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Catz A, Itzkovich M, Rozenblum R, Elkayam K, Kfir A, Tesio L, Chhabra HS, Michaeli D, Zeilig G, Engel-Haber E, Bizzarini E, Pilati C, Stigliano S, Merafina M, Del Popolo G, Righi G, Bonavita J, Baroncini I, Liu N, Xing H, Margalho P, Campos I, Riberto M, Soeira TP, Chandy B, Tharion G, Joshi M, Lemay JF, Laramée MT, Curran D, Leiulfsrud AS, Sørensen L, Biering-Sorensen F, Poder HH, Kesiktas N, Burgess-Collins L, Edwards J, Osman A, Bluvshtein V. A multi-center international study on the spinal cord independence measure, version IV: Rasch psychometric validation. J Spinal Cord Med 2023:1-11. [PMID: 37000427 DOI: 10.1080/10790268.2023.2183334] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/01/2023] Open
Abstract
CONTEXT The Spinal Cord Independence Measure is a comprehensive functional rating scale for individuals with spinal cord lesion (SCL). OBJECTIVE To validate the scores of the three subscales of SCIM IV, the fourth version of SCIM, using advanced statistical methods. STUDY DESIGN Multi-center cohort study. SETTING Nineteen SCL units in 11 countries. METHODS SCIM developers created SCIM IV following comments by experts, included more accurate definitions of scoring criteria in the SCIM IV form, and adjusted it to assess specific conditions or situations that the third version, SCIM III, does not address. Professional staff members assessed 648 SCL inpatients, using SCIM IV and SCIM III, at admission to rehabilitation, and at discharge. The authors examined the validity and reliability of SCIM IV subscale scores using Rasch analysis. RESULTS The study included inpatients aged 16-87 years old. SCIM IV subscale scores fit the Rasch model. All item infit and most item outfit mean-square indices were below 1.4; statistically distinct strata of abilities were 2.6-6; most categories were properly ordered; item hierarchy was stable across most clinical subgroups and countries. In a few items, however, we found misfit or category threshold disordering. We found SCIM III and SCIM IV Rasch properties to be comparable. CONCLUSIONS Rasch analysis suggests that the scores of each SCIM IV subscale are reliable and valid. This reinforces the justification for using SCIM IV in clinical practice and research.
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Affiliation(s)
- Amiram Catz
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Malka Itzkovich
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
| | - Rotem Rozenblum
- School of Mathematical Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | - Keren Elkayam
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Adi Kfir
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Luigi Tesio
- Istituto Auxologico Italiano, IRCCS, and Università degli Studi, Milan, Italy
| | | | - Dianne Michaeli
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
| | - Gabi Zeilig
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
- School of Health Professions, Ono Academic College, Kiryat Ono, Israel
| | - Einat Engel-Haber
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
- Department of Neurological Rehabilitation, The Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Emiliana Bizzarini
- Department of Rehabilitation Medicine, Physical Medicine and Rehabilitation Institute, Udine, Italy
| | - Claudio Pilati
- Spinal Unit, Orthopedic and Rehabilitation Department, C.T.O. Hospital, Rome, Italy
| | - Salvatore Stigliano
- Spinal Unit, Orthopedic and Rehabilitation Department, C.T.O. Hospital, Rome, Italy
| | - Marcella Merafina
- Spinal Unit, Orthopedic and Rehabilitation Department, C.T.O. Hospital, Rome, Italy
| | | | - Gabriele Righi
- The Spinal Unit, Careggi University Hospital, Florence, Italy
| | - Jacopo Bonavita
- Spinal Unit, Azienda Provinciale Servizi Sanitari APSS Trento, Italy
| | - Ilaria Baroncini
- Spinal Unit, Montecatone Rehabilitation Institute, Imola (BO) Italy
| | - Nan Liu
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | - Huayi Xing
- Department of Rehabilitation Medicine, Peking University Third Hospital, Beijing, China
| | | | - Ines Campos
- CMRRC-RP, Rovisco Pais Hospital, Tocha, Portugal
| | - Marcelo Riberto
- The Departament of orthopedics and anesthesiology, Ribeirão Preto Medical School, Universidade de São Paulo, Brazil
| | - Thabata Pasquini Soeira
- The Departament of orthopedics and anesthesiology, Ribeirão Preto Medical School, Universidade de São Paulo, Brazil
| | - Bobeena Chandy
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - George Tharion
- Department of Physical Medicine and Rehabilitation, Christian Medical College, Vellore, Tamil Nadu, India
| | - Mrinal Joshi
- Department of Physical Medicine and Rehabilitation, Rehabilitation Research Centre, SMS Medical College & Associated Hospitals, Jaipur, India
| | - Jean-François Lemay
- Spinal Cord Injury Program, Institut de réadaptation Gingras-Lindsay-de-Montréal, Canada
| | - Marie-Thérèse Laramée
- Spinal Cord Injury Program, Institut de réadaptation Gingras-Lindsay-de-Montréal, Canada
| | - Dorothyann Curran
- Department of Medicine, The Ottawa Hospital Rehabilitation Centre, Ottawa, Canada
| | - Annelie Schedin Leiulfsrud
- Department of Physical Medicine and Rehabilitation, Spinal Cord Unit, St Olav University Hospital, Trondheim, Norway
| | - Linda Sørensen
- Department of Innovation, technology and e-health, Sunnaas Rehabilitation Hospital HF, Nesoddtangen, Norway
| | - Fin Biering-Sorensen
- Department of Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Denmark
| | - Henrik Hagen Poder
- Department of Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Denmark
| | - Nur Kesiktas
- Istanbul Physical Medicine and Rehabilitation Education Research Hospital, University of Health Sciences, Istanbul, Turkey
| | - Lisa Burgess-Collins
- Department of Spinal Injuries, Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Jayne Edwards
- Department of Spinal Injuries, Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Aheed Osman
- Department of Spinal Injuries, Robert Jones & Agnes Hunt Orthopaedic Hospital, Oswestry, UK
| | - Vadim Bluvshtein
- Department of Spinal Rehabilitation, Loewenstein Rehabilitation Medical Center, Raanana, Israel
- Sackler Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel
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Wolfe DL, Walia S, Burns AS, Flett H, Guy S, Knox J, Koning C, Laramée MT, O’Connell C, Scovil CY, Wallace M. Development of an implementation-focused network to improve healthcare delivery as informed by the experiences of the SCI knowledge mobilization network. J Spinal Cord Med 2019; 42:34-42. [PMID: 31573445 PMCID: PMC6781192 DOI: 10.1080/10790268.2019.1649343] [Citation(s) in RCA: 5] [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: 10/25/2022] Open
Abstract
Context: Implementing research findings into clinical practice is challenging. This manuscript outlines the experiences and key learnings from a network that operated as a community of practice across seven Canadian Spinal Cord Injury (SCI) rehabilitation centers. These learnings are being used to inform a new implementation-focused network involving SCI rehabilitation programs based in Ontario, Canada. Methods: The SCI KMN adapted and applied implementation science principles based on the National Implementation Research Network's (NIRN) Active Implementation Frameworks in the implementation of best practices in pressure injury and pain prevention and management. Results: The SCI KMN was successful in implementing best practices in both pressure ulcer and pain prevention and management across the various participating sites. Other key objectives met were building capacity in implementation methods in site personnel so that project scaling could occur with these skills and expertise applied to numerous other initiatives. Additionally, various papers, abstracts and conference presentation as well as an implementation guide were disseminated to inform the field of implementation science. Conclusion: The key lessons learned from this experience are being used to develop a new implementation-focused network. Features felt to be especially important for the SCI KMN includes a highly representative governance structure, the use of indicators within an overall evaluation framework and the systematic application of implementation processes with shared learnings supporting each site.
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Affiliation(s)
- Dalton L. Wolfe
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada,School of Health Studies, University of Western Ontario, London, Ontario, Canada,Correspondence to: Dalton L. Wolfe, Parkwood Institute, PO BOX 5777, STN B, London, Ontario, Canada, N6A 4V2.
| | - Saagar Walia
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada
| | - Anthony S. Burns
- Division of Physiatry, Dept. of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Heather Flett
- Spinal Cord Rehab, Brain and Spinal Cord Injury Rehab Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada
| | - Stacey Guy
- Parkwood Institute Research, Lawson Health Research Institute, London, Ontario, Canada
| | - Jason Knox
- Tertiary Neuro Rehabilitation Unit 58, Foothills Medical Center, Calgary, Alberta, Canada
| | - Cyndie Koning
- Healthcare Improvement Specialist, Healthcare Improvement Team, Glenrose Rehabilitation Hospital,, Edmonton, Alberta, Canada
| | - Marie-Thérèse Laramée
- CIUSSS du Center-Sud-de-l’Ile-de-Montreal- Institut universitaire sur la réadaptation en déficience physique de Montréal, Montreal, Quebec, Canada
| | - Colleen O’Connell
- Stan Cassidy Center for Rehabilitation, University of New Brunswick, Fredericton, New Brunswick, Canada
| | - Carol Y. Scovil
- Spinal Cord Rehab, Brain and Spinal Cord Injury Rehab Program, Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Michelle Wallace
- Adult Brain Injury, Spinal Cord Injury & General Neurology Programs, Spasticity Program for Adults & Adult Convulsive Disorder Clinic, Glenrose Rehabilitation Hospital, Edmonton, Alberta, Canada
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Pancer M, Manganaro M, Pace I, Marion P, Gagnon DH, Laramée MT, Messier F, Amari F, Ahmed S. A Web-Based Physical Activity Portal for Individuals Living With a Spinal Cord Injury: Qualitative Study. JMIR Form Res 2019; 3:e12507. [PMID: 31350835 PMCID: PMC6688442 DOI: 10.2196/12507] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 05/24/2019] [Accepted: 05/25/2019] [Indexed: 01/04/2023] Open
Abstract
Background The population with a spinal cord injury (SCI) largely remains inactive following discharge from rehabilitation despite evidence on the benefits of physical activity. These individuals need to develop skills to self-manage their condition in order to prevent secondary comorbidities and rehospitalization. A Web-based physical activity portal can address this need. Few Web-based interventions incorporate theoretical frameworks, behavior change techniques, and modes of delivery into their design. Objective This study aimed to identify the preferred features of a Web-based self-management physical activity portal through stakeholder engagement with individuals with a spinal cord injury and health care professionals (HCPs). Methods An interpretative phenomenology methodology and participatory design, along with an integrated knowledge translation approach, were used to conduct this study. Convenience sampling was used to recruit individuals with an SCI living in the community, who were either interested or already engaging in physical activity, and HCPs working with individuals with an SCI, from three city-based rehabilitation sites. Individual 1-hour sessions involving navigation of an existing website and a semistructured interview were conducted with all participants. Individuals with an SCI completed a demographics questionnaire prior to the individual sessions, while demographic information of the HCPs was collected during their interviews. Additionally, all participants were asked a question on their intention to use or recommend a portal. An in-depth thematic analysis was used to derive themes from participants’ responses. Results Thirteen individuals with an SCI and nine HCPs participated in the study. Five core themes emerged: (1) knowledge: guidance and barrier management; (2) possibility of achievement: the risks and benefits of physical activity and modelling; (3) self-regulation strategies: action planning, goal setting, tracking, rewards, and reminders; (4) interactivity: peers and professionals; and (5) format: appearance, language, and ease of use. The mean (median) ratings of the likelihood of promoting and using a Web-based portal tailored to individuals’ needs were 9.00 (8.78) and 7.75 (7.88) for HCPs and individuals with an SCI, respectively. Conclusions This study highlights features of an online self-management platform that can provide individuals with an SCI the motivation and volition to engage in physical activity. These findings will inform the design of a Web-based self-management physical activity portal to increase physical activity adherence and behavior change.
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Affiliation(s)
- Max Pancer
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Melissa Manganaro
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Isabella Pace
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Patrick Marion
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Dany H Gagnon
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada.,École de Réadaptation, Université de Montréal, Montreal, QC, Canada.,Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal - Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Montreal, QC, Canada
| | - Marie-Thérèse Laramée
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada.,Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal - Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Montreal, QC, Canada
| | - Frédéric Messier
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada.,Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal - Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Montreal, QC, Canada
| | - Fatima Amari
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada
| | - Sara Ahmed
- School of Physical & Occupational Therapy, Faculty of Medicine, McGill University, Montreal, QC, Canada.,Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC, Canada.,Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île-de-Montréal - Institut Universitaire sur la Réadaptation en Déficience Physique de Montréal, Montreal, QC, Canada.,Centres Intégrés Universitaires de Santé et de Services Sociaux du Centre-Ouest-de-l'Île-de-Montréal, Montreal, QC, Canada.,McGill University Health Center, Montreal, QC, Canada
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4
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Higgins J, Laramée MT, Harrison KR, Delparte JJ, Scovil CY, Flett HM, Burns AS. The Spinal Cord Injury Pressure Ulcer Scale (SCIPUS): an assessment of validity using Rasch analysis. Spinal Cord 2019; 57:874-880. [PMID: 31053776 DOI: 10.1038/s41393-019-0287-z] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 04/23/2019] [Accepted: 04/24/2019] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Secondary analysis of retrospective data. OBJECTIVE The aim of this study was to further validate the Spinal Cord Injury Pressure Ulcer Scale (SCIPUS) using Rasch analysis. SETTING Two rehabilitation centers in Canada. METHOD Data were collected as part of the Spinal Cord Injury Knowledge Mobilization Network (SCI KMN) initiative. The SCIPUS was completed within 72 h of inpatient admission. Persons admitted for initial rehabilitation in two inpatient spinal cord rehabilitation programs were included in the project. RESULTS Data from 886 participants were analyzed, approximately 60% of whom were males. Rasch analyses demonstrated that the SCIPUS, in its current format did not meet criteria required for true measurement. A transformed version of the SCIPUS obtained by deletion of misfitting items and modification of the response scales improved fit to the model and showed preliminary evidence of unidimensionality. The person separation index, however indicated that the scale requires further adjustments of its scoring options. CONCLUSIONS In its original form, the SCIPUS does not meet the requirements of the Rasch model and its total score should be used cautiously. However, following some adjustments to the items such as addressing DIF between sites to insure a standardized assessment across sites and adding response options to some of the items, interval-scale measurement should be possible.
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Affiliation(s)
- Johanne Higgins
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada. .,Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) of the Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada. .,School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada.
| | - Marie-Thérèse Laramée
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.,Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) of the Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Kate Rousseau Harrison
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada.,Institut universitaire sur la réadaptation en déficience physique de Montréal (IURDPM) of the Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Montreal, QC, Canada
| | - Jude J Delparte
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada
| | - Carol Y Scovil
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON, Canada
| | - Heather M Flett
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Anthony S Burns
- Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute-University Health Network, Toronto, ON, Canada.,Division of Physiatry, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Flett HM, Delparte JJ, Scovil CY, Higgins J, Laramée MT, Burns AS. Determining Pressure Injury Risk on Admission to Inpatient Spinal Cord Injury Rehabilitation: A Comparison of the FIM, Spinal Cord Injury Pressure Ulcer Scale, and Braden Scale. Arch Phys Med Rehabil 2019; 100:1881-1887. [PMID: 31054293 DOI: 10.1016/j.apmr.2019.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [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: 01/23/2019] [Revised: 03/27/2019] [Accepted: 04/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Assess the utility of the admission Spinal Cord Injury Pressure Ulcer Scale (SCIPUS), Braden Scale, and the FIM for identifying individuals at risk for developing pressure injury during inpatient spinal cord injury (SCI) rehabilitation. DESIGN Retrospective cohort. SETTING Two tertiary rehabilitation centers. PARTICIPANTS Individuals (N=754) participating in inpatient SCI rehabilitation. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Logistic regression analysis was performed to determine the utility of the SCIPUS, Braden Scale, and FIM for identifying individuals at risk for developing pressure injury (PI) during inpatient SCI rehabilitation. Sensitivity, specificity, positive predictive value, negative predictive value, false negative rate, odds ratio, likelihood ratio, and area under the curve (AUC) are reported. RESULTS The SCIPUS total score and its individual items did not demonstrate acceptable accuracy (AUC≥0.7) whereas the Braden Scale (0.73) and the FIM score (0.74) did. Once items were dichotomized into high and low risk categories, 1 Braden item (friction and shear), 5 FIM items (bathing, toileting, bed/chair transfer, tub/shower transfer, toilet transfer), the FIM transfers subscale, FIM Motor subscale, and the FIM instrument as a whole, maintained AUCs ≥0.7 and negative predictive values ≥0.95. The FIM bed/chair transfer score demonstrated the highest likelihood ratio (2.62) and overall was the most promising measure for determining PI risk. CONCLUSION Study findings suggest that a simple measure of mobility, admission FIM bed/chair transfer score of 1 (total assist), can identify at-risk individuals with greater accuracy than both an SCI specific instrument (SCIPUS) and a PI specific instrument (Braden). The FIM bed/chair transfer score can be readily determined at rehabilitation admission with minimal administrative and clinical burden.
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Affiliation(s)
- Heather M Flett
- Brain and Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON; Department of Physical Therapy, University of Toronto, Toronto, ON.
| | - Jude J Delparte
- Brain and Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON
| | - Carol Y Scovil
- Brain and Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON; Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, ON
| | - Johanne Higgins
- Research Unit, Integrated University Centre for Health and Social Services for South Central Island of Montreal-Institute of Rehabilitation Gingras-Lindsay-de-Montréal, Montreal, QC; School of Rehabilitation Faculty of Medicine, University of Montreal, Montreal, QC; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC
| | - Marie-Thérèse Laramée
- Research Unit, Integrated University Centre for Health and Social Services for South Central Island of Montreal-Institute of Rehabilitation Gingras-Lindsay-de-Montréal, Montreal, QC; Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, QC; Spinal Cord Injury Program, CCSMTL, - Institute of Rehabilitation Gingras-Lindsay-de-Montréal, Montreal, QC
| | - Anthony S Burns
- Brain and Spinal Cord Rehabilitation Program, Lyndhurst Centre, Toronto Rehabilitation Institute, University Health Network, Toronto, ON; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
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Loh E, Guy SD, Craven BC, Guilcher S, Hayes KC, Jeji T, Joshi P, Kras-Dupuis A, Laramée MT, Lee J, Mehta S, Noonan VK, Mings EJ, Salter M, Short C, Bassett-Spiers K, White B, Wolfe DL, Xia N. Advancing research and clinical care in the management of neuropathic pain after spinal cord injury: Key findings from a Canadian summit. Can J Pain 2017; 1:183-190. [PMID: 35005353 PMCID: PMC8730656 DOI: 10.1080/24740527.2017.1385370] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Optimal management of neuropathic pain (NP) is essential to enhancing health-related quality of life for individuals living with spinal cord injury (SCI). A key strategic priority for the Ontario Neurotrauma Foundation (ONF) and Rick Hansen Institute (RHI) is optimizing NP management after SCI. Aims: A National Canadian Summit, sponsored by ONF and RHI, was held to develop a strategic plan to improve NP management after SCI. Methods: In a one-day meeting held in Toronto, Ontario, a multidisciplinary panel of 18 Canadian stakeholders utilized a consensus workshop methodology to (1) describe the current state of the field, (2) create a long-term vision, and (3) identify steps for moving into action. Results: A review of the current state of the field identified strengths including rigourously developed evidence syntheses and practice landscape documentation. Identified gaps included limited evidence on NP hindering recommendation development in evidence syntheses, absence of a national strategy, care silos with limited cross-continuum connections, limited consumer involvement, and limited practice standard implementation. The panel identified key themes for a long-term vision to improve the management of SCI NP in Canada, including establishing an integrated collaborative network; standardized care and outcome evaluation; education; advocacy; and directing resources to innovative solutions. The panel identified the next step as prioritization of areas that will have the greatest impact in a 5-year time frame. Conclusion: A strategic plan outlining a long-term vision to improve management of NP after SCI in Canada was developed and will inform future activities of the sponsors.
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Affiliation(s)
- Eldon Loh
- Parkwood Institute Research, St. Joseph’s Health Care, London, Ontario, Canada
- Lawson Health Research Institute, London, Ontario, Canada
| | - Stacey D. Guy
- Parkwood Institute Research, St. Joseph’s Health Care, London, Ontario, Canada
| | - B. Cathy Craven
- Toronto Rehabilitation Institute, Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
| | - Sara Guilcher
- Rehabilitation Sciences Institute, University of Toronto, Toronto, Ontario, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Ontario, Canada
| | - Keith C. Hayes
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
| | - Tara Jeji
- Ontario Neurotrauma Foundation, Toronto, Ontario, Canada
| | - Phalgun Joshi
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Anna Kras-Dupuis
- Parkwood Institute Research, St. Joseph’s Health Care, London, Ontario, Canada
| | - Marie-Thérèse Laramée
- Centre Intégré Universitaire de Santé et de Services Sociaux du Centre-Sud-de-l’Île-de-Montréal and Centre de Recherche Interdisciplinaire en Réadaptation, Montréal, Quebec, Canada
| | - Joseph Lee
- The Centre for Family Medicine, Kitchener, Ontario, Canada
| | - Swati Mehta
- Parkwood Institute Research, St. Joseph’s Health Care, London, Ontario, Canada
| | | | | | - Michael Salter
- The Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
- Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
- Faculty of Dentistry, University of Toronto, Toronto, Ontario, Canada
- Department of Physiology, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christine Short
- Department of Medicine, Division of Physical Medicine and Rehabilitation Dalhousie University, Halifax, Nova Scotia, Canada
- Nova Scotia Rehabilitation Centre, Halifax, Nova Scotia, Canada
| | | | - Barry White
- Rick Hansen Institute, Vancouver, British Columbia, Canada
| | - Dalton L. Wolfe
- Parkwood Institute Research, St. Joseph’s Health Care, London, Ontario, Canada
| | - Nancy Xia
- SCI Ontario, Toronto, Ontario, Canada
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7
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Kairy D, Bussières AE, Gagnon C, Allaire AS, Messier F, Lamontagne ME, Brière A, Bérubé M, Laramée MT, Lemay JF, Préville K, Voyer M. Implementation of Evidence-Based Practices in Traumatology Continuums of Care: A Multi-Site Assessment. Arch Phys Med Rehabil 2015. [DOI: 10.1016/j.apmr.2015.08.066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
OBJECTIVE To determine the prevalence of secondary impairments among individuals with long-standing spinal cord injury in Quebec and the potential relationships between these impairments and several variables. DESIGN A review of 2,200 medical files was conducted to determine the target population; 976 patients were selected randomly and mailed questionnaires. The results were based on 482 individuals with spinal cord injury who returned the completed questionnaire. The questionnaire included 14 subsections, such as sociodemographic, medical, psychosocial, and environmental information. The medical section, including the type and level of lesion and the presence of secondary impairments, was analyzed. RESULTS Urinary tract infection, spasticity, and hypotension were the most frequently reported secondary impairments, regardless of the severity of injury. Relationships between the prevalence of secondary impairments and the duration of injury, as well as perceived health status, were observed. CONCLUSIONS This is the first study to describe secondary impairments after long-standing spinal cord injury in Quebec. Patients with spinal cord injury still present a high prevalence of secondary impairments many years after their rehabilitation, despite preventive education or medical follow-up visits. Further studies are required to determine the specific impact that these impairments have on the patients' social role and their quality-of-life.
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Affiliation(s)
- L Noreau
- Rehabilitation Institute of Quebec City, Laval University, Quebec, Canada
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9
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Abstract
STUDY DESIGN Cross-sectional study by mail survey of participation in productive activities of individuals who sustained a spinal cord injury (SCI) in Quebec from 1970 to 1993. OBJECTIVES To determine the level of productivity outcomes of a representative sample and to determine the relationship between the productivity outcomes and some personal and environmental variables. SETTINGS Quebec, Canada. METHODS Four hundred and eighteen subjects (mean of age=42.1+/-11. 8) were included in this study. Overall productivity was assessed by the participation into five categories of activities (gainful employment, studies, homemaking and family activities, community organizations and leisure activities). RESULTS Depending on the severity of injury, 30% to 51% of the variance in productivity outcomes can be explained by a set of ten variables: education, ability to drive a car vehicle, other transportation indices, age related variables and type of locomotion. A discriminant analysis was undertaken to classify the subjects into three levels of productivity (low, moderate and high). The percentage of subjects correctly classified was moderate (54% to 71%) to high (72% to 81%) depending on the productivity levels. CONCLUSION The results confirm the significant contribution of education and transportation to explain the productivity outcomes. SPONSORSHIP This project was funded by the 'Société d'Assurance Automobile du Québec', the 'Commission de la Santé et de la Sécurité du Travail' and the 'Fondation André Senécal'.
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Affiliation(s)
- L Noreau
- Rehabilitation Institute of Quebec City, Canada
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Goulet C, Arsenault AB, Bourbonnais D, Laramée MT, Lepage Y. Effects of transcutaneous electrical nerve stimulation on H-reflex and spinal spasticity. Scand J Rehabil Med 1996; 28:169-76. [PMID: 8885040] [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] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The purpose of this study was to investigate the short-term effects of transcutaneous electrical nerve stimulation (TENS; 99 Hz; 250 ms pulses) on H-reflex and spinal spasticity. Considering the reflex hyperexcitability commonly displayed in spinal cord-injured subjects, it was hypothesized that repetitive low threshold afferent stimulation would have an inhibitory effect on the triceps surae H-reflexes which could also be reflected by a decrease in plantarflexor spasticity. Clonus, Achilles tendon reflex and modified Ashworth evaluations were performed on 14 spinal cord-injured subjects prior to and after 30 minutes' application of TENS. Non-parametric statistical analyses (n = 14; alpha = 0.05) failed to reveal significant effects of TENS on H-reflex amplitude. However, there was a significant decrease in scores for the Achilles tendon reflex and the modified Ashworth test. The clonus score decreased in most subjects post-TENS, although not in a statistically significant manner. The present pilot results thus suggest that TENS appears to be effective in reducing spinal spasticity, as measured clinically.
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Affiliation(s)
- C Goulet
- Physiotherapy Program, Faculty of Health Sciences, University of Ottawa, Ontario, Canada
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