Long term outcome of functional independence and quality of life after traumatic SCI in Germany

Complex lived experiences and hidden disability after spinal cord injury: a latent profile analysis of the Australian arm of the International Spinal Cord Injury (Aus-InSCI) Community Survey

PURPOSE

To identify and examine subgroups of people with spinal cord injury (SCI) with different patterns of lived experience, and examine hidden impairments and disability among functionally independent and ambulant people.

MATERIALS AND METHODS

Latent profile analysis of population-based data from the Australian arm of the International Spinal Cord Injury (InSCI) Community survey (n = 1579).

RESULTS

Latent subgroups reflected levels of functional independence and extent of problems with health, activity/participation, environmental barriers, and self-efficacy. Quality of life (QoL), psychological profiles, and activity/participation were often as good or better in participants who reported lower (vs. higher) functional independence alongside comparable burden of health problems and environmental barriers. QoL, mental health, and vitality reflected self-efficacy and problem burdens more closely than functional independence. Ambulant participants reported a substantial burden of underlying, potentially hidden impairments, with QoL and mental health similar to wheelchair users.

CONCLUSION

Hidden disability among more independent and/or ambulant people with SCI can affect well-being substantially. Early and ongoing access to support, rehabilitation, and SCI specialist services is important irrespective of cause, type, severity of injury, and level of functional independence. Improved access to SCI expertise and equity of care would help to improve early recognition and management of hidden disability.

TRIAL REGISTRATION

Not applicable.

Long-term prediction of functional independence using adjusted and unadjusted single items of the functional independence measure (FIM) at discharge from rehabilitation

CONTEXT

Being able to survive in the long-term independently is of concern to patients with spinal cord injury (SCI), their relatives, and to those providing or planning health care, especially at rehabilitation discharge. Most previous studies have attempted to predict functional dependency in activities of daily living within one year after injury.

OBJECTIVES

(1) build 18 different predictive models, each model using one FIM (Functional Independence Measure) item, assessed at discharge, as independent predictor of total FIM score at chronic phase (3-6 years post-injury) (2) build three different predictive models, using in each model an item from a different FIM domain with the highest predictive power obtained in objective (1) to predict "good" functional independence at chronic phase and (3) adjust the 3 models from objective (2) with known confounding factors.

METHODS

This observational study included 461 patients admitted to rehabilitation between 2009 and 2019. We applied regression models to predict total FIM score and "good" functional independence (FIM motor score ≥ 65) reporting adjusted R2, odds ratios, ROC-AUC (95% CI) tested using 10-fold cross-validation.

RESULTS

The top three predictors, each from a different FIM domain, were Toilet (adjusted R2 = 0.53, Transfers domain), Toileting (adjusted R2 = 0.46, Self-care domain), and Bowel (adjusted R2 = 0.35, Sphincter control domain). These three items were also predictors of "good" functional independence (AUC: 0.84-0.87) and their predictive power increased (AUC: 0.88-0.93) when adjusted by age, paraplegia, time since injury, and length of stay.

CONCLUSIONS

Discharge FIM items accurately predict long-term functional independence.

The Association Between Spirituality, Self-Esteem, Anxiety and Depression: A Comparative Exploratory Study Between People with a Spinal Cord Injury and Healthy Subjects in Greece

The purpose of this study was to evaluate spirituality, religiosity, self-esteem, depression, and stress in people with spinal cord injuries. The Royal Free Questionnaire for Spiritual and Religious Beliefs, the Rosenberg Self-Esteem Scale, the Center for Epidemiologic Studies Depression Scale, and the Spielberger State-Trait Anxiety Scale were all designed for the current study to collect demographic and injury-related information. In the study, 88 patients with traumatic SCI and 88 healthy subjects were included. Half of the participants and healthy subjects were women, while the mean age of the healthy subjects was 42.8 years and that of the subjects was 42.4 years. The majority of participants were Greek (97.2%), while 44.1% were married or with a partner and 43.2% were single. The mean depression and stress score was higher in patients than in healthy subjects, and the mean score of self-esteem was lower in patients than healthy subjects. Multivariable linear regression model showed that patients who believed more that a spiritual force or power outside of ourselves can influence what happens in everyday life had less depression and stress. People with spinal cord injuries experience extreme stress, anxiety, and depression. Spirituality and religiosity can play a significant role in their recuperation, rehabilitation, and adaptation.

Effect of inpatient rehabilitation on the quality of life and life satisfaction in spinal cord injury

OBJECTIVE

Assess the impact of inpatient rehabilitation on the quality of life and life satisfaction of individuals with spinal cord injury by considering the level of injury.

DESIGN

QuasiExperimental study.

SETTING

Rehabilitation Hospital.

PARTICIPANTS

A total of 71 Patients with Spinal cord injury were admitted for rehabilitation.

INTERVENTION

The quality of life and life satisfaction of patients were assessed both before and after 63 days of inpatient rehabilitation.

MAIN OUTCOME MEASUREMENTS

Functional independence measure score (FIM), the Short Form-36 (SF-36), and the Life Satisfaction Scale (LSS).

RESULT

The average age of the study population was 34 ± 14 years. At the end of 63 days, significant improvements were observed in FIM, mood, health, physical performance, role physical, role emotional, pain, and total score of LSS (Π - Value <0.05). The variation in FIM changes significantly improved the total LSS score in the thoracic and thoracolumbar subgroups, but not in the cervical group. In addition, the total score of SF36 was improved significantly just in the cervical subgroup (Π = 0.006). No significant correlations were found between SF-36 and LSS scores (before and after the intervention) in relation to marriage, education, and time.

CONCLUSION

In the context of spinal cord injury, inpatient rehabilitation can play a role in improving functional independence which, in turn, impacts certain aspects affecting life satisfaction and the quality of life. It is important to note that the extent of this correlation varies among patients with different injury levels. In some cases, even minor changes, such as those seen in quadriplegic patients, could have a significant impact on their quality of life.

Role of self-efficacy on functional limitations among persons with spinal cord injury

OBJECTIVES

Spinal cord injury (SCI) results in mild to severe functional limitations, decreasing a person's ability to perform activities of daily living. This study aims to identify the influence of SCI characteristics and self-efficacy on functional limitations, controlling for sociodemographic factors.

METHODS

Participants for this cross-sectional descriptive study included 272 persons with SCI. The participants completed questionnaires on sociodemographic information, secondary physical conditions, self-efficacy, and functional limitations, using an online Qualtrics Survey. Multiple hierarchical regression analysis was performed to test the hypothesis.

RESULTS

Participants reported higher functional limitations on dressing the lower body and managing their bowels compared to other activities of daily living. The sociodemographics, injury characteristics, and self-efficacy collectively accounted for 66% variance in functional limitations. A higher level of secondary physical conditions and tetraplegia injury contributed to higher functional limitations. As hypothesized, greater self-efficacy significantly contributed to low functional limitations above and beyond sociodemographic and SCI-related variables.

DISCUSSION

Functional limitations following SCI are a pervasive challange in persons with SCI. Early recognition and management of secondary conditions and implementation of psychological interventions to strengthen self-efficacy in performing activities and managing secondary complications could potentially enhance functional independence and, ultimately, quality of life in this population.

Pre-Hospital and Post-Hospital Quality of Care in Traumatic Spinal Column and Cord Injuries in Iran

STUDY DESIGN

A retrospective study.

OBJECTIVES

The quality of care (QoC) for spinal column/cord injury patients is a major health care concern. This study aimed to implement the QoC assessment tool (QoCAT) in the National Spinal Cord/Column Injury Registry of Iran (NSCIR-IR) to define the current state of pre- and post-hospital QoC of individuals with Traumatic Spinal Column and Spinal Cord Injuries (TSC/SCIs).

METHODS

The QoCAT, previously developed by our team to measure the QoC in patients with TSC/SCIs, was implemented in the NSCIR-IR. The pre-hospital QoC was evaluated through a retrospective analysis of NSCIR-IR registry data. Telephone interviews and follow-ups of patients with SCI evaluated the QoC in the post-hospital phase.

RESULTS

In the pre-hospital phase, cervical collars and immobilization were implemented in 46.4% and 48.5% of the cases, respectively. Transport time from the scene to the hospital was documented as <1 hour and <8 hours in 33.4% and 93.9% of the patients, respectively. Post-hospital indicators in patients with SCI revealed a first-year mortality rate of 12.5% (20/160), a high incidence of secondary complications, reduced access to electrical wheelchairs (4.2%) and modified cars (7.7%), and low employment rate (21.4%).

CONCLUSION

These findings revealed a significant delay in transport time to the first care facilities, low use of immobilization equipment indicating low pre-hospital QoC. Further, the high incidence of secondary complications, low employment rate, and low access to electrical wheelchairs and modified cars indicate lower post-hospital QoC in patients with SCI. These findings imply the need for further planning to improve the QoC for patients with TSC/SCIs.

The role of mindfulness in quality of life of persons with spinal cord injury: a cross-sectional study

BACKGROUND

Quality of life is considered the most overarching psychosocial adaptation outcome following the rehabilitation of persons with spinal cord injury. Literature suggests that the quality of life of persons with spinal cord injury is determined by many personal and psychological factors, including mindfulness. This study aimed to identify the direct and indirect effect of mindfulness on the quality of life of persons living with spinal cord injury.

METHODS

Participants consisted of 231 members of three spinal cord injury organizations in the United States: United Spinal Association, North American Spinal Cord Injury Consortium, and Paralyzed Veterans of America-Wisconsin Chapter. The participants completed a set of standardized self-report questionnaires in an online Qualtrics survey. A hierarchical regression analysis was performed to identify the contribution of mindfulness to quality of life, controlling for sociodemographic and injury-related factors. A serial mediation analysis was performed to examine the indirect effect of mindfulness on quality of life.

RESULTS

In the hierarchical regression analysis, sociodemographic and injury-related factors (i.e., age, gender, race, marital status, education, employment, level and completeness of injury, comorbidities, frequency of hospitalization, pain intensity, and functional limitation) and mindfulness explained 59% variance on quality of life of the participants with spinal cord injury. Mindfulness uniquely contributed to the higher quality of life above and beyond sociodemographic and injury-related variables. In the serial mediation analysis, pain and functional limitation did not significantly mediate the relationship between mindfulness and quality of life. However, the indirect effects of mindfulness on functional limitation and quality of life through pain were significant.

CONCLUSION

The findings underscore the vital role of mindfulness in improving the quality of life of persons with spinal cord injury. Implications of these findings for future research and clinical practice are discussed.

Bowel Management in Patients With Chronic Spinal Cord Injury: A Cross-Sectional Survey

Introduction

Spinal cord injury (SCI) impairs colorectal movement, transit time, and complete evacuation at defecation. Incontinence has been documented to affect quality of life across the globe in different proportions. Bowel management has been recognized as a key factor in SCI patients’ participation in the society and leading a satisfactory life. Limited information on bowel management in SCI patients drove us to study the demographic profile and bowel management in a group of chronic SCI patients at a tertiary care rehabilitation center.

Methods

A total of 42 adults (age: 18-60 years) with SCI and duration > 12 months were enrolled. Patients were evaluated with a semi-structured questionnaire containing both open and closed questions. Data were collected and analyzed using Statistical Package for Social Sciences (SPSS) Version 10.

Results

Most (52.4%) of the patients were manual laborers (85.7% males). Mean age was 37.6 ± 11 years. The injury level was predominantly thoracic level (69%). Only eight (19%) patients had fecal incontinence; 21(50%) patients used suppository and only six patients were using laxatives. Impacted stool was the most common complication followed by hemorrhoids.

Conclusion

Young paraplegics is the most common age group affected by SCI. Most of the patients managed their bowel well conservatively with good adherence to bowel rehabilitation program. The study findings emphasize on patient-centric bowel management in SCI patients to reduce the impact on quality of life and minimize complications.