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Ranjbar Hameghavandi MH, Khodadoust E, Hassan Zadeh Tabatabaei MS, Farahbakhsh F, Ghodsi Z, Rostamkhani S, Ghashghaie S, Abbaszade M, Arbabi A, Hossieni SM, Sadeghi-Naini M, Atlasi R, Kankam SB, Vaccaro AR, Guest J, Fehlings M, Rahimi-Movaghar V. Challenges in traumatic spinal cord injury care in developing countries - a scoping review. Front Public Health 2024; 12:1377513. [PMID: 39224559 PMCID: PMC11368135 DOI: 10.3389/fpubh.2024.1377513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 07/24/2024] [Indexed: 09/04/2024] Open
Abstract
Objective To evaluate the leading challenges in developing countries' traumatic spinal cord injury (TSCI) care. Methods We conducted a systematic search in electronic databases of PubMed, SCOPUS, Web of Science, EMBASE, and Cochrane Library on 16 April 2023. Studies that investigated challenges associated with the management of TSCI in developing countries were eligible for review. We extracted related outcomes and categorized them into four distinct parts: injury prevention, pre-hospital care, in-hospital care, and post-hospital care. Results We identified 82 articles that met the eligibility criteria including 13 studies on injury prevention, 25 on pre-hospital care, 32 on in-hospital care, and 61 on post-hospital care. Challenges related to post-hospital problems including the personal, financial, and social consequences of patients' disabilities and the deficiencies in empowering people with TSCI were foremost studied. Lack of trained human resources, insufficient public education and delays in care delivery were barriers in the acute and chronic management of TSCI. A well-defined pre-hospital network and standard guidelines for the management of acute neurotrauma are needed. Critical challenges in injury prevention include deficiencies in infrastructure and supportive legislation. Conclusion Studies focusing on injury prevention and pre-hospital care in TSCI management in developing countries warrant further investigation. It is imperative to develop systematic and evidence-based initiatives that are specifically tailored to the unique circumstances of each country to address these challenges effectively. By understanding the primary obstacles, policymakers and healthcare providers can establish goals for improving education, planning, legislation, and resource allocation.
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Affiliation(s)
| | - Elaheh Khodadoust
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Farzin Farahbakhsh
- 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
| | - Sabra Rostamkhani
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Shahryar Ghashghaie
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahkame Abbaszade
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Arbabi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyedeh Maede Hossieni
- 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, Shohada Hospital, Lorestan University of medical sciences, Khoram-Abad, Iran
| | - Rasha Atlasi
- Non-Communicable Diseases Research Center, Endocrinology and Metabolism Population Sciences Institute, Tehran, Iran
- Endocrinology and Metabolism Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Samuel Berchi Kankam
- 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
| | - Alexander R. Vaccaro
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - James Guest
- Department of Orthopedics and Neurosurgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, United States
| | - Michael Fehlings
- Neurosurgery and the Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Coral Gables, FL, United States
- Division of Genetics and Development, Krembil Research Institute, University Health Network, Toronto, ON, Canada
- Division of Neurosurgery, Toronto Western Hospital, University Health Network, Toronto, ON, Canada
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Department of Surgery and Spine Program, University of Toronto, Toronto, ON, Canada
- Universal Scientific Education and Research Network (USERN), Tehran, Iran
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Beltchika A, Maoneo I, Ketani T, Mukuetala P, Ojo O, Ntsambi G. Challenges and strategies in the surgical management of traumatic spinal cord injuries in the Democratic Republic of the Congo. J Clin Neurosci 2024; 125:132-138. [PMID: 38796959 DOI: 10.1016/j.jocn.2024.05.013] [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: 12/29/2023] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND Significant progress has been made in the management of traumatic spinal cord injuries. However, deep disparities persist in developing countries. This work aims to describe the different challenges in the surgical management of traumatic spinal cord injuries at the Kinshasa University Teaching Hospital and some strategies implemented to overcome them. METHODS This is a cross-sectional study of 105 patients from January 2016 to June 2023. The variables of interest included: gender, age, cause, levels of lesion, hospital admission modalities, time to admission, time to surgery, AIS score at admission and on discharge, treatment, pre, peri- and post-operative complications and outcome. RESULTS We admitted 105 patients. Only 16 % of them were taken to hospital in an ambulance. The average admission time was 49.9 ± 81.79 days. Seventy-two patients (68.6 %) were operated. The average time to surgery was 62.43 ± 85.20 days. No patient was stabilized at the trauma site. Osteosynthesis was performed with appropriate implants in 63.2 % and with improvised elements in 26.8 %. Four patients were operated without an image intensifier. Short-segmental fixation was performed in 8 patients. Twenty-one patients developed pressure ulcers. At discharge, 24 patients recovered their neurological function. Neurological status remained stationary in 43 patients. Five patients died. Seventeen patients went to rehabilitation center. There was no significant difference between the improvised strategies implemented and conventional procedures on functional recovery upon discharge from hospital or rehabilitation centre (p-value : 0.838 and 0.468 respectively). CONCLUSION Our establishment faces many challenges in TSCI surgery: lack of pre-hospital emergency services and mutual health insurance, delay in admission, lack of surgical implants and image intensifier, the poverty of the population. Some strategies have been implemented to overcome some of them.
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Affiliation(s)
- Antoine Beltchika
- Department of Neurosurgery, Kinshasa University Teaching Hospital, University of Kinshasa, Democratic Republic of the Congo
| | - Israël Maoneo
- Department of Neurosurgery, Kinshasa University Teaching Hospital, University of Kinshasa, Democratic Republic of the Congo; Department of Surgery, Kisangani University Teaching Hospital, University of Kisangani, Democratic Republic of the Congo.
| | - Teddy Ketani
- Department of Neurosurgery, Kinshasa University Teaching Hospital, University of Kinshasa, Democratic Republic of the Congo
| | - Pierre Mukuetala
- Department of Neurosurgery, Kinshasa University Teaching Hospital, University of Kinshasa, Democratic Republic of the Congo
| | - Omotayo Ojo
- Neurosurgery Unit, Department of Surgery, Lagos University Teaching Hospital, Lagos, Nigeria; Department of Surgery, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Glennie Ntsambi
- Department of Neurosurgery, Kinshasa University Teaching Hospital, University of Kinshasa, Democratic Republic of the Congo
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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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Abstract
Neurocritical care (NCC) is an emerging field within critical care medicine, reflecting the widespread prevalence of neurologic injury in critically ill patients. Morbidity and mortality from neurocritical illness (NCI) have been reduced substantially in resource-rich settings (RRS), owing to the development of advanced technologies, neuro-specific units, and subspecialized medical training. Despite shouldering much of the burden of NCI worldwide, resource-limited settings (RLS) face immense hurdles when implementing guidelines generated in RRS. This review summarizes the current epidemiology, management, and outcomes of the most common NCIs in RLS and offers commentary on future directions in NCC practiced in RLS.
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Sharma S, Sivakami M. "God will decide her fate": the trajectories of women with traumatic spinal cord injury in India. Disabil Rehabil 2022:1-10. [PMID: 35654780 DOI: 10.1080/09638288.2022.2083245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Traumatic Spinal Cord Injury (SCI) is one of the most devastating physical disabilities that unexpectedly affects physical, mental, familial, social, and economic aspects of people's lives. This article analyses the trajectories of Indian women with SCI as they attempt to access health care after the injury. METHODS Based on a qualitative research paradigm, this study adopts a phenomenological approach and conducts in-depth interviews with 21 Indian women with traumatic SCI. RESULTS (A) A lack of awareness and basic knowledge about SCI in India makes emergency response and eventual reintegration of persons with SCI in the society challenging. (B) The Indian health systems fail to meet the comprehensive health care needs of women with SCI primarily due to inadequate healthcare infrastructure and lack of empathy, accountability and knowledge about SCI among general healthcare providers. (C) The lack of patient and caregiver education results in diminished health and wellbeing of injured and their families. CONCLUSION The issue of SCI is not only a health issue but an issue of human rights. The persons with SCI, particularly women, must get an equitable access to health care, education, employment, transportation and other basic amenities and opportunities. Implications for rehabilitationA comprehensive response to SCI entails concerted measures such as ramping up the disability-inclusive healthcare infrastructure and enhancing the capacities of all health care providers.Besides providing rehabilitation services through the primary, secondary and tertiary levels of the health systems, India should also prioritise and offer quality community-based rehabilitation, especially in remote and rural areas.Given the unique vulnerabilities faced by women with disabilities in India, a compressive package of gender sensitive rehabilitation services needs to be integrated within the overall rehabilitation services across the country.The persons with SCI (and their families) need to be empowered through comprehensive information, counselling and skills that could help them lead independent, productive, and dignified lives.There is an urgent need to foster SCI research and make disaggregated data on SCI publicly available so that policy response to SCI is based on scientific evidence and local realities.
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Affiliation(s)
- Seema Sharma
- School of Development, Azim Premji University, Bangalore, India
| | - Muthusamy Sivakami
- School of Health Systems Studies, Tata Institute of Social Sciences, Mumbai, India
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Ethical issues and dilemmas in spinal cord injury rehabilitation in the developing world: a mixed-method study. Spinal Cord 2022; 60:882-887. [PMID: 35523952 DOI: 10.1038/s41393-022-00808-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Mixed-method study (small group discussions and online literature search). OBJECTIVES Identify the ethical issues and dilemmas faced by rehabilitation professionals involved in the service delivery to the persons with spinal cord injury (SCI) in the low income and lower-middle-income countries (LIC/LMIC) located in Asia. SETTING Small group discussions in three biomedical conferences in Dhaka, Bangladesh and Kualalampur, Malaysia. METHODS Three small group discussions (30-45 min each) were held during three international conferences in 2019. The conferences brought together experts in the fields of neurology, rehabilitation, neurorehabilitation, and bioethics. A summary of SCI practice points and dilemmas were documented including goals of care, duties of rehabilitation professionals, health care worker-patient relationships, roles, and expectations of family members at different care settings. RESULTS There is a paucity of literature on this topic. The application of the principles of contemporary bioethics in the pluralistic societies of LIC/LMIC can be challenging. The ethical dilemmas faced by rehabilitation professionals working in LIC/LMIC are diverse and different from those reported from the Western and developed countries. Ethical issues and dilemmas identified were understanding patient autonomy in decision making, lack of insurance for SCI rehabilitation, financial challenges, challenges of providing emerging technology in SCI rehabilitation and SCI rehabilitation during disasters. CONCLUSIONS We have summarized the possible ethical issues and dilemmas which rehabilitation professionals in LIC/LMIC may encounter during delivery of SCI rehabilitation services. We hope it generates a discussion on an often-neglected aspect of SCI care in the LIC/LMIC and helps identify the complexities of ethical dilemmas unique to persons with SCI living in a developing country.
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Sengupta D, Bindra A, Kumar N, Goyal K, Singh PK, Chaturvedi A, Malhotra R, Mishra AK. Respiratory morbidity and mortality of traumatic cervical spinal cord injury at a level I trauma center in India. Spinal Cord Ser Cases 2021; 7:36. [PMID: 33986249 PMCID: PMC8117130 DOI: 10.1038/s41394-020-00371-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 11/09/2020] [Accepted: 11/26/2020] [Indexed: 11/18/2022] Open
Abstract
STUDY DESIGN Descriptive retrospective. OBJECTIVES To evaluate the burden of respiratory morbidity in terms of ventilator dependence (VD) days and length of stay in neurotrauma ICU (NICU) and hospital, and to determine mortality in patients with traumatic cervical spinal cord injury (CSCI) in a low middle-income country (LMIC). SETTING Jai Prakash Narayan Apex Trauma Center (JPNATC), All India Institute of Medical Sciences (AIIMS), New Delhi, India. METHODS A total of 135 patients admitted with CSCI in the NICU between January 2017 to December 2018 were screened. Information regarding age, gender, American Spinal Injury Association (ASIA) impairment scale (AIS), level of injury, duration of VD, length of NICU, hospital stay, and outcome in terms of mortality or discharge from the hospital were obtained from the medical records. RESULTS A total of 106 CSCI patients were analyzed. The mean (SD) age of patients was 40 (±16) years and male: female ratio was 5:1. The duration of VD, duration of NICU, and hospital stay was a median of 8 days (IQR 1127), 6 days (IQR 1118), and 15 days (IQR 3127) respectively. Mortality was 19% (20/106). The mortality was significantly associated with poorer AIS score, VD, and duration of ICU and hospital stay. All patients were discharged to home only after they became ventilator-free. CONCLUSIONS The ventilator burden, hospital stay, and mortality are high in patients with CSCI in LMICs. Poor AIS scores, prolonged VD, ICU and hospital stay are associated with mortality. There is a need for comprehensive CSCI rehabilitation programs in LMICs to improve outcome.
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Affiliation(s)
- Deep Sengupta
- Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Bindra
- Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India.
| | - Niraj Kumar
- Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Keshav Goyal
- Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Kumar Singh
- Neurosurgey, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Arvind Chaturvedi
- Neuroanaesthesiology and Critical Care, Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Rajesh Malhotra
- Jai Prakash Narayan Apex Trauma Center, All India Institute of Medical Sciences, New Delhi, India
| | - Ashwani Kumar Mishra
- Biostatistics, National Drug Dependence Treatment Center, All India Institute of Medical Sciences, New Delhi, India
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Pattern of spine fracture in Sub-Himalayan region: A prospective study. J Clin Orthop Trauma 2020; 15:27-32. [PMID: 33717912 PMCID: PMC7920136 DOI: 10.1016/j.jcot.2020.11.003] [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: 06/10/2020] [Revised: 10/29/2020] [Accepted: 11/09/2020] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Though spine trauma contributes to great functional, psychological, and economic loss, research regarding the demographic profile of patients according to different regions of our country are lacking.This study aims to identify the demographic pattern and clinical profile of patients with spinal fracture in the Sub-Himalayan region. METHOD Patients with acute or subacute spine trauma presenting within 8weeks and involving fracture of cervical, dorsal, or lumbar vertebra, from July 2017 to December 2019 were included prospectively. Patients with osteoporotic or metastatic collapse, isolated transverse or spinous process fracture, penetrating trauma or ballistic injuries were excluded. RESULTS Out of 280 enrolled patients, 180 were males and 100 were females. The maximum number of spine trauma patients was in 16-30 years age group. The most common mechanism of injury was fall from height (FFH, 42.5%)> road traffic accident (RTA, 38.6%). RTA was more common among males and FFH among females (p < 0.0001). Most common location of injury was at thoracolumbar junction (D10-L2) (37.5%) followed by cervical spine (25.3%). 58.2% of patients had AO type A facture morphology followed by AO types C (36.1%) and AO type B (5.7%). Spinal Cord Injury (SCI) was seen in 82.1% spine trauma patients with statistically significant association with male gender (p- 0.045). Complete paralysis was seen maximum in patients with cervical spine injury (67.3%, p < 0.0001). Complete neurological deficit (ASIA grade A) was seen maximum in AO type C fracture morphology (74.25%, p < 0.001) followed by AO type A4 (29.6%). Seasonal distribution showed increased incidence during summer and monsoon season. CONCLUSION Young aged males in age group of 16-30 yrs were most commonly affected with fall from height as the most common mechanism of trauma. Association was found between gender and mechanism of injury (RTA in males and FFH in females). Most common vertebral injury level was thoracolumbar junction. AO type A was the most common fracture morphology. SCI seen in 82.1% of spine trauma. Statistically significant association was found between Complete SCI with Location of Injury (Cervical) and Fracture morphology (AO type C).
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Gupta N. Recommendations for standards of physiotherapy care following complete traumatic paraplegia in India. Spinal Cord Ser Cases 2020; 6:14. [PMID: 32161255 DOI: 10.1038/s41394-020-0263-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Revised: 02/06/2020] [Accepted: 02/06/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Qualitative study. OBJECTIVES To formulate recommendations for standards of physiotherapy care for people with complete traumatic paraplegia in India using a Delphi methodology. SETTING India. METHODS Twenty-three physiotherapy experts were invited to participate in an online consensus process. Fourteen (n = 14) of 23 physiotherapy experts from India accepted an invitation to participate in an online consensus development exercise (Response rate-60.86%). Four rounds of consensus meetings were conducted which involved posting the quotations from a previous study on expectations of people with paraplegia to obtain perceptions of physiotherapy experts in round 1, retrieving codes/code groups from round 1, posting these code groups in rounds 2 and 3 for experts' agreement/disagreement, the preparation of the draft of recommendations, and posting it in round 4 for experts' opinion. Data were analyzed using descriptive statistics and ATLASti software for qualitative data analysis. RESULT Recommendations for physiotherapy care for persons with complete traumatic paraplegia in India are presented. CONCLUSIONS Education to patients and/or caregivers regarding care post injury is one of the important recommendations by physiotherapy experts. It is emphasized that the subjective assessment of the patients, including their needs and preferences, is equally important as that of their objective assessment. Physiotherapy students and practicing physiotherapists must also enhance their knowledge to provide optimal physiotherapy care to people with paraplegia.
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Affiliation(s)
- Nalina Gupta
- School of Physiotherapy, R K University, Rajkot, Gujarat, India. .,College of Physiotherapy, Sumandeep Vidyapeeth, An Institution-Deemed-to-be University, Vadodara, Gujarat, India.
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Dorjbal D, Zanini C, Tsegmid N, Stucki G, Rubinelli S. Toward an optimization of rehabilitation services for persons with spinal cord injury in Mongolia: the perspective of medical doctors. Disabil Rehabil 2019; 43:2200-2212. [PMID: 31790290 DOI: 10.1080/09638288.2019.1696415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
PURPOSE To explore medical doctors' views on what are barriers in providing rehabilitation services for persons with SCI in Mongolia. METHODS A qualitative study with semi-structured interviews was conducted with 12 medical doctors. Participants were purposely sampled. The World Health Organization (WHO)'s report International Perspectives on Spinal Cord Injury was chosen as a guide to structure the interviews. The study used inductive thematic analysis. RESULTS Five barriers in the provision of rehabilitation services were identified: low awareness and limited knowledge regarding SCI and rehabilitation issues, inadequate rehabilitation policies, deficiencies in infrastructure, deficiencies in equipment and medication, and a shortage of well-prepared rehabilitation workforce. CONCLUSIONS Based on WHO recommendations "Rehabilitation in health systems", this study provides suggestions on how to strengthen rehabilitation services in Mongolia to better respond to the needs of the SCI population. Our findings highlight that a core issue is the lack of awareness among policymakers regarding rehabilitation and its benefits at the micro, meso and macro levels of the health system. Actions are needed at the level of health policies to ensure, for instance, adequate financing and access to the services. Also, synergies between the Ministries of Education and Health can improve the training of the workforce.Implications for rehabilitationEvidence that rehabilitation services contribute to improving health outcomes and cost-effectiveness could raise awareness among Mongolian policymakers and inform their decisions on funding schemes.Health policies in Mongolia should be reformed to remove barriers in the provision of rehabilitation services for persons with complex and chronic health conditions.Rehabilitation services need to be included into the Mongolian health insurance scheme in order to improve the quality and accessibility of rehabilitation services.Synergies between the Ministry of Education and the Ministry of Health in Mongolia are needed to develop training standards for rehabilitation professionals.
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Affiliation(s)
- Delgerjargal Dorjbal
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Claudia Zanini
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Narantsetseg Tsegmid
- Department of Rehabilitation Medicine, School of Medicine, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
| | - Gerold Stucki
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Sara Rubinelli
- Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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Mansoor SN, Rathore FA. Bladder management practices in spinal cord injury patients: A single center experience from a developing country. J Spinal Cord Med 2019; 42:786-790. [PMID: 29323623 PMCID: PMC6830287 DOI: 10.1080/10790268.2017.1417803] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Context/Objective: Inadequate bladder management in spinal cord injury (SCI) patients results in significant morbidity and even mortality. Clean intermittent catheterization (CIC) is the recommended option for SCI patients. The objective of the study was to document the bladder management practices of SCI patients in a developing country.Design: Questionnaire based cross sectional surveySetting: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi, PakistanParticipants: All patients with SCI (irrespective of duration, level and etiology)Interventions: Data documentation included demographics, level, severity and time since injury, bladder management techniques used, details of CIC, results of Urodynamic studies (if available), complications resulting from bladder management technique and patient awareness of the yearly follow up. SPSS V 20 was used for analysis.Outcome Measures: Not applicableResults: Thirty four consenting patients were enrolled. All were males. Mean age was 31.24 ± 10.9. Most (17) of the patients were thoracic level paraplegics, while 12 patients had sustained a cervical SCI. Majority (23) had complete injury (ASIA A). Fifteen patients used CIC for bladder management followed by in dwelling Foley catheters in thirteen patients. Those using CIC performed the procedure every four hours and used disposable catheters. The same 'disposable' catheter was used for 5-7 days by half of these patients. Only Six patients independently performed CIC. Three patients on CIC reported urinary tract infection.Conclusions: In the largest spinal rehabilitation unit of a developing country; Pakistan CIC was the preferred method of bladder management followed by indwelling catheter. Re-use of disposable catheters is a common practice due to cost issues. The rate of UTI was significantly lower in patients on CIC.
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Affiliation(s)
- Sahibzada Nasir Mansoor
- Department of Rehabilitation Medicine, Combined Military Hospital, PanoAqil Cantonment, Sind, Pakistan
| | - Farooq Azam Rathore
- Department of Rehabilitation Medicine, PNS Shifa Hospital, Karachi, Pakistan
- Department of Rehabilitation Medicine, Bahria University Medical and Dental College, Bahria University, Karachi, Pakistan
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Affiliation(s)
- Harvinder Singh Chhabra
- Medical Director and Chief of Spine Service, Indian Spinal Injuries Centre, New Delhi, India and President of Association of Spine Surgeons of India and International Spinal Cord Society,Address for correspondence: Dr. Harvinder Singh Chhabra, Indian Spinal Injuries Centre, New Delhi, India. E-mail:
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Acute traumatic cervical spinal cord injury in a third-trimester pregnant female with good maternal and fetal outcome: a case report and literature review. Spinal Cord Ser Cases 2018; 4:93. [PMID: 30374412 DOI: 10.1038/s41394-018-0127-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2018] [Revised: 09/30/2018] [Accepted: 10/07/2018] [Indexed: 11/08/2022] Open
Abstract
Background The management of acute traumatic cervical spine injury in a third-trimester pregnancy is challenging with risks involved for both the mother and the fetus. We report one such case that was managed successfully with good maternal and fetal outcomes. Case presentation A 30 years female, gravida 2, para 1, living 1 at 31 weeks 5 days of pregnancy, met with a RTA and was diagnosed with AIS B C4-C5 extension compression spinal cord injury (SCI) with a viable fetus. Closed reduction of C4-C5 dislocation was achieved through controlled cervical traction. Having involved the patient in informed decision-making, anterior cervical discectomy and fusion (ACDF) was performed under general anesthesia (GA), with obstetrician, as well as neonatologist available in the operation theater. The pregnancy was uneventful in the post-operative stage. A healthy baby was delivered at 36 weeks of gestation through cesarean section. At final follow-up review of 12 months the patient was ambulatory without support and was able to perform most of the regular activities independently. Discussion The significant risk of a spontaneous delivery with GA posed the dilemma of either managing the injury conservatively through bed rest, continuing the pregnancy till its term and then opting for surgical stabilization after delivery or opting for surgical stabilization of the spine immediately, with a view for early mobilization and rehabilitation. A successful outcome of traumatic cervical SCI in third-trimester pregnancy can be achieved by multi-disciplinary (anesthetist, obstetrician, neonatologist, spine surgeon, and physiatrist) team, and timely surgical spinal stabilization, followed by early comprehensive rehabilitation.
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Du Plessis M, McGaffin CR, Molepo T, Oelofse R, Van Zyl S, Mashola MK. Perceived readiness for hospital discharge: Patients with spinal cord injury versus physiotherapists. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2018; 74:437. [PMID: 30167501 PMCID: PMC6111384 DOI: 10.4102/sajp.v74i1.437] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 06/01/2018] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Successful discharge from rehabilitation for patients with spinal cord injury (PWSCI) relies on a smooth transition home. Assessing readiness for hospital discharge (RHD) is important in reducing secondary health conditions and improving satisfaction and function. Perception of PWSCI on RHD may be different from their physiotherapists, leading to difficulties. OBJECTIVE To compare the perceptions of PWSCI and physiotherapists with regard to RHD. METHOD A comparative cross-sectional study included 50 PWSCI and their physiotherapists in Tshwane. They completed the Readiness for Hospital Discharge Scale (RHDS) and their responses to the subscales were compared. Data were analysed using descriptive and inferential statistics. Relationships between variables of interest and the general perception of RHD were determined using Pearson's chi-square test. An independent samples t-test was used to analyse the difference in RHDS scores (including subscale scores) between PWSCI and physiotherapists. Results were significant if p < 0.05. RESULTS The total score of the RHDS was not significantly different (t = 1.31, df = 98, p = 0.19). Patients had higher perceptions in coping ability and expected support subscales (t = 3.15, df = 85.97, p = 0.002 and t = 4.23, df = 98, p = 0.0001, respectively). Physiotherapists had higher perceptions in the knowledge subscale regarding what to do and not do at home (t = -2.05, df = 82.08, p = 0.044) and follow-up sessions (t = 2.625, df = 85.28, p = 0.010). CONCLUSION There was no difference in perception of readiness to go home, although physiotherapists gave lower scores for emotional readiness and ability to handle demands at home and higher scores for knowledge. CLINICAL IMPLICATIONS The use of the RHDS in the spinal cord rehabilitation units will better align the goals of rehabilitation and discharge planning to improve overall satisfaction with care and discharge outcomes. All members of a multidisciplinary team can achieve consensus and comparisons can be made on their patient's perceived RHD.
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Affiliation(s)
| | | | - Thamsanqa Molepo
- Department of Physiotherapy, University of Pretoria, South Africa
| | - Roleen Oelofse
- Department of Physiotherapy, University of Pretoria, South Africa
| | - Susan Van Zyl
- Department of Physiotherapy, University of Pretoria, South Africa
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