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Borg SJ, Borg DN, Arora M, Middleton JW, Marshall R, Nunn A, Geraghty T. Unmet healthcare needs, access to services and experiences with health providers among persons with spinal cord injury in Australia. Spinal Cord 2024:10.1038/s41393-024-00997-4. [PMID: 38806626 DOI: 10.1038/s41393-024-00997-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2023] [Revised: 05/12/2024] [Accepted: 05/17/2024] [Indexed: 05/30/2024]
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVES Appropriate and timely lifelong access to healthcare following a spinal cord injury (SCI) is critical, yet unmet healthcare needs in this population are common. Poor experiences with healthcare providers can be a barrier to health-seeking behaviour, and we hypothesised that there would be an association between unmet healthcare needs and care experiences. This study aimed to: (1) describe healthcare provider utilisation in the past year, unmet care needs and satisfaction with healthcare services; (2) explore the association between experiences with healthcare providers and unmet healthcare needs; and (3) explore the association between healthcare provider utilisation and participant characteristics, including unmet healthcare needs. SETTING Community. METHODS Analysis of data for 1579 Australians aged ≥ 18, who were ≥ 1-year post-SCI and living in the community. Bayesian penalised regression was used to model six binary outcomes: unmet healthcare needs; the use of general practitioners (GPs), allied health practitioners, rehabilitation specialists; medical specialists; and hospitalisations in the past 12-months. RESULTS Unmet needs were reported by 17% of participants, with service cost the common deterrent. There was evidence of an effect for provider experiences on unmet healthcare needs, but no evidence that unmet healthcare needs was associated with the use of GPs, allied health practitioners, and rehabilitation or medical specialists. CONCLUSIONS Unmet healthcare needs were reported in the context of high healthcare use and large proportions of secondary conditions in a cohort with long-term SCI. Improved health access for people with SCI include better primary-secondary care collaboration is needed.
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Affiliation(s)
- Samantha J Borg
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia.
- Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, QLD, Australia.
| | - David N Borg
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
- School of Exercise and Nutrition Sciences, Queensland University of Technology, Brisbane, QLD, Australia
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW, Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - James W Middleton
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW, Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Ruth Marshall
- South Australian Spinal Cord Injury Service, Central Adelaide Local Health Network, Adelaide, SA, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, SA, Australia
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Heidelberg, VIC, Australia
| | - Timothy Geraghty
- The Hopkins Centre, Menzies Health Institute Queensland, Griffith University, Brisbane, QLD, Australia
- Division of Rehabilitation, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Pallerla S, Krishnareddy SR, Parthasarathy NB, Navaneetham J, Gupta A. A qualitative study on psycho-social needs of the family caregivers of persons with spinal cord injury. J Family Med Prim Care 2024; 13:1262-1270. [PMID: 38827726 PMCID: PMC11142019 DOI: 10.4103/jfmpc.jfmpc_1349_23] [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] [Received: 08/17/2023] [Revised: 09/29/2023] [Accepted: 10/03/2023] [Indexed: 06/04/2024] Open
Abstract
Background Spinal cord injury is a high-cost long-lasting disability and a life-changing experience for family caregivers (FCGs). The current study aimed to explore the psycho-social needs of the FCGs of persons with spinal cord injury (PwSCI). Materials and Methods An exploratory qualitative approach was used, and sixteen FCGs of PwSCI participated in the face-to-face interviews. All the interviews were audio-recorded, and session notes were added to the existing data and later transcribed. Thematic analysis was used to identify the main themes. Results Three main themes have emerged, namely, awareness needs, resource needs, and personal care needs, from the data as a result of the qualitative analysis: The main themes have been categorised into nine sub-themes, such as want to know, alternative ways of contacting, the helpful or conducive environment of arrangements, sources to get money, pension certificate needs, resources for livelihood, resources for continuing the treatment, need my own time, and controlling of feelings. Conclusion The findings of this research aid in designing or developing need-based tailor-made psychosocial interventions for the FCGs of PwSCI in India. Multidisciplinary team professionals involved in managing spinal cord injury and other stakeholders should understand the importance of meeting the mentioned psycho-social needs of FCGs of PwSCI and delivering such tailor-made psycho-social interventions in a timely.
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Affiliation(s)
- Srikanth Pallerla
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Shanivaram Reddy Krishnareddy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Nirmala Berigai Parthasarathy
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Janardhana Navaneetham
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Middleton JW, Arora M, Jerram KAS, Bourke J, McCormick M, O’Leary D, Weber G, Lembke T, Craig A. Co-design of the Spinal Cord Injury Health Maintenance Tool to Support Self-Management: A Mixed-Methods Approach. Top Spinal Cord Inj Rehabil 2024; 30:59-73. [PMID: 38433736 PMCID: PMC10906369 DOI: 10.46292/sci23-00042] [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: 03/05/2024]
Abstract
Background There is a lack of consumer-friendly tools to empower and support people living with spinal cord injury (SCI) to self-manage complex health needs in community. This article describes the co-design process of the new SCI Health Maintenance Tool (SCI-HMT). Methods Co-design of the SCI-HMT using a mixed-methods approach included a rapid review, e-Delphi surveys with range of multidisciplinary health care professionals (n = 62), interviews of participants with SCI (n = 18) and general practitioners (n = 4), focus groups (n = 3 with 7, 4, and 4 participants with SCI, respectively), design workshops with stakeholders (n = 11, 8), and end-user testing (n = 41). Results The SCI-HMT (healthmaintenancetool.com) was developed based on participatory research with data synthesis from multiple sources. Five priority health maintenance issues for bladder, bowel, skin, pain, and autonomic dysreflexia were originally covered. Best practice recommendations, red flag conditions, referrals, and clinical pathways were agreed on through an e-Delphi technique. Qualitative analysis identified six broad key concepts for self-management, including early symptom recognition, role of SCI peers, knowledge sharing with primary care, general practitioners as gatekeepers, and shared decision-making and highlighted a need to place much stronger emphasis on mental health and well-being. Design workshops and end-user testing provided key insights about user experience, functionality, and content for the SCI-HMT. Conclusion The co-design process engaging end users, including people with SCI and general practitioners, enabled a shared understanding of the problem and identification of important needs and how to meet them. Informed by this process, the SCI-HMT is a freely accessible resource supporting SCI self-management, shared decision-making, and early problem identification.
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Affiliation(s)
- James W. Middleton
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
- Royal Rehab, Ryde NSW Australia
- State Spinal Cord Injury Service, NSW Agency for Clinical Innovation, St Leonards, NSW Australia
| | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - K. Anne Sinnott Jerram
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
| | - John Bourke
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
- Burwood Academy Trust, Burwood Hospital, Christchurch, New Zealand
| | | | | | | | - Tony Lembke
- The Alstonville Clinic, Alstonville, NSW Australia
| | - Ashley Craig
- John Walsh Centre for Rehabilitation Research, Northern Sydney Local Health District, St Leonards, NSW Australia
- The Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW Australia
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Kovacs Burns K, Bhatia Z, Gill B, van der Nest D, Knox J, Mouneimne M, Buck T, Charbonneau R, Aiello K, Loyola Sanchez A, Kamran R, Olayinka O, Ho C. Measures for Persons with Spinal Cord Injury to Monitor Their Transitions in Care, Health, Function, and Quality of Life Experiences and Needs: A Protocol for Co-Developing a Self-Evaluation Tool. Healthcare (Basel) 2024; 12:527. [PMID: 38470643 PMCID: PMC10930772 DOI: 10.3390/healthcare12050527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 01/30/2024] [Accepted: 02/20/2024] [Indexed: 03/14/2024] Open
Abstract
Evaluating the experiences of persons with spinal cord injury (PwSCI) regarding their transitions in care and changes in health, function, and quality of life is complex, fragmented, and involves multiple tools and measures. A staged protocol was implemented with PwSCI and relevant expert stakeholders initially exploring and selecting existing measures or tools through a modified Delphi process, followed by choosing one of two options. The options were to either support the use of the 10 selected tools from the Delphi method or to co-develop one unique condensed tool with relevant measures to evaluate all four domains. The stakeholders chose to co-develop one tool to be used by persons with SCI to monitor their transition experiences across settings and care providers. This includes any issues with care or support they needed to address at the time of discharge from acute care or rehabilitation and in the community at 3, 6, and 12 months or longer post-discharge. Once developed, the tool was made available online for the final stage of the protocol, which proposes that the tool be reliability tested prior to its launch, followed by validation testing by PwSCI.
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Affiliation(s)
- Katharina Kovacs Burns
- Clinical Quality Metrics/Primary Data Support, Data & Analytics, Alberta Health Services, Edmonton, AB T5J 3E4, Canada
- School of Public Health, University of Alberta, Edmonton, AB T6G 1C9, Canada
| | - Zahra Bhatia
- Spinal Cord Injury Alberta, Calgary, AB T2H 1H7, Canada
| | - Benveet Gill
- ReYu Paralysis Recovery Centre, Edmonton, AB T5S 1G8, Canada
| | - Dalique van der Nest
- Slave Lake Healthcare Centre (North Zone), Alberta Health Services, Slave Lake, AB T0G 2A2, Canada
| | - Jason Knox
- Tertiary Neurorehabilitation, Foothills Medical Centre, Calgary, AB T2N 2T9, Canada
| | - Magda Mouneimne
- Tertiary Neurorehabilitation, Foothills Medical Centre, Calgary, AB T2N 2T9, Canada
| | - Taryn Buck
- Glenrose Rehabilitation Hospital, Edmonton, AB T5G 0B7, Canada
| | - Rebecca Charbonneau
- Physical Medicine and Rehabilitation, Foothills Medical Centre, Calgary, AB T2N 2T9, Canada
| | - Kasey Aiello
- Patient Liaison to Neurosciences, Foothills Medical Centre, Calgary, AB T2N 2T9, Canada
| | - Adalberto Loyola Sanchez
- Division of Physical Medicine & Rehabilitation, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada
- Department of Clinical Neurosciences, Glenrose Rehabilitation Hospital, Edmonton, AB T5G 0B7, Canada
| | - Rija Kamran
- Rehabilitation Sciences, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB T2N 1N4, Canada
| | - Olaleye Olayinka
- Division of Physical Medicine & Rehabilitation, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada
| | - Chester Ho
- Glenrose Rehabilitation Hospital, Edmonton, AB T5G 0B7, Canada
- Division of Physical Medicine & Rehabilitation, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB T6G 2S2, Canada
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Mashola MK, Korkie E, Mothabeng DJ. Exploring the Experience of Living with Pain after Spinal Cord Injury: A Qualitative Study. Behav Neurol 2024; 2024:9081530. [PMID: 38343899 PMCID: PMC10857878 DOI: 10.1155/2024/9081530] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 12/28/2023] [Accepted: 01/20/2024] [Indexed: 02/15/2024] Open
Abstract
A spinal cord injury is a life-changing experience that results in functional limitations and an increased risk of secondary health conditions. People with spinal cord injury identify pain as the most devastating health problem following their injury that not only affects their social life but their mental well-being as well. This study is aimed at exploring the lived experience of living with pain by community-dwelling manual wheelchair users with spinal cord injuries. An explorative qualitative design was used to explore their experiences. In-depth interviews were recorded and transcribed, and the data were analysed using inductive thematic content analysis in the MAXQDA v2020. Fifteen manual wheelchair users with paraplegia participated in this study, and four themes were identified from their experience of living with pain: pain constantly lurks, pain is worse than the direct consequences of the SCI, pain is restrictive, and life continues despite the pain. Categories and subcategories included the participants being one with the pain; pain interfering with sleep; feelings of anger, isolation, and suicidal ideation; and uncertainties about what the future holds living with pain. Living with pain after SCI is a challenging feat, and effective management of pain is necessary to improve not only functioning and mobility but also mental health and life satisfaction.
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Affiliation(s)
- Mokgadi Kholofelo Mashola
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elzette Korkie
- Department of Physiotherapy, School of Healthcare Sciences, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Diphale Joyce Mothabeng
- Department of Physiotherapy, School of Healthcare Sciences, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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Murphy LF, Bryce TN, Coker J, Scott M, Roach MJ, Worobey L, Botticello AL. Medical, dental, and optical care utilization among community-living people with spinal cord injury in the United States. J Spinal Cord Med 2024; 47:64-73. [PMID: 35993789 PMCID: PMC10795619 DOI: 10.1080/10790268.2022.2110817] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
CONTEXT/OBJECTIVE Information about patterns of healthcare utilization for people living with spinal cord injury (SCI) is currently limited, and this is needed to understand independent community living after SCI. This study investigates self-reported healthcare utilization among community-living people with SCI and assesses disparities across demographic, socioeconomic, and injury-related subgroups. DESIGN Secondary analysis of cross-sectional survey data administered via telephone interview. SETTING 6 SCI Model Systems centers in the United States (California, Colorado, New Jersey, New York, Ohio, and Pennsylvania). PARTICIPANTS Adults with chronic, traumatic SCI who were community-living for at least one year after the completion of an inpatient rehabilitation program (N = 617). INTERVENTIONS Not applicable. OUTCOME MEASURES Utilization of a usual source of 4 types of health care in the past 12 months: primary, SCI, dental, and optical. RESULTS 84% of participants reported utilizing primary care in the past year. More than half reported utilizing SCI (54%) and dental (57%) care, and 36% reported utilizing optical care. There were no significant differences across key subgroups in the utilization of primary care. Participants who had been injured for 5 years or less and participants with greater educational attainment were more likely to report utilizing SCI care. Participants with higher household income levels were more likely to report using dental care. Female participants and older age groups were more likely to report using optical care. CONCLUSION Rates of healthcare utilization among people with SCI are below recommended rates and vary across demographic, socioeconomic, and injury-related subgroups. This information can inform future research to target barriers to using healthcare services among community-living people with SCI.
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Affiliation(s)
- Lauren F. Murphy
- Center for Spinal Cord Injury Research and Center for Outcomes and Assessment Research, Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - Thomas N. Bryce
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | | | - Michael Scott
- Rancho Los Amigos National Rehabilitation Center, Downey, California, USA
| | - Mary Joan Roach
- Case Western Reserve University, Cleveland, Ohio, USA
- MetroHealth System, Cleveland, OH, USA
| | - Lynn Worobey
- Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
| | - Amanda L. Botticello
- Center for Spinal Cord Injury Research and Center for Outcomes and Assessment Research, Kessler Foundation, West Orange, New Jersey, USA
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, USA
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Mayo AL, Fung V, Hitzig SL, Gould S, Posa S, Summers deLuca L, Kayssi A. Exploring the psychosocial needs of persons with lower extremity amputation and feasibility of internet cognitive behavioural therapy: a qualitative study. Disabil Rehabil 2023; 45:4025-4034. [PMID: 36377342 DOI: 10.1080/09638288.2022.2144492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 11/02/2022] [Indexed: 11/16/2022]
Abstract
PURPOSE Following major lower extremity amputation (LEA), patients experience significant emotional distress and are at risk for anxiety and depression. There is a lack of mental health supports for this population, and internet-based cognitive behavioural therapy (iCBT) may be a useful resource to meet this need. The purpose of this study was to use a qualitative approach to explore the mental health needs of LEA patients and to gauge their attitudes of the use of iCBT to help them cope with their amputation. METHODS Semi-structured qualitative interviews were conducted with inpatients and outpatients with LEA recruited from a major urban rehabilitation hospital. Data were analysed using inductive codebook thematic analysis (TA). RESULTS Ten interviews were completed with individuals with LEA. The main themes identified were: (1) Fixating on the past; (2) Worry about the future; (3) Unmet mental health needs; (4) Barriers to Mental Health Support; (5) Importance of peer support; and (6) Tailoring iCBT. CONCLUSIONS Our findings highlight that patients with LEA are open to learning more about iCBT to meet their mental health needs. Key iCBT implementation considerations include taking into account issues of stigma associated with mental health, timing of delivery, levels of digital literacy, online security, and interactive content.IMPLICATIONS FOR REHABILITATIONFollowing lower extremity amputation (LEA), people experience significant emotional distress and are at risk for the development of anxiety and/or depression.Patients with LEA are receptive to an online mental health resource (i.e., internet-based cognitive behavioural therapy [iCBT]) but it needs to be tailored to meet the various mental health needs and digital literacy of the LEA population.The use of an implementation science approach can help identify factors related to the development and potential uptake of an iCBT for patients with LEA.
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Affiliation(s)
- Amanda L Mayo
- St. John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Canada
- St. John's Rehab Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Vera Fung
- St. John's Rehab, Sunnybrook Health Sciences Centre, Toronto, Canada
| | - Sander L Hitzig
- St. John's Rehab Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sarah Gould
- Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Stephanie Posa
- St. John's Rehab Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Leslie Summers deLuca
- Schulich Heart Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
| | - Ahmed Kayssi
- Schulich Heart Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Division of Vascular Surgery, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
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Wecht JM, Weir JP, Peters CG, Weber E, Wylie GR, Chiaravalloti NC. Autonomic Cardiovascular Control, Psychological Well-Being, and Cognitive Performance in People With Spinal Cord Injury. J Neurotrauma 2023; 40:2610-2620. [PMID: 37212256 DOI: 10.1089/neu.2022.0445] [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: 05/23/2023] Open
Abstract
PURPOSE To examine associations between parameters of psychological well-being, injury characteristics, cardiovascular autonomic nervous system (ANS) control, and cognitive performance in persons with spinal cord injury (SCI) compared with age-matched uninjured controls. This is an observational, cross-sectional study including a total of 94 participants (52 with SCI and 42 uninjured controls: UIC). Cardiovascular ANS responses were continuously monitored at rest and during administration of the Paced Auditory Serial Addition Test (PASAT). Self-report scores on the SCI-Quality of Life questionnaires are reported for depression, anxiety, fatigue, resilience, and positive affect. Participants with SCI performed significantly more poorly on the PASAT compared with the uninjured controls. Although not statistically significant, participants with SCI tended to report more psychological distress and less well-being than the uninjured controls. In addition, when compared with uninjured controls, the cardiovascular ANS responses to testing were significantly altered in participants with SCI; however, these responses to testing did not predict PASAT performance. Self-reported levels of anxiety were significantly related to PASAT score in the SCI group, but there was no significant relationship between PASAT and the other indices of SCI-Quality of Life. Future investigations should more closely examine the relationship among cardiovascular ANS impairments, psychological disorders, and cognitive dysfunction to better elucidate the underpinnings of these deficits and to guide interventions aimed at improving physiological, psychological, and cognitive health after SCI. Tetraplegia, paraplegia, blood pressure variability, cognitive, mood.
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Affiliation(s)
- Jill M Wecht
- James J Peters VA Medical Center, Bronx, New York, USA
- Bronx Veterans Medical Research Foundation, Bronx, New York, USA
- Department of Medicine, the Icahn School of Medicine, Mount Sinai, New York, New York, USA
- Department of Rehabilitation and Human Performance, the Icahn School of Medicine, Mount Sinai, New York, New York, USA
| | - Joseph P Weir
- Department of Health, Sport, and Exercise Science, University of Kansas, Lawrence, Kansas, USA
| | - Caitlyn G Peters
- James J Peters VA Medical Center, Bronx, New York, USA
- Kessler Foundation, West Orange, New Jersey, USA
| | - Erica Weber
- Kessler Foundation, West Orange, New Jersey, USA
- Rutgers-NJ Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey, USA
| | - Glenn R Wylie
- Kessler Foundation, West Orange, New Jersey, USA
- Rutgers-NJ Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey, USA
| | - Nancy C Chiaravalloti
- Kessler Foundation, West Orange, New Jersey, USA
- Rutgers-NJ Medical School, Department of Physical Medicine and Rehabilitation, Newark, New Jersey, USA
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Shoup JA, Welter J, Binswanger IA, Hess F, Dullenkopf A, Coker J, Berliner J. Spinal cord injury and prescribed opioids for pain: a scoping review. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:1138-1152. [PMID: 37280072 DOI: 10.1093/pm/pnad073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/05/2023] [Accepted: 06/01/2023] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Spinal cord injury (SCI) is a life-altering neurological condition affecting physical and psycho-social functioning and associated high rates of pain. Thus, individuals with SCI may be more likely to be exposed to prescription opioids. A scoping review was conducted to synthesize published research findings on post-acute SCI and prescription opioid use for pain, identify literature gaps, and propose recommendations for future research. METHODS We searched 6 electronic bibliographic databases (PubMed [MEDLINE], Ovid [MEDLINE], EMBASE, Cochrane Library, CINAHL, PsychNET) for articles published from 2014 through 2021. Terms for "spinal cord injury" and "prescription opioid use" were used. Included articles were in English and peer reviewed. Data were extracted using an electronic database by 2 independent reviewers. Opioid use risk factors for chronic SCI were identified and a gap analysis was performed. RESULTS Of the 16 articles included in the scoping review, a majority were conducted in the United States (n = 9). Most articles lacked information on income (87.5%), ethnicity (87.5%), and race (75%). Prescription opioid use ranged from 35% to 64% in articles reporting this information (n = 7 articles, n = 3675 participants). Identified risk factors for opioid use included middle age, lower income, osteoarthritis diagnosis, prior opioid use, and lower-level spinal injury. Limited reporting of diversity in study populations, absence of risk of polypharmacy, and limited high quality methodology were identified gaps. CONCLUSIONS Future research should report data on prescription opioid use in SCI populations, with additional demographics such as race, ethnicity, and income, given their importance to risk outcomes.
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Affiliation(s)
- Jo Ann Shoup
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO 80014, United States
- School of Public Affairs, University of Colorado Denver, Denver, CO 80204, United States
| | - JoEllen Welter
- Department of Orthopedic Surgery and Traumatology, Spital Thurgau, 8501 Frauenfeld, Switzerland
- Institute for Anesthesia and Intensive Care Medicine, Spital Thurgau, 8501 Frauenfeld, Switzerland
| | - Ingrid A Binswanger
- Institute for Health Research, Kaiser Permanente Colorado, Aurora, CO 80014, United States
- Colorado Permanente Medical Group, Denver, CO 80218, United States
- Division of General Internal Medicine, University of Colorado School of Medicine, Aurora, CO 80045, United States
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA 91101, United States
| | - Florian Hess
- Department of Orthopedic Surgery and Traumatology, Spital Thurgau, 8501 Frauenfeld, Switzerland
| | - Alexander Dullenkopf
- Institute for Anesthesia and Intensive Care Medicine, Spital Thurgau, 8501 Frauenfeld, Switzerland
| | - Jennifer Coker
- Craig Hospital Research Department, Craig Hospital, Englewood, CO 80113, United States
| | - Jeffrey Berliner
- Craig Hospital Research Department, Craig Hospital, Englewood, CO 80113, United States
- CNS Medical Group, Craig Hospital, Englewood, CO 80113, United States
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10
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Bychkovska O, Strøm V, Tederko P, Engkasan JP, Juocevičius A, Battistella LR, Arora M, Egen C, Gemperli A. Health System's Role in Facilitating Health Service Access among Persons with Spinal Cord Injury across 22 Countries. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6056. [PMID: 37297660 PMCID: PMC10252714 DOI: 10.3390/ijerph20116056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 04/23/2023] [Accepted: 06/02/2023] [Indexed: 06/12/2023]
Abstract
(1) Background: Despite efforts to improve access to health services, between- and within-country access inequalities remain, especially for individuals with complex disabling conditions like spinal cord injury (SCI). Persons with SCI require regular multidisciplinary follow-up care yet experience more access barriers than the general population. This study examines health system characteristics associated with access among persons with SCI across 22 countries. (2) Methods: Study data are from the International Spinal Cord Injury Survey with 12,588 participants with SCI across 22 countries. Cluster analysis was used to identify service access clusters based on reported access restrictions. The association between service access and health system characteristics (health workforce, infrastructure density, health expenditure) was determined by means of classification and regression trees. (3) Results: Unmet needs were reported by 17% of participants: lowest (10%) in Japan, Spain, and Switzerland (cluster 1) and highest (62%) in Morocco (cluster 8). The country of residence was the most important factor in facilitating access. Those reporting access restrictions were more likely to live in Morocco, to be in the lowest income decile, with multiple comorbidities (Secondary Conditions Scale (SCI-SCS) score > 29) and low functioning status (Spinal Cord Independence Measure score < 53). Those less likely to report access restriction tended to reside in all other countries except Brazil, China, Malaysia, Morocco, Poland, South Africa, and South Korea and have fewer comorbidities (SCI-SCS < 23). (4) Conclusions: The country of residence was the most important factor in facilitating health service access. Following the country of residence, higher income and better health were the most important facilitators of service access. Health service availability and affordability were reported as the most frequent health access barriers.
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Affiliation(s)
- Olena Bychkovska
- Swiss Paraplegic Research, Guido A. Zäch Institute, 6207 Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland
| | - Vegard Strøm
- Department of Research, Sunnaas Rehabilitation Hospital, 1453 Nesoddtangen, Norway
| | - Piotr Tederko
- Department of Rehabilitation, Medical University of Warsaw, 02-091 Warsaw, Poland
| | | | | | | | - Mohit Arora
- John Walsh Centre for Rehabilitation Research, The Kolling Institute, St Leonards 2065, Australia
- Faculty of Medicine and Health, University of Sydney, Sydney 2006, Australia
| | - Christoph Egen
- Department of Rehabilitation Medicine, Hannover Medical School, 30625 Hannover, Germany
| | - Armin Gemperli
- Swiss Paraplegic Research, Guido A. Zäch Institute, 6207 Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, 6002 Lucerne, Switzerland
- Center for Primary and Community Care, University of Lucerne, 6002 Lucerne, Switzerland
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11
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Pallerla S, Krishnareddy SR, Parthasarathy NB, Navaneetham J, Gupta A. Rehabilitation Professionals' Perspectives on Psychosocial Needs of Family Caregivers of Persons with Spinal Cord Injury: A Qualitative Study from India. Korean J Fam Med 2023; 44:168-176. [PMID: 37225442 DOI: 10.4082/kjfm.22.0096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/28/2022] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND This study explored the psychosocial needs of family caregivers of persons with spinal cord injuries from the perspective of rehabilitation professionals. METHODS An exploratory qualitative approach was used, and a total of 14 rehabilitation professionals from various backgrounds participated in face-to-face interviews. All interviews were audio recorded, and session notes were added to the existing data and later transcribed. Thematic analysis was used to identify key themes. RESULTS Nine need themes emerged: informational, psychological, personal care, financial, social support, welfare, vocational, telemedicine, and referral. CONCLUSION The findings of this study will aid the design or development of need-based customized psychosocial interventions for family caregivers of persons with spinal cord injuries in India. Multiple stakeholders involved in spinal cord injury management should understand the importance of meeting the needs of family caregivers of persons with spinal cord injuries and the timely delivery of customized psychosocial interventions.
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Affiliation(s)
- Srikanth Pallerla
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | | | | | - Janardhana Navaneetham
- Department of Psychiatric Social Work, National Institute of Mental Health and Neurosciences, Bengaluru, India
| | - Anupam Gupta
- Department of Neurological Rehabilitation, National Institute of Mental Health and Neurosciences, Bengaluru, India
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12
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Herrity AN, Castillo C, Isakov RV, Anele UA, Wang D, Boakye M, Ugiliweneza B. Health Care Utilization and Cost Associated With Urinary Tract Infections in a Privately Insured Spinal Cord Injury Population. Top Spinal Cord Inj Rehabil 2023; 29:108-117. [PMID: 36819926 PMCID: PMC9936897 DOI: 10.46292/sci22-00022] [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: 02/17/2023]
Abstract
Background Urinary tract infections (UTIs) are the most common secondary medical complication following spinal cord injury (SCI), significantly impacting health care resource utilization and costs. Objectives To characterize risk factors and health care utilization costs associated with UTIs in the setting of SCI. Methods IBM's Marketscan Database from 2000-2019 was utilized to identify individuals with traumatic SCI. Relevant ICD-9 and ICD-10 codes classified individuals into two analysis groups: having ≥ 1 UTI episode or no UTI episodes within 2 years following injury. Demographics (age, sex), insurance type, comorbidities, level of injury (cervical, thoracic, lumbar/sacral), and health care utilization/payments were evaluated. Results Of the 6762 individuals retained, 1860 had ≥ 1 UTI with an average of three episodes (SD 2). Younger age, female sex, thoracic level of injury, noncommercial insurance, and having at least one comorbidity were associated with increased odds of UTI. Individuals with a UTI in year 1 were 11 times more likely to experience a UTI in year 2. As expected, those with a UTI had a higher rate and associated cost of hospital admission, use of outpatient services, and prescription refills. UTIs were associated with 2.48 times higher cumulated health care resource use payments over 2 years after injury. Conclusions In addition to bladder management-related causes, several factors are associated with an increased risk of UTIs following SCI. UTI incidence substantially increases health care utilization costs. An increased understanding of UTI-associated risk factors may improve the ability to identify and manage higher risk individuals with SCI and ultimately optimize their health care utilization.
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Affiliation(s)
- April N. Herrity
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
- Department of Physiology, University of Louisville, Louisville, Kentucky
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Camilo Castillo
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
- University of Louisville School of Medicine, Louisville, Kentucky
- Division of Physical Medicine and Rehabilitation, University of Louisville, Louisville, Kentucky
| | - Roman V. Isakov
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Uzoma A. Anele
- University of Louisville School of Medicine, Louisville, Kentucky
- Department of Urology, University of Louisville, Louisville, Kentucky
| | - Dengzhi Wang
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Maxwell Boakye
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
- University of Louisville School of Medicine, Louisville, Kentucky
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, Kentucky
- Department of Neurological Surgery, University of Louisville, Louisville, Kentucky
- University of Louisville School of Medicine, Louisville, Kentucky
- Department of Health Management and Systems Sciences, University of Louisville, Louisville, Kentucky
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13
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Mohammed RS, Boateng EA, Amponsah AK, Kyei-Dompim J, Laari TT. Experiences of family caregivers of people with spinal cord injury at the neurosurgical units of the Komfo Anokye Teaching Hospital, Ghana. PLoS One 2023; 18:e0284436. [PMID: 37083720 PMCID: PMC10121035 DOI: 10.1371/journal.pone.0284436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
BACKGROUND Spinal cord injury (SCI) often leaves affected persons with a lifelong demand for care. As a result, the effect of the condition goes beyond the injured person to affect family members and significant others who have to adjust their lives to provide care and support. However, little is known about the experiences of these family caregivers regarding the care of people with SCI in Ghana. Exploring their experiences would enhance the understanding of family caregiving of people with SCI and contribute to policy intervention. METHODS This qualitative descriptive phenomenology study used the purposive sampling method to select 10 family caregivers. Data were collected using a semi-structured interview guide through individual in-depth interviews. Written informed consent was obtained and interviews were audio-recorded and transcribed verbatim. Data were manually analysed following Colaizzi's method of data analysis. RESULTS In all, 4 main themes emerged from the analysis of data (1) becoming a caregiver, (2) roles of the caregiver, (3) the burden of caregiving, and (4) coping strategies. The family caregivers provided vital assistance to their relatives with SCI and experienced physical and financial burdens as a result of the care. Due to the strains involved in the caregiving process, family caregivers adopted various strategies to cope with the situation. CONCLUSION This study has provided evidence of the lived experiences of family caregivers of people with SCI in the Ghanaian context and further supports the findings of previous studies. Measures including training, counselling, and instituting social support services for family caregivers should be considered by the management of healthcare institutions to enhance the experiences of family caregivers.
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Affiliation(s)
- Rumana Saeed Mohammed
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Edward Appiah Boateng
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Abigail Kusi Amponsah
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Joana Kyei-Dompim
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Timothy Tienbia Laari
- Department of Nursing, Faculty of Allied Health Sciences, College of Health Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- Presbyterian Primary Health Care (PPHC), Bolgatanga, Ghana
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14
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Reeder S, Ameratunga S, Ponsford J, Fitzgerald M, Lyons R, Nunn A, Ekegren C, Cameron P, Gabbe B. Long-term health and mobility of older adults following traumatic injury: a qualitative longitudinal study. Disabil Rehabil 2022; 44:7818-7828. [PMID: 34751629 DOI: 10.1080/09638288.2021.1998671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE The aim of this study was to explore older adults' experiences of and approaches to managing their long-term health and mobility after traumatic injury. METHODS A longitudinal qualitative study was undertaken with older adults following traumatic injury in Victoria, Australia. Fifteen participants (≥65 years) were interviewed at three years post-injury (n = 15), and re-interviewed at four (n = 14) and five years (n = 12) post-injury. Using a framework approach, a longitudinal thematic analysis was performed. RESULTS Older age at the time of injury was identified by participants as a key factor influencing their recovery. Many participants reported actively attempting to regain their strength and fitness in the first five years following injury. However, their age, injury impacts, other health conditions, and weight gain made it difficult to achieve recovery goals. Many older adults reported a decline in their physical function over time. While these experiences and persistent disability constrained or changed the quality of social relationships, community participation, and independence, several participants described adapting to their functional limitations, and managing their secondary conditions over time. CONCLUSION In our cohort, the intertwined combination of ageing, injury, and comorbid conditions negatively affected health and mobility, reinforcing the need for preventative strategies.Implications for rehabilitationOlder adults recovering from traumatic injury may benefit from specialised care pathways that offer long-term and tailored therapies, with programs and services specific to their needs and goals.An integrated service approach by injury insurers, health care, primary care, disability, and aged care could more clearly identify and effectively address the individual needs and goals of older adults with complex conditions.Health and social services that work with people with injuries to develop personalised coping strategies can reduce anxiety related to uncertainty about the future, promote well-being, and support participation in valued activities.
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Affiliation(s)
- Sandra Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Shanthi Ameratunga
- School of Population Health, University of Auckland, Auckland, New Zealand.,Population Health Directorate, Counties Manukau Health (District Health Board), Auckland, New Zealand
| | - Jennie Ponsford
- School of Psychological Sciences, Monash University, Melbourne, Australia.,Monash Epworth Rehabilitation Research Centre, Epworth Healthcare, Melbourne, Australia
| | - Mark Fitzgerald
- Emergency and Trauma Centre, Alfred Health, Melbourne, Australia
| | - Ronan Lyons
- Health Data Research UK, Swansea University, Swansea, UK
| | - Andrew Nunn
- Victorian Spinal Cord Service, Austin Health, Melbourne, Australia
| | - Christina Ekegren
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,School of Primary and Allied Health Care, Melbourne, Australia
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Emergency and Trauma Centre, Alfred Health, Melbourne, Australia
| | - Belinda Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Health Data Research UK, Swansea University, Swansea, UK
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15
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Schwarzman J, Lalor A, Reeder S, Callaway L, Aburumman M, Gabbe BJ, Ekegren CL. Factors influencing care and support for older adults with traumatic injury in Australia: a qualitative study. Disabil Rehabil 2022; 44:6692-6698. [PMID: 34493139 DOI: 10.1080/09638288.2021.1970258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To investigate factors influencing provision of care and support to older adults with traumatic injury in Australia, from a health service and policy perspective. METHODS Semi-structured interviews were undertaken with 16 clinicians, support providers, researchers, policy makers, and representatives from peak bodies in Australia, who had experience across injury, ageing, and disability sectors. A thematic analysis was performed using a framework approach. RESULTS Themes identified included prolonged injury recovery in older adults, limited accommodation options, restricted access to preventive care, escalating care needs over time, issues with siloed funding schemes and funding availability, and the need for advocacy to coordinate care across different schemes. Certain themes were specific to people who were older when injured. Others related to people who had acquired an injury at a younger age and were ageing with injury. However, most themes had relevance for both groups. CONCLUSIONS For older adults, this research has highlighted a range of cross-sector problems which impact upon the potential to recover from injury and to age well with injury. To improve the lives of older adults with injuries, Australia needs better coordinated system interfaces, shared funding models or packages of care across sectors, and improved advocacy and case management.Implications for rehabilitationTo address the lack of long-term, multi-disciplinary preventive care for age-related conditions and secondary complications in people with injuries, older adults may need more prolonged, or individualised, care following injury, episodic health checks, and a greater focus on long-term health care.Accessible and well-coordinated specialist housing and support responses, that offer timely access to health care professionals and carers trained in both ageing and disability, and enable greater support for "ageing in place", are required to manage changing care needs of people ageing with injury.There needs to be greater involvement of geriatricians, nurses, and allied health care professionals within the aged care sector in order to care for people with complex needs, including older adults with injury-related disability.To reduce gaps in care and support for injured older adults, Australia needs better coordinated system interfaces, shared funding models or packages of care across sectors.
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Affiliation(s)
- Joanna Schwarzman
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Aislinn Lalor
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,Department of Occupational Therapy, Monash University, Frankston, Australia
| | - Sandy Reeder
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Central Clinical School, Monash University, Melbourne, Australia
| | - Libby Callaway
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,Department of Occupational Therapy, Monash University, Frankston, Australia
| | - Mohammed Aburumman
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,Monash University Accident Research Centre (MUARC), Monash University, Clayton, Australia
| | - Belinda J Gabbe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Christina L Ekegren
- Rehabilitation, Ageing and Independent Living (RAIL) Research Centre, Monash University, Frankston, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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16
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Dassah E, Aldersey HM, McColl MA, Davison C. Health care providers’ and persons with disabilities’ recommendations for improving access to primary health care services in rural northern Ghana: A qualitative study. PLoS One 2022; 17:e0274163. [PMID: 36112654 PMCID: PMC9481012 DOI: 10.1371/journal.pone.0274163] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 08/23/2022] [Indexed: 11/25/2022] Open
Abstract
In Ghana, many persons with physical disabilities are members of populations who face health disparities including physical, structural, knowledge, attitudinal and financial barriers to various health care services compared to those without disabilities. However, there is limited evidence on how to improve access to primary health care services for persons with physical disabilities. This study aimed to understand persons with physical disabilities’ experiences and health care providers’ perspectives for improving access to primary health care for persons with disabilities in rural Ghana. We used a qualitative approach and interviewed 33 persons with physical disabilities and health care providers, and thematically analysed data from in-depth interviews. We identified 4 major themes. According to the participants, health care could be more accessible by: i) Making it more affordable; ii) Increasing the availability of providers and services; iii) Providing more education about system navigation; and iv) Improving access to disability friendly health facilities and equipment. Participants’ recommendations were nested in the areas of policy and practice modifications. Policy makers need to consider supporting persons with physical disabilities who cannot afford non-medical services (i.e., cost of transportation). In terms of practice, the provision of education and training related to physical disability issues should be extended to both clinical and nonclinical health workers for better client centered care. There is an urgent need for policy makers and relevant key stakeholders to include persons with physical disabilities in designing and implementing policies and programs to ensure that they are meeting their needs.
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Affiliation(s)
- Ebenezer Dassah
- School of Public Health, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
- * E-mail:
| | - Heather M. Aldersey
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen’s University, Kingston, Ontario, Canada
| | - Colleen Davison
- Department of Public Health Sciences, Queen’s University, Kingston, Ontario, Canada
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17
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Borg DN, Bon JJ, Foster MM, Lakhani A, Kendall M, Geraghty T. Healthcare services for people with acquired disability in South-East Queensland, Australia: Assessing potential proximity and its association with service obstacles. SSM Popul Health 2022; 19:101209. [PMID: 36052155 PMCID: PMC9424535 DOI: 10.1016/j.ssmph.2022.101209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 07/18/2022] [Accepted: 08/14/2022] [Indexed: 11/19/2022] Open
Abstract
This study described access potential in South-East Queensland, to healthcare services commonly used by people with acquired disability; and investigated the association between service proximity and perceived service obstacles. First, we described accessibility by conducting a spatial analysis to create maps of potential accessibility to health services in South-East Queensland. Queensland statistical area level 2 (SA2) locations were combined with the residential locations of participants from a longitudinal cohort study involving people with ABI and SCI. The locations of selected health services of interest were identified from Health Direct's National Health Service Directory. Travel times via motor vehicle were modelled with Robust Gaussian Stochastic Process, to smoothly interpolate between the sparse time-to-service observations. Probabilistic predicted values were generated from the model and were used to construct service accessibility maps of South-East Queensland. Disability population data were used to identify SA2s with relatively low service access but a high disability population. Second, we examined perceived service obstacles, by investigating the relationship between potential access to services and perceived service obstacles was examined using data from 63 people with ABI or SCI discharged from the specialist state-wide rehabilitation services, located in South-East Queensland. Obstacles to accessing service in relation to resource availability, transportation and finances were collected three-months after discharge, using the Service Obstacle Scale. Travel times to the closest health service were computed for each individual and were compared to their Service Obstacle Scale responses. Access potential was highly variable, particularly for allied health services. We identified several low-access, high-disability population areas. These hotpots of poor access were generally to the north and west of greater Brisbane. Longer travel times to allied health services were associated with 260% higher odds of agreeing that resource availability was an obstacle to accessing services. Policy makers should be concerned with the hotspots of poor access identified. There was considerable variability in access potential, which was generally greater for allied health than medical specialist services. We highlighted low-access high disability population areas, which were generally in outer suburbia. Poorer potential access to allied health services was associated with resource availability being rated as an service obstacle. We did not find any evidence that proximity to allied health services was associated with transportation or finance obstacles.
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Affiliation(s)
- David N Borg
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Australia.,School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Joshua J Bon
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Australia.,Australian Research Council Centre of Excellence for Mathematical and Statistical Frontiers, Brisbane, Australia.,School of Mathematical Sciences, Queensland University of Technology, St Lucia, Brisbane, Australia
| | - Michele M Foster
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Australia.,School of Health Sciences and Social Work, Griffith University, Brisbane, Australia
| | - Ali Lakhani
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Australia.,School of Health Sciences and Social Work, Griffith University, Brisbane, Australia.,La Trobe University, Melbourne, Australia
| | - Melissa Kendall
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Australia.,Division of Rehabilitation, Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Brisbane, Australia
| | - Timothy Geraghty
- The Hopkins Centre: Research for Rehabilitation and Resilience, Menzies Health Institute Queensland, Griffith University, Nathan, Brisbane, Australia.,Division of Rehabilitation, Princess Alexandra Hospital, Metro South Health Hospital and Health Service, Brisbane, Australia
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18
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Bychkovska O, Tederko P, Engkasan JP, Hajjioui A, Gemperli A. Healthcare service utilization patterns and patient experience in persons with spinal cord injury: a comparison across 22 countries. BMC Health Serv Res 2022; 22:755. [PMID: 35672727 PMCID: PMC9175375 DOI: 10.1186/s12913-022-07844-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 03/22/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Persons with spinal cord injury frequently visit numerous clinical settings. Such all-around experience of the system may serve as a comprehensive experience indicator. This study compared the patient experience of persons with chronic SCI in relation to healthcare service utilization patterns in 22 countries, hypothesizing that primary-care oriented patterns would offer a better experience. METHODS This study was based on International Spinal Cord Injury Survey with 12,588 participants across 22 countries worldwide. Utilization patterns/clusters were identified by cluster analysis and experience score - by the partial credit model. The association between healthcare utilization and experience at the provider and cluster level was explored by regression analysis. RESULTS The highest share of visits was to primary care physicians (18%) and rehabilitation physicians (16%). Utilization patterns had diverse orientations: from primary care to specialized and from inpatient to outpatient. The experience was reported as very good and good across different dimensions: 84% reported respectful treatment; 81% - clear explanations; 77% - involvement in decision making; 65% - satisfaction with care. The average experience score (0-100) was 64, highest - 74 (Brazil) and the lowest - 52 (Japan, South Korea). Service utilization at provider and at cluster levels were associated with patient experience, but no utilization pattern resulted in uniformly better patient experience. CONCLUSION While there are distinct patterns between countries on how persons with chronic SCI navigate the healthcare system, we found that different utilization patterns led to similar patient experience. The observed difference in patient experience is likely determined by other contextual factors than service utilization.
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Affiliation(s)
- Olena Bychkovska
- Swiss Paraplegic Research, 6207, Nottwil, Switzerland.
- Department of Health Sciences and Medicine, University of Lucerne, 6002, Lucerne, Switzerland.
| | - Piotr Tederko
- Department of Rehabilitation, Medical University of Warsaw, 02637, Warsaw, Poland
| | | | - Abderrazak Hajjioui
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, 1975, Fes, Morocco
| | - Armin Gemperli
- Swiss Paraplegic Research, 6207, Nottwil, Switzerland
- Department of Health Sciences and Medicine, University of Lucerne, 6002, Lucerne, Switzerland
- Center for Primary and Community Care, University of Lucerne, 6002, Lucerne, Switzerland
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19
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Krysa JA, Gregorio MP, Pohar Manhas K, MacIsaac R, Papathanassoglou E, Ho CH. Empowerment, Communication, and Navigating Care: The Experience of Persons With Spinal Cord Injury From Acute Hospitalization to Inpatient Rehabilitation. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:904716. [PMID: 36188987 PMCID: PMC9397833 DOI: 10.3389/fresc.2022.904716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/19/2022] [Indexed: 11/25/2022]
Abstract
Background Spinal cord injury (SCI) results in long-term functional impairments that significantly impact participation and role in the community. Newly injured persons are often reintroduced to the community with significant deficits in knowledge, including how to access and navigate community resources and supports. This warrants a better understanding of the patient experience of in-hospital care and discharge planning to ensure individuals with SCI are best supported during transitions in care and while living in the community. Objective To explore the lived experience of persons with acute SCI and their perceptions of care, focusing on the initial hospital experiences to inpatient rehabilitation. Methods A phenomenological research study was conducted using semi-structured interviews. Eligible participants had differing etiologies of SCI (including non-traumatic and traumatic SCI), were over the age of 18 at the time of initial care, and experienced acute hospital and inpatient rehabilitation at an Alberta-based institution within the last 10 years. One-on-one interviews took place between March and June 2021 over telephone or virtual platforms (Zoom). Interview transcripts, and field notes developed the text, which underwent hermeneutic analysis to develop central themes. Results The present study included 10 participants living with an SCI in Alberta, Canada. Most participants (80%) were male. Participants' age ranged from 24 to 69 years. The median years since initial SCI was 3 years. Interviews lasted 45–75 min. Seven participants identified as having a traumatic SCI injury and three identified as having a non-traumatic SCI. The interplay between empowerment and disempowerment emerged as the core theme, permeating participants' meanings and perceptions. Three main themes emerged from the interviews regarding the perceptions of the SCI patient experience. Each theme represents a perception central to their inpatient experience: desire to enhance functional independence to empower confidence and self-management; need for effective communication with healthcare providers to support recovery; and navigating appropriate care supports to enhance preparedness for discharge and returning home. Conclusion This study demonstrates the significant need to enhance education of person/family-centered SCI care, foster positive communication between care recipients and care providers, and facilitate better in-hospital access to appropriate navigation and wayfinding supports.
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Affiliation(s)
- Jacqueline A. Krysa
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
| | - Marianne Pearl Gregorio
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Kiran Pohar Manhas
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Rob MacIsaac
- Spinal Cord Injury Alberta, Edmonton, AB, Canada
| | - Elizabeth Papathanassoglou
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Chester H. Ho
- Neurosciences, Rehabilitation, and Vision Strategic Clinical Network, Alberta Health Services, Edmonton, AB, Canada
- Division of Physical Medicine and Rehabilitation, University of Alberta, Edmonton, AB, Canada
- *Correspondence: Chester H. Ho
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Pilusa SI, Myezwa H, Potterton J. Services and interventions needed to prevent secondary health conditions throughout the life span of people with spinal cord injury, South Africa. Afr J Disabil 2022; 11:881. [DOI: 10.4102/ajod.v11i0.881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 01/01/2022] [Indexed: 11/01/2022] Open
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Jeyathevan G, Jaglal SB, Hitzig SL, Linassi G, Mills S, Noonan VK, Anzai K, Clarke T, Wolfe D, Bayley M, Aslam L, Farahani F, Alavinia SM, Omidvar M, Craven BC. Conception and development of Self-Management indicators to advance the quality of spinal cord injury rehabilitation: SCI-High Project. J Spinal Cord Med 2021; 44:S94-S117. [PMID: 34779736 PMCID: PMC8604486 DOI: 10.1080/10790268.2021.1961054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
CONTEXT Although self-management is linked to reduced secondary health complications (SHCs) and enhanced overall quality of life post-spinal cord injury or disease (SCI/D), it is poorly integrated into the current rehabilitation process. Promoting self-management and assuring equity in care delivery is critical. Herein, we describe the selection of Self-Management structure, process and outcome indicators for adults with SCI/D in the first 18 months after rehabilitation admission. METHODS Experts in self-management across Canada completed the following tasks: (1) defined the Self-Management construct; (2) conducted a systematic search of available outcomes and their psychometric properties; and (3) created a Driver diagram summarizing available evidence related to Self-Management. Facilitated meetings allowed development and selection following rapid-cycle evaluations of proposed structure, process and outcome indicators. RESULTS The structure indicator is the proportion of staff with appropriate education and training in self-management principles. The process indicator is the proportion of SCI/D inpatients who have received a self-management assessment related to specific patient self-management goal(s) within 30 days of admission. The outcome indicator is the Skill and Technique Acquisition, and Self-Monitoring and Insight subscores of the modified Health Education Impact Questionnaire. CONCLUSION The structure indicator will heighten awareness among administrators and policy makers regarding the need to provide staff with ongoing training related to promoting self-management skill acquisition. Successful implementation of the Self-Management process and outcome indicators will promote self-management education and skill acquisition as a rehabilitation priority, allow for personalization of skills related to the individual's self-management goal(s), and empower individuals with SCI/D to manage their health and daily activities while successfully integrating into the community.
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Affiliation(s)
- Gaya Jeyathevan
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Susan B. Jaglal
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Sander L. Hitzig
- St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada,Department of Occupational Science and Occupational Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Rehabilitation Sciences Institute, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Linassi
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Sandra Mills
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | | | - Karen Anzai
- GF Strong Rehab Centre, Vancouver, British Columbia, Canada
| | | | - Dalton Wolfe
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada,School of Health Studies, Western University, London, Ontario, Canada
| | - Mark Bayley
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lubna Aslam
- Spinal Cord Injury Ontario, Toronto, Ontario, Canada
| | - Farnoosh Farahani
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - S. Mohammad Alavinia
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - Maryam Omidvar
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada
| | - B. Catharine Craven
- KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute – University Health Network, Toronto, Ontario, Canada,Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada,Correspondence to: B. Catharine Craven, KITE Research Institute, Toronto Rehabilitation Institute – University Health Network, 206-H 520 Sutherland Drive, Toronto, ON, M4G3V9, Canada; Ph: 416-597-3422x6122.
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Craven BC, Brisbois L, Pelletier C, Rybkina J, Heesters A, Verrier MC. Central Recruitment: A process for engaging and recruiting individuals with spinal cord injury/disease in research at Toronto Rehabilitation Institute. J Spinal Cord Med 2021; 44:S240-S249. [PMID: 34779741 PMCID: PMC8604526 DOI: 10.1080/10790268.2021.1970898] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
CONTEXT Insufficient recruitment is a barrier to research and limits statistical power. We describe an initiative aimed to streamline recruitment and consent processes for inpatients with spinal cord injury or disease (SCI/D) via implementation of a Central Recruitment (CR) process. The CR process adhered to ethical standards, reduced participant burden, and maximized research participation. METHODS In this CR process, the inpatient's nurse affirmed suitability for research approach based on fluency, cognition and health stability. A patient research liaison (PRL) was the sole contact for information regarding the research process, and introduced ongoing studies, screened for eligibility, and completed the consent process(es). RESULTS Over five and a half years, 1,561 inpatients with SCI/D were screened for eligibility upon admission, of whom 80% (1256/1561) were deemed suitable for the PRL approach. Of those suitable for the CR process, 80% (1001/1256) agreed to discuss current research opportunities, 46% (235/516) consented to participate in one or more studies, and 86% (856/1001) agreed to future research contact. CONCLUSION This process adhered to ethical procedures and reduced the burden of having multiple researchers approach each individual inpatient regarding research participation, with high consent rates for low-risk studies. Future evaluation of the process scalability is underway.
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Affiliation(s)
- B. Catharine Craven
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada,Department of Medicine, University of Toronto, Toronto, Ontario, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada,Correspondence to: B. Catharine Craven, KITE Research Institute, Toronto Rehab - University Health Network, 206-H 520 Sutherland Drive, Toronto, OntarioM4G3V9, Canada. Ph: 416-597-3422(6122).
| | - Louise Brisbois
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada
| | - Chelsea Pelletier
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Ontario, Canada
| | - Julia Rybkina
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Ann Heesters
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,The Institute for Education Research (TIER), University Health Network, Toronto, Ontario, Canada
| | - Mary Caroline Verrier
- KITE Research Institute, Toronto Rehab-University Health Network, Toronto, Ontario, Canada,Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada,Department of Physical Therapy, University of Toronto, Ontario, Canada
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Pilusa S, Myezwa H, Potterton J. Exploring prevention and management of secondary health conditions in people with spinal cord injury in South Africa. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2021. [DOI: 10.12968/ijtr.2021.0005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background/Aims Preventative care for people with spinal cord injury is neglected, even though secondary health conditions are prevalent among this group. There is limited information on preventative care for secondary health conditions among people with spinal cord injury. This study aimed to explore how people with spinal cord injury prevent and manage secondary health conditions. Methods A total of 17 individuals with spinal cord injury attending an outpatients clinic at a public rehabilitation hospital were interviewed face to face. All the interviews were transcribed verbatim and analysed using thematic content analysis. Results The participants used different strategies to prevent and manage secondary health conditions, such as medication, assistive devices, self-management, resilience coping strategies and therapeutic approaches. The participants found prevention of secondary health conditions ‘challenging’ and some of the strategies were ineffective. Conclusions Although many strategies are used by people with spinal cord injury to prevent and manage secondary health conditions, the experience is difficult. To minimise the occurrence and the consequence of secondary health conditions among people with spinal cord injury, health professionals must promote and support preventative care for secondary health conditions.
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Affiliation(s)
- Sonti Pilusa
- Department of Physiotherapy, Faculty of Therapeutic Sciences, University of the Witswatersrand, Johannesburg, South Africa
| | - Hellen Myezwa
- School Faculty of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joanne Potterton
- Department of Physiotherapy, Faculty of Therapeutic Sciences, University of the Witswatersrand, Johannesburg, South Africa
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Pacheco Barzallo D, Oña A, Gemperli A. Unmet health care needs and inequality: A cross-country comparison of the situation of people with spinal cord injury. Health Serv Res 2021; 56 Suppl 3:1429-1440. [PMID: 34386981 PMCID: PMC8579205 DOI: 10.1111/1475-6773.13738] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 07/14/2021] [Accepted: 07/15/2021] [Indexed: 11/30/2022] Open
Abstract
Objective To estimate and compare unmet health care needs of persons with spinal cord injury (SCI) across countries, the causes of these shortfalls, and the role of income. Data Sources We analyzed cross‐sectional data of 20 countries from the International Spinal Cord Injury (InSCI) survey, a compendium of comparable data on the living situation of persons with SCI. Data included information on high‐, middle‐, and low‐income countries. The survey comprises information on 12,095 participants. Study Design We used logit regressions to estimate the probability of unmet health care needs of persons with SCI and its causes. We adjusted the results by the individuals' characteristics and countries' fixed effects. We disaggregated the results by income decile of individuals in each country. Data Collection/Extraction Methods The inclusion criteria for the InSCI survey were adults aged 18 years and older with SCI living in the community, who were able to respond to the survey and who provided informed consent. Principal Findings Unmet health care needs are significant for people with long‐term conditions like SCI, where people in low‐income groups tend to be more affected. Among the barriers to meeting health care needs, the foremost is health care cost (in 11 of the 20 countries), followed by transportation and service availability. Persons with SCI in Morocco reported the highest probability of unmet health care needs in the sample, 0.54 (CI: 047–0.59), followed well behind by South Africa, 0.27 (CI: 0.20–0.33), and Brazil, 0.26 (CI: 0.20–0.33). In contrast, persons with SCI in Spain, 0.06 (CI: 0.04–0.08), reported the lowest probability of unmet health care needs, closely followed by Norway, 0.07 (CI: 0.05–0.09), Thailand, 0.08 (CI: 0.05–0.11), France, 0.08 (CI: 0.06–0.11), and Switzerland, 0.09 (CI: 0.07–0.10). Conclusions SCI is a long‐term, irreversible health condition characterized by physical impairment and a series of chronic illness. This makes SCI a high‐need, high‐cost group that faces significant unmet health care needs, which are mainly explained by the costs of health services, transportation, and services availability. This situation is prevalent in low‐, middle‐, and high‐income countries, where persons in lower income groups are disproportionately affected. To improve the situation, a combination of measures from the health and social systems are required.
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Affiliation(s)
- Diana Pacheco Barzallo
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, 6002, Switzerland.,Swiss Paraplegic Research, Rehabilitation, Services & Care Unit, Nottwil, Switzerland.,Center for Rehabilitation in Global Health Systems, WHO Collaborating Center, Lucerne, Switzerland
| | - Ana Oña
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, 6002, Switzerland.,Swiss Paraplegic Research, Rehabilitation, Services & Care Unit, Nottwil, Switzerland
| | - Armin Gemperli
- Department of Health Sciences and Medicine, University of Lucerne, Lucerne, 6002, Switzerland.,Swiss Paraplegic Research, Rehabilitation, Services & Care Unit, Nottwil, Switzerland.,Center for Primary and Community Care, Lucerne, Switzerland
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Pilusa S, Myezwa H, Potterton J. Environmental factors influencing the prevention of secondary health conditions among people with spinal cord injury, South Africa. PLoS One 2021; 16:e0252280. [PMID: 34170928 PMCID: PMC8232458 DOI: 10.1371/journal.pone.0252280] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 05/13/2021] [Indexed: 11/25/2022] Open
Abstract
Background The environment where people live, work or play can influence health and disability outcomes. People with spinal cord injury are at risk for secondary health conditions, with this increasing readmission rates and decreasing quality of life. Studies on preventative care for secondary health conditions and factors influencing the prevention of secondary health conditions are scarce in low to middle-income countries. Aim To explore environmental factors influencing the prevention of secondary health conditions in people with spinal cord injury. Setting This study was based at a public rehabilitation hospital, South Africa. Methods Explorative qualitative design was used. Semi-structured interviews were conducted with 21 therapists, 17 people with a spinal cord injury and six caregivers. The interviews were transcribed verbatim. Analysis was conducted using content analysis. Results The categories that emerged included the impact of social support, inaccessible built environment and transport system, and an inefficient health care system. Sub-categories for the inefficient health care systems were: Shortage of resources, health workers lack of knowledge on prevention of secondary health conditions and inadequate patient care approach. Conclusion Environmental factors influencing the prevention of secondary health conditions are complex and multifactorial. When developing rehabilitation and prevention programmes, environmental factors must be considered.
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Affiliation(s)
- Sonti Pilusa
- Faculty of Health Sciences, Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Hellen Myezwa
- Faculty of Health Sciences, Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Joanne Potterton
- Faculty of Health Sciences, Department of Physiotherapy, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Pilusa SI, Myezwa H, Potterton J. Experiences of secondary health conditions amongst people with spinal cord injury in South Africa: A qualitative study. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2021; 77:1530. [PMID: 33937547 PMCID: PMC8063775 DOI: 10.4102/sajp.v77i1.1530] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 01/26/2021] [Indexed: 01/04/2023] Open
Abstract
Background Secondary health conditions (SHCs) such as pain, pressure sores, sexual problems, bowel and bladder problems are prevalent throughout the lifespan of people with spinal cord injury (SCI). Studies have reported that SHCs decrease life expectancy and increase health care costs. Studies on the lived experience of SHCs are, however, limited. Objectives To explore the experiences of SHCs amongst people with SCI in a public rehabilitation hospital in South Africa. Method Face-to-face semi-structured interviews were conducted with people with SCI from August 2018 to July 2019. All interviews were transcribed verbatim and analysed using a content analysis approach. Results Seventeen people with SCI were interviewed. Participants experienced a range of SHCs. The most common experienced SHC was pain (94%). The main theme that emerged from the analysis was 'the impact of secondary health conditions on health and well-being'. The categories linked to the impact were SHCs co-occurrence and how SHCs limit function, restrict participation, affect mental health and disrupt lives. Conclusion We found that SHCs were enormously impactful on our participants' lives and health, as illustrated by their stories of fear, embarrassment and shame. Understanding people with SCI experiences of SHCs can enhance communication between people with SCI and health professionals and may help develop prevention strategies. Clinical implications To enhance patient-centred care, health professionals are encouraged to actively listen to patients' experiences of illness and the impact on health and wellbeing.
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Affiliation(s)
- Sonti I Pilusa
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Hellen Myezwa
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
| | - Joanne Potterton
- Department of Physiotherapy, School of Therapeutic Sciences, Faculty of Health Sciences, University of the Witwatersrand, Parktown, South Africa
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Farahani MF, Khankeh HR, Hosseini M, Dalvandi A, NorouziTabrizi K. Exploring Facilitators of Regaining Autonomy in People with Spinal Cord Injury: A Qualitative Study. IRANIAN JOURNAL OF NURSING AND MIDWIFERY RESEARCH 2021; 26:154-161. [PMID: 34036064 PMCID: PMC8132859 DOI: 10.4103/ijnmr.ijnmr_25_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/30/2020] [Accepted: 10/20/2020] [Indexed: 11/04/2022]
Abstract
Background One of the most important aims of rehabilitation in Spinal Cord Injuries (SCI) is regaining autonomy, which can affect individuals' Quality of Life (QOL). This study was conducted to understand the experiences of individuals with SCI in terms of regaining autonomy during transition from hospital to community. Materials and Methods The present study was conducted using a qualitative research design. In this study, 15 semi-structured, in-depth interviews were conducted with individuals with SCI in Spinal Cord Injury (SCI) Association of Arak, Iran, from June 2018 to May 2019. The interviews were analyzed using the conventional content analysis method. Results Data analysis emerged four core categories of "self-management" (adaptation to a new life, self-care, responsibility, and seeking information), "social support" (family and friends' support, health care providers' support, and peer support), "access to facilities and resources" (home modification, use of various rehabilitation techniques, and use of mobility equipment), and "spiritual and religious beliefs" (believing in divine destiny and performance of religious rites). Conclusions The present study showed that several factors influenced the regaining of autonomy in individuals with SCI. It is important to consider the impact of these factors during transition from hospital to community. Health service providers can use the findings of this research to help these individuals regain their autonomy.
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Affiliation(s)
| | - Hamid Reza Khankeh
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran.,Research Center in Emergency and Health, University of Social Welfare and Rehabilitation, Tehran, Iran
| | - Mohammadali Hosseini
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Asghar Dalvandi
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Kian NorouziTabrizi
- Department of Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Hall AG, Karabukayeva A, Rainey C, Kelly RJ, Patterson J, Wade J, Feldman SS. Perspectives on life following a traumatic spinal cord injury. Disabil Health J 2021; 14:101067. [PMID: 33722578 DOI: 10.1016/j.dhjo.2021.101067] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/16/2021] [Accepted: 01/19/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND Persons living with traumatic Spinal Cord Injury (SCI) face challenges when returning to their communities. The Spain Rehabilitation Center at the University of Alabama at Birmingham is developing a continuum of care for SCI patients. The perspectives of individuals with SCI are critical to designing a person-centered approach to the continuum. OBJECTIVE This study sought to explore the lived experiences of individuals with SCI after their injury, as well as obtain the perspectives of therapists working with SCI patients. METHODS Ten persons ranging in age from 23 to 65 years old and living with SCI were recruited to participate in in-depth interviews. We utilized a grounded theory approach to develop descriptive codes and themes. RESULTS Our analysis highlighted domains that are critical to the lives of individuals with SCI including: planning for life after SCI, intrinsic motivation, environmental barriers, financial barriers, role of family, friends, and social networks, and relationships with medical providers. A key theme was the need for more information about how to manage their health condition, including the development of plans that are tailored to their specific needs. CONCLUSIONS Individuals with an SCI need access to a continuum of care that addresses both medical and social needs.
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Affiliation(s)
- Allyson G Hall
- University of Alabama at Birmingham, Department of Health Services Administration, 1720 2nd Avenue South, SHPB 565, USA.
| | - Aizhan Karabukayeva
- University of Alabama at Birmingham, Department of Health Services Administration, 1720 2nd Avenue South, SHPB 565, USA
| | - Carmen Rainey
- University of Alabama at Birmingham, Department of Health Services Administration, 1720 2nd Avenue South, SHPB 565, USA
| | - Reena J Kelly
- University of Alabama at Birmingham, Department of Health Services Administration, 1720 2nd Avenue South, SHPB 565, USA
| | - Jonathan Patterson
- University of Alabama at Birmingham, Department of Health Services Administration, 1720 2nd Avenue South, SHPB 565, USA
| | - Jamie Wade
- University of Alabama at Birmingham, Spain Rehabilitation Center, USA
| | - Sue S Feldman
- University of Alabama at Birmingham, Department of Health Services Administration, 1720 2nd Avenue South, SHPB 565, USA
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Ruediger M, Kupfer M, Leiby BE. Decreasing re-hospitalizations and emergency department visits in persons with recent spinal cord injuries using a specialized medical home. J Spinal Cord Med 2021; 44:221-228. [PMID: 31603396 PMCID: PMC7952066 DOI: 10.1080/10790268.2019.1671075] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Objective: To determine whether a specialized medical home can reduce re-hospitalizations and emergency department (ED) visits as compared to reports in the literature for persons with spinal cord injury (SCI) in the first year post-discharge from acute inpatient rehabilitation.Design: A three-year prospective cohort study.Setting: An academic free standing inpatient rehabilitation hospital (IRF), participating in the SCI Model Systems network, serving urban, rural and suburban settings in the mid-Atlantic region of the United States of America.Participants: 176 successive individuals with varying levels of SCI, inclusive of patients requiring mechanical ventilation, discharged from rehabilitation from 2/1/15 to 7/1/17, who met criteria and consented to participate.Interventions: Pre-discharge communication between the inpatient and outpatient staff was initiated, medication education by a pharmacist was added, 1 month of discharge medications was offered, and proactive phone calls to patients after discharge were instituted. In addition, patients were offered a 24/7 hotline to reach physician and nursing staff, and multidisciplinary outpatient follow-up was provided in conjunction with extensive proactive case management.Outcome measures: All-cause hospital readmission and ED visits.Results: Thirty percent of the individuals were readmitted within the first year after discharge from an IRF, and 24% were readmitted within the first year after onset. The incidence of readmission was 0.46 and 0.36 respectively. Forty-one percent had an ED visit.Conclusion: The results suggest that the medical home interventions decreased the rate and incidence of readmission and the rate of ED usage in the first year.
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Affiliation(s)
- Marci Ruediger
- Perfomance Excellence Department, Magee Rehabilitation – Jefferson Health, Philadelphia, Pennsylvania, USA,Correspondence to: Marci Ruediger, Magee Rehabilitation, 1513 Race Street, Philadelphia, Pennsylvania19102, USA. Ph: 215-587-3454.
| | - Mendel Kupfer
- Department of Rehabilitation Medicine, Magee Rehabilitation – Jefferson Health, Philadelphia, Pennsylvania, USA
| | - Benjamin E. Leiby
- Department of Pharmacoloy and Experimental Therapeutics, Division of Biostatistics, Sidney Kimmel Medical College, Philadelphia, Pennsylvania, USA
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Badenhorst M, Verhagen E, Lambert M, van Mechelen W, Brown J. Accessing healthcare as a person with a rugby-related spinal cord injury in South Africa: the injured player's perspective. Physiother Theory Pract 2021; 38:1639-1655. [PMID: 33491535 DOI: 10.1080/09593985.2021.1872753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Background: Rugby carries a risk for serious injuries, including acute spinal cord injuries. The lifetime health consequences of these injuries may be far-reaching.Purpose: In this study, we aimed to describe barriers and facilitators to healthcare and rehabilitation, in individuals with rugby-related spinal cord injuries in South Africa.Methods: This study adopted a pragmatic qualitative approach. Stratified purposive sampling was used to select interviews from players from a variety of socio-economic status and geographical areas for inclusion in this study. The final sample consisted of thirty-one (n = 31) participants. Thematic analysis was used to analyze the data.Results: Participants described long-term, accessible, affordable, quality healthcare and rehabilitation as important contributors to their quality of life. Even though public healthcare is accessible from a cost point of view, quality of care, availability of rehabilitation services and factors such as affordability and availability of adequate transport remain a barrier for lower socio-economic groups.Conclusion: This population was unique, as the support from a dedicated organization enabled participants to overcome some barriers, highlighting the challenges of the healthcare system in maintaining the health of people with spinal cord injuries. Every effort should be made to create equitable access to healthcare and rehabilitation for persons with spinal cord injuries in South Africa.
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Affiliation(s)
- Marelise Badenhorst
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije University, VU University Medical Center, Amsterdam, Netherlands.,Institute of Sport and Exercise Medicine (ISEM), Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.,International Olympic Committee (IOC) Research Centre, South Africa, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
| | - Evert Verhagen
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije University, VU University Medical Center, Amsterdam, Netherlands.,Australian Centre for Research into Injury in Sport and Its Prevention (ACRISP), Edith Cowan University, Joondalup, Australia
| | - Mike Lambert
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije University, VU University Medical Center, Amsterdam, Netherlands
| | - Willem van Mechelen
- Division of Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.,Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health and Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije University, VU University Medical Center, Amsterdam, Netherlands.,School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, Human Movement Studies Building, St Lucia, University of Queensland, Brisbane, Australia.,School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Woodview House Belfield, Dublin, Ireland
| | - James Brown
- Institute of Sport and Exercise Medicine (ISEM), Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa.,International Olympic Committee (IOC) Research Centre, South Africa, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa
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Nunnerley JL, Martin RA, Aldridge M, Bourke JA, Simpson I. Access to community support workers during hospital admission for people with spinal cord injury: a pilot study. Spinal Cord Ser Cases 2021; 7:3. [PMID: 33468996 DOI: 10.1038/s41394-020-00370-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 11/10/2020] [Accepted: 12/01/2020] [Indexed: 11/09/2022] Open
Abstract
STUDY DESIGN A descriptive qualitative study. OBJECTIVES To evaluate a pilot project enabling people with spinal cord injury (SCI) to have their support workers accompany them into a non-SCI specialist/public hospital (excluding ICU) to perform selected care. SETTING The study was conducted in New Zealand. METHODS Interviews and focus groups with people with SCI, support workers, care agency staff, and hospital staff who participated in the pilot project. RESULTS Twenty-five individuals participated in the study. Two themes captured participants' experiences of the pilot: 'Maintaining individualised care' and 'Role, tasks and responsibilities. Support workers were described as knowledgeable about SCI care needs and being better positioned to provide individualised care for people with SCI than general nursing staff. Participants with SCI felt less anxious having a support worker with them, and perceived less risk of acquiring secondary health complications during the hospital admission. Good communications is important to ensure there is a shared understanding of the role and responsibilities of having an unregistered support worker in the hospital environment. CONCLUSIONS Having their regular support worker during admission to public hospital improved the SCI-specific care received. Support workers reduced the demand on hospital nursing staff who did not always have the time or specialist SCI knowledge to provide individualised care. People with SCI may be more likely to access medical assistance earlier and not defer hospital admissions if they can have support workers accompany them into hospital.
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Affiliation(s)
- Joanne L Nunnerley
- Burwood Academy of Independent Living, Christchurch, New Zealand. .,Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand.
| | - Rachelle A Martin
- Burwood Academy of Independent Living, Christchurch, New Zealand.,Rehabilitation Teaching and Research Unit, Department of Medicine, University of Otago, Wellington, New Zealand
| | - Matthew Aldridge
- Burwood Academy of Independent Living, Christchurch, New Zealand
| | - John A Bourke
- Burwood Academy of Independent Living, Christchurch, New Zealand.,Menzies Health Institute, Griffith University, Gold Coast, QLD, Australia.,Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Ian Simpson
- Burwood Academy of Independent Living, Christchurch, New Zealand
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Ho C, Atchison K, Noonan VK, McKenzie N, Cadel L, Ganshorn H, Rivera JMB, Yousefi C, Guilcher SJT. Models of Care Delivery from Rehabilitation to Community for Spinal Cord Injury: A Scoping Review. J Neurotrauma 2021; 38:677-697. [PMID: 33191849 DOI: 10.1089/neu.2020.7396] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Spinal cord injury (SCI) is a chronic condition that results in high healthcare utilization and lifetime cost across the care continuum. In the absence of a standardized model of care delivery for SCI in western countries such as Canada, a scoping review of the literature was performed to identify and summarize existing international SCI models of care delivery. Four databases were searched using key words and subject headings for concepts such as: "spinal cord injury," "delivery of healthcare," "model of care," "patient care planning," and "care pathway." Title, abstract, and full text review were competed by two independent reviewers. A combined total of 46 peer-reviewed and gray literature articles were included. No single SCI model of care has been adopted across different countries internationally. However, optimal attributes of models of care were identified, including the importance of having multidisciplinary SCI specialty care providers along the continuum, provision of rural SCI services and outreach, integration of primary care, peer mentoring, and using a hub and spokes model of care. These findings inform the future development of an SCI model of care, which ideally would serve all geographical locations and span the continuum of care, improving the health status and quality of life of persons with SCI.
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Affiliation(s)
- Chester Ho
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Kayla Atchison
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada
| | - Nicole McKenzie
- Foothills Medical Centre, University of Calgary, Calgary, Alberta, Canada
| | - Lauren Cadel
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Heather Ganshorn
- Libraries and Cultural Resources, University of Calgary, Calgary, Alberta, Canada
| | - Joanna Marie B Rivera
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada
| | - Charlene Yousefi
- Praxis Spinal Cord Institute, Blusson Spinal Cord Centre, Vancouver, British Columbia, Canada
| | - Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
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Nabata KJ, Tse EK, Nightingale TE, Lee AH, Eng JJ, Querée M, Walter M, Krassioukov AV. The Therapeutic Potential and Usage Patterns of Cannabinoids in People with Spinal Cord Injuries: A Systematic Review. Curr Neuropharmacol 2021; 19:402-432. [PMID: 32310048 PMCID: PMC8033968 DOI: 10.2174/1570159x18666200420085712] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/12/2020] [Accepted: 04/15/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND People with spinal cord injuries (SCI) commonly experience pain and spasticity; limitations of current treatments have generated interest in cannabis as a possible therapy. OBJECTIVES We conducted this systematic review to: 1) examine usage patterns and reasons for cannabinoid use, and 2) determine the treatment efficacy and safety of cannabinoid use in people with SCI. METHODS PubMed, Embase, Web of Science and Cumulative Index to Nursing and Allied Health Literature databases were queried for keywords related to SCI and cannabinoids. RESULTS 7,232 studies were screened, and 34 were included in this systematic review. Though 26 studies addressed cannabinoid usage, only 8 investigated its therapeutic potential on outcomes such as pain and spasticity. The most common method of use was smoking. Relief of pain, spasticity and recreation were the most common reasons for use. A statistically significant reduction of pain and spasticity was observed with cannabinoid use in 83% and 100% of experimental studies, respectively. However, on examination of randomized control trials (RCTs) alone, effect sizes ranged from - 0.82 to 0.83 for pain and -0.95 to 0.09 for spasticity. Cannabinoid use was associated with fatigue and cognitive deficits. CONCLUSION Current evidence suggests that cannabinoids may reduce pain and spasticity in people with SCI, but its effect magnitude and clinical significance are unclear. Existing information is lacking on optimal dosage, method of use, composition and concentration of compounds. Long-term, double-blind, RCTs, assessing a wider range of outcomes should be conducted to further understand the effects of cannabinoid use in people with SCI.
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Affiliation(s)
| | | | | | | | | | | | | | - Andrei V. Krassioukov
- Address correspondence to this author at the International Collaboration On Repair Discoveries (ICORD), University of British Columbia (UBC), Vancouver, Canada; E-mail:
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Richardson A, Samaranayaka A, Sullivan M, Derrett S. Secondary health conditions and disability among people with spinal cord injury: A prospective cohort study. J Spinal Cord Med 2021; 44:19-28. [PMID: 30882288 PMCID: PMC7919890 DOI: 10.1080/10790268.2019.1581392] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: To examine how secondary health conditions (SHCs) that develop early after a spinal cord injury (SCI) are related to disability over time.Design: Prospective cohort study.Setting: Two spinal units in New Zealand (Burwood Spinal Unit and Auckland Spinal Rehabilitation Unit).Participants: Between 2007 and 2009, 91 people participated in three telephone interviews approximately 6, 18, and 30 months after the occurrence of a SCI.Outcome measures: SHCs were measured using 14 items derived from the Secondary Complications Survey. Disability was measured using the 12-item World Health Organization Disability Assessment Schedule 2.0. Linear regression analyses were performed to investigate associations between SHCs at 6 months and disability at each assessment point.Results: The most prevalent SHCs were leg spasms, constipation, back pain, pain below the level of SCI, and shoulder pain. Constipation, urinary tract infection, and headaches at 6 months post-SCI were associated with significantly higher levels of disability at each subsequent follow-up, independent of age, sex and SCI impairment. Back pain, and pain below the SCI, at 6 months were associated with significantly greater disability at 18 months, and difficulty coughing at 6 months was associated with significantly greater disability at 30 months.Conclusion: The experience of specific SHCs in the first 6 months after an SCI is related to greater long-term disability. In order to reduce the disability burden of people with SCI, efforts should be directed toward early prevention of these SHCs.
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Affiliation(s)
- Amy Richardson
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Ari Samaranayaka
- Dean’s Department, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Martin Sullivan
- School of Social Work, Massey University, Palmerston North (Turitea) campus, Wellington, New Zealand
| | - Sarah Derrett
- Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand,Correspondence to: Sarah Derrett, Injury Prevention Research Unit, Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, PO Box 56, Dunedin9054, New Zealand.
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35
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Milligan J, Goetz LL, Kennelly MJ. A Primary Care Provider's Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2020; 26:108-115. [PMID: 32760189 DOI: 10.46292/sci2602-108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Neurogenic lower urinary tract dysfunction (NLUTD), previously termed neurogenic bladder dysfunction, is a common secondary complication of spinal cord injury (SCI). It is associated with significant morbidity, reduced quality of life, increased health care costs, and mortality. Primary care providers (PCPs) play an important role in optimizing urohealth over the life span. This article will review NLUTD in SCI, its complication, surveillance, and management. PCPs should be aware of SCI-related NLUTD, its complications, management, and surveillance recommendations, and when to refer to a specialist.
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Affiliation(s)
- James Milligan
- The Centre for Family Medicine, Kitchener, Ontario, Canada.,McMaster University Department of Family Medicine, Hamilton, Ontario, Canada
| | - Lance L Goetz
- Department of Veterans Affairs, Hunter Holmes McGuire VA Medical Center, Richmond, Virginia.,Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia
| | - Michael J Kennelly
- Carolinas Rehabilitation, Charlotte, North Carolina.,Atrium Health, Charlotte, North Carolina
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Legg Ditterline BE, Wade S, Ugiliweneza B, Singam NS, Harkema SJ, Stoddard MF, Hirsch GA. Beneficial Cardiac Structural and Functional Adaptations After Lumbosacral Spinal Cord Epidural Stimulation and Task-Specific Interventions: A Pilot Study. Front Neurosci 2020; 14:554018. [PMID: 33192245 PMCID: PMC7643015 DOI: 10.3389/fnins.2020.554018] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/15/2020] [Indexed: 12/22/2022] Open
Abstract
Cardiac myocyte atrophy and the resulting decreases to the left ventricular mass and dimensions are well documented in spinal cord injury. Therapeutic interventions that increase preload can increase the chamber size and improve the diastolic filling ratios; however, there are no data describing cardiac adaptation to chronic afterload increases. Research from our center has demonstrated that spinal cord epidural stimulation (scES) can normalize arterial blood pressure, so we decided to investigate the effects of scES on cardiac function using echocardiography. Four individuals with chronic, motor-complete cervical spinal cord injury were implanted with a stimulator over the lumbosacral enlargement. We assessed the cardiac structure and function at the following time points: (a) prior to implantation; (b) after scES targeted to increase systolic blood pressure; (c) after the addition of scES targeted to facilitate voluntary (i.e., with intent) movement of the trunk and lower extremities; and (d) after the addition of scES targeted to facilitate independent, overground standing. We found significant improvements to the cardiac structure (left ventricular mass = 10 ± 2 g, p < 0.001; internal dimension during diastole = 0.1 ± 0.04 cm, p < 0.05; internal dimension during systole = 0.06 ± 0.03 cm, p < 0.05; interventricular septum dimension = 0.04 ± 0.02 cm, p < 0.05), systolic function (ejection fraction = 1 ± 0.4%, p < 0.05; velocity time integral = 2 ± 0.4 cm, p < 0.001; stroke volume = 4.4 ± 1.5 ml, p < 0.01), and diastolic function (mitral valve deceleration time = -32 ± 11 ms, p < 0.05; mitral valve deceleration slope = 50 ± 25 cm s-1, p < 0.05; isovolumic relaxation time = -6 ± 1.9 ms, p < 0.05) with each subsequent scES intervention. Despite the pilot nature of this study, statistically significant improvements to the cardiac structure, systolic function, and diastolic function demonstrate that scES combined with task-specific interventions led to beneficial cardiac remodeling, which can reverse atrophic changes that result from spinal cord injury. Long-term improvements to cardiac function have implications for increased quality of life and improved cardiovascular health in individuals with spinal cord injury, decreasing the risk of cardiovascular morbidity and mortality.
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Affiliation(s)
- Bonnie E. Legg Ditterline
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
- Department of NeuroSurgery, University of Louisville, Louisville, KY, United States
| | - Shelley Wade
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
| | - Beatrice Ugiliweneza
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
- Department of NeuroSurgery, University of Louisville, Louisville, KY, United States
| | - Narayana Sarma Singam
- Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, KY, United States
| | - Susan J. Harkema
- Kentucky Spinal Cord Injury Research Center, University of Louisville, Louisville, KY, United States
- Department of NeuroSurgery, University of Louisville, Louisville, KY, United States
| | - Marcus F. Stoddard
- Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, KY, United States
| | - Glenn A. Hirsch
- Division of Cardiovascular Medicine, Department of Medicine, University of Louisville, Louisville, KY, United States
- Division of Cardiology, Department of Medicine, National Jewish Health, Denver, CO, United States
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Guilcher SJT, Hogan ME, Guan Q, McCormack D, Calzavara A, Patel T, Hitzig SL, Packer T, Lofters AK. Prevalence of Prescribed Opioid Claims Among Persons With Traumatic Spinal Cord Injury in Ontario, Canada: A Population-Based Retrospective Cohort Study. Arch Phys Med Rehabil 2020; 102:35-43. [PMID: 32891422 DOI: 10.1016/j.apmr.2020.06.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 06/22/2020] [Accepted: 06/23/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To examine prescription opioid claims among individuals with traumatic spinal cord injury (SCI) and to identify factors associated with both chronic opioid and chronic high-dose opioid use. DESIGN Retrospective cohort study using population-level administrative data. SETTING Ontario, Canada. PARTICIPANTS Individuals (N=1842) with traumatic SCI between April 1, 2004 and March 31, 2015. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Proportion of cohort with chronic opioid use (≥90d supply) and proportion with chronic high-dose opioid use (≥90d supply exceeding 90 mg morphine equivalent) between April 1, 2016 and March 31, 2017 (observation period). RESULTS A total of 1842 individuals with traumatic SCI were identified (74% men), with a median age of 51 years (interquartile range [IQR], 34-64y) and median duration of injury of 6 years (IQR, 4-9y). During the observation period, 35% were dispensed at least 1 opioid and 19.8% received chronic opioids, 39% of whom received more than 90 mg daily (chronic high dose). The median daily morphine equivalent dose was 212 mg morphine equivalent (IQR, 135.5-345.3 mg) for chronic high-dose users. Significant risk factors for chronic opioid use were male sex; age between 40 and 60 years; lower income; multimorbidity; thoracic, lumbar, or sacral level of injury; and having a previous diagnosis of osteoarthritis. Risk factors for chronic high-dose opioid use were an extended time since injury, age between 40 and 50 years, and increasing comorbidity. CONCLUSIONS A large proportion of individuals with traumatic SCI were dispensed an opioid in a recent 1-year period. A substantial proportion were dispensed more than 90 mg of morphine equivalents, which is the maximum recommended by the Canadian opioid guideline. Further research is needed to understand the risk factors associated with chronic, high-dose opioid use in this population.
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Affiliation(s)
- Sara J T Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; ICES, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada; Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.
| | - Mary-Ellen Hogan
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Qi Guan
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Tejal Patel
- University of Waterloo School of Pharmacy, Waterloo, Ontario, Canada; Schlegel - University of Waterloo Research Institute of Aging, Waterloo, Ontario, Canada; Waterloo Institute for Complexity and Innovation, Waterloo, Ontario, Canada
| | - Sander L Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; St. John's Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Tanya Packer
- Schools of Occupational Therapy and Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Rehabilitation, Radboud Medical University, Nijmegen, The Netherlands
| | - Aisha K Lofters
- ICES, Toronto, Ontario, Canada; Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada; Women's College Research Institute, Toronto, Ontario, Canada
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38
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Systolic and diastolic function in chronic spinal cord injury. PLoS One 2020; 15:e0236490. [PMID: 32716921 PMCID: PMC7384657 DOI: 10.1371/journal.pone.0236490] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 07/07/2020] [Indexed: 12/24/2022] Open
Abstract
Individuals with spinal cord injury develop cardiovascular disease more than age-matched, non-injured cohorts. However, progression of systolic and diastolic dysfunction into cardiovascular disease after spinal cord injury is not well described. We sought to investigate the relationship between systolic and diastolic function in chronic spinal cord injury to describe how biological sex, level, severity, and duration of injury correlate with structural changes in the left ventricle. Individuals with chronic spinal cord injury participated in this study (n = 70). Registered diagnostic cardiac sonographers used cardiac ultrasound to measure dimensions, mass, and systolic and diastolic function of the left ventricle. We found no significant relationship to severity or duration of injury with left ventricle measurements, systolic function outcome, or diastolic function outcome. Moreover, nearly all outcomes measured were within the American Society of Echocardiography-defined healthy range. Similar to non-injured individuals, when indexed by body surface area (BSA) left ventricle mass [-14 (5) g/m2, p < .01], end diastolic volume [-6 (3) mL/m2, p < .05], and end systolic volume [-4 (1) mL/m2, p < .01] were significantly decreased in women compared with men. Likewise, diastolic function outcomes significantly worsened with age: E-wave velocity [-5 (2), p < .01], E/A ratio [-0.23 (0.08), p < .01], and e’ velocity [lateral: -1.5 (0.3) cm/s, p < .001; septal: -0.9 (0.2), p < .001] decreased with age while A-wave velocity [5 (1) cm/s, p < .001] and isovolumic relaxation time [6 (3) ms, p < .05] increased with age. Women demonstrated significantly decreased cardiac size and volumes compared with men, but there was no biological relationship to dysfunction. Moreover, individuals were within the range of ASE-defined healthy values with no evidence of systolic or diastolic function and no meaningful relationship to level, severity, or duration of injury. Decreases to left ventricular dimensions and mass seen in spinal cord injury may result from adaptation rather than maladaptive myocardial remodeling, and increased incidence of cardiovascular disease may be related to modifiable risk factors.
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39
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Borg DN, Foster MM, Legg M, Jones R, Kendall E, Fleming J, Geraghty TJ. The Effect of Health Service Use, Unmet Need, and Service Obstacles on Quality of Life and Psychological Well-Being in the First Year After Discharge From Spinal Cord Injury Rehabilitation. Arch Phys Med Rehabil 2020; 101:1162-1169. [DOI: 10.1016/j.apmr.2020.02.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 02/03/2020] [Accepted: 02/06/2020] [Indexed: 01/22/2023]
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Conti A, Clari M, Kangasniemi M, Martin B, Borraccino A, Campagna S. What self-care behaviours are essential for people with spinal cord injury? A systematic review and meta-synthesis. Disabil Rehabil 2020; 44:991-1006. [PMID: 32602384 DOI: 10.1080/09638288.2020.1783703] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Purpose: To systematically identify, evaluate, and synthesise the qualitative literature on the self-care behaviours, skills, and strategies performed by individuals with spinal cord injury (SCI).Review methods: The Joanna Briggs Institute (JBI) meta-aggregation method was followed. The search was conducted on five databases and limited to papers published from January 2000 to March 2020. Two independent reviewers screened, extracted the data from, and assessed the methodological quality of selected papers using the JBI qualitative assessment and critical appraisal instrument.Results: Eleven qualitative papers were included. Three synthesised findings with a moderate level of confidence emerged from 90 findings: people with SCI perform self-directed or directed-by-other behaviours focused on their physical condition (i); and on their social life (ii); people with SCI perform self-directed behaviours focused on their emotional well-being (iii). Individuals with SCI are aware of their condition and incorporate self-care behaviours into their routine to maintain health and prevent complications.Conclusion: This meta-synthesis provides evidence on the self-care behaviours performed by people with SCI to prevent, control, and manage the physical, emotional, and social effects of their condition. These findings may help healthcare providers to understand the self-care process in SCI survivors and tailor educational programmes to their experiences.IMPLICATIONS FOR REHABILITATIONSCI survivors are directly responsible for their health and must reach their maximum level of independence by acquiring self-care behaviours and adjusting them over time.Self-care behaviours must be incorporated into SCI survivors' daily routine to maintain their condition, promote their social participation, and prevent complications.Caregiver contributions to self-care should be given more value, as these are fundamental to maintain SCI survivors' well-being and social participation.
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Affiliation(s)
- Alessio Conti
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Marco Clari
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Mari Kangasniemi
- Department of Nursing Science, Faculty of Medicine, University of Turku, Turku, Finland
| | - Barbara Martin
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Alberto Borraccino
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
| | - Sara Campagna
- Department of Public Health and Pediatrics, University of Torino, Torino, Italy
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De Lange JS, Jacobs J, Meiring N, Moroane B, Verster T, Olorunju S, Mashola MK. Reliability and validity of the Readiness for Hospital Discharge Scale in patients with spinal cord injury. SOUTH AFRICAN JOURNAL OF PHYSIOTHERAPY 2020; 76:1400. [PMID: 32537524 PMCID: PMC7276478 DOI: 10.4102/sajp.v76i1.1400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 02/26/2020] [Indexed: 11/21/2022] Open
Abstract
Background Measuring rehabilitation outcomes in patients with spinal cord injury (PWSCI) requires measurement tools that are valid and reliable and have been psychometrically tested in the population with spinal cord injury (SCI). The Readiness for Hospital Discharge Scale (RHDS) has been found to be reliable and valid in adult surgical patients, post-partum mothers, parents of hospitalised children and geriatrics. However, the psychometric properties have not yet been tested in the population with SCI, furthermore, in a South African context. Objectives The purpose of this study was to psychometrically test the internal consistency and construct validity of the RHDS as a measure of discharge readiness in PWSCI prior to discharge from rehabilitation units in the Tshwane metropolitan area, South Africa. Method A cross-sectional study that included 50 PWSCI who were in their last week of rehabilitation was conducted. The RHDS item and scale statistics were calculated by using descriptive statistics and the scale reliability was measured for internal consistency by using Cronbach’s alpha coefficients. To determine construct validity, convergent and divergent validities were measured by using the RHDS items’ correlation coefficient dimensions. All data were tested at the 0.05 level of significance by using Statistics and Data (STATA) statistical software, version 14. Results Cronbach’s alpha of the RHDS was 0.904, indicating an excellent reliability coefficient. Convergent validity scores showed 81% correlation coefficients, although divergent validity scores showed 62% correlation coefficients. Conclusion The RHDS is a valid and reliable measure of readiness for discharge in a South African sample of PWSCI and can be used in SCI rehabilitation. Clinical implications Over and above using the RHDS to determine if PWSCI are ready for discharge in the clinical setting, the RHDS may also assist health care practitioners to assess the patient’s progress towards readiness and strategies for addressing shortcomings to meet short and long-term goals of the rehabilitation process.
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Affiliation(s)
- Jacques S De Lange
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Jolandi Jacobs
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Nadine Meiring
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Boitumelo Moroane
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Tinei Verster
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Steve Olorunju
- Biostatistics Unit, South African Medical Research Council, Pretoria, South Africa
| | - Mokgadi K Mashola
- Department of Physiotherapy, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
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42
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Veerubhotla A, Hong E, Knezevic S, Spungen A, Ding D. Estimation of Physical Activity Intensity in Spinal Cord Injury Using a Wrist-Worn ActiGraph Monitor. Arch Phys Med Rehabil 2020; 101:1563-1569. [PMID: 32502566 DOI: 10.1016/j.apmr.2020.05.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Revised: 05/13/2020] [Accepted: 05/15/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES To derive accelerometer count thresholds for classifying time spent in sedentary, light intensity, and moderate-to-vigorous physical activity (MVPA) in manual wheelchair users (MWUs) with spinal cord injury (SCI). DESIGN Participants completed 18 activities of daily living and exercises for 10 minutes each with a 3-minute break between activities while wearing a COSMED K4b2 portable metabolic cart and an ActiGraph activity monitor on the dominant wrist. A linear regression was computed between the wrist acceleration vector magnitude and SCI metabolic equivalent of task (MET) for 80% of the participants to obtain thresholds for classifying different activity intensities, and the obtained thresholds were tested for accuracy on the remaining 20% of participants. This cross-validation process was iterated for 1000 times to evaluate the stability of the thresholds on data corresponding to different proportions of sedentary, light intensity, and MVPA. MET values of 1.5 or lower were classified as sedentary behavior, MET values between 1.5 and 3 were classified as light intensity, and MET values of 3 or higher were classified as MVPA. The final thresholds were then validated on an out-of-sample independent dataset. PARTICIPANTS MWUs (N=17) with SCI in the out-of-sample validation data set. INTERVENTIONS Not applicable. SETTING Research lab, community MAIN OUTCOME MEASURES: Accelerometer thresholds to classify sedentary, light intensity, and MVPA were obtained and their accuracy tested using cross-validation and an out-of-sample dataset. RESULTS The threshold between sedentary and light intensity was 2057 counts-per-minute, and the threshold between light intensity and MVPA was 11,551 counts per minute. Based on the out-of-sample validation, the obtained thresholds had an overall accuracy of 85.6%, with a sensitivity and specificity of 95.3% and 97.4% for sedentary behavior, 87.8% and 84.5% for light intensity, 68.5% and 96.3% for MVPA, respectively. CONCLUSION Accelerometer-based thresholds can be used to accurately identify sedentary behavior. However, thresholds may not provide accurate estimations of MVPA throughout the day when participants engage in more resistance-based activities.
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Affiliation(s)
- Akhila Veerubhotla
- Department of Rehabilitation Sciences and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Department of Veteran Affairs Pittsburgh Healthcare System, Pittsburgh, PA
| | - EunKyoung Hong
- Spinal Cord Damage Research Center, James J Peters VA Medical Center, Bronx, NY; Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Steven Knezevic
- VA Rehabilitation Research & Development Service, National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY
| | - Ann Spungen
- Spinal Cord Damage Research Center, James J Peters VA Medical Center, Bronx, NY; VA Rehabilitation Research & Development Service, National Center of Excellence for the Medical Consequences of Spinal Cord Injury, James J. Peters VA Medical Center, Bronx, NY
| | - Dan Ding
- Department of Rehabilitation Sciences and Technology, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA; Human Engineering Research Laboratories, Department of Veteran Affairs Pittsburgh Healthcare System, Pittsburgh, PA.
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Gibson-Gill CM, Williams J, Fyffe D. Triangle of Healthy Caregiving for Veterans With Spinal Cord Injury: Proposal for a Mixed Methods Study. JMIR Res Protoc 2020; 9:e14051. [PMID: 32396130 PMCID: PMC7251480 DOI: 10.2196/14051] [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: 03/18/2019] [Revised: 06/30/2019] [Accepted: 07/07/2019] [Indexed: 12/01/2022] Open
Abstract
Background Spinal cord injury (SCI) is a debilitating injury that results in chronic paralysis, impaired functioning, and drastically altered quality of life (QOL). The Department of Veterans Affairs (VA) estimates that approximately 450 newly injured veterans and active-duty members receive rehabilitation at VA’s Spinal Cord Injury/Disorders Centers annually. VA virtual health services use technology and health informatics to provide veterans with better access and more effective care management. The “Triangle of Healthy Caregiving for SCI Veterans” is a patient-centered intervention that incorporates SCI veterans’ caregivers into the VA SCI health care team and extends into the homes of veterans with SCI by using real-time clinical video teleconferencing (CVT). CVT facilitates video-clinic visits, which can include different types of clinical evaluations, therapy (physical/occupational), or psychosocial services. The “Triangle of Healthy Caregiving for SCI Veterans” builds on interactive, interdisciplinary health care relationships that exist between the veterans with SCI, their caregivers, and the VA SCI health care team. SCI veterans’ propensity to multiple secondary complications makes a healthy partnership crucial for the success of keeping better health and functional outcomes as well as quality of life while living in their homes. Objective The goal of the proposed mixed methods project will assess SCI veterans’, their caregivers’, and the VA health care team’s perspectives and experiences in the “Triangle of Healthy Caregiving for SCI Veterans” to determine the benefits, challenges, and outcomes for everyone involved in the intervention. Methods Data collection methods will be implemented over three sequential phases. First, in-depth interviews will be conducted with the telehealth coordinators to systematically document the administrative procedures involved in enrollment of veterans with SCI into the CVT system. Next, structured observation of the CVT enrollment process and logistics of home installation of the CVT system will be conducted to validate the content of the in-depth interviews and highlight any discrepancies observed. Semistructured interviews will be conducted to assess specific elements of the “Triangle of Healthy Caregiving for SCI Veterans” program, their perceived utility, and effectiveness of the CVT system as well as the general impressions of the impact of the intervention on the SCI veterans’ health and function outcomes, caregiver burden, and daily caregiver burden. Finally, the research team will conduct a focus group to evaluate the ways in which the “Triangle of Healthy Caregiving for SCI Veterans” is useful for health care delivery to veterans with SCI and support services to SCI caregivers. Results This proposal was funded in July 2017. It was reviewed and received institutional review board approval in March 2018, and the project was started immediately after, in the same month. As of September 2019, we have completed Phases I and III and have recruited 52 subjects for Phase II. We are beginning the data analysis. The study is projected to be completed in late summer of 2020, and the expected results are to be published in the fall of 2020. Conclusions The findings from this study will highlight the ways in which virtual health care technologies can be used to improve access to SCI specialized care for veterans and provide an estimation of the potential impact on clinical outcomes for veterans with SCI and their caregivers. International Registered Report Identifier (IRRID) DERR1-10.2196/14051
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Affiliation(s)
- Carol McMara Gibson-Gill
- Veterans Administration, New Jersey Health Care System, East Orange, NJ, United States.,Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States
| | - Joyce Williams
- Veterans Administration, New Jersey Health Care System, East Orange, NJ, United States
| | - Denise Fyffe
- Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School, Newark, NJ, United States.,Kessler Foundation, West Orange, NJ, United States
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Milligan J, Lee J, Smith M, Donaldson L, Athanasopoulos P, Bassett-Spiers K, Howcroft J, Howcroft JW, Jeji T, Joshi PB, Mehan U, Noonan V. Advancing primary and community care for persons with spinal cord injury: Key findings from a Canadian summit. J Spinal Cord Med 2020; 43:223-233. [PMID: 30557085 PMCID: PMC7054958 DOI: 10.1080/10790268.2018.1552643] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Context: Persons with spinal cord injury (SCI) experience significant challenges when they access primary care and community services.Design: A provincial summit was held to direct research, education, and innovation for primary and community care for SCI.Setting: Toronto, Ontario, Canada.Participants: Key stakeholders (N = 95) including persons with SCI and caregivers, clinicians from primary care, rehabilitation, and specialized care, researchers, advocacy groups, and policy makers.Methods: A one-day facilitated meeting that included guest speakers, panel discussions and small group discussions was held to generate potential solutions to current issues related to SCI care and to foster collaborative relationships to advance care for SCI. Perspectives on SCI management were shared by primary care, neurosurgery, rehabilitation, and members of the SCI communityOutcome Measures: Discussions were focused on five domains: knowledge translation and dissemination, application of best practices, communication, research, and patient service accessibility.Results: Summit participants identified issues and prioritized solutions to improve primary and community care including the creation of a network of key stakeholders to enable knowledge creation and dissemination; an online repository of SCI resources, integrated health records, and a clinical network for SCI care; development and implementation of strategies to improve care transitions across sectors; implementation of effective care models and improved access to services; and utilization of empowerment frameworks to support self-management.Conclusions: This summit identified priorities for further collaborative efforts to advance SCI primary and community care and will inform the development of a provincial SCI strategy aimed at improving the system of care for SCI.
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Affiliation(s)
- James Milligan
- Centre for Family Medicine Family Health
Team, Kitchener, Canada
- Department of Family Medicine, Faculty of Health
Sciences, McMaster University, Hamilton, Canada
| | - Joseph Lee
- Centre for Family Medicine Family Health
Team, Kitchener, Canada
- Department of Family Medicine, Faculty of Health
Sciences, McMaster University, Hamilton, Canada
| | - Matt Smith
- Centre for Family Medicine Family Health
Team, Kitchener, Canada
| | | | | | | | - Jeremy Howcroft
- Centre for Family Medicine Family Health
Team, Kitchener, Canada
| | | | - Tara Jeji
- Ontario Neurotrauma Foundation,
Toronto, Canada
| | | | - Upender Mehan
- Centre for Family Medicine Family Health
Team, Kitchener, Canada
- Department of Family Medicine, Faculty of Health
Sciences, McMaster University, Hamilton, Canada
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Guilcher SJT, Everall AC, Patel T, Packer TL, Hitzig SL, Lofters AK. Medication adherence for persons with spinal cord injury and dysfunction from the perspectives of healthcare providers: A qualitative study. J Spinal Cord Med 2019; 42:215-225. [PMID: 31573463 PMCID: PMC6781202 DOI: 10.1080/10790268.2019.1637644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Context: People with spinal cord injury and dysfunction (SCI/D) often take multiple medications (i.e. polypharmacy) to manage secondary health complications and multiple chronic conditions. Numerous healthcare providers are often involved in clinical care, increasing the risk of fragmented care, problematic polypharmacy, and conflicting health advice. These providers can play a crucial role in assisting patients with medication self-management to improve medication adherence. Design: A qualitative study involving telephone interviews, following a semi-structured guide that explored healthcare providers' conceptualization of factors impacting medication adherence for persons with SCI/D. The interviews were transcribed and analyzed descriptively and interpretively using a constant comparative process with the assistance of data display matrices. Analysis was guided by an ecological model of medication adherence. Setting and participants: Thirty-two healthcare providers from Canada, with varying clinical expertise. Intervention: Not Applicable. Outcome measures: Not Applicable. Results: Providers identified several factors that impact medication adherence for persons with SCI/D, which were grouped into micro (medication and patient-related), meso- (provider-related) and macro- (health system-related) factors. Medication-related factors included side effects, effectiveness, safety, and regimen complexity. Patient-specific factors included medication knowledge, preferences/expectations/goals, severity and type of injury, cognitive function/mental health, time since injury, and caregiver support. Provider-related factors included knowledge/confidence and trust. Health system-related factors included access to healthcare and access to medications. While providers were able to identify several factors influencing medication adherence, micro-level factors were the most frequently discussed. Conclusion: Findings from this study indicate that strategies to optimize medication adherence for persons with SCI/D should be multi-faceted.
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Affiliation(s)
- Sara J. T. Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,Correspondence to: Sara J. T. Guilcher, Leslie Dan Faculty of Pharmacy, 144 College Street, Toronto, ON, Canada, M5S 3M2; Ph: 416-946-7020.
| | - Amanda C. Everall
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, Kitchener, Canada,Department of Family Medicine, DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Tanya L. Packer
- School of Occupational Therapy and Health Administration, Dalhousie University, Halifax, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Aisha K. Lofters
- Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
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Kryger MA, Crytzer TM, Fairman A, Quinby EJ, Karavolis M, Pramana G, Setiawan IMA, McKernan GP, Parmanto B, Dicianno BE. The Effect of the Interactive Mobile Health and Rehabilitation System on Health and Psychosocial Outcomes in Spinal Cord Injury: Randomized Controlled Trial. J Med Internet Res 2019; 21:e14305. [PMID: 31464189 PMCID: PMC6737885 DOI: 10.2196/14305] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 07/21/2019] [Accepted: 07/21/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Individuals with spinal cord injury (SCI) are at risk for secondary medical complications, such as urinary tract infections (UTIs) and pressure injuries, that could potentially be mitigated through improved self-management techniques. The Interactive Mobile Health and Rehabilitation (iMHere) mobile health (mHealth) system was developed to support self-management for individuals with disabilities. OBJECTIVE The main objective of this study was to determine if the use of iMHere would be associated with improved health outcomes over a 9-month period. A secondary objective was to determine if the use of iMHere would be associated with improved psychosocial outcomes. Phone usage, app usage, and training time data were also collected to analyze trends in iMHere use. METHODS Overall, 38 participants with SCI were randomized into either the intervention group who used the iMHere system and received standard care or the control group who received standard care without any technology intervention. Health outcomes were recorded for the year before entry into the study and during the 9 months of the study. Participants completed surveys at baseline and every 3 months to measure psychosocial outcomes. RESULTS The intervention group had a statistically significant reduction in UTIs (0.47 events per person; P=.03; number needed to treat=2.11). Although no psychosocial outcomes changed significantly, there was a nonsignificant trend toward a reduction in mood symptoms in the intervention group compared with the control group meeting the threshold for clinical significance. Approximately 34 min per participant per month were needed on average to manage the system and provide technical support through this mHealth system. CONCLUSIONS The use of the iMHere mHealth system may be a valuable tool in the prevention of UTIs or reductions in depressive symptoms. Given these findings, iMHere has potential scalability for larger populations. TRIAL REGISTRATION ClinicalTrials.gov NCT02592291; https://clinicaltrials.gov/ct2/show/NCT02592291.
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Affiliation(s)
- Michael Alan Kryger
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Physical Medicine and Rehabilitation, Penn State University Milton Hershey Medical Center, Hershey, PA, United States
| | - Theresa M Crytzer
- Human Engineering Research Laboratories, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Andrea Fairman
- Department of Occupational Therapy, MGH Institute of Health Professions, Boston, MA, United States
| | - Eleanor J Quinby
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Meredith Karavolis
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Gede Pramana
- Department of Health Information Management, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
| | - I Made Agus Setiawan
- Department of Health Information Management, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Computer Science, Udayana University, Badung, Indonesia
| | - Gina Pugliano McKernan
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
- Human Engineering Research Laboratories, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
| | - Bambang Parmanto
- Human Engineering Research Laboratories, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
- Department of Health Information Management, School of Health and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
| | - Brad E Dicianno
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, United States
- Human Engineering Research Laboratories, Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States
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Barclay L, New PW, Morgan PE, Guilcher SJT. Satisfaction with life, health and well-being: comparison between non-traumatic spinal cord dysfunction, traumatic spinal cord injury and Australian norms. Spinal Cord Ser Cases 2019; 5:50. [PMID: 31632708 PMCID: PMC6786362 DOI: 10.1038/s41394-019-0193-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/23/2019] [Accepted: 05/09/2019] [Indexed: 01/07/2023] Open
Abstract
Study design Cross-sectional survey. Objectives The objective of this study is to compare self-reported satisfaction with life, and self-reported health and well-being of people with NTSCD, to that of people with TSCI, and with Australian population. Setting Victoria, Australia. Methods Participants completed surveys by post or email. The Satisfaction with Life Scale (SWLS) and the Medical Outcomes Study 36-Item Short Form Health Survey (SF-36) were used to assess self-reported satisfaction with life, and health and well-being. Descriptive statistics are reported including median and interquartile range (IQR). The Mann-Whitney U-test was used to investigate differences between groups. Results There were 41 participants: NTSCD (n = 14) and TSCI (n = 27). There were no significant differences in the median scores on the SWLS for NTSCD and TSCI, but both groups scored lower than the Australian non-disabled sample mean. There were significant differences between NTSCD and TSCI for SF-36 domains physical functioning, role limitations physical and vitality (p < 0.05). Median scores for both groups in all eight domains were lower than the means of the comparative Australian sample, except for role limitations emotional. Conclusions There were more apparent difficulties for people with NTSCD in completing desired functional tasks than those with TSCI. Both groups had lower self-reported satisfaction with life, and lower reported health and well-being in comparison to samples of non-disabled Australians.
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Affiliation(s)
- Linda Barclay
- Monash University, Department of Occupational Therapy, 47-49 Moorooduc Highway, Frankston, VIC 3199 Australia
| | - Peter W. New
- Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, 260 Kooyong Road, Caulfield, VIC 3162 Australia
| | - Prue E. Morgan
- Monash University, Department of Physiotherapy, 47- 49 Moorooduc Highway, Frankston, VIC 3199 Australia
| | - Sara J. T. Guilcher
- University of Toronto, Leslie Dan Faculty of Pharmacy, 144 College Street, Toronto, ON M5S 3M2 Canada
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A scoping review of peer-led interventions following spinal cord injury. Spinal Cord 2019; 57:626-635. [DOI: 10.1038/s41393-019-0297-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 04/28/2019] [Accepted: 04/29/2019] [Indexed: 01/15/2023]
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Murray CM, Van Kessel G, Guerin M, Hillier S, Stanley M. Exercising Choice and Control: A Qualitative Meta-synthesis of Perspectives of People With a Spinal Cord Injury. Arch Phys Med Rehabil 2019; 100:1752-1762. [PMID: 30794768 DOI: 10.1016/j.apmr.2019.01.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 01/21/2019] [Accepted: 01/29/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To systematically search the literature and construct a meta-synthesis of how choice and control are perceived by people with spinal cord injury (SCI). DATA SOURCES Medline, Academic Search Premier, CINAHL, Cochrane, EMBASE, HealthSource, ProQuest, PsychInfo, SAGE, and SCOPUS were searched from 1980 until September 2018 including all languages. Reference lists of selected studies were also reviewed. STUDY SELECTION Eligible qualitative studies included perspectives about choice of control as reported by people with an SCI. Studies were excluded if they included perspectives from other stakeholder groups. A total of 6706 studies were screened for title and abstract and full text of 127 studies were reviewed resulting in a final selection of 29. DATA EXTRACTION Characteristics of the studies were extracted along with any data (author interpretations and quotes) relating to perspectives on choice and control. DATA SYNTHESIS First-order analysis involved coding the data in each study and second-order analysis involved translating each segment of coded data into broader categories with third-order analysis condensing categories to 2 broad overarching themes. These themes were experiencing vulnerability or security and adapting to bounded abilities. CONCLUSIONS Perspectives of choice and control are influenced by interrelated environmental, interpersonal, and personal contexts. From a personal perspective, participants reported a readiness for adaptation that included turning points where emotional and cognitive capacity to make choices and take control changed. Health professionals need to be responsive to this readiness, promote empowerment and foster, rather than remove, hope.
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Affiliation(s)
- Carolyn M Murray
- School of Health Sciences, Division of Health Sciences, University of South Australia, South Australia, Australia.
| | - Gisela Van Kessel
- School of Health Sciences, Division of Health Sciences, University of South Australia, South Australia, Australia
| | - Michelle Guerin
- School of Health Sciences, Division of Health Sciences, University of South Australia, South Australia, Australia
| | - Susan Hillier
- School of Health Sciences, Division of Health Sciences, University of South Australia, South Australia, Australia
| | - Mandy Stanley
- School of Medical and Health Sciences, Edith Cowan University, Western Australia, Australia
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Sleight AG, Cogan AM, Hill VA, Pyatak EA, Díaz J, Floríndez LI, Blanchard J, Vigen C, Garber SL, Clark FA. Factors Protecting Against Pressure Injuries in Medically Underserved Adults With Spinal Cord Injury: A Qualitative Study. Top Spinal Cord Inj Rehabil 2019; 25:31-40. [PMID: 30774288 DOI: 10.1310/sci2501-31] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background: Pressure injuries negatively impact quality of life and participation for individuals with spinal cord injury (SCI). Objective: To examine the factors that may protect against the development of medically serious pressure injuries in adults with SCI. Methods: A qualitative analysis was conducted using treatment notes regarding 50 socioeconomically disadvantaged individuals who did not develop medically serious pressure injuries during a 12-month pressure injury prevention intervention program. Results: Eight types of potentially protective factors were identified: meaningful activity, motivation to prevent negative health outcomes, stability/resources, equipment, communication and self-advocacy skills, personal traits, physical factors, and behaviors/activities. Conclusions: Some protective factors (eg, personal traits) may be inherent to certain individuals and nonmodifiable. However, future interventions for this population may benefit from a focus on acquisition of medical equipment and facilitation of sustainable, health-promoting habits and routines. Substantive policy changes may be necessary to facilitate access to adequate resources, particularly housing and equipment, for socioeconomically disadvantaged individuals with SCI. Further research is needed to understand the complex interplay of risk and protective factors for pressure injuries in adults with SCI, particularly in underserved groups.
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Affiliation(s)
| | | | - Valerie A Hill
- Department of Rehabilitation, Exercise & Nutrition Sciences, University of Cincinnati, Cincinnati, Ohio
| | - Elizabeth A Pyatak
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Jesus Díaz
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Lucía I Floríndez
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Jeanine Blanchard
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Cheryl Vigen
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
| | - Susan L Garber
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Florence A Clark
- Mrs. T.H. Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, California
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