scarred tissues to improve the mobility of muscle and skin flaps without large tissue movements, even in the setting of apparent extensive tissue loss. This technique is a reliable option, particularly for the primary ischial pressure ulcer.
Collapse
Affiliation(s)
- Sumanas W Jordan
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Mauricio De la Garza
- Institute for Plastic Surgery, Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Victor L Lewis
- Division of Plastic and Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| |
Collapse
|
50
|
Graham D, Becerril-Martinez G, Tang J. Who is the surgically resilient individual with traumatic spinal cord injury? JOURNAL OF SPINE SURGERY 2016; 2:230-233. [PMID: 27757438 DOI: 10.21037/jss.2016.08.01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- David Graham
- Faculty of Medicine, University of Sydney, Sydney, Australia;; TY Nelson Department of Neurology and Neurosurgery, The Children's Hospital at Westmead, Australia
| | | | - Jonathan Tang
- Faculty of Medicine, University of Sydney, Sydney, Australia
| |
Collapse
|