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Labounek R, Bondy MT, Paulson AL, Bédard S, Abramovic M, Alonso-Ortiz E, Atcheson NT, Barlow LR, Barry RL, Barth M, Battiston M, Büchel C, Budde MD, Callot V, Combes A, De Leener B, Descoteaux M, de Sousa PL, Dostál M, Doyon J, Dvorak AV, Eippert F, Epperson KR, Epperson KS, Freund P, Finsterbusch J, Foias A, Fratini M, Fukunaga I, Gandini Wheeler-Kingshott CAM, Germani G, Gilbert G, Giove F, Grussu F, Hagiwara A, Henry PG, Horák T, Hori M, Joers JM, Kamiya K, Karbasforoushan H, Keřkovský M, Khatibi A, Kim JW, Kinany N, Kitzler H, Kolind S, Kong Y, Kudlička P, Kuntke P, Kurniawan ND, Kusmia S, Laganà MM, Laule C, Law CSW, Leutritz T, Liu Y, Llufriu S, Mackey S, Martin AR, Martinez-Heras E, Mattera L, O’Grady KP, Papinutto N, Papp D, Pareto D, Parrish TB, Pichiecchio A, Prados F, Rovira À, Ruitenberg MJ, Samson RS, Savini G, Seif M, Seifert AC, Smith AK, Smith SA, Smith ZA, Solana E, Suzuki Y, Tackley GW, Tinnermann A, Valošek J, Van De Ville D, Yiannakas MC, Weber KA, Weiskopf N, Wise RG, Wyss PO, Xu J, Cohen-Adad J, Lenglet C, Nestrašil I. Body size interacts with the structure of the central nervous system: A multi-center in vivo neuroimaging study. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.29.591421. [PMID: 38746371 PMCID: PMC11092490 DOI: 10.1101/2024.04.29.591421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Clinical research emphasizes the implementation of rigorous and reproducible study designs that rely on between-group matching or controlling for sources of biological variation such as subject's sex and age. However, corrections for body size (i.e. height and weight) are mostly lacking in clinical neuroimaging designs. This study investigates the importance of body size parameters in their relationship with spinal cord (SC) and brain magnetic resonance imaging (MRI) metrics. Data were derived from a cosmopolitan population of 267 healthy human adults (age 30.1±6.6 years old, 125 females). We show that body height correlated strongly or moderately with brain gray matter (GM) volume, cortical GM volume, total cerebellar volume, brainstem volume, and cross-sectional area (CSA) of cervical SC white matter (CSA-WM; 0.44≤r≤0.62). In comparison, age correlated weakly with cortical GM volume, precentral GM volume, and cortical thickness (-0.21≥r≥-0.27). Body weight correlated weakly with magnetization transfer ratio in the SC WM, dorsal columns, and lateral corticospinal tracts (-0.20≥r≥-0.23). Body weight further correlated weakly with the mean diffusivity derived from diffusion tensor imaging (DTI) in SC WM (r=-0.20) and dorsal columns (-0.21), but only in males. CSA-WM correlated strongly or moderately with brain volumes (0.39≤r≤0.64), and weakly with precentral gyrus thickness and DTI-based fractional anisotropy in SC dorsal columns and SC lateral corticospinal tracts (-0.22≥r≥-0.25). Linear mixture of sex and age explained 26±10% of data variance in brain volumetry and SC CSA. The amount of explained variance increased at 33±11% when body height was added into the mixture model. Age itself explained only 2±2% of such variance. In conclusion, body size is a significant biological variable. Along with sex and age, body size should therefore be included as a mandatory variable in the design of clinical neuroimaging studies examining SC and brain structure.
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Affiliation(s)
- René Labounek
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Monica T. Bondy
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Amy L. Paulson
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
| | - Sandrine Bédard
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Mihael Abramovic
- Department of Radiology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Eva Alonso-Ortiz
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Centre de recherche du CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
| | - Nicole T Atcheson
- Centre for Advanced Imaging, Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, St Lucia, Australia
| | - Laura R. Barlow
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Robert L. Barry
- Athinoula A. Martinos Center for Biomedical Imaging, Department of Radiology, Massachusetts General Hospital, Charlestown, Massachusetts, USA
- Harvard Medical School, Boston, Massachusetts, USA
- Harvard-Massachusetts Institute of Technology Health Sciences & Technology, Cambridge, Massachusetts, USA
| | - Markus Barth
- Centre for Advanced Imaging, Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, St Lucia, Australia
- School of Electrical Engineering and Computer Science, The University of Queensland, St Lucia, Australia
| | - Marco Battiston
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK
| | - Christian Büchel
- Department for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Matthew D. Budde
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
- Clement J. Zablocki Veteran’s Affairs Medical Center, Milwaukee, WI, USA
| | - Virginie Callot
- Aix-Marseille Univ, CNRS, CRMBM, Marseille, France
- APHM, Hopital Universitaire Timone, CEMEREM, Marseille, France
| | - Anna Combes
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK
| | - Benjamin De Leener
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Centre de recherche du CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Department of Computer Engineering and Software Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Maxime Descoteaux
- Sherbrooke Connectivity Imaging Lab (SCIL), Computer Science department, Université de Sherbrooke, Sherbrooke, QC, Canada
| | | | - Marek Dostál
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University, Czech Republic
- Department of Biophysics, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Julien Doyon
- McConnell Brain Imaging Centre, Montreal Neurological Institute, McGill University, Montreal, Quebec, Canada
| | - Adam V. Dvorak
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
| | - Falk Eippert
- Max Planck Research Group Pain Perception, Max Planck Institute for Human Cognitive and Brain Sciences, Leipzig, Germany
| | | | | | - Patrick Freund
- Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Wellcome Trust Centre for Neuroimaging, Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstraße 1a, 04103 Leipzig, Germany
| | - Jürgen Finsterbusch
- Department for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Alexandru Foias
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
| | - Michela Fratini
- Institute of Nanotechnology, CNR, Rome, Italy
- IRCCS Santa Lucia Foundation, Neuroimaging Laboratory, Rome, Italy
| | - Issei Fukunaga
- Department of Radiology, Juntendo University School of Medicine, 1-2-1, Hongo, Bunkyo, Tokyo 113-8421, Japan
| | - Claudia A. M. Gandini Wheeler-Kingshott
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
| | - GianCarlo Germani
- Advanced Imaging and Artificial Intelligence Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | | | - Federico Giove
- IRCCS Santa Lucia Foundation, Neuroimaging Laboratory, Rome, Italy
- CREF - Museo storico della fisica e Centro studi e ricerche Enrico Fermi, Rome, Italy
| | - Francesco Grussu
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK
- Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Akifumi Hagiwara
- Department of Radiology, Juntendo University School of Medicine, 1-2-1, Hongo, Bunkyo, Tokyo 113-8421, Japan
| | - Pierre-Gilles Henry
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Tomáš Horák
- Faculty of Medicine, Masaryk University, Brno, Czech Republic
- Department of Neurology, University Hospital Brno, Brno, Czech Republic
- Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czech Republic
| | - Masaaki Hori
- Department of Radiology, Juntendo University School of Medicine, 1-2-1, Hongo, Bunkyo, Tokyo 113-8421, Japan
- Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
| | - James M. Joers
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Kouhei Kamiya
- Department of Radiology, Toho University Omori Medical Center, Tokyo, Japan
| | - Haleh Karbasforoushan
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Miloš Keřkovský
- Department of Radiology and Nuclear Medicine, University Hospital Brno and Masaryk University, Czech Republic
| | - Ali Khatibi
- Centre of Precision Rehabilitation for Spinal Pain (CPR Spine), University of Birmingham, Birmingham, UK
- Centre for Human Brain Health, University of Birmingham, Birmingham, UK
- Institute for Mental Health, University of Birmingham, Birmingham, UK
| | - Joo-won Kim
- Biomedical Engineering and Imaging Institute, Department of Radiology, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
- Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Nawal Kinany
- Neuro-X Institute, Ecole polytechnique fédérale de Lausanne, Geneva, Switzerland
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Switzerland
| | - Hagen Kitzler
- Institute of Diagnostic and Interventional Neuroradiology, Faculty of Medicine and Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Shannon Kolind
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
- Division of Neurology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Yazhuo Kong
- CAS Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Science, Beijing, 100101, China
- Department of Psychology, University of Chinese Academy of Sciences, Beijing, 100049, China
| | - Petr Kudlička
- Multimodal and Functional Imaging Laboratory, Central European Institute of Technology, Brno, Czech Republic
- First Department of Neurology, St. Anne’s University Hospital and Medical Faculty of Masaryk University, Brno, Czech Republic
| | - Paul Kuntke
- Institute of Diagnostic and Interventional Neuroradiology, Faculty of Medicine and Carl Gustav Carus University Hospital, Technische Universität Dresden, Germany
| | - Nyoman D. Kurniawan
- Centre for Advanced Imaging, Australian Institute for Bioengineering and Nanotechnology, The University of Queensland, St Lucia, Australia
| | | | | | - Cornelia Laule
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Department of Physics and Astronomy, University of British Columbia, Vancouver, BC, Canada
- Department of Pathology & Laboratory Medicine, University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, Canada
| | | | - Tobias Leutritz
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstraße 1a, 04103 Leipzig, Germany
| | - Yaou Liu
- Department of Radiology, Beijing Tiantan Hospital, Capital Medical University, China
| | - Sara Llufriu
- Neuroimmunology and Multiple Sclerosis Unit, Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic Barcelona, Fundació de Recerca Clínic Barcelona-IDIBAPS and Universitat de Barcelona. Barcelona, Spain
| | - Sean Mackey
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Allan R. Martin
- Department of Neurological Surgery, University of California, Davis, CA, USA
| | - Eloy Martinez-Heras
- Neuroimmunology and Multiple Sclerosis Unit, Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic Barcelona, Fundació de Recerca Clínic Barcelona-IDIBAPS and Universitat de Barcelona. Barcelona, Spain
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Loan Mattera
- Fondation Campus Biotech Geneva, Genève, Switzerland
| | - Kristin P. O’Grady
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Nico Papinutto
- Department of Neurology, UCSF Weill Institute for Neurosciences, University of California San Francisco, San Francisco, CA, USA
| | - Daniel Papp
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Wellcome Centre For Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Deborah Pareto
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Todd B. Parrish
- Department of Radiology, Northwestern University, Chicago, IL 60611, USA
| | - Anna Pichiecchio
- Department of Brain and Behavioural Sciences, University of Pavia, Pavia, Italy
- Advanced Imaging and Artificial Intelligence Center, Neuroradiology Department, IRCCS Mondino Foundation, Pavia, Italy
| | - Ferran Prados
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK
- e-Health Center, Universitat Oberta de Catalunya, Barcelona, Spain
- Centre for Medical Image Computing, University College London, London, UK
| | - Àlex Rovira
- Section of Neuroradiology, Department of Radiology, Hospital Universitari Vall d’Hebron, Barcelona, Spain
| | - Marc J. Ruitenberg
- School of Biomedical Sciences, Faculty of Medicine, The University of Queensland, St Lucia, Australia
| | - Rebecca S. Samson
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK
| | - Giovanni Savini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele (MI), Italy
- Neuroradiology Unit, IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano (MI), Italy
| | - Maryam Seif
- Spinal Cord Injury Center Balgrist, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstraße 1a, 04103 Leipzig, Germany
| | - Alan C. Seifert
- Biomedical Engineering and Imaging Institute, Department of Radiology, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Alex K. Smith
- Wellcome Centre For Integrative Neuroimaging, FMRIB, Nuffield Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Seth A. Smith
- Vanderbilt University Institute of Imaging Science, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Biomedical Engineering, Vanderbilt University, Nashville, TN USA
| | - Zachary A. Smith
- Department of Neurosurgery, University of Oklahoma, Oklahoma City, OK, USA
| | - Elisabeth Solana
- Neuroimmunology and Multiple Sclerosis Unit, Laboratory of Advanced Imaging in Neuroimmunological Diseases (ImaginEM), Hospital Clinic Barcelona, Fundació de Recerca Clínic Barcelona-IDIBAPS and Universitat de Barcelona. Barcelona, Spain
| | - Yuichi Suzuki
- The University of Tokyo Hospital, Radiology Center, Tokyo, Japan
| | - George W Tackley
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, Wales, UK
| | - Alexandra Tinnermann
- Department for Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Valošek
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Mila - Quebec AI Institute, Montreal, QC, Canada
- Department of Neurosurgery, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
- Department of Neurology, Faculty of Medicine and Dentistry, Palacký University Olomouc, Olomouc, Czech Republic
| | - Dimitri Van De Ville
- Neuro-X Institute, Ecole polytechnique fédérale de Lausanne, Geneva, Switzerland
- Department of Radiology and Medical Informatics, Faculty of Medicine, University of Geneva, Switzerland
| | - Marios C. Yiannakas
- NMR Research Unit, Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, Queen Square Institute of Neurology, Faculty of Brain Sciences, University College London, UK
| | - Kenneth A. Weber
- Division of Pain Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, USA
| | - Nikolaus Weiskopf
- Wellcome Trust Centre for Neuroimaging, Queen Square Institute of Neurology, University College London, London, UK
- Department of Neurophysics, Max Planck Institute for Human Cognitive and Brain Sciences, Stephanstraße 1a, 04103 Leipzig, Germany
- Felix Bloch Institute for Solid State Physics, Faculty of Physics and Earth Sciences, Leipzig University, Linnéstraße 5, 04103 Leipzig, Germany
| | - Richard G. Wise
- Cardiff University Brain Research Imaging Centre (CUBRIC), School of Psychology, Cardiff University, Cardiff, Wales, UK
- Department of Neurosciences, Imaging, and Clinical Sciences, ‘G. D’Annunzio’ University of Chieti-Pescara, Chieti, Italy
- Institute for Advanced Biomedical Technologies, ‘G. D’Annunzio’ University of Chieti-Pescara, Chieti, Italy
| | - Patrik O. Wyss
- Department of Radiology, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Junqian Xu
- Biomedical Engineering and Imaging Institute, Department of Radiology, Graduate School of Biomedical Sciences, Icahn School of Medicine at Mount Sinai, New York, USA
- Department of Radiology, Baylor College of Medicine, Houston, Texas, USA
- Department of Psychiatry, Baylor College of Medicine, Houston, Texas, USA
| | - Julien Cohen-Adad
- NeuroPoly Lab, Institute of Biomedical Engineering, Polytechnique Montreal, Montreal, QC, Canada
- Centre de recherche du CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada
- Mila - Quebec AI Institute, Montreal, QC, Canada
- Functional Neuroimaging Unit, CRIUGM, University of Montreal, Montreal, Canada
| | - Christophe Lenglet
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - Igor Nestrašil
- Division of Clinical Behavioral Neuroscience, Department of Pediatrics, Masonic Institute for the Developing Brain, University of Minnesota, Minneapolis, MN, USA
- Center for Magnetic Resonance Research, Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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Clark JMR, Cao Y, Krause JS. Pain interference and depressive symptom severity across 10 years in individuals with long-term spinal cord injury. J Spinal Cord Med 2023:1-8. [PMID: 37982813 DOI: 10.1080/10790268.2023.2263940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
OBJECTIVE To examine change in pain interference and depression over a 10-year time period in individuals with long-term traumatic spinal cord injury (SCI) and to identify the extent to which changes in pain interference over time predicts change in depressive symptoms. DESIGN Longitudinal analyses of self-report assessment data. SETTING Specialty and university hospitals in the Southeastern and Midwestern United States. PARTICIPANTS Adults with a history of traumatic SCI (n = 504) who responded to the three most recent data collection periods of the SCI Longitudinal Aging Study (2008 [Time 1], 2013 [Time 2], and 2018 [Time 3]). The participants averaged 59 years of age and 32 years since injury onset at Time 3. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patient Health Questionnaire (PHQ-9) assessed depressive symptom severity. The 7-item Pain Interference scale from the Brief Pain Inventory assessed pain interference. RESULTS Over the three study timepoints, the sample averaged moderate levels of pain interference and mild depressive symptom severity. Unconditional linear growth models, reflecting changes in central tendency, indicated that pain interference significantly decreased and depressive symptom severity significantly increased over time. Multiple independent variables random coefficient modeling based on correlations suggested that change in pain interference was positively associated with change in depressive symptom severity over the 10-year study follow-up. CONCLUSION Average depressive symptom severity worsened over time. Change in pain interference was positively associated with change in depressive symptom severity. These results point to the complexity of aging related changes in depressive symptoms and pain interference. They further support the need for continued assessment of mood and pain experiences, particularly among individuals reaching aging milestones with SCI.
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Affiliation(s)
- Jillian M R Clark
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
- Center of Excellence for Stress and Mental Health, VA San Diego Healthcare System, San Diego, California, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, California, USA
| | - Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
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García-Rudolph A, Wright M, García L, Sauri J, Cegarra B, Tormos JM, Opisso E. Long-term prediction of functional independence using adjusted and unadjusted single items of the functional independence measure (FIM) at discharge from rehabilitation. J Spinal Cord Med 2023:1-12. [PMID: 36913541 DOI: 10.1080/10790268.2023.2183326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/15/2023] Open
Abstract
CONTEXT Being able to survive in the long-term independently is of concern to patients with spinal cord injury (SCI), their relatives, and to those providing or planning health care, especially at rehabilitation discharge. Most previous studies have attempted to predict functional dependency in activities of daily living within one year after injury. OBJECTIVES (1) build 18 different predictive models, each model using one FIM (Functional Independence Measure) item, assessed at discharge, as independent predictor of total FIM score at chronic phase (3-6 years post-injury) (2) build three different predictive models, using in each model an item from a different FIM domain with the highest predictive power obtained in objective (1) to predict "good" functional independence at chronic phase and (3) adjust the 3 models from objective (2) with known confounding factors. METHODS This observational study included 461 patients admitted to rehabilitation between 2009 and 2019. We applied regression models to predict total FIM score and "good" functional independence (FIM motor score ≥ 65) reporting adjusted R2, odds ratios, ROC-AUC (95% CI) tested using 10-fold cross-validation. RESULTS The top three predictors, each from a different FIM domain, were Toilet (adjusted R2 = 0.53, Transfers domain), Toileting (adjusted R2 = 0.46, Self-care domain), and Bowel (adjusted R2 = 0.35, Sphincter control domain). These three items were also predictors of "good" functional independence (AUC: 0.84-0.87) and their predictive power increased (AUC: 0.88-0.93) when adjusted by age, paraplegia, time since injury, and length of stay. CONCLUSIONS Discharge FIM items accurately predict long-term functional independence.
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Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Mark Wright
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Loreto García
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Joan Sauri
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Blanca Cegarra
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Josep Maria Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
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4
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Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury Suggested citation: Jeffery Johns, Klaus Krogh, Gianna M. Rodriguez, Janice Eng, Emily Haller, Malorie Heinen, Rafferty Laredo, Walter Longo, Wilda Montero-Colon, Mark Korsten. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers. Journal of Spinal Cord Med. 2021. Doi:10.1080/10790268.2021.1883385. J Spinal Cord Med 2021; 44:442-510. [PMID: 33905316 PMCID: PMC8115581 DOI: 10.1080/10790268.2021.1883385] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Affiliation(s)
- Jeffery Johns
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Klaus Krogh
- Department of Hepatology and Gastroenterology, Aarhus University Hospital, Aarhus, Denmark
| | - Gianna M Rodriguez
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Janice Eng
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Haller
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas, USA
| | | | - Walter Longo
- Department of Surgery, Division of Gastrointestinal Surgery, Yale University, New Haven, Connecticut, USA
| | | | - Mark Korsten
- Icahn School of Medicine at Mount Sinai, Department of Internal Medicine, Division of Gastroenterology, New York, New York, USA
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Detecting subgroups in social participation among individuals living with spinal cord injury: a longitudinal analysis of community survey data. Spinal Cord 2021; 59:419-428. [PMID: 33446936 DOI: 10.1038/s41393-020-00576-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/10/2020] [Accepted: 09/15/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Longitudinal community survey. OBJECTIVES To determine subgroups in social participation of individuals living with spinal cord injury (SCI). SETTING Community. METHODS Data were collected in 2012 and 2017 as part of the community survey of the Swiss Spinal Cord Injury cohort. Participation was assessed using the 33-item Utrecht Scale of Evaluation of Rehabilitation-Participation evaluating frequency of, restrictions in and satisfaction with productive, leisure, and social activities. Linear mixed-effects model trees were used to distinguish subgroups in participation associated with sociodemographic and lesion characteristics. RESULTS In all, 3079 observations were used for the analysis, of which 1549 originated from Survey 2012, 1530 from Survey 2017, and 761 from both surveys. Participants were mostly male (2012: 71.5%; 2017: 71.2%), aged on average 50 years (2012: 52.3; 2017: 56.5), with an incomplete paraplegia (2012: 37.5%; 2017: 41.8%) of traumatic origin (2012: 84.7%; 2017: 79.3%). There was limited within-person variation in participation over the 5-year period. Participation varied with age, SCI severity, education, financial strain, number of self-reported health conditions (SHCs), and disability pension level. Among modifiable parameters, the number of SHCs and disability pension level emerged as the most frequent partitioning variables, while education was most informative for participation in productive, leisure, and social activities. CONCLUSIONS Long-term rehabilitation management and clinical practice should target people most prone to decreased participation in major life domains. Our study indicates that the alleviation of SHCs, engagement in further education, or adjusting disability pension level are promising areas to improve participation of persons living with SCI.
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Johns J, Krogh K, Rodriguez GM, Eng J, Haller E, Heinen M, Laredo R, Longo W, Montero-Colon W, Wilson C, Korsten M. Management of Neurogenic Bowel Dysfunction in Adults after Spinal Cord Injury: Clinical Practice Guideline for Health Care Providers. Top Spinal Cord Inj Rehabil 2021; 27:75-151. [PMID: 34108835 PMCID: PMC8152174 DOI: 10.46292/sci2702-75] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Jeffery Johns
- Vanderbilt University Medical Center, Nashville, Tennessee USA
| | | | | | - Janice Eng
- University of British Columbia, Vancouver Canada
| | | | - Malorie Heinen
- University of Kansas Health Care System, Kansas City, Kansas USA
| | | | | | | | - Catherine Wilson
- Diplomate, American Board of Professional Psychology (RP) Private Practice, Denver, Colorado
| | - Mark Korsten
- Icahn School of Medicine @ Mt Sinai, New York, New York USA
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Change in environmental barriers experienced over a 5-year period by people living with spinal cord injury in Switzerland: a prospective cohort study. Spinal Cord 2020; 59:441-451. [PMID: 33230271 DOI: 10.1038/s41393-020-00580-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 09/27/2020] [Accepted: 09/29/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Cohort study with two measurement occasions. OBJECTIVES To investigate change in environmental barriers experienced by people living with spinal cord injury (SCI) over a 5-year period. SETTING Community, Switzerland. METHODS Data were from the Swiss spinal cord injury (SwiSCI) survey. Main outcome measure was the Nottwil Environmental Factors Inventory-Short Form. Random-effects Poisson regression featuring between-within estimation was used to examine predictors of the number of environmental barriers and of its change over time. RESULTS One thousand five hundred and forty-nine persons participated in Survey 2012 and 1530 participated in Survey 2017; 761 participated in both surveys. In both surveys most participants reported at least three barriers. Leading issues were unfavorable climate, inaccessibility of buildings and public spaces, and lack of or insufficiently adapted means of transportation. Reporting of barriers related to climate, finances, and state services declined over time. Between subjects, having more health problems, lesser physical independence, poorer mental health, and a lower household income were related to a higher number of barriers experienced. Within subjects, improvements in income, physical independence, and mental health over time were related to a reduction in barriers. CONCLUSIONS Inaccessibility of buildings and places and problems with transportation remained major barriers over a 5-year period and should be priorities of Swiss disability policy. People with reduced mental and physical health, and those with lower income are vulnerable groups deserving specific attention. Policies targeting income and life-long rehabilitation targeting health promotion and maintenance may be suitable means to reduce the experience of environmental barriers.
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Osterthun R, Tjalma TA, Spijkerman DCM, Faber WXM, van Asbeck FWA, Adriaansen JJE, Post MWM. Functional independence of persons with long-standing motor complete spinal cord injury in the Netherlands. J Spinal Cord Med 2018; 43:380-387. [PMID: 30124386 PMCID: PMC7241458 DOI: 10.1080/10790268.2018.1504427] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Context/Objective: Since life expectancy of persons with spinal cord injury (SCI) has improved, it is relevant to know whether this group is able to maintain functional abilities many years after onset of SCI. Objectives of this study were (1) to examine associations between time since injury (TSI) and functional independence in persons with long-standing SCI and (2) to explore associations between functional independence and level of injury, comorbidities, mental health, waist circumference and secondary health conditions (SHCs).Design: TSI-stratified cross-sectional study. Strata were 10-19, 20-29 and 30+ years.Setting: Community.Participants: 226 persons with long-standing SCI. Inclusion criteria: motor complete SCI; age at injury 18-35 years; TSI ≥ 10 years; current age 28-65 years; wheelchair dependency.Interventions: Not applicable.Outcome measures: The Spinal Cord Independence Measure III (SCIM) was administered by a trained research assistant. Level of injury, comorbidities, mental health, waist circumference and SHCs were assessed by a rehabilitation physician.Results: Mean TSI was 23.6 (SD 9.1) years. No significant differences in SCIM scores were found between TSI strata. SCIM scores were lower for persons with tetraplegia, autonomic dysreflexia, hypotension, more than four SHCs and a high waist circumference. In linear regression analyses, TSI nor age was associated with the SCIM total score. Only level of injury (β = -0.7; P < .001) and waist circumference (β = -0.1; P = .042) were independent determinants (explained variance 55%).Conclusion: We found no association between TSI and functional independence in persons with long-standing motor complete SCI. This study confirms the possible effect of overweight on functional independence.
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Affiliation(s)
- Rutger Osterthun
- Tolbrug Rehabilitation Centre, Jeroen Bosch Hospital, ‘s Hertogenbosch, the Netherlands,Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands,Rijndam Rehabilitation, Rotterdam, the Netherlands,Correspondence to: Rutger Osterthun, Rijndam Rehabilitation, Westersingel 300, 3015 LJ Rotterdam, the Netherlands.
| | - Tjitske A. Tjalma
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | | | | | - Floris W. A. van Asbeck
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Jacinthe J. E. Adriaansen
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
| | - Marcel W. M. Post
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands,Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands
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9
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Le Fort M, Espagnacq M, Perrouin-Verbe B, Ravaud JF. Risk Analyses of Pressure Ulcer in Tetraplegic Spinal Cord-Injured Persons: A French Long-Term Survey. Arch Phys Med Rehabil 2017; 98:1782-1791. [DOI: 10.1016/j.apmr.2016.12.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2016] [Revised: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 11/26/2022]
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Itzick M, Kagan M, Tal-Katz P. Perceived social support as a moderator between perceived discrimination and subjective well-being among people with physical disabilities in Israel. Disabil Rehabil 2017; 40:2208-2216. [PMID: 28549403 DOI: 10.1080/09638288.2017.1331380] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE Perceived social support has gained importance as a significant preventive factor of depressive symptoms and as helpful for rebuilding feelings of self-worth and subjective well-being among people with physical disabilities. The current study examined whether perceived social support moderates the association between perceived discrimination and subjective well-being among people with physical disabilities in Israel. MATERIALS AND METHODS Data were collected by means of structured questionnaires among a convenience sample of 433 people with physical disabilities in Israel and hierarchical multiple regression was performed. RESULTS AND CONCLUSIONS The findings reveal that perceived social support has a moderating role in the association between perceived discrimination and subjective well-being among people with physical disabilities, such that those with low and moderate levels of perceived social support showed a negative association between perceived discrimination and subjective well-being, while those with high levels of perceived social support showed no association between perceived discrimination and subjective well-being. Findings are discussed in light of the social model of disability, and practical implications are suggested. Implications for Rehabilitation A negative association was found between perceived discrimination and subjective well-being among people with physical disabilities with low and moderate levels of perceived social support. Professionals working with people with physical disabilities must acknowledge the importance of social support for people with physical disabilities and for their families. Professionals working with people with physical disabilities should take a proactive approach to locating disabled people who do not receive or do not have adequate social support and offer them assistance. Professionals working with people with physical disabilities should engage in wide social activities aimed at providing resources and opportunities to service beneficiaries. Society bears the collective responsibility to act in order to reduce the social problem of discrimination against people with disabilities, as well as to raise public awareness of this issue.
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Affiliation(s)
- Michal Itzick
- a School of Social Work , Ariel University , Ariel , Israel
| | - Maya Kagan
- a School of Social Work , Ariel University , Ariel , Israel
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11
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The natural course of spinal cord injury: changes over 40 years among those with exceptional survival. Spinal Cord 2016; 55:502-508. [PMID: 27922622 DOI: 10.1038/sc.2016.159] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 06/07/2016] [Accepted: 06/10/2016] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To identify 40-year longitudinal changes in health, activity, employment, life satisfaction and self-rated adjustment after spinal cord injury. STUDY DESIGN Longitudinal, mailed self-report. METHODS Participants were identified from outpatient records of a Midwestern USA university hospital in 1973. Follow-ups were conducted in 1984 and approximate 10-year intervals thereafter. A total of 49 participants completed each of the five assessments. Data were reviewed and analyzed by research team members and a research associate with experience in biostatistics at a medical university in Southeastern USA. Life Situation Questionnaire included the following: (1) demographic and injury characteristics, (2) educational status and employment, (3) community participation, (4) life satisfaction, (5) adjustment, and (6) recent medical history. RESULTS Proportion of individuals with 10+ non-routine physician visits increased from consistently <10% to >40% during the 40 years. Proportion who spent a week or more in hospital increased from a low of 10% at 20-year follow-up to 43% at 40-year follow-up. Percentage employed and average hours employed initially improved over time but decreased substantially during the last two times of measurement. Satisfaction with health, sex life and social life declined over time, whereas satisfaction with employment improved initially and was maintained over time. Self-rated current adjustment remained stable, whereas predicted future adjustment declined steadily over 40 years. CONCLUSIONS Age-related declines were apparent for need of physician visits and hospitalizations, with notable declines in satisfaction with sex life, social life and health. However, not all indices declined over time. Participants appeared to maintain stability when rating their own adjustment.
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12
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Carr JJ, Kendall MB, Amsters DI, Pershouse KJ, Kuipers P, Buettner P, Barker RN. Community participation for individuals with spinal cord injury living in Queensland, Australia. Spinal Cord 2016; 55:192-197. [PMID: 27897188 DOI: 10.1038/sc.2016.169] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 10/19/2016] [Accepted: 10/27/2016] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Sequential mixed method design. OBJECTIVES Determine factors associated with community participation for individuals with spinal cord injury (SCI). SETTING Queensland, Australia. METHODS Phase I consisted of a quantitative telephone survey of 270 people who had sustained a SCI within the past 50 years. To verify and interpret survey findings, Phase II involved a qualitative investigation. One focus group, one dyadic and one in-depth interview were conducted with a separate sample of eight people who had sustained a SCI within the past 50 years. RESULTS In Phase I, employment, paid or unpaid, was the strongest independent factor associated with community participation, whereas time since injury, completeness of injury, secondary conditions and functional independence were also independently associated. In Phase II, participants expressed that survey findings were consistent with their lived experiences. They explained that overall, they needed a strong reason to participate so that benefits outweigh the effort required to participate. Once out in the community, they recognised that other opportunities for participation arise. CONCLUSION Rehabilitation services need to support individuals with SCI to find meaningful employment and to engage in activities that provide them with a strong reason to participate.
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Affiliation(s)
- J J Carr
- College of Healthcare Sciences, James Cook University, Cairns, Queensland, Australia
| | - M B Kendall
- Transitional Rehabilitation Program, Queensland Spinal Cord Injuries Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - D I Amsters
- Spinal Outreach Team, Queensland Spinal Cord Injuries Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - K J Pershouse
- Spinal Outreach Team, Queensland Spinal Cord Injuries Service, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - P Kuipers
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South Health, Brisbane, Queensland, Australia
| | - P Buettner
- College of Public Health, Medical & Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - R N Barker
- College of Healthcare Sciences, James Cook University, Cairns, Queensland, Australia
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13
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Hinrichs T, Lay V, Arnet U, Eriks-Hoogland I, Koch HG, Rantanen T, Reinhardt JD, Brinkhof MWG. Age-related variation in mobility independence among wheelchair users with spinal cord injury: A cross-sectional study. J Spinal Cord Med 2016; 39:180-9. [PMID: 25832471 PMCID: PMC5072494 DOI: 10.1179/2045772315y.0000000008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To evaluate age-related variation in mobility independence among community-living wheelchair users with spinal cord injury (SCI). DESIGN Community Survey (2011-2013) as part of the Swiss Spinal Cord Injury Cohort Study. SETTING Community. PARTICIPANTS Individuals aged 16 years or older with traumatic or non-traumatic SCI permanently residing in Switzerland and using a wheelchair for moving around moderate distances (10-100 m). INTERVENTIONS Not applicable. OUTCOME MEASURES Mobility-related items of the Spinal Cord Independence Measure-Self Report were matched to the three principal domains "changing basic body position," "transferring oneself" and "moving around." Binary outcomes ("independence" vs. "no independence") were created for every domain and analyzed using multivariable logistic regression (adjusted for sex, socioeconomic factors, SCI characteristics, and health conditions). RESULTS Regression analyses (N = 949; 27% women; median age 51, interquartile range 41-61) showed a decline in the odds of independence (odds ratio; 95% confidence interval) with increasing age for "changing basic body position" (age 16-30 (reference), 31-45 (0.99; 0.53-1.83), 46-60 (0.64; 0.33-1.21), 61-75 (0.45; 0.22-0.92), 76+ (0.18; 0.07-0.44); P < 0.001), "transferring oneself" (age 16-30 (reference), 31-45 (0.77; 0.37-1.61), 46-60 (0.39; 0.18-0.84), 61+ (0.05; 0.02-0.14); P < 0.001), and "moving around" (age 16-30 (reference), 31-45 (0.79; 0.42-1.48), 46-60 (0.49; 0.26-0.94), 61-75 (0.49; 0.24-1.01), 75+ (0.11; 0.04-0.30); P < 0.001). CONCLUSIONS Mobility independence was negatively associated with age in wheelchair users with SCI. Future longitudinal analyses are required to gain further insights into the causal factors for the age-related decline.
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Affiliation(s)
- Timo Hinrichs
- Swiss Paraplegic Research, Nottwil, Switzerland,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland,Correspondence to: Timo Hinrichs, Swiss Paraplegic Research, Guido A. Zäch-Strasse 4, CH-6207 Nottwil, Switzerland.
| | | | - Ursina Arnet
- Swiss Paraplegic Research, Nottwil, Switzerland,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Inge Eriks-Hoogland
- Swiss Paraplegic Research, Nottwil, Switzerland,Swiss Paraplegic Center, Nottwil, Switzerland
| | | | - Taina Rantanen
- Gerontology Research Center and Department of Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Jan D. Reinhardt
- Swiss Paraplegic Research, Nottwil, Switzerland,Institute for Disaster Management and Reconstruction, Sichuan University, Chengdu, People’s Republic of China,Hong Kong Polytechnic University, Hong Kong, People’s Republic of China
| | - Martin W. G. Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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Long-term change in respiratory function following spinal cord injury. Spinal Cord 2016; 54:714-9. [PMID: 26754472 DOI: 10.1038/sc.2015.233] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVES To model the effect of time since injury on longitudinal respiratory function measures in spinal cord injured-individuals and to investigate the effect of patient characteristics. SETTING A total of 173 people who sustained a spinal cord injury between 1966 and April 2013 and who had previously participated in research or who underwent clinically indicated outpatient respiratory function tests at the Austin Hospital in Melbourne, Australia, were included in the study. At least two measurements over time were available for analysis in 59 patients. METHODS Longitudinal data analysis was performed using generalised linear regression models to determine changes in respiratory function following spinal cord injury from immediately post injury to many years later. Secondly, we explored whether injury severity, age, gender and body mass index (BMI) at injury altered the time-dependent change in respiratory function. RESULTS The generalised linear regression model showed no significant change (P=0.276) in respiratory function measured in (forced) vital capacity ((F)VC) after the spinal cord injury. However, significant (P<0.05) differences in respiratory function over time were found when categorising age and BMI. CONCLUSION This clinical cohort with long-term, repeated measurements of respiratory function showed no significant overall change in respiratory function over 23 years. However, a decline in respiratory function over time was observed in subgroups of individuals older than 30 years at the onset of injury and in those with a BMI>30 kg m(-2).
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Hwang M, Zebracki K, Chlan KM, Vogel LC. Longitudinal changes in medical complications in adults with pediatric-onset spinal cord injury. J Spinal Cord Med 2014; 37:171-8. [PMID: 24090490 PMCID: PMC4066425 DOI: 10.1179/2045772313y.0000000150] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES To determine longitudinal changes in the occurrence of medical complications in adults with pediatric-onset spinal cord injury (SCI). DESIGN Longitudinal study of long-term outcomes. SETTING Community. PARTICIPANTS Individuals who had sustained an SCI before age 19, were 23 years of age or older at initial interview, and followed annually between 1996 and 2011. They were classified into four American Spinal Injury Association (ASIA) Impairment Scale (AIS) severity groups: C1-4 AIS ABC, C5-8 AIS ABC, T1-S5 AIS ABC, AIS D. OUTCOME MEASURES Generalized estimating equation (GEE) models were formulated to obtain the odds ratio (OR) of having a medical complication over time. RESULTS A total of 1793 interviews were conducted among 226 men and 125 women (86% Caucasian; age at baseline, 26.7 ± 3.6 years; time since injury at baseline, 12.9 ± 5.2 years). Odds of complication occurrence over time varied among severity groups, with increased ORs of severe urinary tract infection (1.05, confidence interval (CI) 1.02-1.09), autonomic dysreflexia (AD) (1.09, CI 1.05-1.14), spasticity (1.06, CI 1.01-1.11), pneumonia/respiratory failure (1.09, CI 1.03-1.16), and hypertension/cardiac disease (1.07, CI 1.01-1.15) in the C1-4 ABC group; AD (1.08, CI 1.04-1.13) and pneumonia/respiratory failure (1.09, CI 1.02-1.16) in the C5-8 ABC group; and hypertension/cardiac disease (1.08, CI 1.02-1.14) in the T1-S5 ABC group. Upper extremity joint pain had increased odds of occurrence in all injury severity groups. CONCLUSION The significantly increased odds of having medical complications over time warrants awareness of risk factors and implementation of preventive measures to avoid adverse consequences of complications and to maintain independence in individuals with pediatric-onset SCI.
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Affiliation(s)
- Miriam Hwang
- Correspondence to: Miriam Hwang, Department of Clinical Research, Shriners Hospitals for Children, 2211 N Oak Park Avenue, Chicago, IL 60707, USA.
| | | | - Kathleen M. Chlan
- Department of Clinical Research, Shriners Hospitals for Children, Chicago, IL, USA
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Frequency and age effects of secondary health conditions in individuals with spinal cord injury: a scoping review. Spinal Cord 2013; 51:882-92. [PMID: 24126851 DOI: 10.1038/sc.2013.112] [Citation(s) in RCA: 123] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 07/21/2013] [Accepted: 08/01/2013] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Scoping review. OBJECTIVES To gain a better understanding of the prevalence, course and association with age of secondary health conditions in individuals with spinal cord injury (SCI). SETTING Seattle, Washington, USA. METHODS We performed searches of electronic databases for studies published from 1986-2011 that provided information regarding the prevalence, course or associations with age and duration of secondary health conditions in individuals with SCI. RESULTS Ninety-two studies were included. The findings indicate that: (1) individuals with SCI experience a number of secondary health conditions, many of which occur at a higher rate in those with SCI than the normative population; (2) the most common conditions or symptoms are pain, bowel and bladder regulation problems, muscle spasms, fatigue, esophageal symptom and osteoporosis; (3) a number of conditions, including cardiovascular disease, diabetes, bone mineral density loss, fatigue and respiratory complications or infections, occur with higher frequency in older individuals or those with longer SCI duration, relative to younger individuals or those with shorter SCI duration; and (4) there is a marked lack of longitudinal research examining the natural course of health conditions in individuals aging with SCI. CONCLUSIONS The findings support the conclusion that individuals with SCI show signs of 'premature aging' in different organ systems. Longitudinal research is needed to understand when problems are most likely to emerge, and to develop and test the efficacy of interventions to prevent these health conditions and their negative impact.
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Alschuler KN, Jensen MP, Sullivan-Singh SJ, Borson S, Smith AE, Molton IR. The association of age, pain, and fatigue with physical functioning and depressive symptoms in persons with spinal cord injury. J Spinal Cord Med 2013; 36:483-91. [PMID: 23941796 PMCID: PMC3739898 DOI: 10.1179/2045772312y.0000000072] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
CONTEXT/OBJECTIVE To describe the relationship of pain and fatigue with physical and psychological functioning in adults with spinal cord injury (SCI). DESIGN Cross-sectional survey. SETTING Community-based survey. PARTICIPANTS Convenience sample of individuals with SCI. INTERVENTION Not applicable. OUTCOME MEASURES Physical functioning (Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Functioning item bank items), depression (Patient Health Questionnaire-9 (PHQ-9)), pain severity (0-10 Numerical Rating Scale (NRS)), and fatigue (0-10 NRS). RESULTS Pain and fatigue were independently associated with depression, but only pain was associated with physical functioning. Additionally, depression was more severe among middle-aged participants relative to younger or older participants. Physical functioning declined with increasing age, as well as with higher level of injury. CONCLUSIONS The findings support the need for continued development of effective treatments for both pain and fatigue in order to prevent and mitigate the negative effects these symptoms can have on functioning.
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Affiliation(s)
- Kevin N. Alschuler
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA,Correspondence to: Kevin N. Alschuler, Department of Rehabilitation Medicine, University of Washington, UW Medicine Multiple Sclerosis Center, 1536 N 115th St., Seattle, WA 98133, USA.
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Sarah J. Sullivan-Singh
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Soo Borson
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA
| | - Amanda E. Smith
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Ivan R. Molton
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Biering-Sørensen F, Burns AS, Curt A, Harvey LA, Jane Mulcahey M, Nance PW, Sherwood AM, Sisto SA. International spinal cord injury musculoskeletal basic data set. Spinal Cord 2012; 50:797-802. [PMID: 22945748 DOI: 10.1038/sc.2012.102] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To develop an International Spinal Cord Injury (SCI) Musculoskeletal Basic Data Set as part of the International SCI Data Sets to facilitate consistent collection and reporting of basic musculoskeletal findings in the SCI population. SETTING International. METHODS A first draft of an SCI Musculoskeletal Basic Data Set was developed by an international working group. This was reviewed by many different organizations, societies and individuals over 9 months. Revised versions were created successively. RESULTS The final version of the International SCI Musculoskeletal Basic Data Set contains questions on neuro-musculoskeletal history before spinal cord lesion; presence of spasticity/spasms; treatment for spasticity within the last 4 weeks; fracture(s) since the spinal cord lesion; heterotopic ossification; contracture; the location of degenerative neuromuscular and skeletal changes due to overuse after SCI; SCI-related neuromuscular scoliosis; the method(s) used to determine the presence of neuromuscular scoliosis; surgical treatment of the scoliosis; other musculoskeletal problems; if any of the musculoskeletal challenges above interfere with activities of daily living. Instructions for data collection and the data collection form are freely available on the International Spinal Cord Society (ISCoS) website (www.iscos.org.uk). CONCLUSION The International SCI Musculoskeletal Basic Data Set will facilitate consistent collection and reporting of basic musculoskeletal findings in the SCI population.
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Affiliation(s)
- F Biering-Sørensen
- Clinic for Spinal Cord Injuries, Glostrup Hospital and Rigshospitalet, Copenhagen, Denmark.
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Rose J. Lessons for spinal cord injury rehabilitation taken from adult developmental psychology: 2011 Essie Morgan Lecture. J Spinal Cord Med 2012; 35:133-9. [PMID: 22507022 PMCID: PMC3324829 DOI: 10.1179/2045772312y.0000000006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND/OBJECTIVE Developmental phases affect how individuals cope with and challenge threats to self-concept, health and functioning. Understanding prominent models of adult psychological development can help spinal cord injury/disease (SCI/D) rehabilitation professionals facilitate positive change and growth. DESIGN Author's theoretical model informed by literature review and personal experience. SETTING Veterans administration (VA) medical center interdisciplinary outpatient clinic providing primary and specialty care to veterans with spinal cord injuries and disorders. CONCLUSION Threats to life expectations, health, well-being, identity, and other aspects of self create crises that can result in psychopathology or psychological growth. SCI/D can present multiple threats across the lifespan. For example, self-image, ability to perform various activities, ability to feel attractive, and even life itself may be challenged by SCI/D or its complications. Threats may be perceived at the time of injury or onset of symptoms. Also, as the injured body declines further over time, complications can cause significant temporary or permanent functional decline. Individuals interpret each of these threats in the context of current developmental needs. How people cope is influenced by developmental factors and personality traits. An integrated model of adult psychological development based on the works of Erikson, Gutmann, and Baltes is related to the literature on coping with SCI/D. This model provides insights that interdisciplinary rehabilitation teams may use to facilitate personal growth, optimal functioning, and physical health as adults with SCI negotiate normal developmental challenges throughout their lifetimes.
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Affiliation(s)
- Jon Rose
- Veterans Affairs Palo Alto Health Care System, Spinal Cord Injuries and Disorders Clinic, Palo Alto, CA 94304, USA.
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Krause JS, Bozard JL. Natural course of life changes after spinal cord injury: a 35-year longitudinal study. Spinal Cord 2011; 50:227-31. [DOI: 10.1038/sc.2011.106] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Yorkston KM, McMullan KA, Molton I, Jensen MP. Pathways of change experienced by people aging with disability: a focus group study. Disabil Rehabil 2010; 32:1697-704. [PMID: 20225933 DOI: 10.3109/09638281003678317] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To examine the issues related to aging with disability from the perspective of the person with the disabilities. METHOD Twelve community-dwelling adults with spinal cord injury (SCI), post-polio syndrome (PPS) or multiple sclerosis (MS) participated in focus groups where they were asked open-ended questions about changes related to aging with disability, accommodations made and perspectives on the future. RESULTS Results of qualitative analysis suggested five major themes related to aging with a disability: (1) Participant identity, including comments about how participants described themselves and their lives with a long-standing disability; (2) Physical pathways including comments about the progression of physical symptoms; (3) Psychosocial pathways, including descriptions of adaptations to disability, the development of emotional well-being and strategies to deal with disability; (4) Changing health care, reflecting improvement noted over time in health care services; and (5) Concerns about the future, including comments reflecting participant uncertainty about the potential course of disability. CONCLUSIONS The process of aging with disability was characterised by multiple pathways. Some, including positive psychosocial adjustment and medical advancements, were favourable, while others, including physical decline, were not. The co-existence of high quality of life in the presence of physical decline is consistent with a larger literature in older adults, and future research should focus on identifying aging factors that may contribute to the buffering the psychological impact of physical decline.
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Affiliation(s)
- Kathryn M Yorkston
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA 98195-6490, USA.
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An evidence-based review of aging of the body systems following spinal cord injury. Spinal Cord 2010; 49:684-701. [PMID: 21151191 DOI: 10.1038/sc.2010.178] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVE To systematically review evidence on aging of the body systems after spinal cord injury (SCI). SETTING Toronto, Ontario and Vancouver, British Columbia, Canada. METHODS Electronic databases (MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO), were searched for studies published between 1980 and 2009. The search was augmented by reviewing the reference lists of relevant papers. Non-intervention studies that were longitudinal or cross-sectional with able-bodied controls that were at minimum matched on chronological age were included for review. Levels of evidence were assigned to the study design using a modified Sackett scale. RESULTS Of the 74 studies selected for inclusion, 16 were longitudinal in design. The hypothesis that SCI represents a model for premature aging is supported by a large proportion of level 5 evidence for the cardiovascular and endocrine systems, level 2, 4 and 5 evidence for the musculoskeletal system, and limited level 5 evidence for the immune system. Only a few level 4 and 5 studies for the respiratory system were found. The evidence on the genitourinary system, gastrointestinal system, and for skin and subcutaneous tissues provide level 4 and 5 evidence that premature aging may not be occurring. The evidence on the nervous system does not provide evidence of premature aging as a result of SCI. CONCLUSIONS Premature aging appears to occur in some systems after SCI. Additional longitudinal studies are required to confirm these findings.
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Mackay J, Charles ST, Kemp B, Heckhausen J. Goal striving and maladaptive coping in adults living with spinal cord injury: associations with affective well-being. J Aging Health 2010; 23:158-76. [PMID: 20876363 DOI: 10.1177/0898264310382039] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The current study examined how goal engagement and two coping strategies (self-blame and denial) hypothesized to prevent successful disengagement relate to affective well-being among adults with a functional disability. METHOD Ninety-nine community-dwelling adults (23 to 76 years old, 66 men) with spinal cord injury participated in structured interviews assessing affective well-being using the Positive and Negative Affect Scale (Watson, Clark, & Tellegen, 1988); goal engagement using a modified version of the Optimization, Primary, and Secondary Control Scale (Heckhausen, Schulz, & Wrosch, 1998); and self-blame and denial using items from Carver's (1997) Brief COPE Inventory. RESULTS Greater goal engagement was significantly associated with positive but not negative affect. Greater use of self-blame and denial coping was associated with lower positive affect for older adults and higher negative affect across the age range. IMPLICATIONS
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Groah S, Kehn M. The State of Aging and Public Health for People with Spinal Cord Injury: Lost in Transition? Top Spinal Cord Inj Rehabil 2010. [DOI: 10.1310/sci1503-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Savic G, Charlifue S, Glass C, Soni B, Gerhart K, Ali Jamous. British Ageing with SCI Study: Changes in Physical and Psychosocial Outcomes over Time. Top Spinal Cord Inj Rehabil 2010. [DOI: 10.1310/sci1503-41] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Abstract
STUDY DESIGN A postal survey. OBJECTIVE To ascertain the incidence of pain in individuals with paraplegia in India and to associate it with demographic characteristics. SETTING India. METHOD The study was done by means of a questionnaire. This questionnaire was mailed to the identified individuals (n=600) on the addresses obtained from the medical records section of hospitals and from various organizations. Data analysis was done by using non-parametric tests of association. RESULTS The return rate was 46% (276/600). Fifty-seven percent of individuals complained of pain. Of this, pain in the back and chest ranked the highest (30.1%), followed by pain below the level of lesion (6.9%), pain in the shoulder and upper limb (4.7%) and neck (0.4%). Fifteen percent of individuals complained of pain at multiple sites. We found a significant association of pain with age, duration since injury and ambulation. CONCLUSION More than half of the subjects complained of pain in the study. Pain was found to be associated with age, duration since injury and ambulation. As pain has a dramatic effect on a subjects' quality of life, there is a need to evaluate it in detail and treat accordingly with preventive, rehabilitative or surgical procedures.
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Wearmouth H, Wielandt T. 'Reserve is no place for a wheelchair': challenges to consider during wheelchair provision intended for use in First Nations community. Disabil Rehabil Assist Technol 2009; 4:321-8. [PMID: 19484640 DOI: 10.1080/17483100902807120] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to gain an understanding of the post-rehabilitation experiences of First Nations persons with spinal cord injury who returned to live on reserve using a wheelchair. METHOD A phenomenological approach with purposive sampling was employed to recruit participants with spinal cord injuries who used a wheelchair and lived in a First Nations community. Data were collected using a short demographic questionnaire and a semi-structured interview. RESULTS Most participants returned to live on reserve in homes that were not wheelchair accessible and only two had home assessments completed. Nearly all either moved to modified homes or had homes purpose built for them after waiting considerable periods of time to relocate. However, only one of these homes was considered completely accessible. Participants identified other challenges they coped with including the effects of other medical conditions, negotiating reserve terrain and accessing cultural activities. CONCLUSIONS The findings show that policy changes are required regarding the allocation of funding to ensure accessible on reserve housing for First Nations persons with a SCI. Further recommendations were made regarding the cultural content of health professional curricula as well as the need for health professionals to liaison more closely with Aboriginal health care workers.
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Affiliation(s)
- Heather Wearmouth
- Department of Occupational Therapy, Foothills Medical Centre, Calgary, Alberta, Canada
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Employment status after spinal cord injury (1992–2005): a review with implications for interpretation, evaluation, further research, and clinical practice. Int J Rehabil Res 2009; 32:1-11. [DOI: 10.1097/mrr.0b013e32831c8b19] [Citation(s) in RCA: 67] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Margot-Duclot A, Tournebise H, Ventura M, Fattal C. What are the risk factors of occurence and chronicity of neuropathic pain in spinal cord injury patients? Ann Phys Rehabil Med 2009; 52:111-23. [PMID: 19909702 DOI: 10.1016/j.rehab.2008.12.003] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Accepted: 12/17/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Analyze the epidemiological data on neuropathic pain in spinal cord injury patients and determine the risk factors for its occurrence and chronicity. METHOD Review and analysis of the literature. RESULTS Epidemiological data report that 40% of spinal cord injury (SCI) patients suffer from neuropathic pain and 40% of these patients report an intense neuropathic pain. Some factors do not seem to be predictive for the onset of neuropathic pain: the level of injury, complete or incomplete injury, the existence of an initial surgery, sex. However, old age at the time of injury, bullet injury as the cause of trauma, early onset of pain in the weeks following the injury, their initial nature, intensity and continuous pain, as well as associated symptoms all appear to be negative prognostic factors. CONCLUSION Neuropathic pain in SCI patients is a major issue, its determining factors still need to be evaluated properly by refining the epidemiological data.
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van Koppenhagen CF, Post MW, van der Woude LH, de Witte LP, van Asbeck FW, de Groot S, van den Heuvel W, Lindeman E. Changes and determinants of life satisfaction after spinal cord injury: a cohort study in the Netherlands. Arch Phys Med Rehabil 2008; 89:1733-40. [PMID: 18675395 DOI: 10.1016/j.apmr.2007.12.042] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2007] [Revised: 12/09/2007] [Accepted: 12/17/2007] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the impact of spinal cord injury (SCI) on life satisfaction of persons with SCI 1 year after discharge of inpatient rehabilitation. DESIGN A cohort study. Life satisfaction before SCI was retrospectively measured at the start of active rehabilitation. One year after discharge from inpatient rehabilitation, current life satisfaction was measured. SETTING Eight rehabilitation centers in The Netherlands. PARTICIPANTS Persons (N=147) aged 18 to 65 and wheelchair-dependent at least for long distances. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The Life Satisfaction Questionnaire. RESULTS Mean satisfaction with life +/- SD as a whole was 5.3+/-0 before SCI and 4.3+/-1.3 one year after inpatient rehabilitation. Sexual life, self-care, and vocational situation showed the largest impact of SCI (P<.05), whereas the social relationships domains appeared to be the least affected. Decrease of life satisfaction after SCI was larger when using the retrospective ratings than when using general population scores. Significant determinants of life satisfaction after SCI were high lesion level (beta=.31, P<.05), pain (beta=.19, P<.05), and secondary impairments (beta=.22, P<.05). CONCLUSIONS Life satisfaction decreased in persons with SCI. Level of lesion and suffering secondary impairments or pain were associated with low life satisfaction 1 year after discharge from inpatient rehabilitation.
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The relationship between quality of life and disability across the lifespan for people with spinal cord injury. Spinal Cord 2008; 47:149-55. [PMID: 18594553 DOI: 10.1038/sc.2008.82] [Citation(s) in RCA: 107] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
STUDY DESIGN Prospective cross-sectional survey. OBJECTIVES To compare quality of life (QOL) for people with spinal cord injury (SCI) and their able-bodied peers and to investigate the relationship between QOL and disability (impairments, activity limitations and participation restrictions) across the lifespan, for people with SCI. SETTING A community outreach service for people with SCI in Queensland, Australia. METHODS A random sample of 270 individuals who sustained SCI during the past 60 years was surveyed using a guided telephone interview format. The sample was drawn from the archival records of a statewide rehabilitation service. QOL was measured using the World Health Organization Quality of Life Assessment Instrument-Bref, impairment was measured according to the American Spinal Injury Association classification and the Secondary Condition Surveillance Instrument, activity limitations using the motor subscale of the Functional Independence Measure and participation restrictions using the Community Integration Measure. Lifespan was considered in terms of age and time since injury. Correlation and regression analyses were employed to determine the relationship between QOL and components of disability across the lifespan. RESULTS QOL was significantly poorer for people with SCI compared to the Australian norm. It was found to be associated with secondary impairments, activity limitations and participation restrictions but not with neurological level, age or time since injury. The single most important predictor of QOL was secondary impairments whereas the second most important predictor was participation. CONCLUSION To optimize QOL across the lifespan, rehabilitation services must maintain their focus on functional attainment and minimizing secondary conditions, although at the same time enabling participation.
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Lidal IB, Veenstra M, Hjeltnes N, Biering-Sørensen F. Health-related quality of life in persons with long-standing spinal cord injury. Spinal Cord 2008; 46:710-5. [DOI: 10.1038/sc.2008.17] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Nash MS, Mendez AJ. A guideline-driven assessment of need for cardiovascular disease risk intervention in persons with chronic paraplegia. Arch Phys Med Rehabil 2007; 88:751-7. [PMID: 17532897 DOI: 10.1016/j.apmr.2007.02.031] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine percentages of persons with chronic paraplegia who qualify for lipid-lowering therapeutic lifestyle intervention (TLI) as assessed by authoritative guidelines. DESIGN Cross-sectional. SETTING Academic medical center. PARTICIPANTS Forty-one subjects (mean age +/- standard deviation, 34+/-11 y) with motor-complete paraplegia (American Spinal Injury Association grade A or B) at T6-L1 levels for greater than 2 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Percentages of subjects qualifying for TLI were independently assessed and then compared using National Cholesterol Education Project Adult Treatment Panel (ATP) II (1994) and ATP III (2002) Guidelines. RESULTS A total of 34.1% of subjects qualified for intervention based on the ATP II Guidelines and 63.4% based on ATP III (chi1(2) test=4.53; 2-tailed, P=.003). Seventy-six percent (31/41) of study participants had high-density lipoprotein cholesterol levels below the high-risk criterion of 40 mg/dL established by ATP III. Almost one third of subjects had hypertension, and 34.1% satisfied criteria for diagnosis of the metabolic syndrome. CONCLUSIONS A high percentage of young, apparently healthy people with chronic paraplegia are at risk for cardiovascular disease and qualify for lipid-lowering TLI. Updated guidelines of the ATP III have increased the urgency for early risk assessment and intervention.
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Affiliation(s)
- Mark S Nash
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, FL 33136, USA.
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Jain NB, Sullivan M, Kazis LE, Tun CG, Garshick E. Factors associated with health-related quality of life in chronic spinal cord injury. Am J Phys Med Rehabil 2007; 86:387-96. [PMID: 17449983 PMCID: PMC2292343 DOI: 10.1097/phm.0b013e31804a7d00] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVE An important goal of rehabilitation and treatment after spinal cord injury (SCI) is to improve function and enhance health-related quality of life (HRQoL). However, previous assessments are limited by use of HRQoL instruments not specific to SCI. Although respiratory dysfunction is common in SCI, it has not been possible to assess the association of comorbid medical conditions, including respiratory symptoms and pulmonary function, to HRQoL. Therefore, we assessed whether these factors were associated with HRQoL in SCI using an SCI-specific HRQoL questionnaire. DESIGN In our cross-sectional study, 356 participants >or=1 yr post-SCI completed a 23-item SCI-specific HRQoL questionnaire and a detailed health questionnaire, and underwent pulmonary function testing and a neurological exam at VA Boston between 1998 and June 2003. RESULTS In a multivariate regression model, age, employment status, motor level and completeness of injury, and ambulatory mode (use of hand-propelled or motorized wheelchair, use of crutches or canes, or walking independently) were independently associated with HRQoL. After adjusting for these factors, chronic cough, chronic phlegm, persistent wheeze, dyspnea with activities of daily living, and lower forced expiratory volume in 1 sec and forced vital capacity were each associated with a lower HRQoL. CONCLUSIONS These results provide evidence for the clinical validity of our SCI-specific HRQoL instrument. We also identify potentially modifiable factors that, if addressed, may lead to HRQoL improvement in SCI.
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Affiliation(s)
- Nitin B Jain
- VA Boston Healthcare System, West Roxbury, Massachusetts, USA.
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Abstract
STUDY DESIGN Postal survey from August 2004 to May 2006. OBJECTIVE To ascertain the morbidity trends in individuals with paraplegia in India and to find its association with demographic characteristics. SETTINGS India. METHODS The questionnaire was mailed to the identified individuals (n=600) whose addresses were obtained from the medical records section of our hospital and by contacting non-government organizations (NGOs), working for individuals with paraplegia in various cities. The causes of morbidities surveyed were respiratory complications, use of catheter, pressure sores, spasticity, postural hypotension, pain and fractures. Data were analysed using nonparametric test of association (Goodman Kruskal Tau). RESULTS A total of 276 (46%) individuals responded. Of all the morbidities studied, pain was the leading cause (57.2%) followed by spasticity (39.1%), pressure sore (28.3%), postural hypotension (10.1%), respiratory complications, and fractures (5.8%). We found significant associations between various morbidities and demographics and between morbidities themselves. CONCLUSION The most common cause for morbidity was pain. Ambulation reduced the incidence of secondary complications.
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Affiliation(s)
- N Gupta
- Department of Physiotherapy, Manipal College of Allied Health Sciences, Manipal, Karnataka, India
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Devitt R, Colantonio A, Dawson D, Teare G, Ratcliff G, Chase S. Prediction of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury. Disabil Rehabil 2006; 28:547-59. [PMID: 16690584 DOI: 10.1080/00222930500219258] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE To examine predictors of long-term occupational performance outcomes for adults after moderate to severe traumatic brain injury (TBI). METHOD This study involved analysis of data from a retrospective cohort of adults (N = 306) with moderate to severe TBI discharged from a Pennsylvania rehabilitation treatment facility. Extensive pre-injury sociodemographic, injury-severity, post-injury personal (cognitive, physical, affective), post-injury environmental (social, institutional, physical), and post-injury occupational performance (participation in self-care, productivity, leisure activities) data were gathered from hospital records and using in-person interviews. Interviews occurred at a mean time of 14 (range, 7-24) years post-injury. Hierarchical multiple regression analysis was used to investigate determinants of long-term occupational performance outcomes. RESULTS Pre-injury behavioural problems, male gender, post-injury cognitive and physical deficits, and lack of access to transportation were significant independent predictors of worse occupational performance outcomes. CONCLUSIONS The study supports the use of a comprehensive model for long-term outcomes after TBI where pre-injury characteristics and post-injury cognitive and physical characteristics account for the greatest proportion of explained variance.
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Affiliation(s)
- R Devitt
- Arthritis Community Research and Evaluation Unit, Toronto, Canada
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Affiliation(s)
- Marca L Sipski
- Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham, Birmingham, Alabama 35233, USA
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Barat M. [Assessment of chronic pain in spinal cord injury]. ANNALES DE READAPTATION ET DE MEDECINE PHYSIQUE : REVUE SCIENTIFIQUE DE LA SOCIETE FRANCAISE DE REEDUCATION FONCTIONNELLE DE READAPTATION ET DE MEDECINE PHYSIQUE 2006; 49:138-9. [PMID: 16488049 DOI: 10.1016/j.annrmp.2006.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Accepted: 01/04/2006] [Indexed: 05/06/2023]
Affiliation(s)
- M Barat
- Fédération des neurosciences cliniques, unités de rééducation neurologique, université Victor-Segalen-Bordeaux-II, CHU de Bordeaux, Bordeaux cedex, France.
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Abstract
BACKGROUND/OBJECTIVE This longitudinal study investigated changes in life satisfaction, general health, activities, and adjustment over 3 decades among individuals with spinal cord injury (SCI). PARTICIPANTS The cohort of participants was identified from outpatient records of a large Midwestern United States university hospital. In 1973, 256 individuals completed an initial survey. There were 5 subsequent follow-up surveys, with the most recent being in 2002. Seventy-eight participants completed materials on all 6 occasions. METHODS The Life Situation Questionnaire was used to identify changes over the 30-year period in 6 areas of life satisfaction, self-rated adjustment (current and predicted), employment status, activities, and medical treatments. ANALYSES These analyses used data from 3 points in time, separated by approximately 15-year intervals. One-way analysis of variance with repeated measures was used to identify changes in outcomes between 1973, 1988, and 2002 for all continuous variables. RESULTS We found a mixed pattern of changes over the 30 years, with increases noted during the first 15-year period in sitting tolerance, educational and employment outcomes, satisfaction with employment, and adjustment. Although these changes tended to remain stable during the last 15 years, subtle declines were suggested in some areas, with clear declines noted in terms of diminished sitting tolerance, an increase in the number of physician visits, and decreased satisfaction with social life and sex life. CONCLUSIONS The results suggest that many positive changes occur within the first 2 decades after SCI, followed by a period of stability in some life areas, but decline with aging in some participation and health-related aspects of life.
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Affiliation(s)
- James S Krause
- Department of Rehabilitation Science, Medical University of South Carolina, Charleston, South Carolina
| | - Jennifer L Coker
- Department of Rehabilitation Science, Medical University of South Carolina, Charleston, South Carolina
- Please address correspondence to Jennifer L. Coker, MPH, Medical University of South Carolina, Charleston, SC 31313; phone: 843.792.2605; fax: 843.792.1107 (e-mail: )
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Collins EG, Langbein WE, Smith B, Hendricks R, Hammond M, Weaver F. Patients' perspective on the comprehensive preventive health evaluation in veterans with spinal cord injury. Spinal Cord 2005; 43:366-74. [PMID: 15685261 DOI: 10.1038/sj.sc.3101708] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Survey research methods. OBJECTIVES To assess patient satisfaction with the annual comprehensive preventative health evaluation (CPHE) and to determine if the patient's needs were being met. SETTING Department of Veterans Affairs National Survey, United States. METHODS A total of 853 subjects with spinal cord injuries participated in a mailed survey regarding the annual CPHE. Subjects were asked about satisfaction with the examination, preferences on how the examination is conducted and whether their needs were being met with the examination. RESULTS In all, 76% of the subjects that responded to the survey had completed a CPHE within the previous year. Subjects cited getting their medication and supplies refilled and talking to the doctor as the top two reasons for completing the evaluation. Subjects indicated that they would most like to discuss their muscle strength and weakness, bladder care, chronic pain, digestion and bowel care issues, and equipment problems during their evaluation. The majority of subjects (81%) indicated that they were satisfied with the CPHE. Subjects that were satisfied with the CPHE were also more satisfied with other aspects of care as well. CONCLUSION The majority of respondents had completed a CPHE within the previous year. Most respondents cite health issues related to the spinal cord injury as areas they would most like to discuss during the evaluation. The majority of subjects were satisfied with the conduct of the CPHE.
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Affiliation(s)
- E G Collins
- Midwest Center for Health Services and Policy Research, Research & Development, Edward Hines Jr, Veterans Affairs Hospital, Hines, IL 60141, USA
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Jensen MP, Hoffman AJ, Cardenas DD. Chronic pain in individuals with spinal cord injury: a survey and longitudinal study. Spinal Cord 2005; 43:704-12. [PMID: 15968299 DOI: 10.1038/sj.sc.3101777] [Citation(s) in RCA: 183] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional and longitudinal postal survey. OBJECTIVES To (1) compare the severity of pain in persons with spinal cord injury (SCI) to national norms, (2) examine the association between pain and measures of (a) psychological functioning, (b) community integration and (c) pain interference with daily activities, and (3) examine the change in the prevalence and intensity of pain over time. SETTING Community. METHODS A total of 147 adults with SCI were surveyed twice, 2-6 years apart. Main outcome measures included presence/absence of pain in general and at specific body sites, 0-10 numerical rating scale of average pain intensity, modified Brief Pain Inventory Pain Interference scale, SF-36 Bodily Pain scale, SF-36 Mental Health scale, Community Integration Questionnaire. RESULTS Pain was more severe, on average, in this sample of patients with SCI than it is in normative samples. The presence of pain was associated with trends towards poorer psychological functioning and social integration, and the intensity of pain was associated with interference with a number of important basic activities of daily living. Little systematic change was found in pain over a 2-6-year-period, although there was evidence that the prevalence of shoulder pain increases over time. CONCLUSION The current findings underscore the serious nature of pain in persons with SCI and provide additional support for the need to identify effective treatments for SCI-related pain.
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Affiliation(s)
- M P Jensen
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA 98195-6490, USA
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Abstract
The years after SCI may be associated with acceleration of the aging process because of diminished physiologic reserves and increased demands on functioning body systems. Clinicians with expertise in the treatment and prevention of SCI-specific secondary complications need to collaborate with gerontologists and primary care specialists and need to invest in the training of future physicians to ensure a continuum of accessible, cost-effective, and high-quality care that meets the changing needs of the SCI population. Managed care payers often do not adequately cover long-term disability needs to prevent secondary SCI-specific complications. In this era of increasing accountability, evidence-based clinical practice guidelines are needed to document scientific evidence and professional consensus to effectively diagnose, treat, and manage clinical conditions; to reduce unnecessary testing and procedures; and to improve patient outcomes. Longitudinal research is needed to minimize cohort effects that contribute to misinterpretation of cross-sectional findings as representative of long-term changes in health and functioning. However, longitudinal studies confound chronologic age, time since injury, and environmental change. Thus, time-sequential research, which controls for such confounding effects, is essential, as is research on the effects of gender,culture, and ethnicity. If we consider how much progress has been made over the past 50 years with respect to SCI mortality related to infectious disease, we can expect to achieve even greater progress against the effects of aging in the next 50 years. Recent developments in molecular biology regarding growth and neuro-trophic factors are bringing us closer to the goal of repairing the damaged spinal cord. The challenge remains for rehabilitation professionals to provide the most comprehensive and holistic approach to long-term follow-up, with an emphasis on health promotion and disease prevention, to postpone functional decline and enhance QOL.
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Affiliation(s)
- Jaishree Capoor
- Mount Sinai School of Medicine, 1425 Madison Avenue, New York, NY 10029, USA.
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43
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Liem NR, McColl MA, King W, Smith KM. Aging with a spinal cord injury: factors associated with the need for more help with activities of daily living. Arch Phys Med Rehabil 2004; 85:1567-77. [PMID: 15468013 DOI: 10.1016/j.apmr.2003.12.038] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To determine (1) the frequency of the need for more help with activities of daily living (ADLs), (2) the frequency of medical complications, and (3) the association between medical, injury-related, and sociodemographic factors and the need for more help with ADLs among those aging with spinal cord injury (SCI). DESIGN Cross-sectional survey. SETTING General community, international. PARTICIPANTS Volunteers (N=352) with SCI for more than 20 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE The need for more help with ADLs. RESULTS The need for more help with ADLs during the last 3 years was reported by 32.1% of participants. At least 1 medical complication was reported by 85%. Constipation (47.9%), diarrhea/bowel accidents (41.8%), and pressure ulcers (38.7%) were common. Constipation, pressure ulcers, female gender, and years postinjury were associated with needing more help with ADLs. Constipation and pressure ulcers were associated with a 97% and a 76% increase, respectively, in the likelihood of needing more help with ADLs during a 3-year time period. Female gender was associated with a 96% increased odds of needing more help with ADLs. There was a 42% increased odds of needing more help with ADLs per decade after SCI. CONCLUSIONS People aging with SCI are vulnerable to medical complications, and additional help is required to function. Knowledge of the effect of these factors, particularly the tetrad of constipation, pressure ulcers, female gender, and number of years postinjury, should increase awareness that more help with ADLs may be needed over time.
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Affiliation(s)
- Nathania R Liem
- Division of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, Canada.
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Price GL, Kendall M, Amsters DI, Pershouse KJ. Perceived causes of change in function and quality of life for people with long duration spinal cord injury. Clin Rehabil 2004; 18:164-71. [PMID: 15053125 DOI: 10.1191/0269215504cr714oa] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine those factors perceived to change or threaten function and quality of life among individuals with long duration spinal cord injury. DESIGN Retrospective self-report using telephone-administered questionnaire. SETTING Queensland, Australia. SUBJECTS Eighty-four community-resident persons with spinal cord injury. MAIN OUTCOME MEASURES Functional Independence Measure, Delighted-Terrible Scale, Perceived Causes of Change Inventory. RESULTS Pain and loss of strength were perceived to have caused change in function in 11.9% and 14.3% of participants respectively while these same factors were perceived to have caused change in quality of life in 19.0% and 17.9% of participants respectively. Even when measurable change had not occurred, pain and loss of strength were perceived threats to function in 45.2% and 44.0% of participants respectively, while these same factors were perceived threats to quality of life in 10.7% and 11.9% of individuals respectively. Emotional issues such as stress, depression, family functioning, financial status and employment were also perceived causes of change in quality of life. CONCLUSIONS The ability of participants to identify the perceived causes of change in function and quality of life may have implications for preventative health care if these individuals are encouraged to seek assistance when these factors first become apparent.
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Affiliation(s)
- Glenda L Price
- Spinal Injuries Unit, Princess Alexandra Hospital, Buranda, Australia
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Ashman TA, Spielman LA, Hibbard MR, Silver JM, Chandna T, Gordon WA. Psychiatric challenges in the first 6 years after traumatic brain injury: cross-sequential analyses of axis I disorders11No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the authors(s) or upon any organization with which the author(s) is/are associated. Arch Phys Med Rehabil 2004; 85:S36-42. [PMID: 15083420 DOI: 10.1016/j.apmr.2003.08.117] [Citation(s) in RCA: 113] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the preinjury rates of Axis I disorders and the prospective rates within the first 6 years after traumatic brain injury (TBI). DESIGN Cross-sectional, longitudinal, and cross-sequential. SETTING Community-based research and training center. PARTICIPANTS Persons (N=188) who had sustained TBI within 4 years of enrollment into the project were interviewed at either 2 and 3 assessments. Each assessment was approximately 1 year apart. Several Axis I diagnoses were analyzed to detect cross-sectional differences (by age and time postinjury) and average individual changes over the multiple measurement time points. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders. RESULTS The odds ratios changed longitudinally within each subject, indicating a decreased probability of having an Axis I diagnosis over time. There were few cross-sectional differences in age; therefore, age at the time of injury had little impact on Axis I diagnoses. Cross-sectional time since injury was not associated with more psychiatric disorders, whereas cross-sectional preinjury history of psychiatric disorders was predictive of postinjury psychiatric disorders. After controlling for cross-sectional effects, the frequencies of Axis I disorders increased in depression, anxiety, and posttraumatic stress disorders in the first assessment postinjury and declined in subsequent assessments. CONCLUSIONS Cross-sequential analyses that control for cross-sectional and longitudinal differences produced a more complete description of psychiatric disorders after TBI.
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Affiliation(s)
- Teresa A Ashman
- Department of Rehabilitation Medicine, Mount Sinai School of Medicine, New York, NY 10029, USA.
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46
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Abstract
OBJECTIVE Literature review of the data on aging with spinal cord injury. METHOD Interrogation on Medline using the following keywords: aging, spinal cord injuries, paraplegia, quadriplegia, mortality, morbidity, quality of life, survival, health status. RESULTS The expectation of life of the spinal cord injury patients improved even though it remains even lower than that of the general population. The effects of aging add to the specific complications which are numerous and alter almost every function. Respiratory complications became the first cause of death especially for tetraplegics. Urinary and cutaneous complications remain important as well as osteo-articular pathologies (particular upper limbs) whose consequences can be serious on the functional capacities. Studies on the quality of life show that adaptation to the handicap is done in a continuous way and a long time after the initial phase of rehabilitation. They underline the importance of professional resources, psychological reactions and previous experiences of the spinal cord injury patients in appreciating the quality of life after the traumatism. CONCLUSION The specificities of the aging of the spinal cord injury patients require to be well known and underline the importance and the necessity of an adequate and specific follow-up. On a more general plan, they imply a reflection on the strategies of initial rehabilitation, not to compromise the future of these spinal cord injury patients.
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Affiliation(s)
- F Beuret-Blanquart
- Centre régional de médecine physique et de réadaptation, Les Herbiers, 76231 Bois-Guillaume, France.
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47
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McColl MA, Arnold R, Charlifue S, Glass C, Savic G, Frankel H. Aging, spinal cord injury, and quality of life: structural relationships. Arch Phys Med Rehabil 2003; 84:1137-44. [PMID: 12917851 DOI: 10.1016/s0003-9993(03)00138-2] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To quantify relationships among 3 sets of factors: demographic factors, health and disability factors, and quality of life (QOL). DESIGN Part of a program of longitudinal research on aging and spinal cord injury (SCI) involving 3 populations: American, British, and Canadian. The present analysis uses data from the 1999 interval. SETTING The Canadian sample was derived from the member database of the Ontario and Manitoba divisions of the Canadian Paraplegic Association. The British sample was recruited from a national and a regional SCI center in England. The American sample was recruited through a hospital in Colorado. PARTICIPANTS A sample of 352 participants was assembled from 4 large, well-established databases. The sample included individuals who had incurred an SCI at least 20 years earlier, were admitted to rehabilitation within 1 year of injury, and were between the ages of 15 and 55 at the time of injury. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES A combination of self-completed questionnaires and interviews. Data included demographics, injury-related variables, health and disability-related factors, QOL, and perceptions about aging. RESULTS Using linear structural relationships modeling, we found that QOL was affected both directly and indirectly by age, health and disability problems, and perceptions of aging. Two surprising findings were as follows: those who experienced fewer disability-related problems were more likely to report a qualitative disadvantage in aging, and the younger members of the sample were more likely to report fatigue. CONCLUSIONS Fatigue is a concern because of the relationship of fatigue with perceived temporal disadvantage in aging, health problems, and disability problems. This finding highlights the need for clinical vigilance among those just beginning to experience the effects of aging.
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Barrett H, McClelland JM, Rutkowski SB, Siddall PJ. Pain characteristics in patients admitted to hospital with complications after spinal cord injury. Arch Phys Med Rehabil 2003; 84:789-95. [PMID: 12808528 DOI: 10.1016/s0003-9993(02)04944-4] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To determine characteristics of pain, the relation between pain and mood, the effect of pain on activities, and the perceived difficulty in coping with pain in patients hospitalized for treatment of complications associated with spinal cord injury (SCI). DESIGN Cohort survey. SETTING Hospital inpatient unit in Australia. PARTICIPANTS Consecutive sample of patients (N=88) admitted to a hospital spinal injuries unit with complications after SCI. Two eligible patients declined to participate. INTERVENTION Face-to-face interview with questionnaire. MAIN OUTCOME MEASURES Pain severity, global self-rated health, mood (Kessler Mood Inventory), and interference with activities (Von Korff disability scale). RESULTS Sixty-six (75%) of the 88 subjects experienced pain, with an average time of onset +/- standard deviation of 8.02+/-12.4 years; 27% of those with pain described it as severe or excruciating. Subjects with pain were less likely to rate their global health as excellent or very good when compared with those who did not have pain (22% vs 44%, respectively). Patients with pain had significantly greater levels of psychologic distress than did people with SCI and no pain. CONCLUSIONS Pain is a common problem in people admitted to hospital with SCI for treatment of other complications. It has a significant impact on activities and is associated with a reduction in global self-rated health and higher levels of psychologic distress.
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Affiliation(s)
- Helen Barrett
- Pain Management & Research Centre, University of Sydney, Royal North Shore hospital, St Leonards, NSW, Australia
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Ehde DM, Jensen MP, Engel JM, Turner JA, Hoffman AJ, Cardenas DD. Chronic pain secondary to disability: a review. Clin J Pain 2003; 19:3-17. [PMID: 12514452 DOI: 10.1097/00002508-200301000-00002] [Citation(s) in RCA: 124] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Until recently, very little has been written regarding chronic pain as a secondary problem in persons who already have a physical disability, despite the potential for pain to increase the negative impact of what may already be a very disabling condition. The purpose of this review is to summarize what is currently known concerning the nature and scope of chronic pain as a secondary condition to disability, specifically spinal cord injury, acquired amputations, cerebral palsy, multiple sclerosis, neuromuscular disease, and postpolio syndrome. METHOD What is known concerning the frequency, severity, impact, and treatment of pain in these specific conditions is reviewed, as are the factors that contribute to, or are associated with, adjustment to chronic pain in these disability groups. The authors conclude with several research questions that emerge from this knowledge, the answers to which will contribute to the long-term goal of the reduction of pain and suffering in persons with disabilities. CONCLUSIONS The existing literature clearly documents that many persons with disabilities experience chronic pain. Many questions remain unanswered regarding the scope, severity, and treatment of chronic pain in these groups.
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Affiliation(s)
- Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle 98104, USA.
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50
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Abstract
As most patients who have suffered spinal cord injury can now expect a normal life span, the late complications of these injuries are seen increasingly frequently. Regular surveillance of both the renal tract and the central nervous system (CNS) is important as the treatment of impending, potentially fatal complications can be implemented before damage has progressed too far. Renal tract complications are particularly dangerous as they are often clinically silent but regular surveillance to detect early deterioration in renal function, particularly from reversible causes such as reflux or obstruction can pre-empt problems. Follow-up protocols depend on the bladder management regime but most centres advocate regular ultrasound with less frequent isotope function studies. With the increasing ability to diagnose and treat the neurological complications, surveillance of the state of the spinal cord with MRI is also important and many centres now advocate checks every few years with sagittal midline T2W sections are sufficient unless changes are noted, when axial T1W sections can be added without significant examination time penalty. Imaging is critical in acute problems. In addition to suffering from the usual normal conditions, patients with spinal cord injury suffer others peculiar to, or particularly related to, the injury, which may be missed as their symptomatology is greatly altered by their paraplegic or quadriplegic status and they may often present as generally unwell but with no obvious cause. This review discusses the role of radiology in routine surveillance of the CNS and the renal tract as well as in assessing specific conditions such as deteriorating neurology or renal function, pain, spinal instability, pressure sores, ectopic ossification, muscular spasm, spinal instability, airway problems and elective operations on the renal tract.
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Affiliation(s)
- Roger Bodley
- Department of Radiology, Stoke Mandeville Hospital, Mandeville Road, Aylesbury, Bucks HP21 8AL, UK.
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