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Waller M, Lexell J, Martin Ginis KA, Jörgensen S. Leisure time physical activity in middle-aged and older adults aging with long-term spinal cord injury: Changes over six years. Disabil Health J 2024:101648. [PMID: 38910042 DOI: 10.1016/j.dhjo.2024.101648] [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: 11/15/2023] [Revised: 05/20/2024] [Accepted: 06/05/2024] [Indexed: 06/25/2024]
Abstract
BACKGROUND Regular leisure time physical activity (LTPA) has beneficial health effects in people with spinal cord injury (SCI). Yet, participation in LTPA is low, and little is known about changes many years after injury. OBJECTIVES To determine changes in LTPA in middle-aged and older adults with long-term SCI over six years, investigate associations with gender, age, injury characteristics and changes in secondary health conditions and activity limitations, and investigate factors related to being physically active or sedentary. METHODS Part of the Swedish Aging with Spinal Cord Injury Study (SASCIS). LTPA was assessed twice over a six-year period with the Physical Activity Recall Assessment for people with Spinal Cord Injury (n = 75; 32% women, mean age 67 years, mean time since injury 31 years, injury levels C1-L3, AIS A-D). Changes were assessed with paired t-tests, McNemar test and Wilcoxon signed-rank test, associations with multivariable regression and group comparisons with Mann-Whitney U test and Chi Square test. RESULTS On group level participation in LTPA did not change, but the variability was substantial on individual level. There were no significant associations between changes in LTPA and the investigated variables. Among sedentary participants, higher level and severity of injury were overrepresented and the activity limitations were greater. CONCLUSIONS Our findings indicate stability in LTPA over time, but with a large individual variation. In many participants LTPA was insufficient to reach positive health effects. Promoting participation in LTPA is therefore an important part of the long-term management of middle-aged and older adults aging with long-term SCI.
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Affiliation(s)
- Mikael Waller
- Department of Health Sciences, Lund University, Box 157, SE-221 00, Lund, Sweden; Department of Rehabilitation Medicine, Sunderby Hospital, Norrbotten County Council, 971 80, Luleå, Sweden.
| | - Jan Lexell
- Department of Health Sciences, Lund University, Box 157, SE-221 00, Lund, Sweden.
| | - Kathleen A Martin Ginis
- Department of Medicine, Division of Physical Medicine & Rehabilitation, University of British Columbia, Vancouver, BC, Canada; School of Health and Exercise Sciences, University of British Columbia, Faculty of Health and Social Development, Okanagan Campus, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada; Centre for Chronic Disease Prevention and Management, Kelowna, BC, Canada; International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
| | - Sophie Jörgensen
- Department of Health Sciences, Lund University, Box 157, SE-221 00, Lund, Sweden; Department of Rehabilitation Medicine, Skåne University Hospital, 221 85, Lund, Sweden.
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Fathe MA, Farhat F, Karim SK, Moalla W. Spinal Cord Injuries in Iraq: A Teleassessment Survey of the Survivors from 2017 to 2018 Islamic State of Iraq and Syria War. Telemed J E Health 2024. [PMID: 38683594 DOI: 10.1089/tmj.2024.0037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2024] Open
Abstract
Introduction: The significance of comprehensive investigations specifically addressing the characteristics and implications of nervous system injuries (NSIs) and particularly war-related spinal cord injuries (SCI) remain limited. Iraq lacks comprehensive survey studies for quality of life for people after SCI. The objective of this work was to identify the number of NSIs and mortality of those injured during the Islamic State of Iraq and Syria (ISIS) war in Iraq and analyze events specifically as sociodemographic variables to assess quality of life healthy, psychological, and social disorders from onset of injury till the involving. Methods: A survey-based descriptive study, and analytical retrospective at community-based of Nineveh Governorate, in Iraq. The participants were 34 survivors of ISIS war with SCIs, ages between 9 and 60 years, and 7 females (20.59%) and 27 males (79.41%) as registered in Nineveh Center of Disability Rehabilitation. Data collection was conducted using Telephone Video Interviews and respondents' health information. Protocol-specific questions and some psychological and social scales (PTSD) (DSM-IV), (TAS-20), (SWLS), and (MSPSS) were also used. Results: There were 2,990 NSIs with the highest rate of injuries occurring from 2017 to 2018, and the SCIs were 267 injuries (8.93%), and (70.59%) at level T the mortalities were 57 cases, all participants suffered from physical and psychological chronic complications, while the results of the PTSD, GPC, and SWLS were at a moderate level. Conclusions: In urban warfare, there's a rise in NSIs, notably SCIs influenced by the type of weaponry. The survivors face significant physical, psychological, social, and financial burdens. More research is crucial to understanding their situations and developing strategies to alleviate their health, social, and financial challenges.
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Affiliation(s)
- Munib Abdullah Fathe
- College of Physical Education and Sport Sciences, University of Mosul, Mosul, Iraq
- LR 19JS01 EM2S, Education, Motricity, Sport and Health, Higher Institute for Sport and Physical Education at Sfax, University of Sfax, Sfax, Tunisia
| | - Faical Farhat
- LR 19JS01 EM2S, Education, Motricity, Sport and Health, Higher Institute for Sport and Physical Education at Sfax, University of Sfax, Sfax, Tunisia
| | | | - Wassim Moalla
- LR 19JS01 EM2S, Education, Motricity, Sport and Health, Higher Institute for Sport and Physical Education at Sfax, University of Sfax, Sfax, Tunisia
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Hill M, Jörgensen S, Engström G, Persson M, Lexell J. Coronary and carotid imaging of atherosclerosis and contributing factors in middle-aged people with long-term cervical and upper thoracic spinal cord injuries. PM R 2024; 16:250-259. [PMID: 37492978 DOI: 10.1002/pmrj.13043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 06/15/2023] [Accepted: 07/06/2023] [Indexed: 07/27/2023]
Abstract
BACKGROUND Cardiovascular disease is a major cause of death in people aging with spinal cord injury (SCI) and is predominantly caused by atherosclerosis; however, knowledge of atherosclerosis in people with SCI is scarce. OBJECTIVE To describe coronary and carotid atherosclerosis in middle-aged people with long-term cervical and upper thoracic SCI using coronary computed tomography angiography, carotid ultrasound, and cardiovascular disease risk factors and to compare with the general population. DESIGN Cross-sectional study with matched controls. SETTING Outpatient SCI unit in southern Sweden. PARTICIPANTS Participants (n = 25) in the Swedish SPinal Cord Injury Study on Cardiopulmonary and Autonomic Impairment (SPICA) (20% women, mean age 58 years, mean time since injury 28 years, injury levels C2-T6, American Spinal Injury Association Impairment Scale A-C). Non-SCI controls (n = 125; ratio 5:1) from the Swedish CArdioPulmonary bioImage Study (SCAPIS). INTERVENTIONS Not applicable. MAIN OUTCOME MEASUREMENTS Presence of coronary atherosclerosis, coronary artery calcium score, carotid plaques, carotid intima media thickness, blood pressure, lipids, Systematic Coronary Risk Evaluation (SCORE), and anthropometry. RESULTS Coronary and carotid atherosclerotic plaques occurred in 44% of the participants, 67% of the controls exhibited coronary and 59% carotid plaques; odds ratios (OR; 95% confidence interval [CI]): 0.38 (0.13-1.17) and 0.54 (0.22-1.32), respectively. Mean number of segments with coronary atherosclerosis were 1.0 in participants and 2.1 in controls (OR: 0.74 [0.52-1.06]). Coronary artery calcium score > 100 occurred in 4 (18%) of the participants and 23 (21%) of the controls. The participants had significantly lower levels of total and non-high density lipoprotein cholesterol and SCORE than the controls. CONCLUSIONS This is the first comprehensive assessment of atherosclerosis in people with SCI using advanced imaging techniques. The atherosclerotic burden in middle-aged people with long-term cervical and upper thoracic SCI was not increased, whereas SCORE was lower due to lower cholesterol levels. Imaging techniques may be valuable tools for assessment of atherosclerosis in SCI.
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Affiliation(s)
- Mattias Hill
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Sophie Jörgensen
- Department of Health Sciences, Lund University, Lund, Sweden
- Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Gunnar Engström
- Department of Clinical Sciences in Malmö, Clinical Research Centre, Lund University, Malmö, Sweden
| | - Margaretha Persson
- Department of Clinical Sciences in Malmö, Clinical Research Centre, Lund University, Malmö, Sweden
- Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden
| | - Jan Lexell
- Department of Health Sciences, Lund University, Lund, Sweden
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Zhao H, Cole S. Leisure, Recreation, and Life Satisfaction: A Longitudinal Study for People With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2023; 29:61-72. [PMID: 38076495 PMCID: PMC10704216 DOI: 10.46292/sci23-00020] [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] [Indexed: 12/18/2023]
Abstract
Background Leisure and recreation (LR) are positively associated with social integration and life satisfaction in people with spinal cord injury (SCI). However, few studies have longitudinally observed long-term changes in LR participation among people with SCI and discussed the association of these activities with social integration and life satisfaction. Objectives This study aims to determine for people with SCI, within a 45-year period, the association between mobility and LR participation; the associations between LR participation and social integration and life satisfaction, respectively; and whether the association between LR participation and life satisfaction is mediated by social integration. Methods Growth modeling and linear mixed modeling were employed as the primary data analysis tools to explore longitudinal changes in LR participation, social integration, and life satisfaction. A mediation test was conducted to examine the potential mediation effect of social integration on the relationship between LR participation and life satisfaction. Results The mobility level, LR participation hours, and social integration of people with SCI decreased gradually during the 45-year period, whereas life satisfaction increased as they lived longer with the injury. LR participation was consistently and positively associated with social integration and life satisfaction of people with SCI. A mediation effect by social integration was observed between LR and life satisfaction. Conclusion A decline in mobility level was associated with a decrease in LR participation over time for people with SCI. Engaging in LR activities regularly and maintaining a certain level of social interaction are consistently and positively associated with long-term life satisfaction.
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Affiliation(s)
- Haoai Zhao
- Department of Health and Wellness Design, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
| | - Shu Cole
- Department of Health and Wellness Design, School of Public Health, Indiana University Bloomington, Bloomington, Indiana, USA
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Waller M, Jörgensen S, Lexell J. Changes over 6 years in secondary health conditions and activity limitations in older adults aging with long-term spinal cord injury. PM R 2023; 15:157-167. [PMID: 35092167 DOI: 10.1002/pmrj.12776] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 11/19/2021] [Accepted: 12/28/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND The number of individuals aging with long-term spinal cord injury (SCI) is increasing. Still, there is limited knowledge about changes in secondary health conditions (SHCs) and activity limitations over time. OBJECTIVES To determine changes in SHCs and activity limitations in older adults aging with long-term SCI over 6 years, and to investigate how changes in SHCs and activity limitations are associated with gender, age, and injury characteristics. DESIGN Longitudinal cohort study from the Swedish Aging with Spinal Cord Injury Study (SASCIS). SETTING Community settings, Sweden. PARTICIPANTS From the initial 123 participants in the SASCIS: 78 individuals (32% women); mean age 68 years; mean time since injury 31 years; injury levels C1-L3, AIS A-D. INTERVENTIONS Not applicable MAIN OUTCOME MEASURE: Bowel and bladder function and problems, pain, spasticity, and the Spinal Cord Independence Measure (SCIM III). RESULTS Over 6 years, bowel-related problems increased (31% to 47%, p = .015) and the occurrence of constipation doubled to 24% (p = .013). There were increases in frequent urinary tract infections (10% to 26%, p = .004), use of indwelling urinary catheters (15% to 23%, p = .031), and other bladder-related problems (4% to 22%, p < .001). The occurrence of pain was high (85%), with no significant change. Spasticity increased from 41% to 62% (p < .001). Activity limitations increased (SCIM III total score mean 67 to 61, p < .001, with significant decreases in all subscales). The increase in bowel-related problems was greater in males, and the deterioration in self-care was greater in participants with longer time since injury and with traumatic injuries. CONCLUSIONS These findings support the notion that SHCs and activity limitations increase over time in older adults aging with long-term SCI. The results can inform clinicians and call for a proactive, holistic approach in the long-term follow-up to support healthy and active aging.
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Affiliation(s)
- Mikael Waller
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Rehabilitation Medicine, Sunderby Hospital, Norrbotten County Council, Luleå, Sweden
| | - Sophie Jörgensen
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Jan Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
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Kendall MB, Amsters D, Schuurs S, Borg DN, Pershouse K, Kuipers P. Longitudinal effects of time since injury and age at injury on outcomes of people with spinal cord injury in Queensland, Australia. Spinal Cord 2022; 60:1087-1093. [PMID: 35764703 DOI: 10.1038/s41393-022-00824-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 06/06/2022] [Accepted: 06/07/2022] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Longitudinal cohort study. OBJECTIVES To investigate the longitudinal effects of time since injury and age at injury on outcomes of quality of life, physical function, secondary conditions and participation, in people with traumatic spinal cord injury (SCI). SETTING Community resident people with spinal cord injury in Queensland, Australia. METHODS A baseline sample of 270 people with SCI was recruited. Telephone surveys on measures of quality of life (WHOQOL-Bref), secondary conditions (Secondary Conditions Surveillance Instrument, subset), physical functioning (Functional Independence Measure motor subscale) and participation (Community Integration Measure) were conducted each year between 2004 and 2008, and again in 2018. Random-effect within-between models were used to determine the effect of time since injury and age at injury on each outcome variable. Inverse probability-of-censoring weights were used to correct for selection bias. RESULTS There was an effect of time since injury on secondary conditions, with a one-year change associated with 9% higher odds of having worse Secondary Conditions Surveillance Instrument scores (odds ratio = 1.09, 95% confidence interval = 1.02, 1.17; p = 0.006). We did not find any evidence of a time since injury effect on quality of life, physical function, or participation. Similarly, we did not find any evidence of an age at injury effect on any outcome variable. CONCLUSIONS Secondary conditions may increase with longer time since injury among people with SCI, suggesting appropriate formal and informal supports are required to minimise the impact of these emerging health problems as individuals age.
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Affiliation(s)
- Melissa B Kendall
- Transitional Rehabilitation Program, Queensland Spinal Cord Injuries Service, Metro South Health, Brisbane, QLD, Australia. .,Griffith University, Menzies Health Institute Queensland, The Hopkins Centre, Brisbane, QLD, Australia.
| | - Delena Amsters
- Spinal Outreach Team, Queensland Spinal Cord Injuries Service, Metro South Health, Brisbane, QLD, Australia
| | - Sarita Schuurs
- Spinal Outreach Team, Queensland Spinal Cord Injuries Service, Metro South Health, Brisbane, QLD, Australia
| | - David N Borg
- Griffith University, Menzies Health Institute Queensland, The Hopkins Centre, Brisbane, QLD, Australia
| | - Kiley Pershouse
- Spinal Outreach Team, Queensland Spinal Cord Injuries Service, Metro South Health, Brisbane, QLD, Australia
| | - Pim Kuipers
- Griffith University, Menzies Health Institute Queensland, The Hopkins Centre, Brisbane, QLD, Australia
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Jörgensen S, Lennman E, Lexell J. Sense of coherence and changes over six years among older adults aging with long-term spinal cord injury. Spinal Cord 2021; 59:1278-1284. [PMID: 34593987 DOI: 10.1038/s41393-021-00713-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 09/17/2021] [Accepted: 09/17/2021] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional and longitudinal. OBJECTIVES To (i) describe sense of coherence (SOC) and changes over six years in older adults aging with long-term spinal cord injury (SCI) and (ii) investigate how changes in SOC are associated with injury characteristics and changes in sociodemographics and secondary health conditions (SHCs; bowel-related and bladder-related problems, pain and spasticity). SETTING Community in Southern Sweden. METHODS From the initial 123 participants in the Swedish Aging with Spinal Cord Injury Study (SASCIS), 76 individuals (33% women, median age 66 years, median time since injury 30 years, AIS A-D, 30% complete) responded to the 13-item SOC scale (range 13-91) twice with a 6-year interval. Data were analyzed with multivariable hierarchical regression. RESULTS The participants rated a strong SOC at both assessments (median 73 and 76.5, respectively) which significantly increased over time. Overall, their marital status and vocational situation remained stable whereas SHCs increased. A change from not having a partner to having one was the only significant explanatory factor for a positive change in SOC. CONCLUSIONS The present study describes, for the first time, changes in SOC over time and associated factors in older adults aging with long-term SCI. They generally maintain a strong ability to understand, handle, and being motivated when dealing with stressful events arising in their lives as a result of their SCI. The associations emphasize the importance of the social context for successful adaptation to living with SCI along the aging process.
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Affiliation(s)
- Sophie Jörgensen
- Department of Health Sciences, Lund University, Lund, Sweden. .,Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
| | - Elsa Lennman
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Jan Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
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Eitivipart AC, Arora M, Quel de Oliveira C, Heard R, Middleton JW, Davis GM. Physical activity recall assessment for people with spinal cord injury: Thai translation and cross-cultural adaptation. Disabil Rehabil 2021; 44:4831-4840. [PMID: 33878991 DOI: 10.1080/09638288.2021.1913246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE This research sought to translate and culturally adapt the content of the original Physical Activity Recall Assessment for People with Spinal Cord Injury (PARA-SCI) into the Thai language and to assess its inter- and intra-rater reliability. METHODS This study was divided into two parts; (i) translation and cross-cultural adaptation, using a six-step guideline-based translation-validation process and (ii) reliability assessment of the translated survey tool using intraclass correlation coefficients (ICCs), Bland-Altman plots and one-way ANOVA analyses. RESULTS The Thai-PARA-SCI was successfully developed. The results revealed an excellent inter-rater reliability (ICC = 0.99, 95% CI range from 0.959-0.999) and the Bland-Altman plots showed little difference in times spent engaged physical activity. Intra-rater reliability results were affected inadvertently by testing across an unusual period, demonstrating poor to moderate scores (ICC ranged from 0.05-0.69, 95% CI ranged from -0.067-0.830) with the Bland-Altman plots showing very different ranges of time spent on physical activity. CONCLUSION This study achieved its aims of culturally and systematically translating the English PARA-SCI interview script into the Thai version with excellent scores for inter-rater reliability and was proven to be understandable by prospective users (Thai-PT) and participants (Thai-SCI).Implications for RehabilitationA robust cross-cultural translation and adaptation of the Physical Activity Recall Assessment for people with Spinal Cord Injury (PARA-SCI) into the Thai context has been undertaken, providing an effective exemplar for converting patient reported health outcome measures between languages of different root origins.When using the PARA-SCI as a pre- and post-intervention outcomes survey, clinicians should ensure that the timing of interview administration does not coincide with any unintended alterations in work-life balance, to ensure that the data are representative of the habitual physical activity levels performed by participants in their daily lives.Due to the possibility that physical activity levels could vary day-by-day or week-to-week, using the same day measurement findings may be a more reliable way to deploy the PARA-SCI than repeated assessments week(s) apart.
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Affiliation(s)
- Aitthanatt Chachris Eitivipart
- Discipline of Exercise and Sport Sciences, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Accessibility and Assistive Technology Research Team, Assistive Technology and Medical Devices Research Center, National Science and Technology Development Agency, Pathum Thani, Thailand
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, Australia.,Sydney Medical School - Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Camila Quel de Oliveira
- Discipline of Physiotherapy, Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | - Robert Heard
- Discipline of Behavioural and Social Sciences in Health, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, St Leonards, Australia.,Sydney Medical School - Northern, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Glen M Davis
- Discipline of Exercise and Sport Sciences, Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Jörgensen S, Hedgren L, Sundelin A, Lexell J. Global and domain-specific life satisfaction among older adults with long-term spinal cord injury. J Spinal Cord Med 2021; 44:322-330. [PMID: 31099721 PMCID: PMC7952060 DOI: 10.1080/10790268.2019.1610618] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVE Although life expectancy after spinal cord injury (SCI) has increased, knowledge of life satisfaction and associated factors among older adults with long-term SCI is still very limited. The objective of this study was, therefore, to assess global and domain-specific life satisfaction among older adults with long-term SCI and investigate the association with sociodemographics, injury characteristics and secondary health conditions. DESIGN Cross-sectional cohort study. Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS). SETTING Community settings in southern Sweden. PARTICIPANTS Seventy-eight individuals (32% women, injury levels C1-L3, American Spinal Injury Association Impairment Scale (AIS) A-D) mean age 68 years, mean time since injury 31 years. INTERVENTIONS Not applicable. OUTCOME MEASURES The Life Satisfaction Questionnaire (LiSat-11). RESULTS The participants were at least rather satisfied with most of the 11 life domains. They rated the lowest satisfaction with sexual life, activities of daily living and somatic health. Having a partner and being vocationally active was associated with greater satisfaction with life as a whole and with several other life domains. Participants with AIS D injuries were less satisfied with their somatic health than those with tetraplegia AIS A-C and paraplegia AIS A-C injuries. More secondary health conditions were negatively associated with satisfaction in five life domains. CONCLUSION Life satisfaction can be affected many years after SCI. The social context, participation in meaningful activities and minimizing secondary health conditions seem to be important for maintaining life satisfaction in older adults with a long-term injury.
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Affiliation(s)
- Sophie Jörgensen
- Department of Health Sciences, Lund University, Lund, Sweden,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden,Correspondence to: Sophie Jörgensen, Department of Health Sciences, Rehabilitation Medicine Research Group, PO Box 157, Lund University, SE-221 00Lund, Sweden; Ph: +46 46 222 18 73 (secretary); +46 46 222 19 91 (direct).
| | - Linn Hedgren
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Anna Sundelin
- Department of Health Sciences, Lund University, Lund, Sweden
| | - Jan Lexell
- Department of Health Sciences, Lund University, Lund, Sweden,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden,Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
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Jörgensen S, Costa Andersson MV, Lexell J. Changes in health-related quality of life among older adults aging with long-term spinal cord injury. Spinal Cord 2020; 59:769-776. [PMID: 33184513 PMCID: PMC8257479 DOI: 10.1038/s41393-020-00579-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/22/2020] [Accepted: 10/26/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional and longitudinal. OBJECTIVES To (i) describe health-related quality of life (HRQoL) and changes over 6 years in older adults aging with long-term spinal cord injury (SCI) and (ii) investigate how changes in HRQoL are associated with age, gender, and injury characteristics. SETTING Community in southern Sweden. METHODS From the initial 123 participants (years 2011-2012) in the Swedish Aging with Spinal Cord Injury Study (SASCIS), 77 individuals (32% women, C1-L3, AIS A-D, median age 66 years, median time since injury 31 years, 30% complete injuries) were assessed 6 years later. HRQoL was rated with the Spinal Cord Injury Quality of Life Questionnaire (SCI QL-23). Associations were investigated using multivariable linear regression analyses. RESULTS The median rating of global QoL (scale range 0-100) was relatively high at both assessments (67 and 83, respectively). There was a large variability in all HRQoL-domains and no significant changes over 6 years. As compared to an AIS D injury, a tetraplegia AIS A-C injury and tetraplegia and paraplegia AIS A-C injuries were associated with positive change in depressive symptoms and global QoL, respectively. CONCLUSIONS Older adults aging with long-term SCI show large variations in all HRQoL-domains and have the potential to maintain a high and stable level of HRQoL over time. Persons with AIS D injuries may need increased attention to mitigate negative changes in depressive symptoms and global QoL. Further studies are needed to identify modifiable factors associated with changes in HRQoL in older adults aging with long-term SCI.
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Affiliation(s)
- Sophie Jörgensen
- Department of Health Sciences, Lund University, Lund, Sweden. .,Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
| | | | - Jan Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
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11
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Giroux EE, Casemore S, Clarke TY, McBride CB, Wuerstl KR, Gainforth HL. Enhancing participation while aging with spinal cord injury: applying behaviour change frameworks to develop intervention recommendations. Spinal Cord 2020; 59:665-674. [PMID: 32989252 DOI: 10.1038/s41393-020-00555-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 09/08/2020] [Accepted: 09/10/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Knowledge translation study. OBJECTIVES Use the Theoretical Domains Framework (TDF) and Behaviour Change Wheel (BCW) to (1) identify barriers and facilitators to participation in daily activities and social roles among people aging with spinal cord injury (SCI); and, (2) systematically co-develop participation-focused intervention recommendations with SCI community organizations that can support people aging with SCI. SETTING Canadian SCI community. METHODS Semi-structured interviews were conducted with 22 people (minimum 45 years of age; minimum 10 years post injury). Participants were asked about their experiences with participating in daily activities and social roles while aging and preferences for what participation-focused interventions should entail. Transcripts were analyzed to address three stages of behaviour change intervention design: (1) identify barriers and facilitators; (2) identify intervention functions and policy categories; (3) identify implementation options. Findings were synthesized into intervention recommendations and assessed for feasibility. RESULTS Participation in daily activities and social roles was heavily influenced by three TDF domains: environmental context and resources, skills, and social influences. Six intervention functions and all policy categories within the BCW were considered viable intervention options. Multiple messengers and modes of delivery were identified as important. The synthesized recommendations included educating SCI organization membership, partnering with other disability organizations, and advocating to the provincial government. CONCLUSIONS Findings suggest that multiple intervention formats delivered through a variety of implementation options are needed to enhance participation in daily activities and social roles while aging with SCI. Future efforts should focus on translating the recommendations into real-world behaviour change interventions.
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Affiliation(s)
- Emily E Giroux
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada. .,International Collaboration on Repair Discoveries, Vancouver, BC, Canada.
| | | | | | | | - Kelsey R Wuerstl
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada.,International Collaboration on Repair Discoveries, Vancouver, BC, Canada
| | - Heather L Gainforth
- School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, BC, Canada.,International Collaboration on Repair Discoveries, Vancouver, BC, Canada
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Jörgensen S, Hill M, Lexell J. Cardiovascular Risk Factors Among Older Adults With Long-Term Spinal Cord Injury. PM R 2019; 11:8-16. [PMID: 29964213 DOI: 10.1016/j.pmrj.2018.06.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Accepted: 06/15/2018] [Indexed: 01/08/2023]
Abstract
BACKGROUND Individuals with spinal cord injury (SCI) now live longer, which increases the risk of cardiovascular disease. Knowledge of cardiovascular risk factors amenable to intervention are therefore needed to support their healthy aging. OBJECTIVE To describe the occurrence of cardiovascular risk factors among older adults with long-term SCI and investigate the association with sociodemographics and injury characteristics. DESIGN Cross-sectional descriptive cohort study. SETTING Home settings. PARTICIPANTS In total, 123 individuals (71% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D), mean age 63 years, mean time since injury 24 years. METHODS Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS), collected through interviews and assessments during home visits and from medical records. MAIN OUTCOME MEASURES Anthropometric measurements, blood pressure, fasting plasma glucose and blood lipids, and data on cardiovascular comorbidity and tobacco use. RESULTS One third had a previous diagnosis of hypertension, and 55% presented with a blood pressure ≥ 140/90 mm Hg at the time of assessment. Sixteen percent had a history of diabetes and in 15% fasting glucose levels were ≥ 7 mmol/L. Dyslipidemia was present in 76%, whereas 16% had prediagnosed dyslipidemia. Mean body mass index (BMI) was 27 kg/m2 and mean waist circumference was 101 cm. When SCI-adjusted BMI cut-off values were used, 93% were considered overweight (BMI ≥22 kg/m2 ), and 60% had a waist circumference associated with cardiometabolic risk. A total of 16% smoked regularly. The median number of cardiovascular risk factors was 3. No significant associations were found between the total number of risk factors and sociodemographics and injury characteristics. CONCLUSIONS The high occurrence of cardiovascular risk factors among older adults with long-term SCI can pose additional consequences to their health. Regular assessments and interventions targeting cardiovascular risk in this population are therefore warranted. Further research is needed to identify modifiable factors associated with their risk profile. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Sophie Jörgensen
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund; and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Mattias Hill
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund; and Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - Jan Lexell
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund; and Department of Neuroscience, Rehabilitation Medicine,, Uppsala University, Uppsala, Sweden
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Jörgensen S, Svedevall S, Magnusson L, Martin Ginis KA, Lexell J. Associations between leisure time physical activity and cardiovascular risk factors among older adults with long-term spinal cord injury. Spinal Cord 2019; 57:427-433. [PMID: 30622291 DOI: 10.1038/s41393-018-0233-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Revised: 11/28/2018] [Accepted: 12/03/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This is a cross-sectional study. OBJECTIVES To describe the association between cardiovascular risk factors (body mass index (BMI), waist circumference (WC), blood pressure, blood glucose and lipids) and leisure time physical activity (LTPA) in older adults with long-term spinal cord injury (SCI). SETTING Community settings, southern Sweden. METHODS Data from the baseline data collection of the Swedish Aging with Spinal Cord Injury Study (SASCIS) (n = 123, 71% men, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D, mean age 63 years, mean time since injury 24 years). Data were collected through home interviews, assessments and blood samples. The Physical Activity Recall Assessment for People with SCI was used to assess LTPA. Associations were investigated using multivariable linear regression analyses adjusted for age, gender, level and severity of injury, cause of injury, time since injury and tobacco use. RESULTS More minutes per day of moderate-to-heavy LTPA were significantly associated with a lower BMI (Beta = -0.31; p = 0.001) and a lower WC (Beta = -0.24; p = 0.009). More minutes per day of total LTPA (mild intensity or greater) were associated with a higher systolic blood pressure (Beta = 0.27; p = 0.041) among participants with tetraplegia. No other significant associations between the cardiovascular risk factors and total LTPA were found. CONCLUSION Participation in daily LTPA is associated with better cardiovascular health with regard to BMI and WC in older adults with long-term SCI. Further studies are needed to establish the specific amount of activity needed to obtain positive health effects in this group and the directional causality of the associations. SPONSORSHIP Not applicable.
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Affiliation(s)
- Sophie Jörgensen
- Department of Health Sciences, Lund University, Lund, Sweden. .,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
| | - Stina Svedevall
- Department of Health Sciences, Lund University, Lund, Sweden
| | | | - Kathleen A Martin Ginis
- School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
| | - Jan Lexell
- Department of Health Sciences, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.,Department of Neuroscience, Rehabilitation Medicine, Uppsala University, Uppsala, Sweden
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Ageing, Disability, and Spinal Cord Injury: Some Issues of Analysis. Curr Gerontol Geriatr Res 2018; 2018:4017858. [PMID: 30581466 PMCID: PMC6276527 DOI: 10.1155/2018/4017858] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 11/06/2018] [Indexed: 01/10/2023] Open
Abstract
Spinal cord injury is a disabling disorder, worldwide spread, with important consequences on functioning and health conditions and impacts on physical, psychological, and social well-being. The consequences are related to the lesion itself and to other complications related to the lesion. In the last decades, there have been an increasing of the mean ages of onset and also an increase in life expectancy after the lesion. So, differently from the past, people with spinal cord injury can age after the lesion. Taking into account the need to share data and information about specific disabling conditions and their relationship with ageing, this paper aims to discuss some issues from recent literature on the relationship between aging and disability in the spinal cord injury, according to a narrative review approach. A narrative review of the literature on ageing and spinal cord injury was undertaken. Search was based on the following electronic databases: PubMed/Medline and Ovid/PsychINFO. A combination of the following keywords was used: (1) “ageing” or “aging” and (2) “spinal cord injury” or “spinal cord lesion” and (3) disability. Data on consequences of the lesion in the life of aging people, secondary health conditions, life expectancy, participation, and quality of life are discussed. Then, a brief discussion of clinical issues and the role of interventions aimed to promote wellbeing, health, quality of life, and participation of people with spinal cord injury is proposed.
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Prevalence of parenthood in wheelchair-dependent persons with long-term spinal cord injury in the Netherlands. Spinal Cord 2018; 56:607-613. [PMID: 29352157 DOI: 10.1038/s41393-018-0060-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 12/20/2017] [Accepted: 12/23/2017] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Multicenter cross-sectional study. OBJECTIVES To determine the prevalence of parenthood in long-term wheelchair-dependent persons who sustained a spinal cord injury (SCI) during their reproductive years. Secondary aims were to (1) explore patient-specific and disease-related factors associated with parenthood after SCI; and (2) quantify fertility aids used by men with SCI. SETTING Eight specialized SCI rehabilitation centers in the Netherlands. METHODS Questionnaires and physical examination were applied in 255 persons with SCI. Prevalence rates of parenthood among the general Dutch population were used for comparison. Logistic regression analyses were used to explore factors associated with parenthood after SCI. RESULTS Prevalence of parenthood in SCI was 50% in men and 45% in women, which was significantly (P < 0.05) lower than rates in the general population (74% in men and 81% in women). Among the parents with SCI, most (66% of males and 72% of females) of them had children after SCI. Parenting children after SCI was associated with partnership (OR = 14.5, P < .001 [men]; OR = 3.7, P = .05 [women]), normal micturition (OR = 4.9, P = .02 [men]), incomplete lesion (OR = 5.4, P = .03 [women]), and paraplegia (OR = 7.3, P = .02 [women]). The most frequently used methods for ejaculation and fertilization were electroejaculation (29%) and intracytoplasmatic sperm injection (23%). CONCLUSIONS Prevalence of parenthood in SCI persons is low. However, half of the persons with SCI do become parents, with most doing so following SCI. Demographic and disease-related factors may contribute to this.
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Jörgensen S, Martin Ginis KA, Lexell J. Leisure time physical activity among older adults with long-term spinal cord injury. Spinal Cord 2017; 55:848-856. [PMID: 28322241 DOI: 10.1038/sc.2017.26] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Revised: 02/06/2017] [Accepted: 02/07/2017] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVES To describe participation in leisure time physical activity (LTPA) (amount, intensity and type) among older adults with long-term spinal cord injury (SCI), and to investigate the associations with sociodemographics, injury characteristics and secondary health conditions (SHCs). SETTING Home settings in southern Sweden. METHODS Data from the Swedish Aging with Spinal Cord Injury Study (SASCIS). The physical activity recall assessment for people with SCI was used to assess LTPA among 84 men and 35 women (mean age 63.5 years, mean time since injury 24 years, injury levels C1-L5, American Spinal Injury Association Impairment Scale A-D). Associations were analyzed statistically using hierarchical multivariable regression. RESULTS Twenty-nine percent reported no LTPA, whereas 53% performed moderate-to-heavy intensity LTPA. The mean minutes per day of total LTPA was 34.7 (±41.5, median 15, range 0-171.7) and of moderate-to-heavy LTPA 22.5 (±35.1, median 5.0, range 0-140.0). The most frequently performed activities were walking and wheeling. Sociodemographics, injury characteristics and SHCs (bowel-related and bladder-related problems, spasticity and pain) explained 10.6% and 13.4%, respectively, of the variance in total and moderate-to-heavy LTPA. Age and wheelchair use were significantly, negatively associated with total LTPA. Women, wheelchair users and employed participants performed significantly less moderate-to-heavy LTPA than men, those using walking devices/no mobility device and unemployed participants. CONCLUSION Many older adults with long-term SCI do not reach the amount or intensity of LTPA needed to achieve fitness benefits. Research is needed on how to increase LTPA and to identify modifiable factors that could enhance their participation.
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Affiliation(s)
- S Jörgensen
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
| | - K A Martin Ginis
- School of Health and Exercise Sciences, University of British Columbia, Okanagan Campus, Kelowna, BC, Canada
| | - J Lexell
- Department of Health Sciences, Rehabilitation Medicine Research Group, Lund University, Lund, Sweden.,Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.,Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
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Lundström U, Wahman K, Seiger Å, Gray DB, Isaksson G, Lilja M. Participation in activities and secondary health complications among persons aging with traumatic spinal cord injury. Spinal Cord 2016; 55:367-372. [PMID: 27845357 DOI: 10.1038/sc.2016.153] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 08/19/2016] [Accepted: 09/10/2016] [Indexed: 12/27/2022]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To describe participation in activities and explore the relationship with secondary complications among persons aging with a traumatic spinal cord injury (SCI). SETTING A regional SCI outpatient center in Sweden. METHODS Data were collected through a phone survey, which included 10 activities from the instrument PARTS/M-v3 (PARTicipation Survey/Mobility version-3) together with data from the participants' medical records. Cross-tabulation and χ2 were used for data analysis. RESULTS In this study, 121 persons matched the inclusion criteria and the final study sample comprised 73 participants (60% response rate): 55 men and 18 women. Mean age was 63.7±9.4 years, and mean time since injury was 36.3±9.2 years. Regardless of duration of SCI, all 73 participated in dressing, bathing and leisure activities. Women reported better health than men. Particularly for those who lived 36-55 years after injury; increasing pain, fatigue, spasticity and decreased muscle strength were negatively affecting participation in activities, especially exercise and active recreation. Additionally, a need to save strength/energy was also a reason for not participating in the activities. Perceived future support and concerns in relation to personal assistance, assistive devices and rehabilitation was also reported. CONCLUSION Increasing secondary health complications and a need to save strength/energy influenced participation in activities. Laws and/or governmental policies regarding personal assistance and assistive devices did not always support participation in activities. Interventions should aim to create a balance among activities in everyday life.
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Affiliation(s)
- U Lundström
- Division of Health and Rehabilitation, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - K Wahman
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Å Seiger
- Division of Neurodegeneration, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - D B Gray
- Disability and Community Participation Research Office (DACPRO), Department of Neurology, Washington University School of Medicine, St Louis, MO, USA
| | - G Isaksson
- Division of Health and Rehabilitation, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
| | - M Lilja
- Division of Health and Rehabilitation, Department of Health Sciences, Luleå University of Technology, Luleå, Sweden
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Secondary Health Conditions, Activity Limitations, and Life Satisfaction in Older Adults With Long-Term Spinal Cord Injury. PM R 2016; 9:356-366. [DOI: 10.1016/j.pmrj.2016.09.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2016] [Revised: 09/05/2016] [Accepted: 09/10/2016] [Indexed: 11/19/2022]
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