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BACKGROUND: The COVID-19 pandemic has created opportunity for multiple rehabilitation science learners and clinicians to critically evaluate and synthesize published research in the field of spinal cord injury (SCI) rehabilitation. OBJECTIVE: To provide a step-by-step guide for rehabilitation science learners and clinicians outlining how to conduct rigorous systematic reviews in the field of SCI. RESULTS: Steps for conducting a systematic review (SR) include: (1) formation of the SR team consisting of interprofessional experts; (2) formulation of the research question(s) with patient/population/problem, Intervention, Comparison, and Outcome (PICO) specification; (3) determination of inclusion and exclusion criteria; (4) development of SR protocol and registration; (5) development of the search strategies (database specific); (6) screening of titles and abstracts (level 1 screening), and full-texts (level 2 screening); (7) quality assessment of the included studies; (8) data extraction; (9) summary of findings and discussion; and, (10) dissemination of results. CONCLUSIONS: The enclosed ten steps for conducting SRs in SCI rehabilitation research have the potential to significantly improve the quality of evidence synthesis and the associated inferences. The importance of assembling team with diverse expertise is emphasized to assure a quality product with the potential to influence practice and inform the content of clinical practice recommendations.
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COVID-19 , Traumatismos de la Médula Espinal , Humanos , Pandemias , SARS-CoV-2RESUMEN
PURPOSE: To describe objective social disconnectedness and perceived social isolation post-spinal cord injury/dysfunction (SCI/D), and to examine associations among social disconnectedness and social isolation by sociodemographic and clinical characteristics. MATERIALS AND METHODS: A telephone-based questionnaire was administered to 170 community dwelling individuals with a SCI/D. Social disconnectedness was measured by social network size, composition, and frequency of contact. Social isolation was measured using the revised three item UCLA Loneliness Scale. RESULTS: Of the 170 participants, the majority were men (n = 136, 80%), had a traumatic injury (n = 149, 87.6%), and had incomplete tetraplegia (n = 58, 34%). The mean network size was 3.86 (SD = 2.0) of a maximum seven. The mean loneliness score for the sample was 4.93 (SD = 1.87). Factors associated with lower feelings of loneliness included being married, living with a higher proportion of network members, and being employed. Size of networks was not significantly associated with feelings of loneliness. CONCLUSIONS: This study highlights the vulnerability for perceived social isolation among persons with SCI/D. The size of network does not seem to matter as much as the frequency and quality of social interactions. Findings reinforce the complexity of social disconnectedness and the importance in understanding the various indicators of social disconnectedness as they relate to social isolation. IMPLICATIONS FOR REHABILITATION Social relationships have been shown to be a vital component of optimal health and well-being. Individuals with a spinal cord injury/dysfunction are faced with a number of challenges in developing and maintaining social relationships and community participation. Rehabilitation professionals should encourage opportunities for social inclusion, employment and community participation to optimize health and well-being for this population.
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Aislamiento Social , Traumatismos de la Médula Espinal , Estudios Transversales , Femenino , Humanos , Soledad , Masculino , Encuestas y CuestionariosRESUMEN
Purpose: Family members make an important contribution to informal and formal care, as well as the overall health and wellbeing of individuals with spinal cord injury. Caregiving often results in negative outcomes which, if not addressed, threaten the sustainability of these critical supports. We sought to explore the perceptions of individuals with spinal cord injury and their family caregivers regarding the facilitators and barriers to undertaking and sustaining the caregiving role in the community.Methods: A qualitative descriptive approach with semi-structured interviews. Thematic analysis was employed to determine key themes arising from individuals with spinal cord injury (n = 19) and their family members' (n = 16) experiences.Results: The following four facilitators to caregiving were identified: access to community support services, positive coping in relationship, social support, and mastery of caregiving roles. Conversely, the following six barriers to caregiving were identified: lack of access to community resources, lack of knowledge about resources and formal training, fragmented continuity of care, negative coping in relationship, role strain, and caregiver injury or illness.Conclusions: The current study demonstrated that positive coping, social support, skills training, access to community services and continuity of care contribute significantly to the sustainability of the spinal cord injury family caregiving role. As such, the development of future caregiver interventions should consider these facilitators.Implications for RehabilitationFamily caregivers make an important contribution to the care processes and overall quality of life of individuals with spinal cord injury post-discharge into the community.The potential negative effects of caregiving could threaten the sustainability of these critical supports.Positive coping, social support, skills training, access to community services, and continuity of care contribute significantly to the sustainability of the spinal cord injury family caregiving role.This study shows the need for better integration of family members during the rehabilitation and discharge process to better prepare them for the caregiving role.
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Cuidadores , Traumatismos de la Médula Espinal , Cuidados Posteriores , Familia , Humanos , Alta del Paciente , Calidad de Vida , Apoyo SocialRESUMEN
Context: Spinal cord injury (SCI) presents numerous physiological, psychosocial, and environmental complexities resulting in significant healthcare system resource demands. Objective: To describe the current health system surveillance mechanisms in Ontario, Canada and highlight gaps in health surveillance among adults with SCI across their lifespan. Methods: A review of administrative data sources capturing SCI-specific information took place via internet searching and networking among SCI rehabilitation and health services experts with emphasis on functionality, health service utilization, and quality of life data. Results: The review identified a distinct paucity of data elements specific to the health surveillance needs of individuals with SCI living in the community. The gaps identified are: (1) a lack of data usability; (2) inadequate linkage between available datasets; (3) inadequate/infrequent reporting of outcomes; (4) a lack of relevant content/patient-reported outcomes; and, (5) failure to incorporate additional data sources (e.g. Insurance datasets). Conclusion: Currently, SCI-specific health data is disproportionately weighted towards the first 3-6 months post injury with detailed data regarding pre-hospital care, acute management and rehabilitation, but little existing infrastructure supporting community-based health surveillance. Given this reality, the bolstering of meaningful community health surveillance of this population across the lifespan is needed. Addressing the identified gaps in health surveillance must inform the creation of a comprehensive community health dataset incorporating patient-reported outcome measures and enabling linkage with existing administrative and/or clinical databases. A future harmonized data surveillance strategy would, in turn, positively impact function, health services, resource utilization and health-related quality of life surveillance.
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Indicadores de Enfermedades Crónicas , Rehabilitación Neurológica/normas , Traumatismos de la Médula Espinal/epidemiología , Traumatismos de la Médula Espinal/rehabilitación , Atención a la Salud/organización & administración , Atención a la Salud/normas , Atención a la Salud/estadística & datos numéricos , Humanos , Rehabilitación Neurológica/estadística & datos numéricos , OntarioRESUMEN
INTRODUCTION: Current tertiary Spinal Cord Injury (SCI) rehabilitation funding and rehabilitation length of stay (R-LOS) in most North American jurisdictions are linked to an individual's impairment. Our objectives were to: 1) describe the impact of relevant demographic, impairment and medical complexity variables at rehabilitation admission on R-LOS among adult Canadians with traumatic SCI; and 2) identify factors which extend R-LOS. METHODS: Data from 1,376 adults with traumatic SCI were obtained via chart abstraction and administrative data linkage from 15 Rick Hansen SCI Registry sites (2004-2014). Variables included age, sex, neurological impairment (level, severity), rehabilitation onset days, R-LOS, Glasgow Coma Score (GCS) at admission, prior ventilation or endotracheal tube (Vent/ETT), or indwelling bladder catheter at acute discharge, pain interference score, intensive care unit (ICU) length of stay (LOS), and lower extremity motor scores (LEMS) at rehabilitation admission. Variables related to R-LOS in bivariate analysis were included in multivariate analysis to determine their impact on R-LOS. RESULTS: Prior Vent/ETT tube, indwelling bladder catheter, GCS, LEMS, and neurological impairment were related to R-LOS in bivariate analysis. Multivariate linear regression analyses identified five variables as significant predictors: age, Vent/ETT for >24 hours in acute care, indwelling bladder catheter at acute discharge, LEMS, and NLI/AIS subgroup at rehabilitation admission explained 32% of the variation in R-LOS (p<0.001). CONCLUSIONS: Based on the enclosed formula, and knowledge of an individual's age at injury, spinal cord impairment (level and severity), prior Vent/ETT, presence of an indwelling bladder catheter, and LEMS at admission, administrators and clinicians may readily identify patients for whom an extended R-LOS beyond conventional LOS targets is likely.
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Tiempo de Internación , Rehabilitación Neurológica/estadística & datos numéricos , Traumatismos de la Médula Espinal/epidemiología , Vejiga Urinaria Neurogénica/epidemiología , Adulto , Anciano , Canadá , Femenino , Humanos , Masculino , Persona de Mediana Edad , Modelos Estadísticos , Traumatismos de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/rehabilitación , Vejiga Urinaria Neurogénica/etiología , Vejiga Urinaria Neurogénica/rehabilitaciónRESUMEN
OBJECTIVE Cervical spondylotic myelopathy (CSM) is the most common cause of nontraumatic spinal cord impairment and disability in the world. Given that the Japanese Orthopaedic Association (JOA) score is the most frequently used outcome measure in clinical research and practice for treating patients with CSM, this review was undertaken to comprehensively and critically evaluate the psychometric properties of the JOA score. METHODS The authors identified studies (published in the period of January 1975 to November 2015) on the psychometric properties of the original, revised, and modified versions of the JOA score in Medline, PsycINFO, Excerpta Medica dataBASE (EMBASE), American College of Physicians Journal Club, and Cochrane Database of Systematic Reviews. Additional publications were captured in a secondary search of the bibliographies in both original research articles and literature reviews identified in the original search. The JOA scores were evaluated for item generation and reduction, internal consistency, reliability, validity, and responsiveness. This review included all those versions of the JOA score whose psychometric properties had been reported in at least 2 published studies. RESULTS The primary search strategy identified 59 studies, of which 9 fulfilled the inclusion and exclusion criteria. An additional 18 publications were captured in the secondary search and included in the analysis. The key findings from the 27 studies analyzed indicated the following: 1) the original JOA score (1975) was the source for the revised JOA score (1994) and 3 modified versions (1991, 1993, and 1999 JOA scores) reported or used in at least 2 published studies; 2) the revised and modified versions of the JOA score are markedly different from each other; 3) only the revised JOA score (1994) was validated with the original JOA score; and 4) the 1975 JOA score is the most appropriate instrument for assessing patients in Asian populations (especially from Japan) because of its psychometric attributes, and the 1991 JOA score is the most appropriate version for use in Western populations. CONCLUSIONS The authors' results indicate that the original (1975), revised (1994), and modified (1991, 1993, and 1999) versions of the JOA score are substantially different from each other in terms of their content and have been incompletely examined for their psychometric properties and cultural sensitivity. Whereas the 1975 JOA score is the most appropriate version for assessing individuals from Asian populations (particularly those eating with chopsticks), the 1991 JOA score is most suitable for evaluating patients in Western populations. Nonetheless, further investigation of the psychometric properties of the 1975 and 1991 JOA scores is recommended because of a paucity of studies reporting on the responsiveness of these 2 scoring instruments.
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Psicometría , Sociedades Médicas/normas , Espondilosis/diagnóstico , Espondilosis/psicología , Bases de Datos Factuales/estadística & datos numéricos , Evaluación de la Discapacidad , Femenino , Humanos , Japón , Masculino , Ortopedia/normas , Evaluación de Resultado en la Atención de Salud/métodos , Reproducibilidad de los Resultados , Estudios Retrospectivos , Sociedades Médicas/estadística & datos numéricos , Encuestas y CuestionariosRESUMEN
BACKGROUND: Multi-channel surface functional electrical stimulation (FES) for walking has been used to improve voluntary walking and balance in individuals with spinal cord injury (SCI). OBJECTIVE: To investigate short- and long-term benefits of 16 weeks of thrice-weekly FES-assisted walking program, while ambulating on a body weight support treadmill and harness system, versus a non-FES exercise program, on improvements in gait and balance in individuals with chronic incomplete traumatic SCI, in a randomized controlled trial design. METHODS: Individuals with traumatic and chronic (≥18 months) motor incomplete SCI (level C2 to T12, American Spinal Cord Injury Association Impairment Scale C or D) were recruited from an outpatient SCI rehabilitation hospital, and randomized to FES-assisted walking therapy (intervention group) or aerobic and resistance training program (control group). Outcomes were assessed at baseline, and after 4, 6, and 12 months. Gait, balance, spasticity, and functional measures were collected. RESULTS: Spinal cord independence measure (SCIM) mobility sub-score improved over time in the intervention group compared with the control group (baseline/12 months: 17.27/21.33 vs. 19.09/17.36, respectively). On all other outcome measures the intervention and control groups had similar improvements. Irrespective of group allocation walking speed, endurance, and balance during ambulation all improved upon completion of therapy, and majority of participants retained these gains at long-term follow-ups. CONCLUSIONS: Task-oriented training improves walking ability in individuals with incomplete SCI, even in the chronic stage. Further randomized controlled trials, involving a large number of participants are needed, to verify if FES-assisted treadmill training is superior to aerobic and strength training.
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Terapia por Estimulación Eléctrica/métodos , Trastornos Neurológicos de la Marcha/diagnóstico , Trastornos Neurológicos de la Marcha/rehabilitación , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/rehabilitación , Caminata , Femenino , Trastornos Neurológicos de la Marcha/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Desempeño Psicomotor , Recuperación de la Función , Traumatismos de la Médula Espinal/fisiopatología , Resultado del TratamientoRESUMEN
BACKGROUND/OBJECTIVE: Elevated aortic arterial stiffness (aortic pulse wave velocity: aPWV) is an independent coronary artery disease predictor among the general population. The purpose of this study was to: (1) report aPWV values in a representative cohort of patients with spinal cord injury (SCI); (2) to compare aPWV values in people with SCI based on neurological level of injury; and (3) to contrast the reported aPWV values with available normal values for the general population. METHODS: Adults with chronic SCI (n = 87) were divided into two groups (TETRA group, n = 37 and PARA group, n = 50). aPWV and potential confounders of aPWV were assessed. Analysis of covariance was used for comparisons between groups and adjusted for the confounders. Subjects' aPWV values were contrasted with reference values for general population determined by "The Reference value for arterial stiffness' collaboration" and prevalence of abnormal aPWV defined as greater than or equal to the age-specific 90th percentile was reported. RESULTS: Prevalence of abnormal aPWV in the cohort was 25.3%. After adjusting for covariates, the mean aPWV values were significantly different between two groups (TETRA: 8.0 (95% confidence interval (CI): 7.5-8.6) m/second, PARA: 9.0 (95% CI: 8.5-9.4) m/second, P = 0.010). The prevalence of abnormal aPWV was significantly higher in the PARA group (36%) compared to the TETRA group (11%) (P = 0.012). CONCLUSIONS: One-quarter of the total cohort had an abnormal aPWV. Subjects with paraplegia had higher aPWV values and a higher frequency of abnormal aPWV than subjects with tetraplegia. Elevated aPWV in people with SCI, particularly those with paraplegia, may impart significant adverse cardiovascular consequences.
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Enfermedad de la Arteria Coronaria/epidemiología , Enfermedad de la Arteria Coronaria/fisiopatología , Traumatismos de la Médula Espinal/epidemiología , Traumatismos de la Médula Espinal/fisiopatología , Rigidez Vascular , Distribución por Edad , Causalidad , Comorbilidad , Estudios Transversales , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Factores de Riesgo , Distribución por SexoRESUMEN
CONTEXT/OBJECTIVE: Health preference values relate to a person's state of well-being, and is a single metric anchored at 0 (death) and 1 (perfect health). Health preference plays a key role in health economics and health policy, particularly in interpreting the results of cost-effectiveness studies, and supports the allocation of healthcare resources. The current study used elements of the International Classification of Functioning, Disability and Health (ICF) framework to predict health preference in persons with spinal cord injury (SCI). METHODS: Data were collected by telephone survey on (1) demographics, (2) impairment (etiology, neurological level of injury, and ASIA impairment scale), (3) secondary health conditions (SHCs) using the SCI-Secondary Conditions Scale-Modified, (4) functional abilities using the Spinal Cord Independence Measure (SCIM), and (5) health preference using the Health Utilities Index-Mark III (HUI-Mark III) among adults with chronic SCI. Variables were categorized according to ICF headings and hierarchical regression analyses were used to predict HUI-Mark III scores. RESULTS: Adults with chronic traumatic or non-traumatic SCI (N = 357) reported a mean health preference score of 0.27 (±0.27). In predicting health preference, our model accounted for 55.1% of the variance with "body functions and structure", and "activity and participation", significantly contributing to the model (P < 0.0001). In particular, older age, being employed, and having higher SCIM scores were positively associated with health preference. Conversely, a higher SHC impact score was associated with poorer health preference. CONCLUSIONS: Variables representative of "activity and participation" largely influence health preference among persons with chronic SCI, which may be amenable to intervention. These findings could be applied to advocate for health promotion and employment support programs to maximize well-being in persons aging with chronic SCI in the community.
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Estado de Salud , Prioridad del Paciente/estadística & datos numéricos , Calidad de Vida/psicología , Traumatismos de la Médula Espinal/diagnóstico , Traumatismos de la Médula Espinal/epidemiología , Índices de Gravedad del Trauma , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Enfermedad Crónica , Autoevaluación Diagnóstica , Femenino , Humanos , Clasificación Internacional del Funcionamiento, de la Discapacidad y de la Salud , Masculino , Persona de Mediana Edad , Ontario/epidemiología , Prioridad del Paciente/psicología , Prevalencia , Pronóstico , Reproducibilidad de los Resultados , Factores de Riesgo , Sensibilidad y Especificidad , Distribución por Sexo , Traumatismos de la Médula Espinal/psicología , Encuestas y Cuestionarios , Adulto JovenRESUMEN
OBJECTIVE: To investigate the effects of intermittent passive standing (PS) and whole body vibration (WBV) on the electromyography (EMG) activity, cross-sectional area, and density of lower extremity muscles in individuals with chronic motor complete spinal cord injury (SCI). DESIGN: Case series. METHODS: Seven adult men with chronic (≥2 years), thoracic motor complete (AIS A-B) SCI completed a 40-week course of thrice-weekly intermittent PS-WBV therapy, in a flexed knee posture (160°), for 45 minutes per session at a frequency of 45 Hz and 0.6-0.7 mm displacement using the WAVE(®) Pro Plate, with an integrated EasyStand™ standing frame. EMG was measured in major lower extremity muscles to represent muscle activity during PS-WBV. The cross-sectional area and density of the calf muscles were measured using peripheral quantitative computed tomography at the widest calf cross-section (66% of the tibia length) at pre- and post-intervention. All measured variables were compared between the pre- and post-intervention measurements to assess change after the PS-WBV intervention. RESULTS: PS-WBV acutely induced EMG activity in lower extremity muscles of SCI subjects. No significant changes in lower extremity EMG activity, muscle cross-sectional area, or density were observed following the 40-week intervention. CONCLUSIONS: Although acute exposure to PS-WBV can induce electrophysiological activity of lower extremity muscles during PS in men with motor complete SCI, the PS-WBV intervention for 40 weeks was not sufficient to result in enhanced muscle activity, or to increase calf muscle cross-sectional area or density.
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Músculo Esquelético/fisiopatología , Atrofia Muscular/fisiopatología , Atrofia Muscular/terapia , Postura/fisiología , Traumatismos de la Médula Espinal/fisiopatología , Vibración/uso terapéutico , Adulto , Humanos , Masculino , Persona de Mediana Edad , Contracción Muscular , Músculo Esquelético/patología , Tamaño de los Órganos , Estimulación Física/métodos , Modalidades de Fisioterapia , Equilibrio Postural , Recuperación de la Función , Traumatismos de la Médula Espinal/terapia , Resultado del Tratamiento , Adulto JovenRESUMEN
CONTEXT: Although pressure ulcers may negatively influence quality of life (QoL) post-spinal cord injury (SCI), our understanding of how to assess their impact is confounded by conceptual and measurement issues. To ensure that descriptions of pressure ulcer impact are appropriately characterized, measures should be selected according to the domains that they evaluate and the population and pathologies for which they are designed. OBJECTIVE: To conduct a systematic literature review to identify and classify outcome measures used to assess the impact of pressure ulcers on QoL after SCI. METHODS: Electronic databases (Medline/PubMed, CINAHL, and PsycInfo) were searched for studies published between 1975 and 2011. Identified outcome measures were classified as being either subjective or objective using a QoL model. RESULTS: Fourteen studies were identified. The majority of tools identified in these studies did not have psychometric evidence supporting their use in the SCI population with the exception of two objective measures, the Short-Form 36 and the Craig Handicap Assessment and Reporting Technique, and two subjective measures, the Life Situation Questionnaire-Revised and the Ferrans and Powers Quality of Life Index SCI-Version. CONCLUSION: Many QoL outcome tools showed promise in being sensitive to the presence of pressure ulcers, but few of them have been validated for use with SCI. Prospective studies should employ more rigorous methods for collecting data on pressure ulcer severity and location to improve the quality of findings with regard to their impact on QoL. The Cardiff Wound Impact Schedule is a potential tool for assessing impact of pressure ulcers-post SCI.
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Úlcera por Presión/psicología , Psicometría/métodos , Calidad de Vida , Traumatismos de la Médula Espinal/complicaciones , Humanos , Traumatismos de la Médula Espinal/psicologíaRESUMEN
STUDY DESIGN: Retrospective cohort study, using linked, population-based health-care data. OBJECTIVES: To describe the incidence, management and outcomes of surgically treated kidney stones after spinal cord injury (SCI). To evaluate the impact of a past history of kidney stones on the occurrence of kidney stones. SETTING: Ontario, Canada. METHODS: A total of 5121 patients were followed a median of 4 years after an incident SCI (occurring between 2002 and 2011). The primary outcome was surgical intervention for upper tract kidney stones. RESULTS: In follow-up, 66 patients (1.3%) had 89 episodes of surgically treated kidney stones. Treatments included: ureteroscopic lithotripsy (34%), ureteral stent/percutaneous nephrostomy (30%), shockwave lithotripsy (19%) or percutaneous nephrolithotripsy (17%). Following stone treatment, the 30-day mortality rate was low, and the 30-day admission rate to an intensive care unit was 12%. A history of surgically treated kidney stones before SCI (compared with no such history) was associated with a higher risk of kidney stones after SCI (27 vs 3 per 1000 person-years; adjusted hazard ratio 14.74, 95% confidence interval 5.69-38.22). CONCLUSION: During intermediate follow-up after SCI, surgically treated upper tract kidney stones occur in 1.3% of patients. Ureteroscopy with lithotripsy is the most common treatment. A history of surgically managed kidney stones before SCI portends a higher risk of stones after SCI.