1
|
Krause JS, Cao Y, Forcier NM. Longitudinal Comparisons in Health, Participation, Life Satisfaction, and Depressive Symptoms From Pre- to Post-COVID-19 Pandemic Among People With Spinal Cord Injuries. Arch Phys Med Rehabil 2024:S0003-9993(24)01001-3. [PMID: 38762196 DOI: 10.1016/j.apmr.2024.05.012] [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: 12/07/2023] [Revised: 04/25/2024] [Accepted: 05/05/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE To identify changes in health, health care utilization, participation, life satisfaction, and depressive symptoms from before the coronavirus disease 2019 pandemic to after among ambulatory and nonambulatory participants with spinal cord injury. DESIGN Longitudinal study with the first measurement taken within 3 months prior to pandemic restrictions and 2 follow-ups at approximately 1-year intervals. SETTING Medical university. PARTICIPANTS Adult participants (N=219) with spinal cord injury, including ambulatory (n=155) and nonambulatory (n=64). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Self-report assessment of health outcomes from the Behavioral Risk Factor Surveillance System; health service utilization including physician visits, emergency department visits, and hospitalizations; items from the Craig Handicap Assessment Reporting Technique; 3 life satisfaction scales from the Life Situation Questionnaire; and the brief version of the Patient Health Questionnaire. RESULTS After using a z score correction for nonnormality, none of the time effects or interaction effects of time by ambulatory status were significant. Six comparisons between ambulatory and nonambulatory were statistically significant. Ambulatory participants reported 3 more days in poor physical health (P=.02; statistically significant) and 2 more days feeling worried, tense, or anxious in the last 30 days (P=.03). They visited the emergency department on 0.3 fewer occasions (P=.02) while reporting leaving the house 1 more day every week (P=.02), 2 hours more of sitting tolerance (P<.01), and 1 higher score of vocational satisfaction (P=.03). CONCLUSIONS The absence of statistically significant changes from before to after the pandemic and the absence of time by ambulatory status interactions suggest stability of outcomes, even in the presence of pandemic challenges.
Collapse
Affiliation(s)
- James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, United States.
| | - Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, United States
| | - Noelle M Forcier
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, United States
| |
Collapse
|
2
|
Soegaard K, Sig JR, Nielsen C, Verhaeghe S, Beeckman D, Biering-Sørensen F, Sørensen JA. "I am just trying to live a life!" -a qualitative study of the lived experience of pressure ulcers in people with spinal cord injuries. J Tissue Viability 2024; 33:50-59. [PMID: 38044163 DOI: 10.1016/j.jtv.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Revised: 10/22/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
BACKGROUND Pressure ulcers (PUs) are frequently reported in people with spinal cord injuries (SCI). Wound management in people with SCI involves relieving pressure on the affected area by means of immobilisation and bed rest. The healing time of a PU can vary, but often takes several months or even years, causing people to stay in bed for prolonged periods of time. OBJECTIVE This study aims to explore the perspectives and lived experiences of people with SCI who are affected by PUs. DESIGN and method: This study is a qualitative explorative study that employs individual semi-structured in-depth interviews to obtain the narratives of people with SCI and a pressure ulcer. We used a phenomenological-hermeneutic approach that was inspired by Ricoeur's theory of interpretation. The analysis was performed in three levels: Naïve reading, structural analysis and critical interpretation and discussion. PARTICIPANTS and setting: Ten people with SCI who were being treated in the Danish healthcare system for their PU participated in this study: six participants had experienced a complete traumatic SCI, three had an incomplete traumatic SCI, and one had a non-traumatic complete SCI. The study included nine men and one woman, aged 49-81 years (mean 64). Nine had a PU in the seating area, while one had the ulcer on the leg. RESULTS The analysis revealed three themes: 1. Struggling to balance prevention with an active, meaningful life, 2. Challenges and consequences of pressure relief protocols and bed rest, 3. Experiencing prolonged and incoherent treatment with varying levels of staff engagement and competencies. CONCLUSIONS People with SCI and a PU have difficulty balancing their active, redefined lives when subjected to a strict pressure relief protocol. The consequences of immobility caused by pressure relief include reduced social and community participation and decreased quality of life. PU treatment is experienced as incoherent and unnecessarily lengthy, leading to a deterioration in the wounds. Improving PU treatment for people with SCI is of utmost importance and has the potential to benefit not only the people with SCI but also the healthcare system and the economy.
Collapse
Affiliation(s)
- Knaerke Soegaard
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark.
| | | | - Charlotte Nielsen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark; Department of Oral and Maxillofacial Surgery, Odense University Hospital, Odense, Denmark
| | - Sofie Verhaeghe
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Belgium
| | - Dimitri Beeckman
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University, Belgium; Swedish Centre for Skin and Wound Research, Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Fin Biering-Sørensen
- University of Copenhagen, Denmark; Department for Spinal Cord Injuries, NeuroScience Centre, Rigshospitalet, Denmark
| | - Jens Ahm Sørensen
- Research Unit for Plastic Surgery, Odense University Hospital, Odense, Denmark; Department of Clinical Research, Health Sciences, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
3
|
Heller R, Torri M, Gaab J, Haubruck P, Moghaddam-Alvandi A, Biglari B. Descriptive Analysis of Surgical Outcomes and Stoma Formation for Treating Sacral and Anal Pressure Injuries in Spinal Cord Injury: A Retrospective Study of Selected Cases. SAGE Open Nurs 2024; 10:23779608241229507. [PMID: 38379575 PMCID: PMC10878226 DOI: 10.1177/23779608241229507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 12/15/2023] [Accepted: 01/02/2024] [Indexed: 02/22/2024] Open
Abstract
Introduction Pressure injuries (PIs) arise from sustained pressure on tissue, leading to reduced blood flow to the affected area. In patients with spinal cord injuries (SCIs), these PIs can significantly diminish their independence and overall quality of life. This research sought to assess the frequency of surgical complications in treatment regimens for large sacral PIs involving the anus. Specifically, the study focused on the incorporation of stoma formation in patients with SCIs. Methods A retrospective review identified 25 SCI patients who had extensive sacral PIs. These patients underwent intestinal stoma formation as a preparatory step before plastic reconstructive surgery to address the wounds between 2015 and 2020. Results Successful wound closure was achieved in all instances. Notably, each patient had experienced a minimum of three unsuccessful reconstructive surgeries elsewhere before this intervention. The observed rate of surgical complications aligned with findings from previous analogous studies. Conclusion While often viewed as a treatment of last resort, an intestinal stoma might serve as a valuable strategy, particularly for SCI patients with extensive PIs near the anal region, to promote the healing of such injuries. Tailored decision-making is essential to ensure the best possible patient outcomes.
Collapse
Affiliation(s)
- Raban Heller
- Department of Traumatology and Orthopaedics Septic and Reconstructive Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
- Institute for Experimental Endocrinology, Berlin Institute of Health, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Marco Torri
- Department of Paraplegiology, BG Trauma Centre Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - Jasmin Gaab
- Department of Traumatology and Orthopaedics Septic and Reconstructive Surgery, Bundeswehr Hospital Berlin, Berlin, Germany
| | - Patrick Haubruck
- Raymond Purves Bone and Joint Research Laboratory, Kolling Institute, Institute of Bone and Joint Research, Faculty of Medicine and Health University of Sydney, Royal North Shore Hospital, St. Leonards, NSW, Australia
| | | | - Bahram Biglari
- Department of Paraplegiology, BG Trauma Centre Ludwigshafen, Ludwigshafen am Rhein, Germany
| |
Collapse
|
4
|
Wettstein R, Valido E, Buergin J, Haumer A, Speck N, Capossela S, Stoyanov J, Bertolo A. Understanding the impact of spinal cord injury on the microbiota of healthy skin and pressure injuries. Sci Rep 2023; 13:12540. [PMID: 37532801 PMCID: PMC10397227 DOI: 10.1038/s41598-023-39519-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Accepted: 07/26/2023] [Indexed: 08/04/2023] Open
Abstract
Pressure injuries (PI) are a common issue among individuals with spinal cord injury (SCI), especially in the sitting areas of the body. Considering the risk of infections occurring to PI during the wound healing process, the skin microbiome is likely to be a source of bacteria. We investigated the relationship between skin and PI microbiomes, and assessed any correlation with clinically relevant outcomes related to PI. Samples were isolated from SCI patients undergoing reconstructive surgery of PI, severity grades III and IV. DNA samples from skin and PI were analysed using 16S rRNA gene sequencing. Our results showed disparities in microbiome composition between skin and PI. The skin had lower diversity, while PI showed increased bacterial homogeneity as the severity grade progressed. The skin bacterial composition varied based on its location, influenced by Cutibacterium. Compositional differences were identified between PI grades III and IV, with clusters of bacteria colonizing PI, characterized by Pseudomonas, Proteus and Peptoniphilus. The skin and PI microbiomes were not affected by the level of the SCI. Our study highlights the differences in the microbiome of skin and PI in SCI patients. These findings could be used to target specific bacteria for PI treatment in clinical practice.
Collapse
Affiliation(s)
- Reto Wettstein
- SCI Population Biobanking and Translational Research Group, Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Ezra Valido
- SCI Population Biobanking and Translational Research Group, Swiss Paraplegic Research, Nottwil, Switzerland
- Department of Health Sciences, University of Lucerne, Lucerne, Switzerland
| | - Joel Buergin
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Alexander Haumer
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Nicole Speck
- Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital of Basel, Basel, Switzerland
| | - Simona Capossela
- SCI Population Biobanking and Translational Research Group, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Jivko Stoyanov
- SCI Population Biobanking and Translational Research Group, Swiss Paraplegic Research, Nottwil, Switzerland
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
| | - Alessandro Bertolo
- SCI Population Biobanking and Translational Research Group, Swiss Paraplegic Research, Nottwil, Switzerland.
- Department of Orthopaedic Surgery, Bern Inselspital, University of Bern, Bern, Switzerland.
| |
Collapse
|
5
|
Sgarzani R, Maietti E, Tedeschi S, Trapani FF, Battilana M, Landi S, Kiekens C, Negosanti L. Multidisciplinary treatment protocol for ischiatic, sacral, trochanteric or other pressure injuries in people with spinal cord injury: a retrospective cohort study. Spinal Cord 2023; 61:204-210. [PMID: 36564552 DOI: 10.1038/s41393-022-00869-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
STUDY DESIGN Retrospective cohort study Objectives: to describe the incidence and the associated risk factors of post-surgical complications and recurrence in individuals with spinal cord injury/disorder (SCI/D) presenting deep pressure injuries (PIs), treated with a specific surgical and rehabilitation treatment protocol. SETTING Tertiary Rehabilitation Hospital for SCI/D in Italy. METHODS Retrospective analysis of the medical records of adult individuals with SCI/D, who developed a PI after the first discharge from a Spinal Unit, underwent flap surgery for PI between July 2011 and January 2018. The statistical unit of analysis was the surgical intervention. Logistic regression analysis with robust standard errors was performed to assess risk factors of post-surgical complications. RESULTS 434 surgical intervention records were included, for a total of 378 patients. The treated PIs were ischiatic in 56.2% of the cases, sacral in 32.5%, trochanteric in 15.7%, and 5.8% were in other sites. In 239 cases (55.1%) a histological diagnosis of osteomyelitis was confirmed. Minor complications occurred in 13.6% of interventions, while major complications were 3.9%. Sacral PI (OR = 2.55, 95%CI: 1.50-4.35) and muscular/musculocutaneous flap (OR = 2.12, 95%CI: 1.05-4.28) were significant factors associated with risk of post-surgical complications. After a mean follow-up of 21 months (range 12-36), six people (1.4%) had a recurrence. Patients with a recurrence had at least one comorbidity compared to 57% of people without recurrences (p = 0.036). CONCLUSION Our results demonstrate that complication and recurrence rates can be minimized when an established interdisciplinary and rehabilitation protocol is integrated in the clinical management.
Collapse
Affiliation(s)
- Rossella Sgarzani
- DIMES (Dipartimento di medicina specialistica, diagnostica e sperimentale), Università di Bologna, Bologna, Italy.
| | - Elisa Maietti
- DIBINEM (Dipartimento di Scienze Biomediche e Neuromotorie), Università di Bologna, Bologna, Italy
| | - Sara Tedeschi
- Division of Infectious Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | - Fabio F Trapani
- Division of Infectious Diseases, S. Orsola-Malpighi University Hospital, Bologna, Italy
| | | | | | | | | |
Collapse
|
6
|
Scheel-Sailer A, Koligi K, Lampart P, Fähndrich C, Gmünder HP, Metzger S, Schaefer D, Schmitt K, Stalder S, Wettstein R, Gemperli A. Effect of a computerized decision support system on the treatment approach of stage III or IV pressure injury in patients with spinal cord injury: a feasibility study. BMC Health Serv Res 2023; 23:103. [PMID: 36721265 PMCID: PMC9890825 DOI: 10.1186/s12913-023-09045-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 01/06/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Stage III and IV pressure injuries (PIs) in patients with spinal cord injury (SCI) require complex interdisciplinary and interprofessional treatment approaches that are difficult to implement. Practical aspects, such as information exchange and coordination, remain challenging. We investigated whether a computerized decision support system (CDSS) could increase treatment adherence and improve clinical outcomes and interprofessional collaboration. METHOD In this feasibility study, a core team developed the initial treatment process and adapted it based on several discussions with clinical experts and information technologists. The CDSS followed the Basel Decubitus Approach and was used in a clinic specializing in SCI. Thirty patients with SCI admitted for stage III/IV PI between July 2016 and May 2017 were randomly allocated to standard or CDSS-supported care. Between-group differences in treatment adherence, complication rates, length of stay, and costs were analyzed using descriptive statistics. The use of the CDSS and potential barriers and facilitators were evaluated through interprofessional focus groups, transcribed verbatim, and thematically analyzed (30 participants). RESULTS No differences in SCI characteristics, comorbidities, or PI characteristics (localization: ischium [number (n) = 19 PI, 63%], sacrum [n = 10 PI, 33%], recurrent PI [n = 21, 70%]) were found between the two groups. Furthermore, no statistically significant differences were observed in treatment adherence, frequency of major (20% vs. 13% between CDSS and control group) and minor (33% vs 27%) complications, and length of stay (98 [±28] vs 81 [±23] days). Healthcare professionals found the CDSS to be helpful for visualizing the treatment process. However, the high workload and difficulties in the information technology processes, such as missing reminders, slow computer performance and data processing, and poor accessibility, hindered the effective implementation of the CDSS. CONCLUSION The implementation of the CDSS to support the treatment of stage III/IV PI in patients with SCI was feasible and included definitions of milestones, interventions, and outcomes. However, to assess the impact of the CDSS, a longer observation period is required. Further, the technical difficulties must be addressed, and solid integration of the CDSS into the clinical information system is necessary. TRIAL REGISTRATION This quality improvement project received a declaration of no objection from the Ethics Committee of Northwest and Central Switzerland (EKNZ UBE-16/003), and ethical approval was received for the focus groups (EKNZ Req-2017-00860).
Collapse
Affiliation(s)
- Anke Scheel-Sailer
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland ,grid.449852.60000 0001 1456 7938Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Kamran Koligi
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Patricia Lampart
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Carina Fähndrich
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Hans Peter Gmünder
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Stefan Metzger
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Dirk Schaefer
- grid.410567.1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Klaus Schmitt
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Stefan Stalder
- grid.419769.40000 0004 0627 6016Swiss Paraplegic Centre, Nottwil, Switzerland
| | - Reto Wettstein
- grid.410567.1Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital Basel, Basel, Switzerland
| | - Armin Gemperli
- grid.449852.60000 0001 1456 7938Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland ,grid.419770.cSwiss Paraplegic Research, Nottwil, Switzerland
| |
Collapse
|
7
|
Cantieni T, da Silva-Kress O, Wolf U. Detectability of low-oxygenated regions in human muscle tissue using near-infrared spectroscopy and phantom models. BIOMEDICAL OPTICS EXPRESS 2022; 13:6182-6195. [PMID: 36589557 PMCID: PMC9774876 DOI: 10.1364/boe.473563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 09/30/2022] [Accepted: 10/01/2022] [Indexed: 06/17/2023]
Abstract
The present work aims to describe the detectability limits of hypoxic regions in human muscle under moderate thicknesses of adipose tissue to serve as a groundwork for the development of a wearable device to prevent pressure injuries. The optimal source-detector distances, detection limits, and the spatial resolution of hypoxic volumes in the human muscle are calculated using finite element method-based computer simulations conducted on 3-layer tissue models. Silicone phantoms matching the simulation geometries were manufactured, and their measurement results were compared to the simulations. The simulations showed good agreement with the performed experiments. Our results show detectability of hypoxic volumes under adipose tissue thicknesses of up to 1.5 cm. The maximum tissue depth, at which hypoxic volumes could be detected was 2.8 cm. The smallest detectable hypoxic volume in our study was 1.2 cm3. We thus show the detectability of hypoxic volumes in sizes consistent with those of early-stage pressure injury formation and, consequently, the feasibility of a device to prevent pressure injuries.
Collapse
|
8
|
Cao Y, Murday D, Corley EH, DiPiro ND, Krause JS. Rehospitalization During the First 5 Years After the Onset of Traumatic Spinal Cord Injury: A Population-Based Study Using Administrative Billing Records. Arch Phys Med Rehabil 2022; 103:1263-1268. [PMID: 35218708 PMCID: PMC9246950 DOI: 10.1016/j.apmr.2022.01.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/14/2021] [Accepted: 01/21/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Our objective was to identify the number, length of stay, and charges of rehospitalizations during the subsequent 5 years after discharge from the initial hospitalization by using administrative billing records from a population-based cohort with spinal cord injury (SCI) in the southeastern United States. DESIGN Analysis of administrative billing data. SETTING State-based surveillance data analyzed by an academic medical center in the southeastern United States. PARTICIPANTS A total of 1872 individuals (N=1872) from a state-based surveillance system in the southeastern United States whose onset was between January 1, 1998, and January 1, 2010. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The outcome measures were the number of rehospitalization episodes, length of stay, and total hospital charges for each episode of rehospitalization. RESULTS Seventy percent of participants were rehospitalized during the first 5 years after initial discharge, and the highest rehospitalization rates were in the first year (54%), being relatively stable in years 2-5 (21%-22%). Adjusted to 2019 US dollars, the average total rehospitalization charges were $214,716 per person during the 5 years. Participants who could walk independently had fewer rehospitalizations, fewer rehospitalization days, and less rehospitalization charges than the nonambulatory participants. College education was also associated with less rehospitalization charges. CONCLUSIONS Rehospitalization is a significant cost after SCI. Further longitudinal study on the population cohorts and billing data are needed to quantify these changes over time.
Collapse
Affiliation(s)
- Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - David Murday
- Arnold School of Public Health, University of South Carolina, Columbia SC, USA
| | - Elizabeth H. Corley
- Arnold School of Public Health, University of South Carolina, Columbia SC, USA
| | - Nicole D. DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - James S. Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| |
Collapse
|
9
|
Cai S, Bakerjian D, Bang H, Mahajan SM, Ota D, Kiratli J. Data acquisition process for VA and non-VA emergency department and hospital utilization by veterans with spinal cord injury and disorders in California using VA and state data. J Spinal Cord Med 2022; 45:254-261. [PMID: 32543354 PMCID: PMC8986188 DOI: 10.1080/10790268.2020.1773028] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
Context: To identify VA and non-VA Emergency Department (ED) and hospital utilization by veterans with spinal cord injury and disorders (SCI/D) in California.Design: Retrospective cohort study.Setting: VA and Office of Statewide Health Planning and Development (OSHPD) in California.Participants: Total 300 veterans admitted to the study VA SCI/D Center for initial rehabilitations from 01/01/1999 through 08/17/2014.Interventions: N/A.Outcome Measures: Individual-level ED visits and hospitalizations during the first-year post-rehabilitation.Results: Among 145 veterans for whom ED visit data available, 168 ED visits were identified: 94 (55.2%) at non-VA EDs and 74 (44.8%) at the VA ED, with a mean of 1.16 (±2.21) ED visit/person. Seventy-seven (53.1%) veterans did not visit any ED. Of 68 (46.9%) veterans with ≥ one ED visit, 20 (29.4%) visited the VA ED only, 34 (50.0%) visited non-VA EDs only, and 14 (20.6%) visited both VA and non-VA EDs. Among 212 Veterans for whom hospitalization data were available, 247 hospitalizations were identified: 82 (33.2%) non-VA hospitalizations and 165 (66.8%) VA hospitalization with a mean of 1.17 (±1.62) hospitalizations/person. One hundred-seven (50.5%) veterans had no hospitalizations. Of 105 veterans with ≥ one hospitalization, 58 (55.2%) were hospitalized at the study VA hospital, 15 (14.3%) at a non-VA hospital, and 32 (30.5%) at both VA and non-VA hospitals.Conclusion: Non-VA ED and hospital usage among veterans with SCI/D occurred frequently. The acquisition of non-VA healthcare data managed by state agencies is vital to accurately and comprehensively evaluate needs and utilization rates among veteran populations.
Collapse
Affiliation(s)
- Sujuan Cai
- Department of the Veterans Affairs, Palo Alto Health Care System, Palo Alto, California, USA,The Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, California, USA,Correspondence to: Sujuan Cai, 3801 Miranda Ave. Building 7, VA Palo Alto Health Care System, Spinal Cord Injury/Disorder, Palo Alto, California94304, USA; Ph: 408-832-4205.
| | - Debra Bakerjian
- The Betty Irene Moore School of Nursing, University of California at Davis, Sacramento, California, USA
| | - Heejung Bang
- Division of Biostatistics, Department of Public Health Sciences, University of California at Davis, Davis, California, USA
| | - Satish M. Mahajan
- Department of the Veterans Affairs, Palo Alto Health Care System, Palo Alto, California, USA
| | - Doug Ota
- Department of the Veterans Affairs, Palo Alto Health Care System, Palo Alto, California, USA
| | - Jenny Kiratli
- Department of the Veterans Affairs, Palo Alto Health Care System, Palo Alto, California, USA
| |
Collapse
|
10
|
Cao Y, DiPiro N, Krause JS. Association of Secondary Health Conditions With Future Chronic Health Conditions Among Persons With Traumatic Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2021; 26:283-289. [PMID: 33536734 DOI: 10.46292/sci20-00020] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Secondary health conditions (SHC) are physical and mental health conditions that are causally related to disabilities. Studies have found that SHC increase risk of negative health outcomes among people with traumatic spinal cord injury (TSCI). However, little has been done to assess the association of SHC with the risk of chronic health conditions (CHC) after TSCI. Objectives To identify the prevalence of CHC in adults with TSCI, changes in CHC at follow-up, and the associations of baseline SHC with future CHC. Methods Participants included 501 adults with TSCI of at least 1-year duration, identified through a population-based surveillance system. Baseline and follow-up self-report assessments were completed. We measured seven SHC: fatigue, spasticity, pain, pressure ulcers, subsequent injury, fracture, and anxiety disorder, and measured seven CHC: diabetes, heart attack, coronary artery disease, stroke, cancer, hypertension, and high blood cholesterol. Control variables included gender, race/ethnicity, age at injury, years post injury, injury severity, smoking status, binge drinking, and taking prescription medication. We implemented a Poisson regression model for the multivariate analyses. Results The total number of CHC, the percentage of participants having at least one CHC, and prevalence of three individual CHC (diabetes, cancer, and high cholesterol) increased from baseline to follow-up. After controlling for demographic, injury characteristics, and behavioral factors, pain interference and anxiety disorder at baseline were associated with the total number of CHC at follow-up. Conclusion CHC are common among adults with TSCI and increase significantly over time. Pain and anxiety disorders appear to be risk factors for future CHC.
Collapse
Affiliation(s)
- Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Nicole DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| |
Collapse
|
11
|
Abstract
Spinal cord injury (SCI) causes immune dysfunction, increasing the risk of infectious morbidity and mortality. Since bone marrow hematopoiesis is essential for proper immune function, we hypothesize that SCI disrupts bone marrow hematopoiesis. Indeed, SCI causes excessive proliferation of bone marrow hematopoietic stem and progenitor cells (HSPC), but these cells cannot leave the bone marrow, even after challenging the host with a potent inflammatory stimulus. Sequestration of HSPCs in bone marrow after SCI is linked to aberrant chemotactic signaling that can be reversed by post-injury injections of Plerixafor (AMD3100), a small molecule inhibitor of CXCR4. Even though Plerixafor liberates HSPCs and mature immune cells from bone marrow, competitive repopulation assays show that the intrinsic long-term functional capacity of HSPCs is still impaired in SCI mice. Together, our data suggest that SCI causes an acquired bone marrow failure syndrome that may contribute to chronic immune dysfunction. Spinal cord injury (SCI) often leads to immune dysfunction, but mechanistic insights are still lacking. Here the authors show that SCI alters chemokine signaling and induces long, persisting defects in hematopoietic stem and progenitor cell migration, thereby entrapping them in the bone marrow and disrupting peripheral immune homeostasis.
Collapse
|
12
|
DiPiro ND, Murday D, Corley B, Krause JS. The association between participation and quality of life indicators with hospitalizations in ambulatory adults with spinal cord injury. Spinal Cord 2020; 58:1150-1157. [PMID: 32341477 DOI: 10.1038/s41393-020-0461-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 03/25/2020] [Accepted: 03/26/2020] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Statistical modeling of self-report assessments (SRA) as predictors of future hospitalizations, measured by administrative billing data. OBJECTIVES To examine the relationships between self-reported participation and quality of life (QOL) indicators and future hospital admissions among ambulatory adults with chronic spinal cord injury (SCI). SETTING Data were collected from participants living in and utilizing hospitals in the state of South Carolina. METHODS Participants were identified through the South Carolina SCI Surveillance System Registry. Between 2011 and 2015, 615 ambulatory adults (>18 years old) with chronic (>1-year), traumatic SCI completed mailed SRA. Participant socio-demographic, injury, health, participation, and QOL indicators were assessed using self-report data. Administrative billing data were used to measure hospital utilization in nonfederal, South Carolina hospitals in the year following the SRA. RESULTS Prior year discharges, current pressure ulcers, number of chronic conditions, walking 150 feet more often (never, less than once per week, at least once per week, once or twice per day, or several times per day), and greater home life satisfaction were associated with an increased risk of subsequent hospitalization. Walking 10 feet more frequently and greater global satisfaction were associated with a decreased risk of hospital admission. CONCLUSIONS Specific participation and QOL items may increase the risk of hospitalization in ambulatory adults with SCI. Further study is necessary to understand better the relationships between walking distance and frequency, home life and global satisfaction, and inpatient admissions.
Collapse
Affiliation(s)
- Nicole D DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA
| | - David Murday
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Beth Corley
- Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - James S Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC, USA.
| |
Collapse
|
13
|
Zanini C, Brach M, Lustenberger N, Scheel-Sailer A, Koch HG, Stucki G, Rubinelli S. Engaging in the prevention of pressure injuries in spinal cord injury: A qualitative study of community-dwelling individuals' different styles of prevention in Switzerland. J Spinal Cord Med 2020; 43:247-256. [PMID: 30540555 PMCID: PMC7054934 DOI: 10.1080/10790268.2018.1543094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Context: Spinal cord injury (SCI) is a complex chronic condition with multiple self-management requirements and a high prevalence of complications. Pressure injuries (PIs) are among the most common ones and represent a frequent reason for re-hospitalization. This study aimed to identify styles of prevention that individuals with SCI adopt to deal with the risk of developing PIs.Design: Qualitative explorative interview study. Data was collected through semi-structured interviews, which were transcribed verbatim and analyzed following the principles of thematic analysis.Setting: Switzerland.Participants: The participants were a purposive sample of community-dwelling Swiss residents with SCI for at least five years.Interventions: Not applicable.Outcome measures: Not applicable.Results: Although all participants (N = 20) showed at least a basic knowledge of prevention of PIs by describing some preventive measures, they had different prevention styles characterized by different behavioral patterns (i.e. complying with all recommended measures, performing only a selection of them or delegating them to others) and different beliefs and attitudes towards prevention.Conclusion: By identifying the style of prevention of an individual, it is possible to develop tailored interventions that have an impact on the factors which seem to play a role in determining the adoption of preventive behaviors (i.e. perceived susceptibility to PIs, attitudes towards prevention, and self-efficacy). Such interventions would constitute a concrete effort to support individuals with SCI during their self-management. Besides alleviating a frequent and disabling medical complication and contributing to an enhanced quality of life, these interventions might also help decrease healthcare costs.
Collapse
Affiliation(s)
- Claudia Zanini
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Mirjam Brach
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | | | | | | | - Gerold Stucki
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Sara Rubinelli
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| |
Collapse
|
14
|
Zanini C, Lustenberger N, Essig S, Gemperli A, Brach M, Stucki G, Rubinelli S, Scheel-Sailer A. Outpatient and community care for preventing pressure injuries in spinal cord injury. A qualitative study of service users’ and providers’ experience. Spinal Cord 2020; 58:882-891. [DOI: 10.1038/s41393-020-0444-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Revised: 02/14/2020] [Accepted: 02/14/2020] [Indexed: 11/09/2022]
|
15
|
Li C, Clark JMR, DiPiro N, Roesler J, Krause JS. Trends in nonroutine physician visits and hospitalizations: findings among five cohorts from the Spinal Cord Injury Longitudinal Aging Study. Spinal Cord 2020; 58:658-666. [DOI: 10.1038/s41393-019-0407-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 12/11/2019] [Accepted: 12/12/2019] [Indexed: 11/09/2022]
|
16
|
Dukes EM, Kirshblum S, Aimetti AA, Qin SS, Bornheimer RK, Oster G. Relationship of American Spinal Injury Association Impairment Scale Grade to Post-injury Hospitalization and Costs in Thoracic Spinal Cord Injury. Neurosurgery 2019; 83:445-451. [PMID: 28945855 PMCID: PMC6096161 DOI: 10.1093/neuros/nyx425] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Accepted: 07/11/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The lifetime economic burden of thoracic spinal cord injury (SCI) is known to be high, but evidence of variability of costs in relation to the American Spinal Injury Association Impairment Scale (AIS) grade is limited. OBJECTIVE To estimate lifetime economic costs of hospitalization by AIS grade in thoracic SCI. METHODS Using SCI Model Systems data from January 2000 to March 2016 from the National Spinal Cord Injury Statistical Center, we estimated mean total annual days of all-cause hospitalization by AIS grade among persons with thoracic SCI, based on assessments 1, 5, and 10 yr post-injury. We combined this information with secondary cost data and projections of life expectancy to estimate lifetime economic costs of hospitalization by AIS grade in persons aged 35 yr at time of thoracic SCI. Future costs were discounted to present value at 3% annually. RESULTS One year post-injury, mean total annual days of hospitalization ranged from 2.1 for persons with AIS-D injuries to 5.9 for those who were AIS-A. Similar differences were noted 5 and 10 yr post-SCI. The estimated net present value of expected lifetime costs of hospitalization following thoracic SCI at age 35 yr was $321 534, $249 514, $188 989, and $68 120 (2015 US$) for AIS-A, AIS-B, AIS-C, and AIS-D injuries, respectively. CONCLUSION Persons with less severe thoracic SCI, as reflected in AIS grade, spend fewer days in hospital over their lifetimes, leading to lower costs of inpatient care. Therapies improving AIS grade following thoracic SCI may provide cost savings in addition to addressing substantial unmet need.
Collapse
Affiliation(s)
| | - Steven Kirshblum
- Kessler Institute for Rehabilitation, West Orange, New Jersey.,Department of Physical Medicine and Rehabilitation, New Jersey Medical School, Newark, New Jersey
| | | | - Sarah S Qin
- Policy Analysis Inc (PAI), Brookline, Massachusetts
| | | | - Gerry Oster
- Policy Analysis Inc (PAI), Brookline, Massachusetts
| |
Collapse
|
17
|
Meier C, Boes S, Gemperli A, Gmünder HP, Koligi K, Metzger S, Schaefer DJ, Schmitt K, Schwegmann W, Wettstein R, Scheel-Sailer A. Treatment and cost of pressure injury stage III or IV in four patients with spinal cord injury: the Basel Decubitus Concept. Spinal Cord Ser Cases 2019; 5:30. [PMID: 31632697 PMCID: PMC6462022 DOI: 10.1038/s41394-019-0173-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Revised: 02/14/2019] [Accepted: 02/21/2019] [Indexed: 11/29/2022] Open
Abstract
Study design Retrospective chart analyses as part of a quality improvement project. Objectives To demonstrate treatment of pressure injury (PI) in patients with spinal cord injuries (SCI) and analyse costs using the "modified Basel Decubitus Concept". Setting Inpatient setting of a specialised acute care and rehabilitation clinic for SCI. Methods Complex treatment courses of four patients with chronic SCI and PI stage III or IV were described and costs were recorded. The total healthcare services' costs per patient and different profession's involvement were analysed in relation to patient characteristics, treatment phases and milestones demonstrated. Results The treatment of PI stage III and IV in patients with SCI included input from plastic surgery, rehabilitation medicine, nursing and other involved professions. Recommended interventions were chosen according to the "modified Basel Decubitus Concept". The cost course of PI treatment in patients with SCI depicted the multimodal treatment concept, including three clinically and financially relevant milestones (debridement, flap surgery and mobilisation to wheelchair) as well as the highest costs in the functionally highly dependent patient. Acute care and rehabilitation overlapped with different intensities during the whole treatment process. Conclusion Multimodal treatment concepts connecting acute and rehabilitation care were applied in these complex health conditions. Cost-explication models including treatment phases and milestones helped to understand resources more easily and integrate aspects of process-based management and quality of care. Scientific evidence is needed to create a recommended quality standard in line with adequate financing of this health condition.
Collapse
Affiliation(s)
- Christine Meier
- Swiss Paraplegic Centre (SPC), Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Stefan Boes
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Armin Gemperli
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research (SPF), Nottwil, Switzerland
| | | | | | | | - Dirk J. Schaefer
- Swiss Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
| | | | | | - Reto Wettstein
- Swiss Department of Plastic, Reconstructive, Aesthetic and Hand Surgery, University Hospital, Basel, Switzerland
| | - Anke Scheel-Sailer
- Swiss Paraplegic Centre (SPC), Nottwil, Switzerland
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| |
Collapse
|
18
|
Carlson M, Vigen CL, Rubayi S, Blanche EI, Blanchard J, Atkins M, Bates-Jensen B, Garber SL, Pyatak EA, Diaz J, Florindez LI, Hay JW, Mallinson T, Unger JB, Azen SP, Scott M, Cogan A, Clark F. Lifestyle intervention for adults with spinal cord injury: Results of the USC-RLANRC Pressure Ulcer Prevention Study. J Spinal Cord Med 2019; 42:2-19. [PMID: 28414254 PMCID: PMC6340272 DOI: 10.1080/10790268.2017.1313931] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
CONTEXT/OBJECTIVE Medically serious pressure injuries (MSPrIs), a common complication of spinal cord injury (SCI), have devastating consequences on health and well-being and are extremely expensive to treat. We aimed to test the efficacy of a lifestyle-based intervention designed to reduce incidence of MSPrIs in adults with SCI. DESIGN A randomized controlled trial (RCT), and a separate study wing involving a nonrandomized standard care control group. SETTING Rancho Los Amigos National Rehabilitation Center, a large facility serving ethnically diverse, low income residents of Los Angeles County. PARTICIPANTS Adults with SCI, with history of one or more MSPrIs over the past 5 years: N=166 for RCT component, N=66 in nonrandomized control group. INTERVENTIONS The Pressure Ulcer Prevention Program, a 12-month lifestyle-based treatment administered by healthcare professionals, largely via in-home visits and phone contacts. OUTCOME MEASURES Blinded assessments of annualized MSPrI incidence rates at 12 and 24 months, based on: skin checks, quarterly phone interviews with participants, and review of medical charts and billing records. Secondary outcomes included number of surgeries and various quality-of-life measures. RESULTS Annualized MSPrI rates did not differ significantly between study groups. At 12 months, rates were .56 for intervention recipients, .48 for randomized controls, and .65 for nonrandomized controls. At follow-up, rates were .44 and .39 respectively for randomized intervention and control participants. CONCLUSIONS Evidence for intervention efficacy was inconclusive. The intractable nature of MSPrI threat in high-risk SCI populations, and lack of statistical power, may have contributed to this inability to detect an effect. TRIAL REGISTRATION ClinicalTrials.gov NCT01999816.
Collapse
Affiliation(s)
- Mike Carlson
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Cheryl L.P. Vigen
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA,Correspondence to: Cheryl L.P. Vigen, Division of Occupational Science and Occupational Therapy, University of Southern California, 1540 Alcazar St. CHP 133, Los Angeles, CA 90089–9003, USA.
| | - Salah Rubayi
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Erna Imperatore Blanche
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Jeanine Blanchard
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Michal Atkins
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Barbara Bates-Jensen
- School of Nursing, University of California Los Angeles, Los Angeles, California, USA
| | - Susan L Garber
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas, USA
| | - Elizabeth A Pyatak
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Jesus Diaz
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Lucia I Florindez
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Joel W Hay
- Leonard Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles, California, USA
| | - Trudy Mallinson
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Jennifer B Unger
- Institute for Health Promotion & Disease Prevention Research, University of Southern California, Los Angeles, California, USA
| | - Stanley Paul Azen
- Division of Biostatistics, Department of Preventive Medicine, University of Southern California, Los Angeles, California, USA
| | - Michael Scott
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Alison Cogan
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| | - Florence Clark
- Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California, USA
| |
Collapse
|
19
|
Prevalence of chronic health conditions and hospital utilization in adults with spinal cord injury: an analysis of self-report and South Carolina administrative billing data. Spinal Cord 2018; 57:33-40. [DOI: 10.1038/s41393-018-0185-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Revised: 06/22/2018] [Accepted: 06/25/2018] [Indexed: 12/27/2022]
|
20
|
Faw TD, Lerch JK, Thaxton TT, Deibert RJ, Fisher LC, Basso DM. Unique Sensory and Motor Behavior in Thy1-GFP-M Mice before and after Spinal Cord Injury. J Neurotrauma 2018; 35:2167-2182. [PMID: 29385890 DOI: 10.1089/neu.2017.5395] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Sensorimotor recovery after spinal cord injury (SCI) is of utmost importance to injured individuals and will rely on improved understanding of SCI pathology and recovery. Novel transgenic mouse lines facilitate discovery, but must be understood to be effective. The purpose of this study was to characterize the sensory and motor behavior of a common transgenic mouse line (Thy1-GFP-M) before and after SCI. Thy1-GFP-M positive (TG+) mice and their transgene negative littermates (TG-) were acquired from two sources (in-house colony, n = 32, Jackson Laboratories, n = 4). C57BL/6J wild-type (WT) mice (Jackson Laboratories, n = 10) were strain controls. Moderate-severe T9 contusion (SCI) or transection (TX) occurred in TG+ (SCI, n = 25, TX, n = 5), TG- (SCI, n = 5), and WT (SCI, n = 10) mice. To determine responsiveness to rehabilitation, a cohort of TG+ mice with SCI (n = 4) had flat treadmill (TM) training 42-49 days post-injury (dpi). To characterize recovery, we performed Basso Mouse Scale, Grid Walk, von Frey Hair, and Plantar Heat Testing before and out to day 42 post-SCI. Open field locomotion was significantly better in the Thy1 SCI groups (TG+ and TG-) compared with WT by 7 dpi (p < 0.01) and was maintained through 42 dpi (p < 0.01). These unexpected locomotor gains were not apparent during grid walking, indicating severe impairment of precise motor control. Thy1 derived mice were hypersensitive to mechanical stimuli at baseline (p < 0.05). After SCI, mechanical hyposensitivity emerged in Thy1 derived groups (p < 0.001), while thermal hyperalgesia occurred in all groups (p < 0.001). Importantly, consistent findings across TG+ and TG- groups suggest that the effects are mediated by the genetic background rather than transgene manipulation itself. Surprisingly, TM training restored mechanical and thermal sensation to baseline levels in TG+ mice with SCI. This behavioral profile and responsiveness to chronic training will be important to consider when choosing models to study the mechanisms underlying sensorimotor recovery after SCI.
Collapse
Affiliation(s)
- Timothy D Faw
- 1 Neuroscience Graduate Program, The Ohio State University , Columbus, Ohio.,2 School of Health and Rehabilitation Sciences, The Ohio State University , Columbus, Ohio.,3 Center for Brain and Spinal Cord Repair, The Ohio State University , Columbus, Ohio
| | - Jessica K Lerch
- 3 Center for Brain and Spinal Cord Repair, The Ohio State University , Columbus, Ohio.,4 Department of Neuroscience, The Ohio State University , Columbus, Ohio
| | - Tyler T Thaxton
- 2 School of Health and Rehabilitation Sciences, The Ohio State University , Columbus, Ohio.,3 Center for Brain and Spinal Cord Repair, The Ohio State University , Columbus, Ohio
| | - Rochelle J Deibert
- 2 School of Health and Rehabilitation Sciences, The Ohio State University , Columbus, Ohio.,3 Center for Brain and Spinal Cord Repair, The Ohio State University , Columbus, Ohio
| | - Lesley C Fisher
- 2 School of Health and Rehabilitation Sciences, The Ohio State University , Columbus, Ohio.,3 Center for Brain and Spinal Cord Repair, The Ohio State University , Columbus, Ohio
| | - D Michele Basso
- 2 School of Health and Rehabilitation Sciences, The Ohio State University , Columbus, Ohio.,3 Center for Brain and Spinal Cord Repair, The Ohio State University , Columbus, Ohio
| |
Collapse
|
21
|
Evardone M, Wilson CS, Weinel D, Soble JR, Kang Y. Does attendance in SCI education courses impact health outcomes in acute rehabilitation? J Spinal Cord Med 2018; 41:17-27. [PMID: 27146326 PMCID: PMC5810801 DOI: 10.1080/10790268.2016.1177269] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE Though education about secondary complications following spinal cord injury (SCI) is a component of many rehabilitation programs, there is little research on their success in promoting healthier outcomes. This study examined 1) whether greater education course attendance was associated with improved health outcomes and quality of life and 2) whether completion of bladder management and skin care courses was associated with decreased incidence of urinary tract infections (UTIs) and pressure ulcers (PUs). DESIGN Retrospective medical record review. SETTING AND PARTICIPANTS Patients (N = 106) in a Veterans Administration (VA) SCI rehabilitation program who completed at least one education class from August 2008 to September 2012. METHODS AND OUTCOME MEASURES Records were reviewed to determine the number of education courses completed and patients' responses to the Satisfaction with Life Survey (SWLS), the short form of the Craig Handicap and Assessment Reporting Technique (CHART-SF), and Short Form Health Survey (SF-8) at admission, discharge, and 90 days post-discharge. Records were reviewed to determine frequency of UTIs and PUs from admission to discharge and from discharge to 90-day follow-up. RESULTS Regression analyses revealed no association between number of classes and self-reported health and quality of life. Skin care class attendance was associated with a decreased number of PUs. Greater overall attendance at education courses was unexpectedly associated with a higher number of UTIs from admission to discharge. CONCLUSION Results of the study are mixed. Multiple factors appear to impact the success of education interventions. Future research is needed to clarify the best approach.
Collapse
Affiliation(s)
- Milagros Evardone
- Mental Health & Behavioral Service, James A. Haley Veterans Hospital & Clinics, Tampa, FL, USA
- Milagros Evardone is now affilitiated with MH Service, Orlando VA Medical Center, Orlando, FL, USA
| | - Catherine S. Wilson
- Mental Health & Behavioral Service, James A. Haley Veterans Hospital & Clinics, Tampa, FL, USA
| | - Diana Weinel
- Spinal Cord Injury Nursing Service, James A. Haley Veterans Hospital & Clinics, Tampa, FL, USA
| | - Jason R. Soble
- Mental Health & Behavioral Service, James A. Haley Veterans Hospital & Clinics, Tampa, FL, USA
- Jason Soble is now affiliated with Psychology Service, South Texas Veterans' Healthcare System, San Antonio, Texas, USA
| | - Younghee Kang
- Spinal Cord Injury Nursing Service, James A. Haley Veterans Hospital & Clinics, Tampa, FL, USA
| |
Collapse
|
22
|
Marson L, Thor KB, Katofiasc M, Burgard EC, Rupniak NMJ. Prokinetic effects of neurokinin-2 receptor agonists on the bladder and rectum of rats with acute spinal cord transection. Eur J Pharmacol 2017; 819:261-269. [PMID: 29237540 DOI: 10.1016/j.ejphar.2017.12.017] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Revised: 11/29/2017] [Accepted: 12/08/2017] [Indexed: 11/18/2022]
Abstract
The suitability of various neurokinin-2 (NK2) receptor agonists and routes of administration to elicit on-demand voiding of the bladder and bowel, as future therapy for individuals with spinal cord injury, was examined using a rat model. The current study examined the feasibility of alternative routes of administration, which are more practical for clinical use than intravenous (IV) administration. Voiding and isovolumetric cystometry were recorded in anesthetized, acutely spinalized, female rats after IV, subcutaneous (SC), intramuscular (IM), intranasal (IN), or sublingual (SL) administration of [Lys5,MeLeu9,Nle10]-NKA(4-10) (LMN-NKA). Administration of LMN-NKA (1-10μg/kg IV; 10-300μg/kg SC or IM; 15-1000μg/kg IN or 300-1500μg/kg SL) elicited rapid-onset, short-duration, dose-related increases in bladder pressure and voiding with the rank order for time of both onset and duration being IV < IN < SC = IM < SL. The incidence of voiding was dependent on the dose and route, with all routes resulting in a high voiding efficiency (~ 70%). Like LMN-NKA, neurokinin A (NKA 1-100μg/kg IV) and GR 64349 (0.1-30μg/kg IV or 1-300μg/kg SC) produced rapid-onset, short-duration increases in bladder pressure, as well as colorectal pressure. Administration of vehicle never produced bladder or rectal contractions or voiding. Transient hypotension was observed after IV injection of LMN-NKA, which was less pronounced after SC injection. Hypotension was not apparent with GR 64349. In conclusion, selective NK2 receptor agonists, administered through various non-IV routes of administration, may provide a safe, convenient, and efficacious method for inducing voiding.
Collapse
Affiliation(s)
- Lesley Marson
- Dignify Therapeutics LLC, 2 Davis Drive, P.O. Box 13169, Research Triangle Park, NC 27709, USA.
| | - Karl B Thor
- Dignify Therapeutics LLC, 2 Davis Drive, P.O. Box 13169, Research Triangle Park, NC 27709, USA
| | - Mary Katofiasc
- Dignify Therapeutics LLC, 2 Davis Drive, P.O. Box 13169, Research Triangle Park, NC 27709, USA
| | - Edward C Burgard
- Dignify Therapeutics LLC, 2 Davis Drive, P.O. Box 13169, Research Triangle Park, NC 27709, USA
| | - Nadia M J Rupniak
- Dignify Therapeutics LLC, 2 Davis Drive, P.O. Box 13169, Research Triangle Park, NC 27709, USA
| |
Collapse
|
23
|
Morrison SA, Lorenz D, Eskay CP, Forrest GF, Basso DM. Longitudinal Recovery and Reduced Costs After 120 Sessions of Locomotor Training for Motor Incomplete Spinal Cord Injury. Arch Phys Med Rehabil 2017; 99:555-562. [PMID: 29107040 DOI: 10.1016/j.apmr.2017.10.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 09/29/2017] [Accepted: 10/02/2017] [Indexed: 12/31/2022]
Abstract
OBJECTIVE To determine the impact of long-term, body weight-supported locomotor training after chronic, incomplete spinal cord injury (SCI), and to estimate the health care costs related to lost recovery potential and preventable secondary complications that may have occurred because of visit limits imposed by insurers. DESIGN Prospective observational cohort with longitudinal follow-up. SETTING Eight outpatient rehabilitation centers that participate in the Christopher & Dana Reeve Foundation NeuroRecovery Network (NRN). PARTICIPANTS Individuals with motor incomplete chronic SCI (American Spinal Injury Association Impairment Scale C or D; N=69; 0.1-45y after SCI) who completed at least 120 NRN physical therapy sessions. INTERVENTIONS Manually assisted locomotor training (LT) in a body weight-supported treadmill environment, overground standing and stepping activities, and community integration tasks. MAIN OUTCOME MEASURES International Standards for Neurological Classification of Spinal Cord Injury motor and sensory scores, orthostatic hypotension, bowel/bladder/sexual function, Spinal Cord Injury Functional Ambulation Inventory (SCI-FAI), Berg Balance Scale, Modified Functional Reach, 10-m walk test, and 6-minute walk test. Longitudinal outcome measure collection occurred every 20 treatments and at 6- to 12-month follow-up after discharge from therapy. RESULTS Significant improvement occurred for upper and lower motor strength, functional activities, psychological arousal, sensation of bowel movement, and SCI-FAI community ambulation. Extended training enabled minimal detectable changes at 60, 80, 100, and 120 sessions. After detectable change occurred, it was sustained through 120 sessions and continued 6 to 12 months after treatment. CONCLUSIONS Delivering at least 120 sessions of LT improves recovery from incomplete chronic SCI. Because walking reduces rehospitalization, LT delivered beyond the average 20-session insurance limit can reduce rehospitalizations and long-term health costs.
Collapse
Affiliation(s)
| | - Douglas Lorenz
- Department of Bioinformatics and Biostatistics, School of Public Health and Information Science, University of Louisville, Louisville, KY
| | - Carol P Eskay
- Wexner Medical Center, Outpatient Neurological Clinic, The Ohio State University, Columbus, OH
| | - Gail F Forrest
- Human Performance and Movement Analysis Laboratory, Kessler Foundation Research Center, West Orange, NJ
| | - D Michele Basso
- School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
| |
Collapse
|
24
|
Lussi C, Frotzler A, Jenny A, Schaefer DJ, Kressig RW, Scheel-Sailer A. Nutritional blood parameters and nutritional risk screening in patients with spinal cord injury and deep pressure ulcer—a retrospective chart analysis. Spinal Cord 2017; 56:168-175. [DOI: 10.1038/s41393-017-0016-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Revised: 09/10/2017] [Accepted: 09/13/2017] [Indexed: 01/12/2023]
|
25
|
Fehlings MG, Cheng CL, Chan E, Thorogood NP, Noonan VK, Ahn H, Bailey CS, Singh A, Dvorak MF. Using Evidence To Inform Practice and Policy To Enhance the Quality of Care for Persons with Traumatic Spinal Cord Injury. J Neurotrauma 2017; 34:2934-2940. [PMID: 28566019 PMCID: PMC5652974 DOI: 10.1089/neu.2016.4938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
In today's economic climate, there is a need to demonstrate a return on investment for healthcare spending and for clinical practice and policy to be informed by evidence. Navigating this process is difficult for decision-makers, clinicians, and researchers alike. This article will describe how a knowledge translation framework and an evidence-based policy-making process were integrated to clarify the problem, frame options, and plan implementation, to impact clinical practice and policy in the area of traumatic spinal cord injury (tSCI). The Access to Care and Timing (ACT) project is focused on optimizing the access and timing of specialized healthcare delivery for persons sustaining a tSCI in Canada. A simulation model was developed that uses current patient data to address complex problems faced by the healthcare system. At a workshop, participants stressed the importance of linking interventions to short- and long-term outcomes to drive change. Presently, there are no national, system level indicators to monitor performance after tSCI. Although the ideal system of care after tSCI is unknown, indicator collection will establish a baseline to measure improvement. The workshop participants prioritized two indicators important from the clinician and patient perspective-timely admission to rehabilitation and meaningful community participation. The ACT simulation model for tSCI care will be used to promote the uptake of identified indicators and provide a predictive link between interventions on potential outcomes. The standardized collection of outcome-oriented indicators will help to evaluate the access and timing of care and to define the ideal system of care after SCI.
Collapse
Affiliation(s)
| | | | - Elaine Chan
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | | | | | - Henry Ahn
- University of Toronto Spine Program, Toronto, Ontario, Canada
| | - Christopher S. Bailey
- Division of Orthopaedics, Department of Surgery, Western University, London, Ontario, Canada
| | - Anoushka Singh
- SCI Clinical Research Unit, Toronto Western Hospital, Toronto, Ontario, Canada
| | - Marcel F. Dvorak
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
26
|
White BA, Dea N, Street JT, Cheng CL, Rivers CS, Attabib N, Kwon BK, Fisher CG, Dvorak MF. The Economic Burden of Urinary Tract Infection and Pressure Ulceration in Acute Traumatic Spinal Cord Injury Admissions: Evidence for Comparative Economics and Decision Analytics from a Matched Case-Control Study. J Neurotrauma 2017; 34:2892-2900. [DOI: 10.1089/neu.2016.4934] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Nicolas Dea
- Service de Neurochirurgie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - John T. Street
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Najmedden Attabib
- Dalhousie University, Halifax, Nova Scotia; Horizon Health Network, Division of Neurosurgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G. Fisher
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel F. Dvorak
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| |
Collapse
|
27
|
Li C, Clark JM, Krause JS. Latent Structural Analysis of Health Outcomes in People Living With Spinal Cord Injury. Arch Phys Med Rehabil 2017; 98:2457-2463. [PMID: 28583463 DOI: 10.1016/j.apmr.2017.04.025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Revised: 04/12/2017] [Accepted: 04/29/2017] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To develop a latent structural model of health outcomes in people with spinal cord injury (SCI) that accounts for the measurement of underlying factors and their association with demographic and injury-related exogenous variables. DESIGN Cross-sectional study. SETTING Specialty hospital and medical university. PARTICIPANTS Participants with traumatic SCI (N=1871) of at least 1-year duration. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Exploratory factor analysis was used to identify latent health outcome structures. Several key exogenous variables were also linked with the latent health outcome factors. RESULTS Six latent health outcome factors were identified by the exploratory factor analysis with excellent model fit (root mean square error of approximation=.040). These latent factors included (1) global health problems; (2) chronic disease; (3) acute treatments; (4) symptoms of SCI complications, (5) pressure ulcers; and (6) subsequent injuries. Sex, race/ethnicity, age, years since injury, and injury severity were all significantly associated with at least 1 latent health outcome factor, which indicates that these latent health outcomes varied as a function of the exogenous variables. CONCLUSIONS This study improved our understanding of the structure of health outcomes, and utilization of latent health outcome factors provides more stable and comprehensive composite scores than does utilization of a single observed health outcome indicator.
Collapse
Affiliation(s)
- Chao Li
- Medical University of South Carolina, Charleston, SC.
| | | | | |
Collapse
|
28
|
Saunders LL, Murday D, Corley B, Cao Y, Krause JS. Comparison of Rates of Hospitalization and Emergency Department Visits Using Self-Report and South Carolina Administrative Billing Data Among a Population-Based Cohort With Spinal Cord Injury. Arch Phys Med Rehabil 2016; 97:1481-1486. [DOI: 10.1016/j.apmr.2016.03.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Revised: 03/17/2016] [Accepted: 03/19/2016] [Indexed: 10/21/2022]
|
29
|
Cogan AM, Blanchard J, Garber SL, Vigen CL, Carlson M, Clark FA. Systematic review of behavioral and educational interventions to prevent pressure ulcers in adults with spinal cord injury. Clin Rehabil 2016; 31:871-880. [PMID: 27440806 DOI: 10.1177/0269215516660855] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the efficacy of behavioral or educational interventions in preventing pressure ulcers in community-dwelling adults with spinal cord injury (SCI). DATA SOURCES Cochrane, Clinical Trials, PubMed, and Web of Science were searched in June 2016. The search combined related terms for pressure ulcers, spinal cord injury, and behavioral intervention. Each database was searched from its inception with no restrictions on year of publication. REVIEW METHODS Inclusion criteria required that articles were (a) published in a peer-reviewed journal in English, (b) evaluated a behavioral or educational intervention for pressure ulcer prevention, (c) included community-dwelling adult participants aged 18 years and older with SCI, (d) measured pressure ulcer occurrence, recurrence, or skin breakdown as an outcome, and (e) had a minimum of 10 participants. All study designs were considered. Two reviewers independently screened titles and abstracts. Extracted information included study design, sample size, description of the intervention and control condition, pressure ulcer outcome measures, and corresponding results. RESULTS The search strategy yielded 444 unique articles of which five met inclusion criteria. Three were randomized trials and two were quasi-experimental designs. A total of 513 participants were represented. The method of pressure ulcer or skin breakdown measurement varied widely among studies. Results on pressure ulcer outcomes were null in all studies. Considerable methodological problems with recruitment, intervention fidelity, and participant adherence were reported. CONCLUSIONS At present, there is no positive evidence to support the efficacy of behavioral or educational interventions in preventing pressure ulcer occurrence in adults with SCI.
Collapse
Affiliation(s)
- Alison M Cogan
- 1 Mrs TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA
| | - Jeanine Blanchard
- 1 Mrs TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA
| | - Susan L Garber
- 2 Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, USA
| | - Cheryl Lp Vigen
- 1 Mrs TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA
| | - Mike Carlson
- 1 Mrs TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA
| | - Florence A Clark
- 1 Mrs TH Chan Division of Occupational Science and Occupational Therapy, University of Southern California, USA
| |
Collapse
|
30
|
Effectiveness of a Wellness Program for Individuals With Spina Bifida and Spinal Cord Injury Within an Integrated Delivery System. Arch Phys Med Rehabil 2016; 97:1969-1978. [PMID: 27311718 DOI: 10.1016/j.apmr.2016.05.014] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 04/29/2016] [Accepted: 05/09/2016] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine whether an evidence-based wellness program for individuals with spina bifida and spinal cord injury would improve health outcomes and patient experience of care, result in a positive return on investment (ROI), and provide evidence for scalability. DESIGN Nonrandomized, noncontrolled cohort study; 2 years of enrollment. SETTING Academic hospital-based outpatient physiatry clinic partnered with an insurance division within an integrated health care delivery and financing system. PARTICIPANTS Individuals (N=69) with spina bifida and spinal cord injury were consented; 4 were excluded (5.7%), and the remaining 65 (94.2%) participated in the intervention. INTERVENTIONS Evidence-based wellness program consisting of care coordination from a mobile nurse, patient education, and patient incentives. MAIN OUTCOME MEASURES Validated measures of function, mood, quality of life, and perception of care delivery; knowledge of preventable conditions; self-rating of health; and utilization and cost. RESULTS Improvements in all main outcome measures were seen after 2 years of enrollment. Although cost in year 1 of enrollment increased because of hospitalizations and the overall ROI was negative, a small positive ROI was seen in year 2 of enrollment. CONCLUSIONS Participation in an evidence-based wellness program was associated with improved health and experience of care. Scaling the program to larger numbers may result in an overall positive ROI.
Collapse
|
31
|
Squair JW, White BAB, Bravo GI, Martin Ginis KA, Krassioukov AV. The Economic Burden of Autonomic Dysreflexia during Hospitalization for Individuals with Spinal Cord Injury. J Neurotrauma 2016; 33:1422-7. [PMID: 27002855 DOI: 10.1089/neu.2015.4370] [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] [Indexed: 11/13/2022] Open
Abstract
We sought to determine the economic burden of autonomic dysreflexia (AD) from the perspective of the Canadian healthcare system in a case series of individuals with spinal cord injury (SCI) presenting to emergency care. In doing so, we sought to illustrate the potential return on investments in the translation of evidence-informed practices and developments in the prevention, diagnosis, and management of AD. Activity-based costing methodology was employed to estimate the direct healthcare or hospitalization costs of AD following presentation to the emergency department. Differences in trends were noted between patients who were promptly diagnosed, managed, and discharged, and patients whose experience followed a less direct or ideal path to discharge. We recorded 29 emergency room visits for conditions ultimately diagnosed as AD. Overall, median length of stay was 3 days (interquartile range [IQR] = 1.25-5.75), but extended up to 103 consecutive days. Cost analysis revealed median healthcare costs of $5029 (IQR = $2397-9522) for hospital admissions for AD, with the highest estimated hospital cost for a single admission > $190,000. Emergency room admissions resulting from AD can result in dramatic healthcare costs. Delayed diagnosis and inefficient management of AD may lead to further complications, adding to the strain on already limited healthcare resources. Prompt recognition of AD; broader translation of evidence-informed practices; and novel diagnosis, self-management, and/or therapeutic/pharmaceutical applications may prove to mitigate the burden of AD and improve patient well-being.
Collapse
Affiliation(s)
- Jordan W Squair
- 1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada .,2 MD/PhD Training Program, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Barry A B White
- 1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada .,3 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | - Grace I Bravo
- 4 Department of Paediatrics, Western University , Ottawa, Canada
| | | | - Andrei V Krassioukov
- 1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada .,6 Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia , Vancouver, British Columbia, Canada .,7 GF Strong Rehabilitation Centre , Vancouver Health Authority, Vancouver, British Columbia, Canada
| |
Collapse
|
32
|
Selassie A, Cao Y, Saunders LL. Epidemiology of Traumatic Spinal Cord Injury Among Persons Older Than 21 Years: A Population-Based Study in South Carolina, 1998–2012. Top Spinal Cord Inj Rehabil 2015. [DOI: 10.1310/sci2015-313] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|
33
|
Tulsky DS, Kisala PA, Tate DG, Spungen AM, Kirshblum SC. Development and psychometric characteristics of the SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks and short forms and the SCI-QOL Bladder Complications scale. J Spinal Cord Med 2015; 38:288-302. [PMID: 26010964 PMCID: PMC4445020 DOI: 10.1179/2045772315y.0000000030] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To describe the development and psychometric properties of the Spinal Cord Injury--Quality of Life (SCI-QOL) Bladder Management Difficulties and Bowel Management Difficulties item banks and Bladder Complications scale. DESIGN Using a mixed-methods design, a pool of items assessing bladder and bowel-related concerns were developed using focus groups with individuals with spinal cord injury (SCI) and SCI clinicians, cognitive interviews, and item response theory (IRT) analytic approaches, including tests of model fit and differential item functioning. SETTING Thirty-eight bladder items and 52 bowel items were tested at the University of Michigan, Kessler Foundation Research Center, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital, and the James J. Peters VA Medical Center, Bronx, NY. PARTICIPANTS Seven hundred fifty-seven adults with traumatic SCI. RESULTS The final item banks demonstrated unidimensionality (Bladder Management Difficulties CFI=0.965; RMSEA=0.093; Bowel Management Difficulties CFI=0.955; RMSEA=0.078) and acceptable fit to a graded response IRT model. The final calibrated Bladder Management Difficulties bank includes 15 items, and the final Bowel Management Difficulties item bank consists of 26 items. Additionally, 5 items related to urinary tract infections (UTI) did not fit with the larger Bladder Management Difficulties item bank but performed relatively well independently (CFI=0.992, RMSEA=0.050) and were thus retained as a separate scale. CONCLUSION The SCI-QOL Bladder Management Difficulties and Bowel Management Difficulties item banks are psychometrically robust and are available as computer adaptive tests or short forms. The SCI-QOL Bladder Complications scale is a brief, fixed-length outcomes instrument for individuals with a UTI.
Collapse
Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - Denise G. Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | | | | |
Collapse
|
34
|
Predictive factors of hospitalization in adults with pediatric-onset SCI: a longitudinal analysis. Spinal Cord 2015; 53:314-9. [DOI: 10.1038/sc.2015.13] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Revised: 12/30/2015] [Accepted: 01/08/2015] [Indexed: 11/08/2022]
|
35
|
Abstract
CONTEXT/OBJECTIVE Health preference values relate to a person's state of well-being, and is a single metric anchored at 0 (death) and 1 (perfect health). Health preference plays a key role in health economics and health policy, particularly in interpreting the results of cost-effectiveness studies, and supports the allocation of healthcare resources. The current study used elements of the International Classification of Functioning, Disability and Health (ICF) framework to predict health preference in persons with spinal cord injury (SCI). METHODS Data were collected by telephone survey on (1) demographics, (2) impairment (etiology, neurological level of injury, and ASIA impairment scale), (3) secondary health conditions (SHCs) using the SCI-Secondary Conditions Scale-Modified, (4) functional abilities using the Spinal Cord Independence Measure (SCIM), and (5) health preference using the Health Utilities Index-Mark III (HUI-Mark III) among adults with chronic SCI. Variables were categorized according to ICF headings and hierarchical regression analyses were used to predict HUI-Mark III scores. RESULTS Adults with chronic traumatic or non-traumatic SCI (N = 357) reported a mean health preference score of 0.27 (±0.27). In predicting health preference, our model accounted for 55.1% of the variance with "body functions and structure", and "activity and participation", significantly contributing to the model (P < 0.0001). In particular, older age, being employed, and having higher SCIM scores were positively associated with health preference. Conversely, a higher SHC impact score was associated with poorer health preference. CONCLUSIONS Variables representative of "activity and participation" largely influence health preference among persons with chronic SCI, which may be amenable to intervention. These findings could be applied to advocate for health promotion and employment support programs to maximize well-being in persons aging with chronic SCI in the community.
Collapse
|
36
|
Vaislic M, Vaislic C, Alsac JM, Benjelloun A, Chocron S, Unterseeh T, Fabiani JN. Economic Impacts of Treatment for Type II or III Thoracoabdominal Aortic Aneurysm in the United States. Res Cardiovasc Med 2014; 3:e9568. [PMID: 25478532 PMCID: PMC4253747 DOI: 10.5812/cardiovascmed.9568] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 11/16/2013] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Current treatment for extensive thoracoabdominal aortic aneurysms (TAAAs) involves high-risk surgical and endovascular repairs, with a hospital mortality exceeding 20%, and a postoperative paraplegia rate beyond 10.5%. OBJECTIVES The aim of this study was to present an estimation of the economic impacts of surgical and endovascular treatments of types II and III TAAAs in the US as well as the economic consequences of the elimination of spinal cord injury and mortality via an endovascular repair of extensive TAAAs (1). MATERIALS AND METHODS We compared the current hospital charges of endovascular and surgical repair of extensive TAAAs, also provided a cost analysis of health care charges resulting from paraplegia in the United States, and determined the prevalence of extensive TAAAs found yearly during autopsies in the U.S. Based on the figures gathered and the frequency of Thoracic Aortic Aneurysms per year, we were able to calculate the nationwide inpatient hospital charges, the total average expenses affected by paraplegia during the first 12 months after the repair, the total average expenses after paraplegia for each subsequent year, mortality rate at 30 days and one year, and the number of extensive TAAAs ruptures. RESULTS The current nationwide inpatient hospital charges for type II or III TAAA repair cost $12484324 and $37612665 for endovascular repair and surgical repair respectively, and the total average expenses for patients affected by paraplegia during the first 12-month were $4882291 and $23179110 after endovascular repair and surgical repair respectively. The nationwide average expense after 10 years for patients undergoing surgical repair and affected by paraplegia is $33421910 and $6,316,183 for patients undergoing endovascular repair. Moreover, 55 patients with a type II or type III TAAA died after 30 days, and 100 after 1 year. The potential risk of type II or III TAAA ruptures is totally 1637 in a year. CONCLUSIONS Major economic impacts of type II or III TAAA repairs in the United States have been identified. An endovascular repair excluding spinal cord injury and mortality with the same average costs as present endovascular treatments makes it possible to save at least $53189742 after one year, 100 lives of operated patients would be saved after one year, and 1637 type II and III TAAA ruptures would be avoided yearly.
Collapse
Affiliation(s)
| | - Claude Vaislic
- Cardiovascular Surgery, Parly II Private Hospital, Le Chesnay, France
| | - Jean-Marc Alsac
- Vascular Surgery, Georges Pompidou European Hospital, Paris, France
| | - Amira Benjelloun
- Vascular Surgery, Medical and Surgical Centre for Heart and Vessels, Sale, Morocco
| | | | - Thierry Unterseeh
- Cardiology Department, Claude Galien Private Hospital, Quincy-sous-Senart, France
| | | |
Collapse
|
37
|
Scheel-Sailer A, Wyss A, Boldt C, Post MW, Lay V. Prevalence, location, grade of pressure ulcers and association with specific patient characteristics in adult spinal cord injury patients during the hospital stay: a prospective cohort study. Spinal Cord 2013; 51:828-33. [PMID: 23999106 DOI: 10.1038/sc.2013.91] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Revised: 07/05/2013] [Accepted: 07/24/2013] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This was a prospective cohort study. OBJECTIVES The objective was to describe the incidence, prevalence, characteristics of pressure ulcers (PUs) and the association with specific patient characteristics in a consecutive sample of in-patients with a spinal cord injury (SCI). SETTING An acute care and rehabilitation clinic specialized in SCIs in Switzerland. METHODS The presence and characteristics of PUs for all adult patients with a SCI admitted to the clinic from 1 September 2009 to 28 February 2010 were recorded on a daily basis during their complete hospitalization. Risk factors were analyzed in univariate and multivariate logistic regression models. RESULTS A total of 185 patients were included in the study and observed for the entirety of their hospitalization. The prevalence of at least one PU was 49.2% in all patients, compared with 25.4% in the group of patients admitted without PUs. The incidence was 2.2 per person and year. In 91 patients, a total of 219 PUs were observed. PUs were most frequently located on the foot (36.1%), and the coccyx/sacrum (15.1%). The risk for occurrence of a PU increased with age (odds ratio (OR)=1.04) and post SCI (OR=1.03). In the multivariate analyses, the risk for PUs was lower for patients with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) of C or D (ORC=0.25, ORD=0.28) compared with patients with an AIS of A. CONCLUSION Using a daily documentation system, PUs were detected as a frequent complication of SCIs. Completeness of injury, age and time since injury were significant risk factors for PUs. The foot was a region at high risk for PUs.
Collapse
|
38
|
Pyatak EA, Blanche EI, Garber SL, Diaz J, Blanchard J, Florindez L, Clark FA. Conducting intervention research among underserved populations: lessons learned and recommendations for researchers. Arch Phys Med Rehabil 2012; 94:1190-8. [PMID: 23262157 DOI: 10.1016/j.apmr.2012.12.009] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Revised: 11/15/2012] [Accepted: 12/05/2012] [Indexed: 11/17/2022]
Abstract
Randomized controlled trials (RCTs) are considered the criterion standard in research design for establishing treatment efficacy. However, the rigorous and highly controlled conditions of RCTs can be difficult to attain when conducting research among individuals living with a confluence of disability, low socioeconomic status, and being a member of a racial/ethnic minority group, who may be more likely to have unstable life circumstances. Research on effective interventions for these groups is urgently needed, because evidence regarding approaches to reduce health disparities and improve health outcomes is lacking. In this methodologic article, we discuss the challenges and lessons learned in implementing the Lifestyle Redesign for Pressure Ulcer Prevention in Spinal Cord Injury study among a highly disadvantaged population. These issues are discussed in terms of strategies to enhance recruitment, retention, and intervention relevance to the target population. Recommendations for researchers seeking to conduct RCTs among socioeconomically disadvantaged, ethnically diverse populations are provided.
Collapse
Affiliation(s)
- Elizabeth A Pyatak
- Division of Occupational Science and Occupational Therapy, Ostrow School of Dentistry, University of Southern California, Los Angeles, CA 90089, USA.
| | | | | | | | | | | | | |
Collapse
|
39
|
Guilcher SJT, Craven BC, Lemieux-Charles L, Casciaro T, McColl MA, Jaglal SB. Secondary health conditions and spinal cord injury: an uphill battle in the journey of care. Disabil Rehabil 2012; 35:894-906. [PMID: 23020250 PMCID: PMC3665227 DOI: 10.3109/09638288.2012.721048] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To understand the journey of care in the prevention and management of secondary health conditions (SHCs) following spinal cord injury (SCI). METHOD This was a case study design with 'Ontario' as the case. The Network Episode Model was used as the conceptual framework. Data sources included in depth interviews with persons with SCI, care providers, and policy and decision makers. Document analysis was also conducted on relevant materials and policies. Key informants were selected by purposeful sampling as well as snowball sampling to provide maximum variation. Data analysis was an iterative process and involved descriptive and interpretive analyses. A coding structure was developed based on the conceptual framework which allowed for free nodes when emerging ideas or themes were identified. RESULTS Twenty-eight individuals were interviewed (14 persons with SCI and 14 persons representing care providers, community advocacy organization representatives, system service delivery administrators and policy-makers). A major over-arching domain that emerged from the data was the concept of 'fighting'. Eleven themes were identified: at the micro-individual level: (i) social isolation and system abandonment, (ii) funding and equitable care, (iii) bounded freedom and self-management; at the meso care provider level: (iv) gender and caregiving strain, (v) help versus disempowerment, (vi) holistic care-thinking outside the box, (vii) poor communication and coordination of care; and at the macro health system level: (viii) fight for access and availability, (ix) models of care tensions, (x) private versus public tensions and (xi) rigid rules and policies. CONCLUSIONS Findings suggest that the journey is challenging and a persistent uphill struggle for persons with SCI, care providers, and community-based advocates. If we are to make significant gains in minimizing the incidence and severity of SHCs, we need to tailor efforts at the health system level. IMPLICATIONS FOR REHABILITATION • Secondary health conditions are problematic for individuals with a spinal cord injury (SCI). • This study aimed to understand the journey of care in the prevention and management of secondary health conditions (SHCs) following SCI. • Findings suggest that the journey is challenging and a persistent uphill struggle for persons with SCI, care providers, and community-based advocates. • All stakeholders involved recognized the disparities in access to care and resources that exist within the system. We recommend that if we are to make significant gains in minimizing the incidence and severity of SHCs, we need to tailor efforts at the health system level.
Collapse
Affiliation(s)
- Sara J T Guilcher
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
| | | | | | | | | | | |
Collapse
|
40
|
Guilcher SJT, Casciaro T, Lemieux-Charles L, Craven C, McColl MA, Jaglal SB. Social networks and secondary health conditions: the critical secondary team for individuals with spinal cord injury. J Spinal Cord Med 2012; 35:330-42. [PMID: 23031170 PMCID: PMC3459562 DOI: 10.1179/2045772312y.0000000035] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES To describe the structure of informal networks for individuals with spinal cord injury (SCI) living in the community, to understand the quality of relationship of informal networks, and to understand the role of informal networks in the prevention and management of secondary health conditions (SHCs). DESIGN Mixed-method descriptive study. SETTING Ontario, Canada Participants: Community-dwelling adults with an SCI living in Ontario Interventions/methods: The Arizona Social Support Interview Survey was used to measure social networks. Participants were asked the following open-ended questions: (1) What have been your experiences with your health care in the community? (2) What have been your experiences with care related to prevention and/or management of SHCs?, (3)What has been the role of your informal social networks (friends/family) related to SHCs? RESULTS Fourteen key informant interviews were conducted (6 men, 8 women). The overall median for available informal networks was 11.0 persons (range 3-19). The informal network engaged in the following roles: (1) advice/validating concerns; (2) knowledge brokers; (3) advocacy; (4) preventing SHCs; (5) assisting with finances; and (6) managing SHCs. Participants described their informal networks as a "secondary team"; a critical and essential force in dealing with SHCs. CONCLUSIONS While networks are smaller for persons with SCI compared with the general population, these ties seems to be strong, which is essential when the roles involve a level of trust, certainty, tacit knowledge, and flexibility. These informal networks serve as essential key players in filling the gaps that exist within the formal health care system.
Collapse
Affiliation(s)
- Sara J. T. Guilcher
- Institute of Health, Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada,Correspondence to: Sara J. T. Guilcher, Institute of Health, Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, M5G1V7, Canada.
| | - Tiziana Casciaro
- Rotman School of Management, University of Toronto, Toronto, Ontario, Canada
| | - Louise Lemieux-Charles
- Institute of Health, Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Catharine Craven
- Institute of Health, Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; and Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Mary Ann McColl
- Centre for Health Services and Policy Research, Queen's University, Kingston, Ontario, Canada; and Department of Community Health and Epidemiology and School of Rehabilitaion Therapy, Queen's University, Kingston, Ontario, Canada
| | - Susan B. Jaglal
- Institute of Health, Policy, Management & Evaluation, University of Toronto, Toronto, Ontario, Canada; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Graduate Department of Rehabilitation Science, University of Toronto, Toronto, Ontario, Canada; and Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
41
|
Association between the Functional Independence Measure following spinal cord injury and long-term outcomes. Spinal Cord 2012; 50:728-33. [DOI: 10.1038/sc.2012.50] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|