A latent variable structural path model of health behaviors after spinal cord injury

Prevention and management of osteoporosis and osteoporotic fractures in persons with a spinal cord injury or disorder: A systematic scoping review

Objectives: The primary objective was to review the literature regarding methodologies to assess fracture risk, to prevent and treat osteoporosis and to manage osteoporotic fractures in SCI/D.Study Design: Scoping review.Settings/Participants: Human adult subjects with a SCI/D.Outcome measures: Strategies to identify persons with SCI/D at risk for osteoporotic fractures, nonpharmacological and pharmacological therapies for osteoporosis and management of appendicular fractures.Results: 226 articles were included in the scoping review. Risk of osteoporotic fractures in SCI is predicted by a combination of DXA-defined low BMD plus clinical and demographic characteristics. Screening for secondary causes of osteoporosis, in particular hyperparathyroidism, hyperthyroidism, vitamin D insufficiency and hypogonadism, should be considered. Current antiresorptive therapies for treatment of osteoporosis have limited efficacy. Use of surgery to treat fractures has increased and outcomes are good and comparable to conservative treatment in most cases. A common adverse event following fracture was delayed healing.Conclusions: Most of the research in this area is limited by small sample sizes, weak study designs, and significant variation in populations studied. Future research needs to address cohort definition and study design issues.

Health care utilization in persons with traumatic spinal cord injury: the importance of multimorbidity and the impact on patient outcomes

BACKGROUND

Persons with spinal cord injury (SCI) living in the community have high health care utilization (HCU). To date, the interrelationships among multiple secondary health conditions (multimorbidity due to comorbidities and complications) that drive HCU and their impact on patient outcomes are unknown.

OBJECTIVE

To determine the association among multimorbidity, HCU, health status, and quality of life.

METHODS

Community-dwelling persons with traumatic SCI participated in an online/phone SCI Community Survey. Participants were grouped using the 7-item HCU questionnaire (group 1 did not receive needed care and/or rehospitalized; group 2 received needed care but rehospitalized; group 3 received needed care and not rehospitalized). Personal, injury, and environmental factors; multimorbidity (presence/absence of 30 comorbidities/ complications); health status (Short Form-12); and quality of life measures (Life Satisfaction-11 first question and single-item quality of life measure) were collected. Associations among these variables were assessed using multivariate analysis.

RESULTS

The 1,137 survey participants were divided into 3 groups: group 1 (n = 292), group 2 (n = 194), and group 3 (n = 650). Group 1 had the greatest number of secondary health conditions (15.14 ± 3.86) followed by group 2 (13.60 ± 4.00) and group 3 (12.00 ± 4.16) (P < .05). Multimorbidity and HCU were significant risk factors for having a lower SF-12 Mental (P < .001) and Physical Component Score (P < .001). They in turn were associated with participants reporting a lower quality of life (P < .001, for both questions).

CONCLUSIONS

Multimorbidity and HCU are interrelated and associated with lower health status, which in turn is associated with lower quality of life. Future work will include the development of a screening tool to identify persons with SCI at risk of inappropriate HCU (eg, rehospitalization, not able to access care), which should lead to better patient outcomes and cost savings.

Risk behaviors related to cigarette smoking among persons with spinal cord injury

INTRODUCTION

Smoking, while detrimental to health in any population, has greater health implications for those with spinal cord injury (SCI) because of additional risks posed by SCI. The aims of this study were to document smoking status after SCI and to assess relationships between smoking status with injury severity and alcohol/pain medication use.

METHODS

Participants (n = 1,076) were identified from a large rehabilitation hospital in the southeastern part of the United States. Eligibility criteria included (a) traumatic SCI resulting in residual impairment, (b) adult, and (c) 1+ years postinjury. Previous and current cigarette smoking and quitting attempts were assessed. Relationships were assessed between smoking status (current, former, and never), alcohol use, and pain medication use.

RESULTS

Of participants (72% male, M age = 49.6 years, M = 16.1 years since SCI), 49.2% had never smoked, 28.2% were former smokers, and 22.6% were current smokers. Of current smokers, 39.2% attempted quitting in the past year and 77.2% had ever tried to quit. Only 29.9% of those who ever tried to quit sought professional help. Ambulatory persons, regardless of injury level, were 2.32 times more likely to be current smokers than nonambulatory persons with a high-level cervical injury. Lower socioeconomic status, binge drinking, and misuse of pain medication all predicted current smoking.

CONCLUSIONS

Smoking prevalence among persons with SCI is largely consistent with the general population. Additionally, we found smoking to be associated with other risk behaviors (binge drinking and prescription medication misuse) and differs by injury severity. Future studies should assess smoking interventions, which may differ by injury severity.

Theoretical Risk and Prevention Model for Secondary Health Conditions and Mortality After SCI: 15 Years of Research

BACKGROUND

To successfully prevent secondary health conditions (SHCs) and promote longevity after spinal cord injury (SCI), we must first understand the risk factors precipitating their occurrence and develop strategies to address these risk factors. Conceptual models may aid in identifying the nature of SHCs and guide research, clinical practice, and the development of prevention strategies.

OBJECTIVE

Our purpose is to review and refine an existing theoretical risk and prevention model (TRPM) as a means of classifying risk and protective factors for SHCs and mortality after SCI and for identifying points of intervention.

METHODS

We describe conceptual work within the field of SCI research and SHCs, including a description of the TRPM, a review of research using the TRPM, and conceptual enhancements to the TRPM based on previous research.

CONCLUSIONS

The enhanced TRPM directs research to the timing and chronicity of the SHCs and their relationship with overall health and physiologic decline. Future research should identify differences in the nature of SHCs, the extent to which they relate to risk and protective factors, and the degree to which they may be prevented with appropriate research-based strategies.

Qualidade de vida em pacientes com lesão medular

Objetivou-se medir a qualidade de vida de adultos com lesão medular e identificar os domínios que prejudicam a qualidade de vida desses sujeitos. Estudo epidemiológico, realizado no período 2007-2008, em Unidades Básicas de Saúde de Campina Grande/PB. Participaram 47 sujeitos. Utilizou-se questionário contendo variáveis sociodemográficas, etiologia da lesão; instrumento validado para medir qualidade de vida, contendo quatro domínios: Físico, Ambiental, Relações Sociais e Psicológico, com respectivas facetas. Os dados coletados foram processados por meio de análise descritiva e estatística. Domínios com menores escores: Ambiental (55,20 pontos); Físico (58,59 pontos). Facetas que mais comprometem os domínios: locomoção (55,3%), trabalho (55,3%), dinheiro (80,9%), informações (51%), lazer (68,1%); vida sexual (34%). Os resultados expressam a insatisfação dos investigados com a qualidade de vida. O enfermeiro deve contribuir para a reabilitação e reinclusão social da pessoa com lesão medular, respeitando suas limitações, enfatizando o potencial remanescente e a capacidade para autocuidado.

Behavioral factors related to fatigue among persons with spinal cord injury

OBJECTIVE

To examine behavioral risk factors in relation to fatigue after spinal cord injury (SCI), specifically cardiovascular-related behaviors, prescription medication use, and alcohol and cigarette use.

DESIGN

Cross-sectional.

SETTING

A medical university in the southeastern United States.

PARTICIPANTS

Adults (N=2245) at least 1 year post-SCI from a large specialty hospital in the Southeast responded to a mail-in survey.

INTERVENTION

Not applicable.

MAIN OUTCOMES MEASURE

The Modified Fatigue Impact Scale-5-item version was used to assess disabling fatigue.

RESULTS

Of participants, 8.3% had disabling fatigue, 45.3% reported fatigue rarely to never impacted their life, and 46.4% reported having some fatigue. Persons who reported having less exercise than others with a similar injury level were 2.49 times as likely to have disabling fatigue as persons who reported more exercise. Those with a fair or poor diet were also more likely to have disabling fatigue. Use of prescription medication to treat pain was associated with disabling fatigue, as was being CAGE positive. Among nonbehavioral variables, race and injury severity were significantly associated with disabling fatigue.

CONCLUSIONS

We identified several behavioral predictors of disabling fatigue, including cardiovascular risk factors, prescription medication use, and alcohol use. These factors are important because they are able to be modified and could be potential factors for prevention or intervention.

A structural analysis of health outcomes after spinal cord injury

OBJECTIVE

To develop and validate a latent model of health outcomes among persons with spinal cord injury.

METHODS

Survey data were collected at a large specialty hospital in the southeastern USA from 1,388 adult participants with traumatic spinal cord injury of at least 1 year's duration. Multiple indicators of health outcomes were used, including general health ratings, days adversely affected by poor health and poor mental health, treatments and hospitalizations, depressive symptoms, symptoms of illness or infection (eg, sweats, chills, fever), and multiple individual conditions (eg, pressure ulcers, subsequent injuries, fractures, contractures).

RESULTS

We performed exploratory factor analysis on half of the sample and confirmatory factor analysis on the other. A 6-factor solution was the best overall solution, because there was an excellent fit with the exploratory factor analysis (root mean square error of approximation = 0.042) and acceptable fit with the confirmatory factor analysis (root mean square error of approximation = 0.065). Four of the factors were types of secondary conditions, including symptoms of illness or infection, orthopedic conditions, pressure ulcers, and subsequent injuries. The 2 remaining factors reflected global health and treatment. Gender, race-ethnicity, age, injury severity, and years of education were all significantly related to at least 1 factor dimension, indicating variations in health outcomes related to these characteristics.

CONCLUSION

Identification of the 6 factors represents an improvement over the utilization of multiple individual indicators, because composite scores generated from multiple individual indicators provide more informative and stable outcome scores than utilization of single indicators.

Risk of hospitalizations after spinal cord injury: relationship with biographical, injury, educational, and behavioral factors

STUDY DESIGN

Cross-sectional survey.

OBJECTIVES

To assess the risk factors associated with hospitalization and the relationship of individual health behaviors with hospitalizations after spinal cord injury (SCI).

SETTING

A large specialty hospital in the southeastern USA.

METHODS

Persons with SCI responded (n=1386) to a mail survey assessing various aspects of their health, including health behaviors and number of hospitalizations in the past year. Logistic regression was used to assess the relationships between biographical, injury, educational, and health behavior factors with hospitalization in the past year.

RESULTS

Overall, 36.6% of participants were hospitalized on at least one occasion during the earlier year. Two biographical and injury characteristics were associated with hospitalization: race and SCI severity. Specifically, minorities and persons with non-ambulatory high cervical or non-cervical SCI were more likely to be hospitalized. Three behavioral factors were significantly associated with hospitalization after controlling for biographical and injury characteristics. Persons who used prescription medications, those who engaged more in smoking behaviors, and persons who reported more SCI-specific health behaviors were more likely to be hospitalized.

CONCLUSION

Specific health behaviors are associated with an increased hospitalization among persons with SCI. Future research is needed to assess the time sequence of these relationships.