Nurses' intervention goal categories for persons with spinal cord injury based on the International Classification of Functioning, Disability and Health: an international Delphi survey

Development of a swallowing risk screening tool and best practice recommendations for the management of oropharyngeal dysphagia following acute cervical spinal cord injury: an international multi-professional Delphi consensus

PURPOSE

International multi-professional expert consensus was sought to develop best practice recommendations for clinical management of patients following cervical spinal cord injury with oropharyngeal dysphagia and associated complications. Additionally, risk factors for dysphagia were identified to support the development of a screening tool.

MATERIALS AND METHODS

A two-round Delphi study was undertaken with a 27-member panel of expert professionals in cervical spinal cord injury and complex dysphagia. They rated 85 statements across seven topic areas in round one, using a five-point Likert scale with a consensus set at 70%. Statements not achieving consensus were revised for the second round. Comparative group and individual feedback were provided at the end of each round.

RESULTS

Consensus was achieved for 50 (59%) statements in round one and a further 12 (48%) statements in round two. Recommendations for best practice were agreed for management of swallowing, respiratory function, communication, nutrition and oral care. Twelve risk factors for dysphagia were identified for components of a screening tool.

CONCLUSIONS

Best practice recommendations support wider clinical management to prevent complications and direct specialist care. Screening for risk factors allows early dysphagia identification with the potential to improve clinical outcomes. Further evaluation of the impact of these recommendations is needed.Implications for RehabilitationDysphagia is an added complication following cervical spinal cord injury (cSCI) affecting morbidity, mortality and quality of life.Early identification of dysphagia risk allows focused interventions that reduce associated nutritional and respiratory impairments.Best practice recommendations based on expert consensus provide a baseline of appropriate interventions, in the absence of empirical evidence.A multi-professional approach to rehabilitation encourages a consistent and coordinated approach to care across acute and rehabilitation settings.

Altered heart rate variability and pulse-wave velocity after spinal cord injury

BACKGROUND

Heart rate variability (HRV) and pulse-wave velocity (PWV), indicators of cardiac function, are altered in patients with spinal cord injury (SCI), suggesting that autonomic cardiac function and arterial stiffness may underlie the high risk of cardiovascular complications in these patients. No study has simultaneously investigated HRV and PWV in the same patients.

AIM

To evaluate cardiovascular complications in SCI patients by comparing HRV and PWV between patients with and without SCI.

METHODS

In this cross-sectional pilot study, patients with (n = 60) and without SCI (n = 60) were recruited from December 7, 2019 to January 21, 2020. Each participant received a five-minute assessment of HRV and the cardiovascular system using the Medicore HRV Analyzer SA-3000P. Differences in HRV and PWV parameters between participants with and without SCI were statistically examined.

RESULTS

We observed a significant difference between participants with and without SCI with respect to the standard deviation of all normal-to-normal intervals, square root of the mean sum of squared successive risk ratio interval differences, physical stress index, total power, very-low frequency, low frequency, high frequency, and arterial elasticity.

CONCLUSION

Patients with SCI have weaker sympathetic and parasympathetic activity as well as lower arterial elasticity compared to those without, suggesting that SCI may increase cardiac function loading.

Incidence and risk factors of urinary tract infections in hospitalised patients with spinal cord injury

AIMS AND OBJECTIVES

To investigate the incidence of urinary tract infection and analyse its risk factors among hospitalised patients with spinal cord injury.

BACKGROUND

While the incidence of urinary tract infection varies widely according to the healthcare setting and patients' clinical characteristics, formal reports are limited in quantity. There has been no consensus regarding the risk factors for urinary tract infection.

DESIGN

A retrospective descriptive study.

METHODS

Electronic medical records of 964 subjects between 2010-2017 were reviewed. Urinary tract infection status was examined to identify newly occurred cases. Data included demographic and clinical characteristics, hydration status and length of hospitalisation. The reporting of the study followed the EQUATOR Network's STROBE checklist.

RESULTS

Of the sample, 31.7% had urinary tract infection (95% confidence interval: 1.288 to 1.347, p < .001). Sex, completeness of injury, type of bladder emptying, detrusor function and urethral pressure were significant factors affecting urinary tract infection. Patients who were male and those with injury classifications A, B and C had higher risk of urinary tract infection. Patients with urinary or suprapubic indwelling catheters, as well as those with areflexic detrusor combined with normotonic urethral pressure or overactive detrusor combined with normotonic urethral pressure, showed higher risk. Length of hospitalisation in patients with urinary tract infection was greater than that in uninfected patients, which implies the importance of prevention of urinary tract infection.

CONCLUSIONS

Nurses should carefully assess risk factors to prevent urinary tract infection in patients with spinal cord injury in the acute and sub-acute stages of the disease trajectory and provide individualised nursing care.

RELEVANCE TO CLINICAL PRACTICE

This study contributes evidence for up-to-date clinical nursing practice for the comprehensive management of urinary tract infection. This can lead to improvements in nursing care quality and patient outcomes, including length of hospitalisation.

Spontaneous Reduction of Fractured Thoracolumbar Spine With Complete Dislocation: Case Report With Literature Review

Fractures and dislocations with complete lateral displacement of the spine at the lumbar and thoracic levels are some of the most severe types of thoracolumbar trauma. They are usually caused by high-energy trauma and accompanied by extreme, life-threatening injuries and neurological deficits that vary in severity, which may delay operative intervention. It is often difficult to reduce such a complex fracture-dislocation because of the force that the muscles exert on the bone and the injured part of the spinal cord. No absolute guidelines for reduction, fixation, decompression, and fusion of this type of injury have been established. We report a rare case of spontaneous reduction of the fractured thoracolumbar spine with complete dislocation and discuss the management of such severe injuries through review of the existing literature.

How Nurses are Using the International Classifi cation of Functioning, Disability and Health: An Integrative Review

Aim: The purpose of this study is to report the results of an integrative review of use of the International Classification of Functioning, Disability and Health (ICF) by nurses. This review is justified by the need for further investigation into use of the ICF in nursing, by nurses, so as to contribute to dialogue for the development of global, interdisciplinary and classification system comprehension. Methods: This integrative review included studies from 2001 to May 2015 in peer-reviewed journals. Two reviewers independently screened titles and abstracts for inclusion and completed data extraction. The papers were sourced from a number of electronic databases: MEDLINE/NML/PubMed, Web of Science, LILACS, CINAHL and SCIELO. Results: Twenty-six articles were included. Three themes on use of the ICF were identified: clinical nursing practice; teaching nursing students and nurses; and nursing research. Conclusion: This review helps nurses to visualise how and in what care environments the ICF is being used. It demonstrates the ICF has been used specifically in the rehabilitation nursing field, but offers some evidence of its use in occupational health as well.