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Fernández-Canosa S, Brocalero-Camacho A, Martínez-Medina A, Díez-Rodríguez E, Arias P, Oliviero A, Soto-León V. Fatigue insights from walking tests in spinal cord injury and multiple sclerosis individuals. Sci Rep 2024; 14:4761. [PMID: 38413793 PMCID: PMC10899186 DOI: 10.1038/s41598-024-55238-8] [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: 06/28/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
In the last decade, fatigue in clinical populations has been re-conceptualized, including dimensions such as perceived fatigue (trait and state fatigue) and fatigability. The aim of this study was to evaluate different expressions of fatigue in Spinal Cord Injury (SCI) and Multiple Sclerosis (MS) participants compared to able-bodied controls, during activities of daily living, especially during gait. A total of 67 participants were included in this study (23 with SCI, 23 with MS, and 21 able-bodied controls). All participants performed two functional tests (6-Minute Walk Test and 10-Meter Walk Test) and they completed the Fatigue Severity Scale (FSS). The rate of trait fatigue was different between groups, with MS participants showing the highest rate. Moreover, scores on functional tests and state fatigue were different between groups after the tests. Our results indicate that trait fatigue and state fatigue in individuals with SCI and MS are different with respect to able-bodied population. Both SCI and MS groups experienced more trait fatigue than control group in daily life. In addition, walking tasks produced similar levels of state fatigue between healthy people and patients with MS/SCI. However, these tests induced longer-lasting levels of state fatigue in the patients.
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Affiliation(s)
| | | | | | - Eva Díez-Rodríguez
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45004, Toledo, Spain
| | - Pablo Arias
- Department of Physiotherapy, Medicine and Biomedical Sciences and INEF Galicia, NEUROcom (Neuroscience and Motor Control Group) and Biomedical Institute of A Coruña (INIBIC), Universidade da Coruña, 15179, A Coruña, Spain
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45004, Toledo, Spain.
- Advanced Rehabilitation Unit, Hospital Los Madroños, 28690, Brunete, Spain.
| | - Vanesa Soto-León
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, 45004, Toledo, Spain.
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Onate-Figuérez A, Avendaño-Coy J, Fernández-Canosa S, Soto-León V, López-Molina MI, Oliviero A. Factors Associated With Fatigue in People With Spinal Cord Injury: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2023; 104:132-142. [PMID: 35964699 DOI: 10.1016/j.apmr.2022.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 07/13/2022] [Accepted: 07/25/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To investigate the association between fatigue and clinical and demographic variables in people with spinal cord injury (SCI). DATA SOURCES Five databases (MEDLINE, Physiotherapy Evidence Database, Cochrane, Google Scholar, Cumulative Index to Nursing and Allied Health) were searched up to November 2021. STUDY SELECTION Observational studies that reported the association between fatigue and clinical and demographic variables in English or Spanish were eligible. Reviews, qualitative research studies, and nonoriginal articles were excluded. Twenty-three of the 782 identified studies met the inclusion criteria for the meta-analysis. DATA EXTRACTION Two researchers independently extracted the data. The strength of the association between each factor and fatigue was determined by the effect size. When the results of the effect size were expressed with different statistics, the correlation coefficient was the preferred estimation. The risk of bias was assessed using the Appraisal Tool for Cross-Sectional Studies and the Newcastle-Ottawa Scale. DATA SUMMARY A pooled analysis of the associations between fatigue and 17 factors was performed. A direct association was found between fatigue and 9 factors (sorted by effect size): anxiety (r=0.57; 95% CI, 0.29-0.75), stress (r=0.54; 95% confidence interval [CI], 0.26-0.74), depression (r=0.47; 95% CI, 0.44-0.50), pain (r=0.34; 95% CI, 0.16-0.50), analgesic medication (r=0.32; 95% CI, 0.28-0.36), assistive devices (r=0.23; 95% CI, 0.17-0.29), lesion level (r=0.15; 95% CI, 0.07-0.23), incomplete SCI (r=0.13; 95% CI, 0.05-0.22), and medication (r=0.12; 95% CI, 0.01-0.23). An inverse association was found with 3 factors (sorted by effect size): self-efficacy (r=-0.63; 95% CI, -0.81 to -0.35), participation (r=-0.32; 95% CI, -0.58 to -0.001), and physical activity (r=-0.17; 95% CI, -0.28 to -0.05). No association was found with age, sex, educational level, time since injury, and spasticity. CONCLUSIONS Several factors were associated with fatigue in people with SCI, with those related to mental health showing the strongest associations. These results should be interpreted with caution because of the high heterogeneity observed in some factors.
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Affiliation(s)
- Ana Onate-Figuérez
- FENNSI Group, National Hospital for Paraplegics, SESCAM, Spain; GIFTO Group, Faculty of Physiotherapy and Nursing, Universidad de Castilla La Mancha (UCLM), Toledo; National Hospital for Paraplegics, SESCAM, Toledo, Spain
| | - Juan Avendaño-Coy
- GIFTO Group, Faculty of Physiotherapy and Nursing, Universidad de Castilla La Mancha (UCLM), Toledo.
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Onate-Figuérez A, Soto-León V, Avendaño-Coy J, Mordillo-Mateos L, Pérez-Borrego YA, Redondo-Galán C, Arias P, Oliviero A. Hand Motor Fatigability Induced by a Simple Isometric Task in Spinal Cord Injury. J Clin Med 2022; 11:jcm11175108. [PMID: 36079035 PMCID: PMC9457081 DOI: 10.3390/jcm11175108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Revised: 08/22/2022] [Accepted: 08/28/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed: (1) to evaluate the hand motor fatigability in people with spinal cord injury (SCI) and compare it with measurements obtained form an able-bodied population; (2) to compare the hand motor fatigability in people with tetraplegia and in people with paraplegia; and (3) to analyse if motor fatigability is different in people with SCI with and without clinical significant perceived fatigability. Materials and Methods: 96 participants with SCI (40 cervical and 56 thoracolumbar) and 63 able-bodied controls performed a simple hand isometric task to assess motor fatigability. The Fatigue Severity Scale was used for perceived fatigability evaluation. Results: The main results of this study can be summarized as follows: (1) the waning in muscle force (motor fatigability) during a fatiguing task is similar in controls and participants with SCI; (2) the motor fatigability is influenced by the maximal muscle force (measured at the beginning of the task); and (3) the perceived fatigability and the motor fatigability are largely independent in the individuals with SCI. Conclusion: Our findings suggest that the capability to maintain a prolonged effort is preserved in SCI, and this capacity depends on the residual maximal muscle force in people with SCI.
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Affiliation(s)
- Ana Onate-Figuérez
- FENNSI Group, National Hospital for Paraplegics, SESCAM, 45071 Toledo, Spain
- Department of Physiotherapy, Universidad de Castilla La Mancha, 45071 Toledo, Spain
- GIFTO Group, Faculty of Physiotherapy and Nursing, Universidad de Castilla La Mancha (UCLM), 45071 Toledo, Spain
| | - Vanesa Soto-León
- FENNSI Group, National Hospital for Paraplegics, SESCAM, 45071 Toledo, Spain
| | - Juan Avendaño-Coy
- Department of Physiotherapy, Universidad de Castilla La Mancha, 45071 Toledo, Spain
- GIFTO Group, Faculty of Physiotherapy and Nursing, Universidad de Castilla La Mancha (UCLM), 45071 Toledo, Spain
- Correspondence: (J.A.-C.); (A.O.)
| | - Laura Mordillo-Mateos
- FENNSI Group, National Hospital for Paraplegics, SESCAM, 45071 Toledo, Spain
- Department of Physiotherapy, Universidad de Castilla La Mancha, 45071 Toledo, Spain
| | | | - Carolina Redondo-Galán
- Rehabilitation Department, National Hospital for Paraplegics, SESCAM, 45071 Toledo, Spain
| | - Pablo Arias
- Universidade da Coruña, NEUROcom (Neuroscience and Motor Control Group), Department of Physiotherapy, Medicine and Biomedical Sciences-INEF Galicia, 15001 A Coruña, Spain
- Biomedical Institute of A Coruña (INIBIC), 15001 A Coruña, Spain
| | - Antonio Oliviero
- FENNSI Group, National Hospital for Paraplegics, SESCAM, 45071 Toledo, Spain
- Advanced Rehabilitation Unit, Hospital Los Madroños, 28690 Brunete, Spain
- Correspondence: (J.A.-C.); (A.O.)
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Lawrason SVC, Todd KR, Shaw RB, Martin Ginis KA. Physical activity among individuals with spinal cord injury who ambulate: a systematic scoping review. Spinal Cord 2020; 58:735-745. [DOI: 10.1038/s41393-020-0460-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/27/2022]
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Thibaudier Y, Tan AQ, Peters DM, Trumbower RD. Differential deficits in spatial and temporal interlimb coordination during walking in persons with incomplete spinal cord injury. Gait Posture 2020; 75:121-128. [PMID: 31675554 PMCID: PMC6883355 DOI: 10.1016/j.gaitpost.2019.10.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 09/10/2019] [Accepted: 10/14/2019] [Indexed: 02/02/2023]
Abstract
BACKGROUND Returning to community walking remains a major challenge for persons with incomplete spinal cord injury (iSCI) due, in part, to impaired interlimb coordination. Here, we examined spatial and temporal features of interlimb coordination during walking and their associations to gait deficits in persons with chronic iSCI. RESEARCH QUESTION Do deficits in spatial and temporal interlimb coordination correspond differentially to clinical indicators of walking performance in persons with iSCI? METHODS Sixteen persons with chronic iSCI and eleven able-bodied individuals participated in this study. Participants walked at self-selected gait speeds along an instrumented walkway that recorded left and right step lengths and times. We quantified interlimb coordination in terms of normalized differences between left and right step lengths (spatial asymmetry index) and step times (temporal asymmetry index), as well as, gap and phase coordination indices. We then assessed the extent to which these indices independently associated with clinical measures of walking performance. RESULTS Participants with iSCI demonstrated greater spatial and temporal asymmetry, as well as, reduced gap and phase interlimb coordination as compared to age-matched controls (p < 0.001). We found no linear relationships between spatial and temporal asymmetry indices (p > 0.05) or between gap and phase coordination indices (p > 0.05). Spatial and temporal asymmetry indices weakly correlated with SCI-FAI composite scores (r2 = 0.26; p = 0.04). However, only spatial asymmetry indices strongly correlated with slower walking speed (r2 = 0.51; p < 0.002). We also found participants who used a hand-held assistive device (walker) demonstrated great spatial asymmetry as compared to those who did not (p < 0.03). SIGNIFICANCE Differential impairments in spatial and temporal interlimb coordination correspond to overground walking deficits in persons with chronic iSCI. Spatial asymmetry associated with decreased walking speed and increased reliance on hand-held assistive devices. Gait training methods that target well-defined space and time domains of interlimb coordination may enhance overground gait training in persons with iSCI.
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Affiliation(s)
| | | | - Denise M. Peters
- Department of Rehabilitation and Movement Science, University of Vermont
| | - Randy D. Trumbower
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital
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McDonald SD, Mickens MN, Goldberg-Looney LD, Mutchler BJ, Ellwood MS, Castillo TA. Mental disorder prevalence among U.S. Department of Veterans Affairs outpatients with spinal cord injuries. J Spinal Cord Med 2018; 41:691-702. [PMID: 28287932 PMCID: PMC6217469 DOI: 10.1080/10790268.2017.1293868] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Depression and other mental disorders are more prevalent among individuals living with spinal cord injury (SCI) than in the community at large, and have a strong association with quality of life. Yet little is known about the prevalence and predictors of mental disorders among U.S. military Veterans living with SCI. The primary aim of this study was to present an estimate of mental disorder point prevalence in this population. The secondary aim was to examine the relationship of mental disorders to demographics, injury characteristics, and other clinically relevant features such as impairment from mental health problems and life satisfaction. DESIGN Cross-sectional. SETTING A SCI & Disorders Center at a U.S. Veterans Affairs Medical Center. PARTICIPANTS/METHODS Administrative and medical records of 280 Veterans who attended annual comprehensive SCI evaluations were evaluated. Demographics, injury characteristics, self-reported mental and emotional functioning (i.e. SF-8 Health Survey), and clinician-determined mental disorder diagnoses were attained. RESULTS Overall, 40% of patients received at least one mental disorder diagnosis, most commonly depressive disorders (19%), posttraumatic stress disorder (12%), and substance or alcohol use disorders (11%). Several patient characteristics predicted mental disorders, including age, racial minority identity, non-traumatic SCI etiology, and incomplete (i.e. AIS D) vs. complete injury. Mental disorders were associated with greater impairment from health and mental health-related problems and less satisfaction with life. CONCLUSIONS Mental disorders are common among outpatients receiving VA specialty care for SCI. These findings highlight the importance of having adequate and effective available mental health services available for Veterans with SCI.
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Affiliation(s)
- Scott D. McDonald
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Melody N. Mickens
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | | | - Brian J. Mutchler
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Michael S. Ellwood
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Teodoro A. Castillo
- Hunter Holmes McGuire VA Medical Center, Richmond, Virginia, USA
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
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Cudeiro-Blanco J, Onate-Figuérez A, Soto-León V, Avendaño-Coy J, Mordillo-Mateos L, Brocalero-Camacho A, Esclarin-Ruz A, Rotondi M, Aguilar J, Arias P, Oliviero A. Prevalence of Fatigue and Associated Factors in a Spinal Cord Injury Population: Data from an Internet-Based and Face-to-Face Surveys. J Neurotrauma 2017; 34:2335-2341. [DOI: 10.1089/neu.2016.4950] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
| | - Ana Onate-Figuérez
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
- GIFTO Group, E.U. de Enfermia y Fisioterapia de Toledo, Universidad de Castilla La Mancha, Toledo, Spain
| | - Vanesa Soto-León
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Juan Avendaño-Coy
- GIFTO Group, E.U. de Enfermia y Fisioterapia de Toledo, Universidad de Castilla La Mancha, Toledo, Spain
| | | | | | - Ana Esclarin-Ruz
- Rehabilitation Department, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Mario Rotondi
- Unit of Internal Medicine and Endocrinology, ICS-Maugeri I.R.C.C.S., Laboratory for Endocrine Disruptors and University of Pavia, Pavia, Italy
| | - Juan Aguilar
- Experimental Neurophysiology Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
| | - Pablo Arias
- NEUROcom. Neuroscience and Motor Control Group, Department of Medicine-INEF-INIBIC, University of Coruña, Coruña, Spain
| | - Antonio Oliviero
- FENNSI Group, Hospital Nacional de Parapléjicos, SESCAM, Toledo, Spain
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Menon N, Gupta A, Khanna M, Taly AB, Thennarasu K. Prevalence of depression, fatigue, and sleep disturbances in patients with myelopathy: Their relation with functional and neurological recovery. J Spinal Cord Med 2016; 39:620-626. [PMID: 25582227 PMCID: PMC5137574 DOI: 10.1179/2045772314y.0000000284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To observe the prevalence of fatigue, depression, and sleep disturbance in patients with myelopathy and their correlation with neurological and functional recovery. PATIENTS AND METHODS Study conducted in a university tertiary research hospital with 127 patients with myelopathy (92 males) admitted to neurorehabilitation unit between January 2010 and December 2013. Mean age was 32.71 ± 13.08 years (range 15-65 years), and mean duration of injury was 76.22 ± 82.5 days (range 14-365 days). Functional status and impairments were assessed using Barthel Index and Spinal Cord Independence Measures. Depression, fatigue, and sleep disturbances were assessed using Hospital Anxiety and Depression Scale, Fatigue Severity Scale, and Pittsburgh Sleep Quality Index scales, respectively. Neurological recovery was assessed using American Spinal Injury Association's impairment scale. RESULTS Forty-four out of 104 (42%) patients had borderline or confirmed depression, 36/108 (33%) had significant fatigue, and 62/106 (58%) had significant sleep disturbances at admission. Significant correlation was observed between change in fatigue and depression scores with change in functional status scores (P < 0.05) but no correlation (P > 0.05) between change in sleep disturbance scores and functional status score and neurological recovery (P > 0.05). Similarly, change in fatigue and depression scores had no correlation with neurological status improvement. Fatigue, depression, and sleep disturbance scores showed significant improvement, that is, admission vs. discharge scores (P < 0.05) with significant correlation between improvement in all three variables (P < 0.05). CONCLUSIONS Study variables showed significant improvement in the present study with myelopathy patients but not necessarily correlating with functional and neurological recovery.
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Affiliation(s)
- Nitin Menon
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India,Correspondence to: Anupam Gupta, Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore 560029, Karnataka, India.
| | - Meeka Khanna
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - Arun B. Taly
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India,Department of Neurology, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
| | - K. Thennarasu
- Department of Biostatistics, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore, India
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Matsubara J, Wu M, Gordon K. Metabolic cost of lateral stabilization during walking in people with incomplete spinal cord injury. Gait Posture 2015; 41:646-51. [PMID: 25670651 PMCID: PMC4318628 DOI: 10.1016/j.gaitpost.2015.01.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 01/13/2015] [Accepted: 01/14/2015] [Indexed: 02/02/2023]
Abstract
People with incomplete spinal cord injury (iSCI) expend considerable energy to walk, which can lead to rapid fatigue and limit community ambulation. Selecting locomotor patterns that enhance lateral stability may contribute to this population's elevated cost of transport. The goal of the current study was to quantify the metabolic energy demands of maintaining lateral stability during gait in people with iSCI. To quantify this metabolic cost, we observed ten individuals with iSCI walking with and without external lateral stabilization. We hypothesized that with external lateral stabilization, people with iSCI would adapt their gait by decreasing step width, which would correspond with a substantial decrease in cost of transport. Our findings support this hypothesis. Subjects significantly (p<0.05) decreased step width by 22%, step width variability by 18%, and minimum lateral margin of stability by 25% when they walked with external lateral stabilization compared to unassisted walking. Metabolic cost of transport also decreased significantly (p<0.05) by 10% with external lateral stabilization. These findings suggest that this population is capable of adapting their gait to meet changing demands placed on balance. The percent reduction in cost of transport when walking with external lateral stabilization was strongly correlated with functional impairment level as assessed by subjects' scores on the Berg Balance Scale (r=0.778) and lower extremity motor score (r=0.728). These relationships suggest that as functional balance and strength decrease, the amount of metabolic energy used to maintain lateral stability during gait will increase.
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Affiliation(s)
- J.H. Matsubara
- Northwestern University Department of Physical Therapy and Human Movement Sciences,Northwestern University Interdepartmental Neuroscience Program
| | - M. Wu
- Northwestern University Department of Physical Therapy and Human Movement Sciences
| | - K.E. Gordon
- Northwestern University Department of Physical Therapy and Human Movement Sciences,Northwestern University Interdepartmental Neuroscience Program,Edward Hines Jr. VA Hospital
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Depressive Mood and Fatigue in Iranian Patients With Spinal Cord Injury and Spared Walking Ability. ARCHIVES OF NEUROSCIENCE 2014. [DOI: 10.5812/archneurosci.20180] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Dipiro ND, Saunders LL, Brotherton S, Kraft S, Krause JS. Pain and fatigue as mediators of the relationship between mobility aid usage and depressive symptomatology in ambulatory individuals with SCI. Spinal Cord 2014; 52:316-21. [PMID: 24418957 DOI: 10.1038/sc.2013.164] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 10/28/2013] [Accepted: 11/05/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional cohort study. OBJECTIVES To investigate a mediational model where pain (intensity and interference) and fatigue mediate the relationship between the use of mobility aids and moderate-to-severe depressive symptomatology among ambulatory participants with spinal cord injury (SCI). SETTING A medical university in the southeastern United States. METHODS Ambulatory adults (N=652) with chronic SCI responded to a mail-in survey. The Patient Health Questionnaire-9 was used to assess moderate-to-severe depressive symptomatology. The Brief Pain Inventory was used to assess pain intensity and interference, and the Modified Fatigue Impact Scale-5-item version was used to assess fatigue. Participants self-reported use of mobility aids. RESULTS On examining mobility aids used for ambulation, 65% were found to have used at least one aid. Severe pain intensity was reported by 11%, and 14% reported severe pain interference. Disabling fatigue was reported by 10% of the participants. Twenty-one percent (n=138) reported moderate-to-severe levels of depressive symptoms. On examining the relationships between mobility aids and depressive symptomatology, using people as a mobility aid was associated with increased odds of depressive symptomatology (2.6) and always using a wheelchair was associated with lower odds (0.3). However, these relationships were no longer significant after controlling for the mediating variables pain intensity, pain interference and fatigue. CONCLUSIONS Pain and fatigue mediate the relationship between usage of certain mobility aids and depressive symptomatology. The use of people to assist in ambulation is associated with greater odds of moderate-to-severe depressive symptomatology, while always using a wheelchair is associated with lower odds.
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Affiliation(s)
- N D Dipiro
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - L L Saunders
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - S Brotherton
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - S Kraft
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - J S Krause
- Department of Health Sciences and Research, College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
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