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Whelan A, McVeigh S, Barker P, Glennie A, Wang D, Chen M, Cheng CL, Humphreys S, O'Connell C, Attabib N, Engelbrecht A, Christie S. The effect of rurality and distance from care on health outcomes, environmental barriers, and healthcare utilization patterns in persons with traumatic spinal cord injury. Spinal Cord 2023; 61:399-408. [PMID: 37169867 PMCID: PMC10173934 DOI: 10.1038/s41393-023-00898-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 03/21/2023] [Accepted: 04/03/2023] [Indexed: 05/13/2023]
Abstract
STUDY DESIGN Cohort study. OBJECTIVES To evaluate the association between residential living location and health outcomes, environmental barriers, quality of life, and healthcare utilization patterns after traumatic spinal cord injury (tSCI). SETTING Community setting, Atlantic Canada. METHODS An ambispective study of data collected on a subset of individuals enrolled in the Rick Hansen Spinal Cord Injury Registry (RHSCIR) from 2012 to 2018. Outcomes were analyzed using two measures of rurality: postal codes at community follow-up (rural versus urban) and residential travel distance to the nearest RHSCIR facility (>100 km versus ≤100 km). Outcomes studied included the Craig Hospital Inventory of Environmental Factors-Short Form (CHIEF-SF), Short Form-36 Version 2 (SF36v2), Life Satisfaction Questionnaire (LISAT-11), Spinal Cord Independence Measure (SCIM), secondary health complications and healthcare utilization patterns. Outcomes were assessed 9 to 24 months post-discharge from initial hospitalization. RESULTS 104 participants were studied, 21 rural and 83 urban based on postal codes at community follow-up. 59 participants lived more than 100 km away from the nearest RHSCIR facility, while 45 participants lived within 100 km. Individuals from urban area codes reported a greater magnitude of perceived barriers on the policies and work/school subscales of the CHIEF-SF. No differences in function, quality of life, and healthcare utilization patterns according to the measures of rurality were observed. Individuals living >100 km from the nearest RHSCIR facility reported greater rates of sexual dysfunction. CONCLUSIONS Despite differences in environmental barriers, individuals from urban and rural locations in Eastern Canada reported similar health outcomes and quality of life after tSCI.
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Affiliation(s)
- Alexander Whelan
- Department of Medicine (Physical Medicine and Rehabilitation), Dalhousie University, Halifax, NS, Canada
| | - Sonja McVeigh
- Department of Medicine (Physical Medicine and Rehabilitation), Dalhousie University, Halifax, NS, Canada
| | - Paula Barker
- Faculty of Medicine, Memorial University of Newfoundland, Corner Brook, NF, Canada
| | - Andrew Glennie
- Department of Surgery (Orthopaedics), Dalhousie University, Halifax, NS, Canada
| | - Di Wang
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
| | - Melody Chen
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
| | | | | | - Colleen O'Connell
- Division of Physical Medicine and Rehabilitation, Dalhousie Medicine New Brunswick, Fredericton, NB, Canada
| | - Najmedden Attabib
- Division of Neurosurgery, Dalhousie University, Saint John, NB, Canada
| | - Andre Engelbrecht
- Division of Neurosurgery, Memorial University of Newfoundland, St. John's, NF, Canada
| | - Sean Christie
- Department of Surgery (Neurosurgery), Dalhousie University, Halifax, NS, Canada.
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Touhami D, Essig S, Debecker I, Scheel-Sailer A, Gemperli A. The effect of the general practitioner as the first point of contact for care on the satisfaction with health care services in persons living with chronic spinal cord injury: A cross-sectional study. ZEITSCHRIFT FUR EVIDENZ, FORTBILDUNG UND QUALITAT IM GESUNDHEITSWESEN 2023; 177:48-56. [PMID: 36959067 DOI: 10.1016/j.zefq.2022.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 10/15/2022] [Accepted: 12/11/2022] [Indexed: 03/25/2023]
Abstract
OBJECTIVE The primary objective of this study was to investigate the effect of having a general practitioner (GP) as a first point of contact for care on the satisfaction with care services in persons with spinal cord injury (SCI), and how this effect is related to socio-demographic and health-related factors. METHODS This is a cross-sectional survey conducted within the framework of the Swiss Spinal Cord Injury Cohort Study Community Survey 2017. Outcome measures comprised three aspects of care (treatment with respect, understandability of explanations, and involvement in decision-making) and satisfaction with GP care and SCI centres. Information was grouped by first contact of care (GP or SCI specialist) and compared using the Mann-Whitney U test and logistic regression analysis. RESULTS Out of 3,959 invitees, 1,294 participants (33%) completed the survey. No significant association was found between the three aspects of care and the first contact of care. Persons who first contacted a GP and lived within a 10-minute travel distance to the GP practice were significantly less likely to be satisfied with their GP care (-5.7 percentage points, CI 95% = -10.7, -0.7), as compared to those living farther away. Persons who first contacted a GP rather than an SCI specialist were more likely to be satisfied with their GP care if married (7.1 percentage points, CI 95% = 1.4, 12.7), employed (6.6 percentage points, CI 95% = 0.9, 12.3), had a high social status (11.0 percentage points, CI 95% = 2.0, 20.1), or had tetraplegia (10.8 percentage points, CI 95% = 3.6, 18.1). For the same group, satisfaction with SCI centres was significantly higher in persons with good (10.1 percentage points, CI 95% = 0.1, 20.1) or very good health (8.2 percentage points, CI 95% = 1.0, 15.4), as compared to those with poor health. CONCLUSION The majority of participants were satisfied with the services offered by their first contact point for care, with variations due to factors endogenous to the participants. Socio-demographic and health-related factors should be integrated into health care planning strategies and improvement initiatives to ensure equitable access and better quality of health care services.
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Affiliation(s)
- Dima Touhami
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland.
| | - Stefan Essig
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Centre for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
| | | | - Anke Scheel-Sailer
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Armin Gemperli
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Swiss Paraplegic Research, Nottwil, Switzerland; Centre for Primary and Community Care, University of Lucerne, Lucerne, Switzerland
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Leung T, Toatley S, Rodgers MD, Qanungo S, Mueller M, Denny B, Rodriguez A. Feasibility of a Community-Based, Online, Peer-Supported Spinal Cord Injury Self-management Intervention: Protocol for a Pilot Wait-Listed Randomized Trial. JMIR Res Protoc 2023; 12:e42688. [PMID: 36749612 PMCID: PMC9944143 DOI: 10.2196/42688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Revised: 11/27/2022] [Accepted: 11/30/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND People with spinal cord injury (SCI) report feeling unprepared to manage their disability upon discharge to the community. This situation is exacerbated when they return to settings where self-management support and resources are sparse, thus increasing the risk of costly secondary conditions and rehospitalizations. These factors make a compelling case for implementing innovative community-based SCI self-management programs that empower and engage individuals with SCI. Using a community-engaged research (CEnR) approach, we developed a peer-supported SCI self-management intervention, known as PHOENIX (Peer-supported Health Outreach, Education, and Information Exchange), which integrates online educational content and support from peer navigators (PNs) through telehealth, to promote health and community participation after SCI. OBJECTIVE The objective of this pilot study is to evaluate the feasibility and acceptability of PHOENIX and the study design, and to obtain estimates of the variability of relevant outcome measures. METHODS We conducted a pilot randomized waitlist-controlled trial (n=30) in collaboration with the South Carolina Spinal Cord Injury Association (SCSCIA), our long-standing community-based nonprofit organization research partner. We recruited 4 PNs through our SCSCIA collaboration using its existing network of trained peer mentors. Our study design supported comparison of the following 2 randomly assigned groups: PHOENIX intervention group and waitlist enhanced usual care (EUC) group. The PHOENIX intervention was administered online by PNs over 16 weeks through scheduled "video visits." The EUC group participated in the study for 16 weeks with usual community services and no navigation, and received 4 monthly newsletters from the SCSCIA on a variety of SCI-relevant topics. At the end of the waitlist period, the waitlist EUC group received the full PHOENIX intervention. Measures of feasibility included PN and participant recruitment and retention, PN workload, protocol adherence, and incidence of technical issues. We conducted qualitative interviews with participants and PNs to evaluate the acceptability of PHOENIX and the study design. Outcome measures, including community participation, quality of life, and the occurrence and subjective impact of medically serious secondary conditions and rehospitalizations, were assessed at baseline after randomization and at subsequent time points to allow between-group comparisons. RESULTS PN hiring and training were completed in August 2018. Recruitment began in November 2018. A total of 30 participants were recruited across South Carolina, and 28 participants completed follow-up by August 2020. An analysis of the results is being finalized, and the results are expected to be published in 2023. CONCLUSIONS This study will provide valuable information to guide future research seeking to address unmet self-management needs and improve outcomes in individuals with SCI. Feasibility findings of this study will provide evidence from CEnR guided by people with SCI and SCI service providers to inform further development, testing, and dissemination of effective and scalable self-management strategies for people with SCI. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR1-10.2196/42688.
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Affiliation(s)
| | - Sherwood Toatley
- South Carolina Spinal Cord Injury Association, Columbia, SC, United States
| | - Marka Danielle Rodgers
- Center for Spinal Cord Injury, Roper Rehabilitation Hospital, Charleston, SC, United States
| | - Suparna Qanungo
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Martina Mueller
- College of Nursing, Medical University of South Carolina, Charleston, SC, United States
| | - Brian Denny
- South Carolina Spinal Cord Injury Association, Columbia, SC, United States
| | - Angela Rodriguez
- South Carolina Spinal Cord Injury Association, Columbia, SC, United States
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Gibson-Gill C, Mingo T. Primary Care in the Spinal Cord Injury Population: Things to Consider in the Ongoing Discussion. CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2023; 11:74-85. [PMID: 36844900 PMCID: PMC9938514 DOI: 10.1007/s40141-023-00379-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 02/21/2023]
Abstract
Purpose of Review Spinal cord injury (SCI) creates unique needs that if not recognized and addressed timely can have detrimental effects on the health and quality of life (QOL) of people living with a SCI. Primary preventive health care is shown to decrease morbidity and mortality, yet the SCI population reportedly faces challenges getting access to this care. This area in SCI health care is still largely understudied with no consensus on the ideal way or which health care provider is best to provide primary care for this population. Findings Preventive care is generally provided by general primary care providers, but not all primary care providers are trained in recognizing and addressing spinal cord injury-specific needs. SCI providers generally are not trained in addressing all aspects of preventive care. Knowing the recommended preventive care screenings, recognizing and managing specific conditions seen after a SCI, and seamless coordination of care between general practitioners and SCI specialists are some of the interventions to help prevent health complications, decrease morbidity and mortality, improve health outcomes, and promote QOL in this patient population. Summary Prioritized focus on preventive care is necessary for a positive impact on the overall health and QOL in this population. Addressing the knowledge gap reported by primary care providers and SCI providers may help increase the probability of SCI patients getting their preventive and specialty care needs addressed. We present a "cheat sheet" of recommendations for the preventive care evaluation of a person living with a SCI.
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Affiliation(s)
- Carol Gibson-Gill
- Spinal Cord Injury & Disorders Department, Veteran Administration New Jersey Healthcare System, East Orange, NJ USA.,Physical Medicine and Rehabilitation Department, Rutgers New Jersey Medical School, Newark, NJ USA
| | - Tatiyanna Mingo
- Spinal Cord Injury & Disorders Department, Veteran Administration New Jersey Healthcare System, East Orange, NJ USA
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Le Fort M, Lefèvre C, Kieny P, Perrouin-Verbe B, Ravaud JF. Adherence to long-term medical follow-up: A qualitative, experience-focused study of people with spinal cord injury. Ann Phys Rehabil Med 2022; 65:101629. [PMID: 35031498 DOI: 10.1016/j.rehab.2022.101629] [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: 04/18/2021] [Revised: 11/07/2021] [Accepted: 12/21/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Scientific evidence indicates the presence of secondary conditions (such as pressure injuries) after spinal cord injury (SCI). Treatment methods focusing on the management of paraplegia and tetraplegia include systematic preventive follow-up. These advances have significantly improved the functional and vital prognosis of people with SCI, but some people may not have access to these specialized organizations or may not adhere closely to this medicalized vision. We used a narrative approach to explore the perceptions of people with SCI to better understand their adherence to follow-up. OBJECTIVES We aimed to determine the "common denominators" that lead to adherence or non-adherence to long-term follow-up after SCI. METHODS People with SCI who had completed their first rehabilitation period for > 1 year were included with regard to 2 variables: 1) an actual medical follow-up or not and 2) a history of pressure injury or not. A review of the literature was used as preparation for semi-directive interviews, which were prospectively analysed by using qualitative analysis software. Thematic saturation was reached at 28 interviews, and 32 interviews were ultimately completed. RESULT Three main areas concerning participants' perceptions emerged: people's readiness, appropriation and modulation of the systematic follow-up. We developed a broad conceptual framework representing follow-up and the promotion of the long-term health of people with SCI from their perspectives. CONCLUSIONS The medical environment should ensure that people with SCI are ready to actively consider the implementation of prevention strategies and should take into account their ability to establish their own truth, to integrate various life stages after SCI and to negotiate systematic follow-up. The implementation of data about functioning should be conducted using the concept of the Learning Health System.
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Affiliation(s)
- Marc Le Fort
- House of Social Sciences in Disability - School of Advanced Studies in Public Health (EHESP), 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France; Neurological PMR department, University Hospital, 85, rue Saint-Jacques, 44093, Nantes cedex, France.
| | - Chloé Lefèvre
- House of Social Sciences in Disability - School of Advanced Studies in Public Health (EHESP), 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Pierre Kieny
- House of Social Sciences in Disability - School of Advanced Studies in Public Health (EHESP), 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Brigitte Perrouin-Verbe
- House of Social Sciences in Disability - School of Advanced Studies in Public Health (EHESP), 15 Avenue du Professeur Léon Bernard, 35043 Rennes, France
| | - Jean-François Ravaud
- Neurological PMR department, University Hospital, 85, rue Saint-Jacques, 44093, Nantes cedex, France; National Institute for Health and Medical research (INSERM), 101, rue de Tolbiac, 75654, cedex 13, France
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6
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Development of an evidence-based reference framework for care coordination with a focus on the micro level of integrated care: A mixed method design study combining scoping review of reviews and nominal group technique. Health Policy 2022; 126:245-261. [DOI: 10.1016/j.healthpol.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 11/18/2022]
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Jeyathevan G, Jaglal SB, Hitzig SL, Linassi G, Mills S, Noonan VK, Anzai K, Clarke T, Wolfe D, Bayley M, Aslam L, Farahani F, Alavinia SM, Omidvar M, Craven BC. Conception and development of Self-Management indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2021; 44:S94-S117. [PMID: 34779736 PMCID: PMC8604486 DOI: 10.1080/10790268.2021.1961054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
CONTEXT Although self-management is linked to reduced secondary health complications (SHCs) and enhanced overall quality of life post-spinal cord injury or disease (SCI/D), it is poorly integrated into the current rehabilitation process. Promoting self-management and assuring equity in care delivery is critical. Herein, we describe the selection of Self-Management structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. METHODS Experts in self-management across Canada completed the following tasks: (1) defined the Self-Management construct; (2) conducted a systematic search of available outcomes and their psychometric properties; and (3) created a Driver diagram summarizing available evidence related to Self-Management. Facilitated meetings allowed development and selection following rapid-cycle evaluations of proposed structure, process and outcome indicators. RESULTS The structure indicator is the proportion of staff with appropriate education and training in self-management principles. The process indicator is the proportion of SCI/D inpatients who have received a self-management assessment related to specific patient self-management goal(s) within 30 days of admission. The outcome indicator is the Skill and Technique Acquisition, and Self-Monitoring and Insight subscores of the modified Health Education Impact Questionnaire. CONCLUSION The structure indicator will heighten awareness among administrators and policy makers regarding the need to provide staff with ongoing training related to promoting self-management skill acquisition. Successful implementation of the Self-Management process and outcome indicators will promote self-management education and skill acquisition as a rehabilitation priority, allow for personalization of skills related to the individual's self-management goal(s), and empower individuals with SCI/D to manage their health and daily activities while successfully integrating into the community.
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Affiliation(s)
- Gaya Jeyathevan
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Susan B. Jaglal
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sander L. Hitzig
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada,Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Rehabilitation Sciences Institute, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Linassi
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sandra Mills
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | | | - Karen Anzai
- GF Strong Rehab Centre, Vancouver, British Columbia, Canada
| | | | - Dalton Wolfe
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada,School of Health Studies, Western University, London, Ontario, Canada
| | - Mark Bayley
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lubna Aslam
- Spinal Cord Injury Ontario, Toronto, Ontario, Canada
| | - Farnoosh Farahani
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - S. Mohammad Alavinia
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Maryam Omidvar
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Correspondence to: B. Catharine Craven, KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 206-H 520 Sutherland Drive, Toronto, ON, M4G3V9, Canada; Ph: 416-597-3422x6122.
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8
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van Diemen T, Verberne DPJ, Koomen PSJ, Bongers-Janssen HMH, van Nes IJW. Interdisciplinary follow-up clinic for people with spinal cord injury: a retrospective study of a carousel model. Spinal Cord Ser Cases 2021; 7:86. [PMID: 34580276 DOI: 10.1038/s41394-021-00451-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 09/16/2021] [Accepted: 09/16/2021] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN Explorative retrospective cohort study. OBJECTIVE Secondary health conditions (SHCs) are common in people with spinal cord injury (SCI). To date, little is known about the effectiveness of long-term follow-up care in preventing SHCs. The objective of this study was to explore the therapeutic content of an interdisciplinary follow-up clinic by retrospective analyses of provided recommendations and collected data concerning SHCs. SETTING Rehabilitation center Sint Maartenskliniek, The Netherlands. METHODS All people with SCI, who visited one or more outpatient interdisciplinary follow-up clinics between January 2012 and October 2020 were included in this study. Treatment information was retrieved from their medical records. RESULTS The 264 participants of the follow-up clinic received, after their first visit, an average of 3.9 recommendations regarding SHCs. Most recommendations were preventive in nature (43%), and were related to physical SHCs (61%). Most recommendations were followed by the participants (34% out of 40% that could be determined) and half of the underlying problems were solved (31% out of 62%). The bodyweight and respiratory function remained stable over time. CONCLUSION Participants of the interdisciplinary follow-up clinics received extensive recommendations on a variety of subjects, which most likely, reflects the interdisciplinary approach. Recommendations were followed-up to a large extent, resulting in solving half of the underlying SHCs. This way, worse SHCs were prevented by the recommendations. This findings, together with the stability of respiratory function and bodyweight, suggests the added value of the interdisciplinary follow-up clinic to usual care. More prospective research is necessary to investigate the (cost-)effectiveness.
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Affiliation(s)
- Tijn van Diemen
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands.
| | - Daan P J Verberne
- Department of Neurorehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Patrick S J Koomen
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
| | | | - Ilse J W van Nes
- Department of Spinal Cord Injury Rehabilitation, Sint Maartenskliniek, Nijmegen, The Netherlands
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Tschoepe R, Benfield A, Posey R, Mercer V. A Systematic Review of the Effects of Community Transition Programs on Quality of Life and Hospital Readmissions for Adults With Traumatic Spinal Cord Injury. Arch Phys Med Rehabil 2021; 103:1013-1022.e12. [PMID: 34464608 DOI: 10.1016/j.apmr.2021.08.002] [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: 04/10/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effects of community transition programs for adults with traumatic spinal cord injury (tSCI) on hospital readmissions and quality of life (QOL). DATA SOURCES Seven databases (PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Google Scholar, the Joanna Briggs Institute database, OTseeker, and PEDro) and reference lists of relevant articles were searched from inception through March 2020. STUDY SELECTION Original research studies were included that (1) evaluated interventions designed to support individuals aged 18-65 years with newly acquired tSCI in navigating the transition from subacute care to the community and (2) reported data for QOL or hospital readmission outcomes. Searches identified 4694 studies, and 26 of these met the selection criteria. DATA EXTRACTION Two reviewers independently screened and assessed all studies, extracting information about study type, methodological strengths and weaknesses, participant and intervention characteristics, comparator, and significant results. Any discrepancies were resolved by a third reviewer. DATA SYNTHESIS Studies were grouped according to primary intervention: peer mentoring (n=8), telehealth (n=5), education (n=5), independent living (n=3), occupational therapy (n=1), counseling (n=1), and patient navigation (n=4). Reviewers used the Let Evidence Guide Every Decision appraisal tool rubric to grade the body of evidence for each intervention type. Moderate level evidence supports the positive effects of peer mentoring, and low level evidence indicates positive effects of telehealth, education, independent living, and occupational therapy interventions. Peer mentoring, telehealth, and patient navigation were the only intervention types that included hospital readmission outcomes. Of these, peer mentoring had the most evidence, with 3 of the 4 studies that included hospital readmission outcomes demonstrating statistically significant improvements. CONCLUSIONS In general, there is a paucity of high-quality evidence with sufficiently similar characteristics to demonstrate and compare benefits from program participation. When high quality studies have been conducted, they have obtained mixed results. Of the different intervention types, peer mentorship has the strongest supporting evidence. Further research is needed to identify specific intervention components that are most effective in improving QOL and reducing hospital readmission for specific subgroups of individuals recovering from tSCI.
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Affiliation(s)
- Raheleh Tschoepe
- From the Division of Occupational Science and Occupational Therapy, Department of Allied Health Sciences, University of North Carolina-Chapel Hill, Chapel Hill, NC.
| | - Anna Benfield
- From the Division of Occupational Science and Occupational Therapy, Department of Allied Health Sciences, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Rachael Posey
- Health Sciences Library, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Vicki Mercer
- From the Division of Occupational Science and Occupational Therapy, Department of Allied Health Sciences, University of North Carolina-Chapel Hill, Chapel Hill, NC
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Hossain MS, Harvey LA, Islam MS, Rahman MA, Muldoon S, Biering-Sorensen F, Jan S, Liu H, Li Q, Cameron ID, Taylor V, Lindley RI, Billot L, Herbert RD. A community-based intervention to prevent serious complications and death 2 years after discharge in people with spinal cord injury in Bangladesh (CIVIC): a randomised trial. Spinal Cord 2021; 59:649-658. [PMID: 32917948 PMCID: PMC8189918 DOI: 10.1038/s41393-020-00546-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022]
Abstract
STUDY DESIGN Randomised controlled trial. OBJECTIVES To determine the effectiveness of a sustainable community-based intervention designed to prevent serious complications and death 2 years after discharge in people with spinal cord injury in Bangladesh. SETTING Bangladesh. METHODS A pragmatic randomised controlled trial was undertaken. People who had sustained a spinal cord injury in the preceding 2 years, were wheelchair-dependent, and were about to be discharged from hospital in Bangladesh were recruited and randomised to an Intervention or Control group using a concealed allocation procedure stratified by level of lesion (tetraplegia/paraplegia). Participants in the Intervention group received 36 phone calls and three home visits over the first 2 years following discharge. All participants received usual post-discharge care. Survival status and date of death were determined by blinded assessors 2 years after randomisation. RESULTS Between July 2015 and March 2018, 410 participants were randomised (204 to Intervention, 206 to Control). There was no loss to follow up. At 2 years, 15 (7.4%) participants in the Intervention group and 16 (7.8%) participants in the Control group had died (hazard ratio from unadjusted Cox model = 0.93 [95% CI, 0.46 to 1.89]; p from log rank test 0.85). There were no clinically important or statistically significant average causal effects of intervention on the incidence or severity of complications. CONCLUSION A program of community-based care for people with recent spinal cord injury in Bangladesh involving frequent phone contact and occasional in-person contact with a health professional after discharge from hospital is no better at preventing death at 2 years than usual care.
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Affiliation(s)
- Mohammad Sohrab Hossain
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia.
| | - Md Shofiqul Islam
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
| | - Md Akhlasur Rahman
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
| | - Stephen Muldoon
- Muldoon Rehabilitation, 72 Liscreevin Road, Lisnarick, Co Fermanagh, BT94 1PZ, Northern Ireland
| | - Fin Biering-Sorensen
- Department for Spinal Cord Injuries, University of Copenhagen, Havnevej 25, DK-3100, Hornbæk, Denmark
| | - Stephen Jan
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Hueiming Liu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Qiang Li
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
| | - Valerie Taylor
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
| | - Richard I Lindley
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Laurent Billot
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Barker Street, Randwick, 2031, NSW, Australia
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11
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Lefèvre C, Bessard A, Aubert P, Joussain C, Giuliano F, Behr-Roussel D, Perrouin-Verbe MA, Perrouin-Verbe B, Brochard C, Neunlist M. Enteric Nervous System Remodeling in a Rat Model of Spinal Cord Injury: A Pilot Study. Neurotrauma Rep 2020; 1:125-136. [PMID: 34223537 PMCID: PMC8240894 DOI: 10.1089/neur.2020.0041] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The physiopathology of digestive disorders in patients with spinal cord injury (SCI) remains largely unknown, particularly the involvement of the enteric nervous system (ENS). We aimed in a rat model of chronic thoracic SCI to characterize (1) changes in the neurochemical coding of enteric neurons and their putative consequences upon neuromuscular response, and (2) the inflammatory response of the colon. Ex vivo motility of proximal and distal colon segments of SCI and control (CT) rats were studied in an organ chamber in response to electrical field stimulation (EFS) and bethanechol. Immunohistochemical analysis of proximal and distal segments was performed using antibodies again Hu, neuronal nitric oxide synthase, (nNOS), and choline acetyltransferase. Colonic content of acetylcholine and acetylcholinesterase was measured; messenger RNA (mRNA) expression of inflammatory cytokines was measured using reverse transcription quantitative polymerase chain reaction (RT-qPCR) approaches. Compared with the CT rats, the contractile response to bethanechol was significantly decreased in the proximal colon of SCI rats but not in the distal colon. The proportion of nNOS immunoreactive (IR) neurons was significantly reduced in the proximal but not distal colon of SCI rats. No change in proportion of choline acetyltransferase (ChAT)-IR was reported; the tissue concentration of acetylcholine was significantly decreased in the proximal colon of SCI rats. The expression of tumor necrosis factor alpha (TNF-α) and intercellular adhesion molecule-1 (ICAM-1) was significantly reduced in the proximal and distal colon of SCI rats. This study demonstrates that functional motor and enteric neuroplastic changes affect preferentially the proximal colon compared with the distal colon. The underlying mechanisms and factors responsible for these changes remain to be discovered.
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Affiliation(s)
- Chloë Lefèvre
- UMR Inserm 1235, Research Unit, The Enteric Nervous System in Gut and Brain Diseases (TENS), University of Nantes, Nantes, France.,Neurological Physical and Rehabilitation Medicine Department, University Hospital of Nantes, Nantes, France
| | - Anne Bessard
- UMR Inserm 1235, Research Unit, The Enteric Nervous System in Gut and Brain Diseases (TENS), University of Nantes, Nantes, France
| | - Philippe Aubert
- UMR Inserm 1235, Research Unit, The Enteric Nervous System in Gut and Brain Diseases (TENS), University of Nantes, Nantes, France
| | - Charles Joussain
- UMR Inserm 1179, Research Unit, Neuromuscular Disability, Physiopathology, Biotherapy, and Applied Pharmacology (END-ICAP), University of Versailles-St-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - François Giuliano
- UMR Inserm 1179, Research Unit, Neuromuscular Disability, Physiopathology, Biotherapy, and Applied Pharmacology (END-ICAP), University of Versailles-St-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Delphine Behr-Roussel
- Pelvipharm, University of Versailles-St-Quentin-en-Yvelines, Montigny-le-Bretonneux, France
| | - Marie-Aimée Perrouin-Verbe
- UMR Inserm 1235, Research Unit, The Enteric Nervous System in Gut and Brain Diseases (TENS), University of Nantes, Nantes, France.,Urology Unit, University Hospital of Nantes, Nantes, France
| | - Brigitte Perrouin-Verbe
- UMR Inserm 1235, Research Unit, The Enteric Nervous System in Gut and Brain Diseases (TENS), University of Nantes, Nantes, France.,Neurological Physical and Rehabilitation Medicine Department, University Hospital of Nantes, Nantes, France
| | - Charlène Brochard
- UMR Inserm 1235, Research Unit, The Enteric Nervous System in Gut and Brain Diseases (TENS), University of Nantes, Nantes, France.,Digestive Physiology Unit, University Hospital of Rennes, Rennes, France
| | - Michel Neunlist
- UMR Inserm 1235, Research Unit, The Enteric Nervous System in Gut and Brain Diseases (TENS), University of Nantes, Nantes, France
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12
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Wake E, Atkins H, Willock A, Hawkes A, Dawber J, Weir KA. Telehealth in trauma: A scoping review. J Telemed Telecare 2020; 28:412-422. [PMID: 32715866 DOI: 10.1177/1357633x20940868] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The purpose of this scoping review was to ascertain how 'telehealth' is utilised within health care, from pre hospital to admission, discharge and post discharge, with patients who have suffered major trauma. METHODS A scoping review of the literature published in English since 1980 was conducted using MEDLINE, Ovid EMBASE, PsychINFO, CINAHL, Austhealth, Cochrane Central Register of Controlled Trials (CENTRAL; Cochrane library) and Web of Science MEDLINE and MEBASE to identify relevant studies. RESULTS We included 77 eligible studies with both randomised controlled trial and cohort design methodology. A variety of trauma was included such as traumatic brain injuries (n = 52; 67.5%), spinal cord injury (n = 14; 18.2%) and multi-trauma (n = 9; 11.7%) to both adult (n = 38) and paediatric (n = 32) participants. Telehealth is used in pre-hospital and acute-care settings (n = 11; 14.3%) to facilitate assessment, and in rehabilitation and follow-up (n = 61; 79.2%) to deliver therapy. Effects on health were reported the most (n = 46), with no negative outcomes. The feasibility of telehealth as a delivery mode was established, but coordination and technical issues are barriers to use. Overall, both patients and clinicians were satisfied using this mode of delivery. CONCLUSION This review demonstrates how telehealth is utilised across a spectrum of patients with traumatic injuries and to facilitate delivery of therapy, specialist consultations and assessments, with many studies reporting improvements to health. There is a paucity of high-quality rigorous research, which makes replication of findings and uptake of the intervention problematic. Future telehealth and trauma research should focus on the quality and reproducibility of telehealth interventions and the economic feasibility of using this platform to deliver trauma care.
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Affiliation(s)
- Elizabeth Wake
- Gold Coast Hospital and Health Service, Australia.,Griffith University, Australia
| | - Heidi Atkins
- Clinical Excellence Queensland, Queensland Health, Australia
| | | | | | - Jessica Dawber
- Gold Coast Hospital and Health Service, Australia.,Menzies Health Institute, Australia
| | - Kelly A Weir
- Gold Coast Hospital and Health Service, Australia.,Menzies Health Institute, Australia
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13
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Chamberlain JD, Eriks-Hoogland IE, Hug K, Jordan X, Schubert M, Brinkhof MWG. Attrition from specialised rehabilitation associated with an elevated mortality risk: results from a vital status tracing study in Swiss spinal cord injured patients. BMJ Open 2020; 10:e035752. [PMID: 32647022 PMCID: PMC7351285 DOI: 10.1136/bmjopen-2019-035752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Study drop-out and attrition from treating clinics is common among persons with chronic health conditions. However, if attrition is associated with adverse health outcomes, it may bias or mislead inferences for health policy and resource allocation. METHODS This retrospective cohort study uses data attained through the Swiss Spinal Cord Injury (SwiSCI) cohort study on persons with spinal cord injury (SCI). Vital status (VS) was ascertained either through clinic medical records (MRs) or through municipalities in a secondary tracing effort. Flexible parametric survival models were used to investigate risk factors for going lost to clinic (LTC) and the association of LTC with subsequent risk of mortality. RESULTS 1924 individuals were included in the tracing study; for 1608 of these cases, contemporary VS was initially checked in the MRs. VS was ascertained for 704 cases of the 1608 cases initially checked in MRs; of the remaining cases (n=904), nearly 90% were identified in municipalities (n=804). LTC was associated with a nearly fourfold higher risk of mortality (HR=3.62; 95% CI 2.18 to 6.02) among persons with traumatic SCI. Extended driving time (ie, less than 30 min compared with 30 min and longer to reach the nearest specialised rehabilitation facility) was associated with an increased risk of mortality (HR=1.51, 95% CI 1.02 to 2.22) for individuals with non-traumatic SCI. CONCLUSION The differential risk of LTC according to sociodemographic and SCI lesion characteristics underscores the importance of accounting for attrition in cohort studies on chronic disease populations requiring long-term care. In addition, given the associated risk of mortality, LTC is an issue of concern to clinicians and policy makers aiming to optimise the long-term survival of community-dwelling individuals with traumatic SCI. Future studies are necessary to verify whether it is possible to improve survival prospects of individuals LTC through more persistent outreach and targeted care.
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Affiliation(s)
- Jonviea D Chamberlain
- Swiss Paraplegic Research, Nottwil, Switzerland
- Centre INSERM U1219, CIC 1401-EC, Institut de Santé Publique, d'Epidémiologie et de Développement (ISPED), Bordeaux School of Public Health, University of Bordeaux, Bordeaux, France
| | | | | | | | | | - Martin W G Brinkhof
- Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, Luzern, Switzerland
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14
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Liu H, Hossain MS, Islam MS, Rahman MA, Costa PD, Herbert RD, Jan S, Cameron ID, Muldoon S, Chhabra HS, Lindley RI, Biering-Sorensen F, Ducharme S, Taylor V, Harvey LA. Understanding how a community-based intervention for people with spinal cord injury in Bangladesh was delivered as part of a randomised controlled trial: a process evaluation. Spinal Cord 2020; 58:1166-1175. [PMID: 32541882 PMCID: PMC7606133 DOI: 10.1038/s41393-020-0495-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 11/09/2022]
Abstract
Design Mixed methods study Setting Community, Bangladesh Objectives To understand how a community-based intervention for people with spinal cord injury (SCI) in Bangladesh was delivered as part of a randomised controlled trial and to gauge the perceptions of participants and healthcare professionals to the intervention. Methods A community-based intervention was administered to 204 participants as part of a large randomised controlled trial (called the CIVIC trial). Case-managers followed-up participants with regular telephone calls and home visits over the first 2 years after discharge. The following data were collected alongside the trial: (i) chart audit of telephone calls and home visits (ii) recordings of 20 telephone calls (iii) interviews with 14 Intervention participants and four healthcare professionals including three case-managers. Results Participants received the target number of telephone calls and home visits. Pressure injuries were identified as a problem during at least one telephone call by 43% of participants. Participants and case-managers valued regular telephone calls and home visits, and believed that calls and visits prevented complications and alleviated social isolation. Participants trusted case-managers and were confident in the care and advice provided. Case-managers expressed concerns that people with SCI in Bangladesh face many problems impacting on well-being and motivation stemming from poverty, limited employment opportunities, societal attitudes and inaccessible environments. Conclusion A community-based intervention involving regular telephone calls and home visits was administered as intended and was well received by the recipients of the care. Nonetheless, people with SCI in Bangladesh face economic and social problems which cannot be fully addressed by this type of intervention alone.
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Affiliation(s)
- Hueiming Liu
- George Institute for Global Health, Sydney, NSW, Australia
| | - Mohammad Sohrab Hossain
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School/Northern, University of Sydney, St Leonards, NSW, Australia.,Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Md Shofiqul Islam
- Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Md Akhlasur Rahman
- Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Punam D Costa
- Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Robert D Herbert
- Neuroscience Research Australia, Barker Street, Randwick, NSW, Australia
| | - Stephen Jan
- George Institute for Global Health, Sydney, NSW, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School/Northern, University of Sydney, St Leonards, NSW, Australia
| | - Stephen Muldoon
- Muldoon Rehabilitation, 72 Liscreevin Road, Lisnarick, Co Fermanagh, BT, Northern Ireland, Northern Ireland
| | | | - Richard I Lindley
- George Institute for Global Health, Sydney, NSW, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Fin Biering-Sorensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Stanley Ducharme
- Boston Medical Centre and Boston University School of Medicine, 725 Albany street, Boston, MA, USA
| | - Valerie Taylor
- Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School/Northern, University of Sydney, St Leonards, NSW, Australia.
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15
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Milligan J, Lee J, Smith M, Donaldson L, Athanasopoulos P, Bassett-Spiers K, Howcroft J, Howcroft JW, Jeji T, Joshi PB, Mehan U, Noonan V. Advancing primary and community care for persons with spinal cord injury: Key findings from a Canadian summit. J Spinal Cord Med 2020; 43:223-233. [PMID: 30557085 PMCID: PMC7054958 DOI: 10.1080/10790268.2018.1552643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Context: Persons with spinal cord injury (SCI) experience significant challenges when they access primary care and community services.Design: A provincial summit was held to direct research, education, and innovation for primary and community care for SCI.Setting: Toronto, Ontario, Canada.Participants: Key stakeholders (N = 95) including persons with SCI and caregivers, clinicians from primary care, rehabilitation, and specialized care, researchers, advocacy groups, and policy makers.Methods: A one-day facilitated meeting that included guest speakers, panel discussions and small group discussions was held to generate potential solutions to current issues related to SCI care and to foster collaborative relationships to advance care for SCI. Perspectives on SCI management were shared by primary care, neurosurgery, rehabilitation, and members of the SCI communityOutcome Measures: Discussions were focused on five domains: knowledge translation and dissemination, application of best practices, communication, research, and patient service accessibility.Results: Summit participants identified issues and prioritized solutions to improve primary and community care including the creation of a network of key stakeholders to enable knowledge creation and dissemination; an online repository of SCI resources, integrated health records, and a clinical network for SCI care; development and implementation of strategies to improve care transitions across sectors; implementation of effective care models and improved access to services; and utilization of empowerment frameworks to support self-management.Conclusions: This summit identified priorities for further collaborative efforts to advance SCI primary and community care and will inform the development of a provincial SCI strategy aimed at improving the system of care for SCI.
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Affiliation(s)
- James Milligan
- Centre for Family Medicine Family Health
Team, Kitchener, Canada
- Department of Family Medicine, Faculty of Health
Sciences, McMaster University, Hamilton, Canada
| | - Joseph Lee
- Centre for Family Medicine Family Health
Team, Kitchener, Canada
- Department of Family Medicine, Faculty of Health
Sciences, McMaster University, Hamilton, Canada
| | - Matt Smith
- Centre for Family Medicine Family Health
Team, Kitchener, Canada
| | | | | | | | - Jeremy Howcroft
- Centre for Family Medicine Family Health
Team, Kitchener, Canada
| | | | - Tara Jeji
- Ontario Neurotrauma Foundation,
Toronto, Canada
| | | | - Upender Mehan
- Centre for Family Medicine Family Health
Team, Kitchener, Canada
- Department of Family Medicine, Faculty of Health
Sciences, McMaster University, Hamilton, Canada
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16
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Rapidi CA, Tederko P, Moslavac S, Popa D, Branco CA, Kiekens C, Varela Donoso E, Christodoulou N. Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice for persons with spinal cord injury. The European PRM position (UEMS PRM Section). Eur J Phys Rehabil Med 2018; 54:797-807. [PMID: 29952157 DOI: 10.23736/s1973-9087.18.05374-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
INTRODUCTION Spinal cord injury (SCI) is a devastating condition and a challenge for every health system and every society. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians for people with SCI. The aim of the paper was to improve Physical and Rehabilitation Medicine (PRM) physicians' professional practice for persons with SCI in order to improve their functionality, social and community reintegration, and to overcome activity limitations and/or participation restrictions. EVIDENCE ACQUISITION A systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. EVIDENCE SYNTHESIS The systematic literature review is reported together with thirty-eight recommendations resulting from the Delphi procedure. CONCLUSIONS The professional role of PRM physicians who have expertise in the rehabilitation of SCI is to run rehabilitation programmes in multi-professional teams, working in an interdisciplinary way in a variety of settings to improve the functioning of people with SCI.
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Affiliation(s)
| | - Piotr Tederko
- Department of Rehabilitation, Medical University of Warsaw, Warsaw, Poland
| | - Sasa Moslavac
- Department of Physical and Rehabilitation Medicine, Special Hospital for Medical Rehabilitation, Varaždinske Toplice, Croatia
| | - Daiana Popa
- Clinical Rehabilitation Hospital Felix-Spa Bihor County, Oradea, Romania
| | - Catarina A Branco
- Department of Physical and Rehabilitation Medicine, Centro Hospitalar de Entre o Douro e Vouga E.P.E, Porto, Portugal
| | - Carlotte Kiekens
- Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Enrique Varela Donoso
- Physical and Rehabilitation Medicine Department, Complutense University School of Medicine, Madrid, Spain
| | - Nicolas Christodoulou
- Medical School, European University Cyprus, Nicosia, Cyprus.,UEMS PRM Section, Brussels, Belgium
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17
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Glennie RA, Batke J, Fallah N, Cheng CL, Rivers CS, Noonan VK, Dvorak MF, Fisher CG, Kwon BK, Street JT. Rural and Urban Living in Persons with Spinal Cord Injury and Comparing Environmental Barriers, Their Health, and Quality-of-Life Outcomes. J Neurotrauma 2017; 34:2877-2882. [PMID: 28462633 PMCID: PMC5653139 DOI: 10.1089/neu.2016.4931] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
There is worldwide geographic variation in the epidemiology of traumatic spinal cord injury (tSCI). The aim of this study was to determine whether environmental barriers, health status, and quality-of-life outcomes differ between patients with tSCI living in rural or urban settings, and whether patients move from rural to urban settings after tSCI. A cohort review of the Rick Hansen SCI Registry (RHSCIR) was undertaken from 2004 to 2012 for one province in Canada. Rural/urban setting was determined using postal codes. Outcomes data at 1 year in the community included the Short Form-36 Version 2 (SF36v2™), Life Satisfaction Questionnaire, Craig Hospital Inventory of Environmental Factors-Short Form (CHIEF-SF), Functional Independent Measure® Instrument, and SCI Health Questionnaire. Statistical methodologies used were t test, Mann-Whitney U test, and Fisher's exact or χ2 test. In the analysis, 338 RHSCIR participants were included; 65 lived in a rural setting and 273 in an urban setting. Of the original patients residing in a rural area at discharge,10 moved to an urban area by 1 year. Those who moved from a rural to urban area reported a lower SF-36v2™ Mental Component Score (MCS; p = 0.04) and a higher incidence of depression at 1 year (p = 0.04). Urban patients also reported a higher incidence of depression (p = 0.02) and a lower CHIEF-SF total score (p = 0.01) indicating fewer environmental barriers. No significant differences were found in other outcomes. Results suggest that although the patient outcomes are similar, some patients move from rural to urban settings after tSCI. Future efforts should target screening mental health problems early, especially in urban settings.
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Affiliation(s)
- R. Andrew Glennie
- Department of Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Juliet Batke
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nader Fallah
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | | | | | | | - Marcel F. Dvorak
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G. Fisher
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - John T. Street
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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18
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Divanoglou A, Tasiemski T, Augutis M, Trok K. Active Rehabilitation-a community peer-based approach for persons with spinal cord injury: international utilisation of key elements. Spinal Cord 2017; 55:545-552. [PMID: 28374811 DOI: 10.1038/sc.2017.28] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 02/19/2017] [Accepted: 02/20/2017] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Active Rehabilitation (AR) is a community peer-based approach that started in Sweden in 1976. As a key component of the approach, AR training camps provide intensive, goal-oriented, intentional, group-based, customised training and peer-support opportunities in a community environment for individuals with spinal cord injury. STUDY DESIGN Prospective cross-sectional study. OBJECTIVES To describe the profile of the organisations that use components of the AR approach, and to explore the characteristics and the international variations of the approach. SETTING Twenty-two organisations from 21 countries from Europe, Asia and Africa reported using components of the AR approach during the past 10 years. METHODS An electronic survey was developed and distributed through a personalised email. Sampling involved a prospective identification of organisations that met the inclusion criteria and snowball strategies. RESULTS While there were many collaborating links between the organisations, RG Active Rehabilitation from Sweden and Motivation Charitable Trust from the United Kingdom were identified as key supporting organisations. The 10 key elements of the AR approach were found to be used uniformly across the participating organisations. Small variations were associated with variations in country income and key supporting organisation. CONCLUSIONS This is the first study to describe the key elements and international variations of the AR approach. This will provide the basis for further studies exploring the effectiveness of the approach, it will likely facilitate international collaboration on research and operational aspects and it could potentially support higher integration in the health-care system and long-term funding of these programmes.
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Affiliation(s)
- A Divanoglou
- Department of Physiotherapy, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.,Physiotherapy Program, School of Human Health and Social Sciences, Central Queensland University, North Rockhampton, QLD, Australia.,Alli Opsi, Non-Governmental Organization, Thessaloniki, Greece
| | - T Tasiemski
- Poznań University of Physical Education, Poznan, Poland
| | - M Augutis
- Research and Development, Västernorrland County Council, Sundsvall, Sweden.,Karolinska Institutet, Department of NVS, Stockholm, Sweden.,Rekryteringsgruppen Active Rehabilitation, Stockholm, Sweden
| | - K Trok
- Rekryteringsgruppen Active Rehabilitation, Stockholm, Sweden.,Karolinska University Hospital, Spinal Cord Injury Unit, Stockholm, Sweden
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19
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Perceived effectiveness and mechanisms of community peer-based programmes for Spinal Cord Injuries—a systematic review of qualitative findings. Spinal Cord 2016; 55:225-234. [DOI: 10.1038/sc.2016.147] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2016] [Revised: 08/02/2016] [Accepted: 08/27/2016] [Indexed: 11/09/2022]
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20
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Bloemen-Vrencken J, de Witte L, Post M, Pons C, van Asbeck F, van der Woude L, van den Heuvel W. Comparison of two Dutch follow-up care models for spinal cord-injured patients and their impact on health problems, re-admissions and quality of care. Clin Rehabil 2016; 21:997-1006. [DOI: 10.1177/0269215507079835] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To evaluate whether transmural care for people with spinal cord injury living in the community has more impact on health outcomes than traditional follow-up care within the Netherlands. Design: Quasi-experiment with 12 months of follow-up. Setting: Eight Dutch rehabilitation centres. Subjects: Thirty-one patients who received transmural care in two `experimental' rehabilitation centres were compared with a matched sample of 31 patients having received `usual follow-up care' in six other rehabilitation centres. Intervention: The core component of the transmural care consists of a transmural nurse, who `liaises' between former patients living in the community, primary care professionals and the rehabilitation team. The transmural care model provides activities to support patients and their family/partners and activities to promote continuity of care. Main measures: The prevalence of pressure sores and urinary tract infections; the number and duration of re-admissions to hospital and rehabilitation centre due to pressure sores, bladder and bowel problems; and the experienced quality of follow-up care. Results: The transmural care, as implemented, did not influence the health outcomes. The prevalence of pressure sores, urinary tract infections and the number of re-admissions (due to pressure sores, bladder and bowel problems) was respectively 13, 13 and 4 in the intervention group versus 14, 15 and 6 in the usual follow-up care group. Since the transmural care had been incompletely implemented and there were methodological and practical limitations, we formulated no final conclusions regarding its effectiveness. Conclusion: Implementing the transmural care model strictly according to protocol may improve its effectiveness.
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Affiliation(s)
| | - L.P. de Witte
- Institute for Rehabilitation Research, iRv, Hoensbroek, Maastricht University, Maastricht
| | - M.W.M. Post
- Rehabilitation Centre De Hoogstraat, Utrecht
| | - C. Pons
- Rehabilitation Centre Hoensbroeck, Hoensbroek
| | | | - L.H.V. van der Woude
- Institute for Fundamental and Clinical Human Movement Sciences, Faculty of Human Movement Sciences, Vrije Universiteit Amsterdam, Rehabilitation Centre Amsterdam
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21
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Outcomes and Lessons Learned From a Randomized Controlled Trial to Reduce Health Care Utilization During the First Year After Spinal Cord Injury Rehabilitation: Telephone Counseling Versus Usual Care. Arch Phys Med Rehabil 2016; 97:1793-1796.e1. [PMID: 27039058 DOI: 10.1016/j.apmr.2016.03.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 03/01/2016] [Accepted: 03/08/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe the outcomes and lessons learned from a trial of telephone counseling (TC) to reduce medical complications and health care utilization and to improve psychosocial outcomes during the first year after spinal cord injury rehabilitation. DESIGN Single-site, single-blind, randomized (1:1) controlled trial comparing usual care plus TC with usual care (UC). SETTING Two inpatient rehabilitation programs. PARTICIPANTS Adult patients (N=168) discharged between 2007 and 2010. INTERVENTIONS The TC group (n=85, 51%) received up to eleven 30- to 45-minute scheduled telephone calls to provide education, resources, and support. The UC group (n=83, 49%) received indicated referrals and treatment. MAIN OUTCOME MEASURES The primary outcome was a composite of self-reported health care utilization and medical complications. Secondary outcomes were depression severity, current health state, subjective health, and community participation. RESULTS No significant differences were observed between TC and UC groups in the primary or secondary psychosocial outcomes. CONCLUSIONS This study had a number of strengths, but included potential design weaknesses. Intervention studies would benefit from prescreening participants to identify those with treatable problems, those at high risk for poor outcomes, or those with intentions to change target behaviors. Interventions focused on treatment goals and designed to work in collaboration with the participant's medical care system may lead to improved outcomes.
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Dorstyn D, Mathias J, Denson L. Applications of telecounselling in spinal cord injury rehabilitation: a systematic review with effect sizes. Clin Rehabil 2013; 27:1072-83. [PMID: 23823709 DOI: 10.1177/0269215513488001] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the short- and medium-term efficacy of counselling services provided remotely by telephone, video or internet, in managing mental health outcomes following spinal cord injury. DATA SOURCES A search of electronic databases, critical reviews and published meta-analyses was conducted. REVIEW METHODS Seven independent studies (N = 272 participants) met the inclusion criteria. The majority of these studies utilized telephone-based counselling, with limited research examining psychological interventions delivered by videoconferencing (N study = 1) or online (N study = 1). RESULTS There is some evidence that telecounselling can significantly improve an individual's management of common comorbidities following spinal cord injury, including pain and sleep difficulties (d = 0.45). Medium-term treatment effects were difficult to evaluate, with very few studies providing these data, although participants have reported gains in quality of life 12 months after treatment (d = 0.88). The main clinical advantages are time efficiency and consumer satisfaction. CONCLUSION The results highlight the need for further evidence, particularly randomized controlled trials, to establish the benefits and clinical viability of telecounselling.
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Affiliation(s)
- Diana Dorstyn
- School of Psychology, University of Adelaide, South Australia
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A pilot study of a telehealth intervention for persons with spinal cord dysfunction. Spinal Cord 2013; 51:715-20. [PMID: 23752260 DOI: 10.1038/sc.2013.45] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Revised: 03/01/2013] [Accepted: 04/04/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Single-blind randomized controlled trial of 6 months' duration. OBJECTIVES To evaluate the efficacy of a novel telehealth intervention, 'CareCall', on reducing pressure ulcers and depression and enhancing the use of appropriate health care. SETTING General community, Massachusetts and Connecticut, United States METHODS 'CareCall' is an automated, interactive voice response system that combines patient education, cognitive behavioral interventions, screening and referrals, with alerts to a nurse telerehabilitation coordinator for direct non-emergent phone follow up. Participants consisted of a convenience sample of 142 persons with multiple sclerosis or spinal cord injury using a wheelchair >6 h per day. The intervention group received CareCall (n=71) The control group received usual care (n=71). The main outcome measures were: The pressure ulcer scale for healing tool, Patient Health Questionnaire-9 depression scale, Cornell Services Index and Craig Hospital Inventory of Environmental Factors-Short Form Question 5. RESULTS CareCall achieved a reduction in presence of pressure ulcers at 6 months in women (P<0.0001). Among those with baseline depression, CareCall reduced 6-month severity of depression, adjusting for age and gender (P<0.047). CareCall did not have a significant impact on health-care utilization (OR=1.8, P=0.07), but did significantly improve participants' report of health-care availability (OR=2.03, P<0.04). CONCLUSION This is the first study to demonstrate the efficacy of a largely automated telehealth intervention for adults with spinal cord dysfunction. Future research needs to replicate this study in a larger, multisite trial.
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Chhabra HS, Harvey LA, Muldoon S, Chaudhary S, Arora M, Brown DJ, Biering-Sorensen F, Wyndaele JJ, Charlifue S, Horsewell J, Ducharme S, Green D, Simpson D, Glinsky J, Weerts E, Upadhyay N, Aito S, Wing P, Katoh S, Kovindha A, Krassioukov A, Weeks C, Srikumar V, Reeves R, Siriwardane C, Hasnan N, Kalke YB, Lanig I. www.elearnSCI.org: a global educational initiative of ISCoS. Spinal Cord 2013; 51:176-82. [DOI: 10.1038/sc.2012.177] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
Study design one group pre- and post-test design Objective The primary aim was to examine both the short- and long-term effects of an oral home telecare program on improving gingival health among adults with tetraplegia. Methods Eight adults with tetraplegia participated. The oral home telecare program consisted of individualized oral hygiene training in the use of assistive devices (powered toothbrush and adapted flosser and/or oral irrigator) using PC-based videoconferencing between each participant and an occupational therapist. Training was conducted on an average of five 15 to 30 min sessions across three months. During these training sessions, supervised practice of oral hygiene, and provision of immediate corrective feedback and positive reinforcement in the use of adaptive oral hygiene devices was emphasized. Gingival health assessment using the Löe-Silness gingival index (LSGI) was conducted at baseline, six months and 12 months. Results From baseline to six months, participants showed statistically significant differences (i.e., improvement with less gingival inflammation) in their LSGI scores (z=2.18, P=.03). From baseline to 12 months, participants also showed a statistically significant difference (i.e., improvement, z=2.03; P=.04) in their LSGI scores. Conclusion This study indicates that preventive oral home telecare with repeated oral hygiene training in the use of adaptive devices improved gingival health at six and 12 months among adults with tetraplegia.
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Kooijmans H, Post MWM, van der Woude LHV, de Groot S, Stam HJ, Bussmann JBJ. Randomized controlled trial of a self-management intervention in persons with spinal cord injury: design of the HABITS (Healthy Active Behavioural Intervention in SCI) study. Disabil Rehabil 2012; 35:1111-8. [PMID: 23033846 DOI: 10.3109/09638288.2012.718406] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
PURPOSE To evaluate the effectiveness of a 16-week self-management intervention on physical activity level and self-management skills (self-efficacy, proactive coping and problem solving skills) in persons with chronic SCI. METHOD AND DESIGN Multicenter randomized controlled trial (RCT). Eighty persons with a SCI for at least 10 years and aged 18 to 65 will randomly be assigned to the intervention (self-management) or the control group (information provision). During the 16-week self-management intervention (one home-visit, five group and five individual sessions) active lifestyle will be stimulated and self-management skills will be taught. Data will be collected at baseline (T0), 16 (T1) and 42 (T2) weeks after baseline. Primary outcome measure is level of daily physical activity (self-report/objectively measured). Secondary outcome measures are self-managements skills, stage of behaviour change and attitude. CONCLUSION This is the first RCT on self-management in people with chronic spinal cord injury. This trial will provide knowledge on the effects of a self-management intervention on physical active lifestyle in persons with a long-term SCI.
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Affiliation(s)
- H Kooijmans
- Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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van der Woude LHV, de Groot S, Postema K, Bussmann JBJ, Janssen TWJ, Post MWM. Active LifestyLe Rehabilitation interventions in aging spinal cord injury (ALLRISC): a multicentre research program. Disabil Rehabil 2012; 35:1097-103. [PMID: 23030594 DOI: 10.3109/09638288.2012.718407] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND With today's specialized medical care, life expectancy of persons with a spinal cord injury (SCI) has considerably improved. With increasing age and time since injury, many individuals with SCI, however, show a serious inactive lifestyle, associated with deconditioning and secondary health conditions (SHCs) (e.g. pressure sores, urinary and respiratory tract infections, osteoporosis, upper-extremity pain, obesity, diabetes, cardiovascular disease) and resulting in reduced participation and quality of life (QoL). Avoiding this downward spiral, is crucial. OBJECTIVES To understand possible deconditioning and SHCs in persons aging with a SCI in the context of active lifestyle, fitness, participation and QoL and to examine interventions that enhance active lifestyle, fitness, participation and QoL and help prevent some of the SHCs. METHODS A multicentre multidisciplinary research program (Active LifestyLe Rehabilitation Interventions in aging Spinal Cord injury, ALLRISC) in the setting of the long-standing Dutch SCI-rehabilitation clinical research network. RESULTS ALLRISC is a four-study research program addressing inactive lifestyle, deconditioning, and SHCs and their associations in people aging with SCI. The program consists of a cross-sectional study (n = 300) and three randomized clinical trials. All studies share a focus on fitness, active lifestyle, SHCs and deconditioning and outcome measures on these and other (participation, QoL) domains. It is hypothesized that a self-management program, low-intensity wheelchair exercise and hybrid functional electrical stimulation-supported leg and handcycling are effective interventions to enhance active life style and fitness, help to prevent some of the important SHCs in chronic SCI and improve participation and QoL. CONCLUSION ALLRISC aims to provide evidence-based preventive components of a rehabilitation aftercare system that preserves functioning in aging persons with SCI.
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Affiliation(s)
- L H V van der Woude
- Centre for Human Movement Sciences, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.
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Web-Based Specialist Support for Spinal Cord Injury Person's Care: Lessons Learned. Int J Telemed Appl 2012; 2012:861860. [PMID: 22934107 PMCID: PMC3426237 DOI: 10.1155/2012/861860] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Revised: 07/06/2012] [Accepted: 07/08/2012] [Indexed: 11/18/2022] Open
Abstract
Persons with disability from spinal cord injury (SCI) are subject to high risk of pathological events and need a regular followup even after discharge from the rehabilitation hospital. To help in followup, we developed a web portal for providing online specialist as well as GP support to SCI persons. After a feasibility study with 13 subjects, the portal has been introduced in the regional healthcare network in order to make it compliant with current legal regulations on data protection, including smartcard authentication. Although a number of training courses have been made to introduce SCI persons to portal use (up to 50 users), the number of accesses remained very low. Reasons for that have been investigated by means of a questionnaire submitted to the initial feasibility study subjects and included the still easier use of telephone versus our web-based smartcard-authenticated portal, in particular, because online communications are still perceived as an unusual way of interacting with the doctor. To summarize, the overall project has been appreciated by the users, but when it is time to ask for help to, the specialist, it is still much easier to make a phone call.
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Dorstyn D, Mathias J, Denson L, Robertson M. Effectiveness of telephone counseling in managing psychological outcomes after spinal cord injury: a preliminary study. Arch Phys Med Rehabil 2012; 93:2100-8. [PMID: 22705237 DOI: 10.1016/j.apmr.2012.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2012] [Revised: 05/29/2012] [Accepted: 06/01/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE To determine whether an individualized counseling intervention delivered by telephone-telecounseling-feasibly improves the emotional adjustment of adults with a newly acquired spinal cord injury (SCI). DESIGN Randomized controlled trial. SETTING Spinal injuries unit of a rehabilitation center. PARTICIPANTS Adults (N=40) aged 18 or older, who were recently discharged home from inpatient spinal rehabilitation, were randomly assigned to a telecounseling treatment or standard-care control group. All participants had recently received psychological treatment as inpatients in order to help assist them in adjusting to their disability. Referral to the inpatient psychology service was therefore a key indicator of participants' baseline distress levels and, consequently, their need for counseling support postdischarge. INTERVENTION Seven telecounseling sessions were delivered over a 12-week period by a single psychologist (D.D.). Pre- and postintervention data, plus a 3-month follow-up assessment, were compared with that of an SCI control group who received standard care. MAIN OUTCOME MEASURES Psychosocial outcome was measured using the following: Depression Anxiety Stress Scale-21; Mini International Neuropsychiatric Interview; Spinal Cord Lesion Emotional Wellbeing and Coping Strategies Questionnaires; and the Multidimensional Measure of Social Support. Cost-effectiveness and clinical feasibility were also evaluated. RESULTS Telecounseling participants reported clinical improvements in depression and anxiety and aspects of SCI coping immediately postintervention. However, these treatment gains were not statistically significant. Additionally, treatment effects were minimal at 3-month follow-up. Delivery related outcomes, including participation rate and cost analyses, were all positive. CONCLUSIONS The results suggest that continued psychological services for individuals reporting distress during their inpatient rehabilitation is important and that such services can be delivered by telephone cost-effectively and efficiently. However, the long-term benefits of telecounseling, once ceased, were not demonstrated.
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Affiliation(s)
- Diana Dorstyn
- South Australian Spinal Cord Injury Service, Hampstead Rehabilitation Centre, Northfield, South Australia, Australia.
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Abstract
Pressure ulcers and depression are common preventable conditions secondary to a spinal cord dysfunction. However, few successful, low-cost preventive approaches have been identified. We have developed a dynamic automated telephone calling system, termed Care Call, to empower and motivate people with spinal cord dysfunction to improve their skin care, seek treatment for depression, and appropriately use the healthcare system. Herein, we describe the design and development of Care Call, its novel features, and promising preliminary results of our pilot testing. Voice quality testing showed that Care Call was able to understand all voice characteristics except very soft-spoken speech. Importantly, pilot study subjects felt Care Call could be particularly useful for people who are depressed, those with acute injury, and those without access to quality care. The results of a randomized controlled trial currently underway to evaluate Care Call will be available in 2011.
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Woo C, Guihan M, Frick C, Gill CM, Ho CH. What's happening now! Telehealth management of spinal cord injury/disorders. J Spinal Cord Med 2011; 34:322-31. [PMID: 21756573 PMCID: PMC3127362 DOI: 10.1179/2045772311y.0000000003] [Citation(s) in RCA: 32] [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
CONTEXT Spinal cord injury and/or disorders (SCI/D) is a costly chronic condition. Impaired mobility, and lengthy travel distances to access specialty providers are barriers that can have adverse impact on expenses and quality of care. Although ample opportunities for use of telehealth technologies exist between medical facilities, and from clinical to home settings, field experience has largely been focused on home telehealth services to promote better patient self-management skills and improve clinical outcomes. FINDINGS This paper provides an overview of published literature on use of telehealth technologies with the SCI/D population. Presentation of case studies describe telehealth as a potential strategy for addressing disparities in providing quality care, and explore comprehensive management of multiple health issues in individuals with SCI/D. Experiences of providers in both private sector health-care systems and VHA medical facilities are described. Development of telehealth clinical protocols and adaptive devices that can be integrated with equipment to accommodate for the functional limitations in the SCI/D population are discussed as necessary for expansion of use of telehealth services. Rigorous research studies are lacking. As use of this technology spreads and issues surrounding implementation are addressed, we look forward to increased research to assess and evaluate its efficacy in the SCI/D population. CONCLUSION/CLINICAL RELEVANCE Telehealth in the home setting appears to be able to help persons with SCI/D remain in the community. As the use of telehealth increases, research will be necessary in both clinical and home settings to assess its efficacy in improving outcomes in the SCI/D population.
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Affiliation(s)
- Christine Woo
- National SCI/D Telehealth Program Coordinator, Cleveland SCI/D Clinical and Research Telehealth Programs, Cleveland, OH
| | - Marylou Guihan
- VA Medical Center, Hines, IL,Correspondence to: Marylou Guihan, VA Medical Center, Hines, IL 60141, USA.
| | | | - Carol M. Gill
- Chief of Spinal Cord Injury/Disorders Service Veterans Affairs, East Orange, NJ
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Whiteneck GG, Gassaway J, Dijkers MP, Lammertse DP, Hammond F, Heinemann AW, Backus D, Charlifue S, Ballard PH, Zanca JM. Inpatient and Postdischarge Rehabilitation Services Provided in the First Year After Spinal Cord Injury: Findings From the SCIRehab Study. Arch Phys Med Rehabil 2011; 92:361-8. [DOI: 10.1016/j.apmr.2010.07.241] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2010] [Revised: 05/24/2010] [Accepted: 07/06/2010] [Indexed: 11/26/2022]
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Spreyermann R, Lüthi H, Michel F, Baumberger ME, Wirz M, Mäder M. Long-term follow-up of patients with spinal cord injury with a new ICF-based tool. Spinal Cord 2010; 49:230-5. [DOI: 10.1038/sc.2010.93] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Kimbler TS, Willis FB. Dynamic splinting for pronation contracture following a spinal cord injury. HAND THERAPY 2010. [DOI: 10.1258/ht.2009.010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background This report discusses the success of using multiple protocols/modalities to reduce forearm contracture in a 34-year-old, African American man who had suffered a spinal cord injury (SCI) over 2 years before this treatment. The patient's initial maximal active range of motion (AROM) in supination was −85° left and −60° right, and his initial passive range of motion (PROM) was +12° left and +50° right. Methods Intervention included occupational therapy five times per week and the protocols employed included manual AROM and PROM training, isometric strength training, handwriting, self-feeding and grooming training. Electrical stimulation for shoulder flexion and elbow extension, and a unique new modality, the Supination Dynasplint®, was also used for 45 min on each arm, twice daily. Results After three months, the patient regained over 40° AROM of supination in each arm. This benefitted the patient's ability to use utensils for eating, improved his handwriting skills and he regained the ability to use a urinal at night while in bed.
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Affiliation(s)
- Tonya S Kimbler
- Occupational Therapy, Heartland of Springfield, St Paris, OH, USA
| | - F Buck Willis
- University of Phoenix: Axia College, Phoenix, AZ, USA
- Dynasplint Systems Inc, Severna Park, MD, USA
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Martin P, Cherian B, John J, Tharion G, Bhattacharjee S. Long-term follow-up of persons with spinal cord injury integrated in the community. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2010. [DOI: 10.12968/ijtr.2010.17.2.46333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Priya Martin
- Christian Medical College, Vellore, Tamilnadu, India
| | - Binu Cherian
- Christian Medical College, Vellore, Tamilnadu, India
| | - Judy John
- Christian Medical College, Vellore, Tamilnadu, India
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Suddick K, O'Neill A. Reintegration and rehabilitation after spinal cord injury: a small-scale pilot study. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2009. [DOI: 10.12968/ijtr.2009.16.10.44563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kitty Suddick
- Physiotherapy, School of Health Professions, University of Brighton, Eastbourne, UK
| | - Aoife O'Neill
- The Mater Misericordiae University Hospital, Dublin, Ireland
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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.
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Hwang K, Johnston M, Tulsky D, Wood K, Dyson-Hudson T, Komaroff E. Access and Coordination of Health Care Service for People With Disabilities. JOURNAL OF DISABILITY POLICY STUDIES 2008. [DOI: 10.1177/1044207308315564] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Individuals with disabilities often have multiple complex medical and nonmedical needs. Furthermore, in the current facility-directed health care system, they are at enhanced risk of receiving poorly coordinated, suboptimal care. This is especially problematic because individuals with disabilities face multiple barriers to receiving quality health care services, ranging from structural barriers (e.g., physical access to doctors' offices) to procedural barriers (e.g., difficulty scheduling appointments, problems obtaining insurance coverage). By contrast, a consumer-directed approach to health care (distinct from facility-directed health care) can be effectual, cost-effective, and subjectively satisfying. This brief commentary addresses the importance of a consumer-directed approach to the delivery of health care to individuals with disabilities and the need for specific assessments of the experiences of people with disabilities regarding their care. As such, it proposes recommendations for future policy interventions.
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Affiliation(s)
- Karen Hwang
- University of Medicine and Dentistry of New Jersey-New Jersey Medical and School Kessler Medical Rehabilitation Research and Education Center, West Orange, New Jersey,
| | | | - David Tulsky
- Kessler Medical Rehabilitation Research and Education Center, West Orange, New Jersey and University of Medicine and Dentistry of New Jersey-New Jersey Medical School
| | - Ken Wood
- Kessler Medical Rehabilitation Research and Education Center, West Orange, New Jersey and University of Medicine and Dentistry of New Jersey-New Jersey Medical School
| | - Trevor Dyson-Hudson
- Kessler Medical Rehabilitation Research and Education Center, West Orange, New Jersey and University of Medicine and Dentistry of New Jersey-New Jersey Medical School
| | - Eugene Komaroff
- Kessler Medical Rehabilitation Research and Education Center, West Orange, New Jersey and University of Medicine and Dentistry of New Jersey-New Jersey Medical School
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Bloemen-Vrencken JHA, de Witte LP, Engels JPGM, van den Heuvel WJA, Post MWM. Transmural care in the rehabilitation sector: implementation experiences with a transmural care model for people with spinal cord injury. Int J Integr Care 2005; 5:e02. [PMID: 16773154 PMCID: PMC1395505 DOI: 10.5334/ijic.126] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSES The purpose of this article is first to describe the development and content of a transmural care model in the rehabilitation sector, which aims to reduce the number and severity of health problems of people with spinal cord injury (SCI) and improve the continuity of care. Second, the purpose is to describe the applicability and implementation experiences of a transmural care model in the rehabilitation sector. METHODS The transmural care model was developed in cooperation with the Dutch Association of Spinal Cord Injured Patients, community nurses, general practitioners, rehabilitation nurses, rehabilitation managers, physiatrists and researchers. The core component of the care model consists of a transmural nurse, who 'liaises' between people with SCI living in the community, professional primary care professionals and the rehabilitation centre. The transmural care model provides a job description containing activities to support people with SCI and their family/partners and activities to promote continuity of care. The transmural care model was implemented in two Dutch rehabilitation centres. The following three aspects, as experienced by the transmural nurses, were evaluated: the extent to which the care model was implemented; enabling factors and barriers for implementation; strength and weakness of the care model. RESULTS The transmural care model was not implemented in all its details, with a clear difference between the two rehabilitation centres. Enabling factors and barriers for implementation were found at three levels: 1. the level of the individual professional (e.g. competencies, attitude and motivation), 2. the organisational and financing level (e.g. availability of facilities and finances), and 3. the social context (the opinion of colleagues, managers and other professionals involved with the care). The most important weakness experienced was that there was not enough time to put all the activities into practice. The strength of the care model lies in the combination of support of patients after discharge, support of and cooperation with primary care professionals, and feedback of experiences to the clinical rehabilitation teams. CONCLUSION We recommend further improving and implementing the care model and encourage other care professionals and researchers to share their implementation experiences of follow-up care innovations for people with SCI.
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Affiliation(s)
- J H A Bloemen-Vrencken
- Rehabilitation Centre Hoensbroeck, Institute for Rehabilitation Research, The Netherlands.
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