Qualidade de vida em pacientes com lesão medular

A Systematic Review of the Impact of Spinal Cord Injury on Costs and Health-Related Quality of Life

OBJECTIVE

To systematically review the health-related quality of life (HRQoL) burden and costs of spinal cord injury (SCI) on health services, patients and wider society.

METHODS

A systematic review guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement was conducted in March 2021 through Scopus, PubMed and Embase databases. Inclusion criteria were quantitative studies on SCI reporting healthcare costs, social costs and/or HRQoL measured with the Euroqol EQ-5D or Short-Form 36. Risk of bias was assessed using the QualSyst tool. Descriptive analyses, random-effects direct meta-analysis and random-effects meta-regression were conducted.

RESULTS

A total of 67 studies were eligible for inclusion. SCI individuals tend to report higher HRQoL in mental than physical dimensions of the Short-Form 36. Neurological level of SCI negatively affects HRQoL. Cross-sectional studies find employment is associated with better HRQoL, but the effect is not observed in longitudinal studies. The estimated lifetime expenditure per individual with SCI ranged from US$0.7 million to US$2.5 million, with greater costs associated with earlier age at injury, neurological level, United States of America healthcare setting and the inclusion of non-healthcare items in the study.

CONCLUSIONS

SCI is associated with low HRQoL on mobility and physical dimensions. Mental health scores tend to be greater than physical scores, and most dimensions of HRQoL appear to improve over time, at least over the first year. SCI is associated with high costs which vary by country.

CLINICAL TRIALS REGISTRATION

This review was registered in PROSPERO (registration number: CRD42021235801).

Surveying people with spinal cord injuries in Brazil to ascertain research priorities

Scientists are concerned that the research they conduct accurately portrays the needs of people living with spinal cord injuries (SCI). As such, this study set out to investigate the main problems faced by people with SCI and their expectations for research. This quantitative, exploratory, analytical, and cross-sectional study was carried out online, with a non-probabilistic sample of 618 Brazilian adults with SCI who had registered voluntarily to participate in the research of the Neurorehab group. The virtual questionnaire consisted of 22 questions based on ISCOS Data Sets. The majority (68.9%) of participants were male, with higher education or a post-graduate qualification (49.5%). Most injuries had experienced traumatic injuries (78.5%) and 58.7% were paraplegic. The mean age was 38.04 years (SD = 9.85). The main difficulties faced after SCI were locomotion/accessibility (70.9%), neurogenic bladder (68.8%), neurogenic bowel (48.2%), and sexuality (36.1%). The highest demand was for experimental studies on stem cells (22.5%), rehabilitation (14.2%), and cures (13.9%). Most (84.3%) of those who reported sexuality problems after SCI were men (p = 0.013). The findings obtained empower people with SCI by enabling them to influence the agenda of scientific research based on their expectations and difficulties. This survey will also aid organizations to engage stakeholders to implement a comprehensive SCI management program.

A comparison of one year outcomes between standardized locomotor training and usual care after motor incomplete spinal cord injury: Community participation, quality of life and re-hospitalization

CONTEXT/OBJECTIVE

Spinal cord injury (SCI) often results in a significant loss of mobility and independence coinciding with reports of decreased quality of life (QOL), community participation, and medical complications often requiring re-hospitalization. Locomotor training (LT), the repetition of stepping-like patterning has shown beneficial effects for improving walking ability after motor incomplete SCI, but the potential impact of LT on psychosocial outcomes has not been well-established. The purpose of this study was to evaluate one year QOL, community participation and re-hospitalization outcomes between individuals who participated in a standardized LT program and those who received usual care (UC).

DESIGN/SETTING/PARTICIPANTS

A retrospective (nested case/control) analysis was completed using SCI Model Systems (SCIMS) data comparing one year post-injury outcomes between individuals with traumatic motor incomplete SCI who participated in standardized LT to those who received UC.

OUTCOME MEASURES

Outcomes compared include the following: Satisfaction with Life Scale (SWLS™), Craig Handicap Assessment and Reporting Technique-Short Form (CHART-SF™), and whether or not an individual was re-hospitalized during the first year of injury.

RESULTS

Statistically significant improvements for the LT group were found in the following outcomes: SWLS (P = 0.019); and CHART subscales [mobility (P = <0.001)]; occupation (P = 0.028); with small to medium effects sizes.

CONCLUSION

Individuals who completed a standardized LT intervention reported greater improvements in satisfaction with life, community participation, and fewer re-hospitalizations at one year post-injury in comparison to those who received UC. Future randomized controlled trials are needed to verify these findings.

Health Care for People with Disabilities in the Unified Health System in Brazil: A Scoping Review

People with disabilities have greater need for healthcare on average, but often face barriers when accessing these services. The Brazilian government launched the National Health Policy for People with Disabilities (PNSPD) in 2002 to address this inequality. PNSPD has six areas of focus: quality of life, impairment prevention, comprehensive health care, organization and functioning of health services, information mechanisms, and training of human resources. The aim of this article was to undertake a scoping review to assess the evidence on the experience of people with disabilities in Brazil with respect to the six themes of the PNSPD. The scoping review included articles published between 2002 and 2019, from four electronic databases: PUBMED/MEDLINE, LILACS, Science Direct, and Scielo. In total, 8076 articles were identified, and after review of titles, abstracts, and full texts by two independent reviewers, 98 were deemed eligible for inclusion. The evidence was relatively limited in availability and scope. However, it consistently showed large gaps in delivery of healthcare to people with disabilities across the six dimensions considered. There was lack of actions aimed at promoting quality of life; insufficient professional training about disability; little evidence on the health profile of people with disabilities; large gaps in the availability of care due to widespread physical, informational, and attitudinal barriers; and poor distribution of the supply and integration of services. In conclusion, the policy framework in Brazil is supportive of the inclusion of people with disabilities in health services; however, large inequalities remain due to poor implementation of the policy into practice.

Quality of Life and Self-Care Ability Among Individuals With Spinal Cord Injury

This study aimed to identify self-care ability, quality of life (QOL), and their related factors in individuals with spinal cord injury (SCI). A cross-sectional design and a convenience sample of 152 individuals with SCI from four SCI units and clinics in Jordan were used. Modified Barthel Index of Activities of Daily Living and the World Health Organization Quality of Life-BREF instruments were used. About 55.3% of participants reported moderate dependence on others to support their self-care ability, 48.0% reported good QOL, 65.8% were satisfied with their health after SCI, and physical and environmental domains received the highest scores. Having incomplete injury or paraplegia significantly predicted higher self-care ability. Being male, having a higher level of education, incomplete injury, paraplegia, and no pressure injury significantly predicted higher QOL (p < .000). Collaboration is needed among health institutions, families, and communities to improve self-care ability and QOL after SCI.

A percepção de qualidade de vida de pessoas com deficiência motora: diferenças entre cadeirantes e deambuladores

RESUMO A rotina das pessoas com deficiência física inclui o uso de diferentes recursos de tecnologia assistiva, que podem auxiliar em seu desenvolvimento físico e intelectual, afetando diretamente sua qualidade de vida. O objetivo deste estudo foi avaliar a percepção da qualidade de vida de pessoas cadeirantes e deambuladoras com deficiência física no município de Itajaí, Santa Catarina. Trata-se de uma pesquisa descritiva de corte transversal e caráter exploratório quantitativo, cuja. amostra foi constituída por 163 participantes (91 cadeirantes e 72 deambuladores), que responderam a um questionário estruturado com informações socioeconômicas e de saúde e ao instrumento do World Health Organization Quality of Life Instruments (WHOQOL-bref), para mensurar a qualidade de vida. Na avaliação dos domínios físico e psicológico não foram observadas diferenças significativas entre os dois grupos, portanto a percepção da qualidade de vida não foi afetada pela utilização da cadeira de rodas. No entanto, examinando-se o domínio de relações sociais e meio ambiente, a percepção da qualidade de vida foi significativamente menor para cadeirantes com paresias, em relação às plegias e à amputação.