1
|
Peters J, Chen M, Huang K, Siero M, Elliot J, Bleakney A, Hsiao-Wecksler E, McDonagh D. A user-inspired mobility experience of the future: a qualitative investigation. Disabil Rehabil Assist Technol 2024:1-10. [PMID: 38958198 DOI: 10.1080/17483107.2024.2373303] [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: 02/20/2024] [Accepted: 06/22/2024] [Indexed: 07/04/2024]
Abstract
Wheelchair users (WCUs) face additional challenges than non-WCU to multi-tasking (i.e. open doors, cook, use a cell-phone) while navigating their environments. While assistive devices have attempted to provide WCUs with mobility solutions that enable multi-tasking capabilities, current devices have been developed without the input of end-users and have proven to be non-usable. More balanced approaches that integrate the end-users' voices may improve current assistive technology usability trends. This study sought to empathically understand the lived experience of WCUs, their needs towards a mobility device, and their perceptions towards hands-free mobility. Full-time WCUs and care providers participated in semi-structured interviews examining wheelchair use and perceptions towards current and future mobility devices. Thematic analysis was used to analyze interview data. 9 WCUs (aged 32.1 ± 7.0 years; wheelchair experience 17.9 ± 11.6 years) and five care providers (years caring for WCU 3.75 ± 0.96 years) participated in the study. The most common disability type was spinal cord injury (WCUs: n = 3; care providers: n = 3). Qualitative analysis revealed four key themes: (1) Current wheelchair usage, (2) WCU and care provider perspectives, (3) Future wheelchair, and (4) Hands-free wheelchair. Accordingly, participants desire bespoke, light-weight mobility devices that can through tight spaces, access uneven terrain, and free the hands during navigation. This study provides meaningful insight into the needs of WCUs and care providers that assistive technology innovators can use to develop more usable assistive technologies. Amongst study participants, the concept of a hands-free mobility device appears to be usable and desirable.
Collapse
Affiliation(s)
- Joseph Peters
- Kansas City University College of Osteopathic Medicine, Kansas City University of Medicine and Bioscience, Kansas, MO, USA
| | - Michael Chen
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Kathryn Huang
- Disability Resources and Educational Services, University of Illinois at Urbana-Champaign, Champaign, IL, USA
- Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Marissa Siero
- Technology Entrepreneur Center, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Jeannette Elliot
- Disability Resources and Educational Services, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Adam Bleakney
- Disability Resources and Educational Services, University of Illinois at Urbana-Champaign, Champaign, IL, USA
| | - Elizabeth Hsiao-Wecksler
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| | - Deana McDonagh
- Carle Illinois College of Medicine, University of Illinois at Urbana-Champaign, Urbana, IL, USA
- Beckman Institute for Advanced Science and Technology, University of Illinois at Urbana-Champaign, Urbana, IL, USA
| |
Collapse
|
2
|
Yun K, Lim JC, Kim O. Significance of physical factors on activities of daily living in patients with tetraplegia after spinal cord injury: a retrospective study. BMC Sports Sci Med Rehabil 2024; 16:148. [PMID: 38961503 PMCID: PMC11221102 DOI: 10.1186/s13102-024-00928-z] [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: 12/29/2023] [Accepted: 06/13/2024] [Indexed: 07/05/2024]
Abstract
BACKGROUND Tetraplegia is a debilitating sequela of spinal cord injury (SCI). However, comprehensive approaches for determining the influence of various factors on activities of daily living (ADL) in patients with tetraplegia are limited. Therefore, this study aimed to determine the influence of physical factors on ADL in patients with tetraplegia after adjusting for demographic, SCI-related, and cognitive factors. METHODS This retrospective cross-sectional study enrolled 201 patients with tetraplegia who underwent inpatient rehabilitation at the National Rehabilitation Center in South Korea between 2019 and 2021. Patients' mean age was 50.5 years (standard deviation, 16.3), and 170 (84.6%) were men. The Korean Spinal Cord Independence Measure III (K-SCIM III) was used as the main outcome measure to assess patients' ADL ability. Hierarchical multiple regression modeling was conducted with K-SCIM as the dependent variable to examine the level of functioning and relative influencing factors. RESULTS Upper-extremity motor score (UEMS), upper-extremity spasticity and sitting balance scores were significant predictors of self-care; lower-extremity motor score (LEMS), musculoskeletal pain of shoulder, and sitting balance were significant predictors of respiratory and sphincter management; UEMS, LEMS, and sitting balance score were significant predictors of mobility; and UEMS, LEMS, musculoskeletal pain of shoulder, and sitting balance scores were significant predictors of the K-SCIM III total score after adjustment for demographic, SCI-related, and cognitive factors. CONCLUSIONS Physical factors had the greatest impact on all subscores and the K-SCIM III total score. Upper- and lower-extremity muscle strength and sitting balance significantly affected functional ability across all subscores.
Collapse
Affiliation(s)
- Kimin Yun
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, 58, Samgaksan-ro, Gangbuk-gu, Seoul, 01022, Republic of Korea
| | - Jin-Cheol Lim
- Department of Education Measurement and Evaluation, Sungkyunkwan University, Seoul, Korea
| | - Onyoo Kim
- Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, 58, Samgaksan-ro, Gangbuk-gu, Seoul, 01022, Republic of Korea.
| |
Collapse
|
3
|
Peiffer JW, Philippus A, Kanaster K, Monden KR. Understanding the association between perceived injustice, depression symptoms, and stigma in individuals with traumatic spinal cord injury. Spinal Cord 2024:10.1038/s41393-024-01007-3. [PMID: 38871826 DOI: 10.1038/s41393-024-01007-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 05/31/2024] [Accepted: 06/05/2024] [Indexed: 06/15/2024]
Abstract
STUDY DESIGN This is a secondary analysis of data from a cross-sectional, observational study. OBJECTIVES The study aimed to determine whether stigma mediates the relationship between preceived injustice and depression symptoms among individuals with spinal cord injuries. SETTING Secondary analysis of participants enrolled in the Spinal Cord Injury Model System at a specialty rehabilitation hospital in the Western United States. METHODS A sample of 225 participants completed the questionnaires; eight participants were removed due to incomplete data, resulting in a final sample size of 217 participants (79% male; 21% female). Participants were, on average, 53 years old and were predominantly male, white, and 20 years post-injury. A bootstrapping mediation analysis was conducted to evaluate the stigma-mediated relationship between injustice appraisals and depression symptoms. Injustice appraisals were assessed using the Injustice Experience Questionnaire, stigma with the Spinal Cord Injury Quality of Life Stigma-Short Form, and depression symptoms with the Patient Health Questionnaire-9. RESULTS Stigma was found to mediate the relationship between injustice appraisals and depression, with an estimated proportion mediated of 80.9% (p ≤ 0.0001). CONCLUSIONS This study provides a novel finding that the relationship between injustice appraisals and depression symptoms is mediated by stigma. Consistent with previous research, injustice appraisals were associated with greater severity of depression symptoms. Results provide further evidence for the role of injustice appraisals after spinal cord injury and a potential mechanism (i.e., stigma) by which it may exert its effect on depression symptoms.
Collapse
Affiliation(s)
- Joshua W Peiffer
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Angela Philippus
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Karen Kanaster
- Department of Biostatistics and Informatics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Kimberley R Monden
- Department of Rehabilitation Medicine, University of Minnesota Medical School, Minneapolis, MN, USA.
| |
Collapse
|
4
|
Ownsworth T, Mols H, O'Loghlen J, Xie Y, Kendall M, Nielsen M, Mitchell J, Jones R, Geraghty T. Stigma following acquired brain injury and spinal cord injury: relationship to psychological distress and community integration in the first-year post-discharge. Disabil Rehabil 2024; 46:1796-1806. [PMID: 37128900 DOI: 10.1080/09638288.2023.2205173] [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: 11/07/2022] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
PURPOSE This study aimed to compare stigma levels after acquired brain injury (ABI) and spinal cord injury (SCI) during the first 12-months post-discharge and investigate relationships between stigma, psychological distress and community integration. METHODS 110 adults with ABI (55%) or SCI (45%) were recruited from brain and spinal cord injury inpatient rehabilitation units of a tertiary healthcare facility. They were administered Neuro-QOL Stigma subscale and Depression Anxiety and Stress Scales (DASS-21) at discharge, 3-months and 12-months post-discharge, and Community Integration Measure at 12-months post-discharge. RESULTS Stigma levels did not significantly differ between individuals with ABI and SCI. However, stigma significantly decreased between discharge and 12-months post-discharge for the total sample. Stigma was positively associated with psychological distress at discharge and 3-months post-discharge, but not at 12-months post-discharge. Lower functional status and power wheelchair use were associated with higher stigma at 12-months post-discharge. Stigma at 3-months post-discharge predicted community integration at 12-months post-discharge, controlling for psychological distress and functional status. CONCLUSION Experience of stigma in the first few months post-discharge may negatively impact individuals' community reintegration. The early post-discharge period may be a pivotal time for supporting individuals to explore disability and injury-related appraisals and enhance connection to their community.
Collapse
Affiliation(s)
- Tamara Ownsworth
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Helen Mols
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Jessica O'Loghlen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Yanfei Xie
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- RECOVER Injury Research Centre, The University of Queensland, Brisbane, Australia
| | - Melissa Kendall
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Mandy Nielsen
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Jessie Mitchell
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- School of Applied Psychology, Griffith University, Brisbane, Australia
| | - Rachel Jones
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
- Division of Rehabilitation, Metro South Health Hospital and Health Service, Brisbane, Australia
| |
Collapse
|
5
|
Raulli SJ, Gomes VC, Parodi FE, Vasan P, Sun D, Marston WA, Pascarella L, McGinigle KL, Wood JC, Farber MA. Five-year outcomes of fenestrated and branched endovascular repair of complex aortic aneurysms based on aneurysm extent. J Vasc Surg 2024:S0741-5214(24)00959-5. [PMID: 38608964 DOI: 10.1016/j.jvs.2024.04.017] [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: 01/29/2024] [Revised: 03/31/2024] [Accepted: 04/04/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE The aim of this study was to evaluate the 5-year outcomes of fenestrated/branched endovascular aortic repair (F/BEVAR) for the treatment of complex aortic aneurysms stratified by the aneurysm extent. METHODS Patients with the diagnosis of complex aortic aneurysm, who underwent F/BEVAR at a single center were included in this study and retrospectively analyzed. The cohort was divided according to the aneurysm extent, comparing group 1 (types I-III thoracoabdominal aneurysms [TAAAs]), group 2 (type IV TAAAs), and group 3 (juxtarenal [JRAAs], pararenal [PRAAs], or paravisceral [PVAAs] aortic aneurysms). The primary endpoints were 30-day and 5-year survival. The secondary endpoints were technical success, occurrence of spinal cord ischemia, primary patency of the visceral arteries, freedom from target vessel instability, and secondary interventions. RESULTS Of 436 patients who underwent F/BEVAR between July 2012 and May 2023, 131 presented with types I to III TAAAs, 69 with type IV TAAAs, and 236 with JRAAs, PRAAs, or PVAAs. All cases were treated under a physician-sponsored investigational device exemption protocol with a patient-specific company-manufactured or off-the-shelf device. Group 1 had significantly younger patients than group 2 or 3 respectively (69.6 ± 8.7 vs 72.4 ± 7.1 vs 73.2 ± 7.3 years; P < .001) and had a higher percentage of females (50.4% vs 21.7% vs 17.8%; P < .001). Prior history of aortic dissection was significantly more common among patients in group 1 (26% vs 1.4% vs 0.9%; P < .001), and mean aneurysm diameter was larger in group 1 (64.5 vs 60.7 vs 63.2 mm; P = .033). Comorbidities were similar between groups, except for coronary artery disease (P < .001) and tobacco use (P = .003), which were less prevalent in group 1. Technical success was similar in the three groups (98.5% vs 98.6% vs 98.7%; P > .99). The 30-day mortality was 4.5%, 1.4%, and 0.4%, in groups 1, 2, and 3, respectively, and was significantly higher in group 1 when compared with group 3 (P = .01). The incidence of spinal cord ischemia was significantly higher in group 1 compared with group 3 (5.3% vs 4.3% vs 0.4%; P = .004). The 5-year survival was significantly higher in group 3 when compared with group 1 (P = .01). Freedom from secondary intervention was significantly higher in group 3 when compared with group 1 (P = .003). At 5 years, there was no significant difference in freedom from target vessel instability between groups or primary patency in the 1652 target vessels examined. CONCLUSIONS Larger aneurysm extent was associated with lower 5-year survival, higher 30-day mortality, incidence of secondary interventions, and spinal cord ischemia. The prevalence of secondary interventions in all groups makes meticulous follow-up paramount in patients with complex aortic aneurysm treated with F/BEVAR.
Collapse
Affiliation(s)
- Stephen J Raulli
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC.
| | - Vivian Carla Gomes
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - F Ezequiel Parodi
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Priya Vasan
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Dichen Sun
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - William A Marston
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Luigi Pascarella
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Katharine L McGinigle
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Jacob C Wood
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| | - Mark A Farber
- Division of Vascular Surgery, Department of Surgery, University of North Carolina, Chapel Hill, NC
| |
Collapse
|
6
|
Patel PB, Marcaccio CL, Swerdlow NJ, O'Donnell TFX, Rastogi V, Marino R, Patel VI, Zettervall SL, Lindsay T, Schermerhorn ML. Thoracoabdominal aortic aneurysm life-altering events following endovascular aortic repair in the Vascular Quality Initiative. J Vasc Surg 2023:S0741-5214(23)01018-2. [PMID: 37044316 DOI: 10.1016/j.jvs.2023.03.499] [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: 01/02/2023] [Revised: 03/18/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023]
Abstract
OBJECTIVE Endovascular aortic aneurysm repair has lower rates of postoperative mortality and morbidity when compared with open repair. However, endovascular repair still carries the risk of postoperative dialysis, paralysis, and stroke. This study examined the rates of postoperative mortality and morbidity stratified by type of endovascular aortic aneurysm repair. METHODS All patients who underwent endovascular aortic aneurysm repair in the Vascular Quality Initiative registry from January 2011 - May 2022 were identified. Patients were stratified by repair type: infrarenal endovascular aortic repair (EVAR), complex EVAR, thoracic endovascular aortic repair (TEVAR), extent I-III thoracoabdominal aortic aneurysm (TAAA) repair, or aortic arch repair. The primary outcome was postoperative thoracoabdominal aortic aneurysm life-altering events (TALE) across the different treatment groups. TALE was defined as a composite outcome of postoperative mortality, dialysis, paralysis, and/or stroke. Mixed effect logistic regression modeling was used to identify procedural and anatomic factors that were independently associated with TALE. RESULTS A total of 52,592 EVARs, 3,768 complex EVARs, 3,899 TEVARs, 1,139 extent I-III TAAA repairs, and 479 arch repairs were identified. TALE was observed in 1.2% of EVARs, 4.8% of complex EVARs, 6.0% of TEVARs, 10% of extent I-III TAAA repairs, and 14% of arch repairs. More proximal landing zone was associated with higher odds of TALE after complex EVAR (OR 1.9 [1.2-3.1]; p=.008), TEVAR (OR 2.2 [1.4-3.5]; p=.001), and extent I-III TAAA repair (OR 2.7 [1.5-4.9]; p=.001). Aortic diameter >65mm was associated with higher odds of TALE after infrarenal EVAR (OR 1.8 [1.4-2.3]; p<.001), complex EVAR (OR 1.6 [1.1-2.3]; p=.010), TEVAR (OR 2.7 [2.0-3.8]; p<.001), and arch repair (OR 2.4; [1.3-4.4]; p=.007). The use of parallel grafting technique (chimney/snorkel/periscope) during extent I-III TAAA repair was also associated with higher odds of TALE (OR 1.8 [1.1-3.2]; p=.032). Preoperative chronic kidney disease was also associated with higher odd of TALE after infrarenal EVAR (OR 4.3 [3.0-5.7]; p<.001), complex EVAR (OR 5.2 [3.3-8.2]; p<.001), TEVAR (OR 4.5 [2.8-7.1]; p<.001), and extent I-III TAAA repair (OR 3.2 [1.6-6.7]; p=.001). CONCLUSION While TALE was originally described for thoracoabdominal aortic aneurysm repairs, TALE may occur after complex EVAR, TEVAR, and arch repairs as well. Therefore, TALE and its component parts should be used to evaluate the efficacy of all aortic repairs and for preoperative counseling. Additionally, surgeons should be aware of anatomic and procedural characteristics that are associated with higher odds of TALE. The anticipated need for such interventions during aortic repair should be factored into preoperative risk assessment of patients.
Collapse
Affiliation(s)
- Priya B Patel
- The Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Christina L Marcaccio
- The Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Nicholas J Swerdlow
- The Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | - Thomas F X O'Donnell
- The Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA; Division of Vascular Surgery and Endovascular Interventions, Columbia University Medical Center, New York, NY
| | - Vinamr Rastogi
- The Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA
| | | | - Virendra I Patel
- Division of Vascular Surgery and Endovascular Interventions, Columbia University Medical Center, New York, NY
| | - Sara L Zettervall
- Division of Vascular Surgery, University of Washington Medicine, Seattle, WA
| | - Thomas Lindsay
- Department of Vascular Surgery, University of Toronto, Canada
| | - Marc L Schermerhorn
- The Division of Vascular and Endovascular Surgery, Beth Israel Deaconess Medical Center, Boston, MA.
| |
Collapse
|
7
|
Carlozzi NE, Graves C, Troost JP, Kallen MA, Tulsky DS, Hanks RA, Ianni PA, Miner JA, Sander AM. Initial Evidence for Reliable and Valid Use of Scores on the 8-Item Econ-QOL Short Form to Measure Economic Quality of Life in Caregivers of Persons With Traumatic Brain Injury. Arch Phys Med Rehabil 2023; 104:430-437. [PMID: 35944601 PMCID: PMC9899870 DOI: 10.1016/j.apmr.2022.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/21/2022] [Accepted: 07/28/2022] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To provide reliability and validity data to support the clinical utility of Economic Quality of Life Measure (Econ-QOL) scores in caregivers of civilians and service members/veterans with traumatic brain injury (TBI). DESIGN Cross-sectional survey study. SETTING Three academic medical centers and a Veterans Affairs treatment facility. PARTICIPANTS 376 caregivers of civilians (n=213) and service members/veterans (n=163) with TBI (N=376). INTERVENTIONS N/A. MAIN OUTCOME MEASURES Econ-QOL and several patient-reported outcome measures (Traumatic Brain Injury Caregiver Quality of Life Caregiver-Specific Anxiety and Caregiver Strain, Patient-Reported Outcomes Measurement Information System sleep-related impairment, Neurological Quality of Life Measurement System positive affect and well-being) and measures of financial status (self-reported income). RESULTS Internal consistency reliability of the Econ-QOL Short Form scores were excellent (all Cronbach's alphas ≥.92). There were no floor or ceiling effects for scores. There was evidence of convergent and discriminant validity, with the Econ-QOL scores having the strongest relationships with self-reported income (convergent validity evidence) and weak relationships with the other measures (discriminant validity evidence). Individuals with scores that were "below or possibly below" the poverty line (according to 2016 federal government poverty level thresholds) reported worse economic quality of life relative to those individuals who were definitely above the poverty line, supporting known-groups validity. CONCLUSIONS This article establishes the clinical utility of scores on the Econ-QOL Short Form in caregivers of persons with TBI and provides evidence that it is valid and appropriate to use such scores not only in a variety of different disability populations (eg, spinal cord injury, stroke) but also in caregivers.
Collapse
Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI.
| | - Christopher Graves
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Jonathan P Troost
- Michigan Institute for Clinical & Health Research, University of Michigan, Ann Arbor, MI
| | - Michael A Kallen
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL; MHBS, James A. Haley Veterans' Hospital, Tampa, FL
| | - David S Tulsky
- Center for Health Assessment Research and Translation, and Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE
| | - Robin A Hanks
- Department of Psychology and Neuropsychology, Rehabilitation Institute of Michigan, Detroit, MI; Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, MI
| | - Phillip A Ianni
- Michigan Institute for Clinical & Health Research, University of Michigan, Ann Arbor, MI
| | - Jennifer A Miner
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine/Harris Health System, Houston, TX; Brain Injury Research Center, TIRR Memorial Hermann, Houston, TX, USA
| |
Collapse
|
8
|
Kuzu D, Perrin PB, Pugh M. The Affiliate Stigma Scale: Psychometric refinement and validation of a short form in Turkish spinal cord injury/disorder caregivers. NeuroRehabilitation 2023; 52:83-91. [PMID: 36617754 DOI: 10.3233/nre-210127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Despite the widespread international use of the Affiliate Stigma Scale in the context of disability, much research on its psychometric properties has taken dubious statistical approaches. OBJECTIVE The aim of this study was to examine the psychometric properties of the Affiliate Stigma Scale in a sample of Turkish spinal cord injury/disorder (SCI/D) caregivers. METHODS Participants completed the Affiliate Stigma Scale, Zarit Burden Interview, and Generalized Anxiety Disorder-7. This study conducted a series of confirmatory factor analyses (CFAs) of the Turkish Affiliate Stigma Scale using its originally theorized 3-factor structure and a 1-factor structure, as well as an exploratory factor analysis (EFA) to refine the scale items to create a short form, with a final CFA of the items in the short form. RESULTS The 3-factor and 1-factor CFAs of the 22 items from the Affiliate Stigma Scale suggested poor fit to the data across every fit index. An EFA yielded four factors, although the patterns of item loading onto the factors did not map in any discernible way to the original subscales theorized by the scale creators. A 1-factor CFA with the six items loading onto factor 1 of the EFA showed much better fit indices, with most achieving good or adequate fit. CONCLUSION The current study supports a 1-factor solution with a short form comprised of six items, at least in Turkish and with SCI/D caregivers.
Collapse
Affiliation(s)
- Duygu Kuzu
- University of Michigan, Ann Arbor, MI, USA
| | | | - Mickeal Pugh
- Virginia Commonwealth University, Richmond, VA, USA
| |
Collapse
|
9
|
Thøgersen MB, Mohammadi M, Gull MA, Bengtson SH, Kobbelgaard FV, Bentsen B, Khan BYA, Severinsen KE, Bai S, Bak T, Moeslund TB, Kanstrup AM, Andreasen Struijk LNS. User Based Development and Test of the EXOTIC Exoskeleton: Empowering Individuals with Tetraplegia Using a Compact, Versatile, 5-DoF Upper Limb Exoskeleton Controlled through Intelligent Semi-Automated Shared Tongue Control. SENSORS (BASEL, SWITZERLAND) 2022; 22:6919. [PMID: 36146260 PMCID: PMC9502221 DOI: 10.3390/s22186919] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
This paper presents the EXOTIC- a novel assistive upper limb exoskeleton for individuals with complete functional tetraplegia that provides an unprecedented level of versatility and control. The current literature on exoskeletons mainly focuses on the basic technical aspects of exoskeleton design and control while the context in which these exoskeletons should function is less or not prioritized even though it poses important technical requirements. We considered all sources of design requirements, from the basic technical functions to the real-world practical application. The EXOTIC features: (1) a compact, safe, wheelchair-mountable, easy to don and doff exoskeleton capable of facilitating multiple highly desired activities of daily living for individuals with tetraplegia; (2) a semi-automated computer vision guidance system that can be enabled by the user when relevant; (3) a tongue control interface allowing for full, volitional, and continuous control over all possible motions of the exoskeleton. The EXOTIC was tested on ten able-bodied individuals and three users with tetraplegia caused by spinal cord injury. During the tests the EXOTIC succeeded in fully assisting tasks such as drinking and picking up snacks, even for users with complete functional tetraplegia and the need for a ventilator. The users confirmed the usability of the EXOTIC.
Collapse
Affiliation(s)
- Mikkel Berg Thøgersen
- Center for Rehabilitation Robotics, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Mostafa Mohammadi
- Center for Rehabilitation Robotics, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Muhammad Ahsan Gull
- Department of Materials and Production Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Stefan Hein Bengtson
- Visual Analysis and Perception (VAP) Lab, Department of Architecture, Design, and Media Technology, Aalborg University, 9000 Aalborg, Denmark
| | | | - Bo Bentsen
- Center for Rehabilitation Robotics, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Benjamin Yamin Ali Khan
- Spinal Cord Injury Centre of Western Denmark, Viborg Regional Hospital, 8800 Viborg, Denmark
| | - Kåre Eg Severinsen
- Spinal Cord Injury Centre of Western Denmark, Viborg Regional Hospital, 8800 Viborg, Denmark
| | - Shaoping Bai
- Department of Materials and Production Technology, Aalborg University, 9220 Aalborg, Denmark
| | - Thomas Bak
- Department of Electronic Systems, Aalborg University, 9220 Aalborg, Denmark
| | - Thomas Baltzer Moeslund
- Visual Analysis and Perception (VAP) Lab, Department of Architecture, Design, and Media Technology, Aalborg University, 9000 Aalborg, Denmark
| | | | - Lotte N. S. Andreasen Struijk
- Center for Rehabilitation Robotics, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark
| |
Collapse
|
10
|
Budd MA, Gater DR, Channell I. Psychosocial Consequences of Spinal Cord Injury: A Narrative Review. J Pers Med 2022; 12:jpm12071178. [PMID: 35887675 PMCID: PMC9320050 DOI: 10.3390/jpm12071178] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 07/09/2022] [Accepted: 07/15/2022] [Indexed: 11/26/2022] Open
Abstract
Consequences of a spinal cord injury (SCI) entail much more than damage to the spinal cord. The lives of people with SCI, along with those around them, experience profound long-lasting changes in nearly every life domain. SCI is a physical (biological) injury that is inextricably combined with various psychological and social consequences. The objective of this review is to present psychosocial challenges following SCI through the biopsychosocial model, beginning with acknowledgement of the larger societal effects of ableism and stigma before addressing the many unique psychosocial aspects of living with SCI. Included in this review are qualitative studies and systematic reviews on current psychosocial outcomes and consequences. This paper attempts to structure this information by dividing it into the following sections: relationships and family; changes in finances and employment; issues related to the person’s living situation; community reintegration; factors associated with mood and coping (e.g., depression, anxiety, substance use, and PTSD); self-harm behaviors (ranging from nonadherence to suicide); effects of traumatic brain injury; considerations regarding sexual health; aging with SCI; and concludes with a brief discussion about post-traumatic growth. Cultivating an understanding of the unique and interrelated psychosocial consequences of people living with SCI may help mitigate the psychosocial aftermath and serve as a reminder to providers to maintain a person-centered approach to care.
Collapse
Affiliation(s)
- Maggi A. Budd
- Spinal Cord Injury/Disease Service, VA Boston Healthcare System, Boston, MA 02130, USA;
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Center for Bioethics, Harvard Medical School, Boston, MA 02115, USA
- Correspondence:
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL 33136, USA;
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA
- The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Isabella Channell
- Spinal Cord Injury/Disease Service, VA Boston Healthcare System, Boston, MA 02130, USA;
- Mental Health Counseling and Behavioral Medicine Graduate Program, Boston University School of Medicine, Boston, MA 02128, USA
| |
Collapse
|
11
|
Mohammadi M, Knoche H, Thøgersen M, Bengtson SH, Gull MA, Bentsen B, Gaihede M, Severinsen KE, Andreasen Struijk LNS. Eyes-Free Tongue Gesture and Tongue Joystick Control of a Five DOF Upper-Limb Exoskeleton for Severely Disabled Individuals. Front Neurosci 2022; 15:739279. [PMID: 34975367 PMCID: PMC8718615 DOI: 10.3389/fnins.2021.739279] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Accepted: 11/23/2021] [Indexed: 11/30/2022] Open
Abstract
Spinal cord injury can leave the affected individual severely disabled with a low level of independence and quality of life. Assistive upper-limb exoskeletons are one of the solutions that can enable an individual with tetraplegia (paralysis in both arms and legs) to perform simple activities of daily living by mobilizing the arm. Providing an efficient user interface that can provide full continuous control of such a device—safely and intuitively—with multiple degrees of freedom (DOFs) still remains a challenge. In this study, a control interface for an assistive upper-limb exoskeleton with five DOFs based on an intraoral tongue-computer interface (ITCI) for individuals with tetraplegia was proposed. Furthermore, we evaluated eyes-free use of the ITCI for the first time and compared two tongue-operated control methods, one based on tongue gestures and the other based on dynamic virtual buttons and a joystick-like control. Ten able-bodied participants tongue controlled the exoskeleton for a drinking task with and without visual feedback on a screen in three experimental sessions. As a baseline, the participants performed the drinking task with a standard gamepad. The results showed that it was possible to control the exoskeleton with the tongue even without visual feedback and to perform the drinking task at 65.1% of the speed of the gamepad. In a clinical case study, an individual with tetraplegia further succeeded to fully control the exoskeleton and perform the drinking task only 5.6% slower than the able-bodied group. This study demonstrated the first single-modal control interface that can enable individuals with complete tetraplegia to fully and continuously control a five-DOF upper limb exoskeleton and perform a drinking task after only 2 h of training. The interface was used both with and without visual feedback.
Collapse
Affiliation(s)
- Mostafa Mohammadi
- Neurorehabilitation Robotics and Engineering, Center for Rehabilitation Robotics, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Hendrik Knoche
- Human Machine Interaction, Department of Architecture, Design and Media Technology, Aalborg University, Aalborg, Denmark
| | - Mikkel Thøgersen
- Neurorehabilitation Robotics and Engineering, Center for Rehabilitation Robotics, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Stefan Hein Bengtson
- Human Machine Interaction, Department of Architecture, Design and Media Technology, Aalborg University, Aalborg, Denmark
| | - Muhammad Ahsan Gull
- Department of Materials and Production, Aalborg University, Aalborg, Denmark
| | - Bo Bentsen
- Neurorehabilitation Robotics and Engineering, Center for Rehabilitation Robotics, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Michael Gaihede
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Lotte N S Andreasen Struijk
- Neurorehabilitation Robotics and Engineering, Center for Rehabilitation Robotics, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| |
Collapse
|
12
|
McIntyre A, Sadowsky C, Behrman A, Martin R, Augutis M, Cassidy C, Betz R, Ertzgaard P, Mulcahey MJ. A Systematic Review of the Scientific Literature for Rehabilitation/Habilitation Among Individuals With Pediatric-Onset Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2022; 28:13-90. [PMID: 35521053 PMCID: PMC9009193 DOI: 10.46292/sci21-00046] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objectives To conduct a systematic review to examine the scientific literature for rehabilitation/habilitation among individuals with pediatric-onset spinal cord injury (SCI). Methods A literature search of multiple databases (i.e., PubMed/MEDLINE, CINAHL, EMBASE, PsychINFO) was conducted and was filtered to include studies involving humans, published as full-length articles up to December 2020, and in English. Included studies met the following inclusion criteria: (1) ≥50% of the study sample had experienced a traumatic, acquired, nonprogressive spinal cord injury (SCI) or a nontraumatic, acquired, noncongenital SCI; (2) SCI onset occurred at ≤21 years of age; and (3) sample was assessed for a rehabilitation/habilitation-related topic. Studies were assigned a level of evidence using an adapted Sackett scale modified down to five levels. Data extracted from each study included author(s), year of publication, country of origin, study design, subject characteristics, rehabilitation/habilitation topic area, intervention (if applicable), and outcome measures. Results One hundred seventy-six studies were included for review (1974-2020) with the majority originating from the United States (81.3%). Most studies were noninterventional observational studies (n = 100; 56.8%) or noninterventional case report studies (n = 5; 2.8%). Sample sizes ranged from 1 to 3172 with a median of 26 (interquartile range [IQR], 116.5). Rehabilitation/habilitation topics were categorized by the International Classification of Functioning, Disability and Health (ICF); most studies evaluated ICF Body Function. There were 69 unique clinical health outcome measures reported. Conclusion The evidence for rehabilitation/habilitation of pediatric-onset SCI is extremely limited; nearly all studies (98%) are level 4-5 evidence. Future studies across several domains should be conducted with novel approaches to research design to alleviate issues related to sample sizes and heterogeneity.
Collapse
Affiliation(s)
- Amanda McIntyre
- Parkwood Institute Research, Parkwood Institute, London, Canada
| | - Cristina Sadowsky
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, John Hopkins University, Baltimore, Maryland
,International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Andrea Behrman
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
,Kosair Charities Center for Pediatric Neurorecovery, Louisville, Kentucky
| | - Rebecca Martin
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, John Hopkins University, Baltimore, Maryland
,International Center for Spinal Cord Injury, Kennedy Krieger Institute, Baltimore, Maryland
| | - Marika Augutis
- Department of Neurobiology, Care Sciences and Society, Division of Neurogeriatrics, Karolinska Institute, Solna, Sweden
| | - Caitlin Cassidy
- St. Joseph’s Health Care London, Parkwood Institute, London, Canada
| | - Randal Betz
- Institute for Spine and Scoliosis, Lawrenceville, New Jersey
,Department of Orthopedics, Mount Sinai Hospital, New York, New York
| | - Per Ertzgaard
- Department of Rehabilitation Medicine, Linköping University, Linköping, Sweden
| | - MJ Mulcahey
- Department of Occupational Therapy, Jefferson College of Rehabilitation Sciences, Thomas Jefferson University, Woodbury, New Jersey
| | | |
Collapse
|
13
|
Auerbacher M, Kakoschke TK, Hickel R, Kaisarly D. Treatment Plan and Challenges in Full-Mouth Rehabilitation of a Quadriplegic Patient: A Clinical Report. J Prosthodont 2021; 31:183-189. [PMID: 34859932 DOI: 10.1111/jopr.13461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2021] [Indexed: 11/28/2022] Open
Abstract
Spinal cord injuries lead to physical limitations, and the resulting levels of dependency and emotional distress have devastating consequences on individuals' oral health. A 46-year-old patient with incomplete quadriplegia due to a complicated medical history presented for prosthetic rehabilitation. The patient's ability and tolerance to be treated in the dental chair was assessed. Prosthetic treatment options were discussed considering his dependency on alternating caregivers. The final treatment plan involved restorative treatment, implant-supported crowns, an implant-supported fixed dental prosthesis and, in the upper jaw, an implant-supported overdenture to allow proper oral hygiene. The dental treatment sessions were performed with frequent interruptions in the dental chair, whereas the implants were placed under general anesthesia in the maxillo-facial surgery department. The final treatment plan resulted in a compromise between the prosthetic recommendation and the patient's wish. The decisive factor for choosing an implant-supported overdenture rather than an implant-supported fixed dental prosthesis in the upper jaw was the inability of the patient to maintain adequate hygiene measures by himself and his dependence on the caregivers. This clinical report demonstrates how special care dentistry can improve quality of life, even in people with severe physical and/or mental impairments. We would like to encourage dental professionals to provide high-quality care for patients with disabilities in particular, and this practice is in line with the requirements of the UN convention on the rights of persons with disabilities.
Collapse
Affiliation(s)
- Marc Auerbacher
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany
| | - Tamara Katharina Kakoschke
- Department of Oral & Maxillofacial Surgery & Facial Plastic Surgery, University Hospital, LMU Munich, Munich, Germany
| | - Reinhard Hickel
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany
| | - Dalia Kaisarly
- Department of Conservative Dentistry and Periodontology, University Hospital, LMU Munich, Munich, Germany.,Biomaterials Department, Faculty of Oral and Dental Medicine, Cairo University, Cairo, Egypt
| |
Collapse
|
14
|
Wetherill MS, Duncan AR, Bowman H, Collins R, Santa-Pinter N, Jackson M, Lynn CM, Prentice K, Isaacson M. Promoting nutrition equity for individuals with physical challenges: A systematic review of barriers and facilitators to healthy eating. Prev Med 2021; 153:106723. [PMID: 34271075 DOI: 10.1016/j.ypmed.2021.106723] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 07/05/2021] [Accepted: 07/11/2021] [Indexed: 10/20/2022]
Abstract
Impaired mobility is the most common form of functional disability in the US, affecting one out of every sixteen working-age adults. Little is known about the barriers to and facilitators of healthy eating among people with impaired mobility (PWIM), who are at increased risk for diet-related chronic disease. The pathways by which impaired mobility influence dietary intake are unclear, yet likely involve a complex interplay between structural determinants of health and individual factors. To help advance nutrition equity initiatives for PWIM, this systematic review aimed to qualitatively synthesize factors associated with dietary intake across four levels of ecologic influence. An interprofessional team devised a comprehensive search strategy to identify these factors among working-age (18-64 years) PWIM. We queried Ovid MEDLINE, Web of Science, Scopus, and Embase via Ovid for articles published between January 1, 1990 and April 25, 2021. Twelve studies met our review criteria. We classified factors within one of four ecologic levels of influence: individual, social, environmental, and policy/program. Most studies disproportionately reported on personal level factors of influence, with less information on other levels of influence. This systematic review is an important first step for informing the design of evidence-based strategies to support healthy eating among PWIM. However, it also reveals a wide chasm in the needed information to adequately bridge structural determinants of this nutrition divide. More studies are needed that include rigorous measures of dietary intake and that aim to elicit how social, environmental, and policy-level factors contribute to dietary disparities among PWIM.
Collapse
Affiliation(s)
- Marianna S Wetherill
- University of Oklahoma Tulsa Schusterman Center, Hudson College of Public Health, Department of Health Promotion Sciences, 4502 E. 41st St., Tulsa, OK 74135, United States of America; University of Oklahoma Tulsa Schusterman Center, OU-TU School of Community Medicine, 4502 E. 41st St., Tulsa, OK 74135, United States of America.
| | - Ashten R Duncan
- University of Oklahoma Tulsa Schusterman Center, OU-TU School of Community Medicine, 4502 E. 41st St., Tulsa, OK 74135, United States of America
| | - Hartley Bowman
- University of Oklahoma Tulsa Schusterman Center, College of Allied Health, Department of Rehabilitation Sciences, Physical Therapy Program, 4502 E. 41st St., Tulsa, OK 74135, United States of America
| | - Reagan Collins
- University of Oklahoma Tulsa Schusterman Center, College of Allied Health, Department of Rehabilitation Sciences, Occupational Therapy Program, 4502 E. 41st St., Tulsa, OK 74135, United States of America
| | - Natalie Santa-Pinter
- University of Oklahoma Tulsa Schusterman Center, OU-TU School of Community Medicine, 4502 E. 41st St., Tulsa, OK 74135, United States of America
| | - Morgan Jackson
- University of Oklahoma Tulsa Schusterman Center, OU-TU School of Community Medicine, 4502 E. 41st St., Tulsa, OK 74135, United States of America
| | - Catherine M Lynn
- University of Oklahoma Tulsa Schusterman Center, OU-TU School of Community Medicine, 4502 E. 41st St., Tulsa, OK 74135, United States of America
| | - Katherine Prentice
- University of Oklahoma Tulsa Schusterman Center, Schusterman Library, 4502 E. 41st St., Tulsa, OK 74135, United States of America
| | - Mary Isaacson
- University of Oklahoma Tulsa Schusterman Center, College of Allied Health, Department of Rehabilitation Sciences, Occupational Therapy Program, 4502 E. 41st St., Tulsa, OK 74135, United States of America
| |
Collapse
|
15
|
Huynh KA, Cho HE, Yue M, Wang L, Chung KC, Waljee JF. Patterns of Upper Extremity Reconstruction for Patients With Tetraplegia Across the United States: A Retrospective Study. J Hand Surg Am 2021; 46:952-962.e24. [PMID: 34366179 DOI: 10.1016/j.jhsa.2021.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Revised: 06/20/2021] [Accepted: 06/24/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE The rates of upper extremity reconstruction for patients with tetraplegia remain low. We performed a retrospective study to assess recent reconstruction rates and delineate factors associated with the occurrence of reconstruction. METHODS We examined the National Inpatient Sample database (2012-2017) for the rate of reconstruction for patients with tetraplegia. The details of provider distribution characteristics and neighborhood attributes were obtained from the American Medical Association Physician Masterfile and based on the area deprivation index, respectively. We calculated the mean reconstruction rate per year and generated multivariable logistic regression models to examine the influence of patient factors, hospital characteristics, and provider distribution on the odds of undergoing functional reconstruction for tetraplegia patients. RESULTS Among 404,660 encounters with patients with tetraplegia, only 1,430 (0.4%) patients underwent upper extremity reconstruction from 2012 to 2017, with a mean rate of 238 procedures per year. We identified 5,450 hand surgeons, 12,751 physiatrists, and 444 spinal cord injury specialists, with variation in their national distribution. A greater number of surgeons near SCIS was associated with increased probability of reconstruction (odds ratio [OR] 1.07, 95% confidence interval [CI] 1.03-1.12). The odds of surgery were greater for patients receiving care at urban teaching (OR 5.00, 95% CI 3.35-7.47) or urban nonteaching (OR 1.71, 95% CI 1.11-2.63) hospitals, whereas those at private nonprofit (OR 0.67, 95% CI 0.58-0.78) or investor-owned (OR 0.65, 95% CI 0.52-0.82) hospitals had lower odds. Although most patients had insurance coverage, patients with a higher income or those who received subsidized care had greater odds of undergoing reconstruction. CONCLUSIONS Reconstruction rates remain low and are correlated with the environment of care, financial factors, and provider availability. Policies that focus on reducing these factors in addition to increasing interspecialty collaboration could improve access to surgery for patients with tetraplegia. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic I.
Collapse
Affiliation(s)
- Kristine A Huynh
- Oakland University William Beaumont School of Medicine, Rochester, MI; Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Hoyune E Cho
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Molin Yue
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Lu Wang
- Department of Biostatistics, University of Michigan, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Jennifer F Waljee
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
| |
Collapse
|
16
|
Simpson B, Villeneuve M, Clifton S. Exploring well-being services from the perspective of people with SCI: A scoping review of qualitative research. Int J Qual Stud Health Well-being 2021; 16:1986922. [PMID: 34694982 PMCID: PMC8547844 DOI: 10.1080/17482631.2021.1986922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Objective Well-being after spinal cord injury is affected by a range of factors, many of which are within the influence of rehabilitation services. Although improving well-being is a key aim of rehabilitation, the literature does not provide a clear path to service providers who seek to improve well-being. This study aimed to inform service design by identifying the experience and perspective of people with SCI about interventions targeting their well-being. Method The scoping review of qualitative literature used thematic analysis to identify and categorize themes related to service activities, valued aspects, limitations and perceived outcomes. Results Thirty-eight studies were selected, related to a range of service types. Most studies did not adopt a well-being conceptual framework to design and evaluate the services. People with SCI particularly valued being treated with dignity, positive expectations, increased autonomy and peer support. Improvements to well-being were reported, including many years post-SCI. However, people with SCI reported limited opportunities to engage in such services. Conclusions Rehabilitation services can improve well-being across the lifetime of people with SCI, but gaps in service provision are reported. The review identified valued aspects of services that may inform service design, including staff approach and positive expectations, having own skills and worth valued, peer support and interaction, autonomy in valued occupations, and long-term opportunities for gains.
Collapse
Affiliation(s)
- Bronwyn Simpson
- Occupational Therapy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | | | - Shane Clifton
- Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability, Australia; Centre for Disability Research, The University of Sydney, Sydney, Australia
| |
Collapse
|
17
|
Moghalu O, Stoffel JT, Elliott S, Welk B, Lenherr S, Herrick J, Presson A, Myers J. Psychosocial aspects of health-related quality of life and the association with patient-reported bladder symptoms and satisfaction after spinal cord injury. Spinal Cord 2021; 59:987-996. [PMID: 33495582 PMCID: PMC8483561 DOI: 10.1038/s41393-020-00609-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/10/2020] [Accepted: 12/11/2020] [Indexed: 01/28/2023]
Abstract
STUDY DESIGN Prospective, multi-centered, observational. OBJECTIVES To characterize the relationship between psychosocial aspects of health-related quality of life (HRQoL) and patient-reported bladder outcomes. SETTING Multi-institutional sites in the United States, cohort drawn from North America. METHODS We performed a cross-sectional analysis of data collected as part of the multicenter, prospective Neurogenic Bladder Research Group Spinal Cord Injury (SCI) Registry. Outcomes were: Neurogenic Bladder Symptom Score (NBSS), Neurogenic Bladder Symptom Score Satisfaction (NBSS-Satisfaction), and SCI-QoL Bladder Management Difficulties (SCI-QoL Difficulties). Adjusted multiple linear regression models were used with variables including demographic, injury characteristics, and the following psychosocial HRQoL measures; SCI-QoL Pain Interference (Pain), SCI-QoL Independence, and SCI-QoL Positive Affect and Well-being (Positive Affect). Psychosocial variables were sub-divided by tertiles for the analysis. RESULTS There were 1479 participants, 57% had paraplegia, 60% were men, and 51% managed their bladder with clean intermittent catheterization. On multivariate analysis, higher tertiles of SCI-QoL Pain were associated with worse bladder symptoms, satisfaction, and bladder management difficulties; upper tertile SCI-QoL Pain (NBSS 3.8, p < 0.001; NBSS-satisfaction 0.6, p < 0.001; SCI-QoL Difficulties 2.4, p < 0.001). In contrast, upper tertiles of SCI-QoL Independence and SCI-QoL Positive Affect were associated with improved bladder-related outcomes; upper tertile SCI-QoL Independence (NBSS -2.3, p = 0.03; NBSS-satisfaction -0.4, p < 0.001) and upper tertile SCI-QoL Positive Affect (NBSS -2.8, p < 0.001; NBSS-satisfaction -0.7, p < 0.001; SCI-QoL Difficulties -0.7, p < 0.001). CONCLUSIONS In individuals with SCI, there is an association between psychosocial HRQoL and bladder-related QoL outcomes. Clinician awareness of this relationship can provide insight into optimizing long-term management after SCI.
Collapse
Affiliation(s)
- Odinachi Moghalu
- Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA.
| | - John T Stoffel
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Sean Elliott
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Blayne Welk
- Department of Urology, Western University, London, ON, Canada
| | - Sara Lenherr
- Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA
| | - Jennifer Herrick
- Department of Internal Medicine, Division of Epidemiology and Biostatistics, University of Utah, Salt Lake City, UT, USA
| | - Angela Presson
- Department of Internal Medicine, Division of Epidemiology and Biostatistics, University of Utah, Salt Lake City, UT, USA
| | - Jeremy Myers
- Department of Surgery (Urology), University of Utah, Salt Lake City, UT, USA
| |
Collapse
|
18
|
García-Rudolph A, Cegarra B, Opisso E, Tormos JM, Saurí J. Relationships Between Functionality, Depression, and Anxiety With Community Integration and Quality of Life in Chronic Traumatic Spinal Cord Injury. Am J Phys Med Rehabil 2021; 100:840-850. [PMID: 33935149 DOI: 10.1097/phm.0000000000001773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aims of the study were (1) to identify relationships between functional and psychological aspects with community integration and quality of life assessments in people with chronic traumatic spinal cord injury and (2) to analyze clinical and demographic predictors of quality of life dimensions. DESIGN This is an observational cohort study, and correlation coefficients were calculated between the Functional Independence Measure, the Hospital Anxiety and Depression Scale, the Community Integration Questionnaire, and the World Health Organization Quality of Life-BREF dimensions (physical [D1], psychological [D2], social [D3], and environmental [D4]). Quality of life predictors were identified using multiple linear regression analyses. RESULTS Nine hundred seventy-five people with traumatic spinal cord injury assessed since 2007-2020 were included. The Community Integration Questionnaire home integration correlated strongly with the Functional Independence Measure self-care (r = 0.74) and transfers (r = 0.62) for participants with tetraplegia. The specific Hospital Anxiety and Depression Scale items (known as the anhedonia subscale) correlated strongly with D1 (r = -0.65), D2 (r = -0.69), D3 (r = -0.53), and D4 (r = -0.51) for participants with paraplegia and D1 (r = -0.53), D2 (r = -0.61), D3 (r = -0.47), and D4 (r = -0.53) for participants with tetraplegia. The Hospital Anxiety and Depression Scale-depression was the most relevant predictor of D1 (β = -0.61) and D2 (β = -0.76). CONCLUSIONS The Functional Independence Measure transfers and self-care were strongly associated with the Community Integration Questionnaire home integration (in participants with tetraplegia). Anhedonia was strongly related to all four World Health Organization Quality of Life-BREF Scale dimensions, being the Hospital Anxiety and Depression Scale-depression the most relevant predictor of D1 and D2. TO CLAIM CME CREDITS Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME. CME OBJECTIVES Upon completion of this article, the reader should be able to (1) Determine the associations between functional and psychological measures with community integration domains and quality of life from a multidimensional perspective (physical, psychological, social, and environmental) in persons with chronic traumatic paraplegia or tetraplegia living in the community; (2) Identify long-term clinical and demographic predictors of specific quality of life dimensions (e.g., physical and psychological) in persons with paraplegia or tetraplegia living in the community; and (3) Illustrate the strength of the identified associations and the impact of the quality of life predictors to suggest possible specific aspects to be addressed by professionals in clinical practice. LEVEL Advanced. ACCREDITATION The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Collapse
Affiliation(s)
- Alejandro García-Rudolph
- From the Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain; and Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Badalona, Barcelona, Spain
| | | | | | | | | |
Collapse
|
19
|
Moltaji S, Novak CB, Dengler J. Nerve transfer surgery in spinal cord injury: online information sharing. BMC Neurol 2021; 21:177. [PMID: 33892642 PMCID: PMC8066948 DOI: 10.1186/s12883-021-02209-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Accepted: 04/19/2021] [Indexed: 11/22/2022] Open
Abstract
Background Nerve transfer to improve upper extremity function in persons with cervical spinal cord injury (SCI) is a new reconstructive option, and has led to more people seeking and sharing surgical information and experiences. This study evaluated the role of social media in information-sharing on nerve transfer surgery within the SCI community. Methods Data were collected from Facebook, which is the favored information-sharing platform among individuals seeking medical information. Searched terms included ‘spinal cord injury’ and ‘SCI’ and excluded groups with: less than two members (n = 7); closed groups (n = 2); not pertaining to SCI (n = 13); restricted access (n = 36); and non-English (n = 2). Within public and private accessed groups, searches were conducted for ‘nerve’, ‘transfer’, ‘nerve transfer’, and ‘nerve surgery’. Each post about nerve transfer, responses to posts, and comments about nerve transfer in response to unrelated posts were tabulated. Thematic content analyses were performed and data were categorized as seeking information, sharing information, sharing support, and sharing appreciation. Results The search yielded 99 groups; 35 met the inclusion criteria (average size = 2007, largest = 12,277). Nerve transfer was discussed in nine groups, with 577 total mentions. In the seeking information axis, posts were related to personal experience (54%), objective information (31%), surgeon/center performing the procedure (9%), and second opinion (4%). At least 13% of posts were from individuals learning about nerve transfers for the first time. In the sharing information axis, the posts: shared personal experience (52%); shared objective information (13%); described alternative treatment (3%); tagged someone to share information (11%); linked to outside resources (12%); and recommended a specific surgeon/center (9%). Conclusion Social media is an important source of information and support for people with SCI. There is a paucity of information on nerve transfers. These study findings will inform implementation of future education strategies.
Collapse
Affiliation(s)
- Syena Moltaji
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christine B Novak
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada.,Division of Plastic and Reconstructive Surgery, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jana Dengler
- Division of Plastic and Reconstructive Surgery, Department of Surgery, University of Toronto, Toronto, ON, Canada. .,Division of Plastic and Reconstructive Surgery, Tory Trauma Program, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
| |
Collapse
|
20
|
Lien WC, Wang WM, Wang JD, Wang F. The association between economic indicators and the incidence of tetraplegia from traumatic spinal cord injury in Taiwan. BMC Neurol 2021; 21:117. [PMID: 33731028 PMCID: PMC7968275 DOI: 10.1186/s12883-021-02141-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/05/2021] [Indexed: 12/03/2022] Open
Abstract
Background Economic performance may affect public health parameters. This study aimed to determine the time trend of incidence of traumatic spinal cord injury (SCI) and its association with income, presented by GDP (gross domestic product) per capita. Methods This study was a retrospective observational study in Taiwan. Newly diagnosed SCI patients with moderate to severe disability from 2002 to 2015 were identified from the reimbursement database of the National Health Insurance (NHI) system (1998–2015). CIR16–99 (cumulative incidence rate, aged 16–99 years, per 103 person-years) and CIR16–59 (aged 16–59 years) of SCI from 2002 to 2015 were measured. Results There were 5048 newly diagnosed SCI patients during the study period. After controlling the factors of sex, urbanization level, literacy, income inequality, and global financial crisis (mixed effects models), the CIR16–99 of SCI, traumatic SCI, motor vehicle (MV)-related SCI, fall-related SCI, tetraplegia, traumatic tetraplegia, MV-related tetraplegia, and fall-related tetraplegia were inversely associated with GDP per capita; the β coefficients ranged from − 4.85 (95% confidence interval − 7.09 to − 2.6) for total SCI to − 0.8 (− 1.3 to − 0.29) for fall-related tetraplegia. We restricted our comparison to Taipei City and the 4 lowest densely populated counties, which also corroborated with the above results. The income elasticity analysis revealed when GDP per capita increased by 1%, the total SCI decreased by 1.39‰; which was also associated with a decrease of 1.34‰, 1.55‰, 1.36‰, 1.46‰, 1.54‰, 1.54‰, and 1.62‰ for traumatic SCI, MV-related SCI, fall-related SCI, tetraplegia, traumatic tetraplegia, MV-related tetraplegia, and fall-related tetraplegia respectively. The β coefficients show that the compared areas of urbanization level were also inversely correlated with CIR16–59 in the SCI population. Conclusions We conclude that the incidence of tetraplegia of traumatic SCI in Taiwan decreases with good economic performance, which may be resulted from the provision of public goods and services, possibly through improvements in the infrastructure of transportation and construction. Supplementary Information The online version contains supplementary material available at 10.1186/s12883-021-02141-8.
Collapse
Affiliation(s)
- Wei-Chih Lien
- Department of Physical Medicine and Rehabilitation, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, 704, Taiwan.,Department of Physical Medicine and Rehabilitation, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan.,Ph.D. Program in Tissue Engineering and Regenerative Medicine, National Chung Hsing University, Taichung, 402, Taiwan
| | - Wei-Ming Wang
- Department of Statistics, College of Management, National Cheng Kung University, Tainan, 701, Taiwan
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, 701, Taiwan. .,Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, 704, Taiwan.
| | - Fuhmei Wang
- Department of Economics and Department of Public Health, National Cheng Kung University, Tainan, 701, Taiwan.
| |
Collapse
|
21
|
Eidenberger M. Patient-Reported Outcome Measures With Secondary Lower Limb Lymphedemas: A Systematic Review. J Adv Pract Oncol 2021; 12:174-187. [PMID: 34109049 PMCID: PMC8017801 DOI: 10.6004/jadpro.2021.12.2.5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Patient-reported outcome measures are measures of patients' health-related quality of life. They should be added to other lymphedema measurements. With an improved disease-free survival of secondary lower limb lymphedema, attention must focus on such assessments. Objective The objectives of this study were to locate and critically appraise suitable patient-reported outcomes measures for lower limb lymphedemas and search for existing valid translations for native German speakers. Methods A systematic literature research was conducted. 20 semantical categories for qualitative analysis were evolved. Six questionnaires available in English and some in validated translations remained for analysis. Results Lower limb lymphedema patients experience poor quality of life, and one of the most critical denominators is skin quality. To establish skin care and prevent cellulitis, patients must learn about skin problems. Only two tools asked for past infections. This is considered crucial because of knowledge building and prophylactic behavior. Questions on movement restrictions were available in one questionnaire. As these have a close connection to one's ability to perform activities of daily life, they can affect quality of life. Afflicted patients have problems with the choice and availability of clothing. Only three questionnaires asked questions about clothing or shoes. Lymphedema patients are exposed to more psychological stress than healthy subjects, but only three questionnaires covered questions about this burden. There was a lack of reporting on psychometric data (Cronbach's alpha, intraclass correlation), which hinders the external validity. Analyzed questionnaires were available in English but only one in German. Conclusions The analyzed questionnaires were in English, and only one was adapted and tested for native German speakers. For clinical practice, Devoogdt's questionnaire is recommended despite some shortcomings. There is a need for validated lymphedema questionnaires in German.
Collapse
Affiliation(s)
- Margit Eidenberger
- University of Applied Sciences for Health Professions Upper Austria, Steyr, Austria
| |
Collapse
|
22
|
Anxiety Levels and Sexual Functions of Patients Performing Clean Intermittent Catheterization. SEXUALITY AND DISABILITY 2021. [DOI: 10.1007/s11195-020-09671-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
23
|
Fear of Falling, Community Participation, and Quality of Life Among Community-Dwelling People Who Use Wheelchairs Full Time. Arch Phys Med Rehabil 2020; 102:1140-1146. [PMID: 33347892 DOI: 10.1016/j.apmr.2020.11.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/15/2020] [Accepted: 11/16/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To examine the differences in community participation and quality of life (QOL) among individuals who use wheelchairs full time with and without fear of falling (FOF). DESIGN Cross-sectional study design. SETTING University research laboratory. PARTICIPANTS Individuals (N=85) who use a manual or power wheelchair full time who are living with various health conditions and have a history of at least 1 fall in the past 12 months (age, 45.4±15.8y; disability duration, 21.5±13.6y) were included. Forty-six (54%) were manual wheelchair users. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES To quantify FOF, participants responded (yes/no) to the question: "Are you worried or concerned that you might fall?" Community participation and QOL were indexed by the Community Participation Indicator (CPI) and the World Health Organization Quality of Life-Brief version (WHOQOL-BREF), respectively. A multivariate analysis of variance (MANOVA) was performed to examine the differences in CPI and WHOQOL-BREF scores among wheelchair users who reported FOF and no FOF. RESULTS A total of 54 participants (63.5%) reported that they were worried or concerned about falling. The MANOVA revealed significant differences in overall CPI (F2,82=4.714; P=.012; Wilks' λ=0.897) and WHOQOL-BREF (F4,63=3.32; P=.016; Wilks' λ=.826) scores. Participants who reported FOF demonstrated significantly lower CPI and WHOQOL-BREF scores compared with those who did not report FOF. CONCLUSIONS FOF and associated activity curtailment are prevalent and may be a factor influencing full time wheelchair users' community participation and QOL. Prospective research is needed to better understand how FOF influences community participation and QOL among individuals who use wheelchairs full time. Findings would support the development of interventions, specifically for individuals who use wheelchairs full time, to reduce FOF and improve community participation and QOL.
Collapse
|
24
|
Utilization of Outpatient Physical and Occupational Therapy in People With Spinal Cord Injury in Germany: Results of the German Spinal Cord Injury Survey. Am J Phys Med Rehabil 2020; 99:532-539. [PMID: 32167958 DOI: 10.1097/phm.0000000000001366] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The aim of the study was to assess factors determining the utilization of physical and occupational therapy in people with spinal cord injury. DESIGN Data from the German Spinal Cord Injury study conducted in 2017 were analyzed. The 12-mo prevalence of physical therapy and occupational therapy utilization was determined. To identify underlying determinants, multivariable logistic regression was used. RESULTS Of 1479 participants (response = 26.4%), 72.9% were male, with a mean (SD) age of 55.3 (14.6) yrs and a mean (SD) time since injury of 14.0 (12.0) yrs; 51.2% were people with paraplegia and 66.3% had an incomplete spinal cord injury. In the past 12 mos, 78.1% received physical and 29.3% occupational therapy. Physical therapy and occupational therapy were significantly associated with time since spinal cord injury occurrence, participation in lifelong care programs, and electric wheelchair dependency. Spinal cord injury characteristics, level of impairment, and time since spinal cord injury had a greater impact on occupational therapy than on physical therapy utilization. CONCLUSIONS The use of physical therapy and occupational therapy is much higher in Germans with spinal cord injury than in the general population and in people with similar neurological conditions. Further research should focus on the frequency of use and the types of interventions. Guidelines for lifelong care should include recommendations on physical therapy and occupational therapy.
Collapse
|
25
|
Craven BC, Alavinia SM, Wiest MJ, Farahani F, Hitzig SL, Flett H, Jeyathevan G, Omidvar M, Bayley MT. Methods for development of structure, process and outcome indicators for prioritized spinal cord injury rehabilitation Domains: SCI-High Project. J Spinal Cord Med 2019; 42:51-67. [PMID: 31573444 PMCID: PMC6781197 DOI: 10.1080/10790268.2019.1647386] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background: High-quality rehabilitation care following spinal cord injury or disease (SCI/D) is critical for optimizing neurorecovery and long-term health outcomes. This manuscript describes the methods used for developing, refining, and implementing a framework of structure, process, and outcome indicators that reflect high-quality rehabilitation among adults with SCI/D in Canada. Methods: This quality improvement initiative was comprised of the following processes: (1) prioritization of care Domains by key stakeholders (scientists, clinicians, therapists, patients and stakeholder organizations); (2) assembly of 11 Domain-specific Working Groups including 69 content experts; (3) conduct of literature searches, guideline and best practice reviews, and outcome synthesis by the Project Team; (4) refinement of Domain aim and construct definitions; (5) conduct of cause and effect analysis using Driver diagrams; (6) selection and development of structure, process and outcome indicators; (7) piloting and feasibility analysis of indicators and associated evaluation tools; and, (8) dissemination of the proposed indicators. Result: The Project Team established aims, constructs and related structure, process, and outcome indicators to facilitate uniform measurement and benchmarking across 11 Domains of rehabilitation, at admission and for 18 months thereafter, among adult Canadians by 2020. Conclusion: These processes led to the selection of a feasible set of indicators that once implemented should ensure that adults with SCI/D receive timely, safe, and effective rehabilitation services. These indicators can be used to assess health system performance, monitor the quality of care within and across rehabilitation settings, and evaluate the rehabilitation outcomes of the population to ultimately enhance healthcare quality and equity.
Collapse
Affiliation(s)
- B. Catharine Craven
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada, B. Catharine Craven, KITE – Toronto Rehab – University Health Network, 206-H 520 Sutherland Drive, Toronto, Ontario, Canada M4G3V9; Ph: 416-597-3422 x6122.
| | - S. Mohammad Alavinia
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Matheus J. Wiest
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Farnoosh Farahani
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Sander L. Hitzig
- 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
| | - Heather Flett
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Departmenet of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Gaya Jeyathevan
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Maryam Omidvar
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada
| | - Mark T. Bayley
- KITE, Toronto Rehab – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
26
|
Harris CA, Shauver MJ, Nasser JS, Chung KC. The golden year: How functional recovery sets the stage for tendon transfer surgery among patients with tetraplegia-a qualitative analysis. Surgery 2019; 165:365-372. [PMID: 30172564 PMCID: PMC10684031 DOI: 10.1016/j.surg.2018.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 05/08/2018] [Accepted: 07/09/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Tendon transfer surgery can effectively improve hand function for patients with tetraplegia but remains poorly utilized. Little is known regarding how patients' rehabilitation experiences influence their perception of function, identity, and coping to shape their reconstructive context. METHODS We performed a cross-sectional qualitative analysis of 19 participants with C4-C7 cervical spinal injuries: 9 patients had undergone reconstruction; 10 had not. Semistructured interviews were conducted using an interview guide focusing on rehabilitation experience, the relationship between function and identity, and how patient experience evolved. Interview transcripts were analyzed using grounded theory. RESULTS The study sample was predominantly male (79%), white (89%), and American Spinal Injury Association grades A-D (grade A: 42%; grade B: 32%; grade C: 16%; grade D: 10%). Recognizing rehabilitation's necessity, functional gains, and constructive patient-therapist relationships promoted engagement in therapy. Poor insurance coverage and financial constraints decreased rehabilitation access. Function affected identity through the degree to which it tied participants to a "patient" role. Early in recovery, patients' function, roles, and attitudes were fluid but solidified over time; how satisfied patients were with these final positions influenced how they coped. CONCLUSION The balance of patients' positive and negative coping has been found to influence patients' progression to surgery. This study describes how function and identity contribute to coping. Participants' function and identity evolved during a finite period we call "the golden year," before reaching a fixed point around which they built their lives. The norms patients establish during this time may affect receptiveness to surgery.
Collapse
Affiliation(s)
- Chelsea A Harris
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
| | - Melissa J Shauver
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Jacob S Nasser
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| |
Collapse
|
27
|
Turcotte S, Vallée C, Vincent C. [Occupational therapy and community integration of adults with neurological conditions: A scoping review]. The Canadian Journal of Occupational Therapy 2019; 85:365-377. [PMID: 30599776 DOI: 10.1177/0008417418813399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND. Although community integration (CI) is the ultimate goal of rehabilitation, it is rarely achieved in clinical settings. PURPOSE. The purpose of this study was to (a) synthesize the state of occupational therapy knowledge related to CI for people with neurological issues and to (b) illustrate how CI is conceptualized within the literature. METHOD. A scoping review was completed using two reviewers, resulting in the selection of 47 articles pertaining to four study populations. Themes common across all client populations were identified through content analysis, and an iterative synthesis was used to analyse the evolution of knowledge. FINDINGS. The selected articles covered craniocerebral trauma ( n = 21, 9 experimental categories [EXP]), medullar injuries ( n = 11, 4 EXP), cerebrovascular injuries ( n = 9, 4 EXP), and multiple sclerosis ( n = 4, 1 EXP). CI was used interchangeably with the term social participation. Fifty-one percent of the articles defined CI solely as part of a measurement tool, and 10% did not provide a definition of CI. The physical dimension of CI had been studied more frequently than the social and psychological dimensions. IMPLICATIONS. Innovative practices should work to enable community inclusion and full citizenship to support the long-term enablement.
Collapse
|
28
|
Relationships Between Specific Functional Abilities and Health-Related Quality of Life in Chronic Traumatic Spinal Cord Injury. Am J Phys Med Rehabil 2019; 98:14-19. [DOI: 10.1097/phm.0000000000001006] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
29
|
Foongchomcheay A, Eitivipart AC, Kespichayawattana J, Muangngoen M. Quality of life after spinal cord injury in Thai individuals: A mixed-methods study. Hong Kong Physiother J 2018; 39:35-55. [PMID: 31156316 PMCID: PMC6467828 DOI: 10.1142/s1013702519500045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 12/04/2017] [Indexed: 12/15/2022] Open
Abstract
Background: Patients with spinal cord injury (SCI) face various health-related difficulties. Physical limitations and health-related complications in individuals with SCI can lead to activity restrictions and lowering their quality of life (QoL). It is important to assess the QoL in population with SCI to gain more valuable insights into aspects of health-related QoL (HRQoL) that could play a key role in improving care for persons with SCI. Objective: To quantitatively measure the QoL in persons with SCI in Thailand and expand the results through qualitative investigation to provide meaning, context and depth of “how” and “why” they rated, defined and addressed their QoL in that way. Methods: The philosophical assumption of this study was set based on the post-positivist views using mixed-methods sequential explanatory design. The quantitative data were collected and analyzed in 101 Thai individuals with SCI using standardized Thai version of the Short Form Health Survey version 2 (SF-36v2), followed by the qualitative investigation of semi-structured interviews in 11 volunteers who participated in the SF-36v2 phase. Priority is given to quantitative data. The data integration occurred at the qualitative data collection through the data interpretation and discussion stage. Results: With regard to quantitative data, a recent study found a statistically significant difference (p<0.05) in four domains for male and three domains for the female when comparing the SF-36 Thai normative data with SF-36v2 SCI data. Qualitative data revealed that the most salient themes of HRQoL in individuals with SCI were “supporting factors toward QoL” and “driving force post injury”. The integration of the findings revealed that the qualitative data could individually explain and define QoL as well as support quantitative results. The connection of both findings indicated that the higher scores in psycho-social variables and lower scores in physical domains of SF-36v2 in Thai persons with SCI may be due to unique Thai family traditions and community values. Conclusion: The scores on SF-36v2 and the replies in the qualitative investigation of QoL themes of Thai individuals with SCI were similar to those of other research, but this study is unique in that it specifically represents the Thai socio-environmental-cultural aspects.
Collapse
Affiliation(s)
- Anchalee Foongchomcheay
- Faculty of Alliance Health Science, Department of Physical Therapy Chulalongkorn University, Bangkok, Thailand
| | - Aitthanatt Chachris Eitivipart
- Faculty of Nursing, Chulalongkorn University, Bangkok, Thailand.,Discipline of Exercise and Sport Sciences, Faculty of Health Sciences The University of Sydney, Sydney, Australia
| | | | - Monticha Muangngoen
- Sirindhorn National Medical Rehabilitation Institute, Physical Therapy Unit Nonthaburi, Thailand
| |
Collapse
|
30
|
Li J, Du L, Liu H, Gao F, Liu L, Guo Y, Wang C, Yang M, Li J, Zhang Y. [Hand function reconstruction by tendon transfers in patients with cervical spinal cord injury]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:542-547. [PMID: 29806340 DOI: 10.7507/1002-1892.201711078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Objective To explore the effectiveness of functional reconstruction of hand grasp and pinch by tendon transfers in patients with cervical spinal cord injury. Methods Between July 2013 and January 2016, tendon transfer surgery were performed in 21 patients (41 hands) with cervical spinal injury that motion level was located at C 6 to reconstruct hand grasp and pinch function. There were 18 males and 3 females with a mean age of 42.3 years (range, 17-65 years). Nineteen patients were with complete spinal cord injury [American Spinal Injury Association (ASIA) grading A], 1 patient was with central cord syndrome whose bilateral hands were completely paralyzed and lower limbs were normal (ASIA grading D), and 1 patient was with cervical spondylotic myelopathy (AISA grading D). The time from injury to hospitalization was 12-22 months (mean, 16.8 months). According to the International classification of surgery of the hand in tetraplegia (ICSHT), there were 6 cases of grade O3, 10 of grade O4, 3 of grade OCu5, and 2 of grade O5. The surgery was divided into two stages with an interval of 6-11 months. At the first stage, grip function was reconstructed in all patients by transfering the extensor carpi radialis longus from radialis side to palmar side through subcutaneous tunnel, and braided and sutured with the flexor pollicis longus and flexor digitorum profundus. At the second stage, the lateral pinch function of the thumb and index finger was reconstructed by braiding and suturing the radial half of the extensor carpi ulnaris (the patients graded as ICSHT O3) or pronator tere (the patients graded above ICSHT O3) with extensor pollicis longus and abductor pollicis longus. The grasp force, the thumb and index finger lateral pinch force, and the maximum fingertips distance between the thumb and index finger were measured at preoperation and at different time points after operation. The modified Lamb and Chan questionnaire, based upon the activities of daily living, was used to evaluate the hand function of all patients at 6 months after sencond stage surgery. Results There was 1 patient with elbow skin lesion, 1 patient with wrist stiffness; both of them recovered after corresponding treatment. All the 21 patients were followed up 15-32 months (mean, 19.6 months) without wound infection, tendon adhesion, tendon rupture, and other complications. The grasp forces of all patients were significantly improved at 4 weeks, 3 months, 6 months, and 1 year after the first stage surgery when compared with preoperative value ( P<0.05); and no significant difference was found between different time points after operation ( P>0.05). The thumb and index finger lateral pinch force and the maximum fingertips distance between the thumb and index finger of all patients were also significantly improved at 4 weeks, 3 months, 6 months, and 1 year after the second stage surgery when compared with preoperative values ( P<0.05); and no significant difference was found between different time points after operation ( P>0.05). And there was no significant difference of above indexes between the patients graded as ICSHT O3 and above ICSHT O3 ( P>0.05). The functional outcome was good in 19 cases, fair in 1 case, and poor in 1 case according to modified Lamb and Chan questionnaire at 6 months after second stage surgery. Conclusion Tendon transfer can significantly improve the hand function and the quality of life of the patients with complete cervical spinal cord injury.
Collapse
Affiliation(s)
- Jun Li
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068,
| | - Liangjie Du
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Hongwei Liu
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Feng Gao
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Lu Liu
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Yun Guo
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Chong Wang
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Mingliang Yang
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Jianjun Li
- Department of Spinal and Neural Functional Reconstruction, Beijing Bo'ai Hospital, China Rehabilitation Research Center, Beijing, 100068, P.R.China;Capital Medical University School of Rehabilitation Medicine, Beijing, 100068, P.R.China
| | - Youle Zhang
- Department of Hand Surgery, Beijing Jishuitan Hospital, Beijing, 100035, P.R.China
| |
Collapse
|
31
|
Renwick R, Yoshida K, Eacrett E, Rose N. Meaning of Staring and the Starer-Staree Relationship Related to Men Living With Acquired Spinal Cord Injuries. Am J Mens Health 2018; 12:283-291. [PMID: 26873341 PMCID: PMC5818106 DOI: 10.1177/1557988316632297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
When in public places, many individuals with physical disabilities experience staring. Although staring is typically seen as uncomplicated and something to be "ignored," it has consequences for the person being stared and the staree. Few studies have focused on staring experienced by men following spinal cord injury (SCI). Accordingly, this study explored how adult men with SCI give meaning to the staring from others, the consequences for them, and their responses to the staring and to the starer. Principles of modified grounded theory methods were used to conduct a secondary analysis of interview data for 30 male participants from a larger study of community-dwelling individuals with SCI. Themes revealed through analysis related to context-dependent meanings of staring, negative consequences of staring for some men, and positive opportunities for self-growth and interaction with the public. These findings contribute to a more complex understanding of staring and the relationship between the starer and staree in various social circumstances which can support people living with differences in their public interactions, and improve their quality of life.
Collapse
|
32
|
Hughes M, Burton AE, Dempsey RC. 'I am free in my wheelchair but pain does have a say in it though': The meaning and experience of quality of life when living with paraplegia and chronic pain. J Health Psychol 2017; 24:1356-1367. [PMID: 29284303 DOI: 10.1177/1359105317750254] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
This study investigated how wheelchair-using individuals with paraplegia and chronic pain make sense of the factors associated with quality of life based on interviews using photo-elicitation and interpretative phenomenological analysis. Three superordinate themes emerged in the analysis: experiencing quality of life through the perception of self and identity, interpersonal relationships as facilitators and barriers to quality of life and life in a wheelchair: pain experience and management. Quality of life for those living with paraplegia and chronic pain is experienced as a complex interaction across several life domains. The use of photographs may improve the communication of pain-related experiences and understanding by healthcare staff.
Collapse
|
33
|
The meaning of work after spinal cord injury: a scoping review. Spinal Cord 2017; 56:92-105. [PMID: 29057988 DOI: 10.1038/s41393-017-0006-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Revised: 08/21/2017] [Accepted: 08/21/2017] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Scoping review. OBJECTIVES To explore the meaning of work after spinal cord injury (SCI) in existing literature. METHODS Arksey and O'Malley's widely used methodological framework for scoping reviews was used to guide this review. Studies involving adults with SCI, conducted using qualitative methods, and published in peer reviewed literature were identified based on key terms and searches in three databases (CINAHL, MEDLINE, PsycINFO). Further search steps included checking citations in identified articles and citation tracking for other relevant articles and reviews. Reported qualitative data were then thematically analysed to generate themes. RESULTS Twelve studies were included. Three themes were identified across these studies that describe the meanings of work after spinal cord injury: re-developing a sense of self, re-establishing place in the community and regaining economic self-sufficiency. CONCLUSIONS The varied meanings of work after SCI identified in this review may be used in rehabilitation programs to explore ideas about work, the types of work they wish to pursue, and the ways in which work may be meaningful for people with SCI, so as to identify individually and contextually relevant work. Taking account of meaning in ICF based models of work participation could enhance patient-centred approaches in SCI rehabilitation.
Collapse
|
34
|
Gecht J, Mainz V, Boecker M, Clusmann H, Geiger MF, Tingart M, Quack V, Gauggel S, Heinemann AW, Müller CA. Development of a short scale for assessing economic environmental aspects in patients with spinal diseases using Rasch analysis. Health Qual Life Outcomes 2017; 15:196. [PMID: 29017570 PMCID: PMC5634831 DOI: 10.1186/s12955-017-0767-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 09/26/2017] [Indexed: 11/17/2022] Open
Abstract
Background Economic environmental factors represent important barriers to participation and have deleterious effects on quality of life (QOL) in persons with spinal diseases (SpD). While economic factors are anchored in the International Classification of Functioning, Disability and Health, their influence on QOL and participation from patients’ perspectives is an infrequent focus of research. The aim of the present research is to calibrate a culturally adapted Rasch-based questionnaire assessing economic QOL in patients with SpD. Methods The 11-items of the German economic-QOL-scale were answered by 325 patients with SpD on a four-point Likert-scale. Fit to the Rasch measurement model was investigated by testing for stochastic ordering of the items, unidimensionality, local independence, and differential item functioning (DIF). Results After adjusting for local dependency, fit to the Rasch model was achieved with a non-significant item-trait interaction (chi-squaredf = 20 = 34.8, p = 0.021). The person separation reliability equaled 0.88, the scale was free from age- or gender-related DIF, and unidimensionality could be verified. Conclusions The Rasch-based German version of the economic-QOL-scale represents a suitable instrument to investigate the influences of economic factors on patients’ QOL at a group and individual level. It can be easily applied in research and practice and may be administered quickly in combination with other instruments. The short test duration implies a low test burden for patients and a minimum of time expenditure by clinicians when evaluating the results.
Collapse
Affiliation(s)
- Judith Gecht
- Department of Medical Psychology and Medical Sociology, RWTH Aachen University, Pauwelsstr. 19, 52074, Aachen, Germany
| | - Verena Mainz
- Department of Medical Psychology and Medical Sociology, RWTH Aachen University, Pauwelsstr. 19, 52074, Aachen, Germany.
| | - Maren Boecker
- Department of Medical Psychology and Medical Sociology, RWTH Aachen University, Pauwelsstr. 19, 52074, Aachen, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
| | | | - Markus Tingart
- Department of Orthopedic Surgery, RWTH Aachen University, Aachen, Germany
| | - Valentin Quack
- Department of Orthopedic Surgery, RWTH Aachen University, Aachen, Germany
| | - Siegfried Gauggel
- Department of Medical Psychology and Medical Sociology, RWTH Aachen University, Pauwelsstr. 19, 52074, Aachen, Germany
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | | |
Collapse
|
35
|
Gomes CM, Miranda EP, de Bessa J, Bellucci CHS, Battistella LR, Abdo CHN, Bruschini H, Srougi M, Mulhall JP. Erectile Function Predicts Sexual Satisfaction in Men With Spinal Cord Injury. Sex Med 2017; 5:e148-e155. [PMID: 28823312 PMCID: PMC5562491 DOI: 10.1016/j.esxm.2017.06.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 05/07/2017] [Accepted: 06/11/2017] [Indexed: 10/26/2022] Open
Abstract
INTRODUCTION Spinal cord injury (SCI) is usually a sudden traumatic event and has a negative effect on sexual function. AIM To evaluate the characteristics of sexual activity in men with SCI and identify predictors of being sexually active and having a satisfactory sex life. METHODS We assessed sexual activity profiles of men with SCI from a Brazilian tertiary rehabilitation center from February to August 2012. All patients older than 18 years with SCI for longer than 1 year were invited to participate. We analyzed age, time since SCI, patient age at SCI, employment status, partner status, completeness of lesion, functional independence, urinary continence, and Sexual Health Inventory for Men (SHIM) score. MAIN OUTCOME MEASURES The SHIM was used to assess erectile function (EF). Satisfaction with sex life was analyzed as a dichotomous variable. Predictors of an active and satisfactory sex life were identified using univariable and multivariable analyses. RESULTS We evaluated 295 men with mean age of 40.7 ± 14.5 years. Most patients had a complete SCI (65.1%) and 159 (53.9%) were incontinent. The median SHIM score was 5 (interquartile range = 0-16) and only 71 men (24.1%) had a SHIM score of at least 17. Of these men, 159 (53.9%) were sexually active. Only 63 men (39.6%) were satisfied with their sex life after SCI. In univariable analysis, all variables were associated with an active sex life. Those with a SHIM score of at least 17 had a greater likelihood of being sexually active (odds ratio = 116, 95% confidence interval = 14-432). EF was the only parameter associated with a satisfactory sex life (odds ratio = 1.3, 95% confidence interval = 1.2-1.4). CONCLUSIONS Most men with SCI were sexually inactive and/or dissatisfied with their sex life. Age, duration of SCI, completeness of SCI, continence, having a partner, and good EF were identified as predictors of an active sex life. However, only EF was a predictor of a satisfactory sex life. Gomes CM, Miranda EP, de Bessa J, et al. Erectile Function Predicts Sexual Satisfaction in Men With Spinal Cord Injury. Sex Med 2017;5:e148-e155.
Collapse
Affiliation(s)
- Cristiano M Gomes
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil.
| | - Eduardo P Miranda
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil; Sexual and Reproductive Medicine Program, Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - José de Bessa
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | | | - Linamara Rizzo Battistella
- Institute of Physical Medicine and Rehabilitation, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | | | - Homero Bruschini
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | - Miguel Srougi
- Division of Urology, University of Sao Paulo School of Medicine, Sao Paulo, SP, Brazil
| | - John P Mulhall
- Sexual and Reproductive Medicine Program, Department of Surgery, Urology Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| |
Collapse
|
36
|
Harris CA, Muller JM, Shauver MJ, Chung KC. Leveraging the Medical Context to Increase Upper Extremity Reconstruction Among Patients With Tetraplegia: A Qualitative Analysis. Arch Phys Med Rehabil 2017; 99:459-467.e1. [PMID: 28782539 DOI: 10.1016/j.apmr.2017.06.028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 05/11/2017] [Accepted: 06/14/2017] [Indexed: 10/19/2022]
Abstract
OBJECTIVES To (1) characterize patients' medical experiences from initial injury until they become candidates for upper extremity reconstruction (UER); and (2) identify points in this medical context that may be most amenable to interventions designed to increase UER utilization. DESIGN A qualitative cross-sectional study using grounded theory methodology and constant comparative analysis of data collected through semistructured individual interviews. SETTING Community. PARTICIPANTS A sample of individuals with C4 to C8 cervical spinal injuries (N=19) who sustained injuries at least 1 year before interview. Nine patients had undergone reconstruction, and 10 had not. The study sample was predominantly male (79%) and white (89%), and American Spinal Injury Association grades A through D were represented (A, 42%; B, 32%; C, 16%; D, 10%). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Participants' self-report of their medical experiences from the time of injury through the early recovery period. RESULTS We identified 3 domains that formed patients' medical context before UER candidacy: (1) their ability to achieve and maintain health; (2) their relationship with health care providers; and (3) their expectations regarding clinicians' tetraplegia-specific expertise. Trust emerged as a major theme driving potential intervention targets. Patients transferred to referral centers had higher trust in tertiary providers relative to local physicians. In the outpatient setting, patients' trust correlated with the tetraplegia-specific expertise level they perceived the specialty to have (high for physical medicine and rehabilitation, intermediate for urology, low for primary care). CONCLUSIONS In appropriate candidates, UER produces substantial functional gains, but reconstruction remains underused in the tetraplegic population. By analyzing how patients achieve health and build trust in early recovery/injury, our study provides strategies to improve UER access. We propose that interventions targeting highly trusted points of care (transfer hospitals) and avoiding low-trust points (primary care physicians, home health) will be most effective. Urology may represent a novel entry point for UER interventions.
Collapse
Affiliation(s)
- Chelsea A Harris
- University of Michigan, Section of Plastic Surgery, Division of Hand Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - John-Michael Muller
- University of Michigan, Section of Plastic Surgery, Division of Hand Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - Melissa J Shauver
- University of Michigan, Section of Plastic Surgery, Division of Hand Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - Kevin C Chung
- University of Michigan, Section of Plastic Surgery, Division of Hand Surgery, Department of Surgery, The University of Michigan Health System, Ann Arbor, MI.
| |
Collapse
|
37
|
Harris CA, Muller JM, Shauver MJ, Chung KC. Checkpoints to Progression: Qualitative Analysis of the Personal and Contextual Factors That Influence Selection of Upper Extremity Reconstruction Among Patients With Tetraplegia. J Hand Surg Am 2017; 42:495-505.e11. [PMID: 28669418 PMCID: PMC5753404 DOI: 10.1016/j.jhsa.2017.04.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 04/07/2017] [Accepted: 04/10/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE Patients with tetraplegia consistently rank better use of the upper extremity as their top functional priority. Multiple case series have demonstrated that upper extremity reconstruction (UER) is well-tolerated and can produce substantial functional improvements for appropriate candidates; however, UER remains critically underutilized. The mechanisms that drive differences in provider practice and referral patterns have been studied, but comprehensive examination of the patient factors that influence UER decisions has not been performed for American patients. METHODS Nineteen patients with C4-8 cervical spinal injuries were selected using purposive sampling: 9 patients had undergone UER, 10 had not undergone UER. Semistructured interviews were conducted and transcripts evaluated using grounded theory methodology. RESULTS Our study yielded a conceptual model that describes the characteristics common to all patients who undergo UER. Patients who selected reconstruction proceeded stepwise through a shared sequence of steps: (1) functional dissatisfaction, (2) awareness of UER, and (3) acceptance of surgery. Patients' ability to meet these criteria was determined by 3 checkpoints: how well they coped, their access to information, and the acceptability of surgery. Extremely positive or negative coping prevented patients from moving from the Coping to the Information Checkpoint; thus, they remained unaware of UER and did not undergo surgery. A lack of knowledge regarding reconstruction was the strongest barrier to surgery among our participants. CONCLUSIONS We built a conceptual model that outlines how patients' personal and contextual factors drive their progression to UER. Moving from functional dissatisfaction to understanding that they were candidates for UER was a substantial barrier for participants, particularly those with very high and very low coping skills. CLINICAL RELEVANCE To improve utilization for all patients, interventions are needed to increase UER awareness. Standardizing introduction to UER during the rehabilitation process or improving e-content may represent key awareness access points.
Collapse
Affiliation(s)
- Chelsea A Harris
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - John-Michael Muller
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - Melissa J Shauver
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI
| | - Kevin C Chung
- Section of Plastic Surgery, The University of Michigan Health System, Ann Arbor, MI.
| |
Collapse
|
38
|
Hilton G, Unsworth C, Murphy G. The experience of attempting to return to work following spinal cord injury: a systematic review of the qualitative literature. Disabil Rehabil 2017; 40:1745-1753. [PMID: 28395535 DOI: 10.1080/09638288.2017.1312566] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE This review sought to answer the question "What are the barriers and facilitators influencing people's experience of return to work following spinal cord injury?" METHODS Studies that met the selection criteria were identified, presented and critically appraised using National Institute for Health and Care Excellence guidelines. Thematic synthesis was completed with studies possessing strong methodological rigor. Synthesis and interpretation involved three stages; coding of primary data; development of descriptive themes reflective of the primary data; and establishment of analytical themes to answer the review question. RESULTS Data from nine papers were included in the thematic synthesis. Several descriptive themes and three analytical themes were drawn from the data to answer the research question. Analytical themes included: a matrix of personal and environmental factors exists requiring complex navigation in order to create possibilities and opportunities for postinjury employment; the process of seeking or gaining employment shares a reciprocal relationship with the temporal nature of adjustment to spinal cord injury; and there is an intrinsic need for occupational engagement through paid employment. CONCLUSIONS Returning to or gaining employment after spinal cord injury is a fundamentally difficult experience for people. Multiple strategies are required to support the navigation of the process. There is, however, a need in people with spinal cord injury, to be a worker, and with that comes the inherent benefits of being employed. Implications for rehabilitation Returning to work should be a significant focus of spinal cord injury rehabilitation. Employment is both possible and health promoting following spinal cord injury. Multiple strategies are required to support people to navigate the return to work process. It is important to be cognizant of the individual motivations for being a worker and the complexity of the adjustment process. Spinal cord injury centers can provide a consistent and supportive framework and culture of positivity about employment after spinal cord injury.
Collapse
Affiliation(s)
- Gillean Hilton
- a Department of Occupational Therapy , Central Queensland University , Melbourne , Australia.,b Victorian Spinal Cord Service , Austin Health , Melbourne , Australia
| | - Carolyn Unsworth
- a Department of Occupational Therapy , Central Queensland University , Melbourne , Australia.,c School of Health and Welfare , Jönköping University , Jönköping , Sweden.,d School of Occupational Therapy , Curtin University , Perth , Australia.,e School of Public Health La Trobe University , Melbourne , Australia
| | - Gregory Murphy
- e School of Public Health La Trobe University , Melbourne , Australia
| |
Collapse
|
39
|
Hilton G, Unsworth CA, Murphy GC, Browne M, Olver J. Longitudinal employment outcomes of an early intervention vocational rehabilitation service for people admitted to rehabilitation with a traumatic spinal cord injury. Spinal Cord 2017; 55:743-752. [DOI: 10.1038/sc.2017.24] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 11/09/2022]
|
40
|
Ferdiana A, Post MWM, King N, Bültmann U, van der Klink JJL. Meaning and components of quality of life among individuals with spinal cord injury in Yogyakarta Province, Indonesia. Disabil Rehabil 2017; 40:1183-1191. [PMID: 28271725 DOI: 10.1080/09638288.2017.1294204] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE Knowledge on the meaning of quality of life in individuals with spinal cord injury in developing countries is limited. This study aims to explore the meaning and components of quality of life for individuals with spinal cord injury in a rural area in Indonesia. METHOD Data were obtained through semi-structured interviews with 12 individuals with paraplegia (8 males, 4 females) aged 24-67 years. Thematic analysis was used to identify themes that constitute meaning and components of quality of life. RESULTS Quality of life was not an easily understood concept, while "life satisfaction" and "happiness" were. Life satisfaction was associated with a person's feeling when achieving goals or dreams and related to fulfillment of needs. Thirteen components of life satisfaction were identified and categorized into five domains as follows: (1) participation: earning income and work, being useful to others, community participation, and having skills and knowledge, (2) social support: social support, social relationship, (3) relationship with God: injury is God's will, praying, (4) independence: being independent, mobility and accessibility, and health, and (5) psychological resources: accepting the condition, maintaining goals and motivation. CONCLUSIONS Social, cultural and religious influences were prominent in the perception of life satisfaction. The measurement of quality of life for individuals with spinal cord injury in Indonesia needs to consider locally perceived meaning and components of quality of life. Implications for Rehabilitation Financial, social and health needs of individuals with spinal cord injury in Indonesia must be immediately addressed. To increase financial independence, rehabilitation professionals should equip individuals with spinal cord injury with adequate self-employment skills. Sociocultural and religious aspects should be considered in the measurement of quality of life.
Collapse
Affiliation(s)
- Astri Ferdiana
- a Community and Occupational Medicine, Department of Health Sciences , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands.,b Department of Public Health, Faculty of Medicine , University of Mataram , Mataram , Indonesia
| | - Marcel W M Post
- c Center of Excellence for Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht and De Hoogstraat , Utrecht , The Netherlands.,d Department of Rehabilitation Medicine , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Nigel King
- e School of Human and Health Sciences, University of Huddersfield , Huddersfield , UK
| | - Ute Bültmann
- a Community and Occupational Medicine, Department of Health Sciences , University Medical Center Groningen, University of Groningen , Groningen , The Netherlands
| | - Jac J L van der Klink
- f Tranzo , School of Social and Behavioral Sciences, Tilburg University , Tilburg , The Netherlands
| |
Collapse
|
41
|
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.
Collapse
|
42
|
Ripat J, Borisoff JF, Grant LE, Chan FHN. Patterns of community participation across the seasons: A year-long case study of three Canadian wheelchair users. Disabil Rehabil 2017; 40:722-731. [DOI: 10.1080/09638288.2016.1271463] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Jacquie Ripat
- Department of Occupational Therapy, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada
| | - Jaimie F. Borisoff
- Rehabilitation Engineering Design Lab, British Columbia Institute of Technology, Burnaby, Canada
| | | | - Franco H. N. Chan
- International Collaboration on Repair Discoveries, Vancouver, Canada
| |
Collapse
|
43
|
Strength training for partially paralysed muscles in people with recent spinal cord injury: a within-participant randomised controlled trial. Spinal Cord 2016; 55:460-465. [PMID: 27922626 DOI: 10.1038/sc.2016.162] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2016] [Revised: 10/13/2016] [Accepted: 10/14/2016] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Within-participant randomised controlled trial. OBJECTIVES To determine whether strength training combined with usual care increases strength in partially paralysed muscles of people with recent spinal cord injury (SCI) more than usual care alone. SETTINGS SCI units in Australia and India. METHODS Thirty people with recent SCI undergoing inpatient rehabilitation participated in this 12-week trial. One of the following muscle groups was selected as the target muscle group for each participant: the elbow flexors, elbow extensors, knee flexors or knee extensors. The target muscle on one side of the body was randomly allocated to the experimental group and the same muscle on the other side of the body was allocated to the control group. Strength training was administered to the experimental muscle but not to the control muscle. Participants were assessed at baseline and 12 weeks later. The primary outcome was maximal isometric muscle strength, and the secondary outcomes were spasticity, fatigue and participants' perception of function and strength. RESULTS There were no dropouts, and participants received 98% of the training sessions. The mean (95% confidence interval (CI)) between-group difference for isometric strength was 4.3 Nm (1.9-6.8) with a clinically meaningful treatment effect of 2.7 Nm. The mean (95% CI) between-group difference for spasticity was 0.03/5 points (-0.25 to 0.32). CONCLUSION Strength training increases strength in partially paralysed muscles of people with recent SCI, although it is not clear whether the size of the treatment effect is clinically meaningful. Strength training has no deleterious effects on spasticity.
Collapse
|
44
|
Tansey TN, Bezyak J, Kaya C, Ditchman N, Catalano D. Resilience and Quality of Life. REHABILITATION COUNSELING BULLETIN 2016. [DOI: 10.1177/0034355216655146] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The construct of resilience is key to understanding adaptation to disability from a strengths-based perspective. The objective of this study was to examine the impact of factors identified in Kumpfer’s resilience model on quality of life (QOL) outcomes for adults with spinal cord injury (SCI), specifically taking into account injury characteristics, self-efficacy, resiliency characteristics, and social support using hierarchical regression analysis. Participants included 255 adults with SCI. Findings revealed that the overall model accounted for 75% of the variance in QOL outcomes. In particular, coexisting pain, participation self-efficacy, core self-evaluation, resiliency characteristics, cognitive strength, general health, and social support independently contributed to the variance in QOL scores. Implications of these findings for developing theory-driven, strengths-based approaches for improving rehabilitation outcomes for individuals with SCI are discussed.
Collapse
Affiliation(s)
| | - Jill Bezyak
- University of Northern Colorado, Greeley, USA
| | - Cahit Kaya
- Southern University and A&M College, Baton Rouge, LA, USA
| | | | | |
Collapse
|
45
|
Model Programs to Address Obesity and Cardiometabolic Disease: Interventions for Suboptimal Nutrition and Sedentary Lifestyles. Arch Phys Med Rehabil 2016; 97:S238-46. [PMID: 27422346 DOI: 10.1016/j.apmr.2016.05.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2015] [Revised: 05/06/2016] [Accepted: 05/10/2016] [Indexed: 12/12/2022]
Abstract
Problems posed by obesity-related endocrine diseases embody a national health crisis. Caloric excess and sedentary lifestyle from which they develop also pose significant challenges for rehabilitation providers. Almost two thirds of the U.S. population are currently overweight or obese, a number that has increased by >10% within the last decade and is expected to grow. An overweight body habitus is strongly associated with clinical hazards, including cardiometabolic syndrome, diabetes hypertension, and coronary artery disease. The component health risks of the cardiometabolic syndrome include coalescing of risk factors that predict a health calamity unless effective interventions can be developed and widely adopted. Obesity by itself is now considered an American Diabetes Association-qualified disability, but it is also disturbingly prevalent in other physical disability groupings of adults and children. This monograph describes successes of the Diabetes Prevention Program (DPP), a National Institutes of Health multisite randomized controlled trial that reported significant weight reduction and a 58% decreased incidence of type-2 diabetes accompanying 1 year of structured lifestyle intervention. This treatment benefit (1) exceeded that of metformin pharmacotherapy, (2) was so powerful that the trial was closed before reaching endpoints, and (3) was judged cost-effective for the patient and society. The DPP roadmap incorporating physical activity, diet, and behavioral approaches has been widely adapted to specific community, faith, racial, ethnic, school, and national populations with excellent outcomes success. The lockstep physical activity approach, activity prescription, and long-term success of the program are described and compared with other programs to illustrate effective countermeasures for the pandemics of obesity and obesity-related cardioendocrine disease. We will illustrate adaptation of the DPP for a cohort of persons with disability from spinal cord injury and the benefits observed.
Collapse
|
46
|
Locatelli SM, LaVela SL. Documentation of weight management practices for individuals with spinal cord injuries and disorders. Spinal Cord 2016; 54:1176-1182. [PMID: 27163450 DOI: 10.1038/sc.2016.59] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 02/19/2016] [Accepted: 03/07/2016] [Indexed: 11/10/2022]
Abstract
STUDY DESIGN This cross-sectional chart review study included 100 US Veterans with spinal cord injuries/disorders (SCI/D) who received care at a Veterans Affairs (VA) SCI facility during a 12-month period. Progress notes were examined to extract need for weight management (WM), patient-provider discussions about risk due to overweight/obesity, recommended lifestyle changes and/or follow-up and WM education. OBJECTIVES To understand what WM services are offered to Veterans with SCI/D within the VA SCI System of Care during comprehensive preventive health evaluations (annual evaluations), inpatient stays and outpatient visits. SETTING VA SCI System of Care, Department of Veterans Affairs, United States. RESULTS Overall, 73% demonstrated a need for WM. Weight was most frequently addressed during the nutrition assessment of annual evaluations, but this assessment was most likely to be skipped. Nutrition histories were missing many key components. Over half received WM education; individuals who were described as overweight/obese by their provider were more likely to receive education. Most of the Veterans who were seen in an inpatient setting were weighed; weight was only discussed with 12%. Less than half of the Veterans with outpatient visits were weighed, and 23% received WM recommendations. CONCLUSIONS Weight was frequently discussed during nutrition assessments, but infrequently addressed during outpatient or inpatient encounters. Few Veterans received specific recommendations on caloric/nutrient requirements and nutrition histories were missing recommended elements. Additional work is needed to help providers to incorporate WM information into care.
Collapse
Affiliation(s)
- S M Locatelli
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Department of Veterans Affairs (DVA), Hines, IL, USA.,Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, DVA, Hines, IL, USA
| | - S L LaVela
- Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Department of Veterans Affairs (DVA), Hines, IL, USA.,Spinal Cord Injury Quality Enhancement Research Initiative, Hines VA Hospital, DVA, Hines, IL, USA.,Center for Healthcare Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| |
Collapse
|
47
|
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.
Collapse
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
| |
Collapse
|
48
|
Tagaki M. Research Development from Acceptance to the Meaning of Acquired Disability in People with Impaired Mobility in Japan. JAPANESE PSYCHOLOGICAL RESEARCH 2016. [DOI: 10.1111/jpr.12123] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
|
49
|
Ganesh S, Mishra C. Physical Activity and Quality of Life among Adults with Paraplegia in Odisha, India. Sultan Qaboos Univ Med J 2016; 16:e54-61. [PMID: 26909214 DOI: 10.18295/squmj.2016.16.01.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2015] [Revised: 10/05/2015] [Accepted: 10/25/2015] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVES The complete rehabilitation of patients with spinal cord injuries (SCI) comprises both physical and psychosocial factors. This study therefore aimed to assess physical activity and quality of life (QOL) among paraplegic patients with SCI in Odisha, India. METHODS This cross-sectional prospective study was conducted between March 2010 and December 2013. All paraplegic patients treated at the Swami Vivekanand National Institute of Rehabilitation Training & Research in Odisha, India, during the study period who met the inclusion criteria were invited to participate in the study (n = 364). Structured face-to-face interviews were held with participants and QOL and physical activity were assessed using the abbreviated World Health Organization QOL instrument and the Physical Activity Scale for Individuals with Physical Disabilities, respectively. RESULTS A total of 84 people participated in the study (response rate: 23.1%). The mean age was 32.54 ± 10.75 years and 90.5% of the participants were male. Participants had a low mean metabolic equivalent score (18.18 ± 10.68 hours/day). Additionally, low mean scores were noted for the physical health, psychological well-being, social relationships and environment QOL domains (49.76 ± 18.74, 48.57 ± 17.04, 57.88 ± 17.04 and 49.85 ± 17.77, respectively). There was a strong positive association between levels of physical activity and all QOL domains (P <0.050). Physical activity and employment status were significant predictors of all QOL domains (P <0.001). CONCLUSION Low physical activity levels and QOL were noted among the paraplegic subjects. Interventions promoting physical activity and employment may help to improve QOL among this patient group.
Collapse
Affiliation(s)
- Shankar Ganesh
- Department of Physiotherapy, Swami Vivekanand National Institute of Rehabilitation Training & Research, Cuttack, Odisha, India
| | - Chittaranjan Mishra
- Department of Physiotherapy, Swami Vivekanand National Institute of Rehabilitation Training & Research, Cuttack, Odisha, India
| |
Collapse
|
50
|
Löfvenmark I, Norrbrink C, Nilsson Wikmar L, Löfgren M. 'The moment I leave my home - there will be massive challenges': experiences of living with a spinal cord injury in Botswana. Disabil Rehabil 2015; 38:1483-92. [PMID: 26694314 DOI: 10.3109/09638288.2015.1106596] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND When suffering a spinal cord injury (SCI), the patient and family face numerous challenges regardless of socio-economic level. The stigmatisation of persons with disabilities has been reported, however, reports from Southern Africa are largely lacking. PURPOSE To explore the experiences of living with a traumatic SCI in Botswana concerning perceived attitudes, obstacles and challenges. METHOD A qualitative approach with semi-structured interviews was conducted. Thirteen community-dwelling persons who have lived with an SCI for at least two years participated. RESULTS A theoretical model was formed that illustrate the associations between the core category, Self, and the categories Relationships and Society. The model illustrates that personal resources, including a strong identity and a positive attitude, are crucial to the experience of inclusion in the community. A supportive family, a source of income, and faith were strong facilitators, while inaccessibility and devaluing attitudes were barriers. Having a disability led to increased risk of poverty and social exclusion. CONCLUSION This study emphasised the importance of personal resources, family support, and improved accessibility to facilitate inclusion in the society. Informants requested legislation to advocate for the rights of persons with disabilities to be respected, with the aim of moving towards an equal accessible society. Implications for Rehabilitation Reclaiming or restructuring one's identity after a SCI is crucial for the person's ability to move on and develop beneficial coping strategies. Support from family and friends, staff and peer support are crucial parts in that process. Spirituality, values, needs and coping strategies vary profoundly among persons sustaining disabling injuries. In striving to optimise care, rehabilitation staff needs to be attentive to the personal resources and preferences to be able to individualise care, encounter, and facilitate transition back to the community. Family members play a crucial part in rehabilitation. It is essential for the patients' well-being and care that they get explicit descriptions of the patient's abilities. Living in a well-adapted home will facilitate well-being, independence, and return to work. Rehabilitation staff needs to focus their efforts on making this successful prior to discharge from hospital.
Collapse
Affiliation(s)
- Inka Löfvenmark
- a Department of Neurobiology, Care Sciences and Society , NVS, Division of Physiotherapy, Karolinska Institutet , Huddinge , Sweden ;,b Spinalis , Rehab Station Stockholm , Solna , Sweden
| | - Cecilia Norrbrink
- a Department of Neurobiology, Care Sciences and Society , NVS, Division of Physiotherapy, Karolinska Institutet , Huddinge , Sweden ;,c Department of Clinical Sciences , Karolinska Institutet Danderyd Hospital (KI DS) , Stockholm , Sweden
| | - Lena Nilsson Wikmar
- a Department of Neurobiology, Care Sciences and Society , NVS, Division of Physiotherapy, Karolinska Institutet , Huddinge , Sweden
| | - Monika Löfgren
- c Department of Clinical Sciences , Karolinska Institutet Danderyd Hospital (KI DS) , Stockholm , Sweden
| |
Collapse
|