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LaVela SL, Farkas GJ, Berryman K, Kale IO, Sneij A, Felix ER, Reyes L. Health consequences associated with poor diet and nutrition in persons with spinal cord injuries and disorders. Disabil Rehabil 2024:1-12. [PMID: 39289885 DOI: 10.1080/09638288.2024.2404182] [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: 03/01/2024] [Revised: 09/09/2024] [Accepted: 09/10/2024] [Indexed: 09/19/2024]
Abstract
PURPOSE To describe health consequences associated with poor diet in persons with spinal cord injuries and disorders (SCI/D). MATERIALS/METHODS Descriptive qualitative design using in-depth interviews with SCI/D health providers. Audio-recorded and transcribed verbatim transcripts were coded and analyzed using thematic analysis. RESULTS Participants (n = 12) were from 11 nationwide VA hospitals. Participants were male (75%), white (67%), 26-49 years of age, and most were dietitians (75%) and physiatrists (17%). Seven key themes identified consequences associated with poor diet in persons with SCI/D, including (1) Weight gain and body composition changes, (2) cardiometabolic conditions, (3) bowel dysfunction, (4) pressure injuries/wounds, (5) other SCI/D secondary conditions/complications (renal/kidney; immune function/susceptibility to infections; autonomic dysreflexia; bone health/osteoporosis; pain), (6) physical fatigue, and (7) poor mental health. CONCLUSIONS Excess weight, cardiometabolic conditions, SCI/D secondary conditions/complications (e.g., bowel dysfunction, pressure injuries), and poor mental health were identified as health consequences of inadequate nutrition. Health providers should make individuals with SCI/D aware of the risks and health consequences to incentivize healthier dietary behaviors. Efforts to identify nutrition shortcomings and to develop interventions and tailored care plans are needed to improve a myriad of health consequences due to poor diet and nutrition in persons with SCI/D.
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Affiliation(s)
- Sherri L LaVela
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Gary J Farkas
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Kelsey Berryman
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Ibuola O Kale
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA
| | - Alicia Sneij
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
- Miami Project to Cure Paralysis, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Elizabeth R Felix
- Department of Physical Medicine and Rehabilitation, University of Miami Miller School of Medicine, Miami, FL, USA
- Research Service, Miami Veterans Affairs Medical Center, Miami, FL, USA
| | - Lorena Reyes
- Department of Veterans Affairs, Center of Innovation for Complex Chronic Healthcare (CINCCH), Edward Hines Jr. VA Hospital, Hines, IL, USA
- Nutrition and Food Services, VA Edward Hines, Jr., Hines, IL, USA
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Kim S, Han KD, Kim B, Min JH, Chang WH, Cho IY, Shin DW. Short-Term and Long-Term Risk of Diabetes Mellitus among Patients with Spinal Cord Injury: A Nationwide Retrospective Cohort Study. Healthcare (Basel) 2024; 12:1859. [PMID: 39337199 PMCID: PMC11431731 DOI: 10.3390/healthcare12181859] [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: 08/11/2024] [Revised: 09/03/2024] [Accepted: 09/13/2024] [Indexed: 09/30/2024] Open
Abstract
OBJECTIVES Estimating the risk of diabetes mellitus (DM) is important for the proper management of patients with spinal cord injury (SCI). We investigated the short-term and long-term risks of DM among patients with SCI, according to the presence or severity of post-SCI disability and the level of injury. METHODS We conducted a retrospective cohort study using the Korean National Health Insurance Service (2010-2018) database. After matching by age and sex, 6129 SCI patients and 22,979 controls were included. The primary outcome was incident DM, and risk was evaluated for both the short term (within 1 year after SCI) and the long term (after 1 year of SCI diagnosis). RESULTS The risk of DM was higher among patients with cervical- and thoracic-level SCI accompanied by disability compared to the controls during follow-up (4.6 ± 2.6 years). The short-term risk of DM was higher among patients with SCI (odds ratio [OR] 2.51, 95% confidence interval [CI] 1.91-3.27) than among the controls and it was even higher among patients with severe disability (OR 5.38, 95% CI 2.91-9.27). According to the level of injury, patients with cervical SCI had the highest short-term risk of DM (with disability, OR 4.93, 95% CI 3.07-7.63). There was no significant increase of DM risk in the long term, after 1 year of SCI diagnosis. CONCLUSIONS Patients with SCI accompanied by severe disability and cervical-level injury had higher risks of pronounced DM in the short term. The findings of this study emphasize the need for active surveillance of DM among patients with high-level SCI and disability, especially in the short term, in addition to continuous monitoring and proper management of DM in the long term.
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Affiliation(s)
- Seonghye Kim
- International Healthcare Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Kyung-Do Han
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea
| | - Bongseong Kim
- Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea
| | - Ju-Hong Min
- Department of Neurology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Neuroscience Center, Samsung Medical Center, Seoul 06351, Republic of Korea
- Department of Health Sciences and Technology, Samsung Advanced Institute for Health Sciences & Technology (SAIHST), Sungkyunkwan University, Seoul 03063, Republic of Korea
| | - Won Hyuk Chang
- Department of Physical and Rehabilitation Medicine, Center for Prevention and Rehabilitation, Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - In Young Cho
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute of Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul 03063, Republic of Korea
| | - Dong Wook Shin
- Department of Family Medicine & Supportive Care Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute of Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul 03063, Republic of Korea
- Department of Digital Health, Samsung Advanced Institute of Health Science and Technology (SAIHST), Sungkyunkwan University, Seoul 03063, Republic of Korea
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LaVela SL, Wu J, Harris AH, Frayne SM, Nevedal AL, Arnow KD, Barreto NB, Davis K, Eisenberg D. Physical and emotional consequences of excess weight as experienced by individuals with spinal cord injuries. J Spinal Cord Med 2024; 47:412-422. [PMID: 36448929 PMCID: PMC11044741 DOI: 10.1080/10790268.2022.2097994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
CONTEXT/OBJECTIVE Excess weight has the potential to carry a substantial physical and emotional burden. A better understanding of perceived consequences of excess weight may facilitate the development of patient-centered programs and interventions to promote weight management efforts in persons with spinal cord injury (SCI). The study objective was to describe consequences of excess weight from the personal perspectives of individuals with SCI. DESIGN Descriptive qualitative design using in-depth semi-structured interviews and thematic analysis. SETTING Veterans Health Administration (VHA) SCI System of Care. PARTICIPANTS Individuals with SCI (n-33). OUTCOME MEASURES Key themes from thematic analysis. RESULTS Participants were male (61%), ranged from 29 to 84 years of age, and about half had tetraplegia (55%). Five themes were identified that demonstrate negative consequences of excess weight experienced by individuals with SCI, including: (1) physical health conditions (including chronic conditions and SCI secondary conditions), (2) physical symptoms (such as pain, discomfort, and fatigue), (3) movement challenges, (4) appearance-related concerns, and (5) emotional impacts. CONCLUSIONS Carrying excess weight is concerning to individuals with SCI and in terms of consequences such onset or exacerbation of chronic conditions, SCI secondary conditions, physical symptoms, e.g. pain, movement impairment (including hampered mobility, difficult transfers and self-care), image/appearance concerns (e.g. body image, clothing misfit), and negative emotions (e.g. unhappy, sad, depressed). Our findings may inform SCI healthcare providers about the consequences of excess weight as experienced by individuals with SCI, highlighting what matters most to persons with SCI and guiding a patient-centered approach to weight management in this population.
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Affiliation(s)
- Sherri L. LaVela
- Center of Innovation for Complex Chronic Care, VA Edward Hines Jr., Hines, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Justina Wu
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Alex H.S. Harris
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Susan M. Frayne
- Center of Innovation for Complex Chronic Care, VA Edward Hines Jr., Hines, Illinois, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Andrea L. Nevedal
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
| | - Katherine D. Arnow
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Nicolas B. Barreto
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Kristen Davis
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
| | - Dan Eisenberg
- Center for Innovation to Implementation, VA Palo Alto Health Care System, Palo Alto, California, USA
- Stanford-Surgery Policy Improvement Research & Education Center, Stanford University School of Medicine, Stanford, California, USA
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Fallah N, Hong HA, Wang D, Humphreys S, Parsons J, Walden K, Street J, Charest-Morin R, Cheng CL, Cheung CJ, Noonan VK. Network analysis of multimorbidity and health outcomes among persons with spinal cord injury in Canada. Front Neurol 2024; 14:1286143. [PMID: 38249735 PMCID: PMC10797060 DOI: 10.3389/fneur.2023.1286143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 10/18/2023] [Indexed: 01/23/2024] Open
Abstract
Introduction Multimorbidity, defined as the coexistence of two or more health conditions, is common in persons with spinal cord injury (SCI). Network analysis is a powerful tool to visualize and examine the relationship within complex systems. We utilized network analysis to explore the relationship between 30 secondary health conditions (SHCs) and health outcomes in persons with traumatic (TSCI) and non-traumatic SCI (NTSCI). The study objectives were to (1) apply network models to the 2011-2012 Canadian SCI Community Survey dataset to identify key variables linking the SHCs measured by the Multimorbidity Index-30 (MMI-30) to healthcare utilization (HCU), health status, and quality of life (QoL), (2) create a short form of the MMI-30 based on network analysis, and (3) compare the network-derived MMI to the MMI-30 in persons with TSCI and NTSCI. Methods Three network models (Gaussian Graphical, Ising, and Mixed Graphical) were created and analyzed using standard network measures (e.g., network centrality). Data analyzed included demographic and injury variables (e.g., age, sex, region of residence, date, injury severity), multimorbidity (using MMI-30), HCU (using the 7-item HCU questionnaire and classified as "felt needed care was not received" [HCU-FNCNR]), health status (using the 12-item Short Form survey [SF-12] Physical and Mental Component Summary [PCS-12 and MCS-12] score), and QoL (using the 11-item Life Satisfaction questionnaire [LiSAT-11] first question and a single item QoL measure). Results Network analysis of 1,549 participants (TSCI: 1137 and NTSCI: 412) revealed strong connections between the independent nodes (30 SHCs) and the dependent nodes (HCU-FNCNR, PCS-12, MCS-12, LiSAT-11, and the QoL score). Additionally, network models identified that cancer, deep vein thrombosis/pulmonary embolism, diabetes, high blood pressure, and liver disease were isolated. Logistic regression analysis indicated the network-derived MMI-25 correlated with all health outcome measures (p <0.001) and was comparable to the MMI-30. Discussion The network-derived MMI-25 was comparable to the MMI-30 and was associated with inadequate HCU, lower health status, and poor QoL. The MMI-25 shows promise as a follow-up screening tool to identify persons living with SCI at risk of having poor health outcomes.
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Affiliation(s)
- Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | | | - Di Wang
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
| | | | | | | | - John Street
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | - Raphaele Charest-Morin
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
- Department of Orthopaedics, Vancouver Spine Surgery Institute, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Vanessa K. Noonan
- Praxis Spinal Cord Institute, Vancouver, BC, Canada
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, BC, Canada
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Tate DG, Forchheimer M, Reber L, Meade M, Tan N, Clarke P. Factors enabling comorbidities and secondary conditions in older adults with spinal cord injury. J Spinal Cord Med 2023; 46:929-940. [PMID: 35993788 PMCID: PMC10653777 DOI: 10.1080/10790268.2022.2108662] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/15/2022] Open
Abstract
OBJECTIVE To examine the role of personal, social, and environmental factors predicting comorbidities and secondary conditions among older adults with spinal cord injury (SCI). DESIGN Cross-sectional study utilizing survey methods were used to collect the data analyzed with two distinct general linear models. SETTING Community-dwelling participants who resided in rural and urban areas. PARTICIPANTS One hundred and eighty-three (183) participants with SCI ages 45 and over at least five years post injury. INTERVENTIONS Not applicable. MEASURES Spinal Cord Injury Secondary Conditions Scale (SCI-SCS); Comorbidities Questionnaire; Spinal Cord Injury Functional Index Assistive Technology (SCI-FI/AT) Basic - Mobility; Spinal Cord Injury Quality of Life (SCI-QOL) Satisfaction with Social Roles and Activities Scale (SSRA); Cohen's Social Network-Social Integration Index, the Medical Outcomes Study (MOS) Social Support Emotional/Informational Support Scale, and the Facilitators and Barriers Survey for Mobility (FABS-Mv2). Questions were also asked from the Behavioral Risk Factor Surveillance System (BRFSS). RESULTS Common predictors of comorbidities and secondary conditions included age, basic mobility, primary health care payer and parking limitations. An interaction between parking and neurological classification was observed for comorbidities. Neurological classification and employment were significantly associated with comorbidities while for secondary conditions, sex, years since injury, education, satisfaction with social roles and the home environment were critical factors. CONCLUSIONS Our study shows the effects of demographic and injury factors, physical functioning, satisfaction with social roles, access to home environment adaptations and health resources in predicting comorbidities and secondary conditions among older adults with SCI.
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Affiliation(s)
- Denise G Tate
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Martin Forchheimer
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Lisa Reber
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Michelle Meade
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Nasya Tan
- Department of Epidemiology, School of Public Health, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Philippa Clarke
- Department of Epidemiology, School of Public Health, Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
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Hong HA, Fallah N, Wang D, Cheng CL, Humphreys S, Parsons J, Noonan VK. Multimorbidity in persons with non-traumatic spinal cord injury and its impact on healthcare utilization and health outcomes. Spinal Cord 2023; 61:483-491. [PMID: 37604933 DOI: 10.1038/s41393-023-00915-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 05/24/2023] [Accepted: 07/12/2023] [Indexed: 08/23/2023]
Abstract
STUDY DESIGN Cross-sectional survey in Canada. OBJECTIVES To explore multimorbidity (the coexistence of two/more health conditions) in persons with non-traumatic spinal cord injury (NTSCI) and evaluate its impact on healthcare utilization (HCU) and health outcomes. SETTING Community-dwelling persons. METHODS Data from the Spinal Cord Injury Community Survey (SCICS) was used. A multimorbidity index (MMI) consisting of 30 secondary health conditions (SHCs), the 7-item HCU questionnaire, the Short Form-12 (SF-12), Life Satisfaction-11 first question, and single-item Quality of Life (QoL) measure were administered. Additionally, participants were grouped as "felt needed healthcare was received" (Group 1, n = 322) or "felt needed healthcare was not received" (Group 2, n = 89) using the HCU question. Associations among these variables were assessed using multivariable analysis. RESULTS 408 of 412 (99%) participants with NTSCI reported multimorbidity. Constipation, spasticity, and fatigue were the most prevalent self-reported SHCs. Group 1 had a higher MMI score compared to Group 2 (p < 0.001). A higher MMI score correlated with the feeling of not receiving needed care (OR 1.4, 95% CI 1.08-1.21), lower SF-12 (physical/mental component summary scores), being unsatisfied with life, and lower QoL (all p < 0.001). Additionally, Group 1 had more females (p < 0.001), non-Caucasians (p = 0.034), and lower personal annual income (p = 0.025). CONCLUSIONS Persons with NTSCI have multimorbidity, and the MMI score was associated with increased HCU and worse health outcomes. This work emphasizes the critical need for improved healthcare and monitoring. Future work determining specific thresholds for the MMI could be helpful for triage screening to identify persons at higher risk of poor outcomes.
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Affiliation(s)
- Heather A Hong
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Nader Fallah
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Di Wang
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | | | | | - Jessica Parsons
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada
| | - Vanessa K Noonan
- Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada.
- International Collaboration on Repair Discoveries, University of British Columbia, Vancouver, British Columbia, Canada.
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Krause JS, Jarnecke M. Perceived impact of the COVID-19 pandemic among people with spinal cord injury: A descriptive study. Arch Rehabil Res Clin Transl 2023; 5:100271. [PMID: 37363128 PMCID: PMC10238114 DOI: 10.1016/j.arrct.2023.100271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Objective To describe the self-reported impact of the COVID-19 pandemic on the lives of persons with spinal cord injury (SCI). Design Cross sectional study. Participants There were a total of 382 adult participants with traumatic SCI of at least one-year duration, all of whom were identified through a state-based surveillance registry in the Southeastern United States. The majority of participants were male (68.4%) and 72% were ambulatory. The average age at the time of the study was 57.7. Main Outcome Measures Participants completed a self-report assessment (SRA) online or by mail on the impact of COVID-19 on quality-of-life, ability to get daily necessities, and access to healthcare. Results Over half of the participants (58.9%) reported a negative impact of the pandemic in at least one of five life areas, with community participation being the primary area affected (51.4%). A small portion of individuals had trouble obtaining necessities, with approximately 12% reporting difficulties getting enough or quality food and 8.2% reporting difficulty getting prescription medications. However, 25% reported delaying healthcare procedures because of fear of catching COVID-19. Among those requiring personal assistance, 32% reported a decrease in quality of care and 51.9% relied more on family to assist with their care. Conclusions The COVID-19 pandemic had multiple negative impacts. Of particular importance were reduced access to healthcare and declines in quality and stability of attendant care, with greater reliance on family. Fear of contracting COVID-19 when accessing routine medical procedures needs to be addressed in future outbreaks.
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Affiliation(s)
- James S. Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Melinda Jarnecke
- College of Health Professions, Medical University of South Carolina, Charleston, SC
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Tan N, Forchheimer M, Tate DG, Meade MA, Reber L, Clarke PJ. Social Integration among Adults Aging with Spinal Cord Injury: The Role of Features in the Built and Natural Environment. JOURNAL OF AGING AND ENVIRONMENT 2023; 38:275-289. [PMID: 39190652 PMCID: PMC10961974 DOI: 10.1080/26892618.2023.2203178] [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] [Indexed: 08/29/2024]
Abstract
A growing number of adults are aging with spinal cord injury (SCI) acquired earlier in life. Social integration is important for health and participation after SCI. However, little is known about the role of the community built environment for supporting social integration among adults aging with SCI. Using a structured telephone survey with 182 adults aging with SCI in the Midwestern United States, we found that more community built environment facilitators (e.g., curb cuts, automatic doors, paved surfaces) and fewer barriers (e.g., gravel surfaces, crowds) significantly increased the odds of regularly engaging in both formal and informal social activities.
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Affiliation(s)
- Nasya Tan
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
| | - Martin Forchheimer
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Denise G Tate
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Michelle A Meade
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Lisa Reber
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Philippa J Clarke
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan
- Institute for Social Research, University of Michigan, Ann Arbor, Michigan
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Morgan KA, Wong AWK, Walker K, Desai RH, Knepper TM, Newland PK. A Mobile Phone Text Messaging Intervention to Manage Fatigue for People With Multiple Sclerosis, Spinal Cord Injury, and Stroke: Development and Usability Testing. JMIR Form Res 2022; 6:e40166. [PMID: 36542466 DOI: 10.2196/40166] [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: 06/21/2022] [Revised: 10/21/2022] [Accepted: 11/05/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Fatigue significantly affects daily functioning in persons with disabilities. Fatigue management can be challenging, and the information provided during routine physician visits to manage fatigue can be overwhelming. One way to address fatigue is to increase knowledge, skills, and confidence for self-management (ie, patient activation). Self-management programs have shown promising effects in targeting fatigue in persons with disabilities. However, satisfaction with self-management programs is low for persons with disabilities, and tailoring interventions to personalized needs has been recommended. SMS text messaging is increasingly being used to implement health behavior change interventions in a person's natural environment. Little has been done to link mobile health approaches with patient activation and self-management to address fatigue in persons with disabilities. OBJECTIVE This study aimed to develop and test a mobile phone-based fatigue self-management SMS text messaging intervention targeting patient activation in 3 groups of persons with disabilities: persons with multiple sclerosis, persons who had a stroke, and persons with a spinal cord injury. METHODS We used evidence-based resources and input from a consumer advisory board (CAB; composed of 2 participants from each of the 3 disability groups) and a neurologist to develop the intervention. The study was conducted using a 4-step process: development of the initial SMS text messaging library and categorization of the content into 9 content areas, review and modification of the SMS text messages by the neurologist and CAB, integration of the content library into a digital platform, and utility testing by CAB members. RESULTS A total of 6 CAB participants rated SMS text messages covering 9 domain areas of fatigue self-management with good clarity (mean ratings=3.5-5.0 out of 5) and relevance (mean ratings=3.2-5.0 out of 5). Overall, SMS text messaging content was reported by CAB participants as helpful, clear, and well suited for a mobile health intervention. The CAB reached consensus on the time of day that SMS text messages should be sent (morning) and their frequency (once per day). This feedback led the research team to narrow down the program to deliver 48 SMS text messages, 1 per day, Monday through Thursday only, a total of 4 SMS text messages per week, over a 12-week period. The final set of SMS text messages was programmed into a digital platform with a predefined delivery schedule. The usability of the intervention was high, with 55 (83%) out of 66 responses endorsing the highest rating. CONCLUSIONS This study demonstrates a step-by-step process for developing a fatigue self-management SMS text messaging intervention for persons with disabilities. For this population, whose access to health services is often limited, this intervention provides an alternative delivery model to increase access to fatigue information and deliver content that aligns with the person's needs.
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Affiliation(s)
- Kerri A Morgan
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Alex W K Wong
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Kim Walker
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Rachel Heeb Desai
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Tina M Knepper
- Program in Occupational Therapy, St. Louis School of Medicine, Washington University, St. Louis, MO, United States
| | - Pamela K Newland
- Goldfarb School of Nursing, Barnes Jewish College, St. Louis, MO, United States
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Cao Y, Murday D, Corley EH, DiPiro ND, Krause JS. Rehospitalization During the First 5 Years After the Onset of Traumatic Spinal Cord Injury: A Population-Based Study Using Administrative Billing Records. Arch Phys Med Rehabil 2022; 103:1263-1268. [PMID: 35218708 PMCID: PMC9246950 DOI: 10.1016/j.apmr.2022.01.162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 12/14/2021] [Accepted: 01/21/2022] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Our objective was to identify the number, length of stay, and charges of rehospitalizations during the subsequent 5 years after discharge from the initial hospitalization by using administrative billing records from a population-based cohort with spinal cord injury (SCI) in the southeastern United States. DESIGN Analysis of administrative billing data. SETTING State-based surveillance data analyzed by an academic medical center in the southeastern United States. PARTICIPANTS A total of 1872 individuals (N=1872) from a state-based surveillance system in the southeastern United States whose onset was between January 1, 1998, and January 1, 2010. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The outcome measures were the number of rehospitalization episodes, length of stay, and total hospital charges for each episode of rehospitalization. RESULTS Seventy percent of participants were rehospitalized during the first 5 years after initial discharge, and the highest rehospitalization rates were in the first year (54%), being relatively stable in years 2-5 (21%-22%). Adjusted to 2019 US dollars, the average total rehospitalization charges were $214,716 per person during the 5 years. Participants who could walk independently had fewer rehospitalizations, fewer rehospitalization days, and less rehospitalization charges than the nonambulatory participants. College education was also associated with less rehospitalization charges. CONCLUSIONS Rehospitalization is a significant cost after SCI. Further longitudinal study on the population cohorts and billing data are needed to quantify these changes over time.
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Affiliation(s)
- Yue Cao
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - David Murday
- Arnold School of Public Health, University of South Carolina, Columbia SC, USA
| | - Elizabeth H. Corley
- Arnold School of Public Health, University of South Carolina, Columbia SC, USA
| | - Nicole D. DiPiro
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - James S. Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC
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11
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Farkas GJ, Burton AM, McMillan DW, Sneij A, Gater DR. The Diagnosis and Management of Cardiometabolic Risk and Cardiometabolic Syndrome after Spinal Cord Injury. J Pers Med 2022; 12:1088. [PMID: 35887592 PMCID: PMC9320035 DOI: 10.3390/jpm12071088] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022] Open
Abstract
Individuals with spinal cord injuries (SCI) commonly present with component risk factors for cardiometabolic risk and combined risk factors for cardiometabolic syndrome (CMS). These primary risk factors include obesity, dyslipidemia, dysglycemia/insulin resistance, and hypertension. Commonly referred to as "silent killers", cardiometabolic risk and CMS increase the threat of cardiovascular disease, a leading cause of death after SCI. This narrative review will examine current data and the etiopathogenesis of cardiometabolic risk, CMS, and cardiovascular disease associated with SCI, focusing on pivotal research on cardiometabolic sequelae from the last five years. The review will also provide current diagnosis and surveillance criteria for cardiometabolic disorders after SCI, a novel obesity classification system based on percent total body fat, and lifestyle management strategies to improve cardiometabolic health.
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Affiliation(s)
- Gary J. Farkas
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Miami Miller, Miami, FL 33136, USA; (A.S.); (D.R.G.J.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
| | - Adam M. Burton
- School of Medicine, University of Miami Miller, Miami, FL 33136, USA;
| | - David W. McMillan
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
- The Miami Project to Cure Paralysis, School of Medicine, University of Miami Miller, Miami, FL 33136, USA
| | - Alicia Sneij
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Miami Miller, Miami, FL 33136, USA; (A.S.); (D.R.G.J.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
| | - David R. Gater
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Miami Miller, Miami, FL 33136, USA; (A.S.); (D.R.G.J.)
- Christine E. Lynn Rehabilitation Center for the Miami Project to Cure Paralysis, Miami, FL 33136, USA;
- School of Medicine, University of Miami Miller, Miami, FL 33136, USA;
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12
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Shen YL, Zhang ZQ, Zhu LJ, Liu JH. Timing theory continuous nursing, resistance training: Rehabilitation and mental health of caregivers and stroke patients with traumatic fractures. World J Clin Cases 2022; 10:1508-1516. [PMID: 35211588 PMCID: PMC8855261 DOI: 10.12998/wjcc.v10.i5.1508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/19/2021] [Accepted: 01/08/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Stroke is the leading cause of adult lifelong disability worldwide. A stroke is an acute cerebrovascular disease with a variety of causes and corresponding clinical symptoms. Around 75% of surviving stroke patients experience impaired nerve function, and some suffer from traumatic fractures, which can lead to special care needs.
AIM To determine the effect of timing theory continuous care, with resistance training, on the rehabilitation and mental health of caregivers and stroke patients with traumatic fractures.
METHODS Between January 2017 to March 2021, we selected 100 hospital admissions with post-stroke hemiplegia complicated with a traumatic fracture. Two participant groups were created: (1) Control group: given resistance training; and (2) Observation group: given timing theory continuous care combined with resistance training. The degree of satisfaction and differences in bone and phosphorus metabolism indexes between the two groups were compared. The self-perceived burden scale (SPBS) and caregiver burden questionnaire were used to evaluate the psychological health of patients and caregivers. The Harris hip function score, ability of daily living (ADL) scale, and global quality of life questionnaire (GQOL-74) were used to evaluate hip function, ability of daily living, and quality of life.
RESULTS Data were collected prior to and after intervention. Alkaline phosphatase (ALP), osteocalcin, and vitamin D3 in the observation group and control group increased after intervention (P < 0.05), and carboxy-terminal peptide of type I collagen β Special sequence (β-CTX) decreased (P < 0.05). ALP and osteocalcin in the observation group were higher than in the control group (P < 0.05). There was no significant difference in β-CTX and vitamin D3 between the two groups (P > 0.05). The SPBS score of the observation group was lower and the ADL score was higher than the control group. The burden score was lower and the Harris hip function and GQOL-74 scores were higher than that of the control group (P < 0.05). The observation group’s satisfaction rating was 94.00%, which was higher than the rating from the control group (P < 0.05).
CONCLUSION Timing theory continuous nursing with resistance training can reduce hip dysfunction in stroke patients with a traumatic fracture and enhance quality of life and mental health of patients and caregivers.
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Affiliation(s)
- Ya-Li Shen
- Department of Orthopedics, Chengde Central Hospital, Chengde 067000, Hebei Province, China
| | - Zong-Qun Zhang
- Department of Neurology, Chengde Central Hospital, Chengde 067000, Hebei Province, China
| | - Li-Juan Zhu
- Department of Orthopedics, Chengde Central Hospital, Chengde 067000, Hebei Province, China
| | - Jing-Hua Liu
- Department of Nursing, Chengde Central Hospital, Chengde 067000, Hebei Province, China
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13
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Lahav Y, Avidor S, Levy D, Ohry A, Zeilig G, Lahav M, Golander H, Chacham-Guber A, Uziel O, Defrin R. Shorter telomeres among individuals with physical disability: The moderating role of perceived stress. J Gerontol B Psychol Sci Soc Sci 2021; 77:1384-1393. [PMID: 34687310 DOI: 10.1093/geronb/gbab200] [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: 06/02/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Evidence suggests that individuals with physical disability may suffer from psychological distress and accelerated cellular aging, manifested by shortened telomere length (TL), compared with healthy individuals. Studies indicate that high levels of perceived stress and depression may increase the physiological susceptibility and thus, may contribute to a short TL. However, the moderating role of perceived stress and depression within the relationship between physical disability and TL remains unknown. METHODS The participants consisted of 119 male subjects (mean age 54.36 years, range 35-70). Of them, 30 were able-bodied and 86 had a physical disability: 34 were due to Poliomyelitis (polio) and 55 were due to spinal cord injury (SCI). Blood samples for TL analysis were collected; the participants completed questionnaires and underwent disability evaluation. RESULTS Participants with disability had a shorter TL as well as elevated levels of perceived stress and depression compared with able-bodied controls. Both the perceived stress and depression were correlated with a shorter TL. Nonetheless, perceived stress, rather than depression, moderated the relationship between disability and TL; among participants with higher perceived stress levels, in particular, individuals with physical disability had a shorter TL than the able-bodied controls. DISCUSSION The present findings suggest that individuals with physical disability and who exhibit high levels of perceived stress may be particularly vulnerable for accelerated cellular aging, suggesting that perceived stress can be used as a valuable target for intervention.
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Affiliation(s)
- Yael Lahav
- Department of Occupational Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University
| | - Sharon Avidor
- Faculty of Social and Community Sciences, Ruppin Academic Center
| | - David Levy
- Department of nursing, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University
| | - Avi Ohry
- Section of Rehabilitation Medicine, Reuth Medical and Rehabilitation Center, Tel Aviv.,Department of Rehabilitation, Sackler Faculty of Medicine, Tel Aviv University
| | - Gabi Zeilig
- Department of Neurological Rehabilitation, Chaim Sheba Medical Center, Tel Hashomer.,Department of Rehabilitation, Sackler Faculty of Medicine, Tel Aviv University
| | - Meir Lahav
- The Felsenstein Medical Research Center, Rabin Medical Center and Tel Aviv University, Petah-Tikva
| | - Hava Golander
- Department of nursing, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University
| | | | - Orit Uziel
- The Felsenstein Medical Research Center, Rabin Medical Center and Tel Aviv University, Petah-Tikva
| | - Ruth Defrin
- Department of Physical Therapy, School of Health Professions, Sackler Faculty of Medicine, Tel-Aviv University, Israel
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14
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Health Promotion and Wellness in Neurologic Physical Therapy: Strategies to Advance Practice. J Neurol Phys Ther 2021; 46:103-117. [PMID: 34507339 DOI: 10.1097/npt.0000000000000376] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND PURPOSE Neurologic physical therapy (PT) can assist people with neurologic conditions and injuries to optimize their health and well-being by addressing barriers at the individual, relationship, community, and societal levels. The purpose of this special interest article is to provide consensus-driven strategies to address barriers to implementing health promotion and wellness (HPW)-related neurologic PT practice. SUMMARY OF KEY POINTS Environmental scan, literature review, and expert input were used to determine barriers and develop strategies. Barriers include lack of time; low knowledge, self-efficacy, and awareness; client complexity; and lack of HPW resources; as well as concerns regarding payment and scope of practice. Four key strategies emerged: (1) develop and disseminate a consensus-based scope of practice for HPW in neurologic PT; (2) increase knowledge of resources related to HPW; (3) promote delivery models for HPW-related neurologic PT; and (4) encourage advocacy, community building and partnership along the continuum of care. RECOMMENDATIONS FOR CLINICAL PRACTICE Clinicians should practice to their full scope of HPW-related PT practice. This includes optimizing movement, including physical activity and fitness, as well as reinforcing the importance of healthy sleep, nutrition, stress, and smoking cessation. These activities address primary, secondary, and tertiary prevention. Clinicians are encouraged to report their experiences with HPW-focused delivery models and outcomes. Additional research is needed to understand the full impact of HPW on PT practice (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A364).
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