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Cook AK, Papp BM, Kalpakjian CZ, Daunter AK. Visual aid for pediatric virtual musculoskeletal exams: A Barbie girl in a telehealth world. PM R 2024; 16:356-362. [PMID: 38545718 DOI: 10.1002/pmrj.13167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 02/13/2024] [Accepted: 02/19/2024] [Indexed: 04/13/2024]
Abstract
BACKGROUND Telehealth is rapidly advancing, yet musculoskeletal physical examinations pose a unique challenge with limited clinically tested tools. OBJECTIVE To measure whether visual aid use improves accuracy and efficiency of musculoskeletal exam maneuvers within a mock pediatric telehealth encounter. DESIGN Randomized controlled trial. SETTING Mock telehealth encounter. PARTICIPANTS A total of 30 volunteer dyads of children aged 4-17 years old and their parent/guardian. To be eligible to participate, the parent/guardian was required to speak and read English proficiently and have access to Zoom technology on a personal electronic device. INTERVENTION The control group received verbal prompts to complete 12 musculoskeletal exam maneuvers. The intervention group had the addition of a Barbie (Mattel) visual aid. MAIN OUTCOME MEASURES Primary outcomes were accuracy (number of completed maneuvers) and efficiency (total verbal prompts, total time). Secondary outcomes were ratings of comfort using telehealth technology, ease of understanding, and perceived usefulness of the visual aid. Standard multiple regression analysis was employed, with significance defined as a p value <.05. RESULTS The intervention group completed an average of 11.67 ± 0.7 maneuvers versus 11.27 ± 1.0 in the control group (p = .21), 13:31 ± 4.02 total time (mm:ss) versus 14:47 ± 4:04 (p = .05), and 4.87 ± 4.4 verbal prompts versus 8.40 ± 4.6 (p = .04), respectively. The overall model of group allocation controlling for age was not statistically significant for total maneuvers (p = .255), total time (p = .061) or total verbal prompts (p = .095). However, group allocation significantly predicted total verbal prompts (p = .032), with participants in the intervention group requiring an average of 4.1 fewer prompts. All participants in the intervention group rated the visual aid as 'definitely helpful'. CONCLUSION Visual aid use improved virtual musculoskeletal exam maneuver ease and efficiency in a pediatric population.
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Affiliation(s)
- Alyssa K Cook
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Britney M Papp
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
- Department of Physical Medicine & Rehabilitation, Marshfield Clinic Health System, Marshfield, Wisconsin, USA
| | - Claire Z Kalpakjian
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Alecia K Daunter
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
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Ianni PA, Samuels EM, Eakin BL, Champagne E, Kalpakjian CZ, Murphy SL. Evaluation of the long-term outcomes of the University of Michigan's Practice-Oriented Research Training (PORT) program. J Clin Transl Sci 2024; 8:e24. [PMID: 38384910 PMCID: PMC10879990 DOI: 10.1017/cts.2023.713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Revised: 12/21/2023] [Accepted: 12/27/2023] [Indexed: 02/23/2024] Open
Abstract
The University of Michigan created the Practice-Oriented Research Training (PORT) program and implemented it between 2008 and 2018. The PORT program provided research training and funding opportunities for allied healthcare professionals. The program consisted of weekly didactics and group discussion related to topics relevant to developing specific research ideas into projects and funding for a mentored research project for those who submitted a competitive grant application. The goal of this evaluation was to assess the long-term impact of the PORT program on the research careers of the participants. Ninety-two participants (74 staff and 18 faculty) participated in both phases of the program. A mixed-methods approach to evaluation was used; 25 participants who received funding for their research completed surveys, and semi-structured interviews were conducted with eight program participants. In addition, data were collected on participants' publication history. Fifteen out of the 74 staff participants published 31 first-authored papers after participating in PORT. Twelve out of 15 staff participants who published first-authored papers did so for the first time after participating in the PORT program. Results of quantitative and qualitative analyses suggest that the PORT program had positive impacts on both participants and the research community.
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Affiliation(s)
- Phillip A. Ianni
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Elias M. Samuels
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Brenda L. Eakin
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Ellen Champagne
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
| | - Claire Z. Kalpakjian
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Susan L. Murphy
- Michigan Institute for Clinical and Health Research, University of Michigan, Ann Arbor, MI, USA
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Kalpakjian CZ, Hanks R, Quint EH, Millis S, Sander AM, Lequerica AH, Bushnik T, Brunner R, Rapport L. Assessing menopause symptoms in women with traumatic brain injury: the development and initial testing of a new scale. Women Health 2024; 64:51-64. [PMID: 38097958 DOI: 10.1080/03630242.2023.2294969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/09/2023] [Indexed: 12/30/2023]
Abstract
With greater survival rates after catastrophic injury, more women with traumatic brain injury (TBI) are living longer than ever. However, knowledge about this transition in these women is largely unexamined and there are no scales that have been developed to assess the experience of symptoms. To address this gap, we developed and tested a new scale of menopause symptoms in midlife women with TBI. We selected candidate items from two existing measures based on feedback from focus group discussions with seven women with TBI. Twenty candidate items were tested in cognitive interviews with six women with TBI/1 non-TBI. Then, these were field tested with 221 participants (TBI, n = 68; non-TBI, n = 153) recruited from registries. Rasch analysis and convergent validity testing were used to evaluate the new scale. Results of the Rasch analysis indicate that overall, the scale fits well the Rasch model with evidence for unidimensionality. Differential item functioning indicated that the scale performed equally well for women with and without TBI and distinguished pre- and post-menopausal states. Convergent validity was found in the expected directions. These findings support further development of the new scale to understand the experience of menopause symptoms among women with TBI.
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Affiliation(s)
- Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, Michigan, USA
| | - Robin Hanks
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott Millis
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine and the Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, USA
| | - Anthony H Lequerica
- Center for Traumatic Brain Injury Research, Kessler Foundation, West Orange, New Jersey, USA
| | - Tamara Bushnik
- Rusk Rehabilitation, NYU Langone Health, New York, NY, USA
| | - Robert Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Lisa Rapport
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
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Oliverio AL, Lewallen M, Hladunewich MA, Kalpakjian CZ, Weber K, Hawley ST, Nunes JW. Supporting Patient-Centered Pregnancy Counseling in Nephrology Care: A Semistructured Interview Study of Patients and Nephrologists. Kidney Int Rep 2023; 8:2235-2242. [PMID: 38025233 PMCID: PMC10658226 DOI: 10.1016/j.ekir.2023.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 07/06/2023] [Accepted: 08/07/2023] [Indexed: 12/01/2023] Open
Abstract
Introduction Individuals with chronic kidney disease (CKD) are at increased risk of adverse pregnancy outcomes and are susceptible to disempowerment and decisional burden when receiving reproductive counseling and considering pregnancy. Nephrologists do not frequently counsel about reproductive health, and no tools exist to support patient-centered reproductive counseling for those with CKD. Methods A total of 30 patients aged 18 to 45 years with CKD stages 1 to 5 who were assigned female sex at birth and 12 nephrologists from a single academic medical center participated in semistructured qualitative interviews. They were asked about information needs, decision support needs, and facilitators and barriers to reproductive health care and counseling. Thematic analysis was performed. Results The following 4 main themes were identified: (i) assessing reproductive intentions; (ii) information about reproductive health and kidney disease; (iii) reproductive risk; and (iv) communication and decision-making needs. Patients' reproductive intentions varied over time and shaped the content of information needed from nephrologists. Patients and nephrologists both felt that risk communication could be improved but focused on different aspects to improve the quality of this counseling; nephrologists focused on providing individualized risk estimates and patients focused on balancing risks with benefits and management. Patients desired nephrologists to bring up the topic of reproductive health and counseling in kidney clinic, and this is not frequently or systematically done currently. Conclusion This work highlights a critical need for more dialog about reproductive health in kidney care, identified differences in what patients and nephrologists think is important in communication and decision-making, and provides an important step in developing patient-centered reproductive counseling tools in nephrology.
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Affiliation(s)
- Andrea L. Oliverio
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Maryn Lewallen
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michelle A. Hladunewich
- Division of Nephrology, Department of Medicine, Sunnybrook Health Sciences Center, University of Toronto, Toronto, Ontario, Canada
| | - Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Kassandra Weber
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Sarah T. Hawley
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Julie Wright Nunes
- Division of Nephrology, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, Ann Arbor, Michigan, USA
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Streur CS, Kreschmer JM, Ernst SD, Quint EH, Rosen MW, Wittmann D, Kalpakjian CZ. "They had the lunch lady coming up to assist": The experiences of menarche and menstrual management for adolescents with physical disabilities. Disabil Health J 2023; 16:101510. [PMID: 37544804 PMCID: PMC11008706 DOI: 10.1016/j.dhjo.2023.101510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 06/30/2023] [Accepted: 07/13/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Menarche is a pivotal time in an adolescent's life but can be experienced differently by those with physical disabilities. Parents typically serve as the primary educators and support for their daughters during this time. Little is known about the parent's perspective of their daughter's experience preparing for menarche and learning to manage menses. OBJECTIVE We sought to understand the parent's perspective of the experience of their daughter with a physical disability around menarche and their preferences for health care provider support. METHODS Individual semi-structured interviews were conducted with 21 parents of a daughter with a physical disability ages 7-26. Interviews were coded by 2 reviewers using Grounded Theory, with disagreements resolved by consensus. RESULTS Six themes emerged regarding the parent's perception of the experiences, including 1) variation in emotional responses to menarche, 2) parent's perception of their daughter's experience with menses and menstrual symptoms, 3) cross-section of disability and menstrual management, 4) menstrual management at school, 5) parental knowledge correlating to daughter's preparation for menarche, and 6) desires for health care provider support. CONCLUSIONS All parents reported that their daughters faced challenges during menarche, ranging from emotional distress to dealing with the inaccessibility of hygiene products. Managing periods at schools was particularly burdensome. Parents who were better educated about what to expect were better able to prepare their daughters, but had difficulties finding informed, supportive providers. Health care providers should provide both anticipatory guidance and holistic, respectful, and equitable options for the management of menstrual symptoms.
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Affiliation(s)
- Courtney S Streur
- Departments of Urology and Pediatrics, University of Michigan, United States.
| | - Jodi M Kreschmer
- Department of Physical Medicine and Rehabilitation, University of Michigan, United States
| | - Susan D Ernst
- Department of Obstetrics and Gynecology, University of Michigan, United States
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, United States
| | - Monica W Rosen
- Department of Obstetrics and Gynecology, University of Michigan, United States
| | | | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, United States
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Kalpakjian CZ, Haapala HJ, Ernst SD, Orians BR, Barber ML, Mulenga L, Bolde S, Kreschmer JM, Parten R, Carlson S, Rosenblum S, Jay GM. Development and pilot test of a pregnancy decision making tool for women with physical disabilities. Health Serv Res 2023; 58:223-233. [PMID: 36401816 PMCID: PMC9836953 DOI: 10.1111/1475-6773.14103] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Design and pilot test a new decision making tool for women with physical disabilities (impairment of physical function due to chronic conditions) considering pregnancy. DATA SOURCES AND STUDY SETTING Quantitative surveys and qualitative interviews were collected from participants living in the community. STUDY DESIGN Clinical guidelines and survey and focus group data about pregnancy informational and decisional needs guided content development. The tool was pilot tested in a 12-week trial with participants with physical disabilities considering or actively planning a pregnancy. Feasibility outcomes were acceptability, implementation, and demand (collected at end of the trial); preliminary efficacy focused on decisional conflict and readiness (baseline, 6 weeks, and end of trial). DATA COLLECTION Survey data were collected using an online form. One-on-one interviews were conducted to learn more about experience using the tool. PRINCIPAL FINDINGS Thirty eight participants with mild, moderate, or severe physical disabilities participated. Feasibility outcomes indicated that the tool provided participants with information, guiding questions, and helped them to consider multiple aspects of the decision about pregnancy. Most participants responded positively to the new decision making tool, finding it easy to use and the information balanced. Feedback highlighted opportunity for improvement, such as more specific information, peer stories, and the limitations of a paper format. There was significant linear effect of time, with increased decisional certainty and readiness, values clarity, and decisional support (partial η2 [90% CI] = 0.310 [0.08, 0.46], 0.435 [0.19, 0.60], 0.134 [0, 0.29], 0.178 [0.01, 0.35], respectively). Decisional certainty and readiness had high observed power (96.7% and 99.3%, respectively) with lower observed power for clarity and support (60.6% and 75.1%, respectively). CONCLUSIONS The new tool shows promise for supporting women with physical disabilities in navigating pregnancy decision making. Future development of complementary strategies to support health care providers will help improve shared decision making and patient-centered care.
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Affiliation(s)
- Claire Z. Kalpakjian
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Heidi J. Haapala
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan D. Ernst
- Department of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | | | | | - Lukonde Mulenga
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Shannen Bolde
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Jodi M. Kreschmer
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Rebecca Parten
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Susan Carlson
- Department of Obstetrics and GynecologyUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
- Department of Obstetrics and GynecologyDuke University School of MedicineDurhamNorth CarolinaUSA
| | - Sara Rosenblum
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
| | - Gina M. Jay
- Department of Physical Medicine and RehabilitationUniversity of Michigan Medical SchoolAnn ArborMichiganUSA
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Nery-Hurwit MB, Kalpakjian CZ, Kreschmer JM, Quint EH, Ernst S. Development of a Conceptual Framework of Sexual Well-being for Women with Physical Disability. Womens Health Issues 2022; 32:376-387. [PMID: 35337722 DOI: 10.1016/j.whi.2022.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 01/27/2022] [Accepted: 02/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Women with physical disability (WWPD) experience more sexual dysfunction, are typically less sexually active, and engage in fewer intimate relationships than women without physical disability. Although patient-reported outcome measures can help researchers and providers to meet the needs of this population, current measures fail to reflect the relevant experiences of WWPD. The purposes of this study were to 1) understand the experiences of WWPD related to sexual wellness, 2) identify the gaps in the current Patient-Reported Outcomes Measurement Information System Sexual Function and Satisfaction, and 3) develop a conceptual framework for the measurement of sexual well-being on which a new supplemental measure will be built. METHODS WWPD (n = 59) were recruited from an online health registry through a large academic medical center and took part in semistructured focus groups and interviews exploring experiences with sexuality, intimate relationships, sexual function, and sexual and reproductive health care. Interviews were transcribed and coded using an inductive approach to thematic analysis. RESULTS Participants expressed that their sexual well-being extends beyond simply physical function and includes aspects of their environment, society, and intrapersonal and interpersonal factors. From themes that emerged from the qualitative data, we developed a conceptual framework of sexual well-being, which includes sexual health and sexual self-efficacy. The framework is composed of five constructs that impact sexual health and sexual self-efficacy: physical factors, intrapersonal factors, environmental factors, relationships and partner opportunity, and stigma. CONCLUSIONS This conceptual framework can be used to develop patient-reported outcome measures items relevant to the experiences of WWPD, facilitate conversations between providers and patients, and identify areas to target for sexual wellness interventions.
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Affiliation(s)
- Mara B Nery-Hurwit
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan
| | - Jodi M Kreschmer
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
| | - Susan Ernst
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan
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Streur CS, Sandberg DE, Kalpakjian CZ, Wittmann DA, Quint EH. How to Discuss Sexual Health With Girls and Young Women With Spina Bifida: A Practical Guide for the Urologist. Urology 2020; 151:72-78. [PMID: 32711015 DOI: 10.1016/j.urology.2020.06.068] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 05/28/2020] [Accepted: 06/28/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To provide urologists with a practical guide for how to provide sexual health counseling to girls and women with spina bifida. METHODS The recommendations and research of several sources were synthesized to create this guidance, including clinical guidance from the Spina Bifida Association and American College of Obstetricians, the current literature on the sexual health of girls and women with spina bifida, and the multidisciplinary experience of the authors. RESULTS Sexual health education should be viewed by urologists as a continuous discussion, starting in early childhood and gradually building through adolescence. Developing a plan for when and how to bring it up, utilizing parents as educational partners, identifying who will provide the detailed one-on-one counseling if not the primary urologist, establishing a referral network for specialized care (eg, adolescent gynecologist, physical therapist, or sex therapist), becoming familiar with how spina bifida impacts sexual health, and being prepared for challenges are key to providing these girls and women with competent sexual health education. Urologists should also screen for abuse at each visit and be familiar with reporting and resources for when abuse is identified. CONCLUSION This guidance can serve to direct urologists in providing competent sexual health education to girls and women with spina bifida. This will ensure these girls and women receive the basic education they need, and that they can be referred to appropriate sexual health experts as indicated.
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Affiliation(s)
- Courtney S Streur
- Department of Urology, University of Michigan, Ann Arbor, MI; Department of Pediatrics, University of Michigan, Ann Arbor, MI.
| | | | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | | | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI
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Streur CS, Schafer CL, Garcia VP, Quint EH, Wiener JS, Sandberg DE, Kalpakjian CZ, Wittmann DA. "I Tell Them What I Can Feel and How Far My Legs Can Bend": Optimizing Sexual Satisfaction for Women With Spina Bifida. J Sex Med 2020; 17:1694-1704. [PMID: 32665213 DOI: 10.1016/j.jsxm.2020.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/29/2020] [Accepted: 05/22/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is a high reported rate of sexual dysfunction among women with spina bifida, but little is known about the etiology of this or how sexual satisfaction could be improved. AIM To identify, through the words of women with spina bifida, perceived causes of diminished sexual satisfaction and recommendations to optimize partnered sexual encounters. METHODS In this qualitative study, we conducted semi-structured individual interviews with 22 women with spina bifida (median age 26.5 years, range 16-52 years) who have had a romantic partner. Using Grounded Theory, interviews were independently coded by 3 reviewers. Disagreements were resolved by consensus. OUTCOMES We identified overlapping themes of issues women experienced during sexual intimacy and strategies they learned to improve sexual encounters. RESULTS 7 salient themes emerged from the data: (i) fear of rejection with resulting difficulty setting boundaries and the risk of coercion; (ii) conflict between spontaneity and self-care in sexual encounters; (iii) worry about incontinence during sex; (iv) trial and error in learning optimal sexual positions; (v) decreased genital sensation; (vi) safety considerations; and (vii) sharing advice with other women with spina bifida. CLINICAL IMPLICATIONS As sexual satisfaction is influenced by physical features as well as psychological, interpersonal, and sociocultural factors, optimizing sexual satisfaction of women with spina bifida is best managed with a holistic approach utilizing a biopsychosocial model. STRENGTHS & LIMITATIONS The sample included women with a diverse range of functional impairments. Women were forthright with their comments and thematic saturation was reached. Recruitment was primarily from a single Midwestern institution, which may have limited sampled perspectives. CONCLUSION While women with spina bifida encounter challenges during sexual encounters, strategies focused on improving communication with partners and addressing specific physical considerations can potentially enhance their sexual experiences. Streur CS, Schafer CL, Garcia VP, et al. "I Tell Them What I Can Feel and How Far My Legs Can Bend": Optimizing Sexual Satisfaction for Women With Spina Bifida. J Sex Med 2020;17;1694-1704.
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Affiliation(s)
| | | | - Valerie P Garcia
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, MI, USA
| | - John S Wiener
- Department of Surgery, Duke University, Durham, NC, USA
| | - David E Sandberg
- Department of Pediatrics, University of Michigan, Ann Arbor, MI, USA
| | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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Kalpakjian CZ, Kreschmer JM, Slavin MD, Kisala PA, Quint EH, Chiaravalloti ND, Jenkins N, Bushnik T, Amtmann D, Tulsky DS, Madrid R, Parten R, Evitts M, Grawi CL. Reproductive Health in Women with Physical Disability: A Conceptual Framework for the Development of New Patient-Reported Outcome Measures. J Womens Health (Larchmt) 2020; 29:1427-1436. [PMID: 32429740 DOI: 10.1089/jwh.2019.8174] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background: Barriers in the built environment, enduring stereotypes and biases, and limited disability competency of health care providers compromise access to and quality of reproductive health care for women with physical disabilities. One way to improve our understanding of critical factors that drive reproductive health inequity and its impact on access to care is to use patient-reported outcome measures (PROMs) that capture relevant and meaningful information about experience. In this study, we developed a conceptual framework as the foundation for relevant and clinically meaningful patient-reported outcome measures targeting the interface of disability and reproductive health. Materials and Methods: We conducted semistructured focus groups and interviews to assess women's experiences around their reproductive health and contextual factors related to disability. We used deductive and inductive qualitative coding approaches to develop the conceptual framework. Results: Eighty-one women between the ages of 16 and 50 with a self-reported physical disability, defined by an impairment of mobility, participated in 13 focus groups (N = 64) and 17 individual interviews. Five major themes characterized the conceptual framework that emerged-knowledge about reproductive health, communication about reproductive health, relationships, the reproductive health care environment, and self-advocacy/identity-all of which had some relationship with five major reproductive health issues-pregnancy and labor/delivery, periods and menstrual management, contraception, sexuality and sexual functioning, and pelvic examinations. Conclusions: This conceptual framework will serve as a foundation for PROM and guide intervention development to reduce reproductive health inequity and improve reproductive health outcomes of women with physical disabilities.
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Affiliation(s)
- Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Jodi M Kreschmer
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Mary D Slavin
- Boston University School of Public Health, Boston, Massachusetts, USA
| | - Pamela A Kisala
- Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
| | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - Natalie Jenkins
- Langone Health Department of Research/Rusk Rehabilitation, New York University, New York, New York, USA
| | - Tamara Bushnik
- Langone Health Department of Research/Rusk Rehabilitation, New York University, New York, New York, USA
| | - Dagmar Amtmann
- Department of Rehabilitation Medicine, University of Washington, Seattle, Washington, USA
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware, Newark, Delaware, USA
| | - Roxanne Madrid
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Rebecca Parten
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Michael Evitts
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - Carolyn L Grawi
- Ann Arbor Center for Independent Living, Ann Arbor, Michigan, USA
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Streur CS, Schafer CL, Garcia VP, Quint EH, Sandberg DE, Kalpakjian CZ, Wittmann DA. "He told me it would be extremely selfish of me to even consider [having kids]": The importance of reproductive health to women with spina bifida and the lack of support from their providers. Disabil Health J 2019; 13:100815. [PMID: 31239106 DOI: 10.1016/j.dhjo.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/23/2019] [Accepted: 06/04/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND As more women with spina bifida (SB) enter their reproductive years, the number having children is significantly increasing. However, little is known about their understanding of their ability to get pregnant or their experiences in considering, planning, or interacting with providers during a pregnancy. OBJECTIVE We sought to determine what women have been told and understand about their reproductive health, their attitudes towards having children, and their experiences interacting with providers when seeking reproductive health care. METHODS In this exploratory study employing qualitative research methods and following Grounded Theory, interviews with women with SB 16 years or older were transcribed verbatim and analyzed by three coders. RESULTS Interviews of 25 women with SB ages 16-52 (median 26) revealed the following themes about their reproductive health perceptions and experiences: 1) poor understanding of reproductive health and potential, 2) interest in having a family, 3) facing provider's opposition to their reproductive goals, 4) going into pregnancy and delivery unprepared, 5) the importance of provider support for reproductive goals. Five women experienced an unintended pregnancy. CONCLUSIONS Although having children is important to most women with SB in this study, they report a poor understanding of their reproductive potential with several noting unintended pregnancies. They feel uninformed and unprepared during pregnancy and face discouragement from providers. Those experiencing supportive providers report a more positive experience. This demonstrates the urgent need to educate women with SB about their reproductive health and the providers who care for them how to support and counsel these women.
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Affiliation(s)
| | | | | | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, United States
| | - David E Sandberg
- Department of Pediatrics and Communicable Diseases, University of Michigan, United States
| | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, United States
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12
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Cheng R, Smith S, Kalpakjian CZ. Comorbidity has no impact on unplanned discharge or functional gains in persons with dysvascular amputation. J Rehabil Med 2019; 51:369-375. [PMID: 30964543 DOI: 10.2340/16501977-2554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To examine how factors associated with infection, organ failure, poor wound healing, or indices of chronic vascular disease are associated with unplanned transfers and functional gains in a population of dysvascular amputees during inpatient rehabilitation. DESIGN Cross-sectional. SETTING Inpatient rehabilitation unit at an academic medical centre. PATIENTS A total of 118 patients with new, dysvascular, lower-extremity, amputation participating in inpatient rehabilitation. METHODS Logistic regression and indices of change (minimal detectable change; MDC90), standardized response mean and effect size were used to examine the risks of unplanned transfer and functional change. MAIN OUTCOME MEASUREMENTS Rate of unplanned transfers from rehabilitation, and Functional Independence Measure (FIM). RESULTS Out of the total of 118 patients 19 had unplanned transfers due to medical complications. Age, creatinine, haemoglobin, white blood cell count, haemodialysis, wound vacuum device use, intravenous antibiotic use, or previous amputations were not independently associated with unplanned transfers, motor FIM change or efficiency. The MDC90 for motor FIM was 17.84, with 21.2% of patients exceeding this value; standardized response mean and effect size were large (1.03 and 1.39, respectively). CONCLUSION This study suggests that the presence of comorbidities in a population of dysvascular amputees participating in inpatient rehabilitation did not increase the risk of unplanned transfers or affect FIM gains.
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Affiliation(s)
- Raymond Cheng
- Physical Medicine and Rehabiltation, Medical Center Arlington, 76015 Arlington, USA.
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13
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Fox MA, Ayyangar R, Parten R, Haapala HJ, Schilling SG, Kalpakjian CZ. Self-report of pain in young people and adults with spastic cerebral palsy: interrater reliability of the revised Face, Legs, Activity, Cry, and Consolability (r-FLACC) scale ratings. Dev Med Child Neurol 2019; 61:69-74. [PMID: 30051908 DOI: 10.1111/dmcn.13980] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/04/2018] [Indexed: 11/28/2022]
Abstract
AIM People with cerebral palsy (CP) are often unable to express pain owing to cognitive or speech impairments. Reports that rely on observation can be inaccurate, because behaviours such as grimacing, common in people with spastic CP, resemble pain expressions. We examined preliminary validity and reliability of the revised Face, Legs, Activity, Cry, and Consolability (r-FLACC) scale in people with spastic CP. METHOD Forty-eight young people and adults (35 females, 13 males; mean [SD] age 29y 2mo [13y]) were video-recorded during a standard examination, rating their pain (0-10) afterwards. Two raters completed the r-FLACC using the video recordings. Interrater reliability was assessed with an unconditional cross-classified random-effects model and item response theory approach; Pearson correlations measured agreement between raters and participants. RESULTS Mean (SD) participant (n=48) pain scores were 2.48 (2.5) and mean (SD) r-FLACC scores were 1.46 (1.68). There was moderate agreement between raters (intraclass coefficient 0.41 and 0.57 respectively) but low agreement between participants and raters (r=0.26). There were no significant effects for raters (lay observers, nurses, physicians, and inexperienced raters). INTERPRETATION Results provide mixed support for the interrater reliability of the r-FLACC in people with spastic CP. WHAT THIS PAPER ADDS The revised Face, Legs, Activity, Cry, and Consolability (r-FLACC) scale can be reliably used by experts and lay raters for people with spastic cerebral palsy (CP). Support is mixed for interrater reliability of the r-FLACC scale used with people with spastic CP.
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Affiliation(s)
- Margaret A Fox
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.,School of Nursing, University of Michigan, Ann Arbor, MI, USA
| | - Rita Ayyangar
- Department of Physical Medicine and Rehabilitation, and, Pediatric Palliative Care Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Rebecca Parten
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Heidi J Haapala
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | | | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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14
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Hall OT, McGrath RP, Peterson MD, Chadd EH, DeVivo MJ, Heinemann AW, Kalpakjian CZ. The Burden of Traumatic Spinal Cord Injury in the United States: Disability-Adjusted Life Years. Arch Phys Med Rehabil 2019; 100:95-100. [DOI: 10.1016/j.apmr.2018.08.179] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 08/08/2018] [Indexed: 11/30/2022]
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15
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Carlozzi NE, Schilling S, Freedman J, Kalpakjian CZ, Kratz AL. The reliability of end of day and ecological momentary assessments of pain and pain interference in individuals with spinal cord injury. Qual Life Res 2018; 27:3003-3012. [PMID: 30073468 DOI: 10.1007/s11136-018-1952-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2018] [Indexed: 11/27/2022]
Abstract
PURPOSE This study investigated the most efficient means of measuring pain intensity and pain interference comparing ecological momentary assessment (EMA) to end of day (EOD) data, with the highest level of measurement reliability as examined in individuals with spinal cord injury. METHODS EMA (five times throughout the day) and EOD ratings of pain and pain interference were collected over a 7-day period. Multilevel models were used to examine the reliability for both EOD and EMA assessments in order to determine the amount of variability in these assessments over the course of a week or the day, and a multilevel version of the Spearman-Brown Prophecy formula was used to estimate values for reliability. RESULTS Findings indicate the minimum of number of EOD and EMA assessments needed to achieve different levels of reliability ("adequate" > 0.70, "good" > 0.80 and excellent > 0.90). In addition, the time of day (either morning, midday or evening) did not impact the estimated reliability for the EMA assessments. CONCLUSIONS These findings can help researchers and clinician balance the cost/benefit tradeoffs of these different types of assessments by providing specific cutoffs for the numbers of each type of assessment that are needed to achieve excellent reliability.
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
- Department of Physical Medicine & Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Road, NCRC B14, Room G216, Ann Arbor, MI, 48109-2800, USA.
| | - Stephen Schilling
- Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - Jenna Freedman
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Claire Z Kalpakjian
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Anna L Kratz
- Department of Physical Medicine & Rehabilitation, University of Michigan, Ann Arbor, MI, USA
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16
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Reslan S, Kalpakjian CZ, Hanks RA, Millis SR, Bombardier CH. Rasch analysis of alcohol abuse and dependence diagnostic criteria in persons with spinal cord injury. Spinal Cord 2017; 55:497-501. [PMID: 28244502 DOI: 10.1038/sc.2016.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional. OBJECTIVE The objective of the study is to examine whether alcohol use disorders should be conceptualized categorically as abuse and dependence as in the 'Diagnostic and Statistical Manual of Mental Disorders' 4th edition or on a single continuum with mild to severe category ratings as in the 'Diagnostic and Statistical Manual of Mental Disorders' 5th edition in people with spinal cord injury (SCI). SETTING United States of America. METHODS Data from 379 individuals who sustained SCI either traumatically or non-traumatically after the age of 18 and were at least 1 year post injury. Rasch analyses used the alcohol abuse and dependence modules of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders Non-patient Edition (SCID-I/NP). RESULTS Fifty-seven percent (n=166) of the entire sample endorsed criteria for alcohol abuse, and 25% (n=65) endorsed criteria for alcohol dependence. Fit values were generally acceptable except for one item (for example, alcohol abuse criterion 2), suggesting that the items fit the expectation of unidimensionality. Examination of the principal components analysis did not provide support for unidimensionality. The item-person map illustrates poor targeting of items. CONCLUSIONS Alcohol abuse and dependence criterion appear to reflect a unidimensional construct, a finding that supports a single latent construct or factor consistent with the DSM-5 diagnostic model.
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Affiliation(s)
- S Reslan
- Department of Rehabilitation Psychology and Neuropsychology, Rehabilitation Institute of Michigan, Detroit Medical Center, Detroit, MI, USA
| | - C Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan School of Michigan, Ann Arbor, MI, USA
| | - R A Hanks
- Department of Rehabilitation Psychology and Neuropsychology, Rehabilitation Institute of Michigan, Detroit Medical Center, Detroit, MI, USA.,Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - S R Millis
- Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA
| | - C H Bombardier
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
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17
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Kratz AL, Kalpakjian CZ, Hanks RA. Are intensive data collection methods in pain research feasible in those with physical disability? A study in persons with chronic pain and spinal cord injury. Qual Life Res 2017; 26:587-600. [PMID: 28097459 DOI: 10.1007/s11136-016-1494-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/21/2016] [Indexed: 11/25/2022]
Abstract
PURPOSE Intensive repeated measures data collection procedures, such as ecological momentary assessment (EMA) and end-of-day (EOD) diaries, are becoming more prominent in pain research. Existing data on the feasibility of such methods is encouraging; however, almost nothing is known about feasibility in clinical populations with significant physical disabilities. Research methodology feasibility is crucial to the inclusion of individuals with physical disability in pain research given the high prevalence and impact of pain in these populations. The aim of this study was to examine study compliance, protocol acceptability, and reactivity of intensive data collection methods in adults with chronic pain and spinal cord injury (SCI). METHODS Secondary analysis of data from a 7-day EMA and EOD diary study in a sample of 131 community dwelling adults with SCI. RESULTS Results showed rates of missing data ranged from 18.4 to 22.8% across measures. Participant compliance was related to time of day/presence of audible prompts, mobility aid use, race, and baseline levels of pain and pain interference, with more missing data at wake and bedtimes/no prompts, and for those who used hand-held mobility devices, identified as black/African American, and/or reported higher baseline pain and pain interference. Participants rated the study methodology as generally highly acceptable and expressed willingness to participate in similar studies of much longer duration. There was no evidence of reactivity, defined as temporal shifts in pain or pain interference ratings. CONCLUSIONS Overall, intensive pain data collection is feasible in persons with SCI with no evidence that the methodology impacts pain intensity or pain interference ratings.
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Affiliation(s)
- A L Kratz
- Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd, Building NCRC B14, Room G218, 325 E. Eisenhower Parkway, Ann Arbor, MI, 48109-2800, USA.
| | - C Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, North Campus Research Complex, 2800 Plymouth Rd, Building NCRC B14, Room G218, 325 E. Eisenhower Parkway, Ann Arbor, MI, 48109-2800, USA
| | - R A Hanks
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Michigan, Wayne State University, 261 Mack Blvd, Suite 555, Detroit, MI, 48201, USA
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18
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Fyffe D, Kalpakjian CZ, Slavin M, Kisala P, Ni P, Kirshblum SC, Tulsky DS, Jette AM. Clinical interpretation of the Spinal Cord Injury Functional Index (SCI-FI). J Spinal Cord Med 2016; 39:527-34. [PMID: 26781769 PMCID: PMC5020585 DOI: 10.1080/10790268.2015.1133483] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To provide validation of functional ability levels for the Spinal Cord Injury - Functional Index (SCI-FI). DESIGN Cross-sectional. SETTING Inpatient rehabilitation hospital and community settings. PARTICIPANTS A sample of 855 individuals with traumatic spinal cord injury enrolled in 6 rehabilitation centers participating in the National Spinal Cord Injury Model Systems Network. INTERVENTIONS Not Applicable. MAIN OUTCOME MEASURES Spinal Cord Injury-Functional Index (SCI-FI). RESULTS Cluster analyses identified three distinct groups that represent low, mid-range and high SCI-FI functional ability levels. Comparison of clusters on personal and other injury characteristics suggested some significant differences between groups. CONCLUSIONS These results strongly support the use of SCI-FI functional ability levels to document the perceived functional abilities of persons with SCI. Results of the cluster analysis suggest that the SCI-FI functional ability levels capture function by injury characteristics. Clinical implications regarding tracking functional activity trajectories during follow-up visits are discussed.
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Affiliation(s)
- Denise Fyffe
- Kessler Foundation, West Orange, NJ, USA,Department of Physical Medicine & Rehabilitation, Rutgers – New Jersey Medical School, Newark, NJ, USA,Correspondence to: Denise Fyffe, Department of Physical Medicine and Rehabilitation New Jersey Medical School Rutgers, the State University of New Jersey, DOC Suite 3100, 90 Bergen Street, Newark, NJ 07103-2499, USA.
| | | | - Mary Slavin
- Health & Disability Research Institute, Boston University School of Public Health, Boston, MA, USA
| | - Pamela Kisala
- Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Pengsheng Ni
- Boston Rehabilitation Outcomes Center, Boston University School of Public Health, Boston, MA, USA
| | - Steven C. Kirshblum
- Kessler Foundation, West Orange, NJ, USA,Department of Physical Medicine & Rehabilitation, Rutgers – New Jersey Medical School, Newark, NJ, USA,Kessler Institute for Rehabilitation, West Orange, NJ, USA
| | - David S. Tulsky
- Kessler Foundation, West Orange, NJ, USA,Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware, Newark, DE, USA
| | - Alan M. Jette
- Health & Disability Research Institute, Boston University School of Public Health, Boston, MA, USA,Boston Rehabilitation Outcomes Center, Boston University School of Public Health, Boston, MA, USA
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19
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Klyce DW, Bombardier CH, Davis TJ, Hartoonian N, Hoffman JM, Fann JR, Kalpakjian CZ. Distinguishing Grief From Depression During Acute Recovery From Spinal Cord Injury. Arch Phys Med Rehabil 2015; 96:1419-25. [DOI: 10.1016/j.apmr.2015.02.018] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2014] [Revised: 01/29/2015] [Accepted: 02/18/2015] [Indexed: 11/29/2022]
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20
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Kalpakjian CZ, Tulsky DS, Kisala PA, Bombardier CH. Measuring grief and loss after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Grief and Loss item bank and short form. J Spinal Cord Med 2015; 38:347-55. [PMID: 26010969 PMCID: PMC4445025 DOI: 10.1179/2045772315y.0000000015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To develop an item response theory (IRT) calibrated Grief and Loss item bank as part of the Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system. DESIGN A literature review guided framework development of grief/loss. New items were created from focus groups. Items were revised based on expert review and patient feedback and were then field tested. Analyses included confirmatory factor analysis (CFA), graded response IRT modeling and evaluation of differential item functioning (DIF). SETTING We tested a 20-item pool at several rehabilitation centers across the United States, including the University of Michigan, Kessler Foundation, Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Department of Veterans Affairs hospital. PARTICIPANTS A total of 717 individuals with SCI answered the grief and loss questions. RESULTS The final calibrated item bank resulted in 17 retained items. A unidimensional model was observed (CFI=0.976; RMSEA=0.078) and measurement precision was good (theta range between -1.48 to 2.48). Ten items were flagged for DIF, however, after examination of effect sizes found this to be negligible with little practical impact on score estimates. CONCLUSIONS This study indicates that the SCI-QOL Grief and Loss item bank represents a psychometrically robust measurement tool. Short form items are also suggested and computer adaptive tests are available.
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Affiliation(s)
- Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
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21
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Bertisch H, Kalpakjian CZ, Kisala PA, Tulsky DS. Measuring positive affect and well-being after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Positive Affect and Well-being bank and short form. J Spinal Cord Med 2015; 38:356-65. [PMID: 26010970 PMCID: PMC4445026 DOI: 10.1179/2045772315y.0000000024] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
OBJECTIVE To develop an item response theory (IRT)-calibrated spinal cord injury (SCI)-specific Positive Affect and Well-being (PAWB) item bank with flexible options for administration. DESIGN Qualitative feedback from patient and provider focus groups was used to expand on the Neurological Disorders and Quality of Life (Neuro-QOL) positive affect & well-being item bank for use in SCI. New items were created and revised based on expert review and patient feedback and were then field tested. Analyses included confirmatory factor analysis, graded response IRT modeling and evaluation of differential item functioning (DIF). SETTING We tested a 32-item pool at several rehabilitation centers across the United States, including the University of Michigan, Kessler Foundation, Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Department of Veterans Affairs hospital. PARTICIPANTS A total of 717 individuals with SCI answered the PAWB questions. RESULTS A unidimensional model was observed (Confirmatory Fit Index=0.947; Root Mean Square Error of Approximation=0.094) and measurement precision was good (reliability in theta of -2.9 to 1.2 is roughly equivalent to classical reliability of 0.95 or above). Twelve items were flagged for DIF, however, after examination of effect sizes, the DIF was determined to be negligible and would have little practical impact on score estimates. The final calibrated item bank resulted in 28 retained items CONCLUSIONS This study indicates that the Spinal Cord Injury--Quality of Life PAWB bank represents a psychometrically robust measurement tool. Short form items are also suggested and a computer adaptive test is available.
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Affiliation(s)
- Hilary Bertisch
- Rusk Rehabilitation, New York University Langone Medical Center, New York, NY, USA
| | - Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
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22
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Kalpakjian CZ, Tate DG, Kisala PA, Tulsky DS. Measuring self-esteem after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Self-esteem item bank and short form. J Spinal Cord Med 2015; 38:377-85. [PMID: 26010972 PMCID: PMC4445028 DOI: 10.1179/2045772315y.0000000014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To describe the development and psychometric properties of the Spinal Cord Injury-Quality of Life (SCI-QOL) Self-esteem item bank. DESIGN Using a mixed-methods design, we developed and tested a self-esteem item bank through the use of focus groups with individuals with SCI and clinicians with expertise in SCI, cognitive interviews, and item-response theory-(IRT) based analytic approaches, including tests of model fit, differential item functioning (DIF) and precision. SETTING We tested a pool of 30 items at several medical institutions across the United States, including the University of Michigan, Kessler Foundation, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital, and the James J. Peters/Bronx Department of Veterans Affairs hospital. PARTICIPANTS A total of 717 individuals with SCI completed the self-esteem items. RESULTS A unidimensional model was observed (CFI=0.946; RMSEA=0.087) and measurement precision was good (theta range between -2.7 and 0.7). Eleven items were flagged for DIF; however, effect sizes were negligible with little practical impact on score estimates. The final calibrated item bank resulted in 23 retained items. CONCLUSION This study indicates that the SCI-QOL Self-esteem item bank represents a psychometrically robust measurement tool. Short form items are also suggested and computer adaptive tests are available.
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Affiliation(s)
- Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Denise G. Tate
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, University of Michigan, Ann Arbor, MI, USA
| | - Pamela A. Kisala
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
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23
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Victorson D, Tulsky DS, Kisala PA, Kalpakjian CZ, Weiland B, Choi SW. Measuring resilience after spinal cord injury: Development, validation and psychometric characteristics of the SCI-QOL Resilience item bank and short form. J Spinal Cord Med 2015; 38:366-76. [PMID: 26010971 PMCID: PMC4445027 DOI: 10.1179/2045772315y.0000000016] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE To describe the development and psychometric properties of the Spinal Cord Injury--Quality of Life (SCI-QOL) Resilience item bank and short form. DESIGN Using a mixed-methods design, we developed and tested a resilience item bank through the use of focus groups with individuals with SCI and clinicians with expertise in SCI, cognitive interviews, and item-response theory based analytic approaches, including tests of model fit and differential item functioning (DIF). SETTING We tested a 32-item pool at several medical institutions across the United States, including the University of Michigan, Kessler Foundation, the Rehabilitation Institute of Chicago, the University of Washington, Craig Hospital and the James J. Peters/Bronx Department of Veterans Affairs medical center. PARTICIPANTS A total of 717 individuals with SCI completed the Resilience items. RESULTS A unidimensional model was observed (CFI=0.968; RMSEA=0.074) and measurement precision was good (theta range between -3.1 and 0.9). Ten items were flagged for DIF, however, after examination of effect sizes we found this to be negligible with little practical impact on score estimates. The final calibrated item bank resulted in 21 retained items. CONCLUSION This study indicates that the SCI-QOL Resilience item bank represents a psychometrically robust measurement tool. Short form items are also suggested and computer adaptive tests are available.
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Affiliation(s)
- David Victorson
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, USA
| | - Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Brian Weiland
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Tulsky DS, Kisala PA, Victorson D, Tate DG, Heinemann AW, Charlifue S, Kirshblum SC, Fyffe D, Gershon R, Spungen AM, Bombardier CH, Dyson-Hudson TA, Amtmann D, Z. Kalpakjian C, W. Choi S, Jette AM, Forchheimer M, Cella D. Overview of the Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system. J Spinal Cord Med 2015; 38:257-69. [PMID: 26010962 PMCID: PMC4445018 DOI: 10.1179/2045772315y.0000000023] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
CONTEXT/OBJECTIVE The Spinal Cord Injury--Quality of Life (SCI-QOL) measurement system was developed to address the shortage of relevant and psychometrically sound patient reported outcome (PRO) measures available for clinical care and research in spinal cord injury (SCI) rehabilitation. Using a computer adaptive testing (CAT) approach, the SCI-QOL builds on the Patient Reported Outcomes Measurement Information System (PROMIS) and the Quality of Life in Neurological Disorders (Neuro-QOL) initiative. This initial manuscript introduces the background and development of the SCI-QOL measurement system. Greater detail is presented in the additional manuscripts of this special issue. DESIGN Classical and contemporary test development methodologies were employed. Qualitative input was obtained from individuals with SCI and clinicians through interviews, focus groups, and cognitive debriefing. Item pools were field tested in a multi-site sample (n=877) and calibrated using item response theory methods. Initial reliability and validity testing was performed in a new sample of individuals with traumatic SCI (n=245). SETTING Five Model SCI System centers and one Department of Veterans Affairs Medical Center across the United States. PARTICIPANTS Adults with traumatic SCI. INTERVENTIONS n/a OUTCOME MEASURES n/a RESULTS The SCI-QOL consists of 19 item banks, including the SCI-Functional Index banks, and 3 fixed-length scales measuring physical, emotional, and social aspects of health-related QOL (HRQOL). CONCLUSION The SCI-QOL measurement system consists of psychometrically sound measures for individuals with SCI. The manuscripts in this special issue provide evidence of the reliability and initial validity of this measurement system. The SCI-QOL also links to other measures designed for a general medical population.
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Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David Victorson
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Denise G. Tate
- University of Michigan Medical School, Ann Arbor, MI, USA
| | | | | | | | | | - Richard Gershon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | | | | | - Alan M. Jette
- Boston University School of Public Health, Boston, MA, USA
| | | | - David Cella
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Kisala PA, Tulsky DS, Kalpakjian CZ, Heinemann AW, Pohlig RT, Carle A, Choi SW. Measuring anxiety after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Anxiety item bank and linkage with GAD-7. J Spinal Cord Med 2015; 38:315-25. [PMID: 26010966 PMCID: PMC4445022 DOI: 10.1179/2045772315y.0000000029] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To develop a calibrated item bank and computer adaptive test to assess anxiety symptoms in individuals with spinal cord injury (SCI), transform scores to the Patient Reported Outcomes Measurement Information System (PROMIS) metric, and create a statistical linkage with the Generalized Anxiety Disorder (GAD)-7, a widely used anxiety measure. DESIGN Grounded-theory based qualitative item development methods; large-scale item calibration field testing; confirmatory factor analysis; graded response model item response theory analyses; statistical linking techniques to transform scores to a PROMIS metric; and linkage with the GAD-7. Setting Five SCI Model System centers and one Department of Veterans Affairs medical center in the United States. Participants Adults with traumatic SCI. MAIN OUTCOME MEASURES Spinal Cord Injury-Quality of Life (SCI-QOL) Anxiety Item Bank RESULTS Seven hundred sixteen individuals with traumatic SCI completed 38 items assessing anxiety, 17 of which were PROMIS items. After 13 items (including 2 PROMIS items) were removed, factor analyses confirmed unidimensionality. Item response theory analyses were used to estimate slopes and thresholds for the final 25 items (15 from PROMIS). The observed Pearson correlation between the SCI-QOL Anxiety and GAD-7 scores was 0.67. CONCLUSIONS The SCI-QOL Anxiety item bank demonstrates excellent psychometric properties and is available as a computer adaptive test or short form for research and clinical applications. SCI-QOL Anxiety scores have been transformed to the PROMIS metric and we provide a method to link SCI-QOL Anxiety scores with those of the GAD-7.
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Affiliation(s)
- Pamela A. Kisala
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - David S. Tulsky
- Correspondence to: David Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Allen W. Heinemann
- Rehabilitation Institute of Chicago, and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ryan T. Pohlig
- Department of Physical Therapy, University of Delaware, College of Health Sciences, Newark, DE, USA
| | - Adam Carle
- Cincinnati Children's Hospital, Cincinnati, OH, USA
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Tulsky DS, Kisala PA, Kalpakjian CZ, Bombardier CH, Pohlig RT, Heinemann AW, Carle A, Choi SW. Measuring depression after spinal cord injury: Development and psychometric characteristics of the SCI-QOL Depression item bank and linkage with PHQ-9. J Spinal Cord Med 2015; 38:335-46. [PMID: 26010968 PMCID: PMC4445024 DOI: 10.1179/2045772315y.0000000020] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To develop a calibrated spinal cord injury-quality of life (SCI-QOL) item bank, computer adaptive test (CAT), and short form to assess depressive symptoms experienced by individuals with SCI, transform scores to the Patient Reported Outcomes Measurement Information System (PROMIS) metric, and create a crosswalk to the Patient Health Questionnaire (PHQ)-9. DESIGN We used grounded-theory based qualitative item development methods, large-scale item calibration field testing, confirmatory factor analysis, item response theory (IRT) analyses, and statistical linking techniques to transform scores to a PROMIS metric and to provide a crosswalk with the PHQ-9. SETTING Five SCI Model System centers and one Department of Veterans Affairs medical center in the United States. PARTICIPANTS Adults with traumatic SCI. MAIN OUTCOME MEASURES Spinal Cord Injury--Quality of Life (SCI-QOL) Depression Item Bank RESULTS Individuals with SCI were involved in all phases of SCI-QOL development. A sample of 716 individuals with traumatic SCI completed 35 items assessing depression, 18 of which were PROMIS items. After removing 7 non-PROMIS items, factor analyses confirmed a unidimensional pool of items. We used a graded response IRT model to estimate slopes and thresholds for the 28 retained items. The SCI-QOL Depression measure correlated 0.76 with the PHQ-9. CONCLUSIONS The SCI-QOL Depression item bank provides a reliable and sensitive measure of depressive symptoms with scores reported in terms of general population norms. We provide a crosswalk to the PHQ-9 to facilitate comparisons between measures. The item bank may be administered as a CAT or as a short form and is suitable for research and clinical applications.
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Affiliation(s)
- David S. Tulsky
- Correspondence to: David S. Tulsky, Professor and Director of the Center on Assessment Research and Translation, STAR Campus, University of Delaware, 540 S. College Ave, Newark, DE 19713, USA.
| | - Pamela A. Kisala
- Department of Physical Therapy, University of Delaware College of Health Sciences, Newark, DE, USA
| | - Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Medical School, Ann Arbor, MI, USA
| | - Charles H. Bombardier
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
| | - Ryan T. Pohlig
- Department of Physical Therapy, University of Delaware College of Health Sciences, Newark, DE, USA
| | - Allen W. Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University and Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Adam Carle
- Cincinnati Children's Hospital, Cincinnati, OH, USA
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McCullumsmith CB, Kalpakjian CZ, Richards JS, Forchheimer M, Heinemann AW, Richardson EJ, Wilson CS, Barber J, Temkin N, Bombardier CH, Fann JR. Novel risk factors associated with current suicidal ideation and lifetime suicide attempts in individuals with spinal cord injury. Arch Phys Med Rehabil 2015; 96:799-808. [PMID: 25613597 DOI: 10.1016/j.apmr.2014.12.017] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2014] [Revised: 11/12/2014] [Accepted: 12/16/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To determine unique associations of suicidal ideation (SI) and lifetime suicide attempts (SAs) in individuals with spinal cord injury (SCI). DESIGN Cross-sectional analysis. SETTING Outpatient. PARTICIPANTS Individuals with SCI (N=2533) who were 18 years or older with a history of traumatic SCI. INTERVENTIONS None. MAIN OUTCOME MEASURES Any SI in the past 2 weeks (9-item Patient Health Questionnaire) and any lifetime SA. RESULTS Three hundred twenty-three individuals (13.3%) reported SI in the past 2 weeks and 179 (7.4%) reported lifetime SA. After controlling for other factors, both lifetime SA and current SI were associated with study site and current level of depression. In addition, SA was associated with less education, younger age at injury, having current or past treatment of depression, and having bipolar disorder or schizophrenia. SI was associated with more years since injury and lifetime SA. Several psychological factors were associated with current SI and lifetime SAs, including lower environmental reward and less positive affect. In addition, control of one's community activities and spiritual well-being were associated with current SI. In bivariate comparisons, severity of SCI was also associated with the 47% of the SAs that occurred after injury. CONCLUSIONS Several unique associations of SI and lifetime SA in individuals with SCI were identified, including level of environmental reward and control, spiritual well-being, and severity of SCI. These factors bear further investigation as prospective risk factors for suicidal behavior after SCI.
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Affiliation(s)
- Cheryl B McCullumsmith
- Department of Psychiatry and Behavioral Neurobiology, University of Cincinnati, Cincinnati, OH; Spain Rehabilitation Center, University of Alabama at Birmingham, Birmingham, AL.
| | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - J Scott Richards
- Spain Rehabilitation Center, University of Alabama at Birmingham, Birmingham, AL
| | - Martin Forchheimer
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Rehabilitation Institute of Chicago, Chicago, IL
| | | | - Catherine S Wilson
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL; Department of Physical Medicine and Rehabilitation, James A. Haley Veterans' Hospital, Tampa, FL
| | - Jason Barber
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Nancy Temkin
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA
| | - Charles H Bombardier
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
| | - Jesse R Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA; Department of Rehabilitation Medicine, University of Washington, Seattle, WA
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Abstract
CONTEXT/OBJECTIVE Examine the relationship of post-traumatic psychological growth (PTG), depression, and personal and injury characteristics in persons with spinal cord injury (SCI). DESIGN Cross-sectional survey. SETTING Community. PARTICIPANTS Eight hundred and twenty-four adults with SCI. INTERVENTIONS None. OUTCOME MEASURES Five items from the Post-traumatic Growth Inventory, reflecting positive change after injury in life priorities, closeness to others, new opportunities being available, stronger faith, and personal strength. RESULTS Initial structural equation model testing of a conceptual model of personal and injury characteristics, violent etiology, depression, and PTG resulted in a poor fit. Model modifications resulted in an improved fit, but explained only 5% of the variance in PTG. Being female, younger, having less formal education, and less time since injury had significant relationships with PTG, whereas depression, violent etiology, and injury level/severity did not. In each PTG domain, between 54 and 79% of the sample reported at least some positive change after injury. CONCLUSIONS The results of this study, while promising, explained only a small portion of the variance in PTG. A majority of the sample experienced some positive change after injury, with the greatest change in discovering that they were stronger than they thought they were. Comparing means previously reported in a non-SCI sample of those who experienced trauma, positive change after injury was comparable for each PTG item except for new opportunities being available, which was significantly lower for those with SCI. Future directions of research include the development of theoretical models of PTG after SCI.
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Affiliation(s)
- Claire Z. Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA,Correspondence to: Claire Z. Kalpakjian, Department of Physical Medicine and Rehabilitation, University of Michigan, 325 E. Eisenhower Parkway, Suite 300, Ann Arbor, MI 48108, USA.
| | | | - Jesse R. Fann
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - John S. Richards
- Spain Rehabilitation Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Allen W. Heinemann
- Feinberg School of Medicine, Northwestern University, Rehabilitation Institute of Chicago, Chicago, IL, USA
| | - Charles H. Bombardier
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA, USA
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Cuff L, Fann JR, Bombardier CH, Graves DE, Kalpakjian CZ. Depression, pain intensity, and interference in acute spinal cord injury. Top Spinal Cord Inj Rehabil 2014; 20:32-9. [PMID: 24574820 DOI: 10.1310/sci2001-32] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND The high prevalence of pain and depression in persons with spinal cord injury (SCI) is well known. However the link between pain intensity, interference, and depression, particularly in the acute period of injury, has not received sufficient attention in the literature. OBJECTIVE To investigate the relationship of depression, pain intensity, and pain interference in individuals undergoing acute inpatient rehabilitation for traumatic SCI. METHODS Participants completed a survey that included measures of depression (PHQ-9), pain intensity ("right now"), and pain interference (Brief Pain Inventory: general activity, mood, mobility, relations with others, sleep, and enjoyment of life). Demographic and injury characteristics and information about current use of antidepressants and pre-injury binge drinking also were collected. Hierarchical multiple regression was used to test depression models in 3 steps: (1) age, gender, days since injury, injury level, antidepressant use, and pre-injury binge drinking (controlling variables); (2) pain intensity; and (3) pain interference (each tested separately). RESULTS With one exception, pain interference was the only statistically significant independent variable in each of the final models. Although pain intensity accounted for only 0.2% to 1.2% of the depression variance, pain interference accounted for 13% to 26% of the variance in depression. CONCLUSION Our results suggest that pain intensity alone is insufficient for understanding the relationship of pain and depression in acute SCI. Instead, the ways in which pain interferes with daily life appear to have a much greater bearing on depression than pain intensity alone in the acute setting.
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Affiliation(s)
| | - Jesse R Fann
- Department of Rehabilitation Medicine, Psychiatry and Behavioral Sciences and Epidemiology, University of Washington , Seattle
| | | | - Daniel E Graves
- Department of Neurosurgery, University of Louisville, Frasier Rehabilitation Institute , Louisville, Kentucky
| | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan , Ann Arbor
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Hartoonian N, Hoffman JM, Kalpakjian CZ, Taylor HB, Krause JK, Bombardier CH. Evaluating a spinal cord injury-specific model of depression and quality of life. Arch Phys Med Rehabil 2013; 95:455-65. [PMID: 24269994 DOI: 10.1016/j.apmr.2013.10.029] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/29/2013] [Accepted: 10/31/2013] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To determine whether demographic, injury, health, and functional factors similarly have the same predictive relation with both somatic and nonsomatic symptoms of depression, as well as whether somatic and nonsomatic symptoms of depression have the same association with quality of life (QOL). DESIGN Secondary analysis of cross-sectional survey data. SETTING Community PARTICIPANTS Patients with traumatic spinal cord injury (N=4976) who completed an interview at 1 year postinjury between 2006 and 2011. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Somatic and nonsomatic symptoms of depression from the Patient Health Questionnaire-9 and QOL measured by the Satisfaction With Life Scale. RESULTS Structural equation modeling showed that the hypothesized model provided a good fit to the data, but modification of the model led to a significant improvement in model fit: Δχ(2)(1)=226.21, P<.001; comparative fit index=.976; χ(2)(199)=585.39, P<.001; root mean square error of approximation=.027 (90% confidence interval, .025-.030). The health-related factors including pain severity, pain interference, and health status were similarly associated with both somatic and nonsomatic symptoms of depression. QOL was negatively associated with nonsomatic symptoms of depression but was unrelated to somatic symptoms of depression. CONCLUSIONS Assessment of depression after spinal cord injury should include a careful assessment of health concerns given the relation between health-related factors and both somatic and nonsomatic symptoms of depression. Treatments of depressive symptoms may be improved by targeting health concerns, such as pain, along with a specific focus on nonsomatic symptoms to improve the QOL.
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Affiliation(s)
- Narineh Hartoonian
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA.
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
| | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Heather B Taylor
- TIRR Memorial Hermann and University of Texas Health Science Center, Houston, TX
| | - James K Krause
- College of Health Professions, Medical University of South Carolina, Charleston, SC
| | - Charles H Bombardier
- Department of Rehabilitation Medicine, University of Washington School of Medicine, Seattle, WA
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Bombardier CH, Kalpakjian CZ, Graves DE, Dyer JR, Tate DG, Fann JR. Validity of the Patient Health Questionnaire-9 in Assessing Major Depressive Disorder During Inpatient Spinal Cord Injury Rehabilitation. Arch Phys Med Rehabil 2012; 93:1838-45. [DOI: 10.1016/j.apmr.2012.04.019] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2011] [Revised: 04/19/2012] [Accepted: 04/19/2012] [Indexed: 10/28/2022]
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Hoffman JM, Bombardier CH, Graves DE, Kalpakjian CZ, Krause JS. A longitudinal study of depression from 1 to 5 years after spinal cord injury. Arch Phys Med Rehabil 2011; 92:411-8. [PMID: 21353823 DOI: 10.1016/j.apmr.2010.10.036] [Citation(s) in RCA: 121] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2010] [Revised: 10/27/2010] [Accepted: 10/28/2010] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe rates of probable major depression and the development and improvement of depression and to test predictors of depression in a cohort of participants with spinal cord injury (SCI) assessed at 1 and 5 years after injury. DESIGN Longitudinal cohort study. SETTING SCI Model System. PARTICIPANTS Participants (N=1035) who completed 1- and 5-year postinjury follow-up interviews from 2000 to 2009. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE Probable major depression, defined as Physician Health Questionnaire-9 score of 10 or higher. RESULTS Probable major depression was found in 21% of participants at year 1 and 18% at year 5. Similar numbers of participants had improvement (25%) or worsening (20%) of symptoms over time, with 8.7% depressed at both 1 and 5 years. Increased pain (odds ratio [OR], 1.10), worsening health status (OR, 1.39), and decreasing unsafe use of alcohol (vs no unsafe use of alcohol; OR, 2.95) are risk factors for the development of depression at 5 years. No predictors of improvement in depression were found. CONCLUSION In this sample, probable major depression was found in 18% to 21% of participants 1 to 5 years after injury. To address this high prevalence, clinicians should use these risk factors and ongoing systematic screening to identify those at risk for depression. Worsening health problems and lack of effective depression treatment in participants with SCI may contribute to high rates of chronic or recurrent depression in this population.
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Affiliation(s)
- Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA.
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Kalpakjian CZ, Houlihan B, Meade MA, Karana-Zebari D, Heinemann AW, Dijkers MP, Wierbicky J, Charlifue S. Marital status, marital transitions, well-being, and spinal cord injury: an examination of the effects of sex and time. Arch Phys Med Rehabil 2011; 92:433-40. [PMID: 21276959 DOI: 10.1016/j.apmr.2010.07.239] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2010] [Revised: 05/18/2010] [Accepted: 07/06/2010] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine the applicability of marital resource (marriage has substantial benefits for well-being over not being married) or marital crisis (marital dissolution leads to poorer well-being) models to the spinal cord injury (SCI) population by studying the effects of sex, marital status, and marital transitions on well-being. DESIGN Prospective cohort study from the SCI Model Systems National Database. SETTING Community. PARTICIPANTS Men (n=4864) and women (n=1277) who sustained traumatic SCI and completed a minimum of 1 follow-up interview beginning at 1 year through 15 years postinjury. INTERVENTIONS None. MAIN OUTCOMES MEASURES Life satisfaction, depressive symptoms, and self-perceived health status by using linear mixed models for longitudinal data. RESULTS In general, well-being improved over time since injury. Hypothesis testing supported the marital crisis model, as marital loss through being or becoming separated or divorced and being or becoming widowed, had the most consistent and negative impact across well-being outcomes, whereas being or becoming married had an advantage for only lower depression symptoms over time. However, marital dissolution or loss did not have a uniformly adverse impact on well-being outcomes, and this effect often was moderated by sex, such that widows had higher depressive symptoms and poorer self-perceived health than widowers, but separated or divorced women had higher life satisfaction and self-perceived health than men. Irrespective of sex, being separated or divorced versus being single was associated with higher depressive symptoms over time. CONCLUSIONS Results support the marital crisis model and that women and men can experience marital dissolution differently. All marital loss does not result in compromised well-being and all marriage does not enhance well-being, highlighting complex dynamics worthy of further investigation in this population.
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Affiliation(s)
- Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA.
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Murphy SL, Kalpakjian CZ, Mullan PB, Clauw DJ. Development and evaluation of the University of Michigan's Practice-Oriented Research Training (PORT) Program. Am J Occup Ther 2010; 64:796-803. [PMID: 21073110 DOI: 10.5014/ajot.2010.08161] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We describe the development and evaluation of a clinical research training program designed specifically for such health professionals as occupational and physical therapists. Outcomes of program success included trainees' self-rating of research skills before and after the program, as well as submission of a formal grant application to a grant competition for program participants. At program completion, participants reported improvements in their research skills, with the most gain in formulating research questions and writing a testable hypothesis and the least gain in understanding statistics. Of the 21 participants, 43% submitted a grant proposal to a competitive intramural grant program. In the next year, grantees of the program will continue to be mentored by the program mentors while conducting their research projects. Given the initial successes, this program represents a promising model for providing research training to practicing clinicians.
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Affiliation(s)
- Susan L Murphy
- Department of Physical Medicine and Rehabilitation, University of Michigan, USA.
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Abstract
STUDY DESIGN Prospective cohort design of married persons with new spinal cord injury (SCI). OBJECTIVES To examine the relationship of demographic and injury characteristics, self-rated health, physical functioning, and life satisfaction to the duration of marriage 1 to 15 years after SCI among individuals who were married at the time of injury. SETTING United States. METHODS Survival analysis was chosen to determine the predictors related to marital longevity, which is defined as non-occurrence of divorce after injury. In all, 2327 subjects were included in the analyses. Predictors were demographics and injury characteristics, level of handicap, self-perceived health, and functional independence. RESULTS Age at injury, being Caucasian vs African American, having a college education vs high school, having 'other' employment status vs being unemployed, having higher social integration and improved or stable self-rated health vs poor health were all significant factors that delayed the time of divorce after injury. Contrary to expectations, level of injury, function, mobility and independence were not significant predictors of marriage longevity. CONCLUSION Social integration and health perception, the most powerful indicators of marriage longevity, can be addressed and facilitated by health care providers and rehabilitation programs.
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Affiliation(s)
- D Karana-Zebari
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48108, USA.
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Kalpakjian CZ, Quint EH, Bushnik T, Rodriguez GM, Terrill MS. Menopause characteristics and subjective symptoms in women with and without spinal cord injury. Arch Phys Med Rehabil 2010; 91:562-9. [PMID: 20382288 DOI: 10.1016/j.apmr.2009.12.012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2009] [Revised: 11/25/2009] [Accepted: 12/02/2009] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To examine menopause transition characteristics and symptom bother in women with spinal cord injury (SCI). DESIGN Prospective cohort (4 data collection periods across 4 years). SETTING Community. PARTICIPANTS Women (n=62) with SCI (injury levels C6-T12, nonambulatory, >36mo postinjury; 86.1% retention) and women without SCI (n=66; 92.9% retention) with intact ovaries, not using hormone therapy, and between the ages of 45 and 60 years volunteered. A total of 505 observations were collected and analyzed. INTERVENTIONS None. MAIN OUTCOME MEASURES Age at final menstrual period (FMP), transitions through menopause status classifications, and menopause symptom bother (vasomotor, somatic, psychologic symptoms). RESULTS The number of women transitioning through a menopause status classification over the course of the study did not significantly vary by group (P=.263), nor did age at FMP (P=.643). Women with SCI experienced greater bother of somatic symptoms (a subscale, P<.001), bladder infections (P<.001), and diminished sexual arousal (P=.012). Women without SCI had significantly greater bother of vasomotor symptoms (P=.020). There were no significant group by menopause status interactions; main effects for menopause status were significant only for vasomotor symptoms and vaginal dryness. CONCLUSIONS Results suggested that women with SCI experience greater symptom bother in certain areas, but that patterns of symptom bother across menopause, transition through menopause, and age at FMP are similar to those of their peers. Larger studies are needed to examine menopause outcomes with respect to level of injury and completeness of injury. These findings provide a framework that women with SCI and their health care providers can use to address the menopause transition and highlight the importance of multidisciplinary involvement to maximize health and well being during this transition.
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Affiliation(s)
- Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI 48108-5744, USA.
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Kwon C, Kalpakjian CZ, Roller S. Factor structure of the PANAS and the relationship between positive and negative affect in polio survivors. Disabil Rehabil 2010; 32:1300-10. [DOI: 10.3109/09638280903464489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Burke LM, Kalpakjian CZ, Smith YR, Quint EH. Gynecologic issues of adolescents with Down syndrome, autism, and cerebral palsy. J Pediatr Adolesc Gynecol 2010; 23:11-5. [PMID: 19643648 DOI: 10.1016/j.jpag.2009.04.005] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2008] [Revised: 04/08/2009] [Accepted: 04/15/2009] [Indexed: 10/20/2022]
Abstract
STUDY OBJECTIVE The gynecologic issues of adolescents with disabilities are understudied. The purpose of this study was to identify and compare the presenting complaints, treatments, and follow-up of adolescent girls with Down syndrome (DS), autism, and cerebral palsy (CP) presenting to a specialized gynecologic clinic for women with developmental disabilities. SETTING Outpatient gynecology clinic. PARTICIPANTS Forty four adolescents (<21 y); 13 with DS, 14 with autism, and 17 with CP who presented to the clinic from 1999 to 2006. INTERVENTIONS None. MAIN OUTCOME MEASURES A retrospective review of the electronic medical records to collect data on age at presentation to clinic, ethnicity, menstrual history, chief complaint, treatment, and follow-up. RESULTS Mean age at presentation to clinic was 15+/-3.5 years, and age of menarche was 12.5+/-2 years; age at menarche did not significantly differ between groups. The most frequent complaints were irregular bleeding (n=10) and mood/behavioral changes (n=6). Girls with autism were significantly (chi(2)=8.89, P=.012) more likely to present with behavioral issues than the other 2 groups. Initial management for the behavior issues in the autism group included nonsteroidal anti-inflammatory drugs (NSAID), oral contraceptives, and education. CONCLUSION The most common gynecologic complaints of adolescent girls with DS, autism, and CP centered on menstruation and mood disorders. Patients with autism were more likely to present with behavioral issues related to the onset of periods.
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Affiliation(s)
- Lori M Burke
- University of Michigan, Department of Obstetrics and Gynecology, Ann Arbor, Michigan, USA
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Webb JR, Toussaint L, Kalpakjian CZ, Tate DG. Forgiveness and health-related outcomes among people with spinal cord injury. Disabil Rehabil 2010; 32:360-6. [DOI: 10.3109/09638280903166360] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
OBJECTIVE Examine the diurnal variation of salivary cortisol in adults with spinal cord injury (SCI) and the effect of stressors on cortisol and mood. METHOD Ecological momentary assessment (EMA) to capture cortisol, stress, and mood from 25 persons with SCI and 26 without SCI. Data were analyzed using linear mixed models. RESULTS There were no systematic differences between groups on missing data. Diurnal variation of cortisol of participants with SCI reflected an expected pattern. No significant group differences for cortisol diurnal pattern, stress, or mood; when group interactions were significant, results indicated lower cortisol reactivity to stress in participants with SCI. Stress had a significant impact on positive, negative and agitated moods. CONCLUSIONS Stress in daily life and its association with cortisol and mood were largely similar between persons with and without SCI. A key methodological contribution is the demonstration of using EMA to collect biological and behavioral data in the field from participants with SCI. The use of EMA in rehabilitation psychology research has great potential to advance our understanding of the dynamics of daily life with disability.
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Alexander MS, Anderson KD, Biering-Sorensen F, Blight AR, Brannon R, Bryce TN, Creasey G, Catz A, Curt A, Donovan W, Ditunno J, Ellaway P, Finnerup NB, Graves DE, Haynes BA, Heinemann AW, Jackson AB, Johnston MV, Kalpakjian CZ, Kleitman N, Krassioukov A, Krogh K, Lammertse D, Magasi S, Mulcahey MJ, Schurch B, Sherwood A, Steeves JD, Stiens S, Tulsky DS, van Hedel HJA, Whiteneck G. Outcome measures in spinal cord injury: recent assessments and recommendations for future directions. Spinal Cord 2009; 47:582-91. [PMID: 19381157 PMCID: PMC2722687 DOI: 10.1038/sc.2009.18] [Citation(s) in RCA: 143] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Review by the spinal cord outcomes partnership endeavor (SCOPE), which is a broad-based international consortium of scientists and clinical researchers representing academic institutions, industry, government agencies, not-for-profit organizations and foundations. OBJECTIVES Assessment of current and evolving tools for evaluating human spinal cord injury (SCI) outcomes for both clinical diagnosis and clinical research studies. METHODS a framework for the appraisal of evidence of metric properties was used to examine outcome tools or tests for accuracy, sensitivity, reliability and validity for human SCI. RESULTS Imaging, neurological, functional, autonomic, sexual health, bladder/bowel, pain and psychosocial tools were evaluated. Several specific tools for human SCI studies have or are being developed to allow the more accurate determination for a clinically meaningful benefit (improvement in functional outcome or quality of life) being achieved as a result of a therapeutic intervention. CONCLUSION Significant progress has been made, but further validation studies are required to identify the most appropriate tools for specific targets in a human SCI study or clinical trial.
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Abstract
PURPOSE This present study describes the development, factor structure and initial validation of the Index of Post-Polio Sequelae (IPPS). METHOD The IPPS was tested on a sample of 849 community-dwelling polio survivors between the ages of 40 and 93 years old who participated in a large, national study of menopause and aging in late polio. Items from the IPPS were submitted to a factor analysis using principal components extraction and rotated to oblique simple structure using promax rotation. Convergent validity was assessed using bivariate correlation. RESULTS Three factors were extracted that accounted for approximately 53% of the variance in the original IPPS items. Factor 1 (Pain) was loaded most heavily by two items referring to muscle and joint pain. Factor 2 (Atrophy) was loaded by items referring to muscle atrophy, involved muscle weakness, and fatigue. Factor 3 (Bulbar) was comprised of two items referring to breathing and swallowing problems. Bivariate correlations between health and psychosocial variables and each of the factors all were significant and in expected directions. CONCLUSIONS This first validation of a standardized scale to assess the severity of post-polio sequelae in polio survivors suggests a psychometrically sound instrument whose factor structure represents commonly reported problems in the extant post-polio literature.
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Affiliation(s)
- Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor 48109, USA.
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Abstract
OBJECTIVES Sleep disturbance in polio survivors is a common complaint, yet little is known about the effects of the interaction of physical disability and menopause on sleep. The purpose of this study was to understand the relative contribution of menopause factors and disability to subjective sleep disturbance. METHODS Participants were 465 women aged 50-65 years who had physical disabilities due to poliomyelitis. Hierarchical regression modeling was used to examine menopause (symptoms, status, hormone replacement use, ovarectomy status) and disability factors (post-polio symptoms) in sleep disturbance. RESULTS In the final model, 19% (frequency) and 17% (severity) of sleep disturbance variance was explained. Psychological symptoms exerted the most influence (for both outcomes) followed by post-polio symptoms, vasomotor symptoms, an interaction of vasomotor and post-polio symptoms and estrogen use. For women with fewer post-polio symptoms, vasomotor symptoms exerted greater influence on sleep disturbance than for women with greater post-polio symptoms. CONCLUSIONS Psychological symptoms had the strongest association with sleep disturbance in these women. Controlling for the influence of various menopause factors, our findings show that vasomotor symptoms were only one of several influences on sleep disturbance.
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Affiliation(s)
- C Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor 48109-0491, USA
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Kalpakjian CZ, Bombardier CH, Schomer K, Brown PA, Johnson KL. Measuring depression in persons with spinal cord injury: a systematic review. J Spinal Cord Med 2009; 32:6-24. [PMID: 19264045 PMCID: PMC2647502 DOI: 10.1080/10790268.2009.11760748] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2008] [Accepted: 06/30/2008] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Depression has been studied extensively among people with spinal cord injury (SCI). However, basic questions persist regarding the reliability and validity of depression measurement in the context of SCI. The objective of this study was to evaluate the state of knowledge of depression measurement in persons with SCI. METHODS English-language peer-reviewed citations from MEDLINE, CINAHL, PsycINFO, ProQuest, Google Scholar, and Web of Science from 1980 to present. Two reviewers screened 377 abstracts on SCI and depression topics to identify 144 containing classifiable psychometric data. All 144 were reviewed by 6 reviewers. Twenty-four studies reporting psychometric data on 7 depression measures in SCI samples were identified, including 7 validity studies. RESULTS Reliability data were limited to internal consistency and were consistently good to excellent across 19 studies. Validity data were limited to concurrent validity, construct validity, and/or clinical utility in 10 studies. Measures were comparable with respect to internal consistency, factor structure, and clinical utility. Results are limited to peer-reviewed, English literature, and studies were not judged for quality. CONCLUSIONS Greater attention should be paid to the psychometric evaluation of established measures. Although existing evidence may not justify universal screening, we recommend depression screening in clinical practice when patients may be seen by nonpsychology personnel. There is insufficient evidence to recommend one screening measure over another. Therefore, selection of measures will depend on clinician preferences. Psychometric studies are needed to show test-retest reliability, criterion validity, and sensitivity to change to improve depression recognition and treatment.
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Affiliation(s)
- Claire Z Kalpakjian
- Model SCI System, University of Michigan, Department of Physical Medicine and Rehabilitation, 300 N. Ingalls, Room NI 2A09, Ann Arbor, MI 48109, USA.
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Kalpakjian CZ, Toussaint LL, Albright KJ, Bombardier CH, Krause JK, Tate DG. Patient health Questionnaire-9 in spinal cord injury: an examination of factor structure as related to gender. J Spinal Cord Med 2009; 32:147-56. [PMID: 19569462 PMCID: PMC2678286 DOI: 10.1080/10790268.2009.11760766] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2007] [Accepted: 07/30/2008] [Indexed: 10/21/2022] Open
Abstract
BACKGROUND/OBJECTIVE Despite the attention depression after spinal cord injury (SCI) has received, research and clinical practice have been hampered by inadequate emphasis on reliable and valid measurement. Assessment of symptoms in persons with SCI is challenged by the presence of "trans-diagnostic" symptoms and unexamined effects of gender. The objective of this study was to examine the factor structure of the Patient Health Questionnaire-9 (PHQ-9; the 9-item depression scale of the Patient Health Questionnaire) and determine whether the structure replicates across gender. METHODS A total of 1,168 women and men were matched on level/completeness of SCI, follow-up year, and age to create 584 pairs. Exploratory factor analysis examined 1- and 2-factor models and congruence in 2 randomly split half samples to establish congruence of the factor solution and replication across gender. RESULTS The 1- and 2-factor solutions fit the structure of the items accounting for 41% to 51% of original item variance. Congruence between random samples was uniformly high for the 1-factor solution (r = 0.791-0.948) but variable for the 2-factor solution. Although congruence was high for the combined sample and men (r = 0.90-0.97 and 0.71-0.94, respectively), it was variable for women (r = 0.29-0.85). CONCLUSIONS Although there was support for the 1-factor structure of the PHQ within and between sexes, the low congruence between sexes and within women for the 2-factor structure indicates potentially important differences about how certain symptoms may be experienced or interpreted differently, by men and women with SCI. Future research should focus on where sexes diverge in cognitive, affective, and somatic dimensions of depressive symptoms and whether sex-specific or sex-neutral measures are warranted.
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Affiliation(s)
- Claire Z Kalpakjian
- Model SCI System, Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor 48109, USA.
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Kalpakjian CZ, Meade M. Writing Manuscripts for Peer Review: Your Guide to Not Annoying Reviewers and Increasing Your Chances of Success. Sex Disabil 2008. [DOI: 10.1007/s11195-008-9090-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Kalpakjian CZ, Albright KJ. An examination of depression through the lens of spinal cord injury. Comparative prevalence rates and severity in women and men. Womens Health Issues 2007; 16:380-8. [PMID: 17188221 DOI: 10.1016/j.whi.2006.08.005] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2005] [Revised: 06/26/2006] [Accepted: 08/31/2006] [Indexed: 02/07/2023]
Abstract
PURPOSE This study describes the prevalence of probable major depressive disorder (MDD) as well as other depressive disorders (ODD) and severity of depressive symptoms in a national sample of women with spinal cord injury (SCI) and compares them with a case-matched sample of men with SCI. METHODS A sample of 585 women was drawn and case-matched with men from the SCI Model System National SCI Database according to level/completeness of injury, follow-up year, and age. The outcome measure of depression was the Patient Health Questionnaire. MAIN FINDINGS Prevalence rates for women were 7.9% for probable MDD and 9.7% for ODD; rates for men were 9.9% and 10.3%, respectively. Logistic regression revealed that women who were divorced or at year 1 follow-up had a higher odds of having probable MDD (odds ratio [OR], 3.4 and 2.9, respectively). Employed women and men had significantly lower odds of probable MDD (OR, 0.274 and 0.358, respectively). Statistically significant differences were not found in gender comparisons for either probable MDD or symptom severity, which also were not associated with injury characteristics. CONCLUSION The most significant, and unexpected, research finding is the absence of gender differences in probable MDD and symptom severity. Results challenge notions that depression will necessarily follow SCI; that injury characteristics determine the development and severity of depression; and that women experience a greater burden of depression than men. The main clinical implication is that depression screening and referral should be a routine feature of health care for women living with SCI, as well as for their male counterparts. Furthermore, nearly one fourth of women and men reported experiencing some or greater difficulty in daily life and relationships in the absence of probable depressive disorder, warranting monitoring of subsyndromal depression as well.
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Affiliation(s)
- Claire Z Kalpakjian
- University of Michigan Model Spinal Cord Injury Care System, Ann Arbor, Michigan 48109, USA.
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Abstract
BACKGROUND/OBJECTIVE Although the impact of secondary conditions after spinal cord injury (SCI) on health, well being, and financial burden have been studied, there are psychometrically sound scales of secondary conditions in the extant literature. The use of such scales allows for cross-sample comparison of secondary condition prevalence rates and associations with functional, medical, and psychosocial factors. Thus, the purpose of this study was to evaluate the preliminary reliability of a SCI secondary conditions scale. METHODS The Spinal Cord Injury Secondary Conditions Scale (SCI-SCS) is a 16-item scale based on the Seekins Secondary Conditions Scale. Sixty-five individuals with SCI completed written surveys at 5 time-points over 2 years. RESULTS Internal consistency across each of the time-points exceeded 0.76; test-retest reliability ranged from 0.569 to 0.805. Convergent validity was assessed with 6 physical functioning items from the SF-12. Spearman (coefficients were all statistically significant and ranged from 0.317 (accomplished less because of health problems) to 0.644 (pain). The most prevalent secondary conditions were chronic pain, joint and muscle pain, and sexual dysfunction. CONCLUSIONS Preliminary testing of the SCI-SCS suggests that it is a reliable and valid scale, and further development (ie, factor analysis, item revision) and examination of validity are recommended with larger and more diverse SCI samples.
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Affiliation(s)
- Claire Z Kalpakjian
- University of Michigan Model SCI Care System, Department of Physical Medicine and Rehabilitation, University of Michigan Health System, 300 N. Ingalls, NI 2A09, Ann Arbor, MI 48109, USA.
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Abstract
OBJECTIVE The goal of this cross-sectional study was to explore quality of life (QOL) in a sample of postmenopausal women with physical disabilities due to polio contracted in childhood. A structural equation model was used to confirm that menopause symptoms will have a minimal effect on QOL when disability-related variables are taken into account. METHODS A sample of 752 women who were postmenopausal completed a written survey. The structural equation model contained two measured predictors (age, severity of postpolio sequelae) and one latent predictor (menopause symptoms defined by four measured indicators). Functional status (defined by two measured indicators) was included as a mediator, with QOL (defined by three measured indicators) as the outcome. RESULTS The original model yielded acceptable fit indices (CFI = 0.96, RMSEA = 0.055) but resulted in a number of unexpected relationships that proved to be artifacts after model respecification. The respecified model yielded a nonsignificant chi-square value, which indicated no significant discrepancy between the proposed model and the observed data (chisquare = 18.5, df = 13, p = 0.138). All fit indices indicated a good fit: CFI = 0.997, NNFI = 0.987, chi-square/df = 1.43, and RMSEA = 0.024. CONCLUSIONS When the effects of postpolio sequelae and functional status are included in the structural equation model, only the psychological symptoms of menopause play a prominent role in explaining QOL in this sample. The clinical implications of these findings suggest that attention to psychological symptoms and an exclusive focus on the physical aspects of menopause to the exclusion of other midlife life stressors and influences on a woman's psychological well-being ignore the larger context of life in which they live. In particular, many women with disabilities may contend with additional or exacerbated stressors related to their disability.
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Affiliation(s)
- Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, Ann Arbor, Michigan 48109, USA.
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Kalpakjian CZ, Quint EH, Tate DG, Roller S, Toussaint LL. Menopause characteristics of women with physical disabilities from poliomyelitis. Maturitas 2006; 56:161-72. [PMID: 16930875 DOI: 10.1016/j.maturitas.2006.07.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2005] [Revised: 07/11/2006] [Accepted: 07/21/2006] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To describe menopause characteristics of women with physical disabilities from poliomyelitis. METHODS Nine hundred and nine women with a history of poliomyelitis completed a survey on health, physical functioning, emotional well being and menopause. RESULTS The majority of the sample was postmenopausal having had a natural menopause around the average age of 50.3 years; 34.7% of the sample had had hysterectomies. Thirty-nine percent were using some form of hormone replacement therapy (HRT). Menopause symptoms were clustered into psychological, somatic-sensory, somatic-sleep and vasomotor factors. Among never and past HRT users, there were significant differences in menopause factor severity by menopause status. Somatic/sleep symptoms were lowest in never users; past users had significantly higher vasomotor symptoms; desire for sexual activity and painful intercourse did not vary by HRT use. Compared to population estimates, post-polio women had similar rates of hysterectomies overall, but among some age cohorts they had significantly lower rates, contrary to expectations. However, they used HRT at significantly higher rates than expected. CONCLUSIONS This study suggests that basic menopause characteristics of women with polio are generally similar to those of their non-disabled peers. There were few substantial differences in severity of menopause symptoms by HRT use, which is critical in light of the dearth of studies examining its risk-benefit ratio among women with physical disabilities. Until such studies provide some evidence of the specific risks or benefits to women with physical disability, each woman should carefully weigh the known risks and benefits with her physician.
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Affiliation(s)
- Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan Health System, 300 N. Ingalls, NI 2A09, Ann Arbor, MI 48109-0491, USA.
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