Correlation between health-related quality of life in veterans with chronic spinal cord injury and their caregiving spouses

Variables Associated With Moderate to High Loneliness Among Individuals Living With Spinal Cord Injuries and Disorders

OBJECTIVE

To identify variables independently associated with moderate to high loneliness in individuals living with Spinal Cord Injuries or Disorders (SCI/D).

DESIGN

A cross-sectional, national survey of a random sample of community-dwelling Veterans with SCI/D in the United States. Survey methodology was used to collect data on demographic and injury characteristics, general health, chronic and SCI-secondary conditions, and loneliness.

SETTING

The VHA SCI/D System of Care including 25 regional SCI/D Centers (or Hubs).

PARTICIPANTS

Among 2466 Veterans with SCI/D, 592 completed surveys (24%). Most participants were men (91%), white (81%), not currently married (42%), had tetraplegia (33%), and on average injured for 18 years at the time of data collection (N=562).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

The dependent variable, loneliness, was collected using the UCLA-3 instrument. Loneliness was dichotomized into never/low loneliness and moderate/high loneliness (UCLA score ≥ 4).

RESULTS

Bivariate analyses assessed unadjusted associations in demographics, injury characteristics, chronic disease, and SCI-secondary conditions. Multivariable logistic regression was used to identify factors independently associated with moderate/high loneliness. Participants had a mean loneliness score of 5.04, SD=1.99. The point prevalence of moderate to high loneliness was 66%. Lower duration of injury, paraplegia, being unmarried, being in fair/poor general health, having dysfunctional sleep, and having a diagnosis of bowel dysfunction were each independently associated with greater odds of moderate/high loneliness.

CONCLUSIONS

Findings suggest that interventions to reduce/manage loneliness in the Veteran SCI/D population should focus on those who are more newly injured, have paraplegia, currently unmarried, have bowel problems, and experience dysfunctional sleep.

Recent Advances in the Treatment of Spinal Cord Injury

Spinal cord injury (SCI) is a complex, multifaceted, progressive, and yet incurable complication that can cause irreversible damage to the individual, family, and society. In recent years strategies for the management and rehabilitation of SCI besides axonal regeneration, remyelination, and neuronal plasticity of the injured spinal cord have significantly improved. Although most of the current research and therapeutic advances have been made in animal models, so far, no specific and complete treatment has been reported for SCI in humans. The failure to treat this complication has been due to the inherent neurological complexity and the structural, cellular, molecular, and biochemical characteristics of spinal cord injury. In this review, in addition to elucidating the causes of spinal cord injury from a molecular and pathophysiological perspective, the complexity and drawbacks of neural regeneration that lead to the failure in SCI treatment are described. Also, recent advances and cutting-edge strategies in most areas of SCI treatment are presented.

Caregiver burden according to ageing and type of care activity in caregivers of individuals with spinal cord injury

OBJECTIVE

To describe caregiver burden according to the caregivers' general characteristics, especially with ageing, and type of care activities provided by caregivers of individuals with spinal cord injury.

DESIGN

A cross-sectional study was conducted utilizing a structured questionnaire that included general characteristics, health conditions, and caregiver burden.

SETTING

A single center study in Seoul, Korea.

SUBJECTS

Participants were recruited from 87 individuals with spinal cord injuries and 87 caregivers.

METHODS

The Caregiver Burden Inventory was used to assess caregiver burden.

RESULTS

Caregiver burden was significantly different by age (p = 0.001), relationship (p = 0.025), sleep hours (p = <0.001), underlying disease (p = 0.018), pain (p = <0.001), and daily activities of individuals with spinal cord injury (p = 0.001). Caregiver's age (B = 0.339, p = 0.049), sleep duration (B = -2.896, p = 0.012) and pain (B = 2.558, p < 0.001) predicted caregiver burden. Toileting assistance was the most challenging and time-consuming for caregivers, while patient transfer was associated with the greatest concerns for body injury.

CONCLUSION

Caregiver education should be targeted according to caregiver's age and type of assistance. Social policies need to be developed to distribute devices and care-robots to reduce caregiver burden and thereby assist caregivers.

Assessment of the unmediated relationship between neurological impairment and health-related quality of life following spinal cord injury

Objective: To assess the unmediated association between neurological impairment and quality of life (QoL) among persons with spinal cord injury (SCI), in the context of both early post-acute and long-term rehabilitation settings.Design: An observational prospective cross-sectional study.Setting: Two neurological rehabilitation centers, specializing in spinal cord injury, within a university hospital.Methods: 156 adults with spinal cord injury in the early post-acute and chronic stages of rehabilitation.Outcome Measures: Participants were categorized into tetraplegia or paraplegia groups based on neurological level of injury, and into complete or incomplete groups based on American Spinal Injury Association (ASIA) Impairment Scale (AIS) score. QoL was assessed by means of the World Health Organization Quality of Life Assessment-BREF (WHOQOL-BREF), Satisfaction with Life Scale (SWLS), Life Satisfaction Questionnaire (LISAT-9), and Personal Well-Being Index (PWI).Results: WHOQOL-BREF and PWI predicted Level of Injury group classification and WHOQOL-BREF predicted Setting group classification. None of the questionnaires differentiated between the Type of Injury groups. At the early post-acute stage of rehabilitation, the QoL scores of participants with tetraplegia and paraplegia did not differ significantly, while significantly higher QoL scores were revealed in paraplegics in the long-term setting group.Conclusions: A direct, unmediated effect of severity of neurological impairment was revealed with the WHOQOL-BREF, which distinguished between the tetraplegia and paraplegia groups, but not between the complete and incomplete injuries. QoL was significantly higher in paraplegia than in tetraplegia following the early post-acute stage of rehabilitation.

Factors Associated with Quality of Life among Caregivers of People with Spinal Cord Injury

Purpose

Often people with spinal cord injury (SCI) require help from their caregivers to carry out activities of daily living. Such assistance may affect caregiver quality of life (QoL). This study investigates the QoL and its associated risk factors among caregivers of people with SCI to find possible ways to increase their QoL. Material and Method. A convenience sample of 135 Iranian caregivers of people with SCI participated in a cross-sectional study from the Brain and Spinal Injury Repair Research Center of Tehran (BASIR), Iran, from June 2018 to October 2019. The World Health Organization's Quality of Life Questionnaire (WHOQoL-BREF), the Beck Depression Inventory-II (BDI-II), the Caregiver Burden Scale (CBS), and a demographic questionnaire were administered. Hierarchical multiple linear regression analysis was then applied to identify risk factors associated with caregiver QoL.

Results

Moderate to highly significant negative correlations were observed between all domains of the WHOQoL scale and subscales of the CBS and the BDI-II. After controlling for demographic and clinical variables, depression, burden, and level of injury were found to predict caregiver QoL significantly. Furthermore, QoL was lower in caregivers of people with quadriplegia than paraplegia (p < 0.05).

Conclusions

The level of injury, self-perceived caregiver burden, and depression are associated with QoL for the caregivers of people with SCI. A holistic approach incorporating caregiver training, psychological interventions, and adequate support may enable better QoL for these caregivers.

[Quality of life in patients with spinal cord injury for at least 10years: Importance of secondary health complications]

OBJECTIVE

To determine the quality of life of spinal cord injuries with more than 10 years of evolution. Assess the prevalence of secondary complications, and their relationship with quality of life and time since the injury.

PATIENTS AND METHOD DESIGN

Cross-sectional epidemiological study.

STUDY SUBJECTS

Patients with traumatic spinal cord injury, more than 10 years after the injury, and who met the inclusion criteria.

METHOD

Quality of life was assessed using the International spinal cord injury quality of life basic data set. Variables included: individual factors, neurological deficit, level of injury and secondary complications.

RESULTS

131 subjects were included in the study with a mean age of 49 years, and a time since the injury of 21 years (11-53 years). The mean number of secondary complications was 2, the most frequent being urological, in 76 subjects (58%). There were no significant differences between the number of complications and the time elapsed since the spinal cord injury. The quality of life was significantly lower in those with a higher number of complications (P=.003). Urological complications (P=.04, 95% CI: -1.02 to 2), musculoskeletal pain (P=.01, 95% CI: 1-6), respiratory complications (P=.05, 95% CI: -3 to 0.1) and neuropathic pain that interfered with basic life activities (P=.01, 95% CI: 1-5) were significantly related to a lower quality of life.

CONCLUSIONS

Secondary complications are common after spinal cord injury, although their number does not increase over time after injury. Quality of life is conditioned by the existence of different complications such as the existence of musculoskeletal pain.

Mental health and life satisfaction of individuals with spinal cord injury and their partners 5 years after discharge from first inpatient rehabilitation

STUDY DESIGN

Cross-sectional study.

OBJECTIVES

To describe and compare mental health and life satisfaction between individuals with spinal cord injury (SCI) and their partners 5 years after discharge from first inpatient rehabilitation; and to examine if injury severity moderates the association between individuals' with SCI and their partners' mental health and life satisfaction.

SETTING

Dutch community.

METHODS

Sixty-five individuals with SCI and their partners completed a self-report questionnaire. Main outcome measures were the mental health subscale of the Short-Form Health Survey and the Life Satisfaction Questionnaire.

RESULTS

Levels of mental health and life satisfaction of individuals with SCI and partners were similar, with median scores of 76 and 4.8 versus 76 and 4.6, respectively. Moderate to strong correlations between individuals with SCI and their partners were found for the mental health (r_S = 0.35) and life satisfaction scores (r_S = 0.51). These associations were generally stronger in the subgroup of individuals with less severe SCI. Associations between scores on separate life domains ranged from negligible (0.05) to moderate (0.53). Individuals with SCI and their partners were least satisfied with their 'sexual life'. Compared with their partners, individuals with SCI were significantly more satisfied in the domains 'leisure situation', 'partnership relation' and 'family life', and less satisfied in 'self-care ability'.

CONCLUSIONS

This study showed similarities but also differences in mental health and life satisfaction between individuals with SCI and their partners. In clinical practice, attention on mental health and life satisfaction should, therefore, focus on different domains for individuals with SCI and partners.

The association between bladder-emptying methods and health-related quality of life among Iranian individuals with spinal cord injury

OBJECTIVES

In this study, we compared the health-related quality of life (HRQoL) among patients with spinal cord injury (SCI) using different bladder emptying methods including normal spontaneous micturition (NSM), micturition with assisted maneuvers (MAM), aseptic intermittent catheterization by patient (IC-P), aseptic IC by an attendant/caregiver (IC-A) and indwelling catheterization.

DESIGN

Cross-sectional.

SETTING

Tertiary rehabilitation center.

PARTICIPANTS

Patients referred to Brain and Spinal Cord Injury Research Center between 2012 and 2014.

OUTCOME MEASURES

HRQoL was assessed by Short Form Health Survey (SF-36). Hierarchical regression analysis with adjustment for probable confounders (demographic and injury-related variables) was performed to assess the relationship between bladder-emptying method and total SF-36 score.

RESULTS

Patients with injury at cervical sections had significantly lower scores in domain of physical functioning (PF), physical component summary (PCS) and total score (P: 0.001, <0.0001 and 0.027, respectively). Longer time since injury was associated with better scores of PCS, Mental component summary (MCS) and total score (P: 0.002, <0.0001 and 0.003, respectively). Regression analysis showed that the effect of bladder-emptying method on total score of SF-36 was significant (P < 0.0001) and this relationship remained significant after adjustment for probable confounders in the second step of hierarchical regression analysis (R: 0.923, R²: 0.852, Adjusted R²: 0.847, P < 0.0001). Patients with NSM had the highest scores in SF-36 instrument and individuals with indwelling catheterization had the poorest HRQoL in all domains.

CONCLUSION

This study shows that the type of bladder management method affects HRQoL significantly in patients with SCI. Intermittent catheterization are recommended to be administered instead of indwelling catheterization to improve HRQoL.

Health Related Quality of Life in a Dutch Rehabilitation Population: Reference Values and the Effect of Physical Activity

PURPOSE

To establish reference values for Health Related Quality of Life (HRQoL) in a Dutch rehabilitation population, and to study effects of patient characteristics, diagnosis and physical activity on HRQoL in this population.

METHOD

Former rehabilitation patients (3169) were asked to fill in a questionnaire including the Dutch version of the RAND-36. Differences between our rehabilitation patients and Dutch reference values were analyzed (t-tests). Effects of patient characteristics, diagnosis and movement intensity on scores on the subscales of the RAND-36 were analyzed using block wise multiple regression analyses.

RESULTS

In total 1223 patients (39%) returned the questionnaire. HRQoL was significantly poorer in the rehabilitation patients compared to Dutch reference values on all subscales (p<0.001) except for health change (p = 0.197). Longer time between questionnaire and last treatment was associated with a smaller health change (p = 0.035). Higher age negatively affected physical functioning (p<0.001), social functioning (p = 0.004) and health change (p = 0.001). Diagnosis affected outcomes on all subscales except role limitations physical, and mental health (p ranged <0.001 to 0.643). Higher movement intensity was associated with better outcomes on all subscales except for mental health (p ranged <0.001 to 0.190).

CONCLUSIONS

HRQoL is poorer in rehabilitation patients compared to Dutch reference values. Physical components of HRQoL are affected by diagnosis. In rehabilitation patients an association between movement intensity and HRQoL was found. For clinical purposes, results of this study can be used as reference values for HRQoL in a rehabilitation setting.

Quality of life of caregiver spouses of veterans with bilateral lower extremity amputations

Background:

Providing care for patients with chronic disability affects caregivers’ social lives and relationships and can lead to poor health and lower quality of life.

Objectives:

In this study, our goal was to assess the quality of life in spouses of war veterans with bilateral lower limb amputations to find factors affecting caregivers’ quality of life.

Patients and Methods:

In a cross-sectional study, spouses of 244 veterans with war-related bilateral lower limb amputations for at least one year were invited to participate in this study; 189 couples accepted to participate. Information about age, gender, education level, duration of time since amputation, duration of care provided by the spouses and SF-36 questionnaire for both veterans and their spouses were collected.

Results:

The average age of spouses was 47 years and duration of care provided by spouses was 25 years. We found lower scores for general health domains in amputees’ spouses compared to the general population. Factors correlated with both Physical Component Summary (PCS) and Mental Component Summary (MCS) included the duration of care, duration of marriage, spouses’ education level and the veterans’ PCS and MCS scores. Veterans’ age, spouses’ age and the number of children only correlated with PCS. Veterans’ education level only correlated with MCS. In multivariable analysis, only spouses’ education level correlated with MCS and the veterans’ PCS only correlated with that of spouses.

Conclusions:

The quality of life of amputees and their spouses were closely correlated; therefore, any improvement in one is likely to improve the other. In addition, lower education level should be considered as a risk factor for poorer quality of life in amputees’ spouses.