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González-Viejo MA, Avellanet M, Boada-Pladellorens A, Montesinos-Magraner L, Jaúregui-Abrisqueta ML, Bárbara-Bataller E, Méndez-Ferrer B, Sánchez-Raya J, Cívicos N, Méndez-Suarez JL, Barrera-Chacón JM. International Spinal Cord Injury Community Survey: Socioeconomic and Healthcare Satisfaction in Spain. Global Spine J 2023:21925682231183972. [PMID: 37326207 DOI: 10.1177/21925682231183972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/17/2023] Open
Abstract
STUDY DESIGN Survey study. OBJECTIVES People living with spinal cord injury (SCI) are major healthcare and rehabilitation services consumers and have unmet healthcare needs. This study aimed to describe the socioeconomic characteristics of people living with SCI in Spain and to determine the level of use and satisfaction with the public healthcare system. METHODS We conducted a survey (the Spanish version of the International Spinal Cord Injury Community Survey) consisting of 134 questions. We analyzed the age, sex, neurological classification of the injury on the American Spinal Injury Association Impairment Scale, time of injury, socio-occupational and socioeconomic status, and level of use and satisfaction with the public health system. RESULTS 472 people responded to the survey [68.9% male; mean age 51.2 years (standard deviation: 13.9 years); 61.7% with paraplegia and 38.3% with tetraplegia]. 89.2% of those surveyed were unemployed and 77.1% received a disability pension. The number of medical visits was 2.3/year, and 19.8% of the patients required at least 1 hospital admission during the previous year. 94.7% of the people with SCI considered the health care received as good or very good. CONCLUSIONS Respondents with SCI in Spain considered they had good access to primary and specialized care and were satisfied with the healthcare system. Notably, we observed a high average of annual visits to medical professionals but a low rate of hospitalizations. Technical aids and state services related to disability should be the most important elements to be improved.
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Affiliation(s)
| | - Merce Avellanet
- Rehabilitation Department, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | - Anna Boada-Pladellorens
- Rehabilitation Department, Hospital Nostra Senyora de Meritxell, Escaldes-Engordany, Andorra
| | | | | | - Enrique Bárbara-Bataller
- SCI Unit, Hospital Universitario Insular Materno-infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
| | | | | | - Nora Cívicos
- SCI Unit, Hospital Universitario Cruces, Barakaldo, Spain
| | - José Luis Méndez-Suarez
- SCI Unit, Hospital Universitario Insular Materno-infantil de Gran Canaria, Las Palmas de Gran Canaria, Spain
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Khosravi S, Khayyamfar A, Shemshadi M, Koltapeh MP, Sadeghi-Naini M, Ghodsi Z, Shokraneh F, Bardsiri MS, Derakhshan P, Komlakh K, Vaccaro AR, Fehlings MG, Guest JD, Noonan V, Rahimi-Movaghar V. Indicators of Quality of Care in Individuals With Traumatic Spinal Cord Injury: A Scoping Review. Global Spine J 2022; 12:166-181. [PMID: 33487062 PMCID: PMC8965305 DOI: 10.1177/2192568220981988] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
STUDY DESIGN Scoping review. OBJECTIVES To identify a practical and reproducible approach to organize Quality of Care Indicators (QoCI) in individuals with traumatic spinal cord injury (TSCI). METHODS A comprehensive literature review was conducted in the Cochrane Central Register of Controlled Trials (CENTRAL) (Date: May 2018), MEDLINE (1946 to May 2018), and EMBASE (1974 to May 2018). Two independent reviewers screened 6092 records and included 262 full texts, among which 60 studies were included for qualitative analysis. We included studies, with no language restriction, containing at least 1 quality of care indicator for individuals with traumatic spinal cord injury. Each potential indicator was evaluated in an online, focused group discussion to define its categorization (healthcare system structure, medical process, and individuals with Traumatic Spinal Cord Injury related outcomes), definition, survey options, and scale. RESULTS A total of 87 indicators were identified from 60 studies screened using our eligibility criteria. We defined each indicator. Out of 87 indicators, 37 appraised the healthcare system structure, 30 evaluated medical processes, and 20 included individuals with TSCI related outcomes. The healthcare system structure included the impact of the cost of hospitalization and rehabilitation, as well as staff and patient perception of treatment. The medical processes included targeting physical activities for improvement of health-related outcomes and complications. Changes in motor score, functional independence, and readmission rates were reported as individuals with TSCI-related outcomes indicators. CONCLUSION Indicators of quality of care in the management of individuals with TSCI are important for health policy strategists to standardize healthcare assessment, for clinicians to improve care, and for data collection efforts including registries.
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Affiliation(s)
- Sepehr Khosravi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran,Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Amirmahdi Khayyamfar
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran,Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Milad Shemshadi
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran,Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Pourghahramani Koltapeh
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran,Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Sadeghi-Naini
- Neurosurgery Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Ghodsi
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Farhad Shokraneh
- King’s Technology Evaluation Centre, London Institute of Healthcare Engineering, School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK,The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Pegah Derakhshan
- Student Research Committee, School of Medicine, Iran University of Medical Sciences, Tehran, Iran,Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Khalil Komlakh
- Neurosurgery Department, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Alex R. Vaccaro
- The Rothman Institute at Thomas Jefferson University, Philadelphia, PA, USA
| | - Michael G. Fehlings
- Department of Surgery, University of Toronto and Division of Neurosurgery, Krembil Neuroscience Centre, University Health Network, Toronto, Ontario, Canada
| | - James D. Guest
- Department of Neurological Surgery, University of Miami, Miami, FL, USA
| | - Vanessa Noonan
- Rick Hansen Institute, University of British Columbia, Vancouver, British Columbia, Canada
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran,Universal Scientific Education and Research Network (USERN), Tehran, Iran,Vafa Rahimi-Movaghar, Sina Trauma and Surgery Research Center, Tehran University of Medical Science, Tehran, Iran.
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Tschoepe R, Benfield A, Posey R, Mercer V. A Systematic Review of the Effects of Community Transition Programs on Quality of Life and Hospital Readmissions for Adults With Traumatic Spinal Cord Injury. Arch Phys Med Rehabil 2021; 103:1013-1022.e12. [PMID: 34464608 DOI: 10.1016/j.apmr.2021.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 08/03/2021] [Accepted: 08/09/2021] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the effects of community transition programs for adults with traumatic spinal cord injury (tSCI) on hospital readmissions and quality of life (QOL). DATA SOURCES Seven databases (PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Google Scholar, the Joanna Briggs Institute database, OTseeker, and PEDro) and reference lists of relevant articles were searched from inception through March 2020. STUDY SELECTION Original research studies were included that (1) evaluated interventions designed to support individuals aged 18-65 years with newly acquired tSCI in navigating the transition from subacute care to the community and (2) reported data for QOL or hospital readmission outcomes. Searches identified 4694 studies, and 26 of these met the selection criteria. DATA EXTRACTION Two reviewers independently screened and assessed all studies, extracting information about study type, methodological strengths and weaknesses, participant and intervention characteristics, comparator, and significant results. Any discrepancies were resolved by a third reviewer. DATA SYNTHESIS Studies were grouped according to primary intervention: peer mentoring (n=8), telehealth (n=5), education (n=5), independent living (n=3), occupational therapy (n=1), counseling (n=1), and patient navigation (n=4). Reviewers used the Let Evidence Guide Every Decision appraisal tool rubric to grade the body of evidence for each intervention type. Moderate level evidence supports the positive effects of peer mentoring, and low level evidence indicates positive effects of telehealth, education, independent living, and occupational therapy interventions. Peer mentoring, telehealth, and patient navigation were the only intervention types that included hospital readmission outcomes. Of these, peer mentoring had the most evidence, with 3 of the 4 studies that included hospital readmission outcomes demonstrating statistically significant improvements. CONCLUSIONS In general, there is a paucity of high-quality evidence with sufficiently similar characteristics to demonstrate and compare benefits from program participation. When high quality studies have been conducted, they have obtained mixed results. Of the different intervention types, peer mentorship has the strongest supporting evidence. Further research is needed to identify specific intervention components that are most effective in improving QOL and reducing hospital readmission for specific subgroups of individuals recovering from tSCI.
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Affiliation(s)
- Raheleh Tschoepe
- From the Division of Occupational Science and Occupational Therapy, Department of Allied Health Sciences, University of North Carolina-Chapel Hill, Chapel Hill, NC.
| | - Anna Benfield
- From the Division of Occupational Science and Occupational Therapy, Department of Allied Health Sciences, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Rachael Posey
- Health Sciences Library, University of North Carolina-Chapel Hill, Chapel Hill, NC
| | - Vicki Mercer
- From the Division of Occupational Science and Occupational Therapy, Department of Allied Health Sciences, University of North Carolina-Chapel Hill, Chapel Hill, NC
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SHIN Y, LEE JW, HONG SM, LEE JH. Exercise improves glucose and insulin response to oral glucose tolerance test in people with spinal cord injury. GAZZETTA MEDICA ITALIANA ARCHIVIO PER LE SCIENZE MEDICHE 2021. [DOI: 10.23736/s0393-3660.19.04137-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Hubli M, Zemp R, Albisser U, Camenzind F, Leonova O, Curt A, Taylor WR. Feedback improves compliance of pressure relief activities in wheelchair users with spinal cord injury. Spinal Cord 2021; 59:175-184. [PMID: 32694751 PMCID: PMC7870807 DOI: 10.1038/s41393-020-0522-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 06/26/2020] [Accepted: 07/07/2020] [Indexed: 01/26/2023]
Abstract
STUDY DESIGN Prospective cross-sectional pre-post pilot study. OBJECTIVES This pilot study aimed to evaluate the potential for improving pressure relief behaviour in wheelchair users with spinal cord injury (SCI) using a novel feedback system based on textile pressure sensor technology. SETTING In- and out-patient clinic of the Spinal Cord Injury Center, Balgrist University Hospital, Zurich, Switzerland. METHODS Nine wheelchair users with SCI (3 females, 50 ± 12 years of age, 2 tetra- and 7 paraplegics) were equipped with a feedback system (sensomativewheelchair) for three continuous weeks. The system consists of a textile pressure mat and a mobile smartphone application that reminds participants to perform missing pressure reliefs during regular and unobserved wheelchair usage in a customized manner. Pressure reliefs were detected using a subject-specific random forest classifier. Improvements of relief quality, duration and frequency were analysed by comparing week 1 (baseline) with no feedback, i.e., only pressure data recorded, against week 2 (with feedback). Carry-over effects of improved relief behaviour were studied in week 3 (no feedback, pressure data only recorded). RESULTS All participants increased their relief frequency and performed in median 82% (IQRs: 55%-99%) of the required reliefs while using the feedback system, whereas the median relief frequency was only 11% (IQRs: 10%-31%) during the baseline condition. Every participant who did not perform reliefs of sufficient duration (based on the recommendations of the therapist) during week 1 showed a significant improvement while using the feedback system. CONCLUSION Subject-specific feedback using the novel feedback system may have the potential for improving the regularity of an individual's relief activities, and may ultimately be an instrument for reducing the risk of developing pressure ulcers.
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Affiliation(s)
- Michèle Hubli
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland.
| | - Roland Zemp
- Department of Health Sciences and Technology, Institute for Biomechanics, Swiss Federal Institute of Technology in Zurich (ETHZ), Zurich, Switzerland
| | - Urs Albisser
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - Franziska Camenzind
- Department of Health Sciences and Technology, Institute for Biomechanics, Swiss Federal Institute of Technology in Zurich (ETHZ), Zurich, Switzerland
| | - Olena Leonova
- Department of Health Sciences and Technology, Institute for Biomechanics, Swiss Federal Institute of Technology in Zurich (ETHZ), Zurich, Switzerland
| | - Armin Curt
- Spinal Cord Injury Center, Balgrist University Hospital, University of Zurich, Zurich, Switzerland
| | - William R Taylor
- Department of Health Sciences and Technology, Institute for Biomechanics, Swiss Federal Institute of Technology in Zurich (ETHZ), Zurich, Switzerland
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Ho C, Atchison K, Noonan VK, McKenzie N, Cadel L, Ganshorn H, Rivera JMB, Yousefi C, Guilcher SJT. Models of Care Delivery from Rehabilitation to Community for Spinal Cord Injury: A Scoping Review. J Neurotrauma 2021; 38:677-697. [PMID: 33191849 DOI: 10.1089/neu.2020.7396] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Spinal cord injury (SCI) is a chronic condition that results in high healthcare utilization and lifetime cost across the care continuum. In the absence of a standardized model of care delivery for SCI in western countries such as Canada, a scoping review of the literature was performed to identify and summarize existing international SCI models of care delivery. Four databases were searched using key words and subject headings for concepts such as: "spinal cord injury," "delivery of healthcare," "model of care," "patient care planning," and "care pathway." Title, abstract, and full text review were competed by two independent reviewers. A combined total of 46 peer-reviewed and gray literature articles were included. No single SCI model of care has been adopted across different countries internationally. However, optimal attributes of models of care were identified, including the importance of having multidisciplinary SCI specialty care providers along the continuum, provision of rural SCI services and outreach, integration of primary care, peer mentoring, and using a hub and spokes model of care. These findings inform the future development of an SCI model of care, which ideally would serve all geographical locations and span the continuum of care, improving the health status and quality of life of persons with SCI.
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Affiliation(s)
- Chester Ho
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kayla Atchison
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada
| | - Nicole McKenzie
- Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Heather Ganshorn
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Joanna Marie B Rivera
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada
| | - Charlene Yousefi
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Carlson M, Vigen CL, Rubayi S, Blanche EI, Blanchard J, Atkins M, Bates-Jensen B, Garber SL, Pyatak EA, Diaz J, Florindez LI, Hay JW, Mallinson T, Unger JB, Azen SP, Scott M, Cogan A, Clark F. Lifestyle intervention for adults with spinal cord injury: Results of the USC-RLANRC Pressure Ulcer Prevention Study. J Spinal Cord Med 2019; 42:2-19. [PMID: 28414254 PMCID: PMC6340272 DOI: 10.1080/10790268.2017.1313931] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CONTEXT/OBJECTIVE Medically serious pressure injuries (MSPrIs), a common complication of spinal cord injury (SCI), have devastating consequences on health and well-being and are extremely expensive to treat. We aimed to test the efficacy of a lifestyle-based intervention designed to reduce incidence of MSPrIs in adults with SCI. DESIGN A randomized controlled trial (RCT), and a separate study wing involving a nonrandomized standard care control group. SETTING Rancho Los Amigos National Rehabilitation Center, a large facility serving ethnically diverse, low income residents of Los Angeles County. PARTICIPANTS Adults with SCI, with history of one or more MSPrIs over the past 5 years: N=166 for RCT component, N=66 in nonrandomized control group. INTERVENTIONS The Pressure Ulcer Prevention Program, a 12-month lifestyle-based treatment administered by healthcare professionals, largely via in-home visits and phone contacts. OUTCOME MEASURES Blinded assessments of annualized MSPrI incidence rates at 12 and 24 months, based on: skin checks, quarterly phone interviews with participants, and review of medical charts and billing records. Secondary outcomes included number of surgeries and various quality-of-life measures. RESULTS Annualized MSPrI rates did not differ significantly between study groups. At 12 months, rates were .56 for intervention recipients, .48 for randomized controls, and .65 for nonrandomized controls. At follow-up, rates were .44 and .39 respectively for randomized intervention and control participants. CONCLUSIONS Evidence for intervention efficacy was inconclusive. The intractable nature of MSPrI threat in high-risk SCI populations, and lack of statistical power, may have contributed to this inability to detect an effect. TRIAL REGISTRATION ClinicalTrials.gov NCT01999816.
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Affiliation(s)
- Mike Carlson
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Cheryl L.P. Vigen
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA,Correspondence to: Cheryl L.P. Vigen, Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St. CHP 133, Los Angeles, CA 90089–9003, USA.
| | - Salah Rubayi
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Erna Imperatore Blanche
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Jeanine Blanchard
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Michal Atkins
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Barbara Bates-Jensen
- School of Nursing, University of California Los Angeles, Los Angeles, California, USA
| | - Susan L Garber
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Elizabeth A Pyatak
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Jesus Diaz
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Lucia I Florindez
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Joel W Hay
- Leonard Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Trudy Mallinson
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Jennifer B Unger
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, California, USA
| | - Stanley Paul Azen
- Division of Biostatistics, Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael Scott
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Alison Cogan
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Florence Clark
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
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Joyce P, Moore ZEH, Christie J. Organisation of health services for preventing and treating pressure ulcers. Cochrane Database Syst Rev 2018; 12:CD012132. [PMID: 30536917 PMCID: PMC6516850 DOI: 10.1002/14651858.cd012132.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Pressure ulcers, which are a localised injury to the skin, or underlying tissue, or both, occur when people are unable to reposition themselves to relieve pressure on bony prominences. Pressure ulcers are often difficult to heal, painful, expensive to manage and have a negative impact on quality of life. While individual patient safety and quality care stem largely from direct healthcare practitioner-patient interactions, each practitioner-patient wound-care contact may be constrained or enhanced by healthcare organisation of services. Research is needed to demonstrate clearly the effect of different provider-orientated approaches to pressure ulcer prevention and treatment. OBJECTIVES To assess the effects of different provider-orientated interventions targeted at the organisation of health services, on the prevention and treatment of pressure ulcers. SEARCH METHODS In April 2018 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched three clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials (RCTs), cluster-RCTs, non-RCTs, controlled before-and-after studies and interrupted time series, which enrolled people at risk of, or people with existing pressure ulcers, were eligible for inclusion in the review. DATA COLLECTION AND ANALYSIS Two review authors independently performed study selection, risk of bias assessment, data extraction and GRADE assessment of the certainty of evidence. MAIN RESULTS The search yielded a total of 3172 citations and, following screening and application of the inclusion and exclusion criteria, we deemed four studies eligible for inclusion. These studies reported the primary outcome of pressure ulcer incidence or pressure ulcer healing, or both.One controlled before-and-after study explored the impact of transmural care (a care model that provided activities to support patients and their family/partners and activities to promote continuity of care), among 62 participants with spinal cord injury. It is unclear whether transmural care leads to a difference in pressure ulcer incidence compared with usual care (risk ratio (RR) 0.93, 95% confidence interval (CI) 0.53 to 1.64; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision).One RCT explored the impact of hospital-in-the-home care, among 100 older adults. It is unclear whether hospital-in-the-home care leads to a difference in pressure ulcer incidence risk compared with hospital admission (RR 0.32, 95% CI 0.03 to 2.98; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision).A third study (cluster-randomised stepped-wedge trial), explored the impact of being cared for by enhanced multidisciplinary teams (EMDT), among 161 long-term-care residents. The analyses of the primary outcome used measurements of 201 pressure ulcers from 119 residents. It is unclear if EMDT reduces the pressure ulcer incidence rate compared with usual care (hazard ratio (HR) 1.12, 95% CI 0.74 to 1.68; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear whether there is a difference in the number of wounds healed (RR 1.69, 95% CI 1.00 to 2.87; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear whether there is a difference in the reduction in surface area, with and without EMDT, (healing rate 1.006; 95% CI 0.99 to 1.03; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear if EMDT leads to a difference in time to complete healing (HR 1.48, 95% CI 0.79 to 2.78, very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision).The final study (quasi-experimental cluster trial), explored the impact of multidisciplinary wound care among 176 nursing home residents. It is unclear whether there is a difference in the number of pressure ulcers healed between multidisciplinary care, or usual care (RR 1.18, 95% CI 0.98 to 1.42; very low-certainty evidence, downgraded twice for very serious study limitations and twice for very serious imprecision). It is unclear if this type of care leads to a difference in time to complete healing compared with usual care (HR 1.73, 95% CI 1.20 to 2.50; very low-certainty evidence; downgraded twice for very serious study limitations and twice for very serious imprecision).In all studies the certainty of the evidence is very low due to high risk of bias and imprecision. We downgraded the evidence due to study limitations, which included selection and attrition bias, and sample size. Secondary outcomes, such as adverse events were not reported in all studies. Where they were reported it was unclear if there was a difference as the certainty of evidence was very low. AUTHORS' CONCLUSIONS Evidence for the impact of organisation of health services for preventing and treating pressure ulcers remains unclear. Overall, GRADE assessments of the evidence resulted in judgements of very low-certainty evidence. The studies were at high risk of bias, and outcome measures were imprecise due to wide confidence intervals and small sample sizes, meaning that additional research is required to confirm these results. The secondary outcomes reported varied across the studies and some were not reported. We judged the evidence from those that were reported (including adverse events), to be of very low certainty.
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Affiliation(s)
- Pauline Joyce
- Royal College of Surgeons in IrelandSchool of Medicine121 St. Stephens GreenDublinIreland2
| | - Zena EH Moore
- Royal College of Surgeons in IrelandSchool of Nursing & Midwifery123 St. Stephen's GreenDublinIrelandD2
| | - Janice Christie
- University of Manchester, Manchester Academic Health Science CentreDivision of Nursing, Midwifery & Social Work, School of Health Sciences, Faculty of Biology, Medicine & HealthOxford RoadManchesterLancashireUKM13 9PL
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Hillebregt CF, Scholten EWM, Ketelaar M, Post MWM, Visser-Meily JMA. Effects of family group conferences among high-risk patients of chronic disability and their significant others: study protocol for a multicentre controlled trial. BMJ Open 2018; 8:e018883. [PMID: 29523560 PMCID: PMC5855389 DOI: 10.1136/bmjopen-2017-018883] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 12/21/2017] [Accepted: 01/15/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Many patients and family members experience a large gap between the protected environment during inpatient medical rehabilitation and life in the community after discharge. They feel insufficiently prepared to cope with the consequences of their disability in daily life. This study protocol describes the design measuring the effectiveness and implementation of family group conferences on the empowerment of patients with a high risk of chronic disability and their significant others. METHODS AND ANALYSIS A multicentre controlled trial will be carried out in 12 rehabilitation centres in the Netherlands. A total of 328 clinically admitted patients will participate (≥18 years, diagnosed with acquired brain injury, spinal cord injury or leg amputation), and their significant others will be included. During three family group conferences, supported by the social worker, the patient, significant other and their social network will be stimulated in collaboration, to set up participation goals, determine the needed help and make a concrete action plan. Self-reported questionnaires will be collected at baseline, clinical discharge, and 3 months and 6 months following clinical discharge. Empowerment as the primary outcome is operationalised as self-efficacy and participation. Secondary outcome measures are psychological (eg, coping, neuroticism) and environmental (eg, family functioning, social support) factors. This is the first controlled trial evaluating the effectiveness of family group conferences in rehabilitation medicine among adult patients and their significant others, providing us with knowledge in improving rehabilitation care. ETHICS AND DISSEMINATION This study has been approved by the Medical Ethics Committee of the University Medical Center Utrecht (number 15-617/C). The results will be published in peer-reviewed journals and presented in local, national and international conferences. TRIAL REGISTRATION NUMBER NTR5742; Pre-results.
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Affiliation(s)
- Chantal F Hillebregt
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht and De Hoogstraat Rehabilitation, the Netherlands
| | - Eline W M Scholten
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht and De Hoogstraat Rehabilitation, the Netherlands
| | - Marjolijn Ketelaar
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht and De Hoogstraat Rehabilitation, the Netherlands
| | - Marcel W M Post
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht and De Hoogstraat Rehabilitation, the Netherlands
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Johanna M A Visser-Meily
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, University Utrecht and De Hoogstraat Rehabilitation, the Netherlands
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10
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Shabany M, Nasrabadi AN, Rahimi-Movaghar V, Mansournia MA, Mohammadi N, Pruitt SD. Reliability and validity of the Persian version of the spinal cord injury lifestyle scale and the health behavior questionnaire in persons with spinal cord injury. Spinal Cord 2018; 56:509-515. [PMID: 29335476 DOI: 10.1038/s41393-017-0056-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 11/29/2017] [Accepted: 12/16/2017] [Indexed: 01/02/2023]
Abstract
STUDY DESIGN Cross-sectional psychometric study. OBJECTIVE To evaluate the reliability and validity of a spinal cord injury lifestyle scale (SCILS) and Health Behavior Questionnaire (HBQ) in the Persian language for persons with spinal cord injury (SCI). SETTING Participants were selected among those referred to health centers and the Brain and Spinal Cord Injury Research Center. METHOD In accordance with standard procedure for translation, two questionnaires, the SCILS and HBQ, were translated using a forward and backward translation approach by professional translators. Face validity of the questionnaires was assessed by ten persons with SCI and content validity was agreed upon by 12 professors from health care teaching universities. To test the final versions of both questionnaires, 97 persons with SCI were included using a consecutive sampling method. Other questionnaires were used to assess concurrent validity (secondary impairment checklist, as well as SCILS and HBQ) and convergent validity (impact of event scale revised, brief symptom inventory, beck depression inventory, and functional independence measure). RESULTS Internal consistency of SCILS and HBQ, assessed by Cronbach's alpha, was 0.75 for SCILS and 0.85 for HBQ. Test-retest reliability intraclass correlations were 0.86 and 0.92 for SCILS and HBQ, respectively. The number of current secondary impairments had a significant and negative correlation with SCILS (r = -0.22, P < 0.001), but it was not correlated with HBQ. SCILS had a significant and strong correlation with HBQ (r = 0.65, P < 0.001). CONCLUSION SCILS and HBQ can be used for measuring the health behavior of persons with SCI in Iran.
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Affiliation(s)
- Maryam Shabany
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Nikbakht Nasrabadi
- Brain and Spinal Cord Injury Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran.,Dept. of Medical Surgical Nursing & Deputy Dean for International Affairs, Nursing and Midwifery School, Tehran University of Medical Sciences, Tehran, Iran
| | - Vafa Rahimi-Movaghar
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - Nooredin Mohammadi
- Dept. of Critical Care Nursing, Nursing and Midwifery School, Iran University of Medical Sciences, Tehran, Iran
| | - Sheri D Pruitt
- Behavioral Science Integration Kaiser Permanente, The Permanente Medical Group, North Valley, Sacramento, CA, USA
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Cogan AM, Blanchard J, Garber SL, Vigen CL, Carlson M, Clark FA. Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury. Clin Rehabil 2016; 31:871-880. [PMID: 27440806 DOI: 10.1177/0269215516660855] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the efficacy of behavioral or educational interventions in preventing pressure ulcers in community-dwelling adults with spinal cord injury (SCI). DATA SOURCES Cochrane, Clinical Trials, PubMed, and Web of Science were searched in June 2016. The search combined related terms for pressure ulcers, spinal cord injury, and behavioral intervention. Each database was searched from its inception with no restrictions on year of publication. REVIEW METHODS Inclusion criteria required that articles were (a) published in a peer-reviewed journal in English, (b) evaluated a behavioral or educational intervention for pressure ulcer prevention, (c) included community-dwelling adult participants aged 18 years and older with SCI, (d) measured pressure ulcer occurrence, recurrence, or skin breakdown as an outcome, and (e) had a minimum of 10 participants. All study designs were considered. Two reviewers independently screened titles and abstracts. Extracted information included study design, sample size, description of the intervention and control condition, pressure ulcer outcome measures, and corresponding results. RESULTS The search strategy yielded 444 unique articles of which five met inclusion criteria. Three were randomized trials and two were quasi-experimental designs. A total of 513 participants were represented. The method of pressure ulcer or skin breakdown measurement varied widely among studies. Results on pressure ulcer outcomes were null in all studies. Considerable methodological problems with recruitment, intervention fidelity, and participant adherence were reported. CONCLUSIONS At present, there is no positive evidence to support the efficacy of behavioral or educational interventions in preventing pressure ulcer occurrence in adults with SCI.
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Affiliation(s)
- Alison M Cogan
- 1 Mrs TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA
| | - Jeanine Blanchard
- 1 Mrs TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA
| | - Susan L Garber
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, USA
| | - Cheryl Lp Vigen
- 1 Mrs TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA
| | - Mike Carlson
- 1 Mrs TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA
| | - Florence A Clark
- 1 Mrs TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA
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Kornhaber R, Wiechula R, McLean L. The effectiveness of collaborative models of care that facilitate rehabilitation from a traumatic injury: a systematic review. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513080-00016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Noonan VK, Wolfe DL, Thorogood NP, Park SE, Hsieh JT, Eng JJ. Knowledge translation and implementation in spinal cord injury: a systematic review. Spinal Cord 2014; 52:578-87. [PMID: 24796445 DOI: 10.1038/sc.2014.62] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 02/12/2014] [Accepted: 03/25/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To conduct a systematic review examining the effectiveness of knowledge translation (KT) interventions in changing clinical practice and patient outcomes. METHODS MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO were searched for studies published from January 1980 to July 2012 that reported and evaluated an implemented KT intervention in spinal cord injury (SCI) care. We reviewed and summarized results from studies that documented the implemented KT intervention, its impact on changing clinician behavior and patient outcomes as well as the facilitators and barriers encountered during the implementation. RESULTS A total of 13 articles featuring 10 studies were selected and abstracted from 4650 identified articles. KT interventions included developing and implementing patient care protocols, providing clinician education and incorporating outcome measures into clinical practice. The methods (or drivers) to facilitate the implementation included organizing training sessions for clinical staff, introducing computerized reminders and involving organizational leaders. The methodological quality of studies was mostly poor. Only 3 out of 10 studies evaluated the success of the implementation using statistical analyses, and all 3 reported significant behavior change. Out of the 10 studies, 6 evaluated the effect of the implementation on patient outcomes using statistical analyses, with 4 reporting significant improvements. The commonly cited facilitators and barriers were communication and resources, respectively. CONCLUSION The field of KT in SCI is in its infancy with only a few relevant publications. However, there is some evidence that KT interventions may change clinician behavior and improve patient outcomes. Future studies should ensure rigorous study methods are used to evaluate KT interventions.
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Affiliation(s)
- V K Noonan
- 1] Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada [2] Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - D L Wolfe
- 1] Program of Aging, Rehabilitation and Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada [2] Department of Physical Medicine and Rehabilitation, Western University, London, Ontario, Canada
| | - N P Thorogood
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - S E Park
- 1] Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada [2] Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - J T Hsieh
- Program of Aging, Rehabilitation and Geriatric Care, Lawson Health Research Institute, London, Ontario, Canada
| | - J J Eng
- 1] Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada [2] International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
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Munce SEP, Perrier L, Tricco AC, Straus SE, Fehlings MG, Kastner M, Jang E, Webster F, Jaglal SB. Impact of quality improvement strategies on the quality of life and well-being of individuals with spinal cord injury: a systematic review protocol. Syst Rev 2013; 2:14. [PMID: 23432954 PMCID: PMC3599324 DOI: 10.1186/2046-4053-2-14] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 02/08/2013] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND After a spinal cord injury, quality of life, as well as the determinants of quality of life, has been widely assessed. However, to date, there have been no systematic reviews on the impact of quality improvement strategies, including self-management strategies, on the quality of life and well-being of individuals with a spinal cord injury. The current protocol outlines a strategy for a systematic review that aims to identify, assess, and synthesize evidence on the impact of quality improvement strategies on the quality of life and physical and psychological well-being of individuals with spinal cord injury. METHODS/DESIGN All study designs, except qualitative studies will be included. Studies reporting on quality improvement including audit and feedback, case management, team changes, electronic patient registries, clinician education, clinical reminders, facilitated relay of clinical information to clinicians, patient education, (promotion of) self-management, patient reminder systems, and continuous quality improvement among individuals with spinal cord injury will be included. The primary outcome is quality of life. The secondary outcomes are physical and psychological well-being. Studies will be included regardless of publication status, year of dissemination, or language of dissemination. Potentially relevant articles not written in English will be translated. We will search Medline, CINAHL, EMBASE, and PsycINFO. The use of these databases will be supplemented by other data sources, including unpublished data. Two independent reviewers will conduct all levels of screening, data abstraction, and quality appraisal. Results will be grouped according to the target group of the varying quality improvement strategies (that is, health system, health-care professionals, or patients) and/or by any other noteworthy grouping variable, such as etiology of spinal cord condition or by sex. If deemed appropriate, a meta-analysis will be conducted. DISCUSSION This systematic review will identify those quality improvement strategies aimed at the health system, health-care professionals, and patients that impact the quality of life and well-being of individuals with spinal cord injury. Knowledge and application of such quality improvement strategies may reduce inappropriate health-care utilization costs, such as acute care inpatient readmission in the years post injury. Prospero registry number: CRD42012003058.
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Affiliation(s)
- Sarah EP Munce
- Institute of Health Policy, Management & Evaluation, University of Toronto, 160-500 University Ave, M5G 1V7, Toronto, ON, Canada
| | - Laure Perrier
- Institute of Health Policy, Management & Evaluation, University of Toronto, 160-500 University Ave, M5G 1V7, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Andrea C Tricco
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Sharon E Straus
- Institute of Health Policy, Management & Evaluation, University of Toronto, 160-500 University Ave, M5G 1V7, Toronto, ON, Canada
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Michael G Fehlings
- Division of Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Monika Kastner
- Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, ON, Canada
| | - Eunice Jang
- Department of Applied Psychology & Human Development Ontario Institute for Studies in Education, Toronto, ON, Canada
| | - Fiona Webster
- Institute of Health Policy, Management & Evaluation, University of Toronto, 160-500 University Ave, M5G 1V7, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Susan B Jaglal
- Institute of Health Policy, Management & Evaluation, University of Toronto, 160-500 University Ave, M5G 1V7, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
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Guilcher SJT, Craven BC, McColl MA, Lemieux-Charles L, Casciaro T, Jaglal SB. Application of the Andersen's health care utilization framework to secondary complications of spinal cord injury: a scoping review. Disabil Rehabil 2011; 34:531-41. [PMID: 22087755 DOI: 10.3109/09638288.2011.608150] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this scoping review was to identify research priority areas related to secondary complications and associated health care use for individuals with spinal cord injury (SCI). METHOD DATA SOURCES Peer-reviewed journals were identified using CINAHL, MEDLINE, PubMed, Embase, Social Sciences Abstracts, Social Works Abstract and PsycInfo search engines. Key references were hand searched. STUDY SELECTION A total of 289 abstracts were identified from the initial search strategy. We removed studies that did not measure health care and those that did not involve analytical investigation. DATA EXTRACTION The selected 31 studies were reviewed in detail using a coding template based on the domains and sub-components of the Andersen model (i.e. environmental, population characteristics, health behavior and outcome). RESULTS Most studies measured predisposing characteristics (e.g., age, gender) and need characteristics (e.g., level of injury). There was a notable absence of environmental characteristics (e.g., health system, neighborhood variables), enabling characteristics and health behaviors (beyond diet and nutrition). CONCLUSIONS We identified a gap in the SCI literature. Future research should focus on longitudinal study designs with more representation of non-traumatic spinal cord injury, as well as utilizing more advanced statistical analyses (i.e., multivariate level) to adjust for confounding variables.
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Affiliation(s)
- Sara J T Guilcher
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Lack of improvement after audit assessing the management of voiding dysfunction in patients with spinal cord injury: necessity for institutional guidelines. Int J Surg 2011; 9:302-5. [PMID: 21278004 DOI: 10.1016/j.ijsu.2011.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2010] [Revised: 01/03/2011] [Accepted: 01/13/2011] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Standard management guidelines for voiding dysfunction in patients with spinal cord injury (SCI) do not exist and these patients are managed on the basis of institutional protocols or individual judgment of managing physicians. OBJECTIVES To notice general trends and improvements over a five-year period, in the institutional practices related to management of voiding dysfunction in SCI patients. METHODOLOGY A retrospective cross-sectional study was conducted by Neurosurgery and Urology services together. A nine years (June 1995-June 2004) internal clinical audit of urological management of SCI patients was compared with a similar audit conducted five years later (January 2008-June 2010). Comparisons were made using chi-square test. A p-value of <0.05 was considered statistically significant. RESULTS A total of 146 patients were compared (89-pre-audit, 57-post-audit). The quality of documentation of examination findings worsened over the two study periods (p = 0.002). Although determination of baseline serum creatinine improved to statistically significant levels (p = 0.019), no imaging for the kidneys was performed as baseline in the post-audit period (p = 0.000). Similarly the number of urodynamic studies performed decreased from 11% to 1.75% (p = 0.045). The number of urological consultations, however, increased from 26% to 31.58% (p = 0.452). During follow-up, only 17 (19.1%) patients in the pre-audit study period and 6 (10.5%) in the post-audit study period were voiding spontaneously. CONCLUSION Our study of two eras clearly demonstrated a worsening trend in quality of patient management, which can be corrected by agreeing upon and implementing standard guidelines for management of SCI patients.
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Health system factors associated with rehospitalizations after traumatic spinal cord injury: a population-based study. Spinal Cord 2009; 47:604-9. [DOI: 10.1038/sc.2009.9] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Bloemen-Vrencken JHA, de Witte LP, Post MWM, van den Heuvel WJA. Health behaviour of persons with spinal cord injury. Spinal Cord 2006; 45:243-9. [PMID: 16969357 DOI: 10.1038/sj.sc.3101967] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Postal survey. OBJECTIVE To describe the health behaviour of persons with spinal cord injury (SCI) living in the community and the relationships between health behaviour, respondent/injury characteristics, and health-related variables: the presence and number of secondary impairments, readmissions in rehabilitation centre and hospital, and perceived health. SETTING Members of the Dutch Association of Patients with SCI. METHODS The frequency of health behaviours, that delay or prevent secondary impairments, was assessed by means of a 22-item, self-report questionnaire. The questionnaire was also focused on 13 secondary impairments. RESULTS The frequency of engaging in health behaviour varied considerably between the respondents. Variance was observed between and within the health behaviours measured. The respondents did not frequently engage in pressure relief methods when sitting/driving in their wheelchair. Almost no statistical differences were observed between health behaviour of subgroups of respondents based on respondent/injury characteristics. However, the total health behaviour scores increased significantly with increasing age and pressure sore prevention was significantly more applied in persons with a complete lesion. Health behaviour was significantly more applied in respondents who had one or more secondary impairments. CONCLUSION As secondary impairments are prevalent among persons with SCI and education on a healthy lifestyle is a core component of every rehabilitation programme, it is of great importance to rigorously test the efficacy of health behaviours promoted during rehabilitation. Therefore, longitudinal research is recommended.
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