Promoting Long-Term Health among People with Spinal Cord Injury: What's New?

Diet quality, diet-related factors and disability status among male adults of reproductive age in the USA

OBJECTIVE

To examine diet quality and diet-related factors among male adults of reproductive age with and without disabilities.

DESIGN

Cross-sectional data from the National Health and Nutrition Examination Surveys, 2013-2018.

SETTING

Disability was reported as serious difficulty hearing, seeing, concentrating, walking, dressing and/or running errands due to physical, mental or emotional conditions. Diet quality was assessed by the Healthy Eating Index (HEI)-2015 and diet-related factors included self-rated diet healthfulness, food security and food assistance programmes. Multivariable linear regression estimated differences in HEI-2015 scores. Multivariable Poisson regression estimated adjusted prevalence ratios (aPR) and 95 % CI for diet-related factors.

PARTICIPANTS

In total, 3249 males, 18-44 years; of whom, 441 (13·4 %) reported having disabilities.

RESULTS

Compared with males without disabilities, those with disabilities had a 2·69-point (95 % CI: -4·18, -1·20) lower mean total HEI-2015 score and approximately one-third to half of a point lower HEI-2015 component scores for greens and beans, total protein foods, seafood and plant proteins, fatty acids and added sugars. Males with any disabilities were more likely to have low food security (aPR = 1·57; 95 % CI: 1·28, 2·92); household participation in food assistance programmes (aPR = 1·61; 95 % CI: 1·34, 1·93) and consume fast food meals during the previous week (1-3 meals: aPR = 1·11; 95 % CI: 1·01-1·21 and 4 or more meals: aPR = 1·18; 95 % CI: 1·01-1·38) compared with males with no disabilities.

CONCLUSIONS

Factors affecting diet and other modifiable health behaviours among male adults of reproductive age with disabilities require further investigation. Health promotion strategies that are adaptive to diverse populations within the disability community are needed.

Prescriptions pour les complications courantes des lésions de la moelle épinière

Objectif

Décrire les modèles de prescriptions dans le cas de 3 complications communes associées à une lésion de la moelle épinière (LME) et proposer aux médecins de famille des stratégies pour optimiser les soins aux patients atteints d’une LME.

Sources de l’information

Les résultats d’une enquête nationale sur l’utilisation des médicaments d’ordonnance par des personnes atteintes d’une LME au Canada et d’une étude longitudinale des complications secondaires liées aux LME.

Message principal

Les fonctions neurologiques et cardiométaboliques altérées chez les patients atteints d’une LME compliquent le choix des régimes pharmacologiques optimaux chez de tels patients. Trois problèmes courants observés en soins primaires chez des patients atteints d’une LME exigent une pharmacothérapie, soit la douleur (traitée chez 57 % des répondants à l’enquête), les spasmes musculaires (54 %) et les infections des voies urinaires récurrentes (43 %). Le contrôle de la douleur peut nécessiter plusieurs médicaments, selon la source ou la nature de la douleur. Certains médicaments d’ordonnance recommandés pour le traitement de la douleur pourraient être sous-utilisés dans cette population, comme l’amitriptyline, tandis que d’autres pourraient être surutilisés chez de tels patients, comme les antibiotiques pour les infections des voies urinaires. La spasticité est souvent liée à un problème sous-jacent, comme la douleur, et le traitement des problèmes concomitants peut donc aussi réduire la spasticité. Il a été observé que des benzodiazépines à courte durée d’action ont été prescrites pour la spasticité à des taux étonnamment élevés, même si elles ne font pas partie du paradigme thérapeutique recommandé. L’étude longitudinale sur les complications secondaires associées aux LME a mené à l’élaboration de pépites exploitables, un outil novateur de transmission des connaissances à l’intention des professionnels des soins primaires.

Conclusion

Dans le but de prodiguer un traitement optimal des patients souffrant d’une LME, les médecins de famille sont encouragés à entamer des communications franches au sujet des médicaments d’ordonnance, y compris sur les aspects liés aux coûts, à la polypharmacie et aux substituts thérapeutiques. Les médecins de famille devraient aussi explorer l’établissement d’une collaboration interprofessionnelle avec des spécialistes des LME et d’autres professionnels de la santé afin d’offrir aux patients des stratégies non pharmacologiques adaptées à leur degré d’activité et à leurs besoins nutritionnels. L’application mobile des pépites exploitables fournit aux médecins de famille des renseignements concis, pratiques et fondés sur des données probantes portant sur les 20 principales préoccupations liées à la santé causées par une LME.

Prescribing for common complications of spinal cord injury

OBJECTIVE

To describe prescribing patterns for 3 common complications associated with spinal cord injury (SCI) and to provide family doctors with strategies for optimizing the care of patients with SCI.

SOURCES OF INFORMATION

Results of a nationwide survey of prescription medication use among people with SCI in Canada and a longitudinal study of secondary complications associated with SCI.

MAIN MESSAGE

Altered neurologic and cardiometabolic function in patients with SCI make it difficult for family physicians to predict optimal medication regimens for these patients. Three common problems seen in primary care among patients with SCI that require pharmacologic treatment are pain (treated in 57% of survey respondents), muscle spasms (54%), and recurrent urinary tract infections (43%). Pain management may require multiple medications, depending on the source or nature of the pain. Some prescription medications recommended for treating pain may be underused in this population, such as amitriptyline, while others may be overused in this population, such as antibiotics for urinary tract infections. Spasticity is often related to an underlying problem such as pain, and treatment of concomitant conditions may also reduce spasticity. Short-acting benzodiazepines were found to have been prescribed for spasticity outside the recommended treatment paradigm at a surprisingly high rate. The longitudinal study of secondary complications associated with SCI led to the development of Actionable Nuggets, an innovative knowledge translation tool for primary care providers.

CONCLUSION

To provide optimal treatment to patients with SCI, family doctors are encouraged to engage in open communication with them about prescription medications, including aspects of cost, polypharmacy, and therapeutic substitutions. Family physicians should also explore interprofessional collaboration with SCI specialists and allied health providers to provide patients with nonpharmacologic strategies tailored to their activity levels and nutritional needs. The Actionable Nuggets mobile app provides family doctors with brief, actionable, evidence-based information on the top 20 health concerns associated with SCI.

A systematic review of economic analyses of home-based telerehabilitation

PURPOSE

Telerehabilitation, or the delivery of rehabilitation using information and communication technologies, may improve timely and equitable access to rehabilitation services at home. A systematic literature review was conducted of studies that formally documented the costs and effects of home-based telerehabilitation versus in-person rehabilitation across all health conditions.

MATERIALS AND METHODS

Six electronic databases were searched from inception to 13 July 2021 (APA, PsycInfo, CINAHL, Embase, EmCare, Medline (Ovid), and PubMed) using a protocol developed by a medical librarian. A quality appraisal of full economic evaluation studies was conducted using the Drummond 10-point quality checklist.

RESULTS

Thirty-five studies were included in this review covering various rehabilitation types and diverse populations. The majority were published in the last six years. Available evidence suggests that telerehabilitation may result in similar or lower costs as compared to in-person rehabilitation for the health care system and for patients. However, the impact of telerehabilitation on long-term clinical outcomes and health-related quality of life remains unclear.

CONCLUSIONS

More high quality and robust economic evaluations exploring the short- and long-term costs and other impacts of telerehabilitation on patients, caregivers, and health care systems across all types of patient populations are still required.Implications for rehabilitationHome-based telerehabilitation may reduce barriers in access to care for individuals living in the community.Economic analyses can inform health care system decision-making by evaluating the costs and effects associated with telerehabilitation.This study found that telerehabilitation may result in similar or lower costs as in-person rehabilitation; however, its impact on health-related quality of life is unclear.

Exploring prevention and management of secondary health conditions in people with spinal cord injury in South Africa

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.

Annual Wellness Visits for Persons With Physical Disabilities Before and After ACA Implementation

PURPOSE

Persons with disabilities often experience uncoordinated health care, with repeated out-of-pocket copays. One purpose of the Patient Protection and Affordable Care Act (ACA) was to create zero copays for preventive health care including an annual wellness visit (AWV). The purpose of this study was to document the use of AWVs by persons with physical disabilities during the ACA rollout.

METHODS

An administrative claims database, including both Medicare Advantage (MA) and commercial (COM) payers from 2008 to 2016, was used to identify unique wellness visits for adults with physical disabilities. We used interrupted time series analysis to compare AWV use by insurance type, sex, disability type, and race over time.

RESULTS

The proportion of zero copays provided a timeline of ACA implementation categorized as pre-ACA, ACA-implementation, and post-ACA periods. By 2016, AWV use maximized at 47.6% (95% CI, 44.7%-50.8%) among COM-insured White women with congenital disabilities. By 2016, the lowest AWV use reached one-half the maximum, at 21.6% (95% CI, 18.4%-25.2%) among COM-insured Hispanic men with acquired disabilities. MA-insured Black and Hispanic men with acquired disabilities reached similarly low levels of AWV use.

CONCLUSION

The ACA mandated zero copays, thereby allowing persons with physical disabilities the option for preventive health care without cost. Insurance type and sex significantly influenced AWV use, followed by disability type and race. Gaps in AWV use were exposed by insurance type, sex, disability, and race for persons with disabilities. Gaps in AWV use were also exposed between the general population and persons with disabilities.Annals "Online First" article.

A one-year prospective study on the occurrence of traumatic spinal cord injury and clinical complications during hospitalisation in North-East Tanzania

BACKGROUND

Clinical complications following spinal cord injury are a big concern as they account for increased cost of rehabilitation, poor outcomes and mortality.

OBJECTIVE

To describe the occurrence of traumatic spinal cord injury and associated clinical complications during hospitalisation in North-East Tanzania.

METHOD

Prospective data were collected from all persons with traumatic spinal cord injury from North-East Tanzania from their admission to discharge from the hospital. Neurological progress and complications were assessed routinely. Data were captured using a form that incorporated the components of the core data set of the International Spinal Cord Society and were analysed descriptively.

RESULTS

A total of 87 persons with traumatic spinal cord injury were admitted at the hospital with a mean age of 40.2 ± 15.8 years. There were 69 (79.3%) males, and 58 (66.6%) of the injuries resulted from falls. Spasms (41 patients, 47.1%), neuropathic pain (40 patients, 46%), and constipation (35 patients, 40.2%) were the most commonly reported complications. The annual incidence rate in the Kilimanjaro region was at least 38 cases per million.

CONCLUSION

The incidence of traumatic spinal cord injury in the Kilimanjaro region is relatively high. In-hospital complications are prevalent and are worth addressing for successful rehabilitation.

Accessing healthcare as a person with a rugby-related spinal cord injury in South Africa: the injured player's perspective

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.

A Primary Care Provider's Guide to Preventive Health After Spinal Cord Injury

Objective: Provide guidance for preventive health and health maintenance after spinal cord injury (SCI) for primary care providers (PCPs). Main message: Individuals with SCI may not receive the same preventive health care as the general population. Additionally, SCI-related secondary conditions may put their health at risk. SCI is considered a complex condition associated with many barriers to receiving quality primary care. Attention to routine preventive care and the unique health considerations of persons with SCI can improve health and quality of life and may prevent unnecessary health care utilization. Conclusion: PCPs are experts in preventive care and continuity of care, however individuals with SCI may not receive the same preventive care due to numerous barriers. This article serves as a quick reference for PCPs.

Experience of a tertiary referral center in managing bladder cancer in conjunction with neurogenic bladder

STUDY DESIGN

Case series.

OBJECTIVES

The aim of this study was to present our experience with the management of bladder cancer (BCa) in individuals followed for neurogenic bladder (NB).

SETTING

An Italian tertiary referral center for NB.

METHODS

We retrospectively collected all pre-operative, intra-operative, and post-operative data of our NB cases with BCa, diagnosed from 2004 to 2019.

RESULTS

We included ten cases: eight with acquired spinal cord injury (SCI) and two with myelomeningocele (MMC). Considering individuals with acquired SCI, the median age at BCa diagnosis and time since SCI were 53 and 34 years, respectively. One out of seven cases had positive urine cytology. All cases underwent a radical cystectomy, diagnosing squamous cell carcinoma (SCC) and transitional cell carcinoma in 60 and 40% cases, respectively. Surgical-related complications occurred after 90% procedures. Three out of eight individuals with acquired SCI died 2, 12, and 80 months after the diagnosis. Both individuals with MMC presented no evidence of disease after 24 and 27 months.

CONCLUSIONS

BCa in individuals with NB proved to be associated with a diagnosis at an advanced stage and a high rate of surgical complications. In this population we advocate annual genitourinary ultrasound exam and urine cytology, and cystoscopy in all cases of macrohematuria. Considering the low accuracy of urine cytology and the difficult-to-interpret inflamed bladder walls at cystoscopy in NB, a patient-tailored follow-up schedule based on specific risk factors (e.g., smoking status, indwelling urinary catheter) is mandatory to diagnose and treat BCa at an early stage.

Classification of obesity, cardiometabolic risk, and metabolic syndrome in adults with spinal cord injury

Objective: To describe and compare (1) classification of obesity using clinical proxies of body composition that are easily accessible in the outpatient clinic setting, (2) cardiometabolic risk using existing screening tools and staging systems, and (3) the presence of metabolic syndrome (MetS) using four commonly-used definitions in adults with spinal cord injury (SCI). Design: Retrospective chart review Setting: Outpatient Veterans Affairs (VA) SCI Annual Evaluation Clinic Participants: Patients who attended an annual evaluation appointment with demographic, anthropometric, and biochemical data documented in their medical records as part of routine medical care. Outcome measures: Obesity classification (body mass index, waist circumference, ideal body weight percentage), cardiometabolic risk scores (Framingham Risk Score, Cardiometabolic Disease Staging System, Edmonton Obesity Staging System), and MetS classification (using four commonly-used definitions) were described and compared. Results: Of the 155 veterans included in this analysis, 93% were considered "at risk" by at least one of the measurements studied. However, there was considerable variation between the different screening tools. The κ-agreement between various definitions of MetS ranged from fair to moderate. Conclusion: Screening tools that were developed for the non-SCI population produced variable assessments of risk when applied to veterans with SCI. Due to the fair to moderate inter-rater agreement between MetS definitions, it is unknown which definition is superior to identify MetS in the SCI population. An SCI-specific screening tool is needed to accurately classify obesity, cardiometabolic risk, and MetS in order to provide timely education and intervention.

Barriers to colorectal cancer screening for people with spinal cord injuries and/or disorders: A qualitative study

BACKGROUND

Limited research has shown people with spinal cord injuries and/or disorders (SCID) are less likely to be up to date with colorectal cancer (CRC) screening and therefore more likely to be diagnosed with advanced stage CRC compared to people without SCID.

OBJECTIVE

The aims of this study were to assess knowledge about CRC, CRC screening, and self-reported barriers to CRC screening for people with SCID.

METHODS

Interviews with 30 individuals with SCID were conducted using a semi-structured interview guide, audio recorded, and transcribed. Coding was performed using a hybrid approach of inductive and deductive analysis. Thematic analysis was used to identify, review, and modify themes and sub-themes.

RESULTS

Themes identified included barriers to CRC screening, such as socioeconomic, health system, transportation, psychological, and environmental or accessibility barriers. While most respondents were able to describe one CRC screening method (usually colonoscopy), knowledge of other screening modalities was limited. Low CRC literacy and misinformation about CRC screening appeared to increase respondent association between CRC screening and colonoscopy. While most respondents associated CRC screening with colonoscopy, almost half reported the colonoscopy preparation was the most substantial barrier to screening.

CONCLUSIONS

In addition to addressing identified barriers such as accessibility and transportation, communication, and prevention interventions should be specifically targeted to ensure all people with SCID are informed about appropriate and various modalities and the benefits of screening. Specific, evidence-based guidelines on the use of stool specimens first with follow up direct visualization, if needed, should be developed for this population.

Prevention care for secondary health conditions among people living with spinal cord injuries: research protocol

Objective

People living with spinal cord injuries are at a high risk to experience preventable secondary health conditions in their lifetime, which can lead to rehospitalisation and death. Given the fact that spinal cord injury is a long term disability requiring on-going care, there is need to strengthen prevention of secondary health conditions. This study aims to establish factors influencing prevention care for secondary health conditions among people living with spinal cord injuries in a metropolitan area in order to develop a prevention model of care.

Results

A record review of patients living with spinal cord injuries will be conducted to identify the prevalence of secondary health conditions and associated factors. Semi-structured interviews will be conducted on patients living with spinal cord injuries, their caregivers and therapists to explore the contextual factors (personal and environmental factors) influencing the prevention of secondary health conditions. Thematic analysis will be used to identify the themes. Nominal group technique will be used to develop the prevention model of care for secondary health conditions. This study will be conducted at a tertiary and specialised rehabilitation hospital in South Africa.