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Raguindin PF, Itodo OA, Eriks-Hoogland I, Muka T, Brach M, Stucki G, Stoyanov J, Glisic M. Does cardiometabolic risk profile differ among individuals with traumatic and non-traumatic spinal cord injury (SCI): the evidence from the multicenter SCI cohort in Switzerland (SwiSCI). Spinal Cord 2024; 62:387-395. [PMID: 38750255 PMCID: PMC11230898 DOI: 10.1038/s41393-024-00996-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 04/08/2024] [Accepted: 04/18/2024] [Indexed: 07/10/2024]
Abstract
STUDY DESIGN Longitudinal study. OBJECTIVE To explore whether individuals with traumatic spinal cord injury (TSCI) and non-traumatic SCI (NTSCI) experience different trajectories in changes of cardiometabolic disease (CMD) factors during initial rehabilitation stay. SETTING Multicenter Swiss Spinal Cord Injury Cohort (SwiSCI) study. METHODS Individuals without history of cardiovascular diseases were included. CMD factors and Framingham risk score (FRS) were compared between TSCI and NTSCI. Linear mixed models' analysis was employed to explore the trajectory in CMD factors changes over rehabilitation period and a multivariate linear regression analysis was used at discharge from inpatient rehabilitation to explore factors associated with CMD risk profile in TSCI and NTSCI. We performed age and sex-stratified analyses. RESULTS We analyzed 530 individuals with SCI (64% with TSCI and 36% NTSCI). The median age was 53 years (IQR:39-64) with 67.9% (n = 363) of the study cohort being male. The median rehabilitation duration was 4.4 months (IQR 2.4-6.4). At admission to rehabilitation, FRS (9.61 vs. 5.89) and prevalence of hypertension (33.16% vs. 13.62%), diabetes (13.68% vs. 4.06%), and obesity (79.05% vs. 66.67%) were higher in NTSCI as compared to TSCI, No difference was observed in cardiometabolic syndrome between the groups (around 40% in both groups). Overall, we observed longitudinal increases in total cholesterol, HDL-C and HDL/total cholesterol ratio, and a decrease in fasting glucose over the rehabilitation period. No differences in longitudinal changes in cardiovascular risk factors were observed between TSCI and NTSCI. CONCLUSIONS There was no deterioration in cardiometabolic risk factors over rehabilitation period, at discharge from initial rehabilitation stay. Both TSCI and NTSCI experienced high burden of cardiometabolic syndrome components with NTSCI experiencing more disadvantageous risk profile. The effectiveness of therapeutic and lifestyle/behavioral strategies to decrease burden of cardiometabolic disease and its components in early phase should be explored in future studies.
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Affiliation(s)
- Peter Francis Raguindin
- Swiss Paraplegic Research, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, 6005, Lucerne, Switzerland
| | - Oche Adam Itodo
- Swiss Paraplegic Research, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
- Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Inge Eriks-Hoogland
- Swiss Paraplegic Research, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland
- Faculty of Health Sciences and Medicine, University of Lucerne, Alpenquai 4, 6005, Lucerne, Switzerland
- Swiss Paraplegic Centre, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland
| | - Mirjam Brach
- Swiss Paraplegic Research, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Guido A. Zäch Strasse 1, 6207, Nottwil, Switzerland.
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, 3012, Bern, Switzerland.
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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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Li R, Ding M, Wang J, Pan H, Sun X, Huang L, Fu C, He C, Wei Q. Effectiveness of robotic-assisted gait training on cardiopulmonary fitness and exercise capacity for incomplete spinal cord injury: A systematic review and meta-analysis of randomized controlled trials. Clin Rehabil 2023; 37:312-329. [PMID: 36373899 DOI: 10.1177/02692155221133474] [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: 11/16/2022]
Abstract
OBJECTIVE To determine the effects of robotic-assisted gait training on cardiopulmonary fitness and exercise capacity for people with incomplete spinal cord injury. METHODS PubMed, Embase, Web of Science, PEDro, CENTRAL and CINAHL were searched from inception until September 4, 2022. Randomized controlled trials that evaluated the effects of robotic-assisted gait training on cardiopulmonary fitness and exercise capacity for individuals with incomplete spinal cord injury were selected. Mean differences (MD) with 95% confidence interval (CI) were calculated. The methodological quality was evaluated by the Cochrane Risk of Bias 2.0 tool. Subgroup analyses were conducted according to the time since injury. RESULTS In total 19 studies involving 770 patients were eligible for analysis. Individuals with acute incomplete spinal cord injury in robotic-assisted gait training groups showed significantly greater improvements in 6-minute walking test (MD 53.32; 95% CI 33.49 to 73.15; P < 0.001), lower extremity motor scale (MD 5.22; 95% CI 3.63 to 6.80; P < 0.001) and walking index for spinal cord injury II (MD 3.18; 95% CI 1.34 to 5.02; P < 0.001). Robotic-assisted gait training improved peak oxygen consumption to a greater degree for chronic incomplete spinal cord injury patients (MD 4.90; 95% CI 0.96 to 8.84; P = 0.01). CONCLUSION Robot-assisted gait training may be a feasible and effective intervention in terms of cardiopulmonary fitness and exercise capacity for individuals with incomplete spinal cord injury.
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Affiliation(s)
- Ran Li
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Mingfu Ding
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Jiao Wang
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Hongxia Pan
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Xin Sun
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Liyi Huang
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Chenying Fu
- National Clinical Research Center for Geriatrics, 34753West China Hospital, Sichuan University, Chengdu, People's Republic of China.,Aging and Geriatric Mechanism Laboratory, West China Hospital, 12530Sichuan University, Chengdu, People's Republic of China
| | - Chengqi He
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
| | - Quan Wei
- Department of Rehabilitation Medicine, West China Hospital, 12530Sichuan University, Chengdu, Sichuan, People's Republic of China.,Key Laboratory of Rehabilitation Medicine in Sichuan Province, Chengdu, Sichuan, People's Republic of China
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Conti A, Campagna S, Gianino MM, Mamo C, Onorati R, Albanesi B, Dimonte V, Borraccino A. Incidence and mortality of spinal cord injury from 2008 to 2020: a retrospective population-based cohort study in the Piedmont Region, Italy. Spinal Cord 2023; 61:99-105. [PMID: 35933474 PMCID: PMC9362101 DOI: 10.1038/s41393-022-00842-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Retrospective population-based cohort study. OBJECTIVES To determine the incidence and mortality of spinal cord injuries (SCI) in the Piedmont Region of Northwestern Italy. SETTING Publicly-funded SCI rehabilitation centres in the Piedmont Region. METHODS Administrative databases were used to identify individuals at their first admission to a SCI rehabilitation centre from January 1st, 2008 to December 31st, 2020. Cases were stratified by age and aetiology (traumatic SCI, TSCI; non-traumatic SCI, NTSCI). Age- and aetiology-specific incidence rate and person-year mortality rates were calculated for each year. Case lethality was reported as deaths among prevalent cases for each year. RESULTS A total of 892 cases were identified (56.4% TSCI). The average annual crude incidence rate was 17.9 per million population, decreasing from 26.0 in 2008 to 10.8 in 2020. Young adults and the elderly represented the majority of TSCI and NTSCI cases, respectively. Of the 235 individuals who died during the study period, 58.3% had NTSCI. The mortality rate per 1000 person-years decreased from 16.3 in 2009 to 8.5 in 2020, while case lethality more than tripled (from 17.2 in 2009 to 57.1 in 2020). CONCLUSIONS We identified a decreasing trend in SCI incidence and mortality rates, with an increased case lethality over the study period, especially in NTSCI. Given these changes in the epidemiology of SCI, community services offered after rehabilitation should be strengthened to enhance their effectiveness and contribute to increased survival in this population.
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Affiliation(s)
- Alessio Conti
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Sara Campagna
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Maria Michela Gianino
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Carlo Mamo
- Epidemiology Unit, Local Health Unit TO3, Grugliasco (TO), Piedmont, Italy
| | - Roberta Onorati
- Epidemiology Unit, Local Health Unit TO3, Grugliasco (TO), Piedmont, Italy
| | - Beatrice Albanesi
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Valerio Dimonte
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy
| | - Alberto Borraccino
- Department of Public Health and Paediatric Sciences, University of Turin, Turin, Italy.
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Papa DCR, Menezes LDCD, Moraes ÍAPD, Silveira AC, Padula N, Silva SDOV, Gaspar RC, Dias ED, Ferreira C, Araújo LVD, Astorino TA, Dawes H, Monteiro CBDM, Silva TDD. Cardiac autonomic modulation in response to postural transition during a virtual reality task in individuals with spinal cord injury: A cross-sectional study. PLoS One 2023; 18:e0283820. [PMID: 37053177 PMCID: PMC10101494 DOI: 10.1371/journal.pone.0283820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Accepted: 03/17/2023] [Indexed: 04/14/2023] Open
Abstract
PURPOSE The postural transition from sitting to standing is a moment of dysautonomic occurrence in individuals with Spinal Cord Injury (SCI). Different tools can be used to minimize this event, such as virtual reality. Thus, we aimed to analyze cardiac autonomic modulation in individuals with SCI during postural transition from the sitting to orthostatism position using a cognitive virtual reality (VR) task. METHODS Individuals with and without SCI were positioned on the Easy Stand® device, sitting at rest, at 0° considering the angle between the seat and the floor, elevation at 45°, and orthostatism at 90°, for 5 minutes in each position. Heart rate variability (HRV) measures of sympathovagal balance were collected (heart rate receiver: Polar V800). The groups were subdivided into two groups, one that performed VR as an intervention during the postural angle changes and another group that did not perform VR. RESULTS We evaluated 76 individuals, 40 with a medical diagnosis of SCI and 36 who composed the able-bodied control group without SCI, matched by age and sex. The HRV results showed that the SCI group who performed the task in VR demonstrated no significant difference in parasympathetic activation and global variability between the sitting versus 90° positions. There was better sympathovagal balance in SCI and able-bodied control groups who performed the VR task between the sitting versus 90° positions. CONCLUSION The use of a VR task seems to contribute to better sympathovagal balance, with the potential to reduce dysautonomia during postural changes.
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Affiliation(s)
- Denise Cardoso Ribeiro Papa
- Postgraduate Program in Medicine (Cardiology) at Escola Paulista de Medicina, Federal University of São Paulo (EPM / UNIFESP), São Paulo, São Paulo, Brazil
| | - Lilian Del Ciello de Menezes
- Postgraduate Program in Medicine (Cardiology) at Escola Paulista de Medicina, Federal University of São Paulo (EPM / UNIFESP), São Paulo, São Paulo, Brazil
- Faculty of Medicine, City of São Paulo University (UNICID), São Paulo, São Paulo, Brazil
| | - Íbis Ariana Peña de Moraes
- Faculty of Medicine, City of São Paulo University (UNICID), São Paulo, São Paulo, Brazil
- Postgraduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, São Paulo, Brazil
- Exeter Biomedical Research Centre, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
| | - Ana Clara Silveira
- Postgraduate Program in Physical Activity Sciences, School of Arts, Science and Humanities of University of São Paulo (EACH-USP), São Paulo, São Paulo, Brazil
| | - Natalia Padula
- Acreditando - Center for Neuromotor Recovery, Health, and Wellness, Brazil
| | | | | | - Eduardo Dati Dias
- Postgraduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, São Paulo, Brazil
| | - Celso Ferreira
- Postgraduate Program in Medicine (Cardiology) at Escola Paulista de Medicina, Federal University of São Paulo (EPM / UNIFESP), São Paulo, São Paulo, Brazil
| | - Luciano Vieira de Araújo
- Postgraduate Program in Information Systems, School of Arts, Science and Humanities of University of São Paulo (EACH-USP), São Paulo, São Paulo, Brazil
| | - Todd A Astorino
- Department of Kinesiology, California State University San Marcos (CSUSM), San Marcos, California, United States of America
| | - Helen Dawes
- Exeter Biomedical Research Centre, College of Medicine and Health, University of Exeter, Exeter, United Kingdom
- Department of Paediatrics, University of Oxford, Oxford, United Kingdom
| | - Carlos Bandeira de Mello Monteiro
- Postgraduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, São Paulo, Brazil
- Postgraduate Program in Physical Activity Sciences, School of Arts, Science and Humanities of University of São Paulo (EACH-USP), São Paulo, São Paulo, Brazil
| | - Talita Dias da Silva
- Postgraduate Program in Medicine (Cardiology) at Escola Paulista de Medicina, Federal University of São Paulo (EPM / UNIFESP), São Paulo, São Paulo, Brazil
- Faculty of Medicine, City of São Paulo University (UNICID), São Paulo, São Paulo, Brazil
- Postgraduate Program in Rehabilitation Sciences, Faculty of Medicine, University of São Paulo (FMUSP), São Paulo, São Paulo, Brazil
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Hencklein LC, Campos DG, Silva JLG, da Silva RLF, Spagnol GS, Sanfelice CFDO, Oliveira-Kumakura ARDS. Knowledge scale of Nursing students about sexuality of people with spinal cord injury. Rev Bras Enferm 2022; 75:e20210288. [PMID: 36000594 PMCID: PMC9749499 DOI: 10.1590/0034-7167-2021-0288] [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: 05/30/2021] [Accepted: 04/13/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES to build, validate and verify the reliability of the Scale of knowledge about sexuality of people with spinal cord injury for nursing students. METHODS a methodological study, following the steps: 1) Construction based on literature review; 2) Validation of the content with calculation of the Content Validity Index and the Modified Kappa Coefficient; 3) Pre-test with Nursing students; and 4) Measurement of reliability by internal consistency (Cronbach's alpha). RESULTS the first version of the instrument presented 13 items. After validation, the items received values above 0.80 and 0.76 for the Content Validity Index and Modified Kappa Coefficient, and it was suggested to separate three items to contemplate gender-specific aspects. After pre-testing, it was recommended that the writing of two items be revised. The final scale, with 16 items, showed Cronbach's alpha equal to 0.93. CONCLUSIONS the constructed scale presented valid content and proved to be reliable for application with nursing students.
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Wan J, Duan L, Chen Q, Wang L, Bai J, Hu J, Lu X, Zhang T, Song W, Yang D, Shan Y, Yan Z. Potential clinical impact of metagenomic next-generation sequencing of plasma for cervical spine injury with sepsis in intensive care unit: A retrospective study. Front Cell Infect Microbiol 2022; 12:948602. [PMID: 36017370 PMCID: PMC9397569 DOI: 10.3389/fcimb.2022.948602] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Cervical spine injury (CSI) accounts for significant mortality in the intensive care unit (ICU), whereas sepsis remains one of the major causes of death in patients with CSI. However, there is no effective method to diagnose sepsis timely. The aim of this study is to investigate the effect of metagenomic next-generation sequencing (mNGS) on the pathogen features and the prognostic prediction of CSI patients with sepsis. A total of 27 blood samples from 17 included patients were tested by mNGS. Data of mNGS were compared with the conventional culture method. The Kaplan–Meier plots were used to visualize survival curves. A Cox proportional hazards model was used to identify independent prognostic factors for survival. Results showed that mNGS detected a wide spectrum of pathogens in CSI patients with sepsis, including 129 bacterial species, 8 viral species, and 51 fungal species. mNGS indicated 85.2% positive results, while the conventional culture method only showed 11.1% positive results in the blood samples. Further analyses revealed that mNGS had no prognostic effect on the septic CSI patients in ICU, whereas positive results of blood culture were closely correlated with an increased hazard ratio (HR) (HR 77.7067, 95%CI 2.860–2641.4595, p = 0.0155). Our results suggested that the mNGS application may provide evidence for clinicians to use antibiotics when a CSI case is diagnosed with sepsis.
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Affiliation(s)
- Jian Wan
- Department of Emergency and Critical Care Medicine, Shanghai Pudong New Area People’s Hospital, Shanghai, China
| | - Liwei Duan
- Department of Emergency and Critical Care Medicine, Shanghai Changzheng Hospital, Shanghai, China
| | - Qitong Chen
- Department of Emergency and Critical Care Medicine, Shanghai Changzheng Hospital, Shanghai, China
| | - Lv Wang
- Department of Emergency and Critical Care Medicine, Shanghai Changzheng Hospital, Shanghai, China
| | - Jinxia Bai
- Department of Emergency and Critical Care Medicine, Shanghai Pudong New Area People’s Hospital, Shanghai, China
| | - Jingyun Hu
- Central Lab, Shanghai Key Laboratory of Pathogenic Fungi Medical Testing, Shanghai Pudong New Area People’s Hospital, Shanghai, China
| | - Xinyuan Lu
- Department of Emergency and Critical Care Medicine, Shanghai Pudong New Area People’s Hospital, Shanghai, China
| | - Tao Zhang
- Department of Emergency and Critical Care Medicine, Shanghai Pudong New Area People’s Hospital, Shanghai, China
| | - Wei Song
- Department of Emergency and Critical Care Medicine, Shanghai Pudong New Area People’s Hospital, Shanghai, China
| | - Degang Yang
- Department of Infectious Diseases, Shanghai Skin Disease Hospital, Tongji University School of Medicine, Shanghai, China
- *Correspondence: Degang Yang, ; Yi Shan, ; Zhu Yan,
| | - Yi Shan
- Department of Emergency and Critical Care Medicine, Shanghai Changzheng Hospital, Shanghai, China
- *Correspondence: Degang Yang, ; Yi Shan, ; Zhu Yan,
| | - Zhu Yan
- Department of Emergency and Critical Care Medicine, Shanghai Changzheng Hospital, Shanghai, China
- *Correspondence: Degang Yang, ; Yi Shan, ; Zhu Yan,
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Raguindin PF, Stoyanov J, Eriks-Hoogland I, Stucki G, Jordan X, Schubert M, Franco OH, Muka T, Glisic M. Cardiometabolic risk profiling during spinal cord injury rehabilitation: A longitudinal analysis from Swiss Spinal Cord Injury cohort (SwiSCI). PM R 2022. [PMID: 35648677 DOI: 10.1002/pmrj.12857] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 05/04/2022] [Accepted: 05/17/2022] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early screening is important in individuals with spinal cord injury (SCI) as they were deemed high-risk for cardiometabolic diseases. Few studies explored changes in cardiometabolic risk profile in the early phase of the injury. Thus, it remains unclear how early the cardiometabolic status deteriorates after injury. OBJECTIVE We determined the longitudinal changes in the cardiometabolic risk profile and examined the association between injury characteristics and cardiometabolic status in subacute SCI. SETTING Multicenter Swiss Spinal Cord Injury Cohort. PARTICIPANTS Adults with traumatic SCI without history of cardiovascular disease or type 2 diabetes. MAIN OUTCOME MEASURES Blood pressure (BP), lipid profile, fasting glucose, waist circumference (WC), weight, body mass index (BMI) and Framingham risk score (FRS) were compared across time and according to the injury characteristics. RESULTS We analyzed the data of 258 individuals with traumatic SCI (110 tetraplegia and 148 paraplegia, 122 motor complete and 136 incomplete). The median age was 50 years (IQR 32-60), with 76.36% (n=197) of the population being male. The median rehabilitation duration was 5.5 months (IQR 3.2-7.1). At admission to rehabilitation, fully-adjusted linear regression models showed higher baseline weight (β 0.06, 95% CI 0.005, 0.11), systolic BP (β 0.05, 95% CI 0.008, 0.09), diastolic BP (β 0.05 95% CI 0.004, 0.10), and triglycerides (β 0.27 95% CI 0.13, 0.42) in paraplegia than tetraplegia. Systolic BP, diastolic BP, HDL-C were higher in incomplete than complete injury. In our main analysis, we observed an increase in cholesterol and HDL-C and lipid ratio when comparing the beginning and end of rehabilitation. Individuals with paraplegia had a higher increase in BMI than tetraplegia, while no differences in other cardiometabolic risk factors were detected when comparing motor incomplete and complete injury. Trajectories of each participant showed that the majority of individuals with SCI decreased FRS score at follow-up compared to baseline and no significant changes in prevalence of cardiometabolic syndrome were observed. At discharge, one-third of study participants were classified as moderate to high risk of CVD, 64% were overweight, and 39.45% had cardiometabolic syndrome. CONCLUSION We observed a modest improvement in lipid profile and FRS during the first inpatient rehabilitation hospitalization. Injury characteristics, such as level and completeness, were not associated with changes in cardiometabolic risk factors in the subacute phase of the injury. Despite this, a significant proportion of study participants remained at risk of cardiometabolic disease at discharge, suggesting that early cardiometabolic preventive strategies may be initiated as early as during the first inpatient rehabilitation hospitalization. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Peter Francis Raguindin
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland.,Graduate School for Health Sciences, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Jivko Stoyanov
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
| | | | - Gerold Stucki
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland
| | - Xavier Jordan
- Clinique Romande de Réadaptation, Avenue du Grand-Champsec 90, 1950 Sion, Switzerland
| | - Martin Schubert
- University Hospital Balgrist, Spinal Cord Injury Center, Forchstrasse 340, Zurich, Switzerland
| | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Guido A. Zäch Str. 4, 6207 Nottwil, Switzerland.,Institute of Social and Preventive Medicine, University of Bern, Mittelstrasse 43, Bern, Switzerland
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Băilă M, Aura Spînu AS, Popescu C, Zamfir C, Constantin E, Brumă E, Răducanu C, Petre Ș, Onose G. Neuromuscular rehabilitation interventions and COVID-19 management in a case of incomplete paraplegia with neurogenic bladder, post T3-T5 ependymoma. BALNEO AND PRM RESEARCH JOURNAL 2022. [DOI: 10.12680/balneo.2022.479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Spinal ependymomas are a group of mostly slow-growing tumors that can cause non-traumatic spinal cord injury with insidious clinical symptomatology ranging from neck or back pain to as-sociated sensory-motor impairment. Due to their neurological and systemic frailty, patients with spinal cord injury might be especially vulnerable to the effects of SARS-CoV-2 infection and the resulting respiratory impairment. CASE PRESENTATION: We present the case of a 66 year old women admitted in our Neuromuscular Rehabilitation Clinic Division for severe in-complete paraplegia and neurogenic bladder. She was previously diagnosed in the Neurosurgi-cal Ward with a thoracic grade II (classic) ependymoma and underwent a gross tumor resection. During the neurorehabilitation program the patient was diagnosed with COVID-19. The multi-drug related treatments were associated with supportive oxygen therapy and neuromuscular and respiratory rehabilitation techniques. RESULTS: Despite of the patient’s favorable rehabili-tation, consisting of walking abilities with support in a walking frame on short distances, her prognosis may be worsened by resting neurogenic bladder symptoms. COVID-19 has led to im-portant acute respiratory morbidity in our patient, regardless of the mild course of the disease, and might further cause a post-infectious respiratory impairment. ONCLUSION: Spinal cord in-jury remains a life-long condition and emphasizes the necessity of supporting the affected pati-ents on the long run.
Keywords: students, balance, postural stability, physical exercise, progress, motor skills
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Affiliation(s)
- Mihai Băilă
- 1 The Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), Bucharest, Romania 3 The University of Medicine and Pharmacy ”Carol Davila” (UMPCD), Bucharest, Romania
| | - Aura Spînu Aura Spînu
- 1 The Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), Bucharest, Romania 3 The University of Medicine and Pharmacy ”Carol Davila” (UMPCD), Bucharest, Romania
| | - Cristina Popescu
- The Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), Bucharest, Romania
| | - Costică Zamfir
- The Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), Bucharest, Romania
| | - Elena Constantin
- The Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), Bucharest, Romania
| | - Elena Brumă
- The Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), Bucharest, Romania
| | - Cristian Răducanu
- The Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), Bucharest, Romania
| | - Ștefan Petre
- The Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), Bucharest, Romania
| | - Gelu Onose
- 1 The Teaching Emergency Hospital “Bagdasar-Arseni” (TEHBA), Bucharest, Romania 3 The University of Medicine and Pharmacy ”Carol Davila” (UMPCD), Bucharest, Romania
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Hencklein LC, Campos DG, Silva JLG, Silva RLFD, Spagnol GS, Sanfelice CFDO, Oliveira-Kumakura ARDS. Escala de conhecimento de estudantes de Enfermagem sobre sexualidade de pessoas com lesão medular. Rev Bras Enferm 2022. [DOI: 10.1590/0034-7167-2021-0288pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
RESUMO Objetivos: construir, validar e verificar a confiabilidade da Escala de conhecimento sobre sexualidade de pessoas com lesão medular para estudantes de Enfermagem. Métodos: estudo metodológico, seguindo as etapas: 1) Construção baseada em revisão da literatura; 2) Validação do conteúdo com cálculo do Índice de Validade de Conteúdo e do Coeficiente Kappa Modificado; 3) Pré-teste com estudantes de Enfermagem; e 4) Medida da confiabilidade pela consistência interna (alfa de Cronbach). Resultados: a primeira versão do instrumento apresentou 13 itens. Após validação, os itens receberam valores acima de 0,80 e 0,76 para o Índice de Validade de Conteúdo e Coeficiente Kappa Modificado, e sugeriu-se separar três itens para contemplar aspectos específicos do sexo. Após pré-teste, recomendou-se a revisão da escrita de dois itens. A escala final, com 16 itens, apresentou alfa de Cronbach igual a 0,93. Conclusões: a escala construída apresentou conteúdo válido e mostrou-se confiável para aplicação com estudantes de Enfermagem.
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Hencklein LC, da Silva RLF, Campos DG, Spagnol GS, Silva JLG, de Oliveira Sanfelice CF, de Souza Oliveira-Kumakura AR. Effectiveness of Clinical Simulation and Peer-Assisted Learning to Teaching About the Sexuality of People With Spinal Cord Injury. J Neurosci Nurs 2021; 53:208-214. [PMID: 34369432 DOI: 10.1097/jnn.0000000000000608] [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: 11/26/2022]
Abstract
ABSTRACT BACKGROUND: The sexuality of people with spinal cord injury (SCI) is a subject often neglected by healthcare professionals because of their lack of knowledge or understanding of how to proceed in this context. Different teaching strategies can be used to fill this knowledge gap, such as clinical simulation and peer-assisted learning. This study evaluates the effects of an educational intervention on nursing students' knowledge acquisition about the sexuality of individuals with SCI and on the students' self-confidence and satisfaction with the experience. METHODS: Quasi-experimental, pretest-posttest design was conducted with nursing students (N = 54). The intervention was the application by a senior-level nursing student of 2 scenarios of high-fidelity clinical simulation. The primary outcome was the knowledge about the sexuality of people with SCI. The secondary outcome was the satisfaction and self-confidence in learning. We performed descriptive and inferential statistics and built multiple linear regression models. RESULTS: The effect of the intervention on knowledge acquisition ranged from the mean of 1.26 in the pretest to 3.10 in the posttest. The means in the scores of satisfaction and self-confidence were considered excellent and correlated with knowledge acquisition. Previous attendance of a class on SCI positively interfered in the scale of knowledge acquisition. CONCLUSION: We verified an effect size ranging from medium to large magnitude for knowledge acquisition, and great satisfaction and self-confidence in learning through the use of simulated experience and peer-assisted learning.
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Oña A, Strøm V, Lee BS, Le Fort M, Middleton J, Gutenbrunner C, Pacheco Barzallo D. Health inequalities and income for people with spinal cord injury. A comparison between and within countries. SSM Popul Health 2021; 15:100854. [PMID: 34258374 PMCID: PMC8259327 DOI: 10.1016/j.ssmph.2021.100854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/21/2021] [Accepted: 06/21/2021] [Indexed: 12/20/2022] Open
Abstract
Income and health are related in a bi-directional manner, whereby level of income affects health and vice versa. People in poorer households tend to experience worse health status and higher mortality rates than people in wealthier households, and, at the same time, having poor health could restrict workability leading to less income. This gap exists in almost every country, and it is more pronounced in more unequal countries and in vulnerable populations, such as people experiencing disability. The goal of this paper is to estimate the health-income gap in people with a Spinal Cord Injury (SCI), which is a chronic health condition often associated with multiple comorbidities that leads to disability. As data on mortality is inexistent, to estimate the health-income gap for persons with SCI, this paper uses two health outcomes: the number of years a person has lived with the injury, and a comorbidity index. Data was obtained from the International Spinal Cord Injury survey (InSCI), which is the first worldwide survey on community-dwelling persons with SCI. To compare across countries, the health outcomes were adjusted through hierarchical models, accounting for country fixed-effects, individual characteristics such as age and gender, and injury characteristics (cause, type and degree). Our results suggest that for the years living with SCI, the gap varies from 1 to 6 years between the lowest and the highest income groups. The main driver of such a difference is the cause of injury, where injuries caused by work accidents showed the biggest gap. Similarly, for the comorbidity index, persons with SCI in poorer deciles reported significantly more comorbidities, forty times more, than people in richer deciles.
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Affiliation(s)
- Ana Oña
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Vegard Strøm
- Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway
| | | | - Marc Le Fort
- Universitaire de Médecine Physique et Réadaptation, France
| | - James Middleton
- John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, Royal North Shore Hospital, Australia
- Sydney Medical School - Northern, Faculty of Medicine and Health, The University of Sydney, Australia
| | | | - Diana Pacheco Barzallo
- Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Christensen J, Biering-Sørensen F, Morgen SS, la Cour K. Survival, discharge destination, and referral for rehabilitation after metastatic spinal cord compression surgery. Spinal Cord Ser Cases 2021; 7:63. [PMID: 34312376 DOI: 10.1038/s41394-021-00428-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/15/2021] [Accepted: 07/15/2021] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN A retrospective review of medical records. OBJECTIVE The objective of this study was to examine probability of survival after 90- and 180-days after surgery, to document the rehabilitation needs, patients discharge destination, and whether discharge destination, re-admission, and probability of survival among patients with metastatic spinal cord compression (MSCC) were associated with potential risk factors. SETTING Copenhagen University Hospital, Rigshospitalet that serves a population of 2.8 million people from the Eastern part of Denmark, Faroe Islands, and Greenland. METHODS Adult (≥18 years) patients with MSCC undergoing surgery in 2017-2018 were included. Descriptive statistics were used to investigate the probability of survival after 90- and 180-days, rehabilitation needs documented in the patient's medical record, and discharge destination. Univariate logistic regression analyses were used to examine the associations between a priory defined potential risk factors for mortality and readmission. RESULTS Seventy-four medical records were included in final analysis. The probability of survival after 90- and 180-days post-surgery were 78% and 57%, respectively. Higher age was the only defined variable that was significantly associated with higher mortality. Ninety-three percent of the patient's medical records described rehabilitation potential, but only 44.6% of the patients were discharged with a rehabilitation plan. Seventy-three percent of the patients were discharged to their home. None had a specialized rehabilitation plan. CONCLUSION Almost all patients diagnosed with MSCC have a rehabilitation potential described in their medical records. However, only half of these patients are discharged with a rehabilitation plan indicating an unmet potential for rehabilitation.
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Affiliation(s)
- Jan Christensen
- Department of Occupational Therapy and Physiotherapy, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. .,REHPA, The Danish Knowledge Centre on Rehabilitation and Palliative Care, University of Southern Denmark, Nyborg, Denmark.
| | - Fin Biering-Sørensen
- Department for Spinal Cord Injuries, Rigshospitalet, and Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Søren Schmidt Morgen
- Spine Unit, Department of Orthopaedic Surgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Karen la Cour
- REHPA, The Danish Knowledge Centre on Rehabilitation and Palliative Care, University of Southern Denmark, Nyborg, Denmark
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Raguindin PF, Muka T, Glisic M. Sex and gender gap in spinal cord injury research: Focus on cardiometabolic diseases. A mini review. Maturitas 2021; 147:14-18. [PMID: 33832642 DOI: 10.1016/j.maturitas.2021.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 12/02/2020] [Accepted: 03/02/2021] [Indexed: 12/27/2022]
Abstract
Cardiometabolic disease (CMD) is among the leading causes of morbidity and mortality in people with a spinal cord injury (SCI). Despite well-acknowledged sex and gender differences in CMD in the general population, they remain insufficiently studied in persons with SCI. To describe the landscape of sex and gender in SCI research, we searched the literature for systematic reviews on cardiometabolic health in this population. Out of 15 systematic reviews identified, only 9 provided meaningful information on sex. Although one-quarter to one-fifth of the SCI population is female, women comprised only one-eighth to a quarter of study participants. A number of clinical studies purposively excluded women, to make the study population more homogenous. For those studies which included both sexes, in general, no sex-specific analyses were performed due to small sample sizes. All these reasons have contributed to the underrepresentation of females in the current body of evidence. Therefore, future studies should adopt a more sex- and gender-sensitive research framework to address cardiometabolic risk in SCI. Novel and advanced epidemiological methods should also be used, considering small sample sizes. Finally, collaborative research (through consortia and multi-center studies) should be encouraged to include more females. More inclusive research will ensure that everyone will benefit from scientific advancements, regardless of sex and gender.
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Affiliation(s)
- Peter Francis Raguindin
- Swiss Paraplegic Research, Nottwil, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland; Graduate School for Health Sciences, University of Bern, Bern, Switzerland
| | - Taulant Muka
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Marija Glisic
- Swiss Paraplegic Research, Nottwil, Switzerland; Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
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Etiology-specific variation in survival following non-traumatic spinal cord injury: a causal inference approach using data from a population-based cohort. Spinal Cord 2020; 59:257-265. [PMID: 32948845 PMCID: PMC7943420 DOI: 10.1038/s41393-020-00554-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 09/07/2020] [Accepted: 09/09/2020] [Indexed: 11/29/2022]
Abstract
Study design Observational, population-based cohort study. Objectives To evaluate the origin and contribution to excess of survival differences following non-traumatic spinal cord injury (NTSCI) using etiology as proxy for variation in underlying health condition. Setting Specialized rehabilitation centers in Switzerland. Methods Medical record data collected by the Swiss Spinal Cord Injury cohort (SwiSCI) study were linked with mortality information from the Swiss National Cohort. Considering contemporary theory and empirical evidence, a directed acyclic graph (DAG) was developed to formally evaluate causal differences among NTSCI etiologies, relative to traumatic SCI (TSCI). Statistical inference was contingent on hazard ratios (HRs) and marginal survival differences, derived using flexible parametric modeling. Results 3643 individuals (NTSCI = 1357; TSCI = 2286) diagnosed with SCI between 1990 and 2011 were included, contributing a cumulative 41,344 person-years and 1323 deaths. Test statistics confirmed DAG-dataset consistency. As compared to TSCI, mortality was elevated in all NTSCI etiological groups; malignant etiologies had the highest HRs (10; 95% CI, 8.0 to 14) followed by infection (2.6; 1.8 to 3.6) and vascular (2.5; 2.0 to 3.2) etiology groups. At the attained age of 55, the estimated reduction in survival among non-malignant etiologies was 9.4% (5.8 to 13) at 5 years and 17% (11 to 23) at 20 years. Conclusions Causal differences in survival among NTSCI etiological groups are likely a result of chronic variation in health conditions. This study supports the development of long-term interdisciplinary management and policy for individuals with NTSCI, specific to etiology.
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Chamberlain JD, Eriks-Hoogland IE, Hug K, Jordan X, Schubert M, Brinkhof MWG. Attrition from specialised rehabilitation associated with an elevated mortality risk: results from a vital status tracing study in Swiss spinal cord injured patients. BMJ Open 2020; 10:e035752. [PMID: 32647022 PMCID: PMC7351285 DOI: 10.1136/bmjopen-2019-035752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Study drop-out and attrition from treating clinics is common among persons with chronic health conditions. However, if attrition is associated with adverse health outcomes, it may bias or mislead inferences for health policy and resource allocation. METHODS This retrospective cohort study uses data attained through the Swiss Spinal Cord Injury (SwiSCI) cohort study on persons with spinal cord injury (SCI). Vital status (VS) was ascertained either through clinic medical records (MRs) or through municipalities in a secondary tracing effort. Flexible parametric survival models were used to investigate risk factors for going lost to clinic (LTC) and the association of LTC with subsequent risk of mortality. RESULTS 1924 individuals were included in the tracing study; for 1608 of these cases, contemporary VS was initially checked in the MRs. VS was ascertained for 704 cases of the 1608 cases initially checked in MRs; of the remaining cases (n=904), nearly 90% were identified in municipalities (n=804). LTC was associated with a nearly fourfold higher risk of mortality (HR=3.62; 95% CI 2.18 to 6.02) among persons with traumatic SCI. Extended driving time (ie, less than 30 min compared with 30 min and longer to reach the nearest specialised rehabilitation facility) was associated with an increased risk of mortality (HR=1.51, 95% CI 1.02 to 2.22) for individuals with non-traumatic SCI. CONCLUSION The differential risk of LTC according to sociodemographic and SCI lesion characteristics underscores the importance of accounting for attrition in cohort studies on chronic disease populations requiring long-term care. In addition, given the associated risk of mortality, LTC is an issue of concern to clinicians and policy makers aiming to optimise the long-term survival of community-dwelling individuals with traumatic SCI. Future studies are necessary to verify whether it is possible to improve survival prospects of individuals LTC through more persistent outreach and targeted care.
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Affiliation(s)
- Jonviea D Chamberlain
- Swiss Paraplegic Research, Nottwil, Switzerland
- Centre INSERM U1219, CIC 1401-EC, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux School of Public Health, University of Bordeaux, Bordeaux, France
| | | | | | | | | | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
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