Information needs of people with spinal cord injuries

Priorities and opportunities for advocacy in SCI: An international web-based review

CONTEXT

For the growing number of people with spinal cord injuries worldwide, advocacy organizations are an invaluable resource of information and education during recovery and rehabilitation.

OBJECTIVE

To examine the structure, information, and accessibility of websites from international organizations that serve and advocate for individuals with SCI.

METHODS

We performed a content analysis of information available from SCI organizations returned from a Google search. We used search terms relevant to SCI and advocacy and applied them to top-level domains for the G20 countries. Organizations that provide services or advocate for people with SCI with English-language websites were included; organizations focused on research, fundraising, clinical care, interprofessional knowledge exchange, or other neurological conditions were excluded. Accessibility, in terms of ease of use to information about participation, was assessed using a 3-point scale.

RESULTS

We identified SCI organizations from 27 different countries across six regions: Africa (N = 4), Asia (N = 5), Europe (N = 27), Middle East (N = 1), North America (N = 12), and Oceania (N = 11). Across these, six categories of resources and services are covered: (1) education, (2) physical health, (3) external, (4) peer support, (5) mental health, and (6) financial and legal. Eleven organizations indicate specific engagement with research or clinical trials. Four websites provided highly accessible information (rank = 3) about participation in research.

CONCLUSION

The SCI organizations identified in this study offer resources that largely pertain to education and physical health services and strategies. Information about clinical trials and SCI research studies are easily accessible on the websites of the limited number of organizations offering avenues for participation.

Health care satisfaction and medical literacy habits among caregivers of individuals with Down syndrome

Patients with Down syndrome have significant specialized health care needs. Our objective was to understand the needs, satisfaction, and online habits of caregivers as they care for persons with Down syndrome. A mixed-method survey was distributed through REDCap from April 2022 to June 2022 in the United States; a Spanish-translated version was distributed through SurveyMonkey from August 2022 to March 2023 in Mexico. We received 290 completed responses from the United States and 58 from caregivers in Mexico. We found that current health care options are not meeting the needs of many individuals with DS in both the United States (39.7%) and Mexico (46.6%). Caregivers expressed frustrations with the inaccessibility and inapplicability of health care information. In particular, they often found the volume of information overwhelming, given their limited medical background. Additionally, health care recommendations were not customized and lacked practical recommendations. Most caregivers in both the United States (72.1%) and Mexico (82.8%) believe it is not easy to find answers to medical questions about their loved ones with DS. Online platforms with customized, specific health information related to DS could offer innovative solutions to these unmet needs for families and primary care providers.

Information Quality and Readability: ChatGPT's Responses to the Most Common Questions About Spinal Cord Injury

OBJECTIVE

This study aimed to assess the quality, readability, and comprehension of texts generated by ChatGPT in response to commonly asked questions about spinal cord injury (SCI).

METHODS

The study utilized Google Trends to identify the most frequently searched keywords related to SCI. The identified keywords were sequentially inputted into ChatGPT, and the resulting responses were assessed for quality using the Ensuring Quality Information for Patients (EQIP) tool. The readability of the texts was analyzed using the Flesch-Kincaid grade level and the Flesch-Kincaid reading ease parameters.

RESULTS

The mean EQIP score of the texts was determined to be 43.02 ± 6.37, the Flesch-Kincaid reading ease score to be 26.24 ± 13.81, and the Flesch-Kincaid grade level was determined to be 14.84 ± 1.79. The analysis revealed significant concerns regarding the quality of texts generated by ChatGPT, indicating serious problems with readability and comprehension. The mean EQIP score was low, suggesting a need for improvement in the accuracy and reliability of the information provided. The Flesch-Kincaid grade level indicated a high linguistic complexity, requiring a level of education equivalent to approximately 14 to 15 years of formal education for comprehension.

CONCLUSIONS

The results of this study show heightened complexity in ChatGPT-generated SCI texts, surpassing optimal health communication readability. ChatGPT currently cannot substitute comprehensive medical consultations. Enhancing text quality could be attainable through dependence on credible sources, the establishment of a scientific board, and collaboration with expert teams. Addressing these concerns could improve text accessibility, empowering patients and facilitating informed decision-making in SCI.

International spinal cord injury socio-demographic basic data set (version 1.0)

STUDY DESIGN

Consensus based on the literature.

OBJECTIVE

Create an International Spinal Cord Injury (SCI) Socio-Demographic Basic Data Set (Version 1.0).

SETTING

International.

METHODS

The development included an iterative process where the authors reviewed existing variables containing socio-demographic variables and created a first dataset draft, which was followed by several revisions through email communications. In addition, the work was conducted in parallel with a similar endeavour within the National Institute of Neurological Disorders and Stroke SCI Common Data Elements project in the United States. Subsequently, harmonization between the two projects was sought. Following this, a review process was initiated, including The International SCI Data Sets Committee, the American Spinal Injury Association (ASIA) Board, and the International Spinal Cord Society (ISCoS) Scientific and Executive Committees, and then by publishing on the respective websites for membership feedback. The draft was sent to about 40 national and international organizations and several interested individuals for feedback. All review comments were discussed in the working group and responded to before the final draft was developed, and finally approved by ASIA Board and the ISCoS Scientific and Executive committees.

RESULTS

The final International SCI Socio-Demographic Basic Data Set includes the following variables: Date of data collection, Marital status, Household member count, Years of formal education, and Primary occupation.

CONCLUSION

The International SCI Socio-Demographic Basic Data Set will facilitate uniform data collection and reporting of socio-demographic information at the time of injury as well as at post-injury follow-ups to facilitate the evaluation and comparisons across studies.

Mobile health community loyalty development process in China: an empirical study from information seeking perspective

Purpose

This study aims to investigate the process of developing loyalty in the Chinese mobile health community from the information seeking perspective.

Design/methodology/approach

A covariance-based structural equation model was developed to explore the mobile health community loyalty development process from information seeking perspective and tested with LISREL 9.30 for the 191 mobile health platform user samples.

Findings

The empirical results demonstrate that the information seeking perspective offers an interesting explanation for the mobile health community loyalty development process. All hypotheses in the proposed research model are supported except the relationship between privacy and trust. The two types of mobile health community loyalty—attitudal loyalty and behavioral loyalty are explained with 58 and 37% variance.

Originality/value

This paper has brought out the information seeking perspective in the loyalty formation process in mobile health community and identified several important constructs for this perspective for the loyalty formation process including information quality, communication with doctors and communication with patients.

The information needs of people with degenerative cervical myelopathy: A qualitative study to inform patient education in clinical practice

BACKGROUND

Individuals with lifelong illnesses need access to adequate information about their condition to make optimal health decisions. Degenerative Cervical Myelopathy (DCM) is the most common form of spinal cord dysfunction in adults worldwide. Its chronic and debilitating nature, varied impact, clinical trajectory, and management options necessitate appropriate informational support to sustain effective clinical and self-directed care strategies. However, before clinicians can meet patients' information needs, they must first have an understanding of their baseline requirements. This study explores the information needs of people with DCM (PwCM). In doing so, it provides a starting point for the development of patient education and knowledge management strategies in clinical practice.

METHODS

Semi-structured interviews with PwCM were conducted using an interview guide. Interviews were audio-recorded and transcribed verbatim. Thematic analysis according to Braun and Clarke's six-phase approach was used to analyse the data. Findings were reported according to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines.

RESULTS

Twenty PwCM (65% female, 35% male), with ages ranging from 39 to 74 years old participated in the interviews. The findings indicated that the provision of information to PwCM during clinical interactions varies. Accordingly, PwCM's information needs were broad-ranging, as was the nature of the information they found useful. Three main themes were identified (1) Variation in the provision of information to PwCM during clinical interactions, (2) Variations in the information needs of PwCM, and (3) Information that PwCM find useful.

CONCLUSION

Efforts must turn to adequately educating patients at the time of the clinical encounter. A comprehensive and consistent patient-centered information exchange in DCM is necessary to achieve this.

"You were lying in limbo and you knew nothing": a thematic analysis of the information needs of spinal cord injured patients and family members in acute care

PURPOSE

To address the lack of research on the information needs of spinal cord injured (SCI) patients and family members in acute care, in order to inform the provision of appropriate information supports.

MATERIALS AND METHODS

Semi-structured interviews were conducted with seven traumatic SCI patients and six family members. Reflexive thematic analysis was used to analyse and interpret the data.

RESULTS

Five themes were generated: (1) "You were lying in limbo and you knew nothing" describes how being situated in non-specialist acute care limited participants' access to information; (2) "You'll never walk again" is not enough describes the need for information about the effects of SCI and the management of secondary conditions; (3) "The delivery was awful" demonstrates the importance of information being explained clearly and empathically; (4) "It was going in one ear and out the other" highlights the need for ongoing conversations with healthcare professionals, as retaining information provided in the early stages post-injury is often difficult; and (5) "Hope" not "false hope" discusses the importance of giving patients and family members hope while simultaneously being realistic about potential recovery.

CONCLUSIONS

SCI patients and family members had significant unmet information needs in acute care.IMPLICATIONS FOR REHABILITATIONSCI patients and family members had significant unmet information needs while in acute care. Being in non-specialist acute care significantly limited most participants' access to information.During the acute phase of care, most patients and family members would like to know the patient's recovery prognosis, the impact of SCI on the patient's functional independence, how to manage secondary complications, and what to expect in rehabilitation.As patients and family members often had difficulty absorbing information in the early stages post-injury, information should be continuously repeated, reinforced and clarified.HCPs should promote realistic hope for SCI patients and family members even in the absence of neurological recovery, by focusing on what the patient is still capable of while being honest about their prognosis.

Surgery to Restore Upper Extremity Function in Tetraplegia-Preferences for Early and Frequent Access to Information

INTRODUCTION

People with cervical spinal cord injury (SCI) identify improving upper extremity (UE) function as a top priority. In addition to comprehensive rehabilitation, UE surgeries, including nerve and tendon transfers, enhance function. However, barriers exist to disseminating information about surgical options to enhance UE function.

OBJECTIVE

To assess the experiences and preferences of people with cervical SCI and their caregivers in accessing information about surgery to enhance UE function.

DESIGN

Prospective cohort study. Participants were followed for 24 months and completed up to three interviews.

SETTING

Tertiary care at academic and affiliated Veterans Administration Health Care Centers.

PARTICIPANTS

Adults with cervical SCI (n=35) ages 18 to 80 years with mid-cervical SCI American Spinal Injury Association Impairment Scale A, B, or C (at least six months post-injury) and their caregivers (n=23) were eligible to participate. Participants were enrolled in three groups: nerve transfer, tendon transfer, or no UE reconstructive surgery.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Semi-structured interviews about surgical knowledge and experiences.

RESULTS

Data were analyzed and three themes were identified. First, providing information about UE surgical options early post-injury was recommended. The acute or inpatient rehabilitation phases of recovery were the preferred times to receive surgical information. Second, challenges with information dissemination were identified. Participants learned about UE surgery through independent research, medical provider interactions, or peers. Third, peers were identified as valuable resources for SCI needs and surgical information.

CONCLUSIONS

Following cervical SCI, information about UE reconstructive surgeries should be a standard component of education during rehabilitation. An increased understanding of the reconstructive options available to improve UE function is necessary to educate stakeholders. Future research is needed to support the development of strategies to effectively present surgical information to individuals with SCI and healthcare providers. This article is protected by copyright. All rights reserved.

SCiPad: evaluating telemedicine via iPad facetime for general spinal cord injury care

Study design

Uncontrolled clinical pilot study.

Objectives

To assess usage, perceived impact, and satisfaction with a telemedicine program among individuals with spinal cord injury (tele-SCI).

Setting

Community-based.

Methods

Participants (N = 83) were recruited from acute SCI inpatient rehabilitation and outpatient SCI care at a community hospital to participate in a 6-month tele-SCI intervention administered by SCI subspecialty board-certified physiatrists via iPad FaceTime. In addition to monthly follow up interview calls, psychosocial and Quality of Life (QoL) measures were collected at baseline and post-intervention. A program satisfaction survey was also collected post-intervention.

Results

Seventy-five percent of participants engaged in tele-SCI visits (Median [IQR]: 2.5 [2.0, 4.0]) for a total of 198 tele-SCI visits. Bladder and bowel concerns were the leading topics discussed during tele-SCI visits, followed by neurological, pain, and functional concerns. Tele-SCI users resided further away (Median miles [IQR] – 114[73–177] vs. 81[46–116], p = 0.023) and reported seeking more clinical advice (Median [IQR] – 1.5[0–4.0] vs. 0[0–1.0], p = 0.002) compared to non-tele-SCI users. All other clinical utilization, baseline characteristics, psychosocial measures, and QoL did not differ among those who used tele-SCI and those who did not. The satisfaction survey suggested satisfaction with the tele-SCI intervention (89%), study equipment (89%), staff responsiveness (100%), and improved motivation for self-monitoring of health (71%).

Conclusion

Study findings suggest that tele-SCI is a feasible modality for providing general SCI care. Further research is required to examine longer-term efficacy of remotely-provided care among individuals living with SCI.

Preferred Strategies for Delivering Health Information to Patients With Musculoskeletal Disorders: A Qualitative Study

BACKGROUND

Patients' information needs may differ from what their care providers may perceive to be the patients' needs. This discordance needs to be recognized and addressed.

OBJECTIVE

We conducted a qualitative study to explore the perceptions of patients with selected musculoskeletal disorders and those of rheumatologists, on their preferred strategies for delivery of disease management information.

METHODS

Fifty-two patients diagnosed with either rheumatoid arthritis, knee osteoarthritis, or osteoporosis took part in 6 focus groups and 18 individual semistructured interviews. In addition, 11 rheumatologists participated in 2 focus groups and 4 semistructured individual interviews. Data were explored by thematic content analysis. Perceived preferences were identified and compared between patients and rheumatologists regarding (a) media, (b) setting, (c) messengers, and (d) key message content.

RESULTS

Patients' preferred media for disease management information were electronic (television and videos delivered as digital optical discs or the Internet), group instruction, and printed material. Patients preferred the information to be delivered in the setting of their homes, doctor's offices, or clinic waiting areas by the rheumatologists and patients with disease experience, addressing healthy lifestyle changes, medication adherence, and consequences of noncompliance. For rheumatologists, the perceived preference for information delivery was through printed material (brochures, booklets, and pamphlets) delivered in waiting areas by nurses and physicians, addressing nature of the disease, complications, and treatment adverse effects.

CONCLUSIONS

Provider perspectives on strategies for education may differ from those of patients. Our findings highlight the need for considering different stakeholder perspectives in designing educational tools and decision support materials for patients with chronic diseases.

TAKEHOME MESSAGE

Rheumatologists' preferences on strategies for education (mode of delivery, delivery setting, messengers, and topics) differ from those of patients. For example, patients want to learn about lifestyle changes and consequences of compliance versus noncompliance, whereas rheumatologists considered more important for patients to understand their disease, treatment adverse effects, and consequences of noncompliance.

Qualitative Investigation of Health Information Resources for Caregivers and Individuals Living With Spinal Cord Injury

Objectives: To identify the information networks of caregivers and individuals with spinal cord injury (SCI) and how the health information is accessed and used. Methods: For this qualitative study, participants from the United States were recruited through hospital listservs, websites, social media, and word of mouth to participate in a phone interview. Fourteen individuals living with a traumatic SCI and 18 caregivers of individuals living with a traumatic SCI were interviewed using a semi-structured interview guide. The interviews were transcribed verbatim, coded using NVivo, and analyzed using qualitative thematic methods. Results: Participants reported that medical resources such as SCI specialists were considered the most reliable sources, but due to accessibility barriers the Internet was used the most. The Internet and social resources, such as online and in-person support groups, provided beneficial content information and emotional support, but they posed credibility concerns and left participants feeling unsure of reliability. Information gaps such as lack of education on basic care practices during the transition from acute to chronic care were identified by the participants. Conclusion: Because SCI is an overwhelming experience, it is difficult for patients to retain information in the initial acute care phase, leading to gaps in knowledge about long-term care. Patients are concerned about the reliability of online sources of information; therefore, there is a need for new methods of SCI information dissemination. Potentially, using primary care providers as conduits for information distribution might improve access to reliable long-term SCI information for caregivers and patients.

Patterns of Upper Extremity Reconstruction for Patients With Tetraplegia Across the United States: A Retrospective Study

PURPOSE

The rates of upper extremity reconstruction for patients with tetraplegia remain low. We performed a retrospective study to assess recent reconstruction rates and delineate factors associated with the occurrence of reconstruction.

METHODS

We examined the National Inpatient Sample database (2012-2017) for the rate of reconstruction for patients with tetraplegia. The details of provider distribution characteristics and neighborhood attributes were obtained from the American Medical Association Physician Masterfile and based on the area deprivation index, respectively. We calculated the mean reconstruction rate per year and generated multivariable logistic regression models to examine the influence of patient factors, hospital characteristics, and provider distribution on the odds of undergoing functional reconstruction for tetraplegia patients.

RESULTS

Among 404,660 encounters with patients with tetraplegia, only 1,430 (0.4%) patients underwent upper extremity reconstruction from 2012 to 2017, with a mean rate of 238 procedures per year. We identified 5,450 hand surgeons, 12,751 physiatrists, and 444 spinal cord injury specialists, with variation in their national distribution. A greater number of surgeons near SCIS was associated with increased probability of reconstruction (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.03-1.12). The odds of surgery were greater for patients receiving care at urban teaching (OR 5.00, 95% CI 3.35-7.47) or urban nonteaching (OR 1.71, 95% CI 1.11-2.63) hospitals, whereas those at private nonprofit (OR 0.67, 95% CI 0.58-0.78) or investor-owned (OR 0.65, 95% CI 0.52-0.82) hospitals had lower odds. Although most patients had insurance coverage, patients with a higher income or those who received subsidized care had greater odds of undergoing reconstruction.

CONCLUSIONS

Reconstruction rates remain low and are correlated with the environment of care, financial factors, and provider availability. Policies that focus on reducing these factors in addition to increasing interspecialty collaboration could improve access to surgery for patients with tetraplegia.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic I.

Developing a consensus on the core educational content to be acquired by people with spinal cord injuries during rehabilitation: findings from a Delphi study followed by a Consensus Conference

STUDY DESIGN

Three-round Delphi study followed by a Consensus Conference with selected stakeholders.

OBJECTIVES

To identify a set of core educational content that people with spinal cord injury (SCI) need to acquire during rehabilitation.

SETTING

The Delphi study was performed electronically. The Consensus Conference was held at the Città della Salute e della Scienza University Hospital of Turin, Italy.

METHODS

A panel of 20 experts (healthcare professionals and SCI survivors) participated in a three-round Delphi study. In round 1, arguments for core educational content were solicited and reduced into items. In rounds 2 and 3, a five-point Likert scale was used to find consensus on and validate core educational content items (threshold for consensus and agreement: 60% and 80%, respectively). A Consensus Conference involving 32 stakeholders was held to discuss, modify (if appropriate) and approve the list of validated items.

RESULTS

The 171 arguments proposed in round 1 were reduced into 74 items; 67 were validated in round 3. The Consensus Conference approved a final list of 72 core educational content items, covering 16 categories, which were made into a checklist.

CONCLUSIONS

Consensus was achieved for a set of core educational content for people with SCI. The resultant checklist could serve as an assessment tool for both healthcare professionals and SCI survivors. It can also be used to support SCI survivors' education, streamline resource use and bridge the gap between information provided during rehabilitation and information SCI survivors need to function in the community.

Self-care in spinal cord injuries inventory (SC-SCII) and self-care self-efficacy scale in spinal cord injuries (SCSES-SCI): development and psychometric properties

STUDY DESIGN

Validation cross-sectional study.

OBJECTIVES

To develop and assess the psychometric properties of two instruments based on the middle-range theory of self-care in chronic illness: the Self-Care in Spinal Cord Injuries Inventory (SC-SCII) and the Self-Care Self-Efficacy Scale in Spinal Cord Injuries (SCSES-SCI).

SETTING

Multicenter study in five spinal units across Italy and Ireland.

METHODS

Instrument development was based on self-care behaviours identified in the scientific literature. Behaviours were grouped into four dimensions during a consensus conference: self-care maintenance, self-care monitoring, self-care management and self-care self-efficacy. Sixty-seven items were subsequently generated based on these dimensions. A multidisciplinary group of 40 experts evaluated content validity. Dimensionality of the final items was tested by confirmatory factor analyses (CFA) with a sample of 318 participants. Internal consistency and test-retest reliability were evaluated for each dimension. Construct validity was assessed using correlations between items and scoring differences amongst participants with more severe conditions and secondary complications.

RESULTS

Content validity of the SC-SCII and SCSES-SCI was satisfactory for thirty-five of the previously generated items, which were further refined. CFA showed comparative fit indexes ranging from 0.94 to 0.97 and root mean square errors of approximation from 0.03 to 0.07. Internal consistency ranged from 0.71 to 0.85, and intraclass correlation coefficients were higher than 0.70. Correlations among dimensions were moderate, and the theoretical hypotheses formulated when designing the instruments were largely confirmed.

CONCLUSIONS

The SC-SCII and the SCSES-SCI represent valid and reliable theoretically-grounded instruments to assess self-care in people with spinal cord injury.

Changes in Internet Use Over Time Among Individuals with Traumatic Spinal Cord Injury

OBJECTIVE

To investigate the changes in total internet and mobile internet use over time and determine how demographic characteristics are related to changes in internet and mobile internet use among individuals with spinal cord injury (SCI).

DESIGN

Cross-sectional analysis of multicenter cohort study.

SETTING

National SCI Database.

PARTICIPANTS

Persons with traumatic SCI with follow-up data collected between 2012 and 2018 (n=13,622).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Proportion of sample reporting internet use at all or through a mobile device over time and specifically in 2018.

RESULTS

The proportion of internet users increased from 77.7% in 2012 to 88.1% in 2018. Older participants (p<0.001), those with lower annual income (p<0.001), less education (p<0.001), non-White race or Hispanic ethnicity (p<0.001), motor incomplete tetraplegia (p=0.004), or males (p=0.035) were less likely to use internet from 2012 to 2018. By 2018, there were no longer differences in internet use based upon race/ethnicity (p=0.290) or sex (p=0.066). Mobile internet use increased each year (52.4% to 87.7% of internet users from 2012 to 2018), with a participant being 13.7 times more likely to use mobile internet in 2018 than 2012. Older age (p<0.001), income less than $50,000 (p<0.001), high school diploma or less (p=0.011), or non-Hispanic White race/ethnicity (p=0.001) were associated with less mobile internet use over time. By 2018 there were no differences in mobile internet use by education (p=0.430) and only participants with incomes greater than $75,000/year had greater odds of mobile internet use (p=0.016).

CONCLUSIONS

Disparities associated with internet access are decreasing likely due to mobile device use. Increased internet access offers an important opportunity to provide educational and training materials to frequently overlooked groups of individuals with SCI.

How individuals with spinal cord injury in the United States access and assess information about experimental therapies and clinical trials: results of a clinical survey

STUDY DESIGN

An internet-based survey.

OBJECTIVES

To determine how individuals with spinal cord injury (SCI) access information about experimental therapies and clinical trials. To understand which factors influence receipt of and perceived trustworthiness of that information.

SETTING

Two academic medical centers and an SCI organization.

METHODS

Demographic information frequencies and percentages were calculated then analyzed using chi-square tests for independence. Fisher's exact test of independence was used to assess significance for contingency tables with categories containing expected counts below five.

RESULTS

Three hundred sixty four persons with SCI participated in the survey. Most felt confident in their ability to evaluate SCI-specific information from a variety of sources, though SCI organizations and the medical literature were deemed the most reliable. Information from SCI specialists was deemed more credible than that from non-SCI specialists, but only 53.6% of participants had access to them. Nearly all (89.0%) respondents who had sought information about experimental therapies had found it online, while 51.4% of those who had participated in a clinical trial had been contacted by a research team. Only 8.4% of participants felt their medical teams offered them sufficient information about experimental therapies and clinical trials. Wealthier and more educated respondents were more knowledgeable about health-related resources on the internet. Nearly all participants (96.9%) expressed interest in learning more about trials related to SCI.

CONCLUSIONS

There is an information deficit among people with SCI pertaining to experimental therapies and clinical trials. It is exacerbated by lack of income, education, and access to SCI specialists.

An exploration of information seeking behavior among persons living with spinal cord injury in Switzerland

STUDY DESIGN

Observational study using data from the second community survey of the Swiss Spinal Cord Injury Cohort Study (Survey 2017).

OBJECTIVES

To examine information seeking of individuals with spinal cord injury (SCI) in Switzerland and its association with personal characteristics, quality of life, satisfaction with health, and healthcare services utilization.

SETTING

Community.

METHODS

Descriptive statistics were used to describe information needs, information sources, and health literacy of the participants. Linear, logistic, and Poisson regression analyses were used to assess the association of information-related variables with personal characteristics, quality of life, satisfaction with health, and healthcare services utilization.

RESULTS

One quarter of the 1294 study participants (24.6%) reported having information needs. Most frequently mentioned were needs for medical information about SCI, complications and comorbidities (30.5%), and information on living with SCI (28.6%). The most often used sources of information were healthcare professionals (72.3%), the Internet (43.2%), and other people living with SCI (40.8%). Almost half of the participants (41.4%) were only somewhat or not at all confident in their ability to find information. Having information needs was associated with suboptimal outcomes.

CONCLUSIONS

This study confirms the importance of information for individuals living with SCI. By providing evidence on topics to be addressed and modalities of information delivery, our findings can help institutions in developing information to support individuals living with SCI in their daily activities. Information should cover all aspects of living with SCI, be relevant to and understandable for people of all backgrounds, and be made available online and offline.

Perspectives of wheelchair users with spinal cord injury on fall circumstances and fall prevention: A mixed methods approach using photovoice

Introduction

Wheelchair users with spinal cord injury are at a high risk of falls. However, the perspectives of wheelchair users with spinal cord injury on their fall circumstances and their preferences for fall prevention strategies/interventions remain understudied. Therefore, we aimed to: a) describe the circumstances of falls experienced by wheelchair users with spinal cord injury over a six-month period, b) explore their perspectives of why falls occurred in certain situations, and c) explore their perspectives on recommended content/structure of fall prevention strategies/interventions.

Methods

This sequential explanatory mixed methods study had two phases. Phase I involved tracking of falls experienced by wheelchair users with spinal cord injury over six months, in which participants completed a survey after experiencing a fall to track the number/circumstance of each fall. Data from the surveys were descriptively reported. Phase II involved a photovoice focus group discussion of the survey findings and their preferences for fall prevention strategies/interventions. Data from the focus group discussion were analyzed using a thematic analysis.

Results

Thirty-two participants completed phase I. More than half of the participants fell at least once in six months. Falls commonly occurred in the afternoon during a transfer, or when participants were wheeling over uneven ground. One-third of the falls caused an injury. Eleven participants that fell during phase I participated in the focus group. Two main themes were identified from the discussion: 1) “circumstances surrounding the falls” (e.g. when falls occurred, the home is a ‘safe space’) and 2) “suggestions and preferences for fall prevention strategies/interventions” (e.g. fall prevention involves all, fall prevention training available as needed).

Conclusion

Fall prevention strategies/interventions should be an integral component of rehabilitation practices across the lifespan. Participants recommend customizing fall prevention strategies/interventions to their specific needs to guide the structure, content, and delivery of targeted fall prevention programs.

Health information seeking and people with disability: A systematic search and scoping review

BACKGROUND

Health information and access to it are important aspects of maintaining health. There are 61 million people with disability in the U.S., many of whom experience health disparities. However, it may not be clear to health professionals how people with disability seek health information.

OBJECTIVE

Assess the breadth, examine the characteristics, and evaluate the risk of bias in the existing literature related to health information seeking and people with disability.

METHODS

The authors conducted a systematic search across five databases (Pubmed, Scopus, PsycINFO, HealthSTAR, and CINAHL) to identify empirical journal articles related to health information seeking among people with disability. Analysis of data items and a quality assessment were completed.

RESULTS

Forty-two articles met the criteria for inclusion and were assessed. The articles primarily used survey methodology (50%), and primarily focused on ten disability types, including MS (19%), CP (17%) and general disability (17%). The articles primarily investigated the internet (88%), and healthcare providers (71%) as sources of health information. Trustworthiness (31%), accuracy (29%), and accessibility (29%) were also commonly assessed. The overall quality was high, with room for improvement in minimizing bias.

CONCLUSIONS

The literature addressing health information seeking among people with disability is heterogeneous, but generally of high quality. Future research may benefit from an inclusive definition of disability and a more consistent definition of health information. Focused research on best practices and interactions among sources of health information would be valuable additions.

What self-care behaviours are essential for people with spinal cord injury? A systematic review and meta-synthesis

Purpose: To systematically identify, evaluate, and synthesise the qualitative literature on the self-care behaviours, skills, and strategies performed by individuals with spinal cord injury (SCI).Review methods: The Joanna Briggs Institute (JBI) meta-aggregation method was followed. The search was conducted on five databases and limited to papers published from January 2000 to March 2020. Two independent reviewers screened, extracted the data from, and assessed the methodological quality of selected papers using the JBI qualitative assessment and critical appraisal instrument.Results: Eleven qualitative papers were included. Three synthesised findings with a moderate level of confidence emerged from 90 findings: people with SCI perform self-directed or directed-by-other behaviours focused on their physical condition (i); and on their social life (ii); people with SCI perform self-directed behaviours focused on their emotional well-being (iii). Individuals with SCI are aware of their condition and incorporate self-care behaviours into their routine to maintain health and prevent complications.Conclusion: This meta-synthesis provides evidence on the self-care behaviours performed by people with SCI to prevent, control, and manage the physical, emotional, and social effects of their condition. These findings may help healthcare providers to understand the self-care process in SCI survivors and tailor educational programmes to their experiences.IMPLICATIONS FOR REHABILITATIONSCI survivors are directly responsible for their health and must reach their maximum level of independence by acquiring self-care behaviours and adjusting them over time.Self-care behaviours must be incorporated into SCI survivors' daily routine to maintain their condition, promote their social participation, and prevent complications.Caregiver contributions to self-care should be given more value, as these are fundamental to maintain SCI survivors' well-being and social participation.

"Theory Does Not Get You From Bed to Wheelchair": A Qualitative Study on Patients' Views of an Education Program in Spinal Cord Injury Rehabilitation

PURPOSE

The aim of this study was to evaluate a new nurse-guided patient education program in spinal cord injury rehabilitation with particular focus on the patients' perspectives and experiences.

DESIGN

Longitudinal qualitative study.

METHODS

We conducted face-to-face interviews with 10 rehabilitation patients and used the content analysis method to analyze the data.

FINDINGS

Patients emphasized the importance of the practical training of the education program. This impacted their well-being as well as their autonomy. They rated discussions with primary nurses and peers about physical or psychological concerns. However, after discharge, the learning process was ongoing, and patients experienced the transition to living at home as a major challenge.

CONCLUSIONS AND CLINICAL RELEVANCE

This research provides valuable information from the patients' perspective for enhancing spinal cord injury patient education. Situational learning, based on the practical parts of patient education and working with peers, is highlighted.

Website Redesign of a 16-Week Exercise Intervention for People With Spinal Cord Injury by Using Participatory Action Research

Background

People with spinal cord injury (SCI) are at higher risk for numerous preventable chronic conditions. Physical activity is a protective factor that can reduce this risk, yet those with SCI encounter barriers to activity and are significantly less likely to be active. Limited evidence supports approaches to promote increased physical activity for those with SCI.

Objective

Building upon our previous theory- and evidence-based approach to increase participation in regular physical activity for those with SCI, this study aimed to use a participatory action research approach to translate a theory-based intervention to be delivered via the Web to individuals with SCI.

Methods

A total of 10 individuals with SCI were invited to participate in consumer input meetings to provide the research team with iterative feedback on an initial website designed as a platform for delivering a theory-based exercise intervention.

Results

A total of 7 individuals with SCI whose average age was 43.6 years (SD 13.4) and lived an average age of 12.5 years (SD 14.9) with SCI met on 2 occasions to provide their feedback of the website platform, both on the initial design and subsequently on the revamped site. Their iterative feedback resulted in redesigning the website content, format, and functionality as well as delivery of the intervention program.

Conclusions

The substantially redesigned website offers an easier-to-navigate platform for people with SCI with greater functionality that delivers information using a module format with less text, short video segments, and presents more resources. Preliminary testing of the site is the next step.

Family-centered empowerment process in individuals with spinal cord injury living in Iran: a grounded theory study

STUDY DESIGN

This was a qualitative study using grounded theory method.

OBJECTIVES

To explain the process of family-centered empowerment in a population of individuals with SCI living in Iran.

SETTING

Brain and SCI Research Center, Social Welfare Center, and SCI Association of Tehran; Iran.

METHODS

Participants were 19 persons with traumatic SCI, 13 family member caregivers, and 11 health care providers selected through purposeful sampling. Data were collected using face-to-face, semi-structured interviews, which were continued until data saturation. The interview data were methodically collected and analyzed using Strauss and Corbin's (1998) recommended method for grounded theory. Constant comparative analysis was simultaneously conducted through reviews of the interview statements, observations of behavior, interviewer field notes, and interviewer memos. The analysis was managed in MAXQDA software version 10.

RESULTS

The process of family-centered empowerment following SCI included five categories: (1) disruption in the existential integrity of the individual; (2) constructive life recovery; (3) inhibitors of family-centered empowerment; (4) facilitators of family-centered empowerment, and (5) back on track. Constructive life recovery was selected as the core variable using the grounded theory method. This core variable identified the strategies most frequently used by the participants to cope with the challenges of SCI-related impairment, disability, and overall life management.

CONCLUSIONS

Family-centered empowerment process in individuals with SCI living in Iran emerged from the data. The model includes early disruptions in the bio-psycho-social and vocational lives of individuals with SCI and their families, strategies for recovery post injury, inhibitors and facilitators of family-centered empowerment, the gradual return to work and daily activities, and the expected social roles for individuals with SCI.

Telemedicine using an iPad in the spinal cord injury population: a utility and patient satisfaction study

Study design

Prospective observational.

Objectives

To explore participants' experience, satisfaction, and utility of telemedicine.

Setting

Spinal cord injury (SCI) rehabilitation clinic at a county hospital.

Methods

Participants in this study received telemedicine appointments for routine scheduled care and/or urgent consults with a spinal cord injury specialist via iPad on FaceTime. Demographic changes, health care utilization, and medical complications were assessed. A Program Satisfaction Survey (PSS) was completed after a 6-month enrollment.

Results

Telemedicine visits included general follow-ups (51.25%), "multiple issues" (24.38%), skin (6.88%), bowel and bladder (5.63%), spasms (3.13%), and pain (3.13%). The PSS was collected (n = 45) and revealed positive results in perceived health, satisfaction with equipment/ease of use, and satisfaction with the program. Analysis of anecdotal comments revealed themes such as efficiency, convenience, and reduced barriers provided by telemedicine visits.

Conclusions

This study shows the feasibility and acceptance of a telemedicine intervention via iPad for individuals with SCI through positive PSS ratings and the wide variety of clinical topics addressed.

Sponsorship

Craig H. Neilsen Foundation.

Personal, family and societal educational needs assessment of individuals with spinal cord injury in Iran

Objectives:

To explore individuals’ perception of the personal, family and societal educational needs following a spinal cord injury (SCI).

Methods:

Sixty-one patients who sustained a traumatic SCI between March 2015 and June 2016 referred to Brain and Spinal Cord Injury Research Center (BASIR) were included in a cross sectional study and completed an online survey containing open-and closed-ended questions, in Iran. Participants’ responses were analyzed i using a qualitative approach with a thematic analysis.

Results:

Following a thematic analysis of the patient’s perceived educational needs, 3 themes and 14 subthemes were identified. The 3 themes included personal, family, and societal educational perceived needs. Within personal educational needs, there were 7 subthemes which included personal independence and transportation, financial independence, life skills modification, knowledge about SCI, prevention of SCI complications, relationships and sexual function, and psychological adjustments. Among family educational needs, the 3 subthemes were caregiver skills and communication, first aid and emergency skills, and emotional and psychological support. For societal educational needs, the 4 subthemes described were social integration, interpersonal communication skills, SCI awareness and injury prevention, sympathize while avoiding pity.

Conclusion:

According to our findings, people with SCI have various needs that need to be addressed. Educational support should be a part of a comprehensive rehabilitation program and geared towards addressing the patients’ personal and family needs, while educating the community about SCI in order to allow for reintegration into society.

Does consumer medicines interest reflect medicines use? An observational study comparing medicines call center queries with medicines use

BACKGROUND

Consumers have questions about their medication but the nature of these concerns and how they reflect medication use is unknown.

OBJECTIVES

To determine the characteristics and medicines interests of callers to an Australian medicines call center and whether the medicines interest of callers corresponds with medicines utilization.

METHODS

Data from consumers who contacted a national medicines call center between September 2002 and June 2010 were analyzed. Patterns of consumer medicines interest were described. Medicines were class-matched by Anatomical Therapeutic Classification, and compared with dispensed use (January 2006-June 2010).

RESULTS

In total 125,951 calls were received between 2002 and 2010. Callers were mainly female (76.8%), median age 48 years, calling for themselves (71.7%). Motivation to call related to safety (34.7%), efficacy (24.1%) and interactions (14.9%). For the comparison with medicines utilization, 85,416 calls with 124,177 individual medicine counts were analyzed (2006 and 2010). There were 976 unique 'medicines of interest'. Half (49.4%) of these questions involved just fifty unique medicines. Nervous system medicines (antiepileptics, psycholeptics, analgesics) and antibacterials consistently ranked highest for interest compared with use. Conversely, agents acting on the renin-angiotensin system, statins and drugs for acid related disorders ranked low for interest despite widespread use.

CONCLUSIONS

Consumer questions about medicines correlate poorly with overall medicines utilization. To promote quality health outcomes, clinicians should target their education to the relatively small number of medicines of real concern to patients.

Self-management interventions for skin care in people with a spinal cord injury: part 1-a systematic review of intervention content and effectiveness

Study design

Systematic review.

Objectives

To review the content and effectiveness of skin care self-management interventions for people with SCI.

Setting

International.

Methods

We searched electronic bibliographic databases, trial registers, and relevant reference lists. Eligibility criteria for the reviews of intervention content and effectiveness were identical with the exception of study design. The review of intervention content included non-randomized and randomized controlled trials (RCTs). The review of effectiveness included RCTs. A Behavior Change Technique (BCT) taxonomy of 93 BCTs was used to code intervention content. Intervention effects on outcomes of interest are summarized descriptively. Effect sizes were calculated, and the Cochrane risk of bias tool applied.

Results

In all, 15 studies testing 17 interventions were included in the review of intervention content. Interventions in these studies included 28 BCTs. The most common were “instructions on how to perform behavior” (16 interventions), “credible source” (12 interventions), and “social support (unspecified)” (9 interventions). Ten RCTs were included in the review of intervention effectiveness and they measured knowledge, self-efficacy, and skills relating to skin care/pressure ulcer (PU) prevention, skin care behaviors, skin status (PU prevalence, severity, and time to PU), and health-care utilization for skin problems. Evidence to support intervention effects on these outcomes was limited, particularly for clinical outcomes. Risk of bias assessments was often inconclusive due to poor reporting.

Conclusions

There is potential to design SCI skin care interventions that include currently untested BCTs. Further research and better consistency in outcome measurements and reporting are required to synthesize evidence on effectiveness.

Translating promising strategies for bowel and bladder management in spinal cord injury

Loss of control over voiding following spinal cord injury (SCI) impacts autonomy, participation and dignity, and can cause life-threatening complications. The importance of SCI bowel and bladder dysfunction warrants significantly more attention from researchers in the field. To address this gap, key SCI clinicians, researchers, government and private funding organizations met to share knowledge and examine emerging approaches. This report reviews recommendations from this effort to identify and prioritize near-term treatment, investigational and translational approaches to addressing the pressing needs of people with SCI.

Experiences With Navigating and Managing Information in the Community Following Spinal Cord Injury

Background: People living with spinal cord injury (SCI) have reported difficulties managing information in the community, which can negatively impact their functional independence and ability to prevent secondary complications. Objective: This exploratory qualitative study aimed to describe the experiences of people living with SCI with navigating and managing information in the community from their perspective. Methods: Participants were recruited through the Australian Quadriplegic Association. Twenty-two semi-structured in-depth interviews were conducted with purposively selected participants to ensure representation of age, gender, SCI level, and compensation status. Data were thematically analyzed using a framework approach. Results: People living with SCI reported using multiple, complementary sources of information to prevent and manage secondary conditions. Over time, they learned to appraise the content, relevance, timing, and sources of information. Information delivered by health professionals in the rehabilitation setting was appraised as lacking personalization, but it acted as a springboard to search for more relevant information. Participants described the process of becoming experts about their condition to overcome the lack of knowledge of many general practitioners, guide their own care, and act as a source of information for others. Due to a lack of information provision, some participants missed health improvement opportunities and experienced frustration at the uncertainty of their future with SCI. Conclusion: Greater support is required for individuals with SCI to navigate information sources in the community. Rehabilitation is an opportune time to provide education related to finding and appraising information. Improved access to community health providers with SCI knowledge is also required.

Potential of personal health record portals in the care of individuals with spinal cord injuries and disorders: Provider perspectives

CONTEXT/OBJECTIVE

Although personal health record (PHR) portals are designed for patients, healthcare providers are a key influence in how patients use their features and realize benefits from them. A few studies have examined provider attitudes toward PHR portals, but none have focused on those who care for individuals with spinal cord injuries and disorders (SCI/D). We characterize SCI/D provider perspectives of PHR portals, including perceived advantages and disadvantages of PHR portal use in SCI/D care.

DESIGN

Cross-sectional; semi-structured interviews.

SETTING

Spinal Cord Injury (SCI) Centers in the Veterans Health Administration.

PARTICIPANTS

Twenty-six SCI/D healthcare providers.

INTERVENTIONS

None.

OUTCOME MEASURES

Perceived advantages and disadvantages of PHR portals.

RESULTS

The complex situations of individuals with SCI/D shaped provider perspectives of PHR portals and their potential role in practice. Perceived advantages of PHR portal use in SCI/D care included the ability to coordinate information and care, monitor and respond to outpatient requests, support patient self-management activities, and provide reliable health information to patients. Perceived disadvantages of PHR portal use in SCI/D care included concerns about the quality of patient-generated health data, other potential liabilities for providers and workload burden, and the ability of individuals with SCI/D to understand clinical information accessed through a portal.

CONCLUSION

Our study highlights advantages and disadvantages that should be considered when promoting engagement of SCI/D healthcare providers in use of PHR portals, and portal features that may have the most utility in SCI/D care.

Determinants of health knowledge and health perceptions from the perspective of health-related education of patients with spinal cord injury: a systematic review

Appropriate health knowledge (HK) and health perceptions (HP) of patients with spinal cord injury (SCI) are linked to health-related behaviors, compliance, the involvement of caregivers and efficacy of prophylaxis, and management of secondary conditions. The significance of factors determining the efficacy of educational interventions in patients with SCI is underestimated. This systematic literature review aims at identification of determinants of HK and HP among patients with SCI. We identified 16 papers with quantitative HK and HP measurements conclusive in the identification of HK and HP determinants in individuals with SCI. Better HK and HP correlated with health condition-related variables (traumatic SCI, history of secondary conditions, except depression), body functions and structures (tetraplegia, incomplete deficit), activities (independence in daily living activities, ability of locomotion on a wheelchair, inability to walk), social and vocational participation, environmental factors (access to a computer with Internet connection, living in a big city, being married, healthcare recently received), and personal factors (younger age among adults, living with SCI for a longer time, younger age at SCI onset, higher educational level, internal locus of control). Limitations encountered included high nonresponse rates among the patients enrolled, and use of heterogeneous and nonvalidated tools. The results of these studies do not cover the entire scope of possible interactions and exclusively apply univariate correlations. The paucity and methodological limitations of studies conclusive in the identification of HK and HP determinants in SCI patients and the development of new approaches to information and education warrant more high-quality research on the basis of multivariate analyses.

A randomized controlled trial to test the efficacy of the SCI Get Fit Toolkit on leisure-time physical activity behaviour and social-cognitive processes in adults with spinal cord injury

STUDY DESIGN

Single blind, two-group randomized controlled trial.

OBJECTIVES

To evaluate the efficacy of the SCI Get Fit Toolkit delivered online on theoretical constructs and moderate-to-vigorous physical activity (MVPA) among adults with SCI.

SETTING

Ontario and Quebec, Canada.

ELIGIBILITY

Inactive, English- and French-speaking Canadian adults with traumatic SCI with Internet access, and no self-reported cognitive or memory impairments.

METHODS

Participants (N=90 M_age=48.12±11.29 years; 79% male) were randomized to view the SCI Get Fit Toolkit or the Physical Activity Guidelines for adults with SCI (PAG-SCI) online. Primary (intentions) and secondary (outcome expectancies, self-efficacy, planning and MVPA behaviour) outcomes were assessed over a 1-month period.

RESULTS

Of the 90 participants randomized, 77 were included in the analyses. Participants viewed the experimental stimuli only briefly, reading the 4-page toolkit for approximately 2.5 min longer than the 1-page guideline document. No condition effects were found for intentions, outcome expectancies, self-efficacy, and planning (ΔR²⩽0.03). Individuals in the toolkit condition were more likely to participate in at least one bout of 20 min of MVPA behaviour at 1-week post-intervention compared to individuals in the guidelines condition (OR=3.54, 95% CI=0.95, 13.17). However, no differences were found when examining change in weekly minutes of MVPA or comparing whether participants met the PAG-SCI.

CONCLUSIONS

No firm conclusions can be made regarding the impact of the SCI Get Fit Toolkit in comparison to the PAG-SCI on social cognitions and MVPA behaviour. The limited online access to this resource may partially explain these null findings.

Identifying and Understanding the Health Information Experiences and Preferences of Individuals With TBI, SCI, and Burn Injuries

Introduction:

Traumatic brain injury, spinal cord injury, and burn injury can cause lifelong disability and changes in quality of life. In order to meet the challenges of postinjury life, various types of health information are needed. We sought to identify preferred sources of health information and services for persons with these injuries and discover how accessibility could be improved.

Methods:

Thirty-three persons with injury participated in semistructured interviews. Responses to interview questions were coded using NVivo.

Results:

Participants’ difficulties accessing health information varied by injury type and individually. The majority of respondents found information via the Internet and advocated its use when asked to describe their ideal health information system. Nearly all participants supported the development of a comprehensive care website. When searching for health information, participants sought doctor and support group networks, long-term health outcomes, and treatments specific to their injury.

Conclusion:

To optimize the quality of health information resources, Internet-based health-care platforms should add or highlight access points to connect patients to medical professionals and support networks while aggregating specialized, injury-specific research and treatment information.

Measuring Access to Information and Technology: Environmental Factors Affecting Persons With Neurologic Disorders

OBJECTIVE

To develop and validate a patient-reported measure of access to information and technology (AIT) for persons with spinal cord injury, stroke, or traumatic brain injury.

DESIGN

A mixed-methods approach was used to develop items, refine them through cognitive interviews, and evaluate their psychometric properties. Item responses were evaluated with the Rasch rating scale model. Correlational and analysis-of-variance methods were used to evaluate construct validity.

SETTING

Community-dwelling individuals participated in telephone interviews or traveled to the academic medical centers where this research took place.

PARTICIPANTS

Individuals with a diagnosis of spinal cord injury, stroke, or traumatic brain injury (aged ≥18y, English speaking) participated in cognitive interviews (n=12 persons), field testing of the items (n=305 persons), and validation testing of the final set of items (n=604 persons).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

A set of items to measure AIT for people with disabilities.

RESULTS

A user-friendly multimedia touchscreen was used for self-administration of the items. A 23-item AIT measure demonstrated good evidence of internal consistency reliability, and content and construct validity.

CONCLUSIONS

This new AIT measure will enable researchers and clinicians to determine to what extent environmental factors influence health outcomes and social participation in people with disabilities. The AIT measure could also provide disability advocates with more specific and detailed information about environmental factors to lobby for elimination of barriers.

A narrative literature review to direct spinal cord injury patient education programming

PURPOSE

To summarize the evidence on SCI-related education literature, while looking at potential barriers, solutions, benefits, and patient preferences regarding SCI patient education.

METHOD

A literature review was conducted using 5 electronic databases. Quality appraisal instruments were designed to determine the methodological rigor of the quantitative and qualitative studies found. Selected articles were read in their entirety and themes were abstracted.

RESULTS

Fourteen articles met the inclusion criteria for this narrative literature review, all of which were based on research studies. Seven of these 14 were quantitative studies, 3 were qualitative studies, and 4 were mixed-methods studies.

CONCLUSION

To improve SCI education during rehabilitation, programs should maximize the receptiveness of newly injured patients to SCI-related information, optimize the delivery of SCI education, increase the number of opportunities for learning, promote and support lifelong learning, and include patient and program evaluation. How these strategies are specifically implemented needs to be determined by program management in consultation with various stakeholders, whilst considering the unique characteristics of the rehabilitation facility.

Consumer Use of "Dr Google": A Survey on Health Information-Seeking Behaviors and Navigational Needs

Background

The Internet provides a platform to access health information and support self-management by consumers with chronic health conditions. Despite recognized barriers to accessing Web-based health information, there is a lack of research quantitatively exploring whether consumers report difficulty finding desired health information on the Internet and whether these consumers would like assistance (ie, navigational needs). Understanding navigational needs can provide a basis for interventions guiding consumers to quality Web-based health resources.

Objective

We aimed to (1) estimate the proportion of consumers with navigational needs among seekers of Web-based health information with chronic health conditions, (2) describe Web-based health information-seeking behaviors, level of patient activation, and level of eHealth literacy among consumers with navigational needs, and (3) explore variables predicting navigational needs.

Methods

A questionnaire was developed based on findings from a qualitative study on Web-based health information-seeking behaviors and navigational needs. This questionnaire also incorporated the eHealth Literacy Scale (eHEALS; a measure of self-perceived eHealth literacy) and PAM-13 (a measure of patient activation). The target population was consumers of Web-based health information with chronic health conditions. We surveyed a sample of 400 Australian adults, with recruitment coordinated by Qualtrics. This sample size was required to estimate the proportion of consumers identified with navigational needs with a precision of 4.9% either side of the true population value, with 95% confidence. A subsample was invited to retake the survey after 2 weeks to assess the test-retest reliability of the eHEALS and PAM-13.

Results

Of 514 individuals who met our eligibility criteria, 400 (77.8%) completed the questionnaire and 43 participants completed the retest. Approximately half (51.3%; 95% CI 46.4-56.2) of the population was identified with navigational needs. Participants with navigational needs appeared to look for more types of health information on the Internet and from a greater variety of information sources compared to participants without navigational needs. However, participants with navigational needs were significantly less likely to have high levels of eHealth literacy (adjusted odds ratio=0.83, 95% CI 0.78-0.89, P<.001). Age was also a significant predictor (P=.02).

Conclusions

Approximately half of the population of consumers of Web-based health information with chronic health conditions would benefit from support in finding health information on the Internet. Despite the popularity of the Internet as a source of health information, further work is recommended to maximize its potential as a tool to assist self-management in consumers with chronic health conditions.

Quality of websites with patient information about spinal cord injury in Spanish

STUDY DESIGN

Descriptive, cross-sectional analysis of websites with information on spinal cord injury (SCI) in Spanish.

OBJECTIVE

To assess the quality, readability and presence of quality labels on web pages with information about SCI in Spanish.

SETTING

The Internet.

METHODS

An Internet search was conducted on Google with the keywords 'lesión medular' (spinal cord injury), 'paraplejia' (paraplegia) and 'tetraplejia' (tetraplegia). The first 50 results of each search were included. The quality of websites was assessed with the LIDA tool while the readability was assessed with the Flesch-Szigriszt index and the INFLESZ scale. We also checked the presence of any quality label.

RESULTS

After excluding duplicated and irrelevant results, 33 websites were analysed. Only four of them had a quality label. The mean score of the LIDA tool was 61.12% (medium quality), and the worst results were those referring to the reliability of the information. The readability of the web pages was somewhat difficult, with a mean of 48.22 in the Flesch-Szigriszt index. Only eight of the websites showed normal readability. We observed no differences in either the quality or the readability of the websites according to their origin or the presence of quality labels.

CONCLUSIONS

The websites analysed present a medium quality. Mainly, they should improve the reliability of their contents and their readability, including more quality labels. For SCI information in Spanish to be understandable and to provide valuable content, websites analysed in our study need to improve the quality parameters.

Text input speed in persons with cervical spinal cord injury

STUDY DESIGN

This is a prospective clinical study.

OBJECTIVES

The objectives of this study were to determine text input speed (TIS) in persons with cervical spinal cord injury (SCI) and to study the influence of personal characteristics and type of computer access device on TIS.

SETTING

This study was conducted in the Rehabilitation Department, Garches, France.

METHODS

People with cervical SCI were included if their level of injury was between C4 and C8 Asia A or B, and if they were computer users. In addition, able-bodied people were recruited from the hospital staff. Each participant underwent a single evaluation using their usual computer access devices. TIS was evaluated during a 10- min copying task. The relationship between the characteristics of participants with cervical SCI, type of computer access device and TIS were analyzed using a Scheirer-Ray-Hare test (nonparametric test similar to a two-way analysis of variance).

RESULTS

Thirty-five participants with cervical SCI and 21 able-bodied people were included. Median TIS of participants with cervical SCI was 11 (6; 14) words per minute (w.p.m.) and of able-bodied participants was 19 (14; 24) w.p.m. (P=0.001). Median TIS of participants with lesions at or above C5 was 12 (4; 13) w.p.m. and of those with lesions below C5 was 10 (9; 18) w.p.m. (P=0.38) [corrected]. The Scheirer-Ray-Hare test showed that only the type of computer access device significantly influenced TIS. Surprisingly, none of the person's characteristics, including the level of cervical lesion, affected TIS.

CONCLUSION

This is the first study to analyze TIS in a group of participants with cervical SCI. The results showed that only the type of computer access device influenced TIS.

Health information needs, sources, and barriers of primary care patients to achieve patient-centered care: A literature review

To synthesize findings from previous studies assessing information needs of primary care patients on the Internet and other information sources in a primary care setting. A systematic review of studies was conducted with a comprehensive search in multiple databases including OVID MEDLINE, CINAHL, and Scopus. The most common information needs among patients were information about an illness or medical condition and treatment methods, while the most common information sources were the Internet and patients' physicians. Overall, patients tend to prefer the Internet for the ease of access to information, while they trust their physicians more for their clinical expertise and experience. Barriers to information access via the Internet include the following: socio-demographic variables such as age, ethnicity, income, education, and occupation; information search skills; and reliability of health information.

CONCLUSION

Further research is warranted to assess how to create accurate and reliable health information sources for both Internet and non-Internet users.

Access to surgical upper extremity care for people with tetraplegia: an international perspective

STUDY DESIGN

Survey.

OBJECTIVES

To determine whether upper extremity reconstruction in patients with tetraplegia is underutilized internationally and, if so, what are the barriers to care.

SETTING

International-attendees of a meeting in Paris, France.

METHODS

One hundred and seventy attendees at the Tetrahand meeting in Paris in 2010 were sent a 13-question survey to determine the access and utilization of upper limb reconstruction in tetraplegic patients in their practice.

RESULTS

Respondents ranged the globe including North America, South America, Europe, Asia and Australia. Fifty-nine percent of respondents had been practicing for more than 10 years. Sixty-four percent of respondents felt that at least 25% of people with tetraplegia would be candidates for surgery. Yet the majority of respondents found that <15% of potential patients underwent upper extremity reconstruction. Throughout the world direct patient referral was the main avenue of surgeons meeting patients with peer networking a distant second. Designated as the top three barriers to this care were lack of knowledge of surgical options by patients, lack of desire for surgery and poor referral patterns to appropriate upper extremity surgeons.

CONCLUSION

The results of this survey, of a worldwide audience, indicate that many of the same barriers to care exist regardless of the patient's address. This was a preliminary opinion survey and thus the results are subjective. However, these results provide a roadmap to improving access to care by improving patient education and interdisciplinary physician communication.

Dr Google and the consumer: a qualitative study exploring the navigational needs and online health information-seeking behaviors of consumers with chronic health conditions

BACKGROUND

The abundance of health information available online provides consumers with greater access to information pertinent to the management of health conditions. This is particularly important given an increasing drive for consumer-focused health care models globally, especially in the management of chronic health conditions, and in recognition of challenges faced by lay consumers with finding, understanding, and acting on health information sourced online. There is a paucity of literature exploring the navigational needs of consumers with regards to accessing online health information. Further, existing interventions appear to be didactic in nature, and it is unclear whether such interventions appeal to consumers' needs.

OBJECTIVE

Our goal was to explore the navigational needs of consumers with chronic health conditions in finding online health information within the broader context of consumers' online health information-seeking behaviors. Potential barriers to online navigation were also identified.

METHODS

Semistructured interviews were conducted with adult consumers who reported using the Internet for health information and had at least one chronic health condition. Participants were recruited from nine metropolitan community pharmacies within Western Australia, as well as through various media channels. Interviews were audio-recorded, transcribed verbatim, and then imported into QSR NVivo 10. Two established approaches to thematic analysis were adopted. First, a data-driven approach was used to minimize potential bias in analysis and improve construct and criterion validity. A theory-driven approach was subsequently used to confirm themes identified by the former approach and to ensure identified themes were relevant to the objectives. Two levels of analysis were conducted for both data-driven and theory-driven approaches: manifest-level analysis, whereby face-value themes were identified, and latent-level analysis, whereby underlying concepts were identified.

RESULTS

We conducted 17 interviews, with data saturation achieved by the 14th interview. While we identified a broad range of online health information-seeking behaviors, most related to information discussed during consumer-health professional consultations such as looking for information about medication side effects. The barriers we identified included intrinsic barriers, such as limited eHealth literacy, and extrinsic barriers, such as the inconsistency of information between different online sources. The navigational needs of our participants were extrinsic in nature and included health professionals directing consumers to appropriate online resources and better filtering of online health information. Our participants' online health information-seeking behaviors, reported barriers, and navigational needs were underpinned by the themes of trust, patient activation, and relevance.

CONCLUSIONS

This study suggests that existing interventions aimed to assist consumers with navigating online health information may not be what consumers want or perceive they need. eHealth literacy and patient activation appear to be prevalent concepts in the context of consumers' online health information-seeking behaviors. Furthermore, the role for health professionals in guiding consumers to quality online health information is highlighted.

Quality Assessment of Spinal Cord Injury Patient Education Resources

STUDY DESIGN

Analysis of spinal cord injury patient education resources.

OBJECTIVE

To assess the quality of online patient education materials written about spinal cord injury.

SUMMARY OF BACKGROUND DATA

The use of online materials by health care consumers to access medical information presents unique challenges. Most Americans have access to the Internet and frequently turn to it as a first-line resource.

METHODS

The quality of online patient education materials was evaluated via a readability analysis. Materials provided by the National Institute of Neurological Disorders and Stroke; Centers for Disease Control and Prevention; American Association of Neurological Surgeons; The National Spinal Cord Injury Association; Mayo Clinic; U.S. Department of Veterans Affairs; Kessler Institute for Rehabilitation; American Academy of Neurology; Paralyzed Veterans of America; and the Shepherd Center were assessed using the Flesch Reading Ease and Flesch-Kincaid Grade Level evaluations with Microsoft Office Word software. Unnecessary formatting was removed and the readability was evaluated with the spelling and grammar function.

RESULTS

A total of 104 sections from 10 different Web sites were analyzed. Overall, the average values of the Flesch-Kincaid Grade Level (11.9) and Flesch Reading Ease (40.2) indicated that most Americans would not be able to fully comprehend this material.

CONCLUSION

Results indicate that the language used on materials provided by the aforementioned sites is perhaps too advanced for the average American to fully comprehend. The quality of these education resources may be improved via Web site revisions, which might be beneficial for improved patient utilization.

LEVEL OF EVIDENCE

2.

Sexual Healthcare for Wounded Warriors with Serious Combat-Related Injuries and Disabilities

INTRODUCTION

Short of the rich literature on sexuality in men following spinal cord injury, started largely by physicians and mental health professionals within the United States Department of Veterans Affairs (VA) system following earlier wars, little attention has been paid to the sexual healthcare of wounded warriors with other serious combat-related injuries. The recent wars in Iraq and Afghanistan-Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND)-resulted in physical injuries including traumatic brain injuries (TBIs), amputations, and serious burns. There are wounded warriors who are left blind or deaf, and a significant percent of OEF/OIF/OND warriors acquire other "invisible" injuries. While the signature injury of the war in Iraq is said to be TBI, there are a substantial number of service members surviving with posttraumatic stress disorder (PTSD). Many with serious injury are struggling with co-occurring depression. Furthermore, many of our wounded warriors are surviving with polytrauma (multiple traumatic injuries, i.e., amputation plus burns). One specific constellation of injuries seen too frequently among our service members in Afghanistan is referred to as a Dismounted Complex Blast Injury (DCBI) sometimes resulting in orchiectomy and/or penile injury. As with other blast injuries, burns, shrapnel injuries, vision loss, hearing loss, TBI, and PTSD often accompany DCBIs. All of the above injuries have significant sexual, endocrine, psychological, and relationship issues that need to be addressed.

AIM

This article presents an overview of the effects of serious, combat-related injuries on sexual health and provides medical and other health professionals a framework within which to address comprehensive sexual healthcare using a medical rehabilitation model.

CONCLUSIONS

Sexual healthcare for persons with combat-related disabilities presents a complex array of biopsychosocial and relational issues that call for a coordinated interdisciplinary approach that connects physical health, psychological health, and sexual health. Tepper MS. Sexual healthcare for wounded warriors with serious combat-related injuries and disabilities. Sex Med Rev 2014;2:64-74.

Personal experiences of pregnancy and fertility in individuals with spinal cord injury

Individuals with spinal cord injuries (SCIs) often face a number of barriers in family planning and pregnancy. These barriers can be structural (i.e. inaccessible health care provider offices and providers unfamiliar with fertility, pregnancy, and SCI) or social (i.e. friends, family, and even providers suggesting that individuals with SCI should not have children), and can affect both men and women. Additionally, much of the information about SCI and pregnancy is from a medical perspective and the psychosocial aspects of pregnancy for individuals with SCI have not been considered. 253 men and women with SCI were asked about the information they received about SCI and pregnancy, where they received this information, and how their SCI affected their family planning. The responses shared in this study can be used to inform individuals who work with people with SCI to better assist their clients or patients who have sustained SCI and are considering pregnancy.