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Daoud A, Nasser Z, Elias C, Elias E. Predictive factors and quality of life assessment among patients with spinal cord injury in the Middle East: a systematic review. Qual Life Res 2024; 33:2081-2094. [PMID: 38700755 DOI: 10.1007/s11136-024-03650-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE Spinal cord injury (SCI) is impairment of the spinal cord that adversely affects patients' health and quality of life (QoL). The aim of the study was to assess the quality of life (QoL) and related factors in patients with traumatic spinal cord injury in Middle Eastern countries. METHODS PubMed, Ovid Medline, Cumulative Index to Nursing and Allied Health Literature (CINAHL), EBSCOhost, psycINFO, and Google Scholar were systematically searched for eligible studies published in peer-reviewed journals up till October 2023. RESULTS Out of 1060 papers found in the literature, only 18 studies from Iran, Lebanon, and Turkey met the inclusion criteria. The majority of the studies employed the SF-36 scale to assess for QoL. In general, all SCI patients had reduced QoL scores when compared to the healthy population. Some of the factors such as age, education level, the level of injury, time since injury onset, marriage, and job opportunities were correlated with SCI subjects QoL. Our papers were assessed and found to be of both good and high quality. CONCLUSION This review emphasizes the significant shortage of QoL studies among SCI patients in the Middle East countries and highlights the importance of improving the QoL of this marginalized population. This work should enhance the governments to establish rehabilitation centers, social and economic support systems, and mental health services to diminish complications arising from SCI.
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Affiliation(s)
- Ali Daoud
- Department of Biology, Illinois College, Jacksonville, IL, USA
| | - Zeina Nasser
- Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | - Charbel Elias
- Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, PA, USA
| | - Elias Elias
- Department of Neurological Surgery, University of Texas Southwestern, 5303 Harry Hines Blvd 7Th Floor, Dallas, TX, USA.
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2
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Manohara V, Nuechterlein A, Barretto TA, Illes J. Priorities and opportunities for advocacy in SCI: An international web-based review. J Spinal Cord Med 2024:1-9. [PMID: 38976887 DOI: 10.1080/10790268.2024.2369736] [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: 07/10/2024] Open
Abstract
CONTEXT For the growing number of people with spinal cord injuries worldwide, advocacy organizations are an invaluable resource of information and education during recovery and rehabilitation. OBJECTIVE To examine the structure, information, and accessibility of websites from international organizations that serve and advocate for individuals with SCI. METHODS We performed a content analysis of information available from SCI organizations returned from a Google search. We used search terms relevant to SCI and advocacy and applied them to top-level domains for the G20 countries. Organizations that provide services or advocate for people with SCI with English-language websites were included; organizations focused on research, fundraising, clinical care, interprofessional knowledge exchange, or other neurological conditions were excluded. Accessibility, in terms of ease of use to information about participation, was assessed using a 3-point scale. RESULTS We identified SCI organizations from 27 different countries across six regions: Africa (N = 4), Asia (N = 5), Europe (N = 27), Middle East (N = 1), North America (N = 12), and Oceania (N = 11). Across these, six categories of resources and services are covered: (1) education, (2) physical health, (3) external, (4) peer support, (5) mental health, and (6) financial and legal. Eleven organizations indicate specific engagement with research or clinical trials. Four websites provided highly accessible information (rank = 3) about participation in research. CONCLUSION The SCI organizations identified in this study offer resources that largely pertain to education and physical health services and strategies. Information about clinical trials and SCI research studies are easily accessible on the websites of the limited number of organizations offering avenues for participation.
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Affiliation(s)
- Vyshnavi Manohara
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Anna Nuechterlein
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Tanya A Barretto
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Judy Illes
- Neuroethics Canada, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, Canada
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3
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Berger H, Wittman J, Smith K, Horick N, Norris K, Young A, Magana Gomez J, Ocampo KKE, Skotko BG. Health care satisfaction and medical literacy habits among caregivers of individuals with Down syndrome. AMERICAN JOURNAL OF MEDICAL GENETICS. PART C, SEMINARS IN MEDICAL GENETICS 2024; 196:e32074. [PMID: 37946659 DOI: 10.1002/ajmg.c.32074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Revised: 10/03/2023] [Accepted: 10/06/2023] [Indexed: 11/12/2023]
Abstract
Patients with Down syndrome have significant specialized health care needs. Our objective was to understand the needs, satisfaction, and online habits of caregivers as they care for persons with Down syndrome. A mixed-method survey was distributed through REDCap from April 2022 to June 2022 in the United States; a Spanish-translated version was distributed through SurveyMonkey from August 2022 to March 2023 in Mexico. We received 290 completed responses from the United States and 58 from caregivers in Mexico. We found that current health care options are not meeting the needs of many individuals with DS in both the United States (39.7%) and Mexico (46.6%). Caregivers expressed frustrations with the inaccessibility and inapplicability of health care information. In particular, they often found the volume of information overwhelming, given their limited medical background. Additionally, health care recommendations were not customized and lacked practical recommendations. Most caregivers in both the United States (72.1%) and Mexico (82.8%) believe it is not easy to find answers to medical questions about their loved ones with DS. Online platforms with customized, specific health information related to DS could offer innovative solutions to these unmet needs for families and primary care providers.
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Affiliation(s)
- Heidi Berger
- Simpson College, Department of Mathematics, Indianola, Iowa, USA
| | | | - Katelyn Smith
- Simpson College, Department of Mathematics, Indianola, Iowa, USA
| | - Nora Horick
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Kenneth Norris
- Simpson College, Department of Mathematics, Indianola, Iowa, USA
| | - Allison Young
- Simpson College, Department of Mathematics, Indianola, Iowa, USA
| | - Javier Magana Gomez
- Nutrition Faculty, Autonomous University of Sinaloa, Culiacan, Sinaloa, Mexico
| | | | - Brian G Skotko
- Down Syndrome Program, Division of Medical Genetics and Metabolism, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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4
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Temel MH, Erden Y, Bağcıer F. Information Quality and Readability: ChatGPT's Responses to the Most Common Questions About Spinal Cord Injury. World Neurosurg 2024; 181:e1138-e1144. [PMID: 38000671 DOI: 10.1016/j.wneu.2023.11.062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 11/26/2023]
Abstract
OBJECTIVE This study aimed to assess the quality, readability, and comprehension of texts generated by ChatGPT in response to commonly asked questions about spinal cord injury (SCI). METHODS The study utilized Google Trends to identify the most frequently searched keywords related to SCI. The identified keywords were sequentially inputted into ChatGPT, and the resulting responses were assessed for quality using the Ensuring Quality Information for Patients (EQIP) tool. The readability of the texts was analyzed using the Flesch-Kincaid grade level and the Flesch-Kincaid reading ease parameters. RESULTS The mean EQIP score of the texts was determined to be 43.02 ± 6.37, the Flesch-Kincaid reading ease score to be 26.24 ± 13.81, and the Flesch-Kincaid grade level was determined to be 14.84 ± 1.79. The analysis revealed significant concerns regarding the quality of texts generated by ChatGPT, indicating serious problems with readability and comprehension. The mean EQIP score was low, suggesting a need for improvement in the accuracy and reliability of the information provided. The Flesch-Kincaid grade level indicated a high linguistic complexity, requiring a level of education equivalent to approximately 14 to 15 years of formal education for comprehension. CONCLUSIONS The results of this study show heightened complexity in ChatGPT-generated SCI texts, surpassing optimal health communication readability. ChatGPT currently cannot substitute comprehensive medical consultations. Enhancing text quality could be attainable through dependence on credible sources, the establishment of a scientific board, and collaboration with expert teams. Addressing these concerns could improve text accessibility, empowering patients and facilitating informed decision-making in SCI.
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Affiliation(s)
- Mustafa Hüseyin Temel
- Physical Medicine and Rehabilitation Clinic, Üsküdar State Hospital, İstanbul, Turkey.
| | - Yakup Erden
- Physical Medicine and Rehabilitation Clinic, İzzet Baysal Physical Medicine and Rehabilitation Training and Research Hospital, Bolu, Turkey
| | - Fatih Bağcıer
- Physical Medicine and Rehabilitation Clinic, Başakşehir Çam and Sakura City Hospital, İstanbul, Turkey
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Manna M, Mortenson WB, Kardeh B, Douglas S, Marks C, Krauss EM, Berger MJ. Patient perspectives and self-rated knowledge of nerve transfer surgery for restoring upper limb function in spinal cord injury. PM R 2022; 15:579-586. [PMID: 35352495 DOI: 10.1002/pmrj.12811] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 02/06/2022] [Accepted: 03/16/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Nerve transfer surgery has the potential to restore upper limb function in patients with spinal cord injury (SCI); however, there has been limited exploration of patient perception of nerve transfer. OBJECTIVE To explore the perspectives of patients with chronic SCI (>2 years from injury) on nerve transfer surgery, and to determine if an educational intervention improved participants' perceived knowledge levels about the procedure. DESIGN Mixed-methods study including qualitative semi-structured interviews and self-reported rating scales. Pre- and post-interviews were completed following an educational presentation. SETTING Two local SCI clinics. PARTICIPANTS Ten patients with chronic traumatic SCI and neurological level of injury C3-C7 (motor complete or incomplete), recruited via snowball sampling (six male, four female). INTERVENTION An educational slide presentation on nerve transfer concepts. MAIN OUTCOME MEASURES The primary study outcome measure is the participants' responses to interview questions. The secondary study outcome measure is their self-reported knowledge levels of nerve transfer before and after education. RESULTS Regaining upper limb function was a priority for all participants. Although most participants had heard of nerve transfer, none were offered it at the time of their SCI, and only two stated that they had any peers who had undergone the procedure. The educational module significantly increased self-rated scores on understanding of nerve transfer (p < .05). Although all participants were open to nerve transfer after the educational module, they described weighing different factors, including (1) potential for loss versus gain of function, (2) inadequate knowledge about nerve transfer, (3) recovery time, and (4) determining their eligibility for the surgery. CONCLUSIONS These findings suggest that people with SCI have limited understanding of nerve transfer as a potential option and would benefit from educational opportunities to help them make informed decisions. This study may inform the development of patient resources to improve pre-surgical consultation and informed decision-making.
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Affiliation(s)
- Mariam Manna
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - W Ben Mortenson
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; International Collaboration on Repair Discoveries (ICORD),Vancouver, British Columbia, Canada; GF Strong Rehabilitation Research Program, Vancouver, British Columbia, Canada
| | - Bahareh Kardeh
- Graduate Program in Rehabilitation Sciences, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Rehabilitation Research Program, GF Strong Rehabilitation Research Program, Vancouver, British Columbia, Canada
| | - Sam Douglas
- University of Victoria, Victoria, British Columbia, Canada
| | - Chris Marks
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Emily M Krauss
- Division of Plastic Surgery, Department of Surgery, University of British Columbia, Victoria, British Columbia, Canada
| | - Michael J Berger
- International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Division of Physical Medicine & Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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6
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Ferguson K, Mitro JP, Bhanji A, Yang S, Gerber L, Cai C, Garfinkel S, Weinstein AA. Qualitative Investigation of Health Information Resources for Caregivers and Individuals Living With Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 27:79-98. [PMID: 34866890 DOI: 10.46292/sci20-00032] [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: 11/19/2022]
Abstract
Objectives: To identify the information networks of caregivers and individuals with spinal cord injury (SCI) and how the health information is accessed and used. Methods: For this qualitative study, participants from the United States were recruited through hospital listservs, websites, social media, and word of mouth to participate in a phone interview. Fourteen individuals living with a traumatic SCI and 18 caregivers of individuals living with a traumatic SCI were interviewed using a semi-structured interview guide. The interviews were transcribed verbatim, coded using NVivo, and analyzed using qualitative thematic methods. Results: Participants reported that medical resources such as SCI specialists were considered the most reliable sources, but due to accessibility barriers the Internet was used the most. The Internet and social resources, such as online and in-person support groups, provided beneficial content information and emotional support, but they posed credibility concerns and left participants feeling unsure of reliability. Information gaps such as lack of education on basic care practices during the transition from acute to chronic care were identified by the participants. Conclusion: Because SCI is an overwhelming experience, it is difficult for patients to retain information in the initial acute care phase, leading to gaps in knowledge about long-term care. Patients are concerned about the reliability of online sources of information; therefore, there is a need for new methods of SCI information dissemination. Potentially, using primary care providers as conduits for information distribution might improve access to reliable long-term SCI information for caregivers and patients.
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Affiliation(s)
- Kacey Ferguson
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia
| | - Jessica Pope Mitro
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia
| | - Alaanah Bhanji
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia
| | - Sejean Yang
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia
| | - Lynn Gerber
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia
| | - Cindy Cai
- American Institutes for Research, Washington, DC
| | | | - Ali A Weinstein
- Center for the Study of Chronic Illness and Disability, George Mason University, Fairfax, Virginia
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Evaluating patient perspectives on participating in scientific research and clinical trials for the treatment of spinal cord injury. Sci Rep 2021; 11:4361. [PMID: 33623068 PMCID: PMC7902830 DOI: 10.1038/s41598-021-83211-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 12/28/2020] [Indexed: 11/08/2022] Open
Abstract
A questionnaire was developed to evaluate patients’ perspective on research aimed at improving functions and overcoming complications associated with spinal cord injury (SCI). The first three sections were based on published and validated assessment tools. The final section was developed to assess participant perspectives on research for SCI. One thousand patients were approached, of which 159 participated. Fifty-eight percent of participants were satisfied with their ‘life as a whole’. Two factors could be generated that reflected the variance in the data regarding participants’ life with a SCI: “Psychosocial and physical wellbeing” and “Independent living”. The majority of participants stated they would be involved in research (86%) or clinical trials (77%). However, the likelihood of participation dropped when potential risks of the research/trials were explained. Which participants would be willing to participate in research could not be predicted based on the severity of their injury, their psychosocial and physical wellbeing or their independent living. Despite participant establishment of a life with SCI, our data indicates that individuals strive for improvements in function. Participant willingness to be included in research studies is noteworthy and scientists and clinicians are encouraged to involve more patients in all aspects of their research.
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8
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Farrehi C, Pazzi C, Capron M, Anderson K, Richardson B, Stillman M. How individuals with spinal cord injury in the United States access and assess information about experimental therapies and clinical trials: results of a clinical survey. Spinal Cord Ser Cases 2020; 6:103. [PMID: 33230100 DOI: 10.1038/s41394-020-00354-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/23/2020] [Accepted: 10/30/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN An internet-based survey. OBJECTIVES To determine how individuals with spinal cord injury (SCI) access information about experimental therapies and clinical trials. To understand which factors influence receipt of and perceived trustworthiness of that information. SETTING Two academic medical centers and an SCI organization. METHODS Demographic information frequencies and percentages were calculated then analyzed using chi-square tests for independence. Fisher's exact test of independence was used to assess significance for contingency tables with categories containing expected counts below five. RESULTS Three hundred sixty four persons with SCI participated in the survey. Most felt confident in their ability to evaluate SCI-specific information from a variety of sources, though SCI organizations and the medical literature were deemed the most reliable. Information from SCI specialists was deemed more credible than that from non-SCI specialists, but only 53.6% of participants had access to them. Nearly all (89.0%) respondents who had sought information about experimental therapies had found it online, while 51.4% of those who had participated in a clinical trial had been contacted by a research team. Only 8.4% of participants felt their medical teams offered them sufficient information about experimental therapies and clinical trials. Wealthier and more educated respondents were more knowledgeable about health-related resources on the internet. Nearly all participants (96.9%) expressed interest in learning more about trials related to SCI. CONCLUSIONS There is an information deficit among people with SCI pertaining to experimental therapies and clinical trials. It is exacerbated by lack of income, education, and access to SCI specialists.
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Affiliation(s)
- Clara Farrehi
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Carlotta Pazzi
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Maclain Capron
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA
| | - Kim Anderson
- Metrohealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Bonnie Richardson
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.,Metrohealth Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Michael Stillman
- Sidney Kimmel Medical College of Thomas Jefferson University, Philadelphia, PA, USA.
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Anderson KD, Bryden AM, Moynahan M. Risk-benefit value of upper extremity function by an implanted electrical stimulation device targeting chronic cervical spinal cord injury. Spinal Cord Ser Cases 2019; 5:68. [PMID: 31632726 PMCID: PMC6786403 DOI: 10.1038/s41394-019-0213-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 07/02/2019] [Accepted: 07/09/2019] [Indexed: 11/20/2022] Open
Abstract
Study design A cross-sectional stated-preference survey using direct-assessment questions. Objective To determine the relative value placed on different outcomes to be used in a pivotal trial for the upper extremity configuration of the Networked Neuroprosthesis (NNP) as well as the tolerance of the expected adverse event profile. Setting Academic medical center in the United States. Methods Distribution of an online survey to adults living with tetraplegia; extent of agreement with each question/statement was obtaining using a 1-7 Likert scale. Results There were 8 statements about potential benefits in arm/hand function; for all statements, more than 70% of participants rated the functions as "1-very important" to regain. There were variable degrees of concern related to risks that could occur during the 30-day post-surgical period and increasing degrees of concern related to risks that could occur in the first 5 years, potentially due to the device, based on the increasing degree of invasiveness of the intervention required to address the event. When analysing the results based on all degrees of interest, more than 64% of responders were interested in getting the NNP with a success rate threshold as low as 50% regardless of time post-injury. Chi-squared analyses revealed some associations between responses and sex, injury level, and injury duration; however, none of these were statistically significant upon post-hoc analysis. Conclusion Data here indicate that people with tetraplegia are highly interested in a range of arm/hand functions and are tolerant of expected risks that may be associated with implanted neuroprosthetics. Sponsorship The Institute for Functional Restoration funded this project through a sub-contract to K.D. Anderson from a larger Special Projects Award (grant number FP0020773) from the Craig H. Neilsen Foundation.
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Affiliation(s)
- Kim D. Anderson
- Miami Project to Cure Paralysis, Department of Neurological Surgery, University of Miami School of Medicine, Miami, FL USA
- Institute for Functional Restoration, Case Western Reserve University, Cleveland, OH USA
| | - Anne M. Bryden
- Institute for Functional Restoration, Case Western Reserve University, Cleveland, OH USA
- Department of Orthopaedics, MetroHealth Medical Center, Case Western Reserve University, Cleveland, OH USA
| | - Megan Moynahan
- Institute for Functional Restoration, Case Western Reserve University, Cleveland, OH USA
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Skelton F, Martin LA, Evans CT, Kramer J, Grigoryan L, Richardson P, Kunik ME, Poon IO, Holmes SA, Trautner BW. Determining Best Practices for Management of Bacteriuria in Spinal Cord Injury: Protocol for a Mixed-Methods Study. JMIR Res Protoc 2019; 8:e12272. [PMID: 30762584 PMCID: PMC6393777 DOI: 10.2196/12272] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 11/20/2018] [Accepted: 12/09/2018] [Indexed: 12/24/2022] Open
Abstract
Background Bacteriuria, either asymptomatic (ASB) or symptomatic, urinary tract infection (UTI), is common in persons with spinal cord injury (SCI). Current Veterans Health Administration (VHA) guidelines recommend a screening urinalysis and urine culture for every veteran with SCI during annual evaluation, even when asymptomatic, which is contrary to other national guidelines. Our preliminary data suggest that a positive urine culture (even without signs or symptoms of infection) drives antibiotic use. Objective Through a series of innovative studies utilizing mixed methods, administrative databases, and focus groups, we will gain further knowledge about the attitudes driving current urine testing practices during the annual exam, as well as quantitative data on the clinical outcomes of these practices. Methods Aim 1 will identify patient, provider, and facility factors driving bacteriuria testing and subsequent antibiotic use after the SCI annual evaluation through qualitative interviews and quantitative surveys. Aim 2 will use national VHA databases to identify the predictors of urine testing and subsequent antibiotic use during the annual examination and compare the clinical outcomes of those who received antibiotics with those who did not. Aim 3 will use the information gathered from the previous 2 aims to develop the Test Smart, Treat Smart intervention, a combination of patient and provider education and resources that will help stakeholders have informed conversations about urine testing and antibiotic use; feasibility will be tested at a single site. Results This protocol received institutional review board and VHA Research and Development approval in July 2017, and Veterans Affairs Health Services Research and Development funding started on November 2017. As of submission of this manuscript, 10/15 (67%) of the target goal of provider interviews were complete, and 77/100 (77%) of the goal of surveys. With regard to patients, 5/15 (33%) of the target goal of interviews were complete, and 20/100 (20%) of the target goal of surveys had been completed. Preliminary analyses are ongoing; the study team plans to present these results in April 2019. Database analyses for aim 2 will begin in January 2019. Conclusions The negative consequences of antibiotic overuse and antibiotic resistance are well-documented and have national and even global implications. This study will develop an intervention aimed to educate stakeholders on evidence-based management of ASB and UTI and guide antibiotic stewardship in this high-risk population. The next step will be to refine the intervention and test its feasibility and effectiveness at multiple sites as well as reform policy for management of this common but burdensome condition. International Registered Report Identifier (IRRID) DERR1-10.2196/12272
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Affiliation(s)
- Felicia Skelton
- Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, United States.,H Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
| | - Lindsey Ann Martin
- Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, United States.,Health Services Research Section, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Charlesnika T Evans
- Center for Innovation for Complex Chronic HealthCare, Hines VA Hospital, Chicago, IL, United States.,Department of Preventive Medicine and Center for Health Care Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jennifer Kramer
- Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, United States
| | - Larissa Grigoryan
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Peter Richardson
- Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, United States
| | - Mark E Kunik
- Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, United States.,Menninger Department of Psychiatry and Behavioral Sciences, Baylor College of Medicine, Houston, TX, United States
| | - Ivy Oiyee Poon
- Department of Pharmacy Practice, Texas Southern University, Houston, TX, United States
| | - S Ann Holmes
- H Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, United States
| | - Barbara W Trautner
- Center for Innovations in Quality, Effectiveness and Safety, Houston, TX, United States.,Infectious Disease Section, Department of Medicine, Baylor College of Medicine, Houston, TX, United States
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11
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Harris CA, Shauver MJ, Nasser JS, Chung KC. The golden year: How functional recovery sets the stage for tendon transfer surgery among patients with tetraplegia-a qualitative analysis. Surgery 2019; 165:365-372. [PMID: 30172564 PMCID: PMC10684031 DOI: 10.1016/j.surg.2018.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/08/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Tendon transfer surgery can effectively improve hand function for patients with tetraplegia but remains poorly utilized. Little is known regarding how patients' rehabilitation experiences influence their perception of function, identity, and coping to shape their reconstructive context. METHODS We performed a cross-sectional qualitative analysis of 19 participants with C4-C7 cervical spinal injuries: 9 patients had undergone reconstruction; 10 had not. Semistructured interviews were conducted using an interview guide focusing on rehabilitation experience, the relationship between function and identity, and how patient experience evolved. Interview transcripts were analyzed using grounded theory. RESULTS The study sample was predominantly male (79%), white (89%), and American Spinal Injury Association grades A-D (grade A: 42%; grade B: 32%; grade C: 16%; grade D: 10%). Recognizing rehabilitation's necessity, functional gains, and constructive patient-therapist relationships promoted engagement in therapy. Poor insurance coverage and financial constraints decreased rehabilitation access. Function affected identity through the degree to which it tied participants to a "patient" role. Early in recovery, patients' function, roles, and attitudes were fluid but solidified over time; how satisfied patients were with these final positions influenced how they coped. CONCLUSION The balance of patients' positive and negative coping has been found to influence patients' progression to surgery. This study describes how function and identity contribute to coping. Participants' function and identity evolved during a finite period we call "the golden year," before reaching a fixed point around which they built their lives. The norms patients establish during this time may affect receptiveness to surgery.
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Affiliation(s)
- Chelsea A Harris
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
| | - Melissa J Shauver
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Jacob S Nasser
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
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12
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Determinants of health knowledge and health perceptions from the perspective of health-related education of patients with spinal cord injury: a systematic review. Int J Rehabil Res 2018; 40:97-106. [PMID: 28106617 DOI: 10.1097/mrr.0000000000000215] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Appropriate health knowledge (HK) and health perceptions (HP) of patients with spinal cord injury (SCI) are linked to health-related behaviors, compliance, the involvement of caregivers and efficacy of prophylaxis, and management of secondary conditions. The significance of factors determining the efficacy of educational interventions in patients with SCI is underestimated. This systematic literature review aims at identification of determinants of HK and HP among patients with SCI. We identified 16 papers with quantitative HK and HP measurements conclusive in the identification of HK and HP determinants in individuals with SCI. Better HK and HP correlated with health condition-related variables (traumatic SCI, history of secondary conditions, except depression), body functions and structures (tetraplegia, incomplete deficit), activities (independence in daily living activities, ability of locomotion on a wheelchair, inability to walk), social and vocational participation, environmental factors (access to a computer with Internet connection, living in a big city, being married, healthcare recently received), and personal factors (younger age among adults, living with SCI for a longer time, younger age at SCI onset, higher educational level, internal locus of control). Limitations encountered included high nonresponse rates among the patients enrolled, and use of heterogeneous and nonvalidated tools. The results of these studies do not cover the entire scope of possible interactions and exclusively apply univariate correlations. The paucity and methodological limitations of studies conclusive in the identification of HK and HP determinants in SCI patients and the development of new approaches to information and education warrant more high-quality research on the basis of multivariate analyses.
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Anderson KD, Cowan RE, Horsewell J. Facilitators and Barriers to Spinal Cord Injury Clinical Trial Participation: Multi-National Perspective of People Living with Spinal Cord Injury. J Neurotrauma 2016; 33:493-9. [DOI: 10.1089/neu.2015.4064] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Kim D. Anderson
- Department of Neurological Surgery, Miami Project to Cure Paralysis, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Rachel E. Cowan
- Department of Neurological Surgery, Miami Project to Cure Paralysis, University of Miami Leonard M. Miller School of Medicine, Miami, Florida
| | - Jane Horsewell
- The European Spinal Cord Injury Federation, Nottwil, Switzerland
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van Wyk K, Backwell A, Townson A. A narrative literature review to direct spinal cord injury patient education programming. Top Spinal Cord Inj Rehabil 2016; 21:49-60. [PMID: 25762860 DOI: 10.1310/sci2101-49] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
PURPOSE To summarize the evidence on SCI-related education literature, while looking at potential barriers, solutions, benefits, and patient preferences regarding SCI patient education. METHOD A literature review was conducted using 5 electronic databases. Quality appraisal instruments were designed to determine the methodological rigor of the quantitative and qualitative studies found. Selected articles were read in their entirety and themes were abstracted. RESULTS Fourteen articles met the inclusion criteria for this narrative literature review, all of which were based on research studies. Seven of these 14 were quantitative studies, 3 were qualitative studies, and 4 were mixed-methods studies. CONCLUSION To improve SCI education during rehabilitation, programs should maximize the receptiveness of newly injured patients to SCI-related information, optimize the delivery of SCI education, increase the number of opportunities for learning, promote and support lifelong learning, and include patient and program evaluation. How these strategies are specifically implemented needs to be determined by program management in consultation with various stakeholders, whilst considering the unique characteristics of the rehabilitation facility.
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Affiliation(s)
- Kim van Wyk
- GF Strong Rehabilitation Centre, University of British Columbia , Vancouver, Canada
| | - Amber Backwell
- GF Strong Rehabilitation Centre, University of British Columbia , Vancouver, Canada ; ICORD, University of British Columbia Faculty of Medicine and VCH Research Institute , Vancouver, Canada ; Division of PM&R, University of British Columbia Department of Medicine , Vancouver, Canada
| | - Andrea Townson
- GF Strong Rehabilitation Centre, University of British Columbia , Vancouver, Canada ; Division of PM&R, University of British Columbia Department of Medicine , Vancouver, Canada
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Hogan TP, Hill JN, Locatelli SM, Weaver FM, Thomas FP, Nazi KM, Goldstein B, Smith BM. Health Information Seeking and Technology Use Among Veterans With Spinal Cord Injuries and Disorders. PM R 2016; 8:123-30. [DOI: 10.1016/j.pmrj.2015.06.443] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2014] [Revised: 06/22/2015] [Accepted: 06/28/2015] [Indexed: 11/16/2022]
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Moghimian M, Kashani F, Cheraghi MA, Mohammadnejad E. Quality of Life and Related Factors Among People With Spinal Cord Injuries in Tehran, Iran. ARCHIVES OF TRAUMA RESEARCH 2015; 4:e19280. [PMID: 26557639 PMCID: PMC4632559 DOI: 10.5812/atr.19280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/05/2014] [Revised: 01/14/2015] [Accepted: 01/18/2015] [Indexed: 11/25/2022]
Abstract
Background: Spinal Cord Injury (SCI) is one of the biggest health problems. Disabilities resulting from injuries such as spinal disability requires special attention because of their potential reduced to cause adverse effects in different systems of the body. Today, improving the Quality of Life (QOL) in patients with SCIs is an important goal of treatment. Objectives: The purpose of this study was to determine the QOL and related factors among people with SCIs. Patients and Methods: In this cross-sectional descriptive study, 106 patients with SCI were selected through sampling based on census. Data were collected using a demographic questionnaire and a Short-Form 36 (SF-36) health survey questionnaire for measuring the QOL among patients. Data were analyzed using SPSS 14 software and descriptive and inferential statistics. P < 0.05 was considered statistically significant. Results: The mean QOL in these patients was 37.1 ± 1.7 years (21 - 65 years) and mean disease duration was 7.3±6 years. The most common injury was paraplegia. Most of the patients have moderate QOL (54.7 %). The results showed a significant relationship between QOL and marital status and employment status (P < 0.05). Also, results showed a significant relationship between QOL and education levels (P = 0.002), age (P = 0.001), and duration of illness (P = 0.001).The highest and lowest scores were 64 ± 7.1 and 36 ± 5.3 for understanding General Health (GH) and role physical, respectively. Conclusions: The results show that patients with SCI have a moderate health-related QOL Determining the QOL is needed to focus on the strengths and weaknesses of patients with spinal cord injuries. Planning principles is recommended in order to reform the disability.
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Affiliation(s)
- Maryam Moghimian
- Department of Nursing, Faculty of Nursing and Midwifery, Najafabad Branch, Islamic Azad University, Najafabad, Isfahan, IR Iran
| | - Fahimeh Kashani
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, IR Iran
| | - Mohammad Ali Cheraghi
- Department of Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, IR Iran
| | - Esmaeil Mohammadnejad
- Department of Nursing, Students’ Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Esmaeil Mohammadnejad, Department of Nursing, Students’ Research Committee, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran. Tel: +98-2166936626, Fax: +98-2166936626, E-mail:
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Pokaczajło J, Tasiemski T. Analysis of selected determinants of health-related quality of life in persons with spinal cord injury. Physiotherapy 2015. [DOI: 10.1515/physio-2015-0024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractThe aim of the study was the analysis of factors determining health-related quality of life (HRQoL) in persons with spinal cord injury (SCI).The study involved 100 persons with SCI dependent on using a wheelchair in everyday life, including 22 females and 78 males. Study conducted using the SF-36 questionnaire used to assess HRQoL.Based on the statistical analysis of the collected research material it has been shown highly significant correlations between the physical and mental dimensions of HRQoL and age at the day of injury and age at the day of the survey. There were also highly significant differences in the physical dimension of HRQoL due to the following variables: clinical pattern of injury, marital status, level of education and participation/non-participation in the active rehabilitation camp. In the case of the mental dimension of the HRQoL there was a significant variation due to the same variables with the exception of clinical pattern of SCI.Based on the undertaken research it was shown that people with higher levels of HRQoL are characterized by: lower age at the time of the study, lower age at the time of injury, long time since injury, paraplegia, marital status – single, secondary/higher level of education and participation in the active rehabilitation camps in the past.
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Mattar AAG, Hitzig SL, McGillivray CF. A qualitative study on the use of personal information technology by persons with spinal cord injury. Disabil Rehabil 2014; 37:1362-71. [DOI: 10.3109/09638288.2014.963708] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | - Sander L. Hitzig
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada and
| | - Colleen F. McGillivray
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada and
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
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Delparte JJ, Chau BA, Mills S, Burns AS. Spinal Cord Essentials: the development of an individualized, handout-based patient and family education initiative for people with spinal cord injury. Spinal Cord 2014; 52:400-6. [DOI: 10.1038/sc.2014.22] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Revised: 12/18/2013] [Accepted: 02/04/2014] [Indexed: 11/09/2022]
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Whitehurst DGT, Engel L, Bryan S. Short Form health surveys and related variants in spinal cord injury research: a systematic review. J Spinal Cord Med 2014; 37:128-38. [PMID: 24559417 PMCID: PMC4066421 DOI: 10.1179/2045772313y.0000000159] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
CONTEXT 'Short Form' health surveys - such as the SF-36 and SF-12 - are widely used in medical research. Spinal cord injury (SCI) is no exception, despite oft-cited concerns regarding measurement properties for populations with physical impairment. OBJECTIVE To provide a comprehensive overview of the use of Short Form health surveys and their variants within the SCI literature. METHODS Papers published between database inception and September 2012 were identified from 11 electronic databases; a supplementary reference list search was also conducted. Data extraction focused on details regarding the range of different Short Form surveys and variants used in SCI research, the respective frequency of use, the nature of reporting (complete versus partial reporting) and the method of survey administration. RESULTS One hundred seventy-four papers were identified. Thirty-six-item Short Form health surveys were frequently administered as complete instruments (n = 82); in 69 of these 82 studies (84%), it was not clearly stated which 36-item version had been used (e.g. SF-36v1, SF-36v2, RAND-36). Data for individual items and domains were often reported (29% of identified studies), indicating significant partial use of standardized measures. Modified variants of standardized health surveys were administered in 12 studies. CONCLUSION Although standardized Short Form health surveys are common within SCI research, attempts to add, delete, or modify items have resulted in a number of variants, often with minimal supportive psychometric evidence. Using established, generic outcome measures is appealing for a number of reasons. However, validity is paramount and requires further explicit consideration within the SCI research community.
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Affiliation(s)
- David G. T. Whitehurst
- Correspondence to: David G. T. Whitehurst, Faculty of Health Sciences, Blusson Hall 10504, Simon Fraser University, 8888 University Drive, Burnaby, British Columbia, V5A 1S6, Canada.
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Folan A, Barclay L, Cooper C, Robinson M. Exploring the experience of clients with tetraplegia utilizing assistive technology for computer access. Disabil Rehabil Assist Technol 2013; 10:46-52. [PMID: 24050283 DOI: 10.3109/17483107.2013.836686] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE Assistive technology for computer access can be used to facilitate people with a spinal cord injury to utilize mainstream computer applications, thereby enabling participation in a variety of meaningful occupations. The aim of this study was to gain an understanding of the experiences of clients with tetraplegia trialing assistive technologies for computer access during different stages in a public rehabilitation service. METHOD In order to explore the experiences of clients with tetraplegia trialing assistive technologies for computer use, qualitative methodology was selected. Data were collected from seven participants using semi-structured interviews, which were audio-taped, transcribed and analyzed thematically. RESULTS Three main themes were identified. These were: getting back into life, assisting in adjusting to injury and learning new skills. CONCLUSIONS The findings from this study demonstrated that people with tetraplegia can be assisted to return to previous life roles or engage in new roles, through developing skills in the use of assistive technology for computer access. Being able to use computers for meaningful activities contributed to the participants gaining an enhanced sense of self-efficacy, and thereby quality of life. Implications for Rehabilitation Findings from this pilot study indicate that people with tetraplegia can be assisted to return to previous life roles, and develop new roles that have meaning to them through the use of assistive technologies for computer use. Being able to use the internet to socialize, and complete daily tasks, contributed to the participants gaining a sense of control over their lives. Early introduction to assistive technology is important to ensure sufficient time for newly injured people to feel comfortable enough with the assistive technology to use the computers productively by the time of discharge. Further research into this important and expanding area is indicated.
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Affiliation(s)
- Alyce Folan
- Department of Occupational Therapy, Monash University , Frankston, Victoria , Australia
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Circles of Health: towards an advanced social network about disabilities of neurological origin. J Biomed Inform 2013; 46:1006-29. [PMID: 24050902 DOI: 10.1016/j.jbi.2013.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Revised: 08/29/2013] [Accepted: 09/04/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This research is concerned with the study of a new social-network platform, which (1) provides people with disabilities of neurological origin, their relatives, health professionals, therapists, carers and institutions with an interoperable platform that supports standard indicators, (2) promotes knowledge democratization and user empowerment, and (3) allows making decisions with a more informed opinion. METHODS A new social network, Circles of Health, has been designed, developed and tested by end-users. To allow monitoring the evolution of people's health status and comparing it with other users and with their cohort, anonymized data of 2675 people from comprehensive and multidimensional medical evaluations, carried out yearly from 2006 to 2010, have been standardized to the International Classification of Functioning, Disability and Health, integrated into the corresponding medical health records and then used to automatically generate and graphically represent multidimensional indicators. These indicators have been integrated into Circles of Health's social environment, which has been then evaluated via expert and user-experience analyses. RESULTS Patients used Circles of Health to exchange bio-psycho-social information (medical and otherwise) about their everyday lives. Health professionals remarked that the use of color-coding in graphical representations is useful to quickly diagnose deficiencies, difficulties or barriers in rehabilitation. Most people with disabilities complained about the excessive amount of information and the difficulty in interpreting graphical representations. CONCLUSIONS Health professionals found Circles of Health useful to generate a more integrative understanding of health based on a comprehensive profile of individuals instead of being focused on patient's diseases and injuries. People with disabilities found enriching personal knowledge with the experiences of other users helpful. The number of descriptors used at the same time in the graphical interface should be reduced in future versions of the social-network platform.
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Shepherd JD, Badger-Brown KM, Legassic MS, Walia S, Wolfe DL. SCI-U: e-learning for patient education in spinal cord injury rehabilitation. J Spinal Cord Med 2012; 35:319-29. [PMID: 23031169 PMCID: PMC3459561 DOI: 10.1179/2045772312y.0000000044] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND/OBJECTIVES To develop an online patient education resource for use in spinal cord injury rehabilitation. PARTICIPANTS The development process involved more than 100 subject-matter experts (SMEs) (rehabilitation professionals and consumers) from across Canada. Preliminary evaluation was conducted with 25 end-users. METHODS An iterative development process was coordinated by a project team; SMEs (including patients) developed the content in working groups using wiki-based tools. Multiple rounds of feedback based on early prototypes helped improve the courses during development. RESULTS Five courses were created, each featuring more than 45 minutes of video content and hundreds of media assets. Preliminary evaluation results indicate that users were satisfied by the courses and perceived them to be effective. CONCLUSIONS This is an effective process for developing multimedia patient education resources; the involvement of patients in all parts of the process was particularly helpful. Future work will focus on implementation, integration into clinical practice and other delivery formats (smart phones, tablets).
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Affiliation(s)
- John D. Shepherd
- Rehabilitation Engineering Laboratory, Toronto Rehabilitation Institute/University Health Network, Toronto, Ontario, Canada,Correspondence to: John D. Shepherd, Toronto Rehabilitation Institute/University Health Network, Lyndhurst Centre, 520 Sutherland Drive, Toronto, Ontario M4G 3V9, Canada.
| | | | | | - Saagar Walia
- Lawson Health Research Institute, London, Ontario, Canada
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Abstract
The primary objective of this study was to assess the quality of life (QoL) in spinal cord injury (SCI) survivors. Secondary objectives were to determine the effects of various sociodemographic and clinical characteristics on QoL. This cross-sectional study included 54 patients with SCI. The Turkish version of the Short-Form-36 Health Survey was used to assess health-related QoL. Functional status was measured with Functional Independence Measure. Higher values were obtained in younger individuals for bodily pain, in paraplegic patients for physical functioning, role-physical, social functioning, and role-emotional. Moreover, it was observed that functional status correlated well with physical functioning, role-physical, social functioning, and role-emotional. Among the complications investigated, bladder incontinence is related to low health-related QoL in most domains. SCI may interfere with some health domains of QoL according to the patient's age, neurologic levels, functional status and presence of complications, mainly bladder incontinence.
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Richard-Greenblatt M, Martin Ginis KA, Leber B, Ditor D. Knowledge mobilization regarding activity and exercise after spinal cord injury: a Canadian undergraduate curriculum scan. Disabil Rehabil 2011; 34:1456-60. [PMID: 22206494 DOI: 10.3109/09638288.2011.644025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this study was to conduct a curriculum scan of Canadian undergraduate university programs to determine the relative emphasis placed on the activity and exercise after spinal cord injury (SCI), in the context of physical disability studies. METHOD Eighty-three Canadian Universities were evaluated for courses discussing: (i) general information about SCI, (ii) physical activity and exercise after SCI, (iii) general information about other physical disabilities and (iv) physical activity and exercise for such disabilities. Online course calendars (2009) were scanned, and their accuracy was verified by instructors or administrative assistants. RESULTS The curriculum scan revealed 113 courses that discuss physical disability. Seventy-four of these courses cover information regarding SCI, 47 of which include content relating to activity and exercise. In comparison, 104 courses discuss other physical disabilities, 76 of which cover material related to activity and exercise. Further, the 47 courses that cover activity and exercise after SCI are only offered in 22 Canadian Universities, and only 31 are mandatory for a degree. CONCLUSIONS A substantial number of future healthcare professionals lack exposure to material regarding activity and exercise after SCI during their undergraduate education. This curricular oversight likely contributes to ineffective exercise strategies and the relative inactivity of the SCI population. [ IMPLICATIONS FOR REHABILITATION • Individuals with spinal cord injury are relatively inactive due to the many physical, psychological and social barriers they face regarding activity and exercise participation.• Effective knowledge mobilization regarding activity and exercise after SCI to future healthcare providers is an essential step in promoting participation.• This undergraduate curriculum scan showed that students lack exposure to issues regarding the activity and exercise after SCI in Canadian Universities.• The lack of effective knowledge mobilization in this area likely contributes to the low levels of activity and exercise participation in the SCI population.]
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Gélis A, Stéfan A, Colin D, Albert T, Gault D, Goossens D, Perrouin-Verbe B, Fattal C, Pelissier J, Coudeyre E. Therapeutic education in persons with spinal cord injury: A review of the literature. Ann Phys Rehabil Med 2011; 54:189-210. [DOI: 10.1016/j.rehab.2011.03.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2010] [Revised: 03/13/2011] [Accepted: 03/17/2011] [Indexed: 11/24/2022]
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Jetha A, Faulkner G, Gorczynski P, Arbour-Nicitopoulos K, Martin Ginis KA. Physical activity and individuals with spinal cord injury: accuracy and quality of information on the Internet. Disabil Health J 2010; 4:112-20. [PMID: 21419374 DOI: 10.1016/j.dhjo.2010.07.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2009] [Revised: 05/01/2010] [Accepted: 07/13/2010] [Indexed: 10/18/2022]
Abstract
BACKGROUND A number of websites on the Internet promote health-enhancing behaviors among people with spinal cord injury (SCI). However, the information available is of unknown accuracy and quality. OBJECTIVE To examine the accuracy, quality, and targeting strategies used in online physical activity (PA) information aimed at people with SCI. METHODS A purposive sample of 30 frequently accessed websites for individuals with SCI that included PA information was examined. Websites were evaluated based on their descriptive characteristics, level of accuracy in relation to newly defined PA recommendations for people with SCI, technical and theoretical quality (i.e., use of behavioral theories) characteristics, and targeting strategies to promote PA among people with SCI. Descriptive statistics were utilized to illustrate the results of the evaluation. RESULTS PA information was easily accessible, as rated by the number of clicks required to access information. Only 6 websites (20%) provided specific PA recommendations and these websites exhibited low accuracy. Technically, websites were of high quality with a mean score of 4.1 of a possible 6 points. In contrast, websites had a low level of theoretical quality, with 23 of the 30 websites (77%) scoring below 9 of a possible 14 points (i.e., 64% of a perfect score) for theoretical content. A majority of websites evaluated did not use cognitive (e.g., self-efficacy, self-talk, and perceived social norms) and behavioral (e.g., self-monitoring, motivational readiness, and realistic goal-setting) strategies in their messages. A majority (80%) of the evaluated websites customized information for persons with different injury levels and completeness. Less than half of the websites evaluated tailored PA information toward people at different stages of their injury rehabilitation (37%) or for their caregivers (30%). CONCLUSION Accuracy and theoretical quality of PA information presented to people with SCI on the Internet may not be optimal. Websites should be improved to incorporate accepted PA recommendations and behavioral theory to better deliver health messages about PA.
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Affiliation(s)
- Arif Jetha
- Institute of Social Psychology, The London School of Economics and Political Science, United Kingdom.
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Abstract
STUDY DESIGN Meta-analytic costeffectiveness analysis. OBJECTIVE Our goal was to compare the results of different management strategies for trauma patients in whom the cervical spine was not clinically evaluable due to impaired consciousness, endotracheal intubation, or painful distracting injuries. SUMMARY OF BACKGROUND DATA We performed a structured literature review related to cervical spine trauma, radiographic clearance techniques (plain radiography, flexion/extension, CT, and MRI), and complications associated with semirigid collar use. METHODS Meta-analytic techniques were used to pool data from multiple sources to calculate pooled mean estimates of sensitivities and specificities of imaging techniques for cervical spinal clearance, rates of complications from various clearance strategies and from empirical use of semirigid collars. A decision analysis model was used to compare outcomes and costs among these strategies. RESULTS Slightly more than 7.5% of patients who are clinically unevaluable have cervical spine injuries, and 42% of these injuries are associated with spinal instability. Sensitivity of plain radiography or fluoroscopy for spinal clearance was 57% (95% CI: 57%-60%). Sensitivities for CT and MRI alone were 83% (82%-84%) and 87% (84%-89%), respectively. Complications associated with collar use ranged from 1.3% (2 days) to 7.1% (10 days) but were usually minor and short-lived. Quadriplegia resulting from spinal instability missed by a clearance test had enormous impacts on longevity, quality of life, and costs. These impacts overshadowed the effects of prolonged collar application, even when the incidence of quadriplegia was extremely low. CONCLUSION As currently used, neuroimaging studies for cervical spinal clearance in clinically unevaluable patients are not cost-effective compared with empirical immobilization in a semirigid collar.
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Norman C, Bender JL, Macdonald J, Dunn M, Dunne S, Siu B, Hitzig SL, Jadad AR, Hunter J. Questions that individuals with spinal cord injury have regarding their chronic pain: A qualitative study. Disabil Rehabil 2009; 32:114-24. [DOI: 10.3109/09638280903033248] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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McGillivray CF, Hitzig SL, Craven BC, Tonack MI, Krassioukov AV. Evaluating knowledge of autonomic dysreflexia among individuals with spinal cord injury and their families. J Spinal Cord Med 2009; 32:54-62. [PMID: 19264050 PMCID: PMC2647501 DOI: 10.1080/10790268.2009.11760753] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Autonomic dysreflexia (AD) is a potentially life-threatening complication of spinal cord injury (SCI) characterized by episodic paroxysmal hypertension and bradycardia in response to a noxious stimulus below the level of injury. Recognition of AD is crucial for individuals with SCI and their family members to facilitate timely and appropriate management. The objectives of this study were to (a) evaluate knowledge of AD among SCI consumers and their family members and (b) identify the preferred format and timing of education regarding AD recognition and management for these stakeholders. METHODS Cross-sectional descriptive study on a cohort of community-dwelling individuals with chronic SCI (N = 100) and their family members (N = 16) by self-report mail survey. Frequency distributions were used to tabulate survey responses on AD knowledge level and to characterize learning preferences and 2 x 2 chi2 analyses were conducted to determine whether there were factors (ie, impairment) associated with AD knowledge (ie, how to treat AD). RESULTS Individuals with SCI and their family members have gaps in their knowledge of AD. Traumatic SCI etiology (vs nontrauma) was associated with greater knowledge about treating AD. Although the SCI sample was a high-risk group, 41% had not heard of AD. More concerning was that 22% of individuals with SCI reported symptoms consistent with unrecognized AD. Respondents indicated that AD education would be best delivered during rehabilitation by a healthcare professional. CONCLUSIONS Further work is needed to promote knowledge about recognizing and managing AD. This may help reduce risk of cardiac and cerebrovascular disease in the SCI population.
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Affiliation(s)
- Colleen F McGillivray
- 1Toronto Rehab—Lyndhurst Centre, University of Toronto, Toronto, Ontario, Canada; 2ICORD, University of British Columbia, British Columbia, Canada
| | - Sander L Hitzig
- 1Toronto Rehab—Lyndhurst Centre, University of Toronto, Toronto, Ontario, Canada; 2ICORD, University of British Columbia, British Columbia, Canada
| | - B. Cathy Craven
- 1Toronto Rehab—Lyndhurst Centre, University of Toronto, Toronto, Ontario, Canada; 2ICORD, University of British Columbia, British Columbia, Canada
| | - Mark I Tonack
- 1Toronto Rehab—Lyndhurst Centre, University of Toronto, Toronto, Ontario, Canada; 2ICORD, University of British Columbia, British Columbia, Canada
| | - Andrei V Krassioukov
- 1Toronto Rehab—Lyndhurst Centre, University of Toronto, Toronto, Ontario, Canada; 2ICORD, University of British Columbia, British Columbia, Canada
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Matter B, Feinberg M, Schomer K, Harniss M, Brown P, Johnson K. Information needs of people with spinal cord injuries. J Spinal Cord Med 2009; 32:545-54. [PMID: 20025150 PMCID: PMC2792460 DOI: 10.1080/10790268.2009.11754556] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2008] [Accepted: 05/07/2009] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE To determine the information needs, level of Internet access, and current and preferred formats and sources of information of adults with spinal cord injuries (SCIs). Individuals with SCIs have a high lifetime risk for medical complications and other health conditions secondary to their injury. Many secondary conditions can be prevented or mitigated through appropriate self-care and/or self-management. People with SCIs need timely, high-quality information about health and medical issues after discharge and throughout their lifetime to improve self-care and maximize quality of life. METHODS A survey was administered as part of the third time point of a longitudinal research study on individuals with SCI. RESULTS A total of 80.2% of the 277 respondents reported having Internet access. The most frequently selected format used currently and preferred by respondents for receiving SCI information was "Web pages/Internet". The top-ranked current and preferred source of SCI information was from a "Physician: SCI Expert/Rehabilitation Specialist". Respondents reported needing information on medical issues the most. Significantly higher percentages of individuals identified as "white" and with higher education levels had access to the Internet and ranked the selection of Web pages/Internet as their top choice. CONCLUSIONS Results confirm that, although people with SCI prefer to receive SCI information from SCI experts, the Internet is a more accessible and more currently used source. Educational level and race predicted current and preferred use of the Internet for obtaining SCI information, suggesting that Internet distribution of SCI information will exclude subgroups.
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Affiliation(s)
- Becky Matter
- Center for Technology and Disability Studies, University of Washington, Seattle, Washington
| | - Melanie Feinberg
- Information School, University of Washington, Seattle, Washington
| | - Katherine Schomer
- Center for Technology and Disability Studies, University of Washington, Seattle, Washington
| | | | - Pat Brown
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
| | - Kurt Johnson
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington
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Anderson KD, Fridén J, Lieber RL. Acceptable benefits and risks associated with surgically improving arm function in individuals living with cervical spinal cord injury. Spinal Cord 2008; 47:334-8. [DOI: 10.1038/sc.2008.148] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Gontkovsky ST, Russum P, Stokic DS. Perceived information needs of community-dwelling persons with chronic spinal cord injury: findings of a survey and impact of race. Disabil Rehabil 2007; 29:1305-12. [PMID: 17654006 DOI: 10.1080/09638280600964364] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine the perceived information needs of community-dwelling individuals with chronic spinal cord injury (SCI) and to determine factors that influence these needs. DESIGN AND PARTICIPANTS Cross-sectional survey mailed to 620 persons with chronic SCI who completed acute inpatient rehabilitation. RESULTS Of 103 (17%) returned surveys, 82 contained complete information and were useable for this study. Individuals with chronic SCI (M time since injury = 7 +/- 6 years) endorsed a multitude of information needs across a broad range of domains. Participant endorsements were most commonly observed in the areas of aging (73%), research (72%), financial aid (66%), and education (63%). Independent variables expected to influence information needs, including Internet use, whether the rehabilitation specialist also served as the primary care physician, and time since injury, showed no significant effect. Race/ethnicity was found to predict perceived information needs, with nonwhite participants endorsing a significantly greater degree of needs than white participants in 11 of 23 (48%) domains. CONCLUSIONS Perceived information needs of community-dwelling persons with SCI are not fully met years after discharge from acute inpatient rehabilitation, which may have implications with respect to psychological adjustment. Race/ethnicity appears to exert a significant influence on the endorsement of perceived information needs, but this finding must be investigated further considering other possible mediating/moderating variables. Results must be considered in light of the relatively low response rate of eligible participants.
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Affiliation(s)
- Samuel T Gontkovsky
- Center for Neuroscience and Neurological Recovery, Methodist Rehabilitation Center, Jackson, MS, USA.
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Ku JH. Health-related quality of life in patients with spinal cord injury: review of the short form 36-health questionnaire survey. Yonsei Med J 2007; 48:360-70. [PMID: 17594142 PMCID: PMC2628081 DOI: 10.3349/ymj.2007.48.3.360] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Advances in medical and rehabilitative care have increased interest in studying how different factors may affect the health-related quality of life (HRQOL) of individuals with spinal cord injury (SCI). There has been a large increase in the number of studies assessing HRQOL among persons with SCI. However, despite these advances, numerous issues remain unanswered because these studies have used a variety of methodologic approaches and assessment tools to examine how different factors have a role in predicting HRQOL in SCI populations. Therefore, standardized instruments should be used as part of this process. The Medical Outcomes Study Short Form (SF-36) was developed in order to survey health status of the general population. However, the available data on the HRQOL of individuals with SCI are currently limited. In addition, there is little information currently available on the factors that are associated with HRQOL in the SCI population and this issue remains controversial. The findings from several individual studies that used the SF-36 to assess the HRQOL of patients suffering from SCI were reviewed, and the results were interpreted with disability in mind. This review article aims to summarize the data regarding the HRQOL of individuals with SCI by using the SF-36.
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Affiliation(s)
- Ja Hyeon Ku
- Department of Urology, Seoul National University Hospital, 28 Yongon-dong, Jongno-gu, Seoul 110-744, Korea.
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Burkell JA, Wolfe DL, Potter PJ, Jutai JW. Information needs and information sources of individuals living with spinal cord injury. Health Info Libr J 2006; 23:257-65. [PMID: 17177946 DOI: 10.1111/j.1471-1842.2006.00686.x] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS AND OBJECTIVES Access to health information is important for the well-being of people living in the community after spinal cord injury (SCI). In order to design appropriate information interventions, it is critical first to understand the information sources typically used. The goal of this study therefore is to identify the information-seeking practices of this group. SAMPLE AND METHODS A sample of 207 individuals living in the community following traumatic spinal cord injury were surveyed regarding their ongoing information needs and practices for seeking information. RESULTS The results reveal that respondents have unmet information needs, despite the fact that they typically access information through a variety of channels. SCI specialists are the most commonly used source, although they are viewed as relatively inaccessible. By contrast, the Internet (used by a relatively high proportion of respondents) is viewed as comparatively accessible, although there are some concerns about the quality of information found there. CONCLUSIONS These survey results point to the need for an information source that is accessible and delivers high quality information. Although respondents use a variety of information sources, none meets this ideal profile. Information professionals should consider this gap in the design of information interventions.
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Affiliation(s)
- Jacquelyn A Burkell
- Faculty of Information and Media Studies, University of Western Ontario, London, ON, Canada.
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Anderson KD, Borisoff JF, Johnson RD, Stiens SA, Elliott SL. The impact of spinal cord injury on sexual function: concerns of the general population. Spinal Cord 2006; 45:328-37. [PMID: 17033620 DOI: 10.1038/sj.sc.3101977] [Citation(s) in RCA: 120] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Secure, web-based survey. OBJECTIVES Obtain information from the spinal cord injured (SCI) population regarding sexual dysfunctions, with the aim of developing new basic science and clinical research and eventual therapies targeting these issues. SETTING Worldwide web. METHODS Individuals 18 years or older living with SCI. Participants obtained a pass-code to enter a secure website and answered survey questions. A total of 286 subjects completed the survey. RESULTS The majority of participants stated that their SCI altered their sexual sense of self and that improving their sexual function would improve their quality of life (QoL). The primary reason for pursuing sexual activity was for intimacy need, not fertility. Bladder and bowel concerns during sexual activity were not strong enough to deter the majority of the population from engaging in sexual activity. However, in the subset of individuals concerned about bladder and/or bowel incontinence during sexual activity, this was a highly significant issue. In addition, the occurrence of autonomic dysreflexia (AD) during typical bladder or bowel care was a significant variable predicting the occurrence and distress of AD during sexual activity. CONCLUSION Sexual function and its resultant impact on QoL is a major issue to an overwhelming majority of people living with SCI. This certainly constitutes the need for expanding research in multiple aspects to develop future therapeutic interventions for sexual health and SCI.
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Affiliation(s)
- K D Anderson
- Department of Neurological Surgery, Reeve-Irvine Research Center, University of California, Irvine, CA 92697, USA
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Abstract
In the United States alone, there are more than 200,000 individuals living with a chronic spinal cord injury (SCI). Healthcare for these individuals creates a significant economic burden for the country, not to mention the physiological, psychological, and social suffering these people endure everyday. Regaining partial function can lead to greater independence, thereby improving quality of life. To ascertain what functions are most important to the SCI population, in regard to enhancing quality of life, a novel survey was performed in which subjects were asked to rank seven functions in order of importance to their quality of life. The survey was distributed via email, postal mail, the internet, interview, and word of mouth to the SCI community at large. A total of 681 responses were completed. Regaining arm and hand function was most important to quadriplegics, while regaining sexual function was the highest priority for paraplegics. Improving bladder and bowel function was of shared importance to both injury groups. A longitudinal analysis revealed only slight differences between individuals injured <3 years compared to those injured >3 years. The majority of participants indicated that exercise was important to functional recovery, yet more than half either did not have access to exercise or did not have access to a trained therapist to oversee that exercise. In order to improve the relevance of research in this area, the concerns of the SCI population must be better known and taken into account. This approach is consistent with and emphasized by the new NIH roadmap to discovery.
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Affiliation(s)
- Kim D Anderson
- Reeve-Irvine Research Center, Department of Anatomy and Neurobiology, University of California at Irvine, Irvine, California 92697-4292, USA.
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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.
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Affiliation(s)
- Alun Ackery
- ICORD, University of British Columbia, Vancouver, Canada
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Dryden DM, Saunders LD, Rowe BH, May LA, Yiannakoulias N, Svenson LW, Schopflocher DP, Voaklander DC. Utilization of health services following spinal cord injury: a 6-year follow-up study. Spinal Cord 2004; 42:513-25. [PMID: 15249928 DOI: 10.1038/sj.sc.3101629] [Citation(s) in RCA: 190] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN Cohort study with 6-years follow-up. OBJECTIVE To describe the utilization of health services by persons with spinal cord injury (SCI) and compare it with that of the general population. SETTING Alberta, Canada. METHODS All persons who sustained an SCI in Alberta between April 1992 and March 1994 were followed from date of injury to 6 years postinjury. Cases were matched (1:5) with controls randomly selected from the general population and matched for age, gender, and region of residence. Administrative data from centralized health care databases were compiled to provide a complete picture of health care use, including hospitalizations, physician contacts, long-term care admissions, home care services, and the occurrence of secondary complications. RESULTS In all, 233 individuals with SCI and 1165 matched controls were followed for 6 years. Compared with the control group, persons with SCI were rehospitalized 2.6 times more often, spent 3.3 more days in hospital, were 2.7 times more likely to have a physician contact, and required 30 times more hours of home care services. Of those with SCI, 47.6% were treated for a urinary tract infection, 33.8% for pneumonia, 27.5% for depression, and 19.7% for decubitus ulcer. CONCLUSION SCI places a heavy burden on the health care system. Persons with SCI have greater rates of contact with the health system compared with the general population. Secondary complications continue to affect persons with SCI long after the acute trauma.
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Affiliation(s)
- D M Dryden
- Department of Public Health Sciences, University of Alberta, Edmonton, AB, Canada
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