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Kelly LC, Glinsky JV, Harvey LA. A case report of three people experiencing intractable autonomic dysreflexia following instillation of Uro-Tainer ® Polyhexanide 0.02. Spinal Cord Ser Cases 2024; 10:17. [PMID: 38580624 PMCID: PMC10997763 DOI: 10.1038/s41394-024-00626-5] [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: 04/29/2023] [Revised: 02/26/2024] [Accepted: 03/05/2024] [Indexed: 04/07/2024] Open
Abstract
INTRODUCTION Historically, bladder washouts were used to instil therapeutic reagents directly into the bladder. This practice has expanded to include instillation of solutions that deal with catheter issues such as encrustation or formation of bio-film. They appear to provide a promising strategy for people with long term catheters. These products are readily available to purchase, but there is concern that people are using these solutions without a complete understanding of the purpose for the rinse and without clinical guidance to monitor response to treatment. CASE PRESENTATION These case studies include three people living with spinal cord injury (SCI) who developed severe autonomic dysreflexia (AD) when a catheter rinse was carried out using a particular solution. Each of the cases developed immediate and, in some cases, intractable AD requiring further intervention to resolve symptoms. DISCUSSION Catheter-associated urinary tract infection is a significant cause of morbidity and mortality in people living with SCI. Long-term catheters provide a vector for opportunistic micro-organisms to form bio-film and create an environment that promotes formation of struvite calculi, thus increasing the risk of chronic catheter blockage and urinary tract infection. Whilst these solutions are used to reduce these risks, they also pose additional risks to people susceptible to AD. These cases highlight the need for judicious patient selection and clinical oversight and management of adverse events when using catheter rinse solutions in certain people living with SCI. This is supported by a decision-making algorithm and a response to AD algorithm. This case report was prepared following the CARE Guidelines (supplementary file 1).
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Affiliation(s)
- Louise C Kelly
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia
- Northern Sydney Local Health District, Sydney, NSW, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Faculty of Medicine & Health, University of Sydney, Sydney, NSW, Australia.
- Northern Sydney Local Health District, Sydney, NSW, Australia.
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Wilson JN, Kigerl KA, Sunshine MD, Taylor CE, Speed SL, Rose BC, Calulot CM, Dong BE, Hawkinson TR, Clarke HA, Bachstetter AD, Waters CM, Sun RC, Popovich PG, Alilain WJ. Targeting the Microbiome to Improve Gut Health and Breathing Function After Spinal Cord Injury. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.06.23.546264. [PMID: 38187534 PMCID: PMC10769193 DOI: 10.1101/2023.06.23.546264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Spinal cord injury (SCI) is a devastating condition characterized by impaired motor and sensory function, as well as internal organ pathology and dysfunction. This internal organ dysfunction, particularly gastrointestinal (GI) complications, and neurogenic bowel, can reduce the quality of life of individuals with an SCI and potentially hinder their recovery. The gut microbiome impacts various central nervous system functions and has been linked to a number of health and disease states. An imbalance of the gut microbiome, i.e., gut dysbiosis, contributes to neurological disease and may influence recovery and repair processes after SCI. Here we examine the impact of high cervical SCI on the gut microbiome and find that transient gut dysbiosis with persistent gut pathology develops after SCI. Importantly, probiotic treatment improves gut health and respiratory motor function measured through whole-body plethysmography. Concurrent with these improvements was a systemic decrease in the cytokine tumor necrosis factor-alpha and an increase in neurite sprouting and regenerative potential of neurons. Collectively, these data reveal the gut microbiome as an important therapeutic target to improve visceral organ health and respiratory motor recovery after SCI. Research Highlights Cervical spinal cord injury (SCI) causes transient gut dysbiosis and persistent gastrointestinal (GI) pathology.Treatment with probiotics after SCI leads to a healthier GI tract and improved respiratory motor recovery.Probiotic treatment decreases systemic tumor necrosis factor-alpha and increases the potential for sprouting and regeneration of neurons after SCI.The gut microbiome is a valid target to improve motor function and secondary visceral health after SCI.
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Mashola MK, Korkie E, Mothabeng DJ. Development of a pain self-management intervention framework for people with spinal cord injury. Afr J Prim Health Care Fam Med 2023; 15:e1-e12. [PMID: 37916727 PMCID: PMC10623601 DOI: 10.4102/phcfm.v15i1.4039] [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: 02/15/2023] [Revised: 08/08/2023] [Accepted: 08/15/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Pain is the most common reason for medical visits to primary health care practitioners. Pain self-management interventions are encouraged and there is no known self-management intervention framework available that clinicians and people with spinal cord injury (PWSCI) can use to guide treatment selection. AIM This study aimed to develop a pain self-management intervention framework for PWSCI. SETTING Online and facilitated in Gauteng, South Africa. METHODS A three-round modified e-Delphi method was used to reach an 80% consensus among a 21-expert panel. Fifty-nine interventions were distributed via REDCap and a final online audio meeting was held to either include or exclude interventions in the final framework. SPSS v27 was used to analyse descriptive data and content analysis was used for qualitative responses. RESULTS The final developed pain self-management framework consists of 56 interventions and includes interventions from multiple health professions to encompass medical, psychological, therapeutic and social interventions. Interventions are also specified for nociceptive and/or neuropathic pain and grouped according to the biopsychosocial model. CONCLUSION The interprofessional framework may be used as a guideline for PWSCI to alleviate pain, as well as assist health professionals in clinical decision-making, by providing them with the freedom to choose acceptable and adequate interventions that may be appropriate to treat the affected individual's pain.Contribution: Pain management is a basic need at the primary healthcare level and PWSCI need access to the broad range of interventions available to manage their pain. The framework highlights the variety of appropriate interventions to guide both health professionals and PWSCI with pain relief options.
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Affiliation(s)
- Mokgadi K Mashola
- Department of Physiotherapy, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; and Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria.
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Hamad I, Van Broeckhoven J, Cardilli A, Hellings N, Strowig T, Lemmens S, Hendrix S, Kleinewietfeld M. Effects of Recombinant IL-13 Treatment on Gut Microbiota Composition and Functional Recovery after Hemisection Spinal Cord Injury in Mice. Nutrients 2023; 15:4184. [PMID: 37836468 PMCID: PMC10574124 DOI: 10.3390/nu15194184] [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: 07/21/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023] Open
Abstract
In recent years, the gut-central nervous system axis has emerged as a key factor in the pathophysiology of spinal cord injury (SCI). Interleukin-13 (IL-13) has been shown to have anti-inflammatory and neuroprotective effects in SCI. The aim of this study was to investigate the changes in microbiota composition after hemisection injury and to determine whether systemic recombinant (r)IL-13 treatment could alter the gut microbiome, indirectly promoting functional recovery. The gut microbiota composition was determined by 16S rRNA gene sequencing, and correlations between gut microbiota alterations and functional recovery were assessed. Our results showed that there were no changes in alpha diversity between the groups before and after SCI, while PERMANOVA analysis for beta diversity showed significant differences in fecal microbial communities. Phylogenetic classification of bacterial families revealed a lower abundance of the Bacteroidales S24-7 group and a higher abundance of Lachnospiraceae and Lactobacillaceae in the post-SCI group. Systemic rIL-13 treatment improved functional recovery 28 days post-injury and microbiota analysis revealed increased relative abundance of Clostridiales vadin BB60 and Acetitomaculum and decreased Anaeroplasma, Ruminiclostridium_6, and Ruminococcus compared to controls. Functional assessment with PICRUSt showed that genes related to glyoxylate cycle and palmitoleate biosynthesis-I were the predominant signatures in the rIL-13-treated group, whereas sulfolactate degradation super pathway and formaldehyde assimilation-I were enriched in controls. In conclusion, our results indicate that rIL-13 treatment promotes changes in gut microbial communities and may thereby contribute indirectly to the improvement of functional recovery in mice, possibly having important implications for the development of novel treatment options for SCI.
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Affiliation(s)
- Ibrahim Hamad
- VIB Laboratory of Translational Immunomodulation, Center for Inflammation Research (IRC), Hasselt University, 3590 Diepenbeek, Belgium (A.C.)
- Department of Immunology and Infection, Biomedical Research Institute (BIOMED), Hasselt University, 3590 Diepenbeek, Belgium; (J.V.B.); (N.H.)
| | - Jana Van Broeckhoven
- Department of Immunology and Infection, Biomedical Research Institute (BIOMED), Hasselt University, 3590 Diepenbeek, Belgium; (J.V.B.); (N.H.)
| | - Alessio Cardilli
- VIB Laboratory of Translational Immunomodulation, Center for Inflammation Research (IRC), Hasselt University, 3590 Diepenbeek, Belgium (A.C.)
- Department of Immunology and Infection, Biomedical Research Institute (BIOMED), Hasselt University, 3590 Diepenbeek, Belgium; (J.V.B.); (N.H.)
| | - Niels Hellings
- Department of Immunology and Infection, Biomedical Research Institute (BIOMED), Hasselt University, 3590 Diepenbeek, Belgium; (J.V.B.); (N.H.)
| | - Till Strowig
- Department of Microbial Immune Regulation, Helmholtz Center for Infection Research, 38124 Braunschweig, Germany
| | - Stefanie Lemmens
- Department of Immunology and Infection, Biomedical Research Institute (BIOMED), Hasselt University, 3590 Diepenbeek, Belgium; (J.V.B.); (N.H.)
| | - Sven Hendrix
- Institute for Translational Medicine, Medical School Hamburg, 20457 Hamburg, Germany
| | - Markus Kleinewietfeld
- VIB Laboratory of Translational Immunomodulation, Center for Inflammation Research (IRC), Hasselt University, 3590 Diepenbeek, Belgium (A.C.)
- Department of Immunology and Infection, Biomedical Research Institute (BIOMED), Hasselt University, 3590 Diepenbeek, Belgium; (J.V.B.); (N.H.)
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Ghodsi Z, Jazayeri SB, Pourrashidi A, Sadeghi-Naeini M, Azadmanjir Z, Baigi V, Maroufi SF, Azarhomayoun A, Faghih-Jouybari M, Amirjamshidi A, Naghdi K, Habibi Arejan R, Shabani M, Sepahdoost A, Dehghanbanadaki H, Habibi R, Mohammadzadeh M, Bahreini M, O'Reilly GM, Vaccaro AR, Harrop JS, Davies BM, Yi L, Ghodsi SM, Rahimi-Movaghar V. Development of a comprehensive assessment tool to measure the quality of care for individuals with traumatic spinal cord injuries. Spinal Cord Ser Cases 2023; 9:12. [PMID: 37005413 PMCID: PMC10067818 DOI: 10.1038/s41394-023-00569-3] [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: 12/09/2021] [Revised: 03/11/2023] [Accepted: 03/20/2023] [Indexed: 04/04/2023] Open
Abstract
OBJECTIVE To develop a comprehensive assessment tool to evaluate the Quality of Care (QoC) in managing individuals with traumatic spinal cord injuries (TSCI). METHOD At first, the concepts of QoC for TSCI were identified by conducting a qualitative interview along with re-evaluation of the results of a published scoping review (conceptualization). After operationalization of indicators, they were valued by using the expert panel method. Afterward, the content validity index (CVI) and content validity ratio (CVR) were calculated and served as cut-offs for indicator selection. Then specific questions were developed for each indicator and classified into three categories: pre-hospital, in-hospital, and post-hospital. Data availability of the National Spinal Cord Injury Registry of Iran (NSCIR-IR) was subsequently used to design questions that represent indicators in an assessment tool format. The comprehensiveness of the tool was evaluated using a 4-item Likert scale by the expert panel. RESULT Twelve experts participated in conceptualization and 11 experts participated in operationalization phase. Overall, 94 concepts for QoC were identified from published scoping review (87 items) and qualitative interviews (7 items). The process of operationalization and indicator selection led to the development of 27 indicators with acceptable content validity. Finally, the assessment tool contained three pre-hospital, twelve in-hospital, nine post-hospital, and three mixed indicators. Ninety-one percent of experts evaluated the entire tool as comprehensive. CONCLUSION Our study presents a health-related QoC tool that contains a comprehensive set of indicators to assess the QoC for individuals with TSCI. However, this tool should be used in various situations to establish construct validity further.
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Affiliation(s)
- Zahra Ghodsi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Behnam Jazayeri
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Ahmad Pourrashidi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Sadeghi-Naeini
- Department of Neurosurgery, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Azadmanjir
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Health Information Management Department, Tehran University of Medical Sciences, Tehran, Iran
| | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Farzad Maroufi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Amir Azarhomayoun
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Morteza Faghih-Jouybari
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Abbas Amirjamshidi
- Department of Neurosurgery, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Khatereh Naghdi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Shabani
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Hojat Dehghanbanadaki
- Metabolic Disorders Research Center, Endocrinology and Metabolism Molecular-Cellular Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Habibi
- Faculty of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Maryam Bahreini
- Emergency Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Gerard Michael O'Reilly
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
- Emergency and Trauma Centre, The Alfred, Melbourne, VIC, Australia
- National Trauma Research Institute, The Alfred, Melbourne, VIC, Australia
| | - Alexander R Vaccaro
- Department of Orthopedics and Neurosurgery, Thomas Jefferson University and the Rothman Institute, Philadelphia, PA, USA
| | - James S Harrop
- Department of Neurological and Orthopedic Surgery, Thomas Jefferson University, Philadelphia, PA, 19107, USA
| | - Benjamin M Davies
- Department of Academic Neurosurgery, University of Cambridge, Cambridge, UK
| | - Lu Yi
- Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Seyed Mohammad Ghodsi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
| | - Vafa Rahimi-Movaghar
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
- Universal Scientific Education and Research Network (USERN), Tehran, Iran.
- Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran.
- Visiting Professor, Spine Program, University of Toronto, Toronto, ON, Canada.
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Causes and length of stay of readmission among individuals with traumatic spinal cord injury: a prospective observational cohort study. Spinal Cord 2023:10.1038/s41393-023-00874-6. [PMID: 36841915 DOI: 10.1038/s41393-023-00874-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 12/31/2022] [Accepted: 01/04/2023] [Indexed: 02/27/2023]
Abstract
BACKGROUND Secondary conditions may reduce function and participation in individuals with chronic Spinal Cord Injury (SCI). The knowledge of reasons for readmission to the hospital may be enlightening to prevent them and remodel the health services. STUDY DESIGN Multicenter prospective observational study of all consecutive readmissions of persons with SCI after rehabilitation completion. OBJECTIVES To explore the characteristics of individuals with SCI readmitted to the hospital, the reasons for readmissions and the burden on hospitalization in terms of length of stay (LoS) for different conditions. SETTING 31 Italian specialized SCI centers. METHODS Data on people with traumatic SCI readmitted to SCI centers were recorded about: age, sex, SCI level and severity group, geographical origin, readmission causes, clinical interventions during hospitalization, LoS and discharge destination. Linear and multiple logistic regression analyses were performed considering LoS (days) as dependent variable for correlations with independent variables. All tests were two-sided. RESULTS Among 1039 persons with traumatic SCI enrolled (mean age 46, males 85%, tetraplegia 43%), 59.09% of the readmissions were caused by urological problems, 39.74% by pressure injury and 35.41% by spasticity (68% readmitted for ≥2 causes, associated with longer LoS). The mean LoS was 48 days: pressure injury, rehabilitative needs, sexual, bowel, and pain problems were associated with longer and urological problems with shorter LoS. People from the South of the country were frequently (68%) readmitted to the northern centers. CONCLUSIONS Urological problems, pressure injury and spasticity were the most frequent causes of re-hospitalization in individuals with traumatic SCI. The migration trend seeking SCI-specific treatments suggests geographic areas to which health care organizations need to pay more attention.
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Jeon M, Kim O, Lee BS, Kim W, Kim JH, Kim EJ, Kim J. Influence of Sociodemographic Factors, Health Conditions, and Activity on Participation in People With Spinal Cord Injury in South Korea. Arch Phys Med Rehabil 2023; 104:52-62. [PMID: 36028101 DOI: 10.1016/j.apmr.2022.08.004] [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: 03/11/2022] [Revised: 08/02/2022] [Accepted: 08/08/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To verify the causal relationship between sociodemographic factors, health conditions, and activities that influence the participation of people with spinal cord injury (SCI) using International Spinal Cord Injury (InSCI) Survey data and to investigate the moderation effects of environmental restrictions and health care system concerns. DESIGN Cross-sectional community survey and structural equation model. SETTING SCI databases of the Korea National Rehabilitation Center and Korea Spinal Cord Injury Association. PARTICIPANTS Community-dwelling adults (N=890) with SCI. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The InSCI questionnaire domains included sociodemographic factors, health conditions, activity, participation, environmental restrictions, and health system concerns. Sociodemographic factors included age, education, and income. Health conditions included bowel dysfunction, respiratory problems, and pain, among others. Activity included "daily routine" and "using hands," among others. Participation included "interacting with people" and "intimate relationships," among others. Environmental restrictions included "public places" and "negative attitudes," among others. Health care system concerns included "nursing care" and "experience of being treated," among others. RESULTS The hypothesis that health conditions would have a significant effect on activity was supported because 51% of the total variance in activity factors was explained by health condition factors. The hypothesis that activity would have a significant effect on participation was also supported because 63.4% of total variance in participation factors was explained by activity factors. The moderation effect tests supported the hypotheses that health conditions, activity, and participation would differ depending on the extent of environmental restrictions as well as the extent of health system concerns. CONCLUSIONS When formulating policies and recommendations to promote the participation of people with SCI living in the South Korean community, the influence of environmental restrictions and health systems as well as the causal influence of health conditions and activity should be considered.
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Affiliation(s)
- Minjae Jeon
- Department of Healthcare and Public Health Research, Rehabilitation Research Institute, Korea National Rehabilitation Center, Seoul
| | - Onyoo Kim
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Korea National Rehabilitation Center, Seoul.
| | - Bum-Suk Lee
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Korea National Rehabilitation Center, Seoul.
| | - Wanho Kim
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Korea National Rehabilitation Center, Seoul
| | - Jung Hwan Kim
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Korea National Rehabilitation Center, Seoul
| | - Eun-Joo Kim
- Department of Rehabilitation Medicine, Rehabilitation Hospital, Korea National Rehabilitation Center, Seoul
| | - Jiin Kim
- Department of Community Reintegration Service, Rehabilitation Hospital, Korea National Rehabilitation Center, Seoul, Republic of Korea
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Malekzadeh H, Golpayegani M, Ghodsi Z, Sadeghi-Naini M, Asgardoon M, Baigi V, Vaccaro AR, Rahimi-Movaghar V. Direct Cost of Illness for Spinal Cord Injury: A Systematic Review. Global Spine J 2022; 12:1267-1281. [PMID: 34289308 PMCID: PMC9210246 DOI: 10.1177/21925682211031190] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
STUDY DESIGN Systematic review. OBJECTIVE Providing a comprehensive review of spinal cord injury cost of illness studies to assist health-service planning. METHODS We conducted a systematic review of the literature published from Jan. 1990 to Nov. 2020 via Pubmed, EMBASE, and NHS Economic Evaluation Database. Our primary outcomes were overall direct health care costs of SCI during acute care, inpatient rehabilitation, within the first year post-injury, and in the ensuing years. RESULTS Through a 2-phase screening process by independent reviewers, 30 articles out of 6177 identified citations were included. Cost of care varied widely with the mean cost of acute care ranging from $290 to $612,590; inpatient rehabilitation from $19,360 to $443,040; the first year after injury from $32,240 to $1,156,400; and the ensuing years from $4,490 to $251,450. Variations in reported costs were primarily due to neurological level of injury, study location, methodological heterogeneities, cost definitions, study populations, and timeframes. A cervical level of the injury, ASIA grade A and B, concomitant injuries, and in-hospital complications were associated with the greatest incremental effect in cost burden. CONCLUSION The economic burden of SCI is generally high and cost figures are broadly higher for developed countries. As studies were only available in few countries, the generalizability of the cost estimates to a regional or global level is only limited to countries with similar economic status and health systems. Further investigations with standardized methodologies are required to fill the knowledge gaps in the healthcare economics of SCI.
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Affiliation(s)
- Hamid Malekzadeh
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran,Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Golpayegani
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Sadeghi-Naini
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran,Neurosurgery Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Science, Tehran, Iran
| | | | - Vali Baigi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alexander R. Vaccaro
- Department of Orthopedics and Neurosurgery, The Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran,Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran,Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran,Universal Scientific Education and Research Network (USERN), Tehran, Iran,Institute of Biochemistry and Biophysics, University of Tehran, Tehran, Iran,Spine Program, University of Toronto, Toronto, Canada,Vafa Rahimi-Movaghar, Sina Trauma and Surgery Research Center, Sina Hospital, Hassan Abad Square, Imam Khomeini Avenue, Tehran, Iran. ;
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The primary and secondary causes of hospitalizations during the first five years after spinal cord injury. Spinal Cord 2022; 60:574-579. [PMID: 35149779 PMCID: PMC9232845 DOI: 10.1038/s41393-022-00750-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/04/2022] [Accepted: 01/05/2022] [Indexed: 11/25/2022]
Abstract
STUDY DESIGN Cohort study. Retrospective analysis of uniform billing discharge data (UB-04). OBJECTIVES To compare and contrast the primary and secondary causes of hospitalization by type of admission, emergency department (ED) versus inpatient only (IP), during the first five years after the traumatic spinal cord injury (SCI). SETTING Academic Medical University in the Southeastern USA. METHODS At total of 2569 adults with traumatic SCI were identified from a population-based registry and matched to billing data. The main outcome measures were primary and secondary diagnoses associated with hospital admissions in non-federal, state hospitals. RESULTS Overall, there were 9733 hospital admissions in the five years after SCI onset, not including the initial hospitalization; 53% were admissions through the ED. The primary causes of hospitalizations after SCI varied by year post injury and admission type (ED versus IP). The top 15 secondary diagnoses included several secondary health conditions associated with SCI, as well as chronic health conditions. CONCLUSIONS Rehabilitation diagnoses were much more prominent during the first year, compared with subsequent years. Septicemia was the leading cause of admissions through the ED, whereas chronic ulcers of the skin were prominent for IP only admissions. This is consistent with the acute nature of septicemia compared with more planned hospitalization for rehabilitation and skin ulcers. These conditions should be targeted for prevention strategies that include patient/family education and early and appropriate access to primary care.
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Cai S, Bakerjian D, Bang H, Mahajan SM, Ota D, Kiratli J. Data acquisition process for VA and non-VA emergency department and hospital utilization by veterans with spinal cord injury and disorders in California using VA and state data. J Spinal Cord Med 2022; 45:254-261. [PMID: 32543354 PMCID: PMC8986188 DOI: 10.1080/10790268.2020.1773028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Context: To identify VA and non-VA Emergency Department (ED) and hospital utilization by veterans with spinal cord injury and disorders (SCI/D) in California.Design: Retrospective cohort study.Setting: VA and Office of Statewide Health Planning and Development (OSHPD) in California.Participants: Total 300 veterans admitted to the study VA SCI/D Center for initial rehabilitations from 01/01/1999 through 08/17/2014.Interventions: N/A.Outcome Measures: Individual-level ED visits and hospitalizations during the first-year post-rehabilitation.Results: Among 145 veterans for whom ED visit data available, 168 ED visits were identified: 94 (55.2%) at non-VA EDs and 74 (44.8%) at the VA ED, with a mean of 1.16 (±2.21) ED visit/person. Seventy-seven (53.1%) veterans did not visit any ED. Of 68 (46.9%) veterans with ≥ one ED visit, 20 (29.4%) visited the VA ED only, 34 (50.0%) visited non-VA EDs only, and 14 (20.6%) visited both VA and non-VA EDs. Among 212 Veterans for whom hospitalization data were available, 247 hospitalizations were identified: 82 (33.2%) non-VA hospitalizations and 165 (66.8%) VA hospitalization with a mean of 1.17 (±1.62) hospitalizations/person. One hundred-seven (50.5%) veterans had no hospitalizations. Of 105 veterans with ≥ one hospitalization, 58 (55.2%) were hospitalized at the study VA hospital, 15 (14.3%) at a non-VA hospital, and 32 (30.5%) at both VA and non-VA hospitals.Conclusion: Non-VA ED and hospital usage among veterans with SCI/D occurred frequently. The acquisition of non-VA healthcare data managed by state agencies is vital to accurately and comprehensively evaluate needs and utilization rates among veteran populations.
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Affiliation(s)
- Sujuan Cai
- Department of the Veterans Affairs, Palo Alto Health Care System, Palo Alto, California, USA,The Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, California, USA,Correspondence to: Sujuan Cai, 3801 Miranda Ave. Building 7, VA Palo Alto Health Care System, Spinal Cord Injury/Disorder, Palo Alto, California94304, USA; Ph: 408-832-4205.
| | - Debra Bakerjian
- The Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, California, USA
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, University of California at Davis, Davis, California, USA
| | - Satish M. Mahajan
- Department of the Veterans Affairs, Palo Alto Health Care System, Palo Alto, California, USA
| | - Doug Ota
- Department of the Veterans Affairs, Palo Alto Health Care System, Palo Alto, California, USA
| | - Jenny Kiratli
- Department of the Veterans Affairs, Palo Alto Health Care System, Palo Alto, California, USA
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A New Electrode Design for Direct Bladder Wall Stimulation: A Pilot Minipig Study with Chronic Testing. APPLIED SCIENCES-BASEL 2022. [DOI: 10.3390/app12031149] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
(1) Aims: To test a newly designed helical-wire hook electrode implanted in the bladder wall to induce contraction and promote voiding. (2) Methods: In three minipigs with a created lesion of the sacral spinal cord, four electrodes were implanted in the bladder wall, ventral to the trigone. Stimulation tests were conducted initially in conscious pigs, and later after general anesthesia. (3) Results: Electrical stimulation in the conscious animals on postoperative days 4 and 7 at 40 Hz was limited to 10 mA, because of abdominal, leg, and anal contractions with animal discomfort; bladder contractions were not induced. Electrical stimulation on postoperative days 9 and 28 at 60 mA under anesthesia induced sustained vesical wall contractions with bladder pressure variations, but without voiding. Simultaneous abdominal contractions occurred, with strong leg and anal contractions. Subsequent stimulation with a single set of electrodes or at 20 Hz induced less vesical pressure response. At autopsy, the electrodes had not migrated, and extraction forces were high, at 7.9 ± 0.9 Newtons (n = 12). (4) Conclusions: Our 28-day study has confirmed the utility of the new electrode design, preventing migration from the bladder wall and making it suitable for long-term electrode implants.
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Shepherd J, Tu K, Young J, Chishtie J, Craven BC, Moineddin R, Jaglal S. Identifying cases of spinal cord injury or disease in a primary care electronic medical record database. J Spinal Cord Med 2021; 44:S28-S39. [PMID: 34779726 PMCID: PMC8604482 DOI: 10.1080/10790268.2021.1971357] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To identify cases of spinal cord injury or disease (SCI/D) in an Ontario database of primary care electronic medical records (EMR). DESIGN A reference standard of cases of chronic SCI/D was established via manual review of EMRs; this reference standard was used to evaluate potential case identification algorithms for use in the same database. SETTING Electronic Medical Records Primary Care (EMRPC) Database, Ontario, Canada. PARTICIPANTS A sample of 48,000 adult patients was randomly selected from 213,887 eligible patients in the EMRPC database. INTERVENTIONS N/A. MAIN OUTCOME MEASURE(S) Candidate algorithms were evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F-score. RESULTS 126 cases of chronic SCI/D were identified, forming the reference standard. Of these, 57 were cases of traumatic spinal cord injury (TSCI), and 67 were cases of non-traumatic spinal cord injury (NTSCI). The optimal case identification algorithm used free-text keyword searches and a physician billing code, and had 70.6% sensitivity (61.9-78.4), 98.5% specificity (97.3-99.3), 89.9% PPV (82.2-95.0), 94.7% NPV (92.8-96.3), and an F-score of 79.1. CONCLUSIONS Identifying cases of chronic SCI/D from a database of primary care EMRs using free-text entries is feasible, relying on a comprehensive case definition. Identifying a cohort of patients with SCI/D will allow for future study of the epidemiology and health service utilization of these patients.
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Affiliation(s)
- John Shepherd
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada,Correspondence to: John Shepherd, Rehabilitation Sciences Institute, University of Toronto, 500 University Ave, Toronto, Ontario, Canada.
| | - Karen Tu
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,North York General Hospital, Toronto, Ontario, Canada,Toronto Western Hospital Family Health Team, University of Toronto, Toronto, Ontario, Canada
| | - Jacqueline Young
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Jawad Chishtie
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - B. Catharine Craven
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,Dalla Lana School of Public Health, Toronto, Ontario, Canada
| | - Susan Jaglal
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
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Hiremath SV, Kupfer M, Ruediger M. Timing and pattern of readmission in individuals with spinal cord injury in the setting of a specialized medical home. J Spinal Cord Med 2021; 44:896-901. [PMID: 33606601 PMCID: PMC8725714 DOI: 10.1080/10790268.2021.1883959] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
BACKGROUND The rate of readmission in individuals with spinal cord injury (SCI) is known to be high (28% to 45%) during the first year post-injury and post-rehabilitation. However, there are several critical gaps in our knowledge including the timing pattern of medical complications and the pattern of health complications associated with readmissions. OBJECTIVE To identify the timing and pattern of complications associated with hospital readmissions in individuals with traumatic SCI and non-traumatic spinal cord disorders (SCI) post-discharge from an inpatient rehabilitation facility (IRF). DESIGN Secondary analysis of a three year prospective cohort study. SETTING An SCI medical home. PARTICIPANTS Individuals who were readmitted (n = 53) within the first year (N = 176) post-discharge from an IRF. INTERVENTIONS N/A. OUTCOME MEASURES Timing and pattern of all-cause hospital readmissions. RESULTS Eighty one percent of the readmitted patients experienced readmission within the first six months after discharge, and 36% of the initial readmissions occurred within 30 days of discharge from an IRF. The trend line for the timing of the first readmission post-discharge from an IRF was curvilinear, with a sharp decrease in the number of new patients readmitted for months 1-7 and then a slight increase between 9 and 12 months. Urological and respiratory complications were related to repeat readmissions. CONCLUSION The patient is at the greatest risk of readmission in the first 6 months, with a secondary increase in risk at 9 months. Possible reasons may include reduction in in-home and outpatient therapy and skilled nursing over the first year post-SCI.
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Affiliation(s)
- Shivayogi V. Hiremath
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University, Philadelphia, Pennsylvania, USA,Correspondence to: Shivayogi V. Hiremath, Personal Health Informatics & Rehabilitation Engineering (PHIRE) Laboratory, Pearson Hall 40, 1800 North Broad Street, 19121Philadelphia, PA, USA; Ph: 215-204-0496.
| | - Mendel Kupfer
- Department of Rehabilitation Medicine, Magee Rehabilitation Hospital, Jefferson Health, Philadelphia, Pennsylvania, USA,Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Marci Ruediger
- Department of Rehabilitation Medicine, Magee Rehabilitation Hospital, Jefferson Health, Philadelphia, Pennsylvania, USA
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14
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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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ATEŞ E, BİLGİLİ N. Effect of Web-Based Training on Complication Control and Quality of Life of Spinal Cord Damaged İndividuals: Randomized Controlled Trial. CLINICAL AND EXPERIMENTAL HEALTH SCIENCES 2021. [DOI: 10.33808/clinexphealthsci.707654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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16
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Ruediger M, Kupfer M, Leiby BE. Decreasing re-hospitalizations and emergency department visits in persons with recent spinal cord injuries using a specialized medical home. J Spinal Cord Med 2021; 44:221-228. [PMID: 31603396 PMCID: PMC7952066 DOI: 10.1080/10790268.2019.1671075] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective: To determine whether a specialized medical home can reduce re-hospitalizations and emergency department (ED) visits as compared to reports in the literature for persons with spinal cord injury (SCI) in the first year post-discharge from acute inpatient rehabilitation.Design: A three-year prospective cohort study.Setting: An academic free standing inpatient rehabilitation hospital (IRF), participating in the SCI Model Systems network, serving urban, rural and suburban settings in the mid-Atlantic region of the United States of America.Participants: 176 successive individuals with varying levels of SCI, inclusive of patients requiring mechanical ventilation, discharged from rehabilitation from 2/1/15 to 7/1/17, who met criteria and consented to participate.Interventions: Pre-discharge communication between the inpatient and outpatient staff was initiated, medication education by a pharmacist was added, 1 month of discharge medications was offered, and proactive phone calls to patients after discharge were instituted. In addition, patients were offered a 24/7 hotline to reach physician and nursing staff, and multidisciplinary outpatient follow-up was provided in conjunction with extensive proactive case management.Outcome measures: All-cause hospital readmission and ED visits.Results: Thirty percent of the individuals were readmitted within the first year after discharge from an IRF, and 24% were readmitted within the first year after onset. The incidence of readmission was 0.46 and 0.36 respectively. Forty-one percent had an ED visit.Conclusion: The results suggest that the medical home interventions decreased the rate and incidence of readmission and the rate of ED usage in the first year.
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Affiliation(s)
- Marci Ruediger
- Perfomance Excellence Department, Magee Rehabilitation – Jefferson Health, Philadelphia, Pennsylvania, USA,Correspondence to: Marci Ruediger, Magee Rehabilitation, 1513 Race Street, Philadelphia, Pennsylvania19102, USA. Ph: 215-587-3454.
| | - Mendel Kupfer
- Department of Rehabilitation Medicine, Magee Rehabilitation – Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Benjamin E. Leiby
- Department of Pharmacoloy and Experimental Therapeutics, Division of Biostatistics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
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17
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Canori A, Kumar A, Hiremath SV. Factors associated with multiple hospital readmissions for individuals with spinal cord injury. ACTA ACUST UNITED AC 2021; 1:57-61. [PMID: 33554212 DOI: 10.15367/ch.v1i2.399] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective To identify patient-level and clinical factors associated with multiple hospital readmissions in individuals with spinal cord injury (SCI). Design Retrospective cohort analysis of the publicly available dataset from the SCI Rehabilitation (SCIRehab) study. Setting Six rehabilitation centers in the U.S. that participated in the SCIRehab study. Participants: Individuals with traumatic SCI (N=1371) who were consecutively enrolled in the SCIRehab study. Outcome measures The primary outcome was all-cause hospital readmission within 1 year of discharge from a rehabilitation center. The patient-level and clinical factors include employment status, depression, caregiver support, state-funded insurance, functional status, and rehabilitation services. Results Of the 1170 participants included in the study, 228 were readmitted once and 120 were readmitted multiple times. In our study, 34.2% and 10.8% were readmitted more than once due to genitourinary and respiratory conditions, respectively. Lower utilization of rehabilitation services, lower functional status, unemployment, and depression were associated with higher odds of being readmitted multiple times within one year of discharge from inpatient rehabilitation facility. Conclusion Psychosocial and clinical factors were associated with increased risk for multiple readmissions in individuals with SCI. In order to reduce recurrent readmissions in individuals with SCI, further research is necessary to maximize efficacy of risk factor modification and prevention strategies.
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Affiliation(s)
- Alexandra Canori
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University
| | - Amit Kumar
- Center for Health Equity Research, Department of Physical Therapy and Athletic Training, Northern Arizona University
| | - Shivayogi V Hiremath
- Department of Health and Rehabilitation Sciences, College of Public Health, Temple University
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18
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Richardson A, Samaranayaka A, Sullivan M, Derrett S. Secondary health conditions and disability among people with spinal cord injury: A prospective cohort study. J Spinal Cord Med 2021; 44:19-28. [PMID: 30882288 PMCID: PMC7919890 DOI: 10.1080/10790268.2019.1581392] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: To examine how secondary health conditions (SHCs) that develop early after a spinal cord injury (SCI) are related to disability over time.Design: Prospective cohort study.Setting: Two spinal units in New Zealand (Burwood Spinal Unit and Auckland Spinal Rehabilitation Unit).Participants: Between 2007 and 2009, 91 people participated in three telephone interviews approximately 6, 18, and 30 months after the occurrence of a SCI.Outcome measures: SHCs were measured using 14 items derived from the Secondary Complications Survey. Disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0. Linear regression analyses were performed to investigate associations between SHCs at 6 months and disability at each assessment point.Results: The most prevalent SHCs were leg spasms, constipation, back pain, pain below the level of SCI, and shoulder pain. Constipation, urinary tract infection, and headaches at 6 months post-SCI were associated with significantly higher levels of disability at each subsequent follow-up, independent of age, sex and SCI impairment. Back pain, and pain below the SCI, at 6 months were associated with significantly greater disability at 18 months, and difficulty coughing at 6 months was associated with significantly greater disability at 30 months.Conclusion: The experience of specific SHCs in the first 6 months after an SCI is related to greater long-term disability. In order to reduce the disability burden of people with SCI, efforts should be directed toward early prevention of these SHCs.
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Affiliation(s)
- Amy Richardson
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ari Samaranayaka
- Dean’s Department, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Martin Sullivan
- School of Social Work, Massey University, Palmerston North (Turitea) campus, Wellington, New Zealand
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand,Correspondence to: Sarah Derrett, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin9054, New Zealand.
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19
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Bannerman CA, Douchant K, Sheth PM, Ghasemlou N. The gut-brain axis and beyond: Microbiome control of spinal cord injury pain in humans and rodents. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2021; 9:100059. [PMID: 33426367 PMCID: PMC7779861 DOI: 10.1016/j.ynpai.2020.100059] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 11/26/2020] [Accepted: 12/10/2020] [Indexed: 12/17/2022]
Abstract
Spinal cord injury (SCI) is a devastating injury to the central nervous system in which 60 to 80% of patients experience chronic pain. Unfortunately, this pain is notoriously difficult to treat, with few effective options currently available. Patients are also commonly faced with various compounding injuries and medical challenges, often requiring frequent hospitalization and antibiotic treatment. Change in the gut microbiome from the "normal" state to one of imbalance, referred to as gut dysbiosis, has been found in both patients and rodent models following SCI. Similarities exist in the bacterial changes observed after SCI and other diseases with chronic pain as an outcome. These changes cause a shift in the regulation of inflammation, causing immune cell activation and secretion of inflammatory mediators that likely contribute to the generation/maintenance of SCI pain. Therefore, correcting gut dysbiosis may be used as a tool towards providing patients with effective pain management and improved quality of life.
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Affiliation(s)
- Courtney A. Bannerman
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
| | - Katya Douchant
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
- Gastrointestinal Disease Research Unit, Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - Prameet M. Sheth
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
- Department of Pathology and Molecular Medicine, Queen’s University, Kingston, Ontario, Canada
- Division of Microbiology, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Gastrointestinal Disease Research Unit, Kingston Health Sciences Center, Kingston, Ontario, Canada
| | - Nader Ghasemlou
- Department of Biomedical and Molecular Sciences, Queen’s University, Kingston, Ontario, Canada
- Department of Anesthesiology and Perioperative Medicine, Kingston Health Sciences Centre, Kingston, Ontario, Canada
- Centre for Neuroscience Studies, Queen’s University, Kingston, Ontario, Canada
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20
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Liu X, Liang F, Zhang J, Li Z, Yang J, Kang N. Hyperbaric Oxygen Treatment Improves Intestinal Barrier Function After Spinal Cord Injury in Rats. Front Neurol 2020; 11:563281. [PMID: 33178107 PMCID: PMC7593681 DOI: 10.3389/fneur.2020.563281] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 08/31/2020] [Indexed: 11/13/2022] Open
Abstract
Intestinal barrier dysfunction is often observed clinically after spinal cord injury (SCI) and seriously affects long-term quality of life. Hyperbaric oxygen (HBO) treatment has been proved to promote barrier function recovery after injury, but the influence of HBO on intestinal barrier function following SCI is unclear. We aimed to investigate the effect and mechanisms of HBO treatment on intestinal barrier function by measuring the level of tight junction (TJ) proteins and the Ras homolog (Rho)/Rho-associated coiled-coil forming protein kinase (ROCK) signaling pathway. SCI model was established in rats, and the animals were randomly assigned into three groups: sham-operation group (SH), SCI group and SCI+HBO group. In the SCI+HBO group, the rats inhaled 100% O2 for 1 h at 2.0 atmospheres absolute pressure (ATA) once per day after surgery. Neurological function and intestinal permeability were assessed after surgery, and the jejunum tissue was excised for histological and intestinal barrier function evaluations. The protein levels of TJ and the Rho/ROCK signaling pathway were also measured. The results showed that in the SCI group, intestinal mucosal injury score, intestinal permeability, and levels of Rho and ROCK1 were higher, and TJ proteins occludin and ZO-1 were lower than those in the SH group (P < 0.01). HBO treatment significantly inhibited the expression of Rho and ROCK1, increased occludin and ZO-1 expression, decreased intestinal permeability, and alleviated intestinal mucosal injury as compared with the SCI group (P < 0.05, P < 0.01). The SCI+HBO group showed higher Basso-Beattie-Bresnahan (BBB) scores relative to the SCI group on postoperative days 7 and 14 (P < 0.01). There was a significant negative correlation between BBB score and intestinal mucosal injury score in rats after HBO treatment (P < 0.05). We concluded from this study that HBO treatment promoted the expression of TJ proteins possibly through inhibiting Rho/ROCK signaling pathway, which protected the intestinal barrier function and improved the intestinal permeability after SCI in rats.
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Affiliation(s)
- Xuehua Liu
- Department of Hyperbaric Oxygen Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Fang Liang
- Department of Hyperbaric Oxygen Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Zhang
- Department of Hyperbaric Oxygen Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Zhuo Li
- Department of Hyperbaric Oxygen Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Jing Yang
- Department of Hyperbaric Oxygen Medicine, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Nan Kang
- Department of Orthopedic Surgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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21
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Guilcher SJT, Hogan ME, Guan Q, McCormack D, Calzavara A, Patel T, Hitzig SL, Packer T, Lofters AK. Prevalence of Prescribed Opioid Claims Among Persons With Traumatic Spinal Cord Injury in Ontario, Canada: A Population-Based Retrospective Cohort Study. Arch Phys Med Rehabil 2020; 102:35-43. [PMID: 32891422 DOI: 10.1016/j.apmr.2020.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine prescription opioid claims among individuals with traumatic spinal cord injury (SCI) and to identify factors associated with both chronic opioid and chronic high-dose opioid use. DESIGN Retrospective cohort study using population-level administrative data. SETTING Ontario, Canada. PARTICIPANTS Individuals (N=1842) with traumatic SCI between April 1, 2004 and March 31, 2015. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Proportion of cohort with chronic opioid use (≥90d supply) and proportion with chronic high-dose opioid use (≥90d supply exceeding 90 mg morphine equivalent) between April 1, 2016 and March 31, 2017 (observation period). RESULTS A total of 1842 individuals with traumatic SCI were identified (74% men), with a median age of 51 years (interquartile range [IQR], 34-64y) and median duration of injury of 6 years (IQR, 4-9y). During the observation period, 35% were dispensed at least 1 opioid and 19.8% received chronic opioids, 39% of whom received more than 90 mg daily (chronic high dose). The median daily morphine equivalent dose was 212 mg morphine equivalent (IQR, 135.5-345.3 mg) for chronic high-dose users. Significant risk factors for chronic opioid use were male sex; age between 40 and 60 years; lower income; multimorbidity; thoracic, lumbar, or sacral level of injury; and having a previous diagnosis of osteoarthritis. Risk factors for chronic high-dose opioid use were an extended time since injury, age between 40 and 50 years, and increasing comorbidity. CONCLUSIONS A large proportion of individuals with traumatic SCI were dispensed an opioid in a recent 1-year period. A substantial proportion were dispensed more than 90 mg of morphine equivalents, which is the maximum recommended by the Canadian opioid guideline. Further research is needed to understand the risk factors associated with chronic, high-dose opioid use in this population.
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Affiliation(s)
- Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Mary-Ellen Hogan
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Qi Guan
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Tejal Patel
- University of Waterloo School of Pharmacy, Waterloo, Ontario, Canada; Schlegel - University of Waterloo Research Institute of Aging, Waterloo, Ontario, Canada; Waterloo Institute for Complexity and Innovation, Waterloo, Ontario, Canada
| | - Sander L Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tanya Packer
- Schools of Occupational Therapy and Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rehabilitation, Radboud Medical University, Nijmegen, The Netherlands
| | - Aisha K Lofters
- ICES, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada
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Guilcher SJT, Hogan ME, McCormack D, Calzavara AJ, Hitzig SL, Patel T, Packer T, Guan Q, Lofters AK. Prescription medications dispensed following a nontraumatic spinal cord dysfunction: a retrospective population-based study in Ontario, Canada. Spinal Cord 2020; 59:132-140. [PMID: 32665709 DOI: 10.1038/s41393-020-0511-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/19/2020] [Accepted: 06/22/2020] [Indexed: 01/05/2023]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To examine the prevalence of polypharmacy for individuals with nontraumatic spinal cord dysfunction (NTSCD) following inpatient rehabilitation and to determine associated risk factors. SETTING Ontario, Canada. METHODS Administrative data housed at ICES, Toronto, Ontario were used. Between 2004 and 2015, we investigated prescription medications dispensed over a 1-year period for persons following an NTSCD-related inpatient rehabilitation admission. Descriptive and analytical statistics were conducted. Using a robust Poisson multivariable regression model, relative risks related to polypharmacy (ten or more drug classes) were calculated. Main independent variables were sex, age, income quintile, and continuity of care with outpatient physician visits. RESULTS We identified 3468 persons with NTSCD during the observation window. The mean number of drug classes taken post-inpatient rehabilitation was 11.7 (SD = 6.0), with 4.0 different prescribers (SD = 2.5) and 1.8 unique pharmacies (SD = 1.0). Significant predictors for post-discharge polypharmacy were: being female, lower income, higher comorbidities prior to admission, lower Functional Independence Measure at discharge, previous number of medication classes dispensed in year prior to admission, and lower continuity of care with outpatient physician visits. The most common drugs dispensed post-inpatient rehabilitation were antihypertensives (70.0%), laxatives (61.6%), opioids (59.5%), and antibiotics (57.8%). CONCLUSION Similar to previous research with traumatic spinal cord injury, our results indicate that polypharmacy is prevalent among persons with NTSCD. Additional research examining medication therapy management for NTSCD is suggested.
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Affiliation(s)
- Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada. .,ICES, Toronto, ON, Canada. .,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada. .,Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.
| | - Mary-Ellen Hogan
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | | | | | - Sander L Hitzig
- Faculty of Medicine, Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Tejal Patel
- Schlegel-University of Waterloo Research Institute of Aging, Waterloo, ON, Canada.,Waterloo Institute for Complexity and Innovation, Waterloo, ON, Canada.,University of Waterloo School of Pharmacy, Kitchener, ON, Canada
| | - Tanya Packer
- Schools of Occupational Therapy and Health Administration, Dalhousie University, Halifax, NS, Canada.,Department of Rehabilitation, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Qi Guan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Aisha K Lofters
- ICES, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.,Women's College Research Institute, Toronto, ON, Canada
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Herrera J, Bockhorst K, Bhattarai D, Uray K. Gastrointestinal vascular permeability changes following spinal cord injury. Neurogastroenterol Motil 2020; 32:e13834. [PMID: 32163655 DOI: 10.1111/nmo.13834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 02/06/2020] [Accepted: 02/18/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Gastrointestinal (GI) dysfunction is observed clinically after spinal cord injury (SCI) and contributes to the diminished long-term quality of life. Our study examined the acute and chronic GI vascular changes that occur following SCI. We demonstrated that the GI vascular tract in SCI mice becomes compromised during the acute phase of injury and persists into the chronic phase of injury. METHODS Gastrointestinal vasculature permeability was measured using dynamic contrast-enhanced magnetic resonance imaging (DCE MRI) at 48 hours, and 2 and 4 weeks following contusion spinal cord injury. Angiopoietin-1, a vascular stabilizing protein, was administered intravenously following injury. Intestinal contractile activity assessments were performed following the last imaging session. KEY RESULTS Our results indicated that a single administration of Ang-1 reduced vascular permeability at 48 hours but the effect was only transient. However, when the treatment paradigm was changed from a single administration to multiple administrations of Ang-1 following contusion injury, our DCE MRI data indicated a significant decrease in GI vascular permeability 4 weeks after injury compared with vehicle control treated animals. This improved GI vascular permeability was associated with improved sustained intestinal contractile activity. We also demonstrated that Ang-1 reduced the expression of sICAM-1 in the ileum compared with the saline-treated group. CONCLUSIONS AND INFERENCES We show that the GI vasculature is compromised in the acute and chronic phase of injury following spinal contusion. Our results also indicate that multiple administrations of Ang-1 can attenuate GI vascular permeability, possibly reduce inflammation, and improve sustained agonist-induced contraction compared with saline treatment.
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Affiliation(s)
- Juan Herrera
- Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Kurt Bockhorst
- Diagnostic and Interventional Imaging, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Deepa Bhattarai
- Pediatric Surgery University of Texas Medical School at Houston, Houston, Texas, USA
| | - Karen Uray
- Pediatric Surgery University of Texas Medical School at Houston, Houston, Texas, USA.,Medicinal Chemistry, University of Debrecen, Debrecen, Hungary
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Soopramanien A, Jamwal S, Thomas PW. Digital Health Rehabilitation Can Improve Access to Care in Spinal Cord Injury in the UK: A Proposed Solution. Int J Telerehabil 2020; 12:3-16. [PMID: 32983365 PMCID: PMC7502813 DOI: 10.5195/ijt.2020.6312] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Lack of specialist beds, inadequate finance and shortage of skilled staff make it difficult for Spinal Cord Injury Centres (SCICs) in the United Kingdom (UK) to admit all newly injured individuals. Length of stay of those admitted can be too brief. At discharge, follow-up care is sparse and inadequate. We therefore propose that specialist spinal units redefine their roles and act as catalysts to build capacity by enhancing expertise in the wider community. SCICs can devolve certain tasks locally to less specialised units with their support, training, and guidance. This Commentary further proposes that use of Digital Health Technologies, (i.e., to deploy telemedicine, telehealth, and telerehabilitation), can enhance rehabilitation opportunities. The authors set-forth their vision for a comprehensive web portal that will serve as a primary resource for evidence-based practice, information on guidelines, care pathways, and protocols of SCI management. At any stage during the acute management of SCI and following discharge, rehabilitation specialists could conduct remote consultation with persons with SCI and acute care specialists via the web portal, allowing timely access to specialist input and better clinical outcomes. The proposed portal would also provide information, advice and support to persons with SCI and their family members. The strategic use of digital health technologies has been shown to result in cost and time savings and increase positive outcomes.
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Affiliation(s)
- Anbananden Soopramanien
- Centre of Postgraduate Medical Research and Education, Bournemouth University, Bournemouth, United Kingdom
| | - Shiva Jamwal
- National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, UK
| | - Peter W Thomas
- Department of Medical Sciences and Public Health, Bournemouth University, United Kingdom
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Legg M, Foster M, Parekh S, Nielsen M, Jones R, Kendall E, Fleming J, Geraghty T. Trajectories of Rehabilitation across Complex Environments (TRaCE): design and baseline characteristics for a prospective cohort study on spinal cord injury and acquired brain injury. BMC Health Serv Res 2019; 19:700. [PMID: 31615532 PMCID: PMC6794776 DOI: 10.1186/s12913-019-4564-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 09/26/2019] [Indexed: 11/21/2022] Open
Abstract
PURPOSE Trajectories of Rehabilitation across Complex Environments (TRaCE), a consented prospective cohort study, addresses a critical need to better understand access to the healthcare system after acute treatment and specialist inpatient rehabilitation for acquired disability. It is expected that this study will produce new knowledge on access to healthcare through the linkage of administrative, survey, and spatial datasets on the one cohort. This paper outlines the study design and baseline characteristics of the cohort. METHODS The TRaCE cohort is comprised of 165 inpatients who are currently being followed up for 12 months after discharge from specialist rehabilitation for acquired brain injury (ABI) and spinal cord injury (SCI). This project combines a data linkage framework on health service use with a prospective survey on psychosocial wellbeing, geographical information systems to examine spatial accessibility to services, and qualitative interviews with a sub-cohort on experiences of service access. CONCLUSION Ultimately, TRaCE will have strong translational impact on strategies for more targeted interventions to improve the healthcare system and support individuals with acquired disabilities in the long-term.
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Affiliation(s)
- Melissa Legg
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Michele Foster
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Sanjoti Parekh
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Mandy Nielsen
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Rachel Jones
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Elizabeth Kendall
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University and the Division of Rehabilitation, Metro South Health Hospital and Health Service, 199 Ipswich Road, Woolloongabba, Brisbane, Queensland 4102 Australia
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Holmes GM, Blanke EN. Gastrointestinal dysfunction after spinal cord injury. Exp Neurol 2019; 320:113009. [PMID: 31299180 PMCID: PMC6716787 DOI: 10.1016/j.expneurol.2019.113009] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 06/13/2019] [Accepted: 07/07/2019] [Indexed: 12/12/2022]
Abstract
The gastrointestinal tract of vertebrates is a heterogeneous organ system innervated to varying degrees by a local enteric neural network as well as extrinsic parasympathetic and sympathetic neural circuits located along the brainstem and spinal axis. This diverse organ system serves to regulate the secretory and propulsive reflexes integral to the digestion and absorption of nutrients. The quasi-segmental distribution of the neural circuits innervating the gastrointestinal (GI) tract produces varying degrees of dysfunction depending upon the level of spinal cord injury (SCI). At all levels of SCI, GI dysfunction frequently presents life-long challenges to individuals coping with injury. Growing attention to the profound changes that occur across the entire physiology of individuals with SCI reveals profound knowledge gaps in our understanding of the temporal dimensions and magnitude of organ-specific co-morbidities following SCI. It is essential to understand and identify these broad pathophysiological changes in order to develop appropriate evidence-based strategies for management by clinicians, caregivers and individuals living with SCI. This review summarizes the neurophysiology of the GI tract in the uninjured state and the pathophysiology associated with the systemic effects of SCI.
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Affiliation(s)
- Gregory M Holmes
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, PA 17033, United states of America.
| | - Emily N Blanke
- Department of Neural and Behavioral Sciences, Penn State University College of Medicine, Hershey, PA 17033, United states of America
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Rowan CP, Chan BCF, Jaglal SB, Catharine Craven B. Describing the current state of post-rehabilitation health system surveillance in Ontario - an invited review. J Spinal Cord Med 2019; 42:21-33. [PMID: 31573448 PMCID: PMC6781471 DOI: 10.1080/10790268.2019.1605724] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Context: Spinal cord injury (SCI) presents numerous physiological, psychosocial, and environmental complexities resulting in significant healthcare system resource demands. Objective: To describe the current health system surveillance mechanisms in Ontario, Canada and highlight gaps in health surveillance among adults with SCI across their lifespan. Methods: A review of administrative data sources capturing SCI-specific information took place via internet searching and networking among SCI rehabilitation and health services experts with emphasis on functionality, health service utilization, and quality of life data. Results: The review identified a distinct paucity of data elements specific to the health surveillance needs of individuals with SCI living in the community. The gaps identified are: (1) a lack of data usability; (2) inadequate linkage between available datasets; (3) inadequate/infrequent reporting of outcomes; (4) a lack of relevant content/patient-reported outcomes; and, (5) failure to incorporate additional data sources (e.g. Insurance datasets). Conclusion: Currently, SCI-specific health data is disproportionately weighted towards the first 3-6 months post injury with detailed data regarding pre-hospital care, acute management and rehabilitation, but little existing infrastructure supporting community-based health surveillance. Given this reality, the bolstering of meaningful community health surveillance of this population across the lifespan is needed. Addressing the identified gaps in health surveillance must inform the creation of a comprehensive community health dataset incorporating patient-reported outcome measures and enabling linkage with existing administrative and/or clinical databases. A future harmonized data surveillance strategy would, in turn, positively impact function, health services, resource utilization and health-related quality of life surveillance.
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Affiliation(s)
- Chip P. Rowan
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Correspondence to: Chip P. Rowan, Research Department, KITE, Toronto Rehab — University Health Network, Lyndhurst Centre, 520 Sutherland Dr, Toronto, Ontario, Canada M4G 3V9; Ph: 416-597-3422 x6217.
| | - Brian C. F. Chan
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Susan B. Jaglal
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE, Toronto Rehab — University Health Network, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Jorge A, White MD, Agarwal N. Outcomes in socioeconomically disadvantaged patients with spinal cord injury: a systematic review. J Neurosurg Spine 2019; 29:680-686. [PMID: 30265226 DOI: 10.3171/2018.5.spine171242] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Accepted: 05/15/2018] [Indexed: 11/06/2022]
Abstract
OBJECTIVEIndividuals with a spinal cord injury (SCI) in socioeconomically disadvantaged settings (e.g., rural or low income) have different outcomes than their counterparts; however, a contemporary literature review identifying and measuring these outcomes has not been published. Here, the authors' aim was to perform a systematic review and identify these parameters in the hope of providing tangible targets for future clinical research efforts.METHODSA systematic review was performed to find English-language articles published from 2007 to 2017 in the PubMed/MEDLINE, EMBASE, and SCOPUS databases. Studies evaluating any outcomes related to patients with an SCI and in a low-resource setting were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and a flowchart was created. Of the 403 articles found, 31 underwent complete review and 26 were eligible for study inclusion. According to the current study criteria, any case studies, studies in less developed countries, studies including and not separating other types of neurological disorders, studies not assessing the effects of a low-resource setting on outcomes in patients with SCI, and studies evaluating the causes of SCI in a low-resource setting were excluded.RESULTSIn SCI patients, a lower income was a predictor of death (OR 2.1, 95% CI 1.7-2.6, p = 0.0002). Moreover, secondary outcomes such as pain intensities (OR 3.32, 95% CI 2.21-4.49, p < 0.001), emergency room visits (11% more likely, p = 0.006), and pressure ulcer formation (OR 2.1, 95% CI 1.5-3.0, p < 0.001) were significantly higher in the lower income brackets. Rurality was also a factor and was significantly associated with increased emergency room visits (OR 1.5, 95% CI 1.1-2.1, p = 0.01) and lower outpatient service utilization (incidence rate ratio [IRR] 0.57, 95% CI 0.35-0.93, p < 0.05).CONCLUSIONSThe authors showed that individuals in a low-resource setting who have suffered an SCI have significantly different outcomes than their counterparts. These specific outcomes are promising targets for future research efforts that focus on improving health conditions among this population.
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Abstract
BACKGROUND The current study involves a national survey of healthcare providers who offer services for individuals with a variety of neurological conditions. It aims to describe the provision of health and community-based services as well as the admission criteria, waitlist practices, and referral sources of these services. METHODS An online survey was directed at administrators/managers from publicly funded hospital programs, long-term care homes, and community-based healthcare provider agencies that were believed to be providing information and/or services to patients with a variety of neurological conditions. RESULTS Approximately 60% (n=254) of respondents reported providing services in either urban/suburban areas or rural/remote areas only, whereas the remaining 40% (n=172) provided services regardless of patient location. A small proportion of respondents reported providing services for individuals with dystonia (28%), Tourette syndrome (17%), and Rett syndrome (13%). There was also a paucity of diverse healthcare professionals across all institutions, but particularly mental healthcare professionals in hospitals. Lastly, the majority of respondents reported numerous exclusion criteria with regard to service provision, including prevalent comorbid conditions. CONCLUSIONS If the few services provided for these neurological patient populations exclude common comorbidities, it is likely that there will be no other place for these individuals to seek care.
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Sikka S, Callender L, Driver S, Bennett M, Reynolds M, Hamilton R, Warren AM, Petrey L. Healthcare utilization following spinal cord injury: Objective findings from a regional hospital registry. J Spinal Cord Med 2019; 42:194-200. [PMID: 30277845 PMCID: PMC6419654 DOI: 10.1080/10790268.2018.1505330] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The purpose was to describe the prevalence and characteristics of healthcare utilization among individuals with spinal cord injury (SCI) from a Level I trauma center. DESIGN Retrospective data analysis utilizing a local acute trauma registry for initial hospitalization and merged with the Dallas-Fort Worth Hospital Council registry to obtain subsequent health care utilization in the first post-injury year. SETTING Dallas, TX, USA. PARTICIPANTS Six hundred and sixty four patients were admitted with an acute traumatic SCI from January 2003 through June 2014 to a Level I trauma center. Fifty five patients that expired during initial hospitalization and 18 patients with unspecified SCI (defined by ICD-9 with no etiology or level of injury specified) were not included in the analysis, leaving a final sample of 591. OUTCOME MEASURES Data included demographic and clinical characteristics, charges, and healthcare utilization. RESULTS Mean age was 46.1 years (±18.9 years), the majority of patients were male (74%), and Caucasian (58%). Of the 591 patients, 345 (58%) had additional inpatient or emergency healthcare utilization accounting for 769 additional visits (median of 3 visits per person). Of the 769 encounters, 534 (69%) were inpatient and 235 (31%) were emergency visits not resulting in an admission. The most prevalent ICD-9 codes listed were pressure ulcer, neurogenic bowel, neurogenic bladder, urinary tract infection, fluid electrolyte imbalance, hypertension, and tobacco use. CONCLUSION Individuals with SCI experience high levels of healthcare utilization which are costly and may be preventable. Increasing our understanding of the prevalence and causes for healthcare utilization after acute SCI is important to target preventive strategies.
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Affiliation(s)
- Seema Sikka
- a Physical Medicine & Rehabilitation , Baylor Institute for Rehabilitation , Dallas , Texas , USA
| | - Librada Callender
- a Physical Medicine & Rehabilitation , Baylor Institute for Rehabilitation , Dallas , Texas , USA
| | - Simon Driver
- a Physical Medicine & Rehabilitation , Baylor Institute for Rehabilitation , Dallas , Texas , USA
| | - Monica Bennett
- b Department of Trauma , Baylor University Medical Center , Dallas , Texas , USA
| | - Megan Reynolds
- a Physical Medicine & Rehabilitation , Baylor Institute for Rehabilitation , Dallas , Texas , USA.,b Department of Trauma , Baylor University Medical Center , Dallas , Texas , USA
| | - Rita Hamilton
- a Physical Medicine & Rehabilitation , Baylor Institute for Rehabilitation , Dallas , Texas , USA
| | - Ann Marie Warren
- b Department of Trauma , Baylor University Medical Center , Dallas , Texas , USA
| | - Laura Petrey
- b Department of Trauma , Baylor University Medical Center , Dallas , Texas , USA
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White AR, Holmes GM. Investigating neurogenic bowel in experimental spinal cord injury: where to begin? Neural Regen Res 2019; 14:222-226. [PMID: 30531001 PMCID: PMC6301179 DOI: 10.4103/1673-5374.244779] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/04/2018] [Indexed: 12/11/2022] Open
Abstract
The devastating losses following traumatic spinal cord injury (SCI) encompass the motor, sensory and autonomic nervous systems. Neurogenic bowel is a slow transit colonic dysfunction marked by constipation, rectal evacuation difficulties, decreased anorectal sensation, fecal incontinence or some combination thereof. Furthermore, neurogenic bowel is one of the most prevalent comorbidities of SCI and is recognized by afflicted individuals and caregivers as a lifelong physical and psychological challenge that profoundly affects quality of life. The restoration of post-injury control of movement has received considerable scientific scrutiny yet the daily necessity of voiding the bowel and bladder remains critically under-investigated. Subsequently, physicians and caregivers are rarely presented with consistent, evidence-based strategies to successfully address the consequences of dysregulated voiding reflexes. Neurogenic bowel is commonly believed to result from the interruption of the supraspinal control of the spinal autonomic circuits regulating the colon. In this mini-review, we discuss the clinical challenges presented by neurogenic bowel and emerging pre-clinical evidence that is revealing that SCI also initiates functional remodeling of the colonic wall concurrent with a decrease in local enteric neurons. Since the enteric input to the colonic smooth muscle is the final common pathway for functional contractions of the colon, changes to the neuromuscular interface must first be understood in order to maximize the efficacy of therapeutic interventions targeting colonic dysfunction following SCI.
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Affiliation(s)
- Amanda R. White
- Department of Neural & Behavioral Sciences, Penn State University College of Medicine, Hershey, PA, USA
| | - Gregory M. Holmes
- Department of Neural & Behavioral Sciences, Penn State University College of Medicine, Hershey, PA, USA
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Huang D, Slocum C, Silver JK, Morgan JW, Goldstein R, Zafonte R, Schneider JC. Functional status predicts acute care readmission in the traumatic spinal cord injury population. J Spinal Cord Med 2019; 42:20-31. [PMID: 29596035 PMCID: PMC6340280 DOI: 10.1080/10790268.2018.1453436] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
CONTEXT/OBJECTIVE Acute care readmission has been identified as an important marker of healthcare quality. Most previous models assessing risk prediction of readmission incorporate variables for medical comorbidity. We hypothesized that functional status is a more robust predictor of readmission in the spinal cord injury population than medical comorbidities. DESIGN Retrospective cross-sectional analysis. SETTING Inpatient rehabilitation facilities, Uniform Data System for Medical Rehabilitation data from 2002 to 2012. PARTICIPANTS traumatic spinal cord injury patients. OUTCOME MEASURES A logistic regression model for predicting acute care readmission based on demographic variables and functional status (Functional Model) was compared with models incorporating demographics, functional status, and medical comorbidities (Functional-Plus) or models including demographics and medical comorbidities (Demographic-Comorbidity). The primary outcomes were 3- and 30-day readmission, and the primary measure of model performance was the c-statistic. RESULTS There were a total of 68,395 patients with 1,469 (2.15%) readmitted at 3 days and 7,081 (10.35%) readmitted at 30 days. The c-statistics for the Functional Model were 0.703 and 0.654 for 3 and 30 days. The Functional Model outperformed Demographic-Comorbidity models at 3 days (c-statistic difference: 0.066-0.096) and outperformed two of the three Demographic-Comorbidity models at 30 days (c-statistic difference: 0.029-0.056). The Functional-Plus models exhibited negligible improvements (0.002-0.010) in model performance compared to the Functional models. CONCLUSION Readmissions are used as a marker of hospital performance. Function-based readmission models in the spinal cord injury population outperform models incorporating medical comorbidities. Readmission risk models for this population would benefit from the inclusion of functional status.
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Affiliation(s)
- Donna Huang
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA,Correspondence to: Donna Huang, MD, Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, 300 First Ave, Charlestown, MA02129, USA; Ph: 404-667-1138.
| | - Chloe Slocum
- Commonwealth Fund Mongan Fellow, Harvard Medical School, Harvard T.H. Chan School of Public Health, Department of Health Policy and Management, Spaulding Rehabilitation Hospital, Department of Physical Medicine and Rehabilitation, Massachusetts, USA
| | - Julie K. Silver
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - James W. Morgan
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - Richard Goldstein
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
| | - Jeffrey C. Schneider
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Massachusetts, USA
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DiMarco AF, Geertman RT, Tabbaa K, Polito RR, Kowalski KE. Economic Consequences of an Implanted Neuroprosthesis in Subjects with Spinal Cord Injury for Restoration of an Effective Cough. Top Spinal Cord Inj Rehabil 2018; 23:271-278. [PMID: 29339903 DOI: 10.1310/sci2303-271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To determine if an implanted neuroprosthesis for restoration of an effective cough is less costly than conventional methods of respiratory management. Methods: Nonrandomized clinical trial of participants (N = 14) with spinal cord injury (SCI) using the Cough Stimulator device in the inpatient hospital setting for Cough Stimulator implantation and outpatient hospital or residence for follow-up. A neuroprosthesis was implanted for restoration of an effective cough. The annual costs associated with respiratory management, without (pre implantation) and with (post implantation) the neuroprosthesis, were examined over a 4-year period. Results: The total cost related to implantation of the Cough Stimulator was $59,891, with no maintenance costs over subsequent years. The incidence of respiratory tract infections and the need for caregiver support fell significantly following implantation. The costs associated with respiratory tract infections fell significantly from a mean of $36,406 ± 11,855/year to $13,284 ± 7,035/year (p < .05) pre and post implantation, respectively. Costs fell further to $8,817 ± 5,990 and $4,467 ± 4,404 following the 2nd and 3rd years post implantation (p < .05), respectively. The costs associated with caregiver support fell significantly from $25,312 ± 8,019/year to $2,630 ± 2,233/year (p < .05) pre and post implantation, respectively, and remained low in subsequent years (p < .05). Other costs related to secretion management fell significantly and remained low in subsequent years (p < .05). Break-even analysis demonstrated that this point was reached in the first year. Conclusion: The results of this investigation demonstrate that implantation and use of the Cough Stimulator resulted in significant reductions in the overall costs of respiratory management in this patient population.
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Affiliation(s)
- Anthony F DiMarco
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University.,MetroHealth Research Institute, Case Western Reserve University
| | | | - Kutaiba Tabbaa
- Department of Anesthesiology, Case Western Reserve University
| | | | - Krzysztof E Kowalski
- Department of Medicine, Case Western Reserve University.,MetroHealth Research Institute, Case Western Reserve University.,Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
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Mitchell R, Harvey L, Stanford R, Close J. Health outcomes and costs of acute traumatic spinal injury in New South Wales, Australia. Spine J 2018; 18:1172-1179. [PMID: 29155343 DOI: 10.1016/j.spinee.2017.11.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2017] [Revised: 10/31/2017] [Accepted: 11/09/2017] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Traumatic spinal injuries are often associated with both long-term disability, higher frequency of hospital readmissions, and high medical costs for individuals of all ages. Age differences in terms of injury profile and health outcomes among those who sustain a spinal cord injury have been identified. However, factors that may influence health outcomes among those with a spinal injury have not been extensively examined at a population level. PURPOSE The present study aims to describe the characteristics of traumatic spinal injury, identify factors predictive of mortality, and estimate the cost of hospital treatment for younger and older people. STUDY DESIGN/SETTING This is a population-based retrospective epidemiological study using linked hospitalization and mortality records during January 1, 2010 to June 30, 2014 in New South Wales, Australia. PATIENT SAMPLE The present study included 13,429 hospitalizations. OUTCOME MEASURES Mortality within 30 and 90 days of hospitalization, hospital length of stay (LOS), and hospitalization costs were determined. METHODS Hospitalizations with a principal diagnosis of spinal cord injury or spinal fractures were used to identify traumatic spinal injuries. Age-standardized incidence rates were calculated and negative binomial regression was used to examine statistical significant changes over time. Cox proportional hazard regression was used to examine the effect of risk factors on survival at 90 days. RESULTS There were 13,429 hospitalizations, with 52.4% of individuals aged ≥65 years. The hospitalization rates for individuals aged ≤64 and ≥65 years were both estimated to significantly increase per year by 3.3% (95% confidence interval [CI] 0.97-5.79, p<.006) and 3.3% (95% CI 1.02-5.71, p=.005), respectively. For individuals aged ≥65 years, there were a higher proportion of women injured, comorbid conditions, injuries after a fall in the home or aged care facility, a longer hospital LOS, unplanned hospital admissions, and deaths than individual aged ≤64 years. The average cost per index hospitalization was AUD$23,808 for individuals aged ≤64 years and AUD$31,187 for individuals aged ≥65 years with a total estimated cost of AUD$371 million. Mortality risk at 90 days was increased for individuals who had one or more comorbidities, a higher injury severity score, and if their injury occurred in the home or an aged care facility. CONCLUSIONS Spinal injury represents a substantial cost and results in debilitating injuries, particularly for older individuals. Spinal injury prevention efforts for older people should focus on the implementation of fall injury prevention, whereas for younger individuals, prevention measures should target road safety.
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Affiliation(s)
- Rebecca Mitchell
- Australian Institute of Health Innovation, Macquarie University, Level 6, 75 Talavera Road, NSW, 2109, Australia.
| | - Lara Harvey
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Barker St, Randwick, 2031, NSW Australia
| | - Ralph Stanford
- Department of Orthopaedic Surgery, Prince of Wales Hospital, Barker Street, Randwick, 2031, NSW Australia
| | - Jacqueline Close
- Falls, Balance and Injury Research Centre, Neuroscience Research Australia, UNSW, Barker St, Randwick, 2031, NSW Australia; Prince of Wales Clinical School, UNSW, Barker Street, Randwick, 2013, NSW, Australia
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O'Connor G, Jeffrey E, Madorma D, Marcillo A, Abreu MT, Deo SK, Dietrich WD, Daunert S. Investigation of Microbiota Alterations and Intestinal Inflammation Post-Spinal Cord Injury in Rat Model. J Neurotrauma 2018; 35:2159-2166. [PMID: 29566601 DOI: 10.1089/neu.2017.5349] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Although there has been a significant amount of research focused on the pathophysiology of spinal cord injury (SCI), there is limited information on the consequences of SCI on remote organs. SCI can produce significant effects on a variety of organ systems, including the gastrointestinal tract. Patients with SCI often suffer from severe, debilitating bowel dysfunction in addition to their physical disabilities, which is of major concern for these individuals because of the adverse impact on their quality of life. Herein, we report on our investigation into the effects of SCI and subsequent antibiotic treatment on the intestinal tissue and microbiota. For that, we used a thoracic SCI rat model and investigated changes to the microbiota, proinflammatory cytokine levels, and bacterial communication molecule levels post-injury and gentamicin treatment for 7 days. We discovered significant changes, the most interesting being the differences in the gut microbiota beta diversity of 8-week SCI animals compared to control animals at the family, genus, and species level. Specifically, 35 operational taxonomic units were enriched in the SCI animal group and three were identified at species level; Lactobacillus intestinalis, Clostridium disporicum, and Bifidobacterium choerinum. In contrast, Clostridium saccharogumia was identified as depleted in the SCI animal group. Proinflammatory cytokines interleukin (IL)-12, macrophage inflammatory protein-2 (MIP-2), and tumor necrosis factor alpha were found to be significantly elevated in intestinal tissue homogenate 4 weeks post-SCI compared to 8-weeks post-injury. Further, levels of IL-1β, IL-12, and MIP-2 significantly correlated with changes in beta diversity 8-weeks post-SCI. Our data provide a greater understanding of the early effects of SCI on the microbiota and gastrointestinal tract, highlighting the need for further investigation to elucidate the mechanism underlying these effects.
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Affiliation(s)
- Gregory O'Connor
- 1 Department of Biochemistry and Molecular Biology, University of Miami , Miller School of Medicine, Miami, Florida
| | - Elisabeth Jeffrey
- 1 Department of Biochemistry and Molecular Biology, University of Miami , Miller School of Medicine, Miami, Florida
| | - Derik Madorma
- 1 Department of Biochemistry and Molecular Biology, University of Miami , Miller School of Medicine, Miami, Florida
| | - Alexander Marcillo
- 2 Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami , Miller School of Medicine, Miami, Florida
| | - Maria T Abreu
- 3 Division of Gastroenterology, University of Miami , Miller School of Medicine, Miami, Florida
| | - Sapna K Deo
- 1 Department of Biochemistry and Molecular Biology, University of Miami , Miller School of Medicine, Miami, Florida
| | - W Dalton Dietrich
- 2 Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami , Miller School of Medicine, Miami, Florida
| | - Sylvia Daunert
- 1 Department of Biochemistry and Molecular Biology, University of Miami , Miller School of Medicine, Miami, Florida
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Le Fort M, Espagnacq M, Albert T, Lefèvre C, Perrouin-Verbe B, Ravaud JF. Risk of pressure ulcers in tetraplegic people: a French survey crossing regional experience with a long-term follow-up. Eur J Public Health 2018; 28:993-999. [DOI: 10.1093/eurpub/cky084] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Affiliation(s)
- Marc Le Fort
- EHESP, High School of Public Health - MSSH, House of Social Sciences and Disability, Rennes Cedex, France
- Neurological Physical Medicine and Rehabilitation Department, University Hospital – Hôpital Saint-Jacques, Nantes Cedex 01, France
| | - Maude Espagnacq
- IRDES – Institute for Research and Documentation in Health Economics, Paris, France
| | | | - Chloë Lefèvre
- Neurological Physical Medicine and Rehabilitation Department, University Hospital – Hôpital Saint-Jacques, Nantes Cedex 01, France
| | - Brigitte Perrouin-Verbe
- Neurological Physical Medicine and Rehabilitation Department, University Hospital – Hôpital Saint-Jacques, Nantes Cedex 01, France
| | - Jean-François Ravaud
- EHESP, High School of Public Health - MSSH, House of Social Sciences and Disability, Rennes Cedex, France
- CERMES3, INSERM, CNRS, EHESS, Université Paris Descartes, Villejuif, France
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Milligan J, Lee J, Hillier LM, Slonim K, Craven C. Improving primary care for persons with spinal cord injury: Development of a toolkit to guide care. J Spinal Cord Med 2018; 43:364-373. [PMID: 29733260 PMCID: PMC7241547 DOI: 10.1080/10790268.2018.1468584] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
OBJECTIVE To identify a set of essential components for primary care for patients with spinal cord injury (SCI) for inclusion in a point-of-practice toolkit for primary care practitioners (PCP) and identification of the essential elements of SCI care that are required in primary care and those that should be the focus of specialist care. DESIGN Modified Delphi consensus process; survey methodology. SETTING Primary care. PARTICIPANTS Three family physicians, six specialist physicians, and five inter-disciplinary health professionals completed surveys. OUTCOME MEASURES Importance of care elements for inclusion in the toolkit (9-point scale: 1 = lowest level of importance, 9 = greatest level of importance) and identification of most responsible physician (family physician, specialist) for completing key categories of care. Open-ended comments were solicited. RESULTS There was consensus between the respondent groups on the level of importance of various care elements. Mean importance scores were highest for autonomic dysreflexia, pain, and skin care and lowest for preventive care, social issues, and vital signs. Although, there was agreement across all respondents that family physicians should assume responsibility for assessing mental health, there was variability in who should be responsible for other care categories. Comments were related to the need for shared care approaches and capacity building and lack of knowledge and specialized equipment as barriers to optimal care. CONCLUSION This study identified important components of SCI care to be included in a point-of-practice toolkit to facilitate primary care for persons with SCI.
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Affiliation(s)
- James Milligan
- Centre for Family Medicine, Kitchener, Ontario, Canada,Correspondence to: Dr. James Milligan, Centre for Family Medicine, 10B Victoria Street South, Kitchener, ON, Canada, N2G 1C5; Ph: (519) 783-0022; Fax: (519) 783-0031.
| | - Joseph Lee
- Centre for Family Medicine, Kitchener, Ontario, Canada
| | - Loretta M. Hillier
- Geriatric Education and Research in Aging Sciences (GERAS), Hamilton, Ontario, Canada
| | - Karen Slonim
- Centre for Family Medicine, Kitchener, Ontario, Canada
| | - Catharine Craven
- Toronto Rehabilitation Institute, Lyndhurst Centre, University Health Network, Toronto, Ontario, Canada
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Allin S, Shepherd J, Tomasone J, Munce S, Linassi G, Hossain SN, Jaglal S. Participatory Design of an Online Self-Management Tool for Users With Spinal Cord Injury: Qualitative Study. JMIR Rehabil Assist Technol 2018; 5:e6. [PMID: 29563075 PMCID: PMC5885063 DOI: 10.2196/rehab.8158] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 11/15/2017] [Accepted: 01/06/2018] [Indexed: 11/13/2022] Open
Abstract
Background Rehospitalization rates resulting from secondary conditions in persons with spinal cord injuries (SCI) are high. Self-management programs for many chronic conditions have been associated with decreases in hospital readmissions. However, in the SCI community, evidence suggests that satisfaction with traditional self-management programs is low. Users with SCI have indicated preference for programs that are online (rather than in-person), that target SCI-specific concerns, and are led by peers with SCI. There is currently no program with all of these features, which addresses self-management of secondary conditions after SCI. Objective The aim of this study was to provide details of a participatory design (PD) process for an internet-mediated self-management program for users with SCI (called SCI & U) and illustrate how it has been used to define design constraints and solutions. Methods Users were involved in development as codesigners, codevelopers, and key informants. Codesigners and codevelopers were recruited from consumer advocacy groups and worked with a core development team. Key informants were recruited from geographically distributed advocacy groups to form a product advisory council that met regularly with the core team. During meetings, codesigners and informants walked through stages of work that typify PD processes such as exploration, discovery, and prototyping. This paper details the process by analyzing 10 meetings that took place between August 2015 and May 2016. Meetings were recorded, transcribed, and subjected to an inductive thematic analysis; resulting themes were organized according to their relationship to PD stages. Results A total of 16 individuals participated in meeting discussions, including 7 researchers and 9 persons with SCI from 4 Canadian provinces. Themes of trust, expertise, and community emerged in every group discussion. The exploration stage revealed interest in online self-management resources coupled with concerns about information credibility. In general, participants indicated that they felt more confident with information received from trusted, in-person sources (eg, peers or health care professionals) than information found online. The discovery stage saw participants propose and discuss concepts to filter credible information and highlight community expertise, namely (1) a community-curated resource database, (2) online information navigators, and (3) group chats with peers. Several tools and techniques were collectively prototyped in an effort to foster trust and community; these are illustrated in the Results section. Conclusions A PD process engaging users as codesigners, codevelopers, and informants can be used to identify design concerns and prototype online solutions to promote self-management after SCI. Future work will assess the usability of the collectively designed tools among a broad population of Canadians with SCI and the tools’ impact on self-efficacy and health.
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Affiliation(s)
- Sonya Allin
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - John Shepherd
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Jennifer Tomasone
- School of Kinesiology and Health Studies, Queen's University, Kingston, ON, Canada
| | - Sarah Munce
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Gary Linassi
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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van Diemen T, Crul T, van Nes I, Geertzen JH, Post MW. Associations Between Self-Efficacy and Secondary Health Conditions in People Living With Spinal Cord Injury: A Systematic Review and Meta-Analysis. Arch Phys Med Rehabil 2017; 98:2566-2577. [DOI: 10.1016/j.apmr.2017.03.024] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/23/2017] [Accepted: 03/30/2017] [Indexed: 01/13/2023]
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Munakomi S, Bhattarai B, Cherian I. Prospective observational research on the clinical profile and outcome analysis among a cohort of patients sustaining traumatic cervical spine and cord injury in a peripheral tertiary spine care centre in Nepal. F1000Res 2017; 6:1957. [PMID: 29250317 PMCID: PMC5701450 DOI: 10.12688/f1000research.12911.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/24/2017] [Indexed: 11/20/2022] Open
Abstract
Background: In developing nations like Nepal, spinal cord injury has multispectral consequences for both the patient and their family members. It has the tendency to cripple and handicap the patients, and burn out their caretakers, both physically and mentally. Furthermore, the centralization of health care with only a handful of dedicated rehabilitation centers throughout Nepal further places patients into disarray. This study was carried out as a pilot study to determine the modes of injury, age groups affected, clinical profiles and patterns of injury sustained, as well as the efficacy of managing a subset of patients, who have sustained cervical spine and cord injuries. Methods: This was a prospective cohort study comprising of 163 patients enrolled over a period of three years that were managed in the spine unit of College of Medical Sciences, Bharatpur, Nepal. Results: Road traffic accidents were implicated in 51% of these patients. 65% of them were in the age group of 30-39 years. Traumatic subluxation occurred in 73 patients with maximum involvement of the C4/5 region (28.76%). Good outcome was seen in patients with ASIA ‘C’ and ‘D’ with 55% of patients showed improvement from ‘C’ to ‘D’ and 95% of patients showed improvement from ‘D’ to ‘E’ at 1 year follow up. The overall mortality in the patients undergoing operative interventions was only 1.98%. Conclusions: The prevalence of cervical spine injuries in the outreach area is still significant. The outcome of managing these patients, even in the context of a resource limited setup in a spine unit outside the capital city of a developing nation, can be as equally as effective and efficient compared to the outcome from a well-equipped and dedicated spine unit elsewhere.
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Affiliation(s)
- Sunil Munakomi
- Department of Neurosurgery, College of Medical Sciences, Chitwan, Bharatpur, 44207, Nepal
| | - Binod Bhattarai
- Department of Neurosurgery, College of Medical Sciences, Chitwan, Bharatpur, 44207, Nepal
| | - Iype Cherian
- Department of Neurosurgery, College of Medical Sciences, Chitwan, Bharatpur, 44207, Nepal
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Munce SE, Allin S, Wolfe DL, Anzai K, Linassi G, Noonan VK, Jaglal SB. Using the theoretical domains framework to guide the development of a self-management program for individuals with spinal cord injury: Results from a national stakeholder advisory group. J Spinal Cord Med 2017; 40:687-695. [PMID: 28758540 PMCID: PMC5778932 DOI: 10.1080/10790268.2017.1356437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVE To determine the implementation considerations for a targeted self-management program for individuals with spinal cord injury (SCI) from the perspective of a national stakeholder advisory group using the Theoretical Domains Framework (TDF) as a guide. DESIGN Qualitative descriptive approach. SETTING Two focus groups held at the 6th National Spinal Cord Injury Conference (October 2-4th, 2014) in Toronto, Ontario, Canada. PARTICIPANTS A total of 25 stakeholders from across Canada participated in focus groups or "brainstorming sessions". The stakeholders included 5 clinicians, 14 researchers, 3 policy makers, and 3 individuals with SCI. INTERVENTIONS Not applicable. OUTCOME MEASURES Not applicable. RESULTS All 14 theoretical domains were identified in the brainstorming sessions. No new themes or domains were identified. The need to consider the theoretical domains of Knowledge, Skills, Reinforcement, Intentions, Goals (e.g. the readiness of the individual with SCI), Environmental Context and Resources (e.g. considerations for governance and ownership of the program and a business model for sustainability), as well as Social Influences (e.g. issues of privacy and security in the context of on-line delivery) was identified. CONCLUSIONS The current study provides complementary results to our previous series of studies on the implementation considerations for the development of a targeted self-management program for individuals with SCI by emphasizing the health care professional/health policy perspective. It is anticipated that such a program could not only reduce secondary complications and subsequent inappropriate health care use but it may also improve the quality of life for individuals with SCI and their caregivers.
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Affiliation(s)
- Sarah E.P. Munce
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada,Correspondence to: Sarah EP Munce, Toronto Rehabilitation Institute-University Health Network, 550 University Avenue, Toronto, Ontario, M5G 2A2, Canada.
| | - Sonya Allin
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Dalton L. Wolfe
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada
| | - Karen Anzai
- GF Strong Rehabilitation Centre, Vancouver Coastal Health, Vancouver, BC, Canada
| | - Gary Linassi
- Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | | | - Susan B. Jaglal
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Cheng CL, Plashkes T, Shen T, Fallah N, Humphreys S, O'Connell C, Linassi AG, Ho C, Short C, Ethans K, Charbonneau R, Paquet J, Noonan VK. Does Specialized Inpatient Rehabilitation Affect Whether or Not People with Traumatic Spinal Cord Injury Return Home? J Neurotrauma 2017; 34:2867-2876. [DOI: 10.1089/neu.2016.4930] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Tova Plashkes
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Tian Shen
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Nader Fallah
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | | | - Colleen O'Connell
- Physical Medicine and Rehabilitation, Dalhousie University, Fredericton, New Brunswick, Canada
| | - A. Gary Linassi
- Physical Medicine and Rehabilitation, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Chester Ho
- Division of Physical Medicine and Rehabilitation, Department of Clinical Neurosciences, University of Calgary, Foothills Hospital, Calgary, Alberta, Canada
| | - Christine Short
- Department of Medicine, Dalhousie University, Nova Scotia Rehabilitation Centre, Halifax, Nova Scotia, Canada
| | - Karen Ethans
- Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Rebecca Charbonneau
- Glenrose Rehabilitation Hospital, University of Alberta, Edmonton, Alberta, Canada
| | - Jérôme Paquet
- Neurosurgery, CHU de Québec; Department of Surgery, Université Laval, Québec, Canada
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Ahn H, Lewis R, Santos A, Cheng CL, Noonan VK, Dvorak MF, Singh A, Linassi AG, Christie S, Goytan M, Atkins D. Forecasting Financial Resources for Future Traumatic Spinal Cord Injury Care Using Simulation Modeling. J Neurotrauma 2017; 34:2917-2923. [PMID: 28594315 PMCID: PMC5653147 DOI: 10.1089/neu.2016.4936] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Survivors of traumatic spinal cord injury (tSCI) have intense healthcare needs during acute and rehabilitation care and often through the rest of life. To prepare for a growing and aging population, simulation modeling was used to forecast the change in healthcare financial resources and long-term patient outcomes between 2012 and 2032. The model was developed with data from acute and rehabilitation care facilities across Canada participating in the Access to Care and Timing project. Future population and tSCI incidence for 2012 and 2032 were predicted with data from Statistics Canada and the Canadian Institute for Health Information. The projected tSCI incidence for 2012 was validated with actual data from the Rick Hansen SCI Registry of the participating facilities. Using a medium growth scenario, in 2032, the projected median age of persons with tSCI is 57 and persons 61 and older will account for 46% of injuries. Admissions to acute and rehabilitation facilities in 2032 were projected to increase by 31% and 25%, respectively. Because of the demographic shift to an older population, an increase in total population life expectancy with tSCI of 13% was observed despite a 22% increase in total life years lost to tSCI between 2012 and 2032. Care cost increased 54%, and rest of life cost increased 37% in 2032, translating to an additional CAD $16.4 million. With the demographics and management of tSCI changing with an aging population, accurate projections for the increased demand on resources will be critical for decision makers when planning the delivery of healthcare after tSCI.
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Affiliation(s)
- Henry Ahn
- 1 University of Toronto Spine Program , Toronto, Ontario, Canada
| | - Rachel Lewis
- 2 Centre for Operations Excellence, Sauder School of Business, University of British Columbia , Vancouver, British Columbia, Canada
| | - Argelio Santos
- 3 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | | | | | - Marcel F Dvorak
- 4 Department of Orthopaedics, University of British Columbia , Vancouver, British Columbia, Canada
| | - Anoushka Singh
- 5 SCI Clinical Research Unit, Toronto Western Hospital , Toronto, Ontario, Canada
| | - A Gary Linassi
- 6 Department of Physical Medicine and Rehabilitation, University of Saskatchewan , Saskatoon, Saskatchewan, Canada
| | - Sean Christie
- 7 Research Division of Neurosurgery, Dalhousie University , Halifax, Nova Scotia, Canada
| | - Michael Goytan
- 8 Sections of Orthopedics and Neurosurgery, University of Manitoba , Winnipeg, Manitoba, Canada
| | - Derek Atkins
- 9 Operations and Logistics Division, Sauder School of Business, University of British Columbia , Vancouver, British Columbia, Canada
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Braaf SC, Lennox A, Nunn A, Gabbe BJ. Experiences of hospital readmission and receiving formal carer services following spinal cord injury: a qualitative study to identify needs. Disabil Rehabil 2017; 40:1893-1899. [DOI: 10.1080/09638288.2017.1313910] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Sandra C. Braaf
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Alyse Lennox
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Hospital, Heidelberg, Victoria, Australia
| | - Belinda J. Gabbe
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- The Farr Institute, Swansea University Medical School, Swansea University, Singleton Park, Swansea, United Kingdom
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LaVela SL, Heinemann AW, Etingen B, Miskovic A, Locatelli SM, Chen D. Relational empathy and holistic care in persons with spinal cord injuries. J Spinal Cord Med 2017; 40:30-42. [PMID: 26833180 PMCID: PMC5376142 DOI: 10.1080/10790268.2015.1114227] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE Describe perceptions of persons with SCI on their receipt of holistic care and relational empathy during health care encounters. DESIGN Mailed survey. PARTICIPANTS/SETTING Individuals with SCI who received care from the largest suppliers of SCI care and rehabilitation (Veterans Health Administration and SCI Model Systems). OUTCOME MEASURES Using a survey and administrative databases, we collected demographic and injury characteristics, health status, health conditions, and the main outcome: Consultation and Relational Empathy (CARE) measure. RESULTS The sample included 450 individuals with SCI (124 Veterans and 326 civilians). Response rate was 39% (450/1160). Analyses were conducted on patients with complete data (n = 389). Veterans and civilians with SCI differed across many demographic characteristics, age at injury, and etiology, but mean CARE scores were equivalent. Fewer than half of the full SCI cohort had CARE scores above the normative value of 43. Having a recent pressure ulcer showed a trend for lower odds of having a normative or higher CARE score. Odds of having an above-normative CARE score were nearly 2 times greater for individuals with tetraplegia, and odds were higher for those with higher physical and mental health status. CONCLUSIONS Higher physical and mental health status and tetraplegia were each independently associated with greater perceptions of holistic care and empathy in the therapeutic patient-provider relationship. Limited empathy, communication, and holistic care may arise when providers focus on disease/disease management, rather than on patients as individuals. Frequent health care use and secondary conditions may affect empathy and holistic care in encounters, making it essential to understand and employ efforts to improve the therapeutic relationship between patients with SCI and their providers.
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Affiliation(s)
- Sherri L. LaVela
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA
- Center for Healthcare Studies, Institute for Public Health and Medicine, General Internal Medicine and Geriatrics, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Allen W. Heinemann
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL, USA
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Bella Etingen
- Department of Veterans Affairs (VA), Spinal Cord Injury Quality Enhancement Research Initiative (SCI QUERI), Edward Hines Jr. VA Hospital, Hines, IL, USA
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Ana Miskovic
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Sara M. Locatelli
- Center of Innovation for Complex Chronic Healthcare, Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - David Chen
- Department of Physical Medicine & Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Rehabilitation Institute of Chicago, Chicago, IL, USA
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Bell N, Kidanie T, Cai B, Krause JS. Geographic Variation in Outpatient Health Care Service Utilization After Spinal Cord Injury. Arch Phys Med Rehabil 2016; 98:341-346. [PMID: 27984029 DOI: 10.1016/j.apmr.2016.09.130] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/24/2016] [Accepted: 09/26/2016] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To assess whether travel distances between patients and providers predict the frequency in which outpatient health care services are accessed after spinal cord injury (SCI). DESIGN A retrospective cohort study was carried out in South Carolina among employee health plan and Medicaid insurance recipients. SETTING Research center. PARTICIPANTS Two years of outpatient claimant data were evaluated from patients (N=243) aged ≥18 years who were hospitalized between 2010 and 2012. INTERVENTIONS Travel distances were estimated by geocoding provider and patient address information onto street network files. MAIN OUTCOME MEASURES Variation in service utilization use was assessed using negative binomial regression. Outpatient visits for physical medicine and rehabilitation, physician and specialty clinic, radiology, internal medicine, behavioral mental health, and "other" were evaluated. RESULTS Longer travel distances were statistically significant predictors of decreased physician/specialty clinic (relative risk [RR]=.87; 95% confidence interval [CI], .79-.96) and physiotherapy (RR=.57; 95% CI, .46-.71) utilization, with mixed findings for other providers. Secondary analyses in which differences in service use were analyzed using census-defined classifications of urban and rural status did not demonstrate any geographic pattern. CONCLUSIONS There are significant geographic variations in the use of select outpatient services among SCI populations across the state that are related to longer travel distances. That these patterns were only visible when using travel distance models as opposed to census-based classifications of urban and rural status adds support to augmenting routine data collection and surveillance with spatial analytical models.
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Affiliation(s)
- Nathaniel Bell
- College of Nursing, University of South Carolina, Columbia, SC.
| | - Tsion Kidanie
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
| | - Bo Cai
- Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC
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Saunders LL, Murday D, Corley B, Cao Y, Krause JS. Comparison of Rates of Hospitalization and Emergency Department Visits Using Self-Report and South Carolina Administrative Billing Data Among a Population-Based Cohort With Spinal Cord Injury. Arch Phys Med Rehabil 2016; 97:1481-1486. [DOI: 10.1016/j.apmr.2016.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 10/21/2022]
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Gabbe BJ, Nunn A. Profile and costs of secondary conditions resulting in emergency department presentations and readmission to hospital following traumatic spinal cord injury. Injury 2016; 47:1847-55. [PMID: 27343134 DOI: 10.1016/j.injury.2016.06.012] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/04/2016] [Accepted: 06/06/2016] [Indexed: 02/02/2023]
Abstract
INTRODUCTION People with traumatic spinal cord injury (SCI) face complex challenges in their care, recovery and life. Secondary conditions can develop to involve many body systems and can impact health, function, quality of life, and community participation. These secondary conditions can be costly, and many are preventable. The aim of this study was to describe the type and direct costs of secondary conditions requiring readmission to hospital, or visit to an emergency department (ED), within the first two years following traumatic spinal cord injury (SCI). METHODS A retrospective cohort study using population-level linked data from hospital ED and admission datasets was undertaken in Victoria, Australia. The incidence and direct treatment costs of readmission to hospital and ED visit within 2-years post-injury for secondary conditions related to SCI were measured for the 356 persons with traumatic SCI with a date of injury from 2008 to 2011. RESULTS Of the 356 cases, 141 (40%) experienced 366 (median 2, range 1-11) readmissions to hospital for secondary conditions. 95 (27%) visited an ED at least once, within two years of injury for a secondary condition. The cost of hospital readmissions was AUD$5,553,004 and AUD$87,790 for ED visits. The mean±SD cost was AUD$15,172±$20,957 per readmission and AUD$670±$198 per ED visit. Urological conditions (e.g. urinary tract infection) were most common, followed by pressure areas/ulcers for readmissions, and fractures in the ED. CONCLUSIONS Hospitalisation for complications within two years of traumatic SCI was common and costly in Victoria, Australia. Improved bladder and pressure area management could result in substantial morbidity and cost savings following SCI.
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Affiliation(s)
- Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia; Farr Institute-CIPHER, Swansea University Medical School, Swansea University, Swansea, United Kingdom.
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Heidelberg, Australia
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49
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McMillan C, Lee J, Milligan J, Hillier LM, Bauman C. Physician perspectives on care of individuals with severe mobility impairments in primary care in Southwestern Ontario, Canada. HEALTH & SOCIAL CARE IN THE COMMUNITY 2016; 24:463-472. [PMID: 25809600 DOI: 10.1111/hsc.12228] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 02/04/2015] [Indexed: 06/04/2023]
Abstract
Despite the high health risks associated with severe mobility impairments, individuals with physical disabilities are less likely to receive the same level of primary care as able-bodied persons. This study explores family physicians' perspectives on primary care for individuals with mobility impairments to identify and better understand the challenges that prevent equitable service delivery to this group of patients. Semi-structured interviews were conducted in the autumn of 2012 with a purposeful sample of 20 family physicians practising in Southwestern Ontario to gather their perspectives of the personal and professional barriers to healthcare delivery for individuals with mobility impairments, including perceptions of challenges, contributing reasons and possible improvements. A thematic analysis was conducted on the transcripts generated from the interviews to identify perceptions of existing barriers and gaps in care, needs and existing opportunities for improving primary care for this patient population. Eight themes emerged from the interviews that contributed to understanding the perceived challenges of providing care to patients with mobility impairments: transportation barriers, knowledge gaps and practice constraints resulting in episodic care rather than preventive care, incongruence between perceived and actual accessibility to care, emergency departments used as centres for primary care, inattention to mobility issues among specialist and community services, lack of easily accessible practice tools, low patient volumes impact decision-making regarding building decreased motivation to expand clinical capacity due to low patient volume, and lastly, remuneration issues. Despite this patient population presenting with high healthcare needs and significant barriers and care gaps in primary care, low prevalence rates negatively impact the acquisition of necessary equipment and knowledge required to optimally care for these patients in typical primary care settings. Novel approaches to address inequitable healthcare practices for this vulnerable group are needed.
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Affiliation(s)
- Colleen McMillan
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- Renison College, University of Waterloo, Waterloo, Ontario, Canada
| | - Joseph Lee
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - James Milligan
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Loretta M Hillier
- Specialized Geriatric Services, St. Joseph's Health Care London, London, Ontario, Canada
- Aging, Rehabilitation & Geriatric Care Research Centre, London, Ontario, Canada
| | - Craig Bauman
- Centre for Family Medicine Family Health Team, Kitchener, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Welk B, Liu K, Shariff SZ. The use of urologic investigations among patients with traumatic spinal cord injuries. Res Rep Urol 2016; 8:27-34. [PMID: 26955621 PMCID: PMC4768889 DOI: 10.2147/rru.s99840] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective To assess the use of urologic investigations among traumatic spinal cord injury (TSCI) patients. Methods This is a retrospective cohort study from Ontario, Canada. We included all adult TSCI patients injured between 2002 and 2012. The primary outcome was the frequency of urodynamic testing, renal imaging, and cystoscopy. Primary exposure was the year of injury. The impact of age, sex, comorbidity, socioeconomic status, and lesion level was assessed with Cox regression models. Results One thousand five hundred and fifty one incident TSCI patients were discharged from a rehabilitation hospital. The median follow-up time of this cohort was 5.0 years (interquartile range =2.9–7.5). At least one urodynamics, renal imaging, or cystoscopy was performed during follow-up for 50%, 80%, and 48% of the cohort, respectively. The overall rate of these tests was 0.22, 0.60, and 0.22 per person-year of follow-up. The proportion of patients who had regular, yearly urodynamics (<2%), renal imaging (6%), or cystoscopy (<2%) was low. There were no significant linear trends in the use of these tests over the 10-year study period. Urodynamics were significantly less likely to be performed in patients over 65 years of age (hazard ratio [HR] =0.63, P<0.01) and those with a higher level of comorbidity (HR =0.72, P<0.01). Patients with quadriplegia were significantly less likely to receive any of the investigations compared to those with paraplegia. Conclusion Renal imaging is done at least once for the majority of patients with TSCI; however, only half undergo urodynamics or cystoscopy. Few patients have regular urologic testing. The reality of urologic testing after TSCI is very different from urologist’s ideals and practice guidelines.
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Affiliation(s)
- Blayne Welk
- Department of Surgery and Epidemiology and Biostatistics, Western University, ON, Canada; Institute for Clinical Evaluative Sciences - Western (ICES Western), London, ON, Canada
| | - Kuan Liu
- Institute for Clinical Evaluative Sciences - Western (ICES Western), London, ON, Canada
| | - Salimah Z Shariff
- Institute for Clinical Evaluative Sciences - Western (ICES Western), London, ON, Canada
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