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Thornton WA, Smulligan K, Weber KA, Tefertiller C, Mañago M, Sevigny M, Wiley L, Stevens-Lapsley J, Smith AC. Lesion characteristics are associated with bowel, bladder, and overall independence following cervical spinal cord injury. J Spinal Cord Med 2024:1-9. [PMID: 38958637 DOI: 10.1080/10790268.2024.2363005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/04/2024] Open
Abstract
CONTEXT/OBJECTIVE There is a growing global interest in quantifying spinal cord lesions and spared neural tissue using magnetic resonance imaging (MRI) in individuals with spinal cord injury (SCI). The primary objective of this study was to assess the relationships between spinal cord lesion characteristics assessed on MRI and bowel, bladder, and overall independence following SCI. DESIGN Retrospective, exploratory study. PARTICIPANTS 93 individuals with cervical SCI who were enrolled in a local United States Model Systems SCI database from 2010 to 2017. METHODS Clinical and MRI data were obtained for potential participants, and MRIs of eligible participants were analyzed. Explanatory variables, captured on MRIs, included intramedullary lesion length (IMLL), midsagittal ventral tissue bridge width (VTBW), midsagittal dorsal tissue bridge width (DTBW), and axial damage ratio (ADR). OUTCOME MEASURES Bowel and bladder management scale of the Functional Independence Measure (FIM) and FIM total motor score. RESULTS When accounting for all four variables, only ADR was significantly associated with bowel independence (OR = 0.970, 95% CI: 0.942-0.997, P = 0.030), and both ADR and IMLL were strongly associated with bladder independence (OR = 0.967, 95% CI: 0.936-0.999, P = 0.046 and OR = 0.948, 95% CI: 0.919-0.978, P = 0.0007, respectively). 32% of the variation in overall independence scores were explained by all four predictive variables, but only ADR was significantly associated with overall independence after accounting for all other predictive variables (β = -0.469, 95% CI: -0.719, -0.218, P = 0.0004). CONCLUSIONS Our results suggest that the MRI-measured extent of spinal cord lesion may be predictive of bowel, bladder, and overall independence following cervical SCI.
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Affiliation(s)
- Wesley A Thornton
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
- Craig Hospital, Englewood, Colorado, USA
| | - Katherine Smulligan
- Department of Orthopedics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Kenneth A Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Mark Mañago
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | | | - Laura Wiley
- Department of Biostatistics & Informatics, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Jennifer Stevens-Lapsley
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Andrew C Smith
- Department of Physical Medicine and Rehabilitation, University of Colorado School of Medicine, Aurora, Colorado, USA
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Bezuidenhout L, Rhoda A, Moulaee Conradsson D, Theron F, Joseph C. Factors influencing employment among people with spinal cord injury in South Africa. Disabil Rehabil 2023; 45:4381-4387. [PMID: 36447405 DOI: 10.1080/09638288.2022.2151651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 11/20/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE The unemployment rate post spinal cord injury (SCI) in South Africa is high with limited knowledge of environmental factors outside the health services, especially in an unevenly developed resource setting like South Africa, affecting the employment rate in people with SCI. Our purpose was to investigate factors associated with employment in people with SCI in South Africa. METHODS Two hundred persons with SCI participated in a cross-sectional survey design. This study formed part of the International Spinal Cord Injury Community Survey. Subsections of the questionnaire responses were used as explanatory variables to predict employment after SCI using logistic regression analysis. RESULTS The response rate of the study was 54%. Of the 200 participants included, 61% reported being employed before SCI onset whereas only 25% reported being engaged in paid work at the time of this study. The logistic regression model showed not requiring physical assistance in the home environment (p = 0.016), the number of education years before SCI (p = 0.007), household income (p < 0.001), having worked before SCI onset (p = 0.041), and environmental factors (p = 0.029) to be factors associated with employment after SCI. CONCLUSION The finding suggests multiple factors influence the employment rate, advocating for interdisciplinary rehabilitation approaches and social development interventions to address meaningful occupations in persons with SCI in South Africa.Implications for rehabilitationRehabilitation programs should be adapted and tailored to enhance physical independence.Public policies regarding environmental factors such as access to reliable transport, assistive devices, and public places for wheelchair users are important and could potentially support individuals with spinal cord injury (SCI) becoming employed/re-employed.For successful social/community/civic reintegration for individuals with SCI an intersectional collaboration (i.e., between policymakers, health professionals, and the labor market) needs to be considered to improve the employment opportunities post-SCI.
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Affiliation(s)
- Lucian Bezuidenhout
- Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
| | - Anthea Rhoda
- Faculty of Community and Health Sciences, University of Western Cape, Cape Town, South Africa
| | - David Moulaee Conradsson
- Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden
- Medical unit Occupational therapy & Physiotherapy, Theme Women's Health and Allied Health Professional, Karolinska University Hospital, Stockholm, Sweden
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa
| | | | - Conran Joseph
- Department of Health and Rehabilitation Sciences, Division of Physiotherapy, Stellenbosch University, Cape Town, South Africa
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Pavese C, Kessler TM. Prediction of Lower Urinary Tract, Sexual, and Bowel Function, and Autonomic Dysreflexia after Spinal Cord Injury. Biomedicines 2023; 11:1644. [PMID: 37371739 DOI: 10.3390/biomedicines11061644] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 06/02/2023] [Accepted: 06/04/2023] [Indexed: 06/29/2023] Open
Abstract
Spinal cord injury (SCI) produces damage to the somatic and autonomic pathways that regulate lower urinary tract, sexual, and bowel function, and increases the risk of autonomic dysreflexia. The recovery of these functions has a high impact on health, functioning, and quality of life and is set as the utmost priority by patients. The application of reliable models to predict lower urinary tract, sexual, and bowel function, and autonomic dysreflexia is important for guiding counseling, rehabilitation, and social reintegration. Moreover, a reliable prediction is essential for designing future clinical trials to optimize patients' allocation to different treatment groups. To date, reliable and simple algorithms are available to predict lower urinary tract and bowel outcomes after traumatic and ischemic SCI. Previous studies identified a few risk factors to develop autonomic dysreflexia, albeit a model for prediction still lacks. On the other hand, there is an urgent need for a model to predict the evolution of sexual function. The aim of this review is to examine the available knowledge and models for the prediction of lower urinary tract, sexual, and bowel function, and autonomic dysreflexia after SCI, and critically discuss the research priorities in these fields.
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Affiliation(s)
- Chiara Pavese
- Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, 27100 Pavia, Italy
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation and Spinal Unit of Pavia Institute, 27100 Pavia, Italy
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, 8008 Zürich, Switzerland
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Pavese C, Scivoletto G, Puci MV, Abel R, Curt A, Maier D, Rupp R, Schubert M, Weidner N, Montomoli C, Kessler TM. Prediction of bowel management independence after ischemic spinal cord injury. Eur J Phys Rehabil Med 2022; 58:709-714. [PMID: 35666490 PMCID: PMC10019474 DOI: 10.23736/s1973-9087.22.07366-x] [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: 11/08/2022]
Abstract
BACKGROUND Ischemic spinal cord injury (SCI) belongs to the heterogeneous group of non-traumatic SCI, while the course of sensorimotor and functional recovery is comparable to traumatic SCI. Recently, we derived from data of patients with traumatic SCI a valid model to predict an independent and reliable bowel management one year after SCI. AIM To evaluate the performance of this model to predict an independent and reliable bowel management one year following ischemic SCI. DESIGN Prognostic study - observational study. SETTING European Multicenter Study about Spinal Cord Injury (EMSCI) ClinicalTrials.gov: NCT01571531. POPULATION One hundred and forty-two patients with ischemic SCI of various level and severity of injury. METHODS The prediction model relied on a single predictor collected within 40 days from injury, the International Standards for Neurological Classification of Spinal Cord Injury total motor score. Bowel outcome one year after SCI derived from the dichotomization of the Spinal Cord Independence Measure (SCIM) item 7 scores. We defined a positive outcome as independent bowel management with regular movements and appropriate timing with no or rare accidents (score of 10 in SCIM version II and score of 8 or 10 in version III). RESULTS The model showed a fair discrimination with an area under the receiver operating characteristic (ROC) curve of 0.780 (95% confidence interval=0.702-0.860). In addition, the model displayed an acceptable accuracy and calibration. CONCLUSIONS The study extends the validity of our rule to patients with ischemic SCI, thus providing the first model to predict an independent and reliable bowel management in this population. CLINICAL REHABILITATION IMPACT The model may be employed in clinical practice to counsel patients, to define the rehabilitation aims and to estimate the need of assistance after discharge, as well as in the research field for the optimization of patients' allocation in the design of future clinical trials.
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Affiliation(s)
- Chiara Pavese
- Department of Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation and Spinal Unit, Pavia Institute, Pavia, Italy
| | - Giorgio Scivoletto
- Spinal Cord Unit and Spinal Rehabilitation (SpiRe) Lab, IRCCS Santa Lucia Foundation, Rome, Italy
| | - Mariangela V Puci
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Rainer Abel
- Spinal Cord Injury Center, Hohe Warte, Bayreuth, Germany
| | - Armin Curt
- Department of Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | | | - Rüdiger Rupp
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Schubert
- Department of Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Cristina Montomoli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland -
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Who recovers independent bowel management during the first year following a traumatic spinal cord injury? A case-control study. Am J Phys Med Rehabil 2021; 101:307-313. [PMID: 34483265 DOI: 10.1097/phm.0000000000001871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES 1) document the characteristics of patients with impaired bowel functioning during the subacute and chronic phases; 2) identify factors associated with recovery of independent bowel functioning during the first year following TSCI in patients who present impaired bowel functioning during the subacute phase, when bowel rehabilitation is completed. DESIGN Case-control study on 123 adult TSCI patients. Bowel function assessments using item 7 of the SCIM-III were obtained 3-months following TSCI and during the early chronic phase. Univariate and multivariate analyses were conducted to identify predictors associated with recovery of independent bowel functioning between the initial assessment and follow-up. RESULTS Of the 110 patients available for analysis, 54 (49%) displayed impaired bowel functioning 3-months following TSCI. Of these, 19 (35%) recovered independent bowel functioning over the following 9 months. The total motor score (TMS) was the only significant predictor of this outcome. A TMS lower than 42 was 100% predictive of absence of recovery. CONCLUSION Recovering independent bowel management 1-year after TSCI was possible in 35% of patients despite impaired bowel functioning during the subacute phase. TMS measured 3-months post-injury could be useful for prognosticating potential for bowel functioning recovery since patients with TMS < 42 are unlikely to recover.
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Pavese C, Scivoletto G, Puci MV, Schubert M, Curt A, Finazzi Agrò E, Montomoli C, Kessler TM. External Validation Confirms Validity of a Simple Model to Predict Bowel Outcome After Traumatic Spinal Cord Injury. Neurorehabil Neural Repair 2021; 35:659-662. [PMID: 34114519 DOI: 10.1177/15459683211023191] [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: 11/15/2022]
Abstract
Background. The prediction of functional outcomes after spinal cord injury (SCI) is essential to plan the rehabilitation phase and the social reintegration. Recently, 2 models to predict independent and reliable bowel management 1 year after traumatic SCI have been derived and validated in 2 cohorts of patients included in the European Multicenter Study about Spinal Cord Injury (EMSCI). Objective. We aimed to validate 2 prediction models for bowel outcome after traumatic SCI in a patient sample external to EMSCI. Methods. The simplified model (based on a single predictor, the International Standards for Neurological Classification of Spinal Cord Injury [ISNCSCI] total motor score) and the full model (based on 2 predictors, the ISNCSCI total motor score and item 3a of the Spinal Cord Independence Measure) were applied to the retrospectively collected data of 111 patients with traumatic SCI. Results. The simplified and the full models showed excellent discrimination with an area under the receiver operating characteristic curve of .939 (95% confidence interval (CI) .87-1.00) and .922 (95% CI 0.85-.99), respectively. Both models displayed similar results for sensitivity and negative predictive values; however, the simplified model showed higher values for specificity, positive predictive values, and accuracy. The calibration analysis showed a partial overlap between predicted probabilities and observed proportion, with better and acceptable calibration for the simplified model. Conclusions. Using an independent sample, our study demonstrates the validity of a simple model to predict independent and reliable bowel management 1 year after traumatic SCI.
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Affiliation(s)
- Chiara Pavese
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Switzerland.,Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Italy.,Neurorehabilitation Unit, IRCCS ICS Maugeri Spa-SB, Pavia, Italy
| | - Giorgio Scivoletto
- Spinal Cord Unit and Spinal Rehabilitation (SpiRe) Lab, IRCCS Fondazione Santa Lucia, Rome, Italy
| | - Mariangela V Puci
- Unit of Bio Statistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Martin Schubert
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Switzerland
| | - Armin Curt
- Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Switzerland
| | - Enrico Finazzi Agrò
- Department of Surgical Sciences, Tor Vergata University, Rome, Italy.,Department of Urology, Policlinico Tor Vergata, Rome, Italy
| | - Cristina Montomoli
- Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Italy
| | - Thomas M Kessler
- Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Switzerland
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