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Desai RH, Kiserow R, Mullings A, Smith M, Tucker S, Eyler A, Stark S, Morgan K. Exploring the Perspectives of Adults Aging With Long-Term Physical Disabilities on Physical Activity: A Qualitative Study. Am J Health Promot 2023; 37:654-663. [PMID: 36624040 PMCID: PMC10468916 DOI: 10.1177/08901171221151123] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND Adults aging with long-term physical disabilities (AAwPD) face personal and environmental barriers to living independently, but little is known about their perspectives on and experiences with physical activity (PA). PURPOSE The purpose of this study was to explore the perspectives of AAwPD on PA. RESEARCH DESIGN Qualitative semi-structured interviews with AAwPD were conducted virtually via phone or videoconference. STUDY SAMPLE A convenience sample of AAwPD aged 45-65 and living with a physical disability for at least 5 years was recruited through aging organizations, disability organizations, and social media in St. Louis, Missouri until thematic saturation was reached (n = 20). DATA COLLECTION AND ANALYSIS Participants were asked semi-structured interview questions about their perspectives and experiences with PA following an interview guide developed by disability, aging, and qualitative research experts. Data were analyzed using text analysis in NVivo 12. Codes were developed into themes by the research team and validated using member checking methods. RESULTS Four themes emerged from the data: barriers and facilitators to engaging in PA, motivations and beliefs regarding PA, benefits of PA, and PA routines and habits. Participants reported a desire to engage in more PA but described barriers such as pain and fatigue symptoms, secondary health conditions, lack of social support, and fear of falling. Accessibility of facilities and equipment (eg, lack of ramps or equipment not at wheelchair height) and transportation barriers (eg, inconvenient schedules or excessive wait times) were specifically described as major environmental barriers. CONCLUSION Most participants' reported PA routines did not meet the quantity or intensity levels recommended by current guidelines. These results may help inform healthcare providers, community programs, and future interventions to improve PA levels for AAwPD, an underserved but growing demographic.
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Affiliation(s)
- Rachel Heeb Desai
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO
| | - Rachel Kiserow
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO
| | - Alicia Mullings
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO
| | - Megan Smith
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO
| | - Susan Tucker
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO
| | - Amy Eyler
- Washington University in St. Louis, Brown School of Public Health, St. Louis, MO
| | - Susan Stark
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO
| | - Kerri Morgan
- Washington University School of Medicine, Program in Occupational Therapy, St. Louis, MO
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2
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Gurung S, Jenkins HT, Chaudhury H, Ben Mortenson W. Modifiable Sociostructural and Environmental Factors That Impact the Health and Quality of Life of People With Spinal Cord Injury: A Scoping Review. Top Spinal Cord Inj Rehabil 2022; 29:42-53. [PMID: 36819929 PMCID: PMC9936894 DOI: 10.46292/sci21-00056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Objective The objective of this scoping review was to identify the modifiable factors that impact the health and quality of life (QOL) of community-dwelling people with spinal cord injury (SCI). Methods Empirical journal articles were identified using three academic databases: CINAHL Complete, MEDLINE with Full Text, and PsycINFO. Full-text journal articlesincluded studies of participants who were community-dwelling with traumatic or nontraumatic SCI and were over the age of 18 years without cognitive impairment; published between 2000 and 2021; focused on modifiable factors impacting health and QOL; and conducted inAustralia, Europe, orNorth America. A data table was used to extract article information including authors, year of publication, country, sample, design and methods, purpose/objectives, and main findings. Qualitative data analysis software was used to categorize major findings inductively through content analysis. Results Thirty-one peer-reviewed articles consisting of qualitive, quantitative, and mixed-methods study design were included. This scoping review revealed modifiable factors that impact the health and QOL of community-dwelling people with SCI: sociostructural factors (social attitudes, health care access, information access, and funding and policies) and environmental factors (built environment, housing, transportation, assistive technology, and natural environment). Conclusion Future research should examine the influence of the modifiable factors on health and QOL using qualitative inquiry, adopting a community-based participatory research approach, and considering the implications of individual characteristics and resources.
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Affiliation(s)
- Shreemouna Gurung
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Hailey-Thomas Jenkins
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Habib Chaudhury
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - W. Ben Mortenson
- Department of Occupational Science & Occupational Therapy, University of British Columbia, Vancouver, Canada
- International Collaboration on Repair Discoveries, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Research Program, Vancouver, British Columbia, Canada
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3
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Singh G, Borah D, Khanna G, Jain S. Efficacy of Local Autologous Platelet-Rich Plasma in the Treatment of Pressure Ulcer in Spinal Cord Injury Patients. Cureus 2021; 13:e18668. [PMID: 34790446 PMCID: PMC8583427 DOI: 10.7759/cureus.18668] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/11/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Pressure ulcer is one of the common complications occurring in spinal cord injury (SCI) patients. Platelet-rich plasma (PRP) has been found useful in the treatment of pressure ulcers in few studies. The purpose of this study was to evaluate the role of PRP in pressure ulcer healing in comparison to hydrogel dressing in SCI patients. METHODS In this randomized interventional study, 52 patients of SCI having pressure ulcers of grade III/IV were randomized into two groups of 26 each. In group A patients, hydrogel dressing was done while freshly prepared PRP was used in patients of group B. Pressure ulcers were evaluated at baseline and after three weeks and six weeks in terms of ulcer surface area, volume, Pressure Ulcer Scale for Healing (PUSH) score, histopathology, and ulcer healing parameters. Data were collected and quantitative variables were compared using unpaired t-test or Mann-Whitney test between the two groups and qualitative variables were compared using the chi-square test or Fisher's exact test. A p-value of <0.05 was considered statistically significant. RESULTS Baseline characteristics were comparable in both groups. There was a significant improvement in ulcers in terms of surface area, volume, and PUSH score in both the groups but it was comparable (p-value >0.05). There was a significant improvement in the PRP group as compared to the other group in terms of epithelization, granulation, and neovascularization at three and six-week follow-up. CONCLUSIONS This study suggests that PRP is a possible and better alternative to conventional dressing methods for the treatment of pressure ulcers.
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Affiliation(s)
- Gurpreet Singh
- Physical Medicine and Rehabilitation, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Diganta Borah
- Physical Medicine and Rehabilitation, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Geetika Khanna
- Pathology, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, IND
| | - Sakshi Jain
- Physical Medicine and Rehabilitation, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, New Delhi, IND
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Kuang N, Wang X, Chen Y, Liu G, Kong F, Wang N, Feng R, Wang Y, Du X, Zheng Z. Olfactory ensheathing cell transplantation for chronic spinal cord injury: A long-term follow-up study. JOURNAL OF NEURORESTORATOLOGY 2021. [DOI: 10.26599/jnr.2021.9040008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Spinal cord injury is a serious disabling condition. Transplantation of olfactory ensheathing cells (OECs) is one of the most promising treatments for spinal cord injury (SCI). Thirty-nine patients with chronic SCI received OEC transplantation and completed long-term follow-up, with a minimum follow-up of 7 years. We assessed sensorimotor function with the American Spinal Injury Association (ASIA) Impairment Scale (AIS) and autonomic nervous function by the International Standards to document remaining Autonomic Function after Spinal Cord Injury (ISAFSCI), and sympathetic skin responses (SSR). The scores of each group were significantly higher after OECs transplantation than before treatment. SSR latencies were shorter and response amplitudes increased after treatment. Long-term follow-up showed further improvement only in motor function and autonomic function compared with 3 months postoperatively. No complications occurred in any patient during long-term follow-up. The results indicate that the transplantation of OECs in spinal cord restored function without serious side effects.
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Attabib N, Kurban D, Cheng CL, Rivers CS, Bailey CS, Christie S, Ethans K, Flett H, Furlan JC, Tsai EC, O'Connell C. Factors Associated with Recovery in Motor Strength, Walking Ability, and Bowel and Bladder Function after Traumatic Cauda Equina Injury. J Neurotrauma 2020; 38:322-329. [PMID: 32907483 PMCID: PMC7826419 DOI: 10.1089/neu.2020.7303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Traumatic cauda equina injury (TCEI) is usually caused by spine injury at or below L1 and can result in motor and/or sensory impairments and/or neurogenic bowel and bladder. We examined factors associated with recovery in motor strength, walking ability, and bowel and bladder function to aid in prognosis and establishing rehabilitation goals. The analysis cohort was comprised of persons with acute TCEI enrolled in the Rick Hansen Spinal Cord Injury Registry. Multi-variable regression analysis was used to determine predictors for lower-extremity motor score (LEMS) at discharge, walking ability at discharge as assessed by the walking subscores of either the Functional Independence Measure (FIM) or Spinal Cord Independence Measure (SCIM), and improvement in bowel and bladder function as assessed by FIM-relevant subscores. Age, sex, neurological level and severity of injury, time from injury to surgery, rehabilitation onset, and length of stay were examined as potential confounders. The cohort included 214 participants. Median improvement in LEMS was 4 points. Fifty-two percent of participants were able to walk, and >20% recovered bowel and bladder function by rehabilitation discharge. Multi-variable analyses revealed that shorter time from injury to rehabilitation admission (onset) was a significant predictor for both improvement in walking ability and bowel function. Longer rehabilitation stay and being an older female were associated with improved bladder function. Our results suggest that persons with TCEI have a reasonable chance of recovery in walking ability and bowel and bladder function. This study provides important information for rehabilitation goals setting and communication with patients and their families regarding prognosis.
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Affiliation(s)
- Najmedden Attabib
- Dalhousie University, Horizon Health Network, Division of Neurosurgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Dilnur Kurban
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | | | - Carly S Rivers
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Christopher S Bailey
- Division of Orthopaedics, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Sean Christie
- Research Division of Neurosurgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Karen Ethans
- Department of Medicine, Section of Physical Medicine and Rehabilitation, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Heather Flett
- Brain and Spinal Cord Injury Rehab Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Julio C Furlan
- Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, Ontario, Canada.,Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Eve C Tsai
- Department of Surgery, Division of Neurosurgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Colleen O'Connell
- Physical Medicine and Rehabilitation, Dalhousie University Faculty of Medicine, Stan Cassidy Centre for Rehabilitation, Fredericton, New Brunswick, Canada
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Mah C, Noonan VK, Bryan S, Whitehurst DGT. Empirical Validity of a Generic, Preference-Based Capability Wellbeing Instrument (ICECAP-A) in the Context of Spinal Cord Injury. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:223-240. [PMID: 32981008 DOI: 10.1007/s40271-020-00451-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Assessing the validity of generic instruments across different clinical contexts is an important area of methodological research in economic evaluation and outcomes measurement. OBJECTIVE Our objective was to examine the empirical validity of a generic, preference-based capability wellbeing instrument (ICECAP-A) in the context of spinal cord injury. METHODS This study consisted of a secondary analysis of data collected using an online cross-sectional survey. The survey included questions regarding demographics, injury classifications and characteristics, secondary health conditions, quality of life and wellbeing, and functioning in activities of daily living. Analysis comprised the descriptive assessment of Spearman's rank correlations between item-/dimension-level data for the ICECAP-A and four preference-based health-related quality of life (HRQoL) instruments, and discriminant and convergent validity approaches to examine 21 evidence-informed or theoretically derived constructs. Constructs were defined using participant and injury characteristics and responses to a range of health, wellbeing and functioning outcomes. RESULTS Three hundred sixty-four individuals completed the survey. Mean index score for the ICECAP-A was 0.761; 12 (3%) individuals reported full capability (upper anchor; score = 1), and there were no reports of zero capabilities (lower anchor; score = 0). The strongest correlations were dominated by items and dimensions on the comparator (HRQoL) instruments that are non-health aspects of quality of life, such as happiness and control over one's life (including self-care). Of 21 hypothesised constructs, 19 were confirmed in statistical tests, the exceptions being the exploratory hypotheses regarding education and age at injury. CONCLUSION The ICECAP-A is an empirically valid outcome measure for assessing capability wellbeing in people with spinal cord injury living in a community setting. The extent to which the ICECAP-A provides complementary information to preference-based HRQoL instruments is dependent on the comparator.
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Affiliation(s)
- Cassandra Mah
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada.,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, BC, Canada.,Blusson Spinal Cord Centre, Vancouver, BC, Canada
| | - Stirling Bryan
- Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - David G T Whitehurst
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada. .,Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, BC, Canada. .,International Collaboration on Repair Discoveries (ICORD), Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
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7
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Impact of neuropathic pain on participation: perspectives from the Canadian SCI community survey. Spinal Cord 2020; 59:141-150. [PMID: 32636522 DOI: 10.1038/s41393-020-0512-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 06/19/2020] [Accepted: 06/23/2020] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Secondary analysis of an observational cohort study. OBJECTIVES To determine if the perceived overall limitation of neuropathic pain on activities (NP limitation) covaries in 26 specific life activities in people with SCI, taking into account the severity of injury. SETTING Community-based in Canada. METHODS Secondary analysis of a cohort (N = 1481) was performed using questionnaires to rate NP frequency and limitation on activities as well as participation in 26 life activities. Relative risks (RR) analyses using Poisson regression were used to examine the data. RESULTS Most participants (N = 1158; 78%) reported living with NP (from once a year to every day). When NP limitation was described as "not at all" or "very little" (N = 394; 34%), there was no statistically significant RR (p > 0.0019), suggesting no additional risk of not participating "as much as wanted" in any of activities compared to participants with no NP. When NP limitation was described as "to some extent" (N = 411; 35%), a significantly higher risk was observed for 5 of the 26 activities (1.34 < RR < 1.62), and for 23 activities with a large range (1.24 < RR < 3.20) when NP limitation was rated as "to a great extent or more" (N = 353; 31%). CONCLUSION The variation of RR observed across the 26 activities suggests that the NP limitation may not be general but rather related to specific activity characteristics, which should be taken into account when evaluating NP limitations with a specific focus on the life activities being affected.
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8
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Battalio SL, Jensen MP, Molton IR. Secondary health conditions and social role satisfaction in adults with long-term physical disability. Health Psychol 2019; 38:445-454. [PMID: 31045428 PMCID: PMC6501832 DOI: 10.1037/hea0000671] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Individuals living with physical disability due to early acquired or traumatic conditions often experience a range of psychological and physical health problems that are associated with their condition but are not directly caused by it. Known as "secondary health conditions," these problems can interact with existing functional limitations and other medical comorbidities to limit social participation. The current study assessed the concurrent and longitudinal associations between secondary health conditions, chronic medical comorbidities, and functional limitations, with a PROMIS® measure of social role participation. METHODS A longitudinal survey study of community-dwelling adults with one of four chronic physical conditions (multiple sclerosis, muscular dystrophy, spinal cord injury, postpoliomyelitis syndrome). The baseline survey (T1) was mailed to 2041 individuals, and1862 baseline surveys were completed and returned (91% response rate). The follow-up survey (T2) was mailed roughly three years later; 1594 completed and returned the T2 survey (86% of T1 survey completers). RESULTS Multiple linear regression analyses revealed that secondary health conditions, functional impairments, and chronic medical comorbidities accounted for 52% of the variance in satisfaction with social roles concurrently at T1. The amount of variance of change in satisfaction with social roles over the ∼3-year period accounted for by these variables was 3%. Functional limitations and more psychologically oriented secondary conditions were the strongest predictors of satisfaction with social roles. CONCLUSIONS Findings suggest that, for people with disabilities, addressing psychologically oriented secondary health conditions may be as important as functional impairment in predicting long-term social health. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Samuel L. Battalio
- Department of Rehabilitation Medicine, University of Washington, WA, USA
| | - Mark P. Jensen
- Department of Rehabilitation Medicine, University of Washington, WA, USA
| | - Ivan R. Molton
- Department of Rehabilitation Medicine, University of Washington, WA, USA
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9
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Hreha KP, Smith AE, Wong JL, Mroz TM, Fogelberg DJ, Molton I. Impact of secondary health conditions on social role participation for a long-term physical disability cohort. PSYCHOL HEALTH MED 2019; 24:1159-1170. [PMID: 30909732 DOI: 10.1080/13548506.2019.1595684] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
For people living with long-term physical disability (LTPD) social participation may involve managing physical impairments and secondary health conditions (SHCs) that are not due to the pathophysiology of the LTPD diagnosis itself. Prior research found a negative relationship between SHCs and participation in social roles in people with spinal cord injury (SCI). We expand on this research by investigating the influence of SHCs on participation in social roles for people with one of four LTPDs, controlling for co-variates. We (1) evaluated the associations between SHCs and participation in social roles; and (2) determined whether SHCs on individuals' ability to participate in social roles varies by type of diagnosis in those aging with either SCI, muscular sclerosis, muscular dystrophy, or post-polio syndrome. Cross-sectional, secondary data analysis from a return-by-mail survey. N = 1,573. Data were analyzed with multiple linear regressions (hypothesis 1), and then three moderated regressions (hypothesis 2). After controlling for demographics, SHCs were associated with lower ability to participate in social roles and accounted for 48% of the variance (all p's <.001). The relationship between depression and social role participation was moderated by diagnosis, such that depression was more negatively associated with social participation among individuals with SCI (p = .020). Thus, SHC negatively impact participation in social roles.
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Affiliation(s)
- Kimberly P Hreha
- Department of Rehabilitation Medicine, University of Washington Department of Rehabilitation Medicine , Seattle, WA , USA
| | - Amanda E Smith
- Department of Future Health Scenarios, Institute for Health Metrics and Evaluation , Seattle, WA , USA
| | - Jennifer L Wong
- Department of Rehabilitation Medicine, University of Washington Department of Rehabilitation Medicine , Seattle, WA , USA
| | - Tracy M Mroz
- Department of Rehabilitation Medicine, University of Washington Department of Rehabilitation Medicine , Seattle, WA , USA
| | - Donald J Fogelberg
- Department of Rehabilitation Medicine, University of Washington Department of Rehabilitation Medicine , Seattle, WA , USA
| | - Ivan Molton
- Department of Rehabilitation Medicine, University of Washington Department of Rehabilitation Medicine , Seattle, WA , USA
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10
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Research on prevalence of secondary conditions in individuals with disabilities: an overview. Int J Rehabil Res 2018; 40:297-302. [PMID: 28953044 DOI: 10.1097/mrr.0000000000000255] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Individuals with disabilities may be at increased risk of a number of secondary conditions. Secondary conditions influence health status and quality of life. Many of these conditions are preventable and their consequences can be managed. Knowledge of the prevalence, course, and association with age of secondary conditions is needed for better prevention and management. The aim of present study was to review the available literature on the prevalence of secondary conditions in individuals with disability. We performed searches of electronic databases for studies published between 1980 and 2017 that provided information on the prevalence of secondary conditions in individuals with disabilities. The reference list of all relevant citations was also reviewed for further material. Nineteen papers were included. The findings indicate that (i) studies were mainly population-based descriptive studies, (ii) researchers used different questionnaires, (iii) the most common studied population are patients with spinal cord injury, and (iv) even though secondary conditions are different in different patient populations, the main secondary conditions are pain, spasticity, urinary tract infections, fatigue, depression, and sleep problems. The prevalence of each condition varies widely depending on the studied population and research methodologies across studies. There is still much information that remains to be obtained on the prevalence, definition, and conceptual organization of secondary conditions. There is also a lack of longitudinal studies on the natural course of these conditions.
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Inskip JA, Lucci VEM, McGrath MS, Willms R, Claydon VE. A Community Perspective on Bowel Management and Quality of Life after Spinal Cord Injury: The Influence of Autonomic Dysreflexia. J Neurotrauma 2018; 35:1091-1105. [PMID: 29239268 PMCID: PMC5908418 DOI: 10.1089/neu.2017.5343] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
Autonomic dysfunction is common in individuals with spinal cord injury (SCI) and leads to numerous abnormalities, including profound cardiovascular and bowel dysfunction. In those with high-level lesions, bowel management is a common trigger for autonomic dysreflexia (AD; hypertension provoked by sensory stimuli below the injury level). Improving bowel care is integral for enhancing quality of life (QoL). We aimed to describe the relationships between bowel care, AD, and QoL in individuals with SCI. We performed an online community survey of individuals with SCI. Those with injury at or above T7 were considered at risk for AD. Responses were received from 287 individuals with SCI (injury levels C1-sacral and average duration of injury 17.1 ± 12.9 [standard deviation] years). Survey completion rate was 73% (n = 210). Bowel management was a problem for 78%: it interfered with personal relationships (60%) and prevented staying (62%) and working (41%) away from home. The normal bowel care duration was >60 min in 24% and most used digital rectal stimulation (59%); 33% reported bowel incontinence at least monthly. Of those at risk for AD (n = 163), 74% had AD symptoms during bowel care; 32% described palpitations. AD interfered with activities of daily living in 51%. Longer durations of bowel care (p < 0.001) and more severe AD (p = 0.04) were associated with lower QoL. Bowel management is a key concern for individuals with SCI and is commonly associated with symptoms of AD. Further studies should explore ways to manage bowel dysfunction, increase self-efficacy, and ameliorate the impact of AD to improve QoL.
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Affiliation(s)
- Jessica A. Inskip
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Vera-Ellen M. Lucci
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Maureen S. McGrath
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Rhonda Willms
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
- GF Strong Rehabilitation Center, Spinal Cord Injury Program, Vancouver Coastal Health, Vancouver, British Columbia, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, UBC, Vancouver, British Columbia, Canada
| | - Victoria E. Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- International Collaboration On Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
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12
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Cobb JE, Leblond J, Dumont FS, Noreau L. Perceived influence of intrinsic/extrinsic factors on participation in life activities after spinal cord injury. Disabil Health J 2018; 11:583-590. [PMID: 29650349 DOI: 10.1016/j.dhjo.2018.03.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 03/01/2018] [Accepted: 03/24/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Various types of limitations on community participation are experienced by people with spinal cord injury (SCI). OBJECTIVES To determine: 1) the perceived influence of six intrinsic/extrinsic factors (i.e. physical impairment, emotional condition, thinking skills, environment, lack of assistance, discrimination) on participation in 26 life activities, 2) if this influence varied based on extent of participation, and 3) if personal or environmental characteristics influenced perceptions. METHODS Secondary analysis of a cohort (SCI Community Survey, n = 1508) using the SCI Person-Perceived Participation in Daily Activities Questionnaire. Frequency tables, Fisher's exact tests and correspondence analyses. RESULTS Respectively, 79.6% and 38.5% of respondents perceived that their physical impairment and the natural and/or built environment were the main factors that limited participation across all activities. Considering participation between three groups (no participation; less than wanted; as much as wanted), significant differences (p < 0.001) of perceptions were observed in 65% of the combinations (26 activities x 6 factors). The hypothesis that respondents who did not participate would perceive the highest proportion of limitations was confirmed in 41% of the combinations. Perceived influence of the intrinsic/extrinsic factors on participation was not significantly influenced by other personal or environmental characteristics. CONCLUSION A majority of people with SCI perceived that their participation is limited by one or more of intrinsic/extrinsic factors. Perceptions regarding which factors influence participation differ between activities and these perceptions appear related to the extent of participation suggesting that those who actively participate could be the most sensitive to limitations in certain activities.
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Affiliation(s)
- John E Cobb
- Vancouver General Hospital, 899 W 12th Ave, Vancouver, V5Z 1M9, British Columbia, Canada.
| | - Jean Leblond
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, 525 blv. Wilfrid-Hamel, Quebec City, Quebec, G1M 2S8, Canada.
| | - Frédéric S Dumont
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, 525 blv. Wilfrid-Hamel, Quebec City, Quebec, G1M 2S8, Canada.
| | - Luc Noreau
- Center for Interdisciplinary Research in Rehabilitation and Social Integration, 525 blv. Wilfrid-Hamel, Quebec City, Quebec, G1M 2S8, Canada; Department of Rehabilitation, Université Laval, 2325 Rue de l'Université, Quebec City, Quebec, G1V 0A6, Canada.
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13
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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.
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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
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Park SE, Elliott S, Noonan VK, Thorogood NP, Fallah N, Aludino A, Dvorak MF. Impact of bladder, bowel and sexual dysfunction on health status of people with thoracolumbar spinal cord injuries living in the community. J Spinal Cord Med 2017; 40:548-559. [PMID: 27576584 PMCID: PMC5815154 DOI: 10.1080/10790268.2016.1213554] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
OBJECTIVE The disruption of autonomic function following a spinal cord injury (SCI) is common and can negatively affect quality of life. The objective of this study was to describe the prevalence of bladder/bowel incontinence and sexual dysfunction in community-dwelling individuals with a thoracolumbar SCI and examine the impact on general physical and mental health status. METHODS Participants who sustained a traumatic SCI to the thoracolumbar region of the spinal cord and classified as American Spinal Injury Association Impairment Scale (AIS) A to D were recruited. Demographic, injury data, MRI classification and neurological data were collected on admission. At follow-up, the neurological data, a questionnaire collecting participant-reported secondary health conditions (SHCs) (e.g. bladder incontinence, depression etc.) following SCI and health status measured by Short Form-36 were obtained. Regression models determined the association of health status with demographic/injury-related data, types and number of SHCs. RESULTS Of the 51 participants, 58.8% reported bladder incontinence, 54.0% bowel incontinence, 60.8% sexual dysfunction and 29.4% had all three. The regression models demonstrated that age at injury, bowel incontinence, sexual dysfunction, presence of pain, motor score at follow-up and the number of SHCs were significant predictors of health status. The number of SHCs was more predictive than all other demographic and injury variables for health status. CONCLUSION Results highlight the high prevalence of self-reported bowel/bladder incontinence and sexual dysfunction in the traumatic thoracolumbar SCI population and support the need for standardized assessments. Several demographic, injury-related and SHCs impacted health status and should be considered for the management of individuals living in the community.
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Affiliation(s)
| | - Stacy Elliott
- Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada,Urologic Sciences, University of British Columbia, Vancouver, BC, Canada,International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, BC, Canada,Vancouver Sperm Retrieval Clinic, Vancouver Coastal Health Authority, Vancouver, BC, Canada,G.F. Strong Rehabilitation Center, Sexual Health Rehabilitation Service, Vancouver, BC, Canada
| | - Vanessa K. Noonan
- Rick Hansen Institute, Vancouver, BC, Canada,Division of Spine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada,Correspondence to: Vanessa Noonan, Research and Best Practice Implementation, Rick Hansen Institute, 6th Floor, Blusson Spinal Cord Centre, 6400 - 818 W. 10th Avenue, Vancouver, British Columbia, Canada V5Z 1M9.
| | | | - Nader Fallah
- Rick Hansen Institute, Vancouver, BC, Canada,Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Allan Aludino
- Division of Spine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada,Vancouver Spine Surgery Institute, Vancouver General Hospital, Vancouver, BC, Canada
| | - Marcel F. Dvorak
- Division of Spine, Department of Orthopaedics, University of British Columbia, Vancouver, BC, Canada,Vancouver Spine Surgery Institute, Vancouver General Hospital, Vancouver, BC, Canada
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15
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Inskip JA, Ravensbergen H(RJC, Sahota IS, Zawadzki C, McPhail LT, Borisoff JF, Claydon VE. Dynamic wheelchair seating positions impact cardiovascular function after spinal cord injury. PLoS One 2017; 12:e0180195. [PMID: 28666000 PMCID: PMC5493360 DOI: 10.1371/journal.pone.0180195] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 06/12/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Innovative wheelchairs allow individuals to change position easily for comfort and social situations. While these wheelchairs are beneficial in multiple ways, the effects of position changes on blood pressure might exacerbate hypotension and cerebral hypoperfusion, particularly in those with spinal cord injury (SCI) who can have injury to autonomic nerves that regulate cardiovascular control. Conversely, cardiovascular benefits may be obtained with lowered seating. Here we investigate the effect of moderate changes in wheelchair position on orthostatic cardiovascular and cerebrovascular reflex control. METHODS Nineteen individuals with SCI and ten neurologically-intact controls were tested in supine and seated positions (neutral, lowered, and elevated) in the Elevation™ wheelchair. Participants with SCI were stratified into two groups by the severity of injury to cardiovascular autonomic pathways. Beat-to-beat blood pressure, heart rate and middle cerebral artery blood flow velocity (MCAv) were recorded non-invasively. RESULTS Supine blood pressure and MCAv were reduced in individuals with lesions to autonomic pathways, and declined further with standard seating compared to those with preserved autonomic control. Movement to the elevated position triggered pronounced blood pressure and MCAv falls in those with autonomic lesions, with minimum values significantly reduced compared to the seated and lowered positions. The cumulative duration spent below supine blood pressure was greatest in this group. Lowered seating bolstered blood pressure in those with lesions to autonomic pathways. CONCLUSIONS Integrity of the autonomic nervous system is an important variable that affects cardiovascular responses to orthostatic stress and should be considered when individuals with SCI or autonomic dysfunction are selecting wheelchairs. SPONSORSHIP This work was supported in part by the Heart and Stroke Foundation of British Columbia and the Yukon (V.E.C).
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Affiliation(s)
- Jessica A. Inskip
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Henrike (Rianne) J. C. Ravensbergen
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Inderjeet S. Sahota
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Christine Zawadzki
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Lowell T. McPhail
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
| | - Jaimie F. Borisoff
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
- British Columbia Institute of Technology (BCIT), Burnaby, British Columbia, Canada
| | - Victoria E. Claydon
- Department of Biomedical Physiology and Kinesiology, Simon Fraser University, Burnaby, British Columbia, Canada
- International Collaboration on Repair Discoveries (ICORD), University of British Columbia, Vancouver, British Columbia, Canada
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An evaluation of the International Standards to Document Remaining Autonomic Function after Spinal Cord Injury: input from the international community. Spinal Cord 2016; 55:198-203. [DOI: 10.1038/sc.2016.152] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 04/27/2016] [Accepted: 05/02/2016] [Indexed: 02/03/2023]
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Impact of health problems secondary to SCI one and five years after first inpatient rehabilitation. Spinal Cord 2016; 55:98-104. [DOI: 10.1038/sc.2016.103] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2016] [Revised: 05/14/2016] [Accepted: 05/28/2016] [Indexed: 12/24/2022]
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