1
|
Wangdell J, Axwalter E, Åhrén G, Lundgren Nilsson Å, Sunnerhagen KS, Melin J. Identified needs to enhance life for people with spinal cord injury: a part of the Swedish Needs Assessment Project. Disabil Rehabil 2024:1-12. [PMID: 39354857 DOI: 10.1080/09638288.2024.2406982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 09/16/2024] [Accepted: 09/17/2024] [Indexed: 10/03/2024]
Abstract
PURPOSE To identify factors that contribute to the enhanced life of people with spinal cord injury (SCI) in Sweden. MATERIALS AND METHODS This cross-sectional study combined workshops (n = 38) and survey data (n = 243) from people living with SCI and their relatives, health professionals, and personal care assistants working with people living with SCI. The data were first categorized using Bronfenbrenner's bioecological model, followed by a conventional content analysis. RESULTS The factors that contribute to an enhanced life for people living with SCI are similar to those of the general population, including relationships, leisure activities, and occupation within the mesosystem. However, the unique components of the exosystem and macrosystem are specifically associated with people living with SCI. The exosystem, particularly in healthcare, plays a major role for medical reasons but also tends to obtrude and minimize the mesosystem. The macrosystem is essential, as it sets the rules that govern the actors in the other layers, creating prerequisites for meeting the needs of the mesosystem and exosystem. CONCLUSIONS The needs that contribute to an enhanced life are multifaceted and individualized. Therefore, these systems must be flexible throughout the lifespan of individuals with SCI.
Collapse
Affiliation(s)
- Johanna Wangdell
- Gothenburg Competence Centre for Spinal Cord Injury, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Hand Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Advanced Reconstruction of Extremities, Sahlgrenska University Hospital/Mölndal, Gothenburg, Sweden
| | - Emelie Axwalter
- Gothenburg Competence Centre for Spinal Cord Injury, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Gunilla Åhrén
- Gothenburg Competence Centre for Spinal Cord Injury, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Åsa Lundgren Nilsson
- Gothenburg Competence Centre for Spinal Cord Injury, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katharina S Sunnerhagen
- Gothenburg Competence Centre for Spinal Cord Injury, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden
- Department of Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jeanette Melin
- Gothenburg Competence Centre for Spinal Cord Injury, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Measurement Science and Technology, Division Safety and Transport, RISE Research Institutes of Sweden, Gothenburg, Sweden
- Department of Leadership and Demand & Control, Swedish Defence University, Karlstad, Sweden
| |
Collapse
|
2
|
de Vries WHK, Fellinghauer CS, Arnet U, Eriks-Hoogland I. Change in mobility independence over 5 years for persons with chronic spinal cord injury. J Spinal Cord Med 2024; 47:125-134. [PMID: 34726572 PMCID: PMC10795633 DOI: 10.1080/10790268.2021.1991164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES To evaluate change in mobility independence (MI) in community dwelling persons with spinal cord injury (SCI). PARTICIPANTS Community Survey. DESIGN Cohort study. Rasch analysis was applied to the mobility subscale of the Spinal Cord Independence Measure - Self-Report data from years 2012 to 2017, resulting in a Rasch Mobility Independence Score (RMIS). We employed multilevel modeling to examine RMIS and its change over 5 years, adjusting for demographics and SCI severity; random forest regression was applied to determine the impact of modifiable factors (e.g. environmental factors, home-support) on its change. RESULTS The analysis included 728 participants. The majority (≈85%) of participants demonstrated little or no change in RMIS from 2012 to 2017; however, a smaller proportion (15%) showed considerably large change of more than 10 on the 100-point scale. A mixed-effects model with random slopes and intercepts described the dataset very well (conditional R2 of 0.95) in terms of demographics and SCI severity. Age was the main predictor of change in RMIS. Considering SCI severity, change in RMIS was related to age for the subgroup with paraplegia, and to time since injury for the subgroup with tetraplegia. No impact of modifiable factors was found. CONCLUSION RMIS in persons with SCI changes over a period of 5 years, especially in elder patients with paraplegia and persons with incomplete tetraplegia with more than 15 years of time since injury. During routine follow-up change in mobility independence should be assessed in order to timely intervene and prevent mobility loss and participation limitations.
Collapse
Affiliation(s)
- Wiebe H. K. de Vries
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University Lucerne, Lucerne, Switzerland
| | | | - Ursina Arnet
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University Lucerne, Lucerne, Switzerland
| | - Inge Eriks-Hoogland
- Swiss Paraplegic Research, Nottwil, Switzerland
- Swiss Paraplegic Center, Nottwil, Switzerland
| |
Collapse
|
3
|
Jindal R, Bansal P, Gupta S, Garg SK. Quality of life after traumatic thoracolumbar spinal cord injury: a North Indian perspective. Spinal Cord 2023; 61:374-382. [PMID: 37161055 DOI: 10.1038/s41393-023-00900-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 05/11/2023]
Abstract
STUDY DESIGN Cross-sectional study. OBJECTIVES To determine the Quality of Life (QOL) in individuals with traumatic Spinal Cord Injury (SCI) of thoracolumbar region in Indian population, the factors affecting QOL and to compare this to other SCI populations. SETTING Tertiary level hospital in low-middle income country. METHODS 93 individuals with SCI of minimum 1 year duration since injury were included in the study. Baseline demographics, socioeconomic parameters, and incidence of complications were ascertained. World Health Organisation Quality of Life-BREF (WHOQOL-BREF) score was used for measurement of QOL and was then compared to healthy Indian population and other SCI studies. Subgroup analysis was done to find out impact of variables on different domains of WHOQOL-BREF. RESULTS The median (IQR) age of the study participants was 35 (25, 45) with a male predominance. The median (IQR) duration since injury in the study population was 50 (26, 70) months. Lowest mean (SD) score was observed in the psychological domain -50.3 (12.1) and comparison to healthy Indian and high-income SCI populations revealed drastically decreased scores across all domains (p < 0.01). Employed individuals and housewives had significantly higher scores across all domains than unemployed individuals (p < 0.05). American Spinal Injury Association Impairment Scale (AIS) grade, socioeconomic status, pain and presence of complications all had significant impact on domain scores (p < 0.05). Multiple regression analysis revealed that mobilisation status and pain had the greatest effect on QOL. CONCLUSION Individuals with SCI have low QOL scores as compared to general Indian population as well as SCI individuals from a high resource setting. Pain and dependent mobilisation were found to be most significant predictors of poor WHOQOL-BREF domain scores. Housewives were found to have domain scores comparable to employed individuals. Presence of complications negatively impacts QOL.
Collapse
Affiliation(s)
- Rohit Jindal
- Department of Orthopaedics, Government Medical College and Hospital (GMCH), Chandigarh, India
| | - Parth Bansal
- Department of Orthopaedics, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
| | - Sandeep Gupta
- Department of Orthopaedics, Government Medical College and Hospital (GMCH), Chandigarh, India
| | - Sudhir Kumar Garg
- Department of Orthopaedics, Government Medical College and Hospital (GMCH), Chandigarh, India
| |
Collapse
|
4
|
Khadour FA, Khadour YA, Meng L, Lixin C, Xu T. Epidemiological features of traumatic spinal cord injury in Wuhan, China. J Orthop Surg Res 2023; 18:72. [PMID: 36717867 PMCID: PMC9885682 DOI: 10.1186/s13018-023-03554-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/19/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Spinal cord injuries are extremely debilitating and fatal injuries. There is currently little research focusing on traumatic spinal cord injuries, and there is little information available about the epidemiological characteristics of patients with traumatic spinal cord injury (TSCI). OBJECTIVE To describe the epidemiological features of traumatic spinal cord injury in Wuhan, China. DESIGN A retrospective hospital-based study. SETTING Rehabilitation department of Wuhan's Tongji Hospital. PARTICIPANTS People who had been diagnosed with a traumatic spinal cord injury (TSCI) were admitted to Tongji Hospital from 2016 to 2021 (n = 463). INTERVENTIONS Not applicable. OUTCOME MEASURES Epidemiological features such as sex, age, marital status, etiology, occupation, neurological level of injury, and the American Spinal Injury Association Impairment Scale on admission, hospitalization, and concomitant injuries were collected. RESULTS The mean age of patients with TSCI was 39.4 ± 14.3 years, and the male/female ratio was 3:1. The leading causes of TSCIs were traffic accidents (38.4%), followed by falls (low falls 24.0%, high falls 13.2%). The most common injury site was the cervical spinal cord, followed by the thoracolumbar level. Of all patients, 463 patients (67.2%) had complications and other injuries. During the hospitalization period, a total of 217 patients experienced complications, with a percentage of 46.9%. Urinary tract infection was the most common (15.6%), followed by pulmonary infection (14.0%). CONCLUSION The results found that the proportion of males was greater, and the first two main reasons were falls and traffic accidents. Farmers and workers are the occupations most vulnerable to SCI. We need to pay more attention to the elderly's risk of falling. These findings suggested that preventive strategies should be based on the features of different types of TSCI patients. Finally, the importance of SCI rehabilitation must be highlighted.
Collapse
Affiliation(s)
- Fater A. Khadour
- grid.33199.310000 0004 0368 7223Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095#, Jie-Fang Avenue, Qiaokou District, Wuhan, 430030 Hubei China ,grid.36402.330000 0004 0417 3507Department of Rehabilitation, Faculty of Medicine, Al Baath University, Homs, Syria
| | - Younes A. Khadour
- grid.33199.310000 0004 0368 7223Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095#, Jie-Fang Avenue, Qiaokou District, Wuhan, 430030 Hubei China ,grid.7776.10000 0004 0639 9286Physical Therapy Department for Neuromuscular and Neurosurgical Disorder and Its Surgery, Cairo University, Cairo, 11835 Egypt
| | - Ling Meng
- grid.33199.310000 0004 0368 7223Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095#, Jie-Fang Avenue, Qiaokou District, Wuhan, 430030 Hubei China
| | - Cui Lixin
- grid.33199.310000 0004 0368 7223Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095#, Jie-Fang Avenue, Qiaokou District, Wuhan, 430030 Hubei China
| | - Tao Xu
- grid.33199.310000 0004 0368 7223Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1095#, Jie-Fang Avenue, Qiaokou District, Wuhan, 430030 Hubei China
| |
Collapse
|
5
|
Chen J, Chen Z, Zhang K, Song D, Wang C, Xuan T. Epidemiological features of traumatic spinal cord injury in Guangdong Province, China. J Spinal Cord Med 2021; 44:276-281. [PMID: 32182195 PMCID: PMC7952077 DOI: 10.1080/10790268.2019.1654190] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Study design: A retrospective hospital-based study.Objective: To describe the epidemiological profile of traumatic spinal cord injury (TSCI) in Guangdong Province.Setting: Two hospitals within Guangdong Province, China.Methods: Medical records of patients diagnosed with TSCI admitted to Foshan Hospital of Traditional Chinese Medicine and Zhujiang Hospital of South Medical University from 1 January 2011 to 31 December 2015 were retrospectively reviewed. Epidemiological characteristics, such as age, sex, occupation, etiology, neurological level of injury, American Spinal Injury Association Impairment Scale at admission, death and cause of death during the acute hospitalization and concomitant injuries.Results: During the study period, 482 cases were identified. Male-to-female ratio was 3.4:1, with a mean age of 41.5 ± 12.6 years old. The leading cause was falls (49.3%), followed by motor vehicle collisions (MVCs) (34.8%). The most common injury site was the cervical spinal cord, especially C4-C6, accounting for 39.8%.Conclusion: The number of TSCI patients in Guangdong Province is large and is exhibiting a rising trend. The leading causes were falls and MVCs. The low-falls (height < 1 m) group has expanded over this period. With China entering an ageing society, more appropriate preventative measures should be implemented for fall-related injuries among the elderly.
Collapse
Affiliation(s)
- Jingli Chen
- Department of Emergency, Foshan Hospital of Traditional Chinese Medicine, Foshan City, Guangdong Province, People’s Republic of China
| | - Zhong Chen
- Department of spine surgery, Zhujiang Hospital of Southern Medical University, Guangzhou City, Guangdong Province, People’s Republic of China
| | - KeHui Zhang
- Department of Neurosurgery, Foshan Hospital of Traditional Chinese Medicine, Foshan City, Guangdong Province, People’s Republic of China
| | - Deyong Song
- Department of spine surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan City, Guangdong Province, People’s Republic of China
| | - Changbing Wang
- Department of spine surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan City, Guangdong Province, People’s Republic of China
| | - Tianhang Xuan
- Department of spine surgery, Foshan Hospital of Traditional Chinese Medicine, Foshan City, Guangdong Province, People’s Republic of China
| |
Collapse
|
6
|
Riedman E, Scott H, Clarke P, Meade M, Forchheimer M, Tate D. "Earth angels" and parking spots: qualitative perspectives on healthy aging with spinal cord injury. Disabil Rehabil 2020; 44:1399-1408. [PMID: 32924639 DOI: 10.1080/09638288.2020.1817987] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE People aging with spinal cord injury (SCI) can experience the premature onset of comorbid conditions, as well as the development and progression of secondary health conditions. The aim of this study was to understand the subjective experiences of persons aging with SCI in relation to their surrounding social and physical environments, including the impact of barriers and facilitators.Material/Methods: Eleven individuals who had an SCI for more than ten years and were 45 years or older participated in a semi-structured phone interview about their experiences with healthy aging, social participation, social supports, and community barriers. RESULTS Four main themes emerged in the qualitative data that captured the subjective experience of aging with SCI. These were: (1) Maintaining Physical Independence; (2) Importance of Resources and Special Equipment; (3) Planning Ahead; and (4) Finding Ways to Adapt. CONCLUSIONS The findings from this study highlight the importance of looking beyond individual factors to consider the social and environmental factors that support continued independence and participation in society as people living with long term SCI experience their aging process. Qualitative research that delves further into the dynamics behind this process is needed to fully anticipate the needs of this growing population.IMPLICATIONS FOR REHABILITATIONPeople aging with spinal cord injury (SCI) who are engaged in their social and physical environments have become increasingly adaptive when faced with accelerating and secondary comorbidities.Programs and facilities should ensure universal access to prevention and self-management programs that target physical activity and health habits when considered in the context of a patient's socio-environmental constraints and resources.Clinical healthcare providers need to engage with their patients to develop an early intervention approach to preserve functional capacity while navigating potential future health problems.Clinicians should act as advocates for ongoing policy changes that help promote an environment more inclusive towards people aging with SCI.
Collapse
Affiliation(s)
- Elizabeth Riedman
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Haley Scott
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Philippa Clarke
- Institute of Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Michelle Meade
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Martin Forchheimer
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| | - Denise Tate
- Physical Medicine and Rehabilitation, Michigan Medicine, Ann Arbor, MI, USA
| |
Collapse
|
7
|
Yuan S, Shi Z, Cao F, Li J, Feng S. Epidemiological Features of Spinal Cord Injury in China: A Systematic Review. Front Neurol 2018; 9:683. [PMID: 30186222 PMCID: PMC6113592 DOI: 10.3389/fneur.2018.00683] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 07/30/2018] [Indexed: 12/19/2022] Open
Abstract
Background: Spinal cord injury (SCI) is a severe condition that disrupts patients' physiological, mental, and social well-being state and exerts great financial burden on patients, their families and social healthcare system. This review intends to compile studies regarding epidemiological features of SCI in China. Methods: Searches were conducted on PubMed, EMBASE, Web of Science and Cochrane Library for relevant studies published through January, 2018. Studies reported methodological and epidemiological data were collected by two authors independently. Results: Seventeen studies met the inclusion criteria. Two studies reported incidence of SCI that is 60.6 in Beijing (2002) and 23.7 in Tianjin (2004–2008). All studies showed male had a larger percentage in SCI compared to female except Taiwan (2000–2003). The average male and female ratio was 3–4:1 in China and the highest male and female ratio was 5.74: 1 in Tianjin (2004–2007). Farmers, laborers and unemployed people accounted for more than half of the SCI patients in China. Fall was the primary causation with exception of Heilongjiang (2009–2013), Beijing (2001–2010), and Taiwan (2002–2003), where motor vehicle collision (MCVs) was the leading causation. Pulmonary infection, urinary tract infection and bedsore were common complications, accounting for approximately 70% of SCI patients in China. Conclusion: This review shows that epidemiological features of SCI are various in different regions in China and prevention should be implemented by regions. The number of patients with SCI result from fall and MCVs may become a main public health problem because population aging and economic developing in China. However, because all included studies were retrospective and lacking a register system in China, some data were incomplete and some cases may be left out, so the conclusion may not be generalizable to the other regions.
Collapse
Affiliation(s)
- Shiyang Yuan
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Zhongju Shi
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China.,F.M. Kirby Neurobiology Center, Boston Children's Hospital and Department of Neurology, Harvard Medical School, Boston, MA, United States
| | - Fujiang Cao
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Jiahe Li
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| | - Shiqing Feng
- Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin, China
| |
Collapse
|
8
|
Associations between time since onset of injury and participation in Dutch people with long-term spinal cord injury. Spinal Cord 2018; 56:1134-1143. [DOI: 10.1038/s41393-018-0134-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Revised: 03/26/2018] [Accepted: 03/27/2018] [Indexed: 11/08/2022]
|
9
|
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.
Collapse
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
| | | |
Collapse
|
10
|
Thomas CK, Grumbles RM. Age at spinal cord injury determines muscle strength. Front Integr Neurosci 2014; 8:2. [PMID: 24478643 PMCID: PMC3899581 DOI: 10.3389/fnint.2014.00002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 01/06/2014] [Indexed: 11/30/2022] Open
Abstract
As individuals with spinal cord injury (SCI) age they report noticeable deficits in muscle strength, endurance and functional capacity when performing everyday tasks. These changes begin at ~45 years. Here we present a cross-sectional analysis of paralyzed thenar muscle and motor unit contractile properties in two datasets obtained from different subjects who sustained a cervical SCI at different ages (≤46 years) in relation to data from uninjured age-matched individuals. First, completely paralyzed thenar muscles were weaker when C6 SCI occurred at an older age. Muscles were also significantly weaker if the injury was closer to the thenar motor pools (C6 vs. C4). More muscles were strong (>50% uninjured) in those injured at a younger (≤25 years) vs. young age (>25 years), irrespective of SCI level. There was a reduction in motor unit numbers in all muscles tested. In each C6 SCI, only ~30 units survived vs. 144 units in uninjured subjects. Since intact axons only sprout 4-6 fold, the limits for muscle reinnervation have largely been met in these young individuals. Thus, any further reduction in motor unit numbers with time after these injuries will likely result in chronic denervation, and may explain the late-onset muscle weakness routinely described by people with SCI. In a second dataset, paralyzed thenar motor units were more fatigable than uninjured units. This gap widened with age and will reduce functional reserve. Force declines were not due to electromyographic decrements in either group so the site of failure was beyond excitation of the muscle membrane. Together, these results suggest that age at SCI is an important determinant of long-term muscle strength, and fatigability, both of which influence functional capacity.
Collapse
Affiliation(s)
- Christine K. Thomas
- The Miami Project to Cure Paralysis, University of Miami Miller School of MedicineMiami, FL, USA
- Department of Neurological Surgery, University of Miami Miller School of MedicineMiami, FL, USA
- Department of Physiology and Biophysics, University of Miami Miller School of MedicineMiami, FL, USA
| | - Robert M. Grumbles
- The Miami Project to Cure Paralysis, University of Miami Miller School of MedicineMiami, FL, USA
| |
Collapse
|
11
|
The Sir Ludwig Guttmann Lecture 2012: the contribution of Stoke Mandeville Hospital to spinal cord injuries. Spinal Cord 2012; 50:790-6. [DOI: 10.1038/sc.2012.109] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
12
|
Abstract
STUDY DESIGN A systematic review. BACKGROUND The number of traumatic spinal cord injury (TSCI) reports grows annually, especially in China and Korea. The epidemiological characteristics of TSCI in Asia differ from those in other countries. Thus, we compiled epidemiological factors from Asia to compare with those from other countries. METHOD We searched articles published in any language between January 1980 to December 2011 using the terms "spinal cord injury", "traumatic spinal cord injury", "epidemiology", and "Asia". The articles were reviewed for information regarding TSCI incidence, total cases, case criteria, case source, causes of injury, male/female ratio, mean age, prospective or retrospective, neurological level of injury, extent of injury, and America Spinal Injury Association Impairment Scale (AIS)/grade. RESULTS Epidemiological data were extracted from 39 reports in the published literature that met the inclusion criteria. Only two studies reported prevalence rates. Incidence rates ranged from 12.06 to 61.6 per million. The average age ranged from 26.8 to 56.6 years old. Men were at higher risk than women. Motor vehicle collisions (MVCs) and falls were the main causes of TSCI. However, several countries reported war wounds as the major cause. The neurological level and extent of injury were mixed, and most patients were categorized as AIS/Frankel grade A. CONCLUSION TSCI is an important public health problem and a major cause of paralysis. We must understand the epidemiology to implement appropriate preventative measures. Asian epidemiology is different from that in other regions, so intervention measures must be established according to population-specific characteristics.
Collapse
Affiliation(s)
| | | | | | - Shi-Qing Feng
- Correspondence to: Shi-Qing Feng, Department of Orthopaedics, Tianjin Medical University General Hospital, Tianjin Heping District Anshan Road 154, Tianjin 300052, PR China.
| |
Collapse
|
13
|
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.
Collapse
Affiliation(s)
- Jon Rose
- Veterans Affairs Palo Alto Health Care System, Spinal Cord Injuries and Disorders Clinic, Palo Alto, CA 94304, USA.
| |
Collapse
|
14
|
Perrier MJ, Latimer-Cheung AE, Ginis KAM. An investigation of seasonal variation in leisure-time physical activity in persons with spinal cord injury. Spinal Cord 2012; 50:507-11. [DOI: 10.1038/sc.2012.11] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
15
|
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]
|
16
|
Hampton NZ. The affective aspect of subjective well-being among Chinese people with and without spinal cord injuries. Disabil Rehabil 2009; 30:1473-9. [DOI: 10.1080/09638280701565037] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
17
|
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.
Collapse
Affiliation(s)
- Heather Wearmouth
- Department of Occupational Therapy, Foothills Medical Centre, Calgary, Alberta, Canada
| | | |
Collapse
|
18
|
Abstract
OBJECTIVES This study describes self-reported incidence of secondary health complications (SHCs) and their associations with age, years postinjury (YPI), and impairment among a Canadian spinal cord-injured (SCI) cohort. DESIGN Cross-sectional telephone survey methods were used to collect data on (1) sociodemographics, (2) impairment, (3) health status, and (4) self-reported SHCs on 781 adults >or=1 yr post-SCI living in Ontario, Canada. RESULTS Logistic regression analyses were used to determine associations between self-reported incidences of SHCs with the following covariates: (1) age, (2) YPI, and (3) impairment. The odds ratios for cardiac complications, high blood pressure (HBP), and respiratory complications increased per year with age, whereas autonomic dysreflexia (AD), bladder infections, heterotopic ossification, psychological distress, and drug addiction decreased. The odds ratios for pressure ulcers, AD, and heterotopic ossification increased per YPI, whereas HBP, bowel problems, psychological distress, and depression decreased. Complete injuries were associated with bladder infections, pressure ulcers, and AD. Paraplegia was associated with HBP and bowel problems, and tetraplegia was associated with AD. CONCLUSIONS The findings provide some clarification on factors associated with the occurrence of SHCs after SCI and are useful for informing health-promotion planners, clinicians, and stakeholders regarding the odds of SHCs with aging or among specific impairment groups.
Collapse
|
19
|
|
20
|
Krahn G, McCarthy M, Westwood D, Powers L. Evaluation of an Innovative Methodology to Recruit Research Participants With Spinal Cord Injury Through Durable Medical Equipment Suppliers. Arch Phys Med Rehabil 2008; 89:1341-9. [DOI: 10.1016/j.apmr.2007.11.035] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2007] [Revised: 10/31/2007] [Accepted: 11/02/2007] [Indexed: 11/15/2022]
|
21
|
Tonack M, Hitzig SL, Craven BC, Campbell KA, Boschen KA, McGillivray CF. Predicting life satisfaction after spinal cord injury in a Canadian sample. Spinal Cord 2007; 46:380-5. [PMID: 17579615 DOI: 10.1038/sj.sc.3102088] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional, survey. OBJECTIVES To extend current theoretical models predicting life satisfaction post-spinal cord injury (SCI). Our primary model predicting life satisfaction as measured by the Satisfaction with Life Scale (SWLS) examined demographic characteristics, elements of the International Classification of Functioning and subjective and objective measures of health. A second model was developed to examine factors that are associated with successful community participation as measured by the Reintegration to Normal Living Index (RNL). In addition, the effects of psychological distress and chronic pain on life satisfaction and community participation were examined. SETTING Toronto Rehabilitation Institute, Spinal Cord Rehabilitation Program, Lyndhurst Centre. METHODS Prospective data collection via semi-structured telephone interview on an established SCI Canadian sample. RESULTS In predicting life satisfaction, our model accounted for 35.3% of the variance with demographic characteristics, objective and subjective health, and community participation significantly contributing to the model. In particular, psychological complications, current health rating and community participation were the only variables that made significant contributions in predicting life satisfaction. With regards to community participation, the presence of psychological complications and number of medical complications were associated with decreased reintegration. Increased time since injury onset, higher health ratings and being employed were positively related to RNL. CONCLUSION It would appear that factors involving functional decline and aging are associated with lower participation but not life satisfaction. Further, models predicting quality of life should incorporate measures of psychological functioning.
Collapse
Affiliation(s)
- M Tonack
- Lyndhurst Centre, Toronto Rehabilitation Institute, Toronto, Ontario, Canada
| | | | | | | | | | | |
Collapse
|
22
|
Fawkes-Kirby TM, Wheeler MA, Anton HA, Miller WC, Townson AF, Weeks CAO. Clinical correlates of fatigue in spinal cord injury. Spinal Cord 2007; 46:21-5. [PMID: 17406379 DOI: 10.1038/sj.sc.3102053] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective chart review. OBJECTIVES To determine the prevalence of fatigue in an outpatient spinal cord injury population and to examine the clinical variables contributing to that fatigue. SETTING GF Strong Rehabilitation Centre, Vancouver, British Columbia, Canada. METHODS Medical charts of 76 individuals admitted to the GF Strong Outpatient SCI Program between December 2004 and December 2005 were reviewed. Data collected included information on clinical characteristics, demographics and Fatigue Severity Scale (FSS) scores. Multivariable analysis was completed to determine the independent association between these variables and fatigue severity. RESULTS A total of 57% (95% confidence interval (CI)=45-67%) of the sample were found to have fatigue severe enough to interfere with function. People that were admitted for medical reasons; had pain, spasticity, incomplete injuries, and/or were on more that one medication with a known side effect of fatigue had significantly higher FSS scores. Multivariable analysis indicated incomplete injury was the only statistically significant predictor of a higher FSS scores; pain approached significance (P=0.07, CI=-0.09, 2.06). Together these variables account for 18% of the variance in FSS scores in this sample. CONCLUSION Fatigue among individuals with spinal cord injury who are seeking outpatient rehabilitation is very common. The severity of fatigue was greater for individuals with incomplete lesions. Pain was also a potentially important covariate of fatigue. Further research is required to determine what else contributes to fatigue severity beyond these clinical variables as only minimal variance was accounted for in our model.
Collapse
Affiliation(s)
- T M Fawkes-Kirby
- School of Rehabilitation Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | | | | | | |
Collapse
|
23
|
Kalpakjian CZ, Scelza WM, Forchheimer MB, Toussaint LL. Preliminary reliability and validity of a Spinal Cord Injury Secondary Conditions Scale. J Spinal Cord Med 2007; 30:131-9. [PMID: 17591225 PMCID: PMC2031942 DOI: 10.1080/10790268.2007.11753924] [Citation(s) in RCA: 130] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Although the impact of secondary conditions after spinal cord injury (SCI) on health, well being, and financial burden have been studied, there are psychometrically sound scales of secondary conditions in the extant literature. The use of such scales allows for cross-sample comparison of secondary condition prevalence rates and associations with functional, medical, and psychosocial factors. Thus, the purpose of this study was to evaluate the preliminary reliability of a SCI secondary conditions scale. METHODS The Spinal Cord Injury Secondary Conditions Scale (SCI-SCS) is a 16-item scale based on the Seekins Secondary Conditions Scale. Sixty-five individuals with SCI completed written surveys at 5 time-points over 2 years. RESULTS Internal consistency across each of the time-points exceeded 0.76; test-retest reliability ranged from 0.569 to 0.805. Convergent validity was assessed with 6 physical functioning items from the SF-12. Spearman (coefficients were all statistically significant and ranged from 0.317 (accomplished less because of health problems) to 0.644 (pain). The most prevalent secondary conditions were chronic pain, joint and muscle pain, and sexual dysfunction. CONCLUSIONS Preliminary testing of the SCI-SCS suggests that it is a reliable and valid scale, and further development (ie, factor analysis, item revision) and examination of validity are recommended with larger and more diverse SCI samples.
Collapse
Affiliation(s)
- Claire Z Kalpakjian
- University of Michigan Model SCI Care System, Department of Physical Medicine and Rehabilitation, University of Michigan Health System, 300 N. Ingalls, NI 2A09, Ann Arbor, MI 48109, USA.
| | | | | | | |
Collapse
|
24
|
Pagliacci MC, Franceschini M, Di Clemente B, Agosti M, Spizzichino L. A multicentre follow-up of clinical aspects of traumatic spinal cord injury. Spinal Cord 2006; 45:404-10. [PMID: 17102809 DOI: 10.1038/sj.sc.3101991] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Prospective, multicentred follow-up (FU) observational study. OBJECTIVES Prospectively evaluate survival, complications, re-admissions and maintenance of clinical outcome in people experiencing traumatic spinal cord injury (SCI). SETTING Seven spinal units and 17 rehabilitation centres participating in the previous GISEM (ie Italian Group for the Epidemiological Study of Spinal Cord Injuries) study. METHOD A total of 511 persons with SCI, discharged between 1997 and 1999 after their first hospitalisation, were enrolled. A standardised questionnaire was administered via telephone. RESULTS Of the 608 persons originally enrolled, 36 died between discharge and follow-up (mean 3.8+/-0.64 years). Of the remainder, 403 completed telephone interviews, 72 refused to participate and 97 could not be contacted. More than half of the patients interviewed (53.6%) experienced at least one SCI-related clinical problem in the 6 months preceding interview; the most frequent being urological complications (53.7%). At least one re-admission was recorded in 56.8% of patients between discharge and FU interview. Of the patients interviewed, 70.5% reported bowel autonomy and 86% bladder management autonomy. On multivariate analysis, lack of bowel/bladder autonomy was the most common variable with a strong predicting value for mortality, occurrence of complications and re-admissions. CONCLUSION Re-admission and major complications seem common after SCI and should be considered when planning facilities. Failure to obtain bowel/bladder autonomy upon discharge from rehabilitation proved to be the most common predictive factor of poor outcome during the period between discharge and FU interview.
Collapse
Affiliation(s)
- M C Pagliacci
- Spinal Cord Injury Unit, Silvestrini Hospital, Perugia, Italy
| | | | | | | | | |
Collapse
|
25
|
Ditunno PL, Patrick M, Stineman M, Morganti B, Townson AF, Ditunno JF. Cross-cultural differences in preference for recovery of mobility among spinal cord injury rehabilitation professionals. Spinal Cord 2005; 44:567-75. [PMID: 16317422 DOI: 10.1038/sj.sc.3101876] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Direct observation of a constrained consensus-building process in three culturally independent five-person panels of rehabilitation professionals from the US, Italy and Canada. OBJECTIVES To illustrate cultural differences in belief among rehabilitation professionals about the relative importance of alternative functional goals during spinal cord injury (SCI) rehabilitation. SETTING Spinal Cord Injury Units in Philadelphia-USA, Rome-Italy and Vancouver-Canada. METHODS Each of the three panels came to independent consensus about recovery priorities in SCI utilizing the features resource trade-off game. The procedure involves trading imagined levels of independence (resources) across different functional items (features) assuming different stages of recovery. RESULTS Sphincter management was of primary importance to all three groups. The Italian and Canadian rehabilitation professionals, however, showed preference for walking over wheelchair mobility at lower stages of assumed recovery, whereas the US professionals set wheelchair independence at a higher priority than walking. CONCLUSIONS These preliminary results suggest cross-cultural recovery priority differences among SCI rehabilitation professionals. These dissimilarities in preference may reflect disparities in values, cultural expectations and health care policies.
Collapse
Affiliation(s)
- P L Ditunno
- Department of Rehabilitation Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | | | | | | | | | | |
Collapse
|
26
|
Abstract
The increasing life expectancy after spinal cord injury has given social participation a new recognition as one of the ultimate goals of a comprehensive rehabilitation process. Recent evolution of the concept suggests 2 different approaches to document participation after spinal cord injury and a careful appraisal of the related outcome measures is important as discrepancies of results between the 2 approaches can be significant. Literature on objective participation reports a large variability in several dimensions that are particularly influenced by intrinsic factors such as severity of injury and secondary impairments. The direct influence of the environmental factors remains to be demonstrated by empirical studies. There are fewer tools available to evaluate subjective impressions of participation but recent investigations support the importance of taking account of the person's perceived restrictions participation in order to get better understandings of an individual's specific needs and problems. The aim of this article is to present the evolution of the conceptualization and measurement of the two approaches and to describe the level of participation of individuals with SCI.
Collapse
Affiliation(s)
- Luc Noreau
- Rehabilitation Department, Faculty of Medicine, Laval University, Quebec City, Canada.
| | | | | | | |
Collapse
|
27
|
Abstract
Spinal cord injury (SCI) is a devastating condition often affecting young and healthy individuals around the world. This debilitating condition not only creates enormous physical and emotional cost to individuals but also is a significant financial burden to society at large. This review was undertaken to understand the global impact of SCI on society. We also attempted to summarize the worldwide demographics and preventative strategies for SCI in varying economic and climatic environments and to evaluate how cultural and economic differences affect the etiology of SCI. A PUBMED database search was performed in order to identify clinical epidemiological studies of SCI within the last decade. In addition, World Bank and World Health Organization websites were used to obtain demographics, economics, and health statistics of countries of interest. A total of 20 manuscripts were selected from 17 countries. We found that SCI varies in etiology, male-to-female ratios, age distributions, and complications in different countries. Nations with similar economies tend to have similar features and incidences in all the above categories. However, diverse methods of classifying SCI were found, making comparisons difficult. Based upon these findings, it is clear that the categorization and evaluation of SCI must be standardized. The authors suggest improved methods of reporting in the areas of etiology, neurological classification, and incidence of SCI so that, in the future, more useful global comprehensive studies and comparisons can be undertaken. Unified injury prevention programs should be implemented through methods involving the Internet and international organizations, targeting the different etiologies of SCI found in different countries.
Collapse
Affiliation(s)
- Alun Ackery
- ICORD, University of British Columbia, Vancouver, Canada
| | | | | |
Collapse
|
28
|
Krause JS, Broderick L. A 25-year longitudinal study of the natural course of aging after spinal cord injury. Spinal Cord 2005; 43:349-56. [PMID: 15711611 DOI: 10.1038/sj.sc.3101726] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Longitudinal; Survey. OBJECTIVE The purpose of this study was to investigate the natural course of changes in activity patterns, health indicators, life satisfaction, and adjustment over 25-year period among people with spinal cord injury (SCI) in the USA. SETTING The preliminary data were collected from a Midwestern United States university hospital of the USA, whereas the follow-up data were collected at a large Southeastern United States rehabilitation hospital. METHOD The Life Situation Questionnaire was used to identify changes in education/employment, activities, medical treatments, adjustment, and life satisfaction. RESULTS Adjustment scores, satisfaction with employment, satisfaction with finances, years of education, and employment indicators significantly improved over time. In contrast, satisfaction with sex life, satisfaction with health, and then number of weekly visitors significantly decreased and the number of nonroutine medical visits and days hospitalized within 2 years prior to the study significantly increased over the 25-year period. CONCLUSION Given the mixed pattern of favorable and unfavorable changes, the findings challenge the assumption that aging will inevitably be associated with the overall decline in outcomes and quality of life.
Collapse
Affiliation(s)
- J S Krause
- Medical University of South Carolina, Charleston, SC, USA
| | | |
Collapse
|
29
|
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.
Collapse
Affiliation(s)
- Nathania R Liem
- Division of Physical Medicine and Rehabilitation, University of Ottawa, Ottawa, ON, Canada.
| | | | | | | |
Collapse
|
30
|
Abstract
OBJECTIVE To identify differences in the aging experiences of men and women with spinal cord injury (SCI). DESIGN This study is part of a longitudinal international study of aging and SCI. SETTING Five centers in England, Canada, and the United States. Three were spinal cord rehabilitation facilities (Stoke-Mandeville Hospital, Southport Hospital, Craig Hospital) and 2 were community agencies (Ontario and Manitoba divisions of the Canadian Paraplegic Association). PARTICIPANTS A matched sample of 67 men and 67 women with SCI for at least 20 years. The 2 groups were matched on age, country of origin, and duration of disability. Participants had an average age of 57 years and an average disability duration of almost 33 years. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Two measures were taken by interview: demographic form and current status interview. Five others were self-administered and returned by mail: the Perceived Stress Scale, Craig Handicap Assessment and Reporting Technique, Index of Psychological Well-Being, Current Problem Questionnaire, and Life Satisfaction Index. RESULTS Although both sexes rated their quality of life about equally, women characterized their aging experience as "accelerated," while men characterized it as "complicated." Women reported more effects of pain, fatigue, and skin problems and more transportation problems. Men experienced more health problems, more diabetes, and more adaptive equipment changes. Older men and women with SCI spent their time differently, consistent with traditional gender roles. CONCLUSIONS These results underline the need for gender-specific consideration of aging experiences associated with SCI and further emphasize the need for primary and preventive care to promote health and well-being as people with SCI survive into old age.
Collapse
|
31
|
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.
Collapse
Affiliation(s)
- F Beuret-Blanquart
- Centre régional de médecine physique et de réadaptation, Les Herbiers, 76231 Bois-Guillaume, France.
| | | |
Collapse
|
32
|
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.
Collapse
|