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Wang L, Peng JL, Chen AL. Effect of robotic-assisted gait training on gait and motor function in spinal cord injury: a protocol of a systematic review with meta-analysis. BMJ Open 2023; 13:e070675. [PMID: 37739462 PMCID: PMC10533792 DOI: 10.1136/bmjopen-2022-070675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 08/16/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION Robotic-assisted gait training (RAGT) has been reported to be effective in rehabilitating patients with spinal cord injury (SCI). However, studies on RAGT showed different results due to a varied number of samples. Thus, summarising studies based on robotic-related factors is critical for the accurate estimation of the effects of RAGT on SCI. This work aims to search for strong evidence showing that using RAGT is effective in treating SCI and analyse the deficiencies of current studies. METHODS AND ANALYSIS The following publication databases were electronically searched in December 2022 without restrictions on publication year: MEDLINE, Cochrane Library, Web of Science, Embase, PubMed, the Cochrane Central Register of Controlled Trials and China National Knowledge Infrastructure. Various combinations of keywords, including 'motor disorders', 'robotics', 'robotic-assisted gait training', 'Spinal Cord Injuries', 'SCI' and 'gait analysis' were used as search terms. All articles on randomised controlled trials (excluding retrospective trials) using RAGT to treat SCI that were published in English and Chinese and met the inclusion criteria were included. Outcomes included motor function, and gait parameters included those assessed by using the instrumented gait assessment, the Berg Balance Scale, the 10-m walk speed test, the 6-min walk endurance test, the functional ambulation category scale, the Walking index of SCI and the American Spinal Injury Association assessment scale. Research selection, data extraction and quality assessment were conducted independently by two reviewers to ensure that all relevant studies were free from personal bias. In addition, the Cochrane risk-of-bias assessment tool was used to assess the risk of bias. Review Manager V.5.3 software was used to produce deviation risk maps and perform paired meta-analyses. ETHICS AND DISSEMINATION Ethics approval is not required for systematic reviews and network meta-analyses. The results will be submitted to a peer-reviewed journal or presented at a conference. PROSPERO REGISTRATION NUMBER CRD42022319555.
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Affiliation(s)
- Lei Wang
- Department of Rehabilitation Medicine, Hunan Provincial People's Hospital, Changsha, Hunan, China
| | - Jin-Lin Peng
- Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Ai-Lian Chen
- Department of Rehabilitation Medicine, Hunan Provincial People's Hospital, Changsha, Hunan, China
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Leidinger A, Zuckerman SL, Feng Y, He Y, Chen X, Cheserem B, Gerber LM, Lessing NL, Shabani HK, Härtl R, Mangat HS. Predictors of spinal trauma care and outcomes in a resource-constrained environment: a decision tree analysis of spinal trauma surgery and outcomes in Tanzania. J Neurosurg Spine 2023; 38:503-511. [PMID: 36640104 DOI: 10.3171/2022.11.spine22763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 11/29/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVE The burden of spinal trauma in low- and middle-income countries (LMICs) is immense, and its management is made complex in such resource-restricted settings. Algorithmic evidence-based management is cost-prohibitive, especially with respect to spinal implants, while perioperative care is work-intensive, making overall care dependent on multiple constraints. The objective of this study was to identify determinants of decision-making for surgical intervention, improvement in function, and in-hospital mortality among patients experiencing acute spinal trauma in resource-constrained settings. METHODS This study was a retrospective analysis of prospectively collected data in a cohort of patients with spinal trauma admitted to a tertiary referral hospital center in Dar es Salam, Tanzania. Data on demographic, clinical, and treatment characteristics were collected as part of a quality improvement neurotrauma registry. Outcome measures were surgical intervention, American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade improvement, and in-hospital mortality, based on existing treatment protocols. Univariate analyses of demographic and clinical characteristics were performed for each outcome of interest. Using the variables associated with each outcome, a machine learning algorithm-based regression nonparametric decision tree model utilizing a bootstrapping method was created and the accuracy of the three models was estimated. RESULTS Two hundred eighty-four consecutively admitted patients with acute spinal trauma were included over a period of 33 months. The median age was 34 (IQR 26-43) years, 83.8% were male, and 50.7% had experienced injury in a motor vehicle accident. The median time to hospital admission after injury was 2 (IQR 1-6) days; surgery was performed after a further median delay of 22 (IQR 13-39) days. Cervical spine injury comprised 38.4% of the injuries. Admission AIS grades were A in 48.9%, B in 16.2%, C in 8.5%, D in 9.5%, and E in 16.6%. Nearly half (45.1%) of the patients underwent surgery, 12% had at least one functional improvement in AIS grade, and 11.6% died in the hospital. Determinants of surgical intervention were age ≤ 30 years, spinal injury level, admission AIS grade, delay in arrival to the referral hospital, undergoing MRI, and type of insurance; admission AIS grade, delay to arrival to the hospital, and injury level for functional improvement; and delay to arrival, injury level, delay to surgery, and admission AIS grade for in-hospital mortality. The best accuracies for the decision tree models were 0.62, 0.34, and 0.93 for surgery, AIS grade improvement, and in-hospital mortality, respectively. CONCLUSIONS Operative intervention and functional improvement after acute spinal trauma in this tertiary referral hospital in an LMIC environment were low and inconsistent, which suggests that nonclinical factors exist within complex resource-driven decision-making frameworks. These nonclinical factors are highlighted by the authors' results showing clinical outcomes and in-hospital mortality were determined by natural history, as evidenced by the highest accuracy of the model predicting in-hospital mortality.
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Affiliation(s)
- Andreas Leidinger
- 1Department of Neurosurgery, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Scott L Zuckerman
- 2Department of Neurosurgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Yueqi Feng
- 3Biostatistics and Data Science, Cornell University, New York, New York
| | - Yitian He
- 3Biostatistics and Data Science, Cornell University, New York, New York
| | - Xinrui Chen
- 3Biostatistics and Data Science, Cornell University, New York, New York
| | | | | | - Noah L Lessing
- 6School of Medicine, University of Maryland, Baltimore, Maryland
| | - Hamisi K Shabani
- 7Department of Neurosurgery, Muhimbili Orthopaedic Institute, Dar es Salaam, Tanzania; and
| | - Roger Härtl
- 8Neurology and Neurological Surgery, Weill Cornell Medical College, New York, New York
| | - Halinder S Mangat
- 9Department of Neurology, Division of Neurocritical Care, University of Kansas Medical Center, Kansas City, Kansas
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Krysa JA, Gregorio MP, Pohar Manhas K, MacIsaac R, Papathanassoglou E, Ho CH. Empowerment, Communication, and Navigating Care: The Experience of Persons With Spinal Cord Injury From Acute Hospitalization to Inpatient Rehabilitation. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:904716. [PMID: 36188987 PMCID: PMC9397833 DOI: 10.3389/fresc.2022.904716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022]
Abstract
Background Spinal cord injury (SCI) results in long-term functional impairments that significantly impact participation and role in the community. Newly injured persons are often reintroduced to the community with significant deficits in knowledge, including how to access and navigate community resources and supports. This warrants a better understanding of the patient experience of in-hospital care and discharge planning to ensure individuals with SCI are best supported during transitions in care and while living in the community. Objective To explore the lived experience of persons with acute SCI and their perceptions of care, focusing on the initial hospital experiences to inpatient rehabilitation. Methods A phenomenological research study was conducted using semi-structured interviews. Eligible participants had differing etiologies of SCI (including non-traumatic and traumatic SCI), were over the age of 18 at the time of initial care, and experienced acute hospital and inpatient rehabilitation at an Alberta-based institution within the last 10 years. One-on-one interviews took place between March and June 2021 over telephone or virtual platforms (Zoom). Interview transcripts, and field notes developed the text, which underwent hermeneutic analysis to develop central themes. Results The present study included 10 participants living with an SCI in Alberta, Canada. Most participants (80%) were male. Participants' age ranged from 24 to 69 years. The median years since initial SCI was 3 years. Interviews lasted 45–75 min. Seven participants identified as having a traumatic SCI injury and three identified as having a non-traumatic SCI. The interplay between empowerment and disempowerment emerged as the core theme, permeating participants' meanings and perceptions. Three main themes emerged from the interviews regarding the perceptions of the SCI patient experience. Each theme represents a perception central to their inpatient experience: desire to enhance functional independence to empower confidence and self-management; need for effective communication with healthcare providers to support recovery; and navigating appropriate care supports to enhance preparedness for discharge and returning home. Conclusion This study demonstrates the significant need to enhance education of person/family-centered SCI care, foster positive communication between care recipients and care providers, and facilitate better in-hospital access to appropriate navigation and wayfinding supports.
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Affiliation(s)
- Jacqueline A. Krysa
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Marianne Pearl Gregorio
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Kiran Pohar Manhas
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rob MacIsaac
- Spinal Cord Injury Alberta, Edmonton, AB, Canada
| | - Elizabeth Papathanassoglou
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Chester H. Ho
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
- *Correspondence: Chester H. Ho
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Scientific and Clinical Abstracts From WOCNext 2020 Reimagined. J Wound Ostomy Continence Nurs 2020. [DOI: 10.1097/won.0000000000000650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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The safety and feasibility of a new rehabilitation robotic exoskeleton for assisting individuals with lower extremity motor complete lesions following spinal cord injury (SCI): an observational study. Spinal Cord 2020; 58:787-794. [PMID: 32034295 DOI: 10.1038/s41393-020-0423-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 02/05/2023]
Abstract
STUDY DESIGN A pre-post observational study. OBJECTIVES To evaluate the safety and feasibility of a new rehabilitation robotic device for assisting individuals with lower extremity motor complete lesions following spinal cord injury (SCI). SETTING Three hospitals in Sichuan Province, China. METHODS Individuals aged 15-75 years with an SCI between vertebrae six (T6) and lumbar 1 (L1) and complete motor paralysis participated in an exoskeletal-assisted walking (EAW) programme (2 weeks, 5 days/week, 30 min/day). Data were collected pre-, mid- (week 1) and post-intervention (week 2). RESULTS Twenty-eight individuals (mean age = 41.3, 71% males) participated in the EAW programme. The distance walked during the 6-min walking test (6MWT) increased relative to that at baseline, during week 1 (13.0 ± 5.3 m) and week 2 (16.2 ± 5.3 m) when wearing the exoskeleton. The walking speed during the 10-m walking test (10MWT) increased from 0.039 ± 0.016 to 0.045 ± 0.016 m/s. The Hoffer walking ability grade, the Spinal Cord Independence Measure (SCIM), and the Walking Index for SCI II (WISCI II) changed after 2 weeks of EAW. No improvement in lower extremity motor score (LEMS) was observed. The rates of adverse events and serious adverse events were 21% and 4%, respectively. CONCLUSIONS The EAW programme with the new robotic exoskeleton provided potential meaningful improvements in mobility for individuals with SCI and had few adverse events.
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Maiman D, Pintar F, Malik W, Yoganandan N. AIS scores in spine and spinal cord trauma: Epidemiological considerations. TRAFFIC INJURY PREVENTION 2018; 19:S169-S173. [PMID: 29584506 DOI: 10.1080/15389588.2017.1410144] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 11/22/2017] [Indexed: 06/08/2023]
Abstract
BACKGROUND The Abbreviated Injury Scale (AIS) is an internationally accepted coding system created by the Association for the Advancement of Automotive Medicine, utilized to code traumatic injuries as a function of severity, the latter often defined as mortality risk. Periodic reassessment of that risk is prudent, in light of advances in health care and relationship of nonanatomic factors to death. OBJECTIVE The objective of this study was to reevaluate the risk of death associated with spine fractures with and without neurologic deficit, age factors associated with it, and the impact of hospital coding on the accuracy of these efforts. METHODS Medical records and imaging of patients treated at a level 1 trauma center from 2014 through 2016 with discharge International Classification of Diseases, 10th revision (ICD-10) diagnoses of spinal trauma and spinal cord injury (SCI) were reviewed. Data were collected on demographics, complications, neurologic status, and outcomes. RESULTS Three hundred seventy patients met the criteria for inclusion in this effort. Errors in ICD-10 discharge codes were seen in 45% of the cases, both false positive and negative. One hundred thirty-four patients, with a mean age of 45, were admitted with neurologic deficit. There were 8 SCI-related deaths; 2 were postoperative out of 110 undergoing surgical treatment. All deaths in this group were in patients with upper level SCI, with a mean age of 68. Ten patients had spontaneous neurologic improvement within 24 h. One hundred nineteen patients without deficit had AIS 2 scored fractures; there was one postoperative death out of 47 patients undergoing surgical treatment. One hundred seventeen patients without deficit suffered AIS 3 fractures; 66 underwent surgery without any deaths. There was one nonoperative death. Age and high quadriplegia were the only factors associated with mortality. CONCLUSIONS Mortality risk in patients with deficit was associated more with age at injury than extent of anatomic injury. Spine trauma without neurologic deficit is benign in younger populations and AIS scores could be age adjusted. Mortality risk is higher in high cervical injuries with neurologic deficit and in the elderly. An incidental finding is that demographic studies based solely on discharge ICD coding may contain errors and should be considered critically.
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Affiliation(s)
- Dennis Maiman
- a Department of Neurosurgery , Medical College of Wisconsin , Milwaukee , Wisconsin
| | - Frank Pintar
- a Department of Neurosurgery , Medical College of Wisconsin , Milwaukee , Wisconsin
- b Department of Biomedical Engineering , Medical College of Wisconsin , Milwaukee , Wisconsin
| | - Waqar Malik
- a Department of Neurosurgery , Medical College of Wisconsin , Milwaukee , Wisconsin
| | - Narayan Yoganandan
- a Department of Neurosurgery , Medical College of Wisconsin , Milwaukee , Wisconsin
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Chuang CH, Chen CH, Bai CH, Chen PC, Wu SC, Liu CH. Risk factors associated with newly psychiatric disorder in spinal cord injury: A retrospective cohort study. J Clin Nurs 2017; 27:e1038-e1047. [PMID: 29076624 DOI: 10.1111/jocn.14139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2017] [Indexed: 12/17/2022]
Abstract
AIM AND OBJECTIVES To predict the risk factors related to newly diagnosed psychiatric disorders resulting from spinal cord injuries (SCIs). BACKGROUND SCIs are a common result of devastating accidents; they can have an essential negative impact on the psychological health of those so afflicted. Psychiatric disorders commonly occur worldwide and are often associated with pain and disability; however, few studies have investigated the risk factors of psychiatric disorders among persons with SCIs. DESIGN A retrospective cohort study design with data obtained from the Taiwan Health Insurance Research Database (THIRD). THIRD involves the claims data on recipients recorded in the Taiwan National Health Insurance (TNHI), which was set up in 1995 and covers about 99% of the 23 million persons in Taiwan. METHODS We used THIRD to predict the risk factors related to newly diagnosed psychiatric disorders among victims of spinal cord injury. RESULTS The majority of persons with SCI were men (51.2%), and their average age was 52.8 years. All 5,828 newly diagnosed psychiatric disorders were included from 1997-2009 in 64,907 SCI in the THIRD data set. These results demonstrated notable differences in hazard risk (HR); the injured persons were inspected for the level of SCI, age, hypertension and chronic obstructive pulmonary disease (HR: 1.637, 95% CI: 1.452-1.844, p < .0001; HR: 1.005, 95% CI: 1.002-1.009, p = .0019; HR: 0.724, 95% CI: 0.642-0.816; HR: 1.267, 95% CI: 1.105-1.454, p = .0007; HR: 1.368, 95% CI: 1.183-1.582, p < .0001, respectively); the persons with SCI exhibited significant independent associations with psychiatric disorders. CONCLUSIONS The results revealed that the level of SCI, female gender and age, respectively, affects the incidence of newly diagnosed psychiatric disorder related to SCI. RELEVANCE TO CLINICAL PRACTICE This study showed that psychiatric disorders may be associated with the development of SCI, and that this risk was more predominant in females with SCI. Our results are of direct clinical relevance as they are meant to assist clinical assessment, counselling, guidance of symptomatic monitoring and early clinical intervention.
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Affiliation(s)
- Ching-Hui Chuang
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan.,Department of Nursing, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Niaosong, Kaohsiung, Taiwan
| | - Chung-Hey Chen
- Department of Nursing, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chyi-Huey Bai
- School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Po-Cheng Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Shih-Chung Wu
- Department of Surgery, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Kaohsiung, Taiwan
| | - Chun-Hao Liu
- Department of Psychiatry, Chang Gung Memorial Hospital-Taoyuan Medical Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
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