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Neves Videira LG, Corbo LN, de Avila MAG, Martins GP, Schoeller SD, Kappler C, Faleiros F. Analysis of Urinary Incontinence in the Neurogenic Bladder and Its Relationship with the Satisfaction and Lifestyle of People with SCI. Healthcare (Basel) 2024; 12:1501. [PMID: 39120204 PMCID: PMC11311287 DOI: 10.3390/healthcare12151501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Revised: 07/22/2024] [Accepted: 07/23/2024] [Indexed: 08/10/2024] Open
Abstract
One of the most common complications of neurogenic bladder secondary to spinal cord injury (SCI) is urinary incontinence, which is possibly related to bladder-emptying methods and changes in quality of life. This study aimed to identify the occurrence of this complication in adults with SCI and analyze its relationship with bladder-emptying methods, satisfaction, and lifestyle. This is a quantitative, exploratory, and cross-sectional study. The variables were collected using the Bowel and Bladder Treatment Index during a telephone interview with 290 participants from February to November 2021. According to the results, 70% of the participants were male and 74.1% performed clean intermediate catheterization (CIC) as the main bladder-emptying method. Moreover, 55.6% were considered incontinent in the last year. Emptying by normal urination and bladder reflex triggering had a statistically significant relationship with urinary incontinence. A statistical association was observed between all the variables of satisfaction and lifestyle with urinary incontinence. Although CIC reduced urine leakage, a considerable number of participants still presented with frequent urine leakage. Urinary incontinence had a negative impact on satisfaction with the bladder-emptying method, effectiveness of bladder management, quality of life, and personal and social relationships.
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Affiliation(s)
- Lorena Gomes Neves Videira
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirao Preto 14040-902, Brazil; (L.G.N.V.); (L.N.C.); (G.P.M.)
| | - Letícia Noelle Corbo
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirao Preto 14040-902, Brazil; (L.G.N.V.); (L.N.C.); (G.P.M.)
| | | | - Giovana Pelosi Martins
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirao Preto 14040-902, Brazil; (L.G.N.V.); (L.N.C.); (G.P.M.)
| | | | - Christoph Kappler
- Faculty of Rehabilitation Sciences, University of Dortmund, 44227 Dortmund, Germany;
| | - Fabiana Faleiros
- Ribeirão Preto College of Nursing, University of São Paulo, Ribeirao Preto 14040-902, Brazil; (L.G.N.V.); (L.N.C.); (G.P.M.)
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Sober-Williams EK, Lee RHY, Whitehurst DGT, McBride CB, Willms R, Claydon VE. Bowel burdens: a systematic review and meta-analysis examining the relationships between bowel dysfunction and quality of life after spinal cord injury. Spinal Cord 2024:10.1038/s41393-024-01002-8. [PMID: 39014196 DOI: 10.1038/s41393-024-01002-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 07/18/2024]
Abstract
STUDY DESIGN Systematic review and meta-analysis. OBJECTIVES Many individuals with spinal cord injury (SCI) experience autonomic dysfunction, including profound impairments to bowel and cardiovascular function. Neurogenic bowel dysfunction (NBD) is emerging as a potential determinant of quality of life (QoL) after SCI. For individuals with high-level lesions ( > T6), bowel care-related autonomic dysreflexia (B-AD; profound episodic hypertension) further complicates bowel care. We aimed to evaluate the extent of bowel dysfunction after SCI, and the impact of bowel dysfunction on QoL after SCI. METHODS We searched five databases to identify research assessing the influence of NBD or B-AD on QoL after SCI. Metrics of bowel dysfunction (fecal incontinence [FI], constipation, time to complete, and B-AD) and QoL data were extracted and synthesised. Where possible, meta-analyses were performed. RESULTS Our search identified 2042 titles, of which 39 met our inclusion criteria. Individuals with SCI identified problems with NBD (74.7%), FI (56.9%), and constipation (54.6%), and 49.3% of individuals with SCI > T6 experienced B-AD. Additionally, 40.3% of individuals experienced prolonged defecation ( > 30 min). Moderate/severe deterioration in QoL due to NBD was reported by 55.5% of individuals with SCI, with negative impacts on physical, emotional, and social health-related QoL associated with inflexibility of bowel routines, fear of accidents, and loss of independence. CONCLUSION Bowel dysfunction and bowel care challenges are prevalent and disabling for individuals with SCI, with a profoundly negative impact on QoL. Improving bowel management is a key target to improve QoL for those living with SCI.
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Affiliation(s)
- Elin K Sober-Williams
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - Rebekah H Y Lee
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
| | - David G T Whitehurst
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | | | - Rhonda Willms
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada
- GF Strong Rehabilitation Centre, Spinal Cord Injury Program, Vancouver Coastal Health, Vancouver, BC, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Victoria E Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, BC, Canada.
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada.
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Tiwari E, Porreca DS, Braverman AS, Holt-Bright L, Frara NA, Brown JM, Johnston BR, Bazarek SF, Hilliard BA, Mazzei M, Pontari MA, Yu D, Ruggieri MR, Barbe MF. Nerve transfer for restoration of lower motor neuron-lesioned bladder, urethral and anal sphincter function. Part 4: Effectiveness of the motor reinnervation. Am J Physiol Regul Integr Comp Physiol 2024; 326:R528-R551. [PMID: 38497126 DOI: 10.1152/ajpregu.00248.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 02/18/2024] [Accepted: 03/11/2024] [Indexed: 03/19/2024]
Abstract
In pilot work, we showed that somatic nerve transfers can restore motor function in long-term decentralized dogs. We continue to explore the effectiveness of motor reinnervation in 30 female dogs. After anesthesia, 12 underwent bilateral transection of coccygeal and sacral (S) spinal roots, dorsal roots of lumbar (L)7, and hypogastric nerves. Twelve months postdecentralization, eight underwent transfer of obturator nerve branches to pelvic nerve vesical branches, and sciatic nerve branches to pudendal nerves, followed by 10 mo recovery (ObNT-ScNT Reinn). The remaining four were euthanized 18 mo postdecentralization (Decentralized). Results were compared with 18 Controls. Squat-and-void postures were tracked during awake cystometry. None showed squat-and-void postures during the decentralization phase. Seven of eight ObNT-ScNT Reinn began showing such postures by 6 mo postreinnervation; one showed a return of defecation postures. Retrograde dyes were injected into the bladder and urethra 3 wk before euthanasia, at which point, roots and transferred nerves were electrically stimulated to evaluate motor function. Upon L2-L6 root stimulation, five of eight ObNT-ScNT Reinn showed elevated detrusor pressure and four showed elevated urethral pressure, compared with L7-S3 root stimulation. After stimulation of sciatic-to-pudendal transferred nerves, three of eight ObNT-ScNT Reinn showed elevated urethral pressure; all showed elevated anal sphincter pressure. Retrogradely labeled neurons were observed in L2-L6 ventral horns (in laminae VI, VIII, and IX) of ObNT-ScNT Reinn versus Controls in which labeled neurons were observed in L7-S3 ventral horns (in lamina VII). This data supports the use of nerve transfer techniques for the restoration of bladder function.NEW & NOTEWORTHY This data supports the use of nerve transfer techniques for the restoration of bladder function.
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Affiliation(s)
- Ekta Tiwari
- School of Engineering, Brown University, Providence, Rhode Island, United States
- Center of Translational Research, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Danielle S Porreca
- Center of Translational Research, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
- Medical Doctor Program, Thomas Jefferson Research, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States
| | - Alan S Braverman
- Aging and Cardiovascular Discovery Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Lewis Holt-Bright
- Aging and Cardiovascular Discovery Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Nagat A Frara
- Aging and Cardiovascular Discovery Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Justin M Brown
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Benjamin R Johnston
- Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Stanley F Bazarek
- Department of Neurological Surgery, Brigham and Women's Hospital, Boston, Massachusetts, United States
| | - Brendan A Hilliard
- Aging and Cardiovascular Discovery Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Michael Mazzei
- Department of Trauma Surgery and General Surgery, LeHigh Valley Health Network, Allentown, Pennsylvania, United States
| | - Michel A Pontari
- Department of Urology, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, Pennsylvania, United States
| | - Daohai Yu
- Center for Biostatistics and Epidemiology, Department of Biomedical Education and Data Science, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
| | - Michael R Ruggieri
- Center of Translational Research, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Mary F Barbe
- Aging and Cardiovascular Discovery Center, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, United States
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Wong V, Ippolito GM, Crescenze I. Integrating Patient Preferences with Guideline-Based Care in Neurogenic Lower Urinary Tract Dysfunction After Spinal Cord Injury. Urol Clin North Am 2024; 51:277-284. [PMID: 38609199 DOI: 10.1016/j.ucl.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2024]
Abstract
Individual and social factors are important for clinical decision-making in patients with neurogenic bladder secondary to spinal cord injury (SCI). These factors include the availability of caregivers, social infrastructure, and personal preferences, which all can drive bladder management decisions. These elements can be overlooked in clinical decision-making; therefore, there is a need to elicit and prioritize patient preferences and values into neurogenic bladder care to facilitate personalized bladder management choices. For the purposes of this article, we review the role of guideline-based care and shared decision-making in the SCI population with neurogenic lower urinary tract dysfunction.
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Affiliation(s)
- Vivian Wong
- Department of Urology, Ohio State University, 915 Olentangy River Road, Suite 3100, Room 3105, Columbus, OH 43212, USA.
| | - Giulia M Ippolito
- Department of Urology, University of Michigan, 1733 Monterey Court, Ann Arbor, MI 48108, USA
| | - Irene Crescenze
- Department of Urology, Ohio State University, 915 Olentangy River Road, 2nd Floor Suite 2000, Columbus, OH 43212, USA
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Mahanes D, Muehlschlegel S, Wartenberg KE, Rajajee V, Alexander SA, Busl KM, Creutzfeldt CJ, Fontaine GV, Hocker SE, Hwang DY, Kim KS, Madzar D, Mainali S, Meixensberger J, Varelas PN, Weimar C, Westermaier T, Sakowitz OW. Guidelines for neuroprognostication in adults with traumatic spinal cord injury. Neurocrit Care 2024; 40:415-437. [PMID: 37957419 PMCID: PMC10959804 DOI: 10.1007/s12028-023-01845-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/17/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Traumatic spinal cord injury (tSCI) impacts patients and their families acutely and often for the long term. The ability of clinicians to share prognostic information about mortality and functional outcomes allows patients and their surrogates to engage in decision-making and plan for the future. These guidelines provide recommendations on the reliability of acute-phase clinical predictors to inform neuroprognostication and guide clinicians in counseling adult patients with tSCI or their surrogates. METHODS A narrative systematic review was completed using Grading of Recommendations Assessment, Development, and Evaluation methodology. Candidate predictors, including clinical variables and prediction models, were selected based on clinical relevance and presence of an appropriate body of evidence. The Population/Intervention/Comparator/Outcome/Timing/Setting question was framed as "When counseling patients or surrogates of critically ill patients with traumatic spinal cord injury, should < predictor, with time of assessment if appropriate > be considered a reliable predictor of < outcome, with time frame of assessment >?" Additional full-text screening criteria were used to exclude small and lower quality studies. Following construction of an evidence profile and summary of findings, recommendations were based on four Grading of Recommendations Assessment, Development, and Evaluation criteria: quality of evidence, balance of desirable and undesirable consequences, values and preferences, and resource use. Good practice recommendations addressed essential principles of neuroprognostication that could not be framed in the Population/Intervention/Comparator/Outcome/Timing/Setting format. Throughout the guideline development process, an individual living with tSCI provided perspective on patient-centered priorities. RESULTS Six candidate clinical variables and one prediction model were selected. Out of 11,132 articles screened, 369 met inclusion criteria for full-text review and 35 articles met eligibility criteria to guide recommendations. We recommend pathologic findings on magnetic resonance imaging, neurological level of injury, and severity of injury as moderately reliable predictors of American Spinal Cord Injury Impairment Scale improvement and the Dutch Clinical Prediction Rule as a moderately reliable prediction model of independent ambulation at 1 year after injury. No other reliable or moderately reliable predictors of mortality or functional outcome were identified. Good practice recommendations include considering the complete clinical condition as opposed to a single variable and communicating the challenges of likely functional deficits as well as potential for improvement and for long-term quality of life with SCI-related deficits to patients and surrogates. CONCLUSIONS These guidelines provide recommendations about the reliability of acute-phase predictors of mortality, functional outcome, American Spinal Injury Association Impairment Scale grade conversion, and recovery of independent ambulation for consideration when counseling patients with tSCI or their surrogates and suggest broad principles of neuroprognostication in this context.
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Affiliation(s)
- Dea Mahanes
- Departments of Neurology and Neurosurgery, UVA Health, University of Virginia, Charlottesville, VA, USA
| | - Susanne Muehlschlegel
- Departments of Neurology, Anesthesiology and Surgery, University of Massachusetts Chan Medical School, Worcester, MA, USA
| | | | | | | | - Katharina M Busl
- Departments of Neurology and Neurosurgery, College of Medicine, University of Florida, Gainesville, FL, USA
| | | | - Gabriel V Fontaine
- Departments of Pharmacy and Neurosciences, Intermountain Health, Salt Lake City, UT, USA
| | - Sara E Hocker
- Department of Neurology, Mayo Clinic, Rochester, MN, USA
| | - David Y Hwang
- Department of Neurology, University of North Carolina, Chapel Hill, NC, USA
| | - Keri S Kim
- Department of Pharmacy Practice, University of Illinois at Chicago, Chicago, IL, USA
| | - Dominik Madzar
- Department of Neurology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Shraddha Mainali
- Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA
| | | | | | - Christian Weimar
- Institute of Medical Informatics, Biometry and Epidemiology, University Hospital Essen, Essen, Germany
- BDH-Clinic Elzach, Elzach, Germany
| | - Thomas Westermaier
- Department of Neurosurgery, Helios Amper-Klinikum Dachau, Dachau, Germany
| | - Oliver W Sakowitz
- Department of Neurosurgery, Neurosurgery Center Ludwigsburg-Heilbronn, Ludwigsburg, Germany.
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6
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Liu R, Li Y, Wang Z, Chen P, Xie Y, Qu W, Wang M, Yu Z, Luo X. Regulatory T cells promote functional recovery after spinal cord injury by alleviating microglia inflammation via STAT3 inhibition. CNS Neurosci Ther 2023. [PMID: 36914969 DOI: 10.1111/cns.14161] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/08/2023] [Accepted: 02/24/2023] [Indexed: 03/15/2023] Open
Abstract
BACKGROUND Immediately after spinal trauma, immune cells, and proinflammatory cytokines infiltrate the spinal cord and disrupt the focal microenvironment, which impedes axon regeneration and functional recovery. Previous studies have reported that regulatory T cells (Tregs) enter the central nervous system and exert immunosuppressive effects on microglia during multiple sclerosis and stroke. However, whether and how Tregs interact with microglia and modulate injured microenvironments after spinal cord injury (SCI) remains unknown. METHOD Regulatory T cells spatiotemporal characteristics were analyzed in a mouse contusion SCI model. Microglia activation status was evaluated by immunostaining and RNA sequencing. Cytokine production in injured spinal cord was examined using Luminex. The role of STAT3 in Treg-microglia crosstalk was investigated in a transwell system with isolated Tregs and primary microglia. RESULTS Regulatory T cells infiltration of the spinal cord peaked on day 7 after SCI. Treg depletion promoted microglia switch to a proinflammatory phenotype. Inflammation-related genes, such as ApoD, as well as downstream cytokines IL-6 and TNF-α were upregulated in microglia in Treg-depleted mice. STAT3 inhibition was involved in Treg-microglia crosstalk, and STAT3 chemical blockade improved function recovery in Treg-depleted mice. CONCLUSION Our results suggest that Tregs promote functional recovery after SCI by alleviating microglia inflammatory reaction via STAT3.
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Affiliation(s)
- Rui Liu
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ying Li
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Ziyue Wang
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Peng Chen
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Yi Xie
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
| | - Wensheng Qu
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| | - Minghuan Wang
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| | - Zhiyuan Yu
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
| | - Xiang Luo
- Department of Neurology, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China.,Hubei Key Laboratory of Neural Injury and Functional Reconstruction, Huazhong University of Science and Technology, Wuhan, China
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7
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Kuo CC, Tsai ST, Huang XL, Chen YC. Potential benefits of spinal cord stimulation treatment on quality of life for paralyzed patients with spinal cord injury. Tzu Chi Med J 2023. [DOI: 10.4103/tcmj.tcmj_102_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
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8
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Xu Z, Jiang Y, Mu W, Li W, Zhang G, Jiang S, Xu P. Electrophysiological, biomechanical, and finite element analysis study of sacral nerve injury caused by sacral fracture. Front Bioeng Biotechnol 2022; 10:920991. [PMID: 36213062 PMCID: PMC9532616 DOI: 10.3389/fbioe.2022.920991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 08/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background: We aimed to study the mechanism of sacral nerve injury caused by sacral fractures and the relationship between nerve decompression and nerve function.Methods: First, we observed the anatomical features of lumbosacral nerve root region in Sprague-Dawley rats. Next, the rats were divided into the sham, 10 g, 30 g, and 60 g groups for electrophysiological studies on nerve root constriction injury. Then we studied the biomechanical properties of rat nerve roots, lumbosacral trunk, and sacrum. Finally, we established a finite element analysis model of sacral nerve roots injury in rats and determined the correlation between sacral deformation and the degree of sacral nerve roots injury.Result: Anatomical study showed L5 constitutes sciatic nerve, the length of the L5 nerve root is 3.67 ± 0.15 mm, which is suitable for electrophysiological research on nerve root compression injury. After a series of electrophysiological study of L5 nerve roots, our results showed that nerve root function was almost unaffected at a low degree of compression (10 g). Nerve root function loss began at 30 g compression, and was severe at 60 g compression. The degree of neurological loss was therefore positively correlated with the degree of compression. Combining biomechanical testing of the lumbosacral nerve roots, finite element analysis and neuroelectrophysiological research, we concluded when the sacral foramina deformation is >22.94%, the sacral nerves lose function. When the compression exceeds 33.16%, early recovery of nerve function is difficult even after decompression.Conclusion: In this study, we found that the neurological loss was positively correlated with the degree of compression. After early decompression, nerve root function recovery is possible after moderate compression; however, in severe compression group, the nerve function would not recover. Furthermore, FEA was used to simulate nerve compression during sacral fracture, as well as calculate force loading on nerve with different deformation rates. The relationship between sacral fractures and neurological loss can be analyzed in combination with neurophysiological test results.
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Affiliation(s)
- Zisheng Xu
- Department of Orthopedic Trauma, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Yifei Jiang
- Department of Orthopedic Trauma, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
| | - Weidong Mu
- Department of Orthopedic Trauma, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- Department of Orthopaedic trauma, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
| | - Wenlong Li
- Department of Orthopaedic trauma, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
- Laiwu People’s Hospital, Jinan, China
| | - Guanjun Zhang
- Laiwu People’s Hospital, Jinan, China
- State Key Laboratory of Advanced Design and Manufacturing for Vehicle Body, Hunan University, Changsha, China
| | - Shichao Jiang
- Department of Orthopedic Trauma, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- Department of Orthopaedic trauma, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
| | - Peng Xu
- Department of Orthopedic Trauma, Shandong Provincial Hospital Affiliated to Shandong University, Jinan, China
- Department of Orthopaedic trauma, Shandong Provincial Hospital affiliated to Shandong First Medical University, Jinan, China
- *Correspondence: Peng Xu,
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Shenot PJ, Teplitsky S, Margules A, Miller A, Das AK. Urinary undiversion by conversion of the incontinent ileovesicostomy to augmentation ileocystoplasty in spinal cord injured patients. J Spinal Cord Med 2022; 45:614-621. [PMID: 33054669 PMCID: PMC9246097 DOI: 10.1080/10790268.2020.1829420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Context: Spinal cord injury (SCI) patients with neurogenic bladder and the inability to self-catheterize may require incontinent diversion to provide low-pressure drainage while avoiding the use of indwelling catheters. We demonstrate that in patients with significant functional improvement, the ileovesicostomy can be a reversible form of diversion, with simultaneous bladder augmentation using the same segment of ileum utilized for the ileovesicostomy. Multidisciplinary management should be utilized to assure mastery of intermittent catheterization before urinary undiversion. This technique allows for transition to a regimen of intermittent self-catheterization with excellent functional and urodynamic outcomes.Design: Case Series.Setting: Tertiary care hospital, Philadelphia, Pennsylvania.Participants: Three individuals with an SCI.Interventions: Conversion of bladder management from an incontinent ileovesicostomy to an augmentation ileocystoplasty, with intermittent catheterization.Outcome Measures: Ability to regain urinary continence with preservation of renal function as determined by serum creatinine and renal ultrasound.Results: Three SCI patients who had an incontinent ileovesicostomy developed sufficient functional improvement to intermittently self-catheterize reliably and underwent conversion of ileovesicostomy to ileocystoplasty. For each, the ileovesicostomy channel was taken down and detubularized, then used to create an ileal patch for augmentation ileocystoplasty. Intermittent catheterization was then used for periodic bladder drainage. All achieved large capacity, low-pressure bladders with complete continence and stable creatinine.Conclusion: In motivated SCI patients, it is possible to regain continence by converting the ileovesicostomy into augmentation ileocystoplasty, avoiding the disadvantages of a urostomy. A multidisciplinary collaborative approach facilitates the optimal rehabilitation of SCI individuals.
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Affiliation(s)
- Patrick J. Shenot
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA,Correspondence to: Patrick J. Shenot, Department of Urology, Thomas Jefferson University, 1025 Walnut St, Ste 1112, Philadelphia, PA19107, USA.
| | - Seth Teplitsky
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Andrew Margules
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aaron Miller
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Akhil K. Das
- Department of Urology, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Abstract
This review provides a concise outline of the advances made in the care of patients and to the quality of life after a traumatic spinal cord injury (SCI) over the last century. Despite these improvements reversal of the neurological injury is not yet possible. Instead, current treatment is limited to providing symptomatic relief, avoiding secondary insults and preventing additional sequelae. However, with an ever-advancing technology and deeper understanding of the damaged spinal cord, this appears increasingly conceivable. A brief synopsis of the most prominent challenges facing both clinicians and research scientists in developing functional treatments for a progressively complex injury are presented. Moreover, the multiple mechanisms by which damage propagates many months after the original injury requires a multifaceted approach to ameliorate the human spinal cord. We discuss potential methods to protect the spinal cord from damage, and to manipulate the inherent inhibition of the spinal cord to regeneration and repair. Although acute and chronic SCI share common final pathways resulting in cell death and neurological deficits, the underlying putative mechanisms of chronic SCI and the treatments are not covered in this review.
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Affiliation(s)
- Stuart Stokes
- Spinal Unit, Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
| | - Martin Drozda
- Spinal Unit, Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
| | - Christopher Lee
- Spinal Unit, Department of Neurosurgery, Hull Royal Infirmary, Hull, UK
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11
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Ture SD, Ozkaya G, Sivrioglu K. Relationship between neurogenic bowel dysfunction severity and functional status, depression, and quality of life in individuals with spinal cord injury. J Spinal Cord Med 2022; 46:424-432. [PMID: 35108161 PMCID: PMC10114961 DOI: 10.1080/10790268.2021.2021043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
OBJECTIVES/CONTEXT To evaluate the relationship between severity of neurogenic bowel dysfunction (NBD) and functional status, depression, and quality of life in individuals with spinal cord injury (SCI) and to determine the factors associated with developing moderate-to-severe NBD. DESIGN Cross-sectional study. SETTING University hospital rehabilitation outpatient clinic. PARTICIPANTS Individuals with traumatic SCI, at least one year post-injury (N = 92). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Neurogenic Bowel Dysfunction Score, Functional Independence Measure (FIM), Beck Depression Inventory (BDI), and Short Form-36 (SF-36). RESULTS In the current sample, we found that half of the individuals with SCI had moderate-to-severe NBD. Individuals with moderate and severe NBD had lower motor FIM (P = 0.008 and P = 0.006, respectively) and SF-36 physical functioning (PF) scale (P = 0.020 and P = 0.031, respectively) scores than individuals with very minor NBD. There was no difference in the BDI scores among individuals with different levels of NBD. Individuals with American Spinal Injury Association Impairment Scale (AIS) A injuries were more likely to develop moderate-to-severe NBD than those with AIS C (odds ratio (OR) = 6.52; 95% confidence interval (CI) 1.13-37.79; P = 0.005) or AIS D (OR = 17.19; 95% CI 3.61-81.82; p < 0.001) injuries. CONCLUSION Individuals with moderate-to-severe NBD had higher levels of dependency in activities of daily living and lower SF-36 PF scale scores than individuals with very minor NBD. Among individuals with SCI, completeness of injury was a significant factor for developing moderate-to-severe NBD.
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Affiliation(s)
- Sevda Demir Ture
- Department of Physical Medicine and Rehabilitation, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Guven Ozkaya
- Department of Biostatistics, Bursa Uludag University School of Medicine, Bursa, Turkey
| | - Koncuy Sivrioglu
- Department of Physical Medicine and Rehabilitation, Bursa Uludag University School of Medicine, Bursa, Turkey
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12
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Diffusional kurtosis imaging as a possible prognostic marker of cervical incomplete spinal cord injury outcome: a prospective pilot study. Acta Neurochir (Wien) 2022; 164:25-32. [PMID: 34671848 DOI: 10.1007/s00701-021-05018-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Spinal cord injury (SCI) is associated with substantial chronic morbidity and mortality. Routine imaging techniques such as T1- and T2-weighted magnetic resonance imaging (MRI) are not effective in predicting neurological deficiency grade or outcome. Diffusional kurtosis imaging (DKI) is an MR imaging technique that provides microstructural information about biological tissue. There are no longitudinal prospective studies assessing DKI metrics in acute traumatic SCI. Therefore, the purpose of this study was to establish a DKI protocol for acute SCI and correlate the DKI metrics to the functional neurological outcome of the patients. METHODS Eight consecutive SCI patients referred to our institution with cervical SCI were included in the study. An acute diagnostic MRI scan was supplemented with a novel fast, mean kurtosis DKI protocol, which describes the average deviation from Gaussian diffusional along nine different directions. Mean kurtosis values were measured at the injury site and normalized to the mean kurtosis values of a non-injured site. At discharge form specialized rehabilitation, patients were evaluated using the Spinal Cord Independence Measure-III (SCIM-III). The DKI metrics and SCIM-III were analysed using Spearman's rank correlation. RESULTS This pilot study found a significant correlation between decreasing mean kurtosis values at the injury site of the spinal cord and higher grade of disability measured by the SCIM-III (p = 0.002). CONCLUSION This pilot study found that DKI may be a valuable tool as a prognostic marker in the acute phase of SCI.
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13
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Kuzu D, Troost JP, Carlozzi NE, Ehde DM, Molton IR, Kratz AL. How Do Fluctuations in Pain, Fatigue, Anxiety, Depressed Mood, and Perceived Cognitive Function Relate to Same-Day Social Participation in Individuals With Spinal Cord Injury? Arch Phys Med Rehabil 2021; 103:385-393. [PMID: 34454899 DOI: 10.1016/j.apmr.2021.07.809] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/02/2021] [Accepted: 07/24/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This study aimed to examine same-day associations of pain, fatigue, depressed mood, anxiety, and perceived cognitive function with social participation in the daily lives of adults with spinal cord injury (SCI). DESIGN Observational study used a combination of baseline surveys and 7 end-of-day (EOD) diaries. SETTING General community. PARTICIPANTS Individuals with SCI (N=168; mean age, 49.8y; 63% male, 37% female). MAIN OUTCOME MEASURES Patient-Reported Outcomes Measurement Information System short form measures (Ability to Participate in Social Roles and Activities, Pain Intensity, Depression, Anxiety, Cognitive Function Abilities) were adapted for daily administrations as EOD diaries. RESULT Results of multivariable model showed that daily increases in fatigue (B=-0.10; P=.004) and depressive symptoms (B=-0.25; P=<.001) and decreases in perceived cognitive function (B=0.11; P=<.001) were significantly related to worse same-day social participation. Daily fluctuations in anxiety and pain were unrelated to same-day social participation. CONCLUSIONS This is the first study that shows within-person associations of common SCI symptoms with social participation in the daily lives of adults with SCI. Results from the current study may help to develop more effective individualized treatments of symptoms and symptom effect aimed at improving social participation.
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Affiliation(s)
- Duygu Kuzu
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
| | - Jonathan P Troost
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Dawn M Ehde
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Ivan R Molton
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Anna L Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
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14
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Henry RS, Perrin PB, Lageman SK, Villaseñor T, Cariello AN, Pugh M, Smith ER, Arroyo M, Zarate A, Avila J, Soto-Escageda JA. Parkinson's Symptoms and Caregiver Affiliate Stigma: A Multinational Study. Curr Alzheimer Res 2021; 18:222-231. [PMID: 34102971 DOI: 10.2174/1567205018666210608100917] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Revised: 03/10/2021] [Accepted: 04/18/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND AND OBJECTIVE Research has documented the stigma that individuals with degenerative neurological diseases experience, but caregivers also experience stigma by association (i.e., affiliate stigma). In order to shed light on the stigma of caregivers of people with degenerative neurological diseases, the current study aimed to explore cross-cultural differences in the prevalence of Parkinson's disease (PD) caregiver affiliate stigma, as well as the relationship between PD symptoms and caregiver affiliate stigma. Applications for Alzheimer's disease are discussed. METHODS Survey data were collected in PD clinics at public, academic medical centers. Informal caregivers of an individual with PD from the US (n = 105) and from Mexico (n = 148) participated in the study. Caregivers completed a questionnaire that included the MDS Unified PD Rating Scale to describe the symptoms of the individual with PD, as well as the Affiliate Stigma Scale and demographic information. RESULTS A series of multiple regressions was run to examine whether PD symptoms were associated with affiliate stigma and if these differed by country. These regressions suggested that different patterns of PD symptoms predicted affiliate stigma in each country. Stigma was higher in the US compared to Mexico, and the relationship between bowel/bladder symptoms and affiliate stigma was significantly stronger in the US. CONCLUSION Symptoms of individuals with neurodegenerative diseases are related to affiliate stigma experienced by caregivers, and these relationships may differ cross-culturally. Negative public attitudes concerning bowl and bladder issues and the physical symptoms that accompany PD remain a source of stigma for caregivers and families, particularly in the US. Interventions for caregivers of individuals with neurodegenerative diseases should include strategies for coping with stigma concerning bladder and bowel problems, as well as other physical and mental health issues.
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Affiliation(s)
- Richard S Henry
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, United States
| | - Paul B Perrin
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, United States
| | - Sarah K Lageman
- Department of Neurology, Parkinson's & Movement Disorders Center, Virginia Commonwealth University, Richmond, VA 23284, United States
| | - Teresita Villaseñor
- Hospital Civil Fray Antonio Alcalde, University of Guadalajara, Americana, 44160 Guadalajara, Jal., Mexico
| | - Annahir N Cariello
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, United States
| | - Mickeal Pugh
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, United States
| | - Erin R Smith
- Department of Psychology, Virginia Commonwealth University, Richmond, VA 23284, United States
| | - Monica Arroyo
- Hospital Civil Fray Antonio Alcalde, University of Guadalajara, Americana, 44160 Guadalajara, Jal., Mexico
| | - Alejandra Zarate
- Hospital Civil Fray Antonio Alcalde, University of Guadalajara, Americana, 44160 Guadalajara, Jal., Mexico
| | - Judith Avila
- Hospital Civil Fray Antonio Alcalde, University of Guadalajara, Americana, 44160 Guadalajara, Jal., Mexico
| | - Jose A Soto-Escageda
- Hospital Civil Fray Antonio Alcalde, University of Guadalajara, Americana, 44160 Guadalajara, Jal., Mexico
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15
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A review of spinal cord perfusion pressure guided interventions in traumatic spinal cord injury. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:3028-3035. [PMID: 34170417 DOI: 10.1007/s00586-021-06905-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 06/17/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the causality between interventions on spinal cord perfusion pressure and neurological outcome in traumatic spinal cord injury. METHODS A systematic review was conducted in concordance with PRISMA guidelines. The literature was found in the EMBASE, PUBMED, SCOPUS, and WEB OF SCIENCE. Eligible studies included those that reported measurements and interventions on the spinal cord perfusion pressure in either animals or patients suffering from spinal cord injury. Only studies that reported a clinical or relevant clinical outcome measure (i.e., neurophysiology) were included. RESULTS The search yielded 795 unique records, and six studies were included after careful review. These studies suggested a positive correlation between spinal cord perfusion pressure and neurological outcome, but conclusions on causality could not be made. CONCLUSION In spite of growing indications that neurological outcomes are related to the spinal cord perfusion pressure in traumatic spinal cord injuries, a solid conclusion cannot be made due to the limited literature available. Additional well-designed studies are needed to address this issue.
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16
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Barbe MF, Testa CL, Cruz GE, Frara NA, Tiwari E, Hobson LJ, McIntyre BS, Porreca DS, Giaddui D, Braverman AS, Day EP, Amin M, Brown JM, Mazzei M, Pontari MA, Wagner IJ, Ruggieri MR. Nerve transfer for restoration of lower motor neuron-lesioned bladder function. Part 2: correlation between histological changes and nerve evoked contractions. Am J Physiol Regul Integr Comp Physiol 2021; 320:R897-R915. [PMID: 33759573 PMCID: PMC8285612 DOI: 10.1152/ajpregu.00300.2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
We determined the effect of pelvic organ decentralization and reinnervation 1 yr later on urinary bladder histology and function. Nineteen canines underwent decentralization by bilateral transection of all coccygeal and sacral (S) spinal roots, dorsal roots of lumbar (L)7, and hypogastric nerves. After exclusions, eight were reinnervated 12 mo postdecentralization with obturator-to-pelvic and sciatic-to-pudendal nerve transfers, then euthanized 8-12 mo later. Four served as long-term decentralized only animals. Before euthanasia, pelvic or transferred nerves and L1–S3 spinal roots were stimulated and maximum detrusor pressure (MDP) recorded. Bladder specimens were collected for histological and ex vivo smooth muscle contractility studies. Both reinnervated and decentralized animals showed less or denuded urothelium, fewer intramural ganglia, and more inflammation and collagen, than controls, although percent muscle was maintained. In reinnervated animals, pgp9.5+ axon density was higher compared with decentralized animals. Ex vivo smooth muscle contractions in response to KCl correlated positively with submucosal inflammation, detrusor muscle thickness, and pgp9.5+ axon density. In vivo, reinnervated animals showed higher MDP after stimulation of L1–L6 roots compared with their transected L7–S3 roots, and reinnervated and decentralized animals showed lower MDP than controls after stimulation of nerves (due likely to fibrotic nerve encapsulation). MDP correlated negatively with detrusor collagen and inflammation, and positively with pgp9.5+ axon density and intramural ganglia numbers. These results demonstrate that bladder function can be improved by transfer of obturator nerves to pelvic nerves at 1 yr after decentralization, although the fibrosis and inflammation that developed were associated with decreased contractile function.
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Affiliation(s)
- Mary F Barbe
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Courtney L Testa
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Geneva E Cruz
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Nagat A Frara
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Ekta Tiwari
- Department of Electrical and Computer Engineering, College of Engineering, Temple University, Philadelphia, Pennsylvania
| | - Lucas J Hobson
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Brian S McIntyre
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Danielle S Porreca
- Department of Electrical and Computer Engineering, College of Engineering, Temple University, Philadelphia, Pennsylvania
| | - Dania Giaddui
- Department of Electrical and Computer Engineering, College of Engineering, Temple University, Philadelphia, Pennsylvania
| | - Alan S Braverman
- Department of Electrical and Computer Engineering, College of Engineering, Temple University, Philadelphia, Pennsylvania
| | - Emily P Day
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania
| | - Mamta Amin
- Department of Electrical and Computer Engineering, College of Engineering, Temple University, Philadelphia, Pennsylvania
| | - Justin M Brown
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Mazzei
- Department of Surgery, Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Michel A Pontari
- Department of Urology, Lewis Katz School of Medicine, Temple University Health System, Philadelphia, Pennsylvania
| | - Ida J Wagner
- Department of Surgery, Lewis Katz School of Medicine, Philadelphia, Pennsylvania
| | - Michael R Ruggieri
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania.,Department of Electrical and Computer Engineering, College of Engineering, Temple University, Philadelphia, Pennsylvania
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17
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Stewart AN, MacLean SM, Stromberg AJ, Whelan JP, Bailey WM, Gensel JC, Wilson ME. Considerations for Studying Sex as a Biological Variable in Spinal Cord Injury. Front Neurol 2020; 11:802. [PMID: 32849242 PMCID: PMC7419700 DOI: 10.3389/fneur.2020.00802] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 06/26/2020] [Indexed: 12/13/2022] Open
Abstract
In response to NIH initiatives to investigate sex as a biological variable in preclinical animal studies, researchers have increased their focus on male and female differences in neurotrauma. Inclusion of both sexes when modeling neurotrauma is leading to the identification of novel areas for therapeutic and scientific exploitation. Here, we review the organizational and activational effects of sex hormones on recovery from injury and how these changes impact the long-term health of spinal cord injury (SCI) patients. When determining how sex affects SCI it remains imperative to expand outcomes beyond locomotor recovery and consider other complications plaguing the quality of life of patients with SCI. Interestingly, the SCI field predominately utilizes female rodents for basic science research which contrasts most other male-biased research fields. We discuss the unique caveats this creates to the translatability of preclinical research in the SCI field. We also review current clinical and preclinical data examining sex as biological variable in SCI. Further, we report how technical considerations such as housing, size, care management, and age, confound the interpretation of sex-specific effects in animal studies of SCI. We have uncovered novel findings regarding how age differentially affects mortality and injury-induced anemia in males and females after SCI, and further identified estrus cycle dysfunction in mice after injury. Emerging concepts underlying sexually dimorphic responses to therapy are also discussed. Through a combination of literature review and primary research observations we present a practical guide for considering and incorporating sex as biological variable in preclinical neurotrauma studies.
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Affiliation(s)
- Andrew N Stewart
- Department of Physiology, University of Kentucky, Lexington, KY, United States.,Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Steven M MacLean
- Department of Physiology, University of Kentucky, Lexington, KY, United States.,Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Arnold J Stromberg
- Department of Statistics, College of Arts and Sciences, University of Kentucky, Lexington, KY, United States
| | - Jessica P Whelan
- Department of Physiology, University of Kentucky, Lexington, KY, United States.,Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - William M Bailey
- Department of Physiology, University of Kentucky, Lexington, KY, United States.,Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - John C Gensel
- Department of Physiology, University of Kentucky, Lexington, KY, United States.,Spinal Cord and Brain Injury Research Center, College of Medicine, University of Kentucky, Lexington, KY, United States
| | - Melinda E Wilson
- Department of Physiology, University of Kentucky, Lexington, KY, United States
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18
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Haldrup M, Dyrskog S, Thygesen MM, Kirkegaard H, Kasch H, Rasmussen MM. Initial blood pressure is important for long-term outcome after traumatic spinal cord injury. J Neurosurg Spine 2020; 33:256-260. [PMID: 32197239 DOI: 10.3171/2020.1.spine191005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/20/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Patients with traumatic spinal cord injury (TSCI) are at risk of developing neurogenic shock that causes hypotension and thereby secondary injury to the spinal cord due to ischemia. Hemodynamic treatment of patients with acute TSCI remains inadequately elucidated. Guidelines for management are divergent and based on limited evidence. To this end, the authors evaluated whether mean arterial blood pressure (MABP) during the prehospital and initial hospital phases of TSCI treatment is correlated with long-term neurological outcome. METHODS The authors performed a retrospective cohort study based on a chart review of MABP data collected during the prehospital transport, in the operating room (OR), and in the neurointensive care unit (NICU) during the first 7 days after trauma. Data from the NICU were divided into two periods: days 1-2 and days 3-7. Data were analyzed using Spearman's rank correlation to evaluate for any correlation between MABP and changes in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) score 1 year postinjury. In the analysis, the MABP target value was 80 mm Hg. Hypotension was treated with metaoxedrin or norepinephrine. Statistically significant differences were evaluated using Spearman's rank correlation coefficient. RESULTS The chart review yielded 129 patients treated for TSCI. The inclusion period was 2010-2017. For the prehospital transport measurements of MABP, the Spearman's rank correlation coefficient was a rho of 0.5662 (p < 0.001), for OR measurements it was a rho of 0.6818 (p < 0.001), and for the NICU measurements it was a rho of 0.4611 (p < 0.001); for NICU unit days 1-2 and days 3-7, the Spearman's rank correlation coefficient was a rho of 0.2209 (p = 0.0681). CONCLUSIONS Continuous MABP levels exceeding 80 mm Hg have a significant impact on neurological outcome-from earliest possible stabilization in the prehospital care, through hospital admission, the surgical phase, and into the first 2 days in the NICU.
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Affiliation(s)
- Mette Haldrup
- 1Department of Neurosurgery, CENSE-Spine, Aarhus University Hospital
| | - Stig Dyrskog
- 2Department of Neuro-Intensive Care, Aarhus University Hospital
| | | | | | - Helge Kasch
- 4Department of Clinical Medicine, Spinal Cord Injury Center of Western Denmark, Aarhus, Denmark
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19
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Steadman CJ, Grill WM. Spinal cord stimulation for the restoration of bladder function after spinal cord injury. Healthc Technol Lett 2020; 7:87-92. [PMID: 32754343 PMCID: PMC7353924 DOI: 10.1049/htl.2020.0026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 05/15/2020] [Accepted: 05/15/2020] [Indexed: 12/20/2022] Open
Abstract
Spinal cord injury (SCI) results in the inability to empty the bladder voluntarily, and neurogenic detrusor overactivity (NDO) and detrusor sphincter dyssynergia (DSD) negatively impact both the health and quality of life of persons with SCI. Current approaches to treat bladder dysfunction in persons with SCI, including self-catheterisation and anticholinergic medications, are inadequate, and novel approaches are required to restore continence with increased bladder capacity, as well as to provide predictable and efficient on-demand voiding. Improvements in bladder function following SCI have been documented using a number of different modalities of spinal cord stimulation (SCS) in both persons with SCI and animal models, including SCS alone or SCS with concomitant activity-based training. Improvements include increased volitional voiding, voided volumes, bladder capacity, and quality of life, as well as decreases in NDO and DSD. Further, SCS is a well-developed therapy for chronic pain, and existing Food And Drug Administration (FDA)-approved devices provide a clear pathway to sustainable commercial availability and impact. However, the effective stimulation parameters and the appropriate timing and location of stimulation for SCS-mediated restoration of bladder function require further study, and studies are needed to determine underlying mechanisms of action.
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Affiliation(s)
- Casey J Steadman
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA
| | - Warren M Grill
- Department of Biomedical Engineering, Duke University, Durham, NC 27708, USA.,Department of Electrical and Computer Engineering, Duke University, Durham, NC 27708, USA.,Department of Neurobiology, Duke University, Durham, NC 27708, USA.,Department of Neurosurgery, Duke University, Durham, NC 27708, USA
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20
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Reliability and validity of the Turkish version of the intermittent self-catheterization questionnaire in patients with spinal cord injury. Int Urol Nephrol 2020; 52:1437-1442. [PMID: 32222882 DOI: 10.1007/s11255-020-02445-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 03/11/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE To evaluate the validity and reliability of the Turkish version of the Intermittent Self-Catheterization Questionnaire (ISC-Q) in patients with spinal cord injury (SCI). This questionnaire evaluates four problems related to the use of ISC, which are ease of use, convenience, discreetness and psychological well-being. METHODS A total of 60 SCI (40 males, 20 females) patients were included in the study. Reliability was assessed using Cronbach's α and intraclass correlation coefficient (ICC) methods, and the validity was assessed using the correlations between the ISC-Q scores and the scores for the King's health questionnaire (KHQ). RESULTS The mean age of the study sample was 37.07 ± 12.6 years. Of patients, 56.6% were completely injured. Both the internal consistency (Cronbach's alpha coefficient 0.899-0.947) and the test-retest reliability (intraclass correlation coefficient 0.899-0.947) of the ISC-Q were found to be high in patients with SCI. In the validity analysis, significant positive correlation was identified between convenience, psychological well-being, and total score domains and most subgroups of the KHQ, and also significant negative correlation was found between the discreetness of the domain and the impact of urinary incontinence, role limitation, physical limitation, social limitation and emotional status domains of the KHQ. CONCLUSION The Turkish version of the ISC-Q can be considered a reliable and valid tool for the evaluation of quality of life related to catheterization in patients with SCI.
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21
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Tiwari E, Salvadeo DM, Braverman AS, Frara NA, Hobson L, Cruz G, Brown JM, Mazzei M, Pontari MA, White AR, Barbe MF, Ruggieri MR. Nerve transfer for restoration of lower motor neuron-lesioned bladder and urethra function: establishment of a canine model and interim pilot study results. J Neurosurg Spine 2020; 32:258-268. [PMID: 31703192 PMCID: PMC7189959 DOI: 10.3171/2019.8.spine19265] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Accepted: 08/13/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Previous patient surveys have shown that patients with spinal cord or cauda equina injuries prioritize recovery of bladder function. The authors sought to determine if nerve transfer after long-term decentralization restores bladder and sphincter function in canines. METHODS Twenty-four female canines were included in this study. Transection of sacral roots and hypogastric nerves (S Dec) was performed in 6 animals, and 7 animals underwent this procedure with additional transection of the L7 dorsal roots (L7d+S Dec). Twelve months later, 3 L7d+S Dec animals underwent obturator-to-pelvic nerve and sciatic-to-pudendal nerve transfers (L7d+S Dec+Reinn). Eleven animals served as controls. Squat-and-void behaviors were tracked before and after decentralization, after reinnervation, and following awake bladder-filling procedures. Bladders were cystoscopically injected with Fluoro-Gold 3 weeks before euthanasia. Immediately before euthanasia, transferred nerves were stimulated to evaluate motor function. Dorsal root ganglia were assessed for retrogradely labeled neurons. RESULTS Transection of only sacral roots failed to reduce squat-and-void postures; L7 dorsal root transection was necessary for significant reduction. Three L7d+S Dec animals showing loss of squat-and-void postures post-decentralization were chosen for reinnervation and recovered these postures 4-6 months after reinnervation. Each showed obturator nerve stimulation-induced bladder contractions and sciatic nerve stimulation-induced anal sphincter contractions immediately prior to euthanasia. One showed sciatic nerve stimulation-induced external urethral sphincter contractions and voluntarily voided twice following nonanesthetized bladder filling. Reinnervation was confirmed by increased labeled cells in L2 and the L4-6 dorsal root ganglia (source of obturator nerve in canines) of L7d+S Dec+Reinn animals, compared with controls. CONCLUSIONS New neuronal pathways created by nerve transfer can restore bladder sensation and motor function in lower motor neuron-lesioned canines even 12 months after decentralization.
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Affiliation(s)
- Ekta Tiwari
- Department of Computer and Electrical Engineering, College of Engineering,Temple University, Philadelphia, Pennsylvania
| | - Danielle M. Salvadeo
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
| | - Alan S. Braverman
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
| | - Nagat A. Frara
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
| | - Lucas Hobson
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
| | - Geneva Cruz
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
| | - Justin M. Brown
- Department of Neurosurgery, Neurosurgery Paralysis Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Michael Mazzei
- Department of Medicine, and Temple University, Philadelphia, Pennsylvania
| | - Michel A. Pontari
- Department of Urology, Temple University, Philadelphia, Pennsylvania
| | - Amanda R. White
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
| | - Mary F. Barbe
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
| | - Michael R. Ruggieri
- Department of Computer and Electrical Engineering, College of Engineering,Temple University, Philadelphia, Pennsylvania
- Department of Anatomy and Cell Biology, Lewis Katz School of Medicine,Temple University, Philadelphia, Pennsylvania
- The Shriners Hospital of Philadelphia, Pennsylvania
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Long term continuation with repeated Botulinum toxin A injections in people with neurogenic detrusor overactivity after spinal cord injury. Spinal Cord 2020; 58:675-681. [PMID: 31913344 DOI: 10.1038/s41393-019-0411-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 12/20/2019] [Accepted: 12/20/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Retrospective chart study. OBJECTIVES The aim was to examine continuation of treatment of individuals with spinal cord injury including myelomeningocele and neurogenic detrusor overactivity, treated with repeated intra-detrusor Botulinum toxin A injections, and to investigate factors associated with discontinuation of treatment. SETTING Rigshospitalet, Denmark METHODS: This study included 128 individuals with spinal cord injury and neurogenic detrusor overactivity, who were offered repeated Botulinum toxin A injections between 2001 and 2018. Continuation rates of the treatment were estimated using Kaplan Meier analysis. A Cox proportional hazard analysis was used to investigate factors predictive of discontinuation. RESULTS A total of 1156 treatments were performed. The median number of treatments was six (IQR 9, range 1-51), and median follow-up was 10.6 years (IQR 8.5, range 0-16.9). All urodynamic parameters changed significantly after the first treatment (p < 0.001). The continuation group had significantly higher mean maximum bladder capacity after the first injections compared with the discontinuation group, with a mean difference between the groups of 84.5 mL (95% CI 4.7-164.2) (p = 0.038). The probability of continuing treatments after 5 years was 59% (95% CI 50.0-67.8) and 50% (95% CI 40.1-59.3) after 10 years. Individuals aged 31-50 years were more likely to continue treatment compared with those aged >50 years (95% CI 0.21‒0.79) (p = 0.008). No other factors predicted discontinuation. CONCLUSIONS This long-term follow-up study showed that 50% of people with spinal cord injury starting intra-detrusor Botulinum toxin A for neurogenic detrusor overactivity are still receiving injections after 10 years.
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Agarwal P, Mishra AN, Sudesh W, Prachir M, Dhananjaya S. Priorities of desired functional recovery in Indian spinal cord injury patients. J Clin Orthop Trauma 2020; 11:896-899. [PMID: 32879577 PMCID: PMC7452300 DOI: 10.1016/j.jcot.2019.08.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/01/2019] [Accepted: 08/01/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Spinal cord injuries (SCI) affect various functions and therefore the Quality of life (QOL) of these patients. Regaining even partial function can lead to improved QOL; making it crucial to know which functions are most important for these patients. MATERIAL AND METHODS This prompted us to conduct a survey in which subjects were asked to rank seven functions in order of importance to improve their quality of life. Survey was administered by personal interview of patients in different spinal injury rehabilitation centers across India. RESULTS A total of 112 patients completed the survey. Regaining arm and hand function was ranked as first priority by quadriplegics while bowel/bladder function and walking movements were ranked as 2nd and 3rd priority. Paraplegics ranked return of walking movements as their first priority, bladder/bowel recovery as second and trunk strength/sexual function as 3rd priority. CONCLUSION This knowledge empowers us to focus our research on what is most important for their QOL.
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Affiliation(s)
- Pawan Agarwal
- Plastic Surgery Unit, Department of Surgery, NSCB Government Medical College, Jabalpur, MP, 482003, India,Corresponding author. 292/293, Napier Town, Jabalpur, MP, 482001, India.
| | - Anchal N. Mishra
- Indian Spinal Injury Center, Vasant Kunj, 110070, New Delhi, India
| | - Wankhede Sudesh
- Department of Surgery, NSCB Government Medical College, Jabalpur, MP, 482003, India
| | - Mukati Prachir
- Department of Surgery, NSCB Government Medical College, Jabalpur, MP, 482003, India
| | - Sharma Dhananjaya
- Department of Surgery, NSCB Government Medical College, Jabalpur, MP, 482003, India
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Haldrup M, Schwartz OS, Kasch H, Rasmussen MM. Early decompressive surgery in patients with traumatic spinal cord injury improves neurological outcome. Acta Neurochir (Wien) 2019; 161:2223-2228. [PMID: 31402417 DOI: 10.1007/s00701-019-04031-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 07/31/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND The role and timing of a decompressive surgical intervention in patients with traumatic spinal cord injury (SCI) remain controversial. Given the impact of SCI on the individual and society, decompressive surgery to reduce the extent of tissue destruction and improving neurological outcome after initial spinal cord trauma are needed. OBJECTIVE To evaluate any possible correlation between the time of a decompressive procedure after traumatic SCI and end-neurologic outcome for traumatic SCI patients. METHODS A retrospective cohort study on patients with traumatic SCI in Western Denmark from 2010 to 2017. Data on date and time of injury and time of surgery and data on neurologic status at admission and one-year post-trauma were found in the Electronic Patients Journal (EPJ) and in paper journals. Patients were divided into 4 groups (< 6 h, < 12 h, < 24 h, and > 24 h) based on the time between injury and surgery. Further, patients were separated into two groups depending on whether they did or did not achieve neurological improvement one-year post-trauma. We used Fisher's exact test to compare the abovementioned groups to examine an eventual correlation between time from injury to operation and change in neurological outcome one-year post-trauma. RESULTS Patients undergoing surgery < 24 h after trauma obtained a significantly better neurological outcome as compared with patients who underwent surgery > 24 h after trauma (p < 0.001). This result did not change for subgroups of incomplete SCI patients (p = 0.002). However, complete SCI patients operated < 24 h as compared with > 24 h did not obtain better outcome (p = 0.14). We did not find a statistically significant correlation when time from trauma to surgery was reduced further to < 6 or < 12 h post-trauma. Furthermore, stratification on patients undergoing surgery before and after 24 h was made regarding gender, completeness, and years of age. The groups did not differ concerning gender and SCI completeness, but significant difference in age was found (44 and 58 years of age, respectively, p < 0.001). The chance of improved outcome was significantly higher for patients < 50 years of age (42% versus 24%, p = 0.05). Patients under the age of 50 seemed to benefit from early intervention (50% improvement versus 23%); however, difference was not statistically significant (p = 0.08). In patients aged above 50, the trend was similar, but significant correlation was found (40% versus 16%, p = 0.05). CONCLUSION The present study reports a beneficial effect of early decompression surgery, especially for incomplete SCI patients; however, surgical decision-making is complex, and all cases of acute spinal cord injury should be cautiously interpreted and handled on an individual basis.
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Affiliation(s)
- Mette Haldrup
- CENSE-Spine, Department of Neurosurgery, Aarhus University Hospital, Palle-Juel Jensens Boulevard 164, 8000, Aarhus, Denmark.
- Department of Neurosurgery, Aarhus University Hospital, Nørrebrogade 44, 8000, Aarhus, Denmark.
| | - Ole Søndergaard Schwartz
- DANDRITE-Danish Research Institute of Translational Neuroscience, Nordic EMBL Partnership for Molecular Medicine & Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Helge Kasch
- Spinal Cord Injury Centre of Western Denmark, Viborg Regional Hospital, Viborg, Denmark
| | - Mikkel Mylius Rasmussen
- CENSE-Spine, Department of Neurosurgery, Aarhus University Hospital, Palle-Juel Jensens Boulevard 164, 8000, Aarhus, Denmark
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Elliott CS, Stoffel JT, Myers JB, Lenherr SM, Welk B, Elliott SP, Shem K. Validation of Upper Extremity Motor Function as a Key Predictor of Bladder Management After Spinal Cord Injury. Arch Phys Med Rehabil 2019; 100:1939-1944. [PMID: 31348899 DOI: 10.1016/j.apmr.2019.06.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Revised: 05/17/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To validate if better upper extremity (UE) motor function predicts clean intermittent catheterization (CIC) adoption and adherence after spinal cord injury (SCI) using a validated instrument (as opposed to prior research using scales based on expert opinion). DESIGN We examined data from the Neurogenic Bladder Research Group SCI registry, a multicenter, prospective, observational study assessing persons with neurogenic bladder following SCI. All participants who were unable to volitionally void and were >1 year post injury were included. Participants were dichotomized into those performing CIC vs those using other bladder management methods. In addition to demographic and clinical characteristics, UE motor function was examined using the SCI-Fine Motor Function Index using validated categorization levels: (1) no activities requiring hand function, (2) some activities involving gross hand movement, (3) some activities requiring dexterity or coordinated UE movement, or (4) most activities requiring dexterity and coordinated UE movement. Associations were examined using logistic regression. SETTING Multicenter study. PARTICIPANTS Registry participants unable to volitionally void after SCI (N=1236). INTERVENTION Not applicable. MAIN OUTCOME MEASURE Upper extremity motor function association with CIC. RESULTS A total of 1326 individuals met inclusion criteria (66% performing CIC, 60% male, and 82% white). On multivariate analysis, better UE motor function was associated with a statistically increased odds of performing CIC (odds ratio, 3.10 [Level 3] and odds ratio, 8.12 [Level 4] vs Levels 1 and 2 [P<.001]). CONCLUSION In persons with SCI who are unable to volitionally void, UE motor function is highly associated with CIC. These results validate prior findings and continue to suggest that following SCI, the degree of preserved UE motor function is associated with CIC more than any other factor.
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Affiliation(s)
- Christopher S Elliott
- Department of Urology, Stanford University Medical Center, Stanford, California; Division of Urology, Santa Clara Valley Medical Center, San Jose, California.
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, Michigan
| | - Jeremy B Myers
- Division of Urology, University of Utah, Salt Lake City, Utah
| | - Sara M Lenherr
- Division of Urology, University of Utah, Salt Lake City, Utah
| | - Blayne Welk
- Division of Urology, Western University, London, Ontario, Canada
| | - Sean P Elliott
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Kazuko Shem
- Department of Physical Medicine and Rehabilitation, Santa Clara Valley Medical Center, Fruitdale, California
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Rohn EJ, Tate DG, Forchheimer M, DiPonio L. Contextualizing the lived experience of quality of life for persons with spinal cord injury: A mixed-methods application of the response shift model. J Spinal Cord Med 2019; 42:469-477. [PMID: 30188802 PMCID: PMC6718176 DOI: 10.1080/10790268.2018.1517471] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Abstract
Objective: The objective of this study was to gain greater insight into individuals' quality of life (QOL) definitions, appraisals, and adaptations following spinal cord injury (SCI). Design: A mixed-methods design, applying the Schwartz and Sprangers response shift (RS) model. RS is a cognitive process wherein, in response to a change in health status, individuals change internal standards, values, or conceptualization of QOL Setting: Community-dwelling participants who receive medical treatment at a major Midwestern medical system and nearby Veterans' Affairs hospital. Participants: A purposive sample of participants with SCI (N = 40) completed semi-structured interviews and accompanying quantitative measures. Interventions: Not applicable. Outcome Measures: Qualitative data were analyzed using content analysis to identify themes. Analysis of variance were performed to detect differences based on themes and QOL, well-being, and demographic and injury characteristics. Results: Four RS themes were identified, capturing the range of participant perceptions of QOL. The themes ranged from complete RS, indicating active engagement in maintaining QOL, to awareness and comparisons redefining QOL, to a relative lack of RS. Average QOL ratings differed as a function of response shift themes. PROMIS Global Health, Anxiety, and Depression also differed as a function of RS themes. Conclusion: The RS model contextualizes differences in QOL definitions, appraisals, and adaptations in a way standardized QOL measures alone do not.
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Affiliation(s)
- Edward J. Rohn
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA,Correspondence to: Edward J. Rohn, Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower Parkway, Suite 300, Ann Arbor, MI 48108, USA.
| | - Denise G. Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Martin Forchheimer
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa DiPonio
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA,Veterans Administration Ann Arbor Healthcare System, Ann Arbor, Michigan, USA
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Acute bladder decentralization in hound dogs: Preliminary results of effects on hypogastric nerve electroneurograms and detrusor pressure responses to spinal root and hypogastric nerve stimulation. PLoS One 2019; 14:e0215036. [PMID: 30970000 PMCID: PMC6457673 DOI: 10.1371/journal.pone.0215036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 03/25/2019] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE We aimed to refine electroneurogram techniques for monitoring hypogastric nerve activity during bladder filling, and then examined nerve activity in normal intact versus acutely decentralized bladders. METHODS Effects of electrical stimulation of hypogastric nerves or lumbar ventral roots on detrusor pressure were examined, as were effects of isoflurane versus propofol anesthetics on hypogastric nerve stimulation evoked pressure. Hypogastric nerve activity was then recorded using custom-made bipolar cuff electrodes during bladder filling before and after its transection between the spinal cord and electrode to eliminate efferent nerve signals. RESULTS Electrical stimulation of hypogastric nerves evoked low amplitude detrusor pressures that did not differ between the two anesthetics. Upper lumbar (L2) ventral root stimulation evoked detrusor pressures were suppressed, yet not eliminated, after transection of hypogastric nerves and all spinal roots below L5. Afferent and efferent hypogastric nerve activity did not change with bladder filling in neuronally intact bladders yet decreased in decentralized bladders. No change in afferent activity was observed during bladder filling in either intact or decentralized bladders. CONCLUSIONS These findings indicate that a more complete decentralized bladder model should include transection of lumbosacral spinal roots innervating the bladder as well as hypogastric nerves. These refined electroneurogram recording methods may be suitable for evaluating the effectiveness of nerve transfer surgeries for bladder reinnervation by monitoring sensory activity in the transferred nerve.
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A Korean Postmarketing Study Assessing the Effectiveness of OnabotulinumtoxinA for the Treatment of Neurogenic Detrusor Overactivity or Idiopathic Overactive Bladder Using a Validated Patient-Reported Outcome Measure. Int Neurourol J 2019; 23:30-39. [PMID: 30943692 PMCID: PMC6449655 DOI: 10.5213/inj.1836176.088] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 12/27/2018] [Indexed: 01/10/2023] Open
Abstract
Purpose OnabotulinumtoxinA has demonstrated efficacy and safety in the treatment of urinary incontinence (UI) associated with neurogenic detrusor overactivity (NDO) and idiopathic overactive bladder (OAB); however, real-world evidence is limited. This postmarketing surveillance study aimed to assess the effectiveness and safety of onabotulinumtoxinA in Korean patients with UI associated with NDO or OAB with an inadequate response or intolerance to anticholinergics. Methods Patients received 200 U (NDO) or 100 U (OAB) of onabotulinumtoxinA. Effectiveness (assessed using the validated International Consultation on Incontinence Questionnaire-Short Form [ICIQ-SF]) and safety were assessed for 1–4 months after onabotulinumtoxinA administration. Results Overall, 686 patients (NDO, 161; OAB, 525) comprised the safety population; of these, 612 patients were analyzed for effectiveness. There was a significant decrease (P<0.0001) in the mean (standard deviation) ICIQ-SF scores in the NDO (–6.8±5.5) and OAB (–6.0±6.4) groups after onabotulinumtoxinA administration. A decrease of >5 points from baseline in the ICIQ-SF score was observed in 64.9% and 47.3% of patients in the NDO and OAB groups, respectively. Following treatment, 59.9% in the NDO group and 43.0% in the OAB group were dry. There was no effect of age on effectiveness in either group. Only 10 adverse drug reactions (ADRs) were reported in 5.6% of NDO patients and 20 ADRs in 3.2% of OAB patients. Most ADRs in both groups were related to the lower urinary tract such as dysuria (NDO, 1.2%; OAB, 0.6%) and urinary retention (NDO, 0.6%; OAB, 1.5%). Conclusions Effectiveness and safety of onabotulinumtoxinA in Korea in a real-world setting was demonstrated.
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A clinically relevant blunt spinal cord injury model in the regeneration competent axolotl ( Ambystoma mexicanum) tail. Exp Ther Med 2019; 17:2322-2328. [PMID: 30867717 PMCID: PMC6395952 DOI: 10.3892/etm.2019.7193] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 01/16/2019] [Indexed: 12/30/2022] Open
Abstract
A randomized controlled and blinded animal trial was conducted in the axolotl (Ambystoma mexicanum), which has the ability to regenerate from transectional spinal cord injury (SCI). The objective of the present study was to investigate the axolotl's ability to regenerate from a blunt spinal cord trauma in a clinical setting. Axolotls were block-randomized to the intervention (n=6) or sham group (n=6). A laminectomy of two vertebrae at the level caudal to the hind limbs was performed. To induce a blunt SCI, a 25 g rod was released on the exposed spinal cord. Multiple modalities were applied at baseline (pre-surgery), and subsequently every third week for a total of 9 weeks. Gradient echo magnetic resonance imaging (MRI) was applied to assess anatomical regeneration. To support this non-invasive modality, regeneration was assessed by histology, and functional regeneration was investigated using swimming tests and functional neurological examinations. MRI suggested regeneration within 6 to 9 weeks. Histological analysis at 9 weeks confirmed regeneration; however, this regeneration was not complete. By the experimental end, all animals exhibited restored full neurological function. The present study demonstrated that the axolotl is capable of regenerating a contusion SCI; however, the duration of complete regeneration required further investigation.
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Welk B, McGarry P, Kennelly M, Myers J. Bladder management experiences among people living with neurologic disease: A systematic review and meta-synthesis of qualitative research. Neurourol Urodyn 2018; 38:668-676. [PMID: 30499226 DOI: 10.1002/nau.23887] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2018] [Accepted: 10/11/2018] [Indexed: 12/19/2022]
Abstract
AIM To systematically review the qualitative literature on neurogenic bladder management to better understand the relevant psychosocial issues. METHODS We used two reviewers to systematically review EMBASE, CINAHL, and PsycINFO for qualitative studies that included a neurogenic bladder patient population and were relevant to bladder management. We used a meta-ethnography technique to summarize and synthesize the data. RESULTS We found 13 studies that were relevant. When choosing a bladder management technique (three studies), there were two major themes (bladder management decision makers, and characteristics and risks) that impacted the process. For studies evaluating life with a urinary catheter (five about intermittent catheters, and five about indwelling catheters), relevant themes could be arranged into three consecutive periods: First, a changed life (the initial stage of selecting and using a catheter: coping, teaching and technical challenges, and control and independence). Second, learning to live with a catheter (the practical skill and knowledge that goes into using a catheter: knowledge, adjustments, and normalization). Third, a new life (the acceptance and integration of a catheter into a person's life: problems and benefits, unpredictability, travel and social activities, intimacy and relationships, and dealing with negative emotions). Themes were generally consistent across studies. Conclusions Several important themes were identified from the existing qualitative literature; these can provide insight into how neurogenic bladder patients select a bladder management method, and how physicians can optimize their counseling and the long-term management of these patients.
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Affiliation(s)
- Blayne Welk
- Department of Surgery, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Patrick McGarry
- Department of Surgery, Western University, London, Ontario, Canada
| | - Michael Kennelly
- Department of Surgery, Carolinas HealthCare System, Charlotte, North Carolina
| | - Jeremy Myers
- Department of Surgery, University of Utah, Salt Lake City, Utah
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Silveira SL, Winter LL, Clark R, Ledoux T, Robinson-Whelen S. Baseline Dietary Intake of Individuals with Spinal Cord Injury Who Are Overweight or Obese. J Acad Nutr Diet 2018; 119:301-309. [PMID: 30393077 DOI: 10.1016/j.jand.2018.08.153] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 08/20/2018] [Accepted: 08/21/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Individuals with spinal cord injury (SCI) experience significant secondary health conditions including excess adiposity. Dietary guidelines for individuals with chronic SCI do not exist. OBJECTIVE To describe baseline dietary intake and quality based on conformance with dietary recommendations in participants enrolled in GoHealthySCI, a weight loss intervention for individuals with SCI, which promotes lifestyle change. DESIGN Cross-sectional analyses were conducted on data collected from April through August 2017 in a randomized pilot study. PARTICIPANTS Thirty-seven participants enrolled in the study in Houston, TX. All participants were at least 1 year post injury with a self-reported body mass index (calculated as kg/m2) ≥23. The racially/ethnically diverse sample was predominantly male (n=23), average age was 41.8±13.5 years, and average number of years since injury was 18.1±14.9. Participants varied in terms of level of injury; 19 participants identified as having tetraplegia and 19 identified as having paraplegia. MAIN OUTCOME MEASURES The Automated Self-Administered 24-Hour Recall dietary assessment was used to obtain baseline dietary intake data. Participants reported food intake on 3 nonconsecutive days. STATISTICAL ANALYSIS Descriptive statistics were conducted for the primary research objectives. Mean macronutrient and micronutrient intake and Healthy Eating Index-2015 total and component scores are described. RESULTS Average daily energy intake was 1618±434 kcal. Daily intakes of whole fruits (0.6±0.7 cups), vegetables (1.6±0.9 cups), and whole grains (15%) of total grains were lower than recommendations from the 2015-2020 Dietary Guidelines for Americans. Average daily fiber (15.0g±6.0) met the Academy of Nutrition and Dietetics Evidence Analysis Library minimum target range for individuals with SCI. All percentages of calories from macronutrients were within the acceptable macronutrient distribution ranges: total fat (34.3%±6.2%), protein (16.7%±4.2%), and carbohydrate (49.3%±8.4%). Mean Healthy Eating Index-2015 score was 54.4. CONCLUSIONS This study provides a description of dietary intake by individuals with SCI who are overweight or obese. Although macronutrients are within the acceptable distribution range, calories from fat are at the high end and those from protein are at the low end of those ranges. In addition, on average, individuals reported inadequate intake of fruits, vegetables, whole grains, fiber, seafood and plant protein, and healthy fats and excess intake of added sugars and saturated fat. Results provide preliminary evidence of dietary inadequacies and suggest that larger studies examining dietary intake are warranted.
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Choukou MA, Best KL, Craven BC, Hitzig SL. Identifying and Classifying Quality of Life Tools for Assessing Neurogenic Bowel Dysfunction After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2018; 25:1-22. [PMID: 30774286 DOI: 10.1310/sci18-00019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Objectives: To identify and classify tools for assessing the influence of neurogenic bowel dysfunction (NBD) on quality of life (QoL) after spinal cord injury (SCI). Methods: In this systematic review, MEDLINE/PubMed, CINAHL, and PsycInfo were searched to identify studies assessing the influence of NBD on QoL (or related construct) after SCI. Two independent reviewers screened titles and abstracts, and both reviewers classified tools as subjective or objective according to Dijkers' theoretical QoL framework. Results: Seventy-two studies were identified, and 35 studies met the inclusion criteria. Five objective measures assessed the influence of NBD on QoL, which were validated for use in SCI, but no measure was condition-specific to NBD. Eight measures were classified as subjective tools; two had an established reliability and validity for SCI while six had some psychometric evidence for use in the SCI population. Five subjective measures (NBD score, Burwood QoL Questionnaire, Impediments to Community Integration [ICI] Scale, SCI-QoL Bowel Management Difficulties, and Survey of Neurogenic Bowel Characteristics) were developed specifically for SCI. The NBD score showed sensitivity to the influence of NBD on QoL in experimental trials. Conclusion: Thirteen tools assessed the influence of NBD on QoL in SCI. Although not developed specifically for SCI, the Health Utility Index (HUI-III) was the only tool identified that provided data on "QoL as utility" on the impact of NBD. The validated NBD score was the only condition-specific tool to assess QoL as "subjective well-being." Further validation of existing tools could help to inform practice and policy related to resource allocation for bowel care post SCI.
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Affiliation(s)
- Mohamed-Amine Choukou
- Département de réadaptation, Université Laval, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Institut de réadaptation en déficience physique de Québec, Québec City, Canada
| | - Krista L Best
- Département de réadaptation, Université Laval, Québec, Canada.,Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, Institut de réadaptation en déficience physique de Québec, Québec City, Canada
| | - B Catharine Craven
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,Division of Physiatry, Department of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Sander L Hitzig
- Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada.,St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,School of Kinesiology and Health Science, Faculty ofHealth, York University, Toronto, Ontario, Canada
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Karapolat H, Akkoç Y, Eyigör S, Tanıgör G. Bladder-related quality of life in people with neurological disorders: reliability and validity of the Turkish version of the King's Health Questionnaire in people with spinal cord injury. Turk J Urol 2018; 44:411-417. [PMID: 29799397 DOI: 10.5152/tud.2018.45556] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 01/05/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To assess the validity and reliability of the Turkish version of the King's Health Questionnaire (KHQ) in patients with spinal cord injury (SCI) and to compare the bladder- related quality of life between patients with SCI and multiple sclerosis (MS). MATERIAL AND METHODS Thirty-five patients with SCI and 57 patients with multiple sclerosis (MS) were included in the study. For analysis of test-retest reliability, the Turkish version of the KHQ scale was developed using the back translation method, and it was administered on the day of admission and again one week later. The Qualiveen and SF-36 questionnaires were administered to the patients for validity analysis. Moreover, the results of KHQ that had been administered to 35 patients with SCI were compared with those of 57 patients with MS. RESULTS Both the internal consistency (Cronbach's alpha coefficient: 0.68-0.93) and the test-retest reliability (intraclass correlation coefficient: 0.69-0.94) of the KHQ in patients with SCI were found to be high. Although a weak correlation between the subscales of the KHQ and SF-36, a moderate correlation between the subscales of KHQ, and the Qualiveen questionnaire (0.34<r<0.76, p<0.05) were found. The comparison of patients with SCI and patients with MS in terms of KHQ revealed that patients with SCI had significantly higher scores in some of the subscales of KHQ (p<0.05). These higher scores represented the worst health state, and the uppermost limit was determined as 100 points. CONCLUSION The KHQ scale is an internally consistent, reliable, and valid scale for people with SCI. In addition, bladder-related quality of life was poorer in patients with SCI than in MS patients.
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Affiliation(s)
- Hale Karapolat
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, İzmir, Turkey
| | - Yeşim Akkoç
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, İzmir, Turkey
| | - Sibel Eyigör
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, İzmir, Turkey
| | - Göksel Tanıgör
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, İzmir, Turkey
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Quality of Life and the Neurogenic Bladder: Does Bladder Management Technique Matter? CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0443-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Elliott CS, Shem K. Volitional Voiding After Spinal Cord Injury—Who Will and Who Will Not. CURRENT BLADDER DYSFUNCTION REPORTS 2017. [DOI: 10.1007/s11884-017-0448-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Yasami S, Khadem M, Safaei G, Latifi S, Koushki D, Yazdanshenas Ghazwin M. The association between bladder-emptying methods and health-related quality of life among Iranian individuals with spinal cord injury. J Spinal Cord Med 2017; 40:530-537. [PMID: 27104684 PMCID: PMC5815148 DOI: 10.1080/10790268.2016.1173320] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES In this study, we compared the health-related quality of life (HRQoL) among patients with spinal cord injury (SCI) using different bladder emptying methods including normal spontaneous micturition (NSM), micturition with assisted maneuvers (MAM), aseptic intermittent catheterization by patient (IC-P), aseptic IC by an attendant/caregiver (IC-A) and indwelling catheterization. DESIGN Cross-sectional. SETTING Tertiary rehabilitation center. PARTICIPANTS Patients referred to Brain and Spinal Cord Injury Research Center between 2012 and 2014. OUTCOME MEASURES HRQoL was assessed by Short Form Health Survey (SF-36). Hierarchical regression analysis with adjustment for probable confounders (demographic and injury-related variables) was performed to assess the relationship between bladder-emptying method and total SF-36 score. RESULTS Patients with injury at cervical sections had significantly lower scores in domain of physical functioning (PF), physical component summary (PCS) and total score (P: 0.001, <0.0001 and 0.027, respectively). Longer time since injury was associated with better scores of PCS, Mental component summary (MCS) and total score (P: 0.002, <0.0001 and 0.003, respectively). Regression analysis showed that the effect of bladder-emptying method on total score of SF-36 was significant (P < 0.0001) and this relationship remained significant after adjustment for probable confounders in the second step of hierarchical regression analysis (R: 0.923, R2: 0.852, Adjusted R2: 0.847, P < 0.0001). Patients with NSM had the highest scores in SF-36 instrument and individuals with indwelling catheterization had the poorest HRQoL in all domains. CONCLUSION This study shows that the type of bladder management method affects HRQoL significantly in patients with SCI. Intermittent catheterization are recommended to be administered instead of indwelling catheterization to improve HRQoL.
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Affiliation(s)
- Sara Yasami
- Islamic Azad University, Tehran Medical Branch, Tehran, Iran
| | | | - Golsa Safaei
- International Campus Tehran University of Medical Sciences, Tehran, Iran
| | - Sahar Latifi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran,Correspondence to: Sahar Latifi, Brain and Spinal Cord Injury Research Center, Imam Khomeini Hospital, Gharib Street, Keshavarz Boulevard, Tehran, Iran.
| | | | - Manijeh Yazdanshenas Ghazwin
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
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Best KL, Ethans K, Craven BC, Noreau L, Hitzig SL. Identifying and classifying quality of life tools for neurogenic bladder function after spinal cord injury: A systematic review. J Spinal Cord Med 2017; 40:505-529. [PMID: 27734771 PMCID: PMC5815152 DOI: 10.1080/10790268.2016.1226700] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To identify and classify quality of life (QoL) tools for assessing the influence of neurogenic bladder after spinal cord injury/disease (SCI). DESIGN Systematic Review Methods: Medline/Pubmed, CINAHL, and PsycInfo were searched using terms related to SCI, neurogenic bladder and QoL. Studies that assessed the influence neurogenic bladder on QoL (or related construct) in samples consisting of ≥50% individuals with SCI were included. Two independent reviewers screened titles and abstracts of 368 identified references; 118 full-text articles were assessed for eligibility, and 42 studies were included. Two reviewers independently classified outcomes as objective (societal viewpoint) or subjective (patient perspective) using a QoL framework. RESULTS Ten objective QoL measures were identified, with the Medical Outcomes Short Form (SF-36/SF-12) used most frequently. Fourteen subjective QoL measures were identified; 8 were specific to neurogenic bladder. Psychometric evidence for SCI-specific neurogenic bladder QoL tools was reported for the Quality of Life Index (QLI), Qualiveen, Bladder Complications Scale, Spinal Cord Injury-Quality of Life (SCI-QOL) Bladder Management Difficulties, and the SCI-QOL Bladder Management Difficulties-Short Form. The QLI and Qualiveen showed sensitivity to neurogenic bladder in experimental designs. CONCLUSION Several objective and subjective tools exist to assess the influence of neurogenic bladder on QoL in SCI. The QLI and Qualiveen, both subjective tools, were the only validated SCI-specific tools that showed sensitivity to neurogenic bladder. Further validation of existing subjective SCI-specific outcomes is needed. Research to validate objective measures of QoL would be useful for informing practice and policy related to resource allocation for bladder care post-SCI.
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Affiliation(s)
- Krista L. Best
- Department of Rehabilitation, Université Laval, Quebec City, QC, Canada,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de réadaptation en déficience physique de Québec, Quebec City, QC, Canada,Correspondence to: Krista L. Best, Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), 525 Blvd Hamel, Québec, QC, G1M 2S8, Canada.
| | - Karen Ethans
- University of Manitoba, Department of Medicine, Winnipeg, MB, Canada,Health Sciences Centre, Section of Physical Medicine and Rehabilitation, Winnipeg, MB, Canada
| | - B. Catharine Craven
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada
| | - Luc Noreau
- Department of Rehabilitation, Université Laval, Quebec City, QC, Canada,Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Institut de réadaptation en déficience physique de Québec, Quebec City, QC, Canada
| | - Sander L. Hitzig
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada,St-John's Rehab Research Program, Sunnybrook Research Institute, Toronto, ON, Canada,School of Kinesiology and Health Science, Faculty of Health, York University, Toronto, ON, Canada
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Patel DP, Myers JB, Lenherr SM. How to Measure Quality-of-Life Concerns in Patients with Neurogenic Lower Urinary Tract Dysfunction. Urol Clin North Am 2017; 44:345-353. [DOI: 10.1016/j.ucl.2017.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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Ni J, Wang X, Cao N, Si J, Gu B. Is repeat Botulinum Toxin A injection valuable for neurogenic detrusor overactivity-A systematic review and meta-analysis. Neurourol Urodyn 2017; 37:542-553. [PMID: 28745818 DOI: 10.1002/nau.23354] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 05/31/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Jianshu Ni
- Department of Urology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai People's Republic of China
| | - Xiaohu Wang
- Department of Urology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai People's Republic of China
| | - Nailong Cao
- Department of Urology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai People's Republic of China
| | - Jiemin Si
- Department of Urology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai People's Republic of China
| | - Baojun Gu
- Department of Urology; Shanghai Jiao Tong University Affiliated Sixth People's Hospital; Shanghai People's Republic of China
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Walia P, Kaur J. Development and validation of Incontinence - Activity Participation Scale for spinal cord injury. Indian J Urol 2017; 33:159-164. [PMID: 28469306 PMCID: PMC5396406 DOI: 10.4103/0970-1591.203413] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION We aimed to develop and validate an Incontinence - Activity Participation Scale (I-APS) for measurement of activity limitation and participation restriction due to bladder problems in spinal cord injury (SCI). MATERIALS AND METHODS The process of development was initiated by formation of open-ended questions after thorough review of literature which were then administered to SCI participants, caretakers, and professionals working with SCI. Items were generated based on their responses and initial draft of scale was formulated. This initial draft of the scale containing 77 items was then administered to 56 SCI participants for reduction of items using factor analysis, and a prefinal version of the scale was obtained containing thirty items only. Content validity and face validity was then established. RESULTS The I-APS is both health professional and self-administered questionnaire including two domains: Activities of daily living and occupation with 16 items having a content validity of 0.84. The overall internal consistency reliability was 0.86. CONCLUSION The I-APS is a valid, comprehensive instrument that measures the activity limitation and participation restrictions due to bladder problems in SCI.
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Affiliation(s)
- Priya Walia
- Indian Spinal Injuries Centre, New Delhi, India
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41
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Social activity and relationship changes experienced by people with bowel and bladder dysfunction following spinal cord injury. Spinal Cord 2017; 55:679-686. [PMID: 28244500 DOI: 10.1038/sc.2017.19] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 12/04/2016] [Accepted: 01/22/2017] [Indexed: 01/13/2023]
Abstract
STUDY DESIGN Exploratory qualitative. OBJECTIVES The aim of this study was to describe the experiences of bowel and bladder dysfunction on social activities and relationships in people with spinal cord injury living in the community. SETTING People living with spinal cord injury experiencing bowel and bladder dysfunction. METHODS Participants were recruited through the Australian Quadriplegic Association Victoria. Semi-structured in-depth interviews were undertaken with purposively selected participants to ensure representation of age, gender, spinal cord injury level and compensation status. A thematic analysis was performed to interpret patient experiences. RESULTS Twenty-two participants took part in the study. Bladder and bowel dysfunction altered relationships because of issues with intimacy, strained partner relationships and role changes for family and friends. A lack of understanding from friends about bladder and bowel dysfunction caused frustration, as this impairment was often responsible for variable attendance at social activities. Issues with the number, location, access and cleanliness of bathrooms in public areas and in private residences negatively affected social engagement. Social activities were moderated by illness, such as urinary tract infections, rigid and unreliable bowel routines, stress and anxiety about incontinence and managing the public environment, and due to continuous changes in plans related to bowel and bladder issues. Social support and adaptation fostered participation in social activities. CONCLUSION Tension exists between managing bowel and bladder dysfunction and the desire to participate in social activities. Multiple intersecting factors negatively affected the social relationships and activities of people with spinal cord injury and bowel and bladder dysfunction.
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Factors Which Facilitate or Impede Interpersonal Interactions and Relationships after Spinal Cord Injury: A Scoping Review with Suggestions for Rehabilitation. Rehabil Res Pract 2017; 2016:9373786. [PMID: 28127471 PMCID: PMC5227179 DOI: 10.1155/2016/9373786] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 10/20/2016] [Accepted: 11/16/2016] [Indexed: 11/22/2022] Open
Abstract
Interpersonal interactions and relationships can influence an individual's perceptions of health and quality of life in the presence of disability. In the case of people with spinal cord injury (SCI), positive interpersonal interactions and relationships have been shown to contribute to resilience and adaptability. Understanding factors which facilitate or impede the development and maintenance of relationships after SCI may form the basis for proactive relationship support for people with SCI. To gain a broad insight into these factors, a scoping review was undertaken. Databases were searched for English language studies published between 2000 and 2015 that informed the review question. Sixty-two (62) studies were identified. Thematic analysis was conducted on data extracted from the studies and 51 factors which may facilitate relationships and 38 factors which may impede relationships after SCI were noted. The majority of factors could be categorized as environmental or personal according to the domains of the International Classification of Functioning, Disability, and Health (ICF). The facilitating factors included partner and social support, reciprocity in relationships, and presenting oneself positively. Impeding factors included physical environmental barriers, real and perceived social biases, and poor self-image. Factors identified may inform the provision of supportive, holistic rehabilitation for people with SCI.
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Tsai IH, Graves DE, Chan W, Darkoh C, Lee MS, Pompeii LA. Environmental barriers and social participation in individuals with spinal cord injury. Rehabil Psychol 2017; 62:36-44. [PMID: 28045281 DOI: 10.1037/rep0000117] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The study aimed to examine the relationship between environmental barriers and social participation among individuals with spinal cord injury (SCI). METHOD Individuals admitted to regional centers of the Model Spinal Cord Injury System in the United States due to traumatic SCI were interviewed and included in the National Spinal Cord Injury Database. This cross-sectional study applied a secondary analysis with a mixed effect model on the data from 3,162 individuals who received interviews from 2000 through 2005. Five dimensions of environmental barriers were estimated using the short form of the Craig Hospital Inventory of Environmental Factors-Short Form (CHIEF-SF). Social participation was measured with the short form of the Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF) and their employment status. RESULTS Subscales of environmental barriers were negatively associated with the social participation measures. Each 1 point increase in CHIEF-SF total score (indicated greater environmental barriers) was associated with a 0.82 point reduction in CHART-SF total score (95% CI: -1.07, -0.57) (decreased social participation) and 4% reduction in the odds of being employed. Among the 5 CHIEF-SF dimensions, assistance barriers exhibited the strongest negative association with CHART-SF social participation score when compared to other dimensions, while work/school dimension demonstrated the weakest association with CHART-SF. CONCLUSIONS Environmental barriers are negatively associated with social participation in the SCI population. Working toward eliminating environmental barriers, especially assistance/service barriers, may help enhance social participation for people with SCI. (PsycINFO Database Record
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Affiliation(s)
- I-Hsuan Tsai
- School of Public Health, National Defense Medical Center
| | - Daniel E Graves
- Department of Neurological Surgery/Division of Physical Medicine & Rehabilitation, The University of Louisville
| | - Wenyaw Chan
- School of Public Health, The University of Texas Health Science Center at Houston
| | - Charles Darkoh
- School of Public Health, The University of Texas Health Science Center at Houston
| | | | - Lisa A Pompeii
- School of Public Health, The University of Texas Health Science Center at Houston
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Lo C, Tran Y, Anderson K, Craig A, Middleton J. Functional Priorities in Persons with Spinal Cord Injury: Using Discrete Choice Experiments To Determine Preferences. J Neurotrauma 2016; 33:1958-1968. [PMID: 27080545 DOI: 10.1089/neu.2016.4423] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Major goals of rehabilitation and health interventions in people with spinal cord injury (SCI) are to improve functional independence, increase social participation, and enhance quality of life (QOL). Determining functional areas perceived by consumers as most important can assist in research prioritization, planning for delivery of health services, and policy development. Five high priority areas of functioning for the SCI population (arm/hand use, walking, bladder/bowel control, sexual function, and relief of pain) were chosen to determine the preferences for these five attributes. A discrete choice experiment was conducted involving 151 persons with SCI sampled from Australia and the United States of America. Consistent with prior research, arm/hand function had the highest preference, with odds ratios of subjects being 44-76% more likely to choose arm/hand function over the other four functions. Preference for normal arm/hand function was found to be significantly more preferred by the group with paraplegia compared with those with tetraplegia; that is, retaining and not trading off existing arm/hand function for other improved functions. There were no significant differences found in preferences between bladder/bowel function and walking or elimination of pain, although walking was preferred in earlier (≤ 10) post-injury years and pain amelioration became more important with a longer duration (>10 years) post-injury. Sexual function had the lowest preference when traded against the other four functions. Understanding the functional preferences of persons with SCI will help to inform future research design, as well as enabling successful translation of research into practice and health policy, meeting the needs of people with SCI.
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Affiliation(s)
- Charles Lo
- 1 John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney , Kolling Institute, Sydney, New South Wales, Australia
| | - Yvonne Tran
- 1 John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney , Kolling Institute, Sydney, New South Wales, Australia
| | - Kim Anderson
- 2 Department of Education, The Miami Project to Cure Paralysis, Department of Neurological Surgery, Lois Pope Life Center, University of Miami , Miami, Florida
| | - Ashley Craig
- 1 John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney , Kolling Institute, Sydney, New South Wales, Australia
| | - James Middleton
- 1 John Walsh Centre for Rehabilitation Research, Sydney Medical School-Northern, The University of Sydney , Kolling Institute, Sydney, New South Wales, Australia
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Carter MW, Johnson KM, Lee JY, Hulsebosch CE, Gwak YS. Comparison of Mechanical Allodynia and Recovery of Locomotion and Bladder Function by Different Parameters of Low Thoracic Spinal Contusion Injury in Rats. Korean J Pain 2016; 29:86-95. [PMID: 27103963 PMCID: PMC4837124 DOI: 10.3344/kjp.2016.29.2.86] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Revised: 02/12/2016] [Accepted: 03/05/2016] [Indexed: 11/30/2022] Open
Abstract
Background The present study was designed to examine the functional recovery following spinal cord injury (SCI) by adjusting the parameters of impact force and dwell-time using the Infinite Horizon (IH) impactor device. Methods Sprague-Dawley rats (225–240 g) were divided into eight injury groups based on force of injury (Kdyn) and dwell time (seconds), indicated as Force-Dwell time: 150-4, 150-3, 150-2, 150-1, 150-0, 200-0, 90-2 and sham controls, respectively. Results After T10 SCI, higher injury force produced greater spinal cord displacement (P < 0.05) and showed a significant correlation (r = 0.813) between the displacement and the force (P < 0.05). In neuropathic pain-like behavior, the percent of paw withdrawals scores in the hindpaw for the 150-4, 150-3, 150-2, 150-1 and the 200-0 injury groups were significantly lowered compared with sham controls (P < 0.05). The recovery of locomotion had a significant within-subjects effect of time (P < 0.05) and the 150-0 group had increased recovery compared to other groups (P < 0.05). In addition, the 200-0 and the 90-2 recovered significantly better than all the 150 kdyn impact groups that included a dwell-time (P < 0.05). In recovery of spontaneous bladder function, the 150-4 injury group took significantly longer recovery time whereas the 150-0 and the 90-2 groups had the shortest recovery times. Conclusions The present study demonstrates SCI parameters optimize development of mechanical allodynia and other pathological outcomes.
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Affiliation(s)
- Michael W Carter
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch at Galveston, TX, USA
| | - Kathia M Johnson
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch at Galveston, TX, USA
| | - Jun Yeon Lee
- Department of Physiology, Daegu Haany University, Daegu, Korea
| | - Claire E Hulsebosch
- Department of Neuroscience and Cell Biology, University of Texas Medical Branch at Galveston, TX, USA
| | - Young Seob Gwak
- Department of Physiology, Daegu Haany University, Daegu, Korea
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Sandner B, Ciatipis M, Motsch M, Soljanik I, Weidner N, Blesch A. Limited Functional Effects of Subacute Syngeneic Bone Marrow Stromal Cell Transplantation after Rat Spinal Cord Contusion Injury. Cell Transplant 2016; 25:125-39. [DOI: 10.3727/096368915x687679] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Cell transplantation might be one means to improve motor, sensory, or autonomic recovery after traumatic spinal cord injury (SCI). Among the different cell types evaluated to date, bone marrow stromal cells (BMSCs) have received considerable interest due to their potential neuroprotective properties. However, uncertainty exists whether the efficacy of BMSCs after intraspinal transplantation justifies an invasive procedure. In the present study, we analyzed the effect of syngeneic BMSC transplantation following a moderate to severe rat spinal cord injury. Adult Fischer 344 rats underwent a T9 contusion injury (200 kDy) followed by grafting of GFP-expressing BMSCs 3 days postinjury. Animals receiving a contusion injury without cellular grafts or an injury followed by grafts of syngeneic GFP-expressing fibroblasts served as control. Eight weeks post-transplantation, BMSC-grafted animals showed only a minor effect in one measure of sensorimotor recovery, no significant differences in tissue sparing, and no changes in the recovery of bladder function compared to both control groups in urodynamic measurements. Both cell types survived in the lesion site with fibroblasts displaying a larger graft volume. Thus, contrary to some reports using allogeneic or xenogeneic transplants, subacute intraparenchymal grafting of syngeneic BMSCs has only a minor effect on functional recovery.
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Affiliation(s)
- Beatrice Sandner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Mareva Ciatipis
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Melanie Motsch
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Irina Soljanik
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Norbert Weidner
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
| | - Armin Blesch
- Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany
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Gallagher G, Bell A. Combining Adult Learning Theory with Occupational Therapy Intervention for Bladder and Bowel Management after Spinal Cord Injury: A Case Report. Occup Ther Health Care 2015; 30:202-9. [PMID: 26694910 DOI: 10.3109/07380577.2015.1116130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Bladder and bowel management is an important goal of rehabilitation for clients with spinal cord injury. Dependence is these areas have been linked to a variety of secondary complications, including decreased quality of life, urinary tract infections and pressure ulcers (Hammell, 2010; Hicken et al, 2001). Occupational therapists have been identified as important members of the health care team in spinal cord injury rehabilitation; however, specific roles and interventions have not been clearly described. This case report will describe occupational therapy interventions embedded with principles of adult learning theory to address bladder and bowel management with an adult client who sustained an incomplete thoracic level spinal cord injury.
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Affiliation(s)
- Gina Gallagher
- a Wellspan Surgery & Rehabilitation Hospital , York , PA , USA
| | - Alison Bell
- b Occupational Therapy , Thomas Jefferson University , Philadelphia , PA , USA
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Kennelly M, Dmochowski R, Schulte-Baukloh H, Ethans K, Del Popolo G, Moore C, Jenkins B, Guard S, Zheng Y, Karsenty G. Efficacy and safety of onabotulinumtoxinA therapy are sustained over 4 years of treatment in patients with neurogenic detrusor overactivity: Final results of a long-term extension study. Neurourol Urodyn 2015; 36:368-375. [PMID: 26607743 DOI: 10.1002/nau.22934] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 11/09/2015] [Indexed: 11/06/2022]
Abstract
AIMS To present final efficacy/safety results from a prospective, long-term extension trial of onabotulinumtoxinA for urinary incontinence (UI) due to neurogenic detrusor overactivity (NDO); patients received treatment for up to 4 years. METHODS Patients who completed a 52-week, phase III trial of onabotulinumtoxinA for NDO were eligible to enter a 3-year, multicenter, open-label extension study of intradetrusor onabotulinumtoxinA (200U or 300U). Patients were treated "as needed" based on their request and fulfillment of prespecified qualification criteria (≥12 weeks since previous treatment and a UI episode threshold). Assessments included change from study baseline in UI episodes/day (primary efficacy measure), volume/void, and Incontinence Quality of Life (I-QOL) total score (week 6); duration of effect; adverse events (AEs); and initiation of de novo clean intermittent catheterization (CIC). Data are presented for up to six treatments. RESULTS OnabotulinumtoxinA 200U consistently reduced UI episodes/day; reductions from baseline ranged from -3.2 to -4.1 across six treatments. Volume/void consistently increased, nearly doubling after treatment. I-QOL improvements were consistently greater than twice the minimally important difference (+11 points). Overall median duration of effect was 9.0 months (200U). Results were similar for onabotulinumtoxinA 300U. Most common AEs were urinary tract infections and urinary retention. De novo CIC rates were 29.5, 3.4, and 6.0% (200U), and 43.0, 15.0, and 4.8% (300U) for treatments 1-3, respectively; de novo CIC rates were 0% for treatments 4-6. CONCLUSIONS OnabotulinumtoxinA treatments consistently improve UI, volume/void, and QOL in patients with UI due to NDO in this 4-year study, with no new safety signals. Neurourol. Urodynam. 36:368-375, 2017. © 2015 The Authors. Neurourology and Urodynamics Published by Wiley Periodicals, Inc.
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Affiliation(s)
- Michael Kennelly
- Department of Urology, Carolinas Rehabilitation, Charlotte, North Carolina
| | - Roger Dmochowski
- Department of Urological Surgery, Vanderbilt University, Nashville, Tennessee
| | | | - Karen Ethans
- University of Manitoba, Winnipeg, Manitoba, Canada
| | - Giulio Del Popolo
- Department of Neurourology, Careggi University Hospital, Florence, Italy
| | - Courtenay Moore
- Glickman Urological Institute, Cleveland Clinic, Cleveland, Ohio
| | | | | | - Yan Zheng
- Allergan, Inc., Bridgewater, New Jersey
| | - Gilles Karsenty
- Department of Urology, Aix-Marseille Université, Marseille, France
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Tulsky DS, Kisala PA. The Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system: Development, psychometrics, and item bank calibration. J Spinal Cord Med 2015; 38:251-6. [PMID: 26010961 PMCID: PMC4445017 DOI: 10.1179/2045772315y.0000000035] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Department of Physical Therapy, University of Delaware, College of Health Sciences, 540 S. College Ave., Newark, DE 19713.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
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Tulsky DS, Kisala PA, Tate DG, Spungen AM, Kirshblum SC. Development and psychometric characteristics of the SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks and short forms and the SCI-QOL Bladder Complications scale. J Spinal Cord Med 2015; 38:288-302. [PMID: 26010964 PMCID: PMC4445020 DOI: 10.1179/2045772315y.0000000030] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the development and psychometric properties of the Spinal Cord Injury--Quality of Life (SCI-QOL) Bladder Management Difficulties and Bowel Management Difficulties item banks and Bladder Complications scale. DESIGN Using a mixed-methods design, a pool of items assessing bladder and bowel-related concerns were developed using focus groups with individuals with spinal cord injury (SCI) and SCI clinicians, cognitive interviews, and item response theory (IRT) analytic approaches, including tests of model fit and differential item functioning. SETTING Thirty-eight bladder items and 52 bowel items were tested at the University of Michigan, Kessler Foundation Research Center, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital, and the James J. Peters VA Medical Center, Bronx, NY. PARTICIPANTS Seven hundred fifty-seven adults with traumatic SCI. RESULTS The final item banks demonstrated unidimensionality (Bladder Management Difficulties CFI=0.965; RMSEA=0.093; Bowel Management Difficulties CFI=0.955; RMSEA=0.078) and acceptable fit to a graded response IRT model. The final calibrated Bladder Management Difficulties bank includes 15 items, and the final Bowel Management Difficulties item bank consists of 26 items. Additionally, 5 items related to urinary tract infections (UTI) did not fit with the larger Bladder Management Difficulties item bank but performed relatively well independently (CFI=0.992, RMSEA=0.050) and were thus retained as a separate scale. CONCLUSION The SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks are psychometrically robust and are available as computer adaptive tests or short forms. The SCI-QOL Bladder Complications scale is a brief, fixed-length outcomes instrument for individuals with a UTI.
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Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Denise G. Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
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