RESUMEN
INTRODUCTION: Falls are a concern for wheelchair users with spinal cord injury (SCI). Falls can negatively impact the physical and psychological well-being of fallers. To date, the perspectives of wheelchair users with lived experiences of SCI on the contributors to falls has been understudied. Information about factors that influence fall risk would guide the development of effective fall prevention strategies. OBJECTIVES: To gain a comprehensive understanding of the factors that influenced the risk of falling as perceived by wheelchair users with SCI. DESIGN: A qualitative study using photo-elicitation interviews. SETTING: A Canadian SCI rehabilitation hospital and the participants' home/community environments. PARTICIPANTS: Twelve wheelchair users living in the community with chronic SCI. METHODS: Participants captured photographs of situations, places or things that they perceived increased and decreased their risk of falling. Semistructured photo-elicitation interviews were conducted to discuss the content of the photographs and explore perceptions of fall risk factors. A hybrid thematic analysis and the Biological, Behavioural, Social, Economic, and Environmental model were used as a framework to organise/synthesise the data. RESULTS: Overall, the findings indicated that the risk of falling was individualised, complex and dynamic to each person's life situation. Four main themes were revealed in our analysis: (1) Falls and fall risk caused by multiple interacting factors; (2) Dynamic nature of fall risk; (3) Single factors were targeted to reduce falls and fall-related injuries; and (4) Fall prevention experiences and priorities. CONCLUSIONS: Each wheelchair user encountered numerous fall risk factors in their everyday lives. Information from this study can be used to set priorities for fall prevention. Fall prevention initiatives should consider a wheelchair user's fall risks in a holistic manner, acknowledging that a person's current situation, as well as anticipating their fall risks and fall prevention needs, will change over time.
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Accidentes por Caídas/prevención & control , Traumatismos de la Médula Espinal/complicaciones , Silla de Ruedas , Adolescente , Adulto , Anciano , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Percepción , Investigación Cualitativa , Factores de Riesgo , Traumatismos de la Médula Espinal/psicología , Traumatismos de la Médula Espinal/rehabilitación , Adulto JovenRESUMEN
OBJECTIVE: To identify a set of essential components for primary care for patients with spinal cord injury (SCI) for inclusion in a point-of-practice toolkit for primary care practitioners (PCP) and identification of the essential elements of SCI care that are required in primary care and those that should be the focus of specialist care. DESIGN: Modified Delphi consensus process; survey methodology. SETTING: Primary care. PARTICIPANTS: Three family physicians, six specialist physicians, and five inter-disciplinary health professionals completed surveys. OUTCOME MEASURES: Importance of care elements for inclusion in the toolkit (9-point scale: 1 = lowest level of importance, 9 = greatest level of importance) and identification of most responsible physician (family physician, specialist) for completing key categories of care. Open-ended comments were solicited. RESULTS: There was consensus between the respondent groups on the level of importance of various care elements. Mean importance scores were highest for autonomic dysreflexia, pain, and skin care and lowest for preventive care, social issues, and vital signs. Although, there was agreement across all respondents that family physicians should assume responsibility for assessing mental health, there was variability in who should be responsible for other care categories. Comments were related to the need for shared care approaches and capacity building and lack of knowledge and specialized equipment as barriers to optimal care. CONCLUSION: This study identified important components of SCI care to be included in a point-of-practice toolkit to facilitate primary care for persons with SCI.
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Actitud del Personal de Salud , Personal de Salud , Guías de Práctica Clínica como Asunto/normas , Atención Primaria de Salud , Mejoramiento de la Calidad , Traumatismos de la Médula Espinal/terapia , Adulto , Técnica Delphi , Humanos , Atención Primaria de Salud/organización & administración , Atención Primaria de Salud/normas , Mejoramiento de la Calidad/organización & administración , Mejoramiento de la Calidad/normasRESUMEN
OBJECTIVES: To describe the structure of informal networks for individuals with spinal cord injury (SCI) living in the community, to understand the quality of relationship of informal networks, and to understand the role of informal networks in the prevention and management of secondary health conditions (SHCs). DESIGN: Mixed-method descriptive study. SETTING: Ontario, Canada Participants: Community-dwelling adults with an SCI living in Ontario Interventions/methods: The Arizona Social Support Interview Survey was used to measure social networks. Participants were asked the following open-ended questions: (1) What have been your experiences with your health care in the community? (2) What have been your experiences with care related to prevention and/or management of SHCs?, (3)What has been the role of your informal social networks (friends/family) related to SHCs? RESULTS: Fourteen key informant interviews were conducted (6 men, 8 women). The overall median for available informal networks was 11.0 persons (range 3-19). The informal network engaged in the following roles: (1) advice/validating concerns; (2) knowledge brokers; (3) advocacy; (4) preventing SHCs; (5) assisting with finances; and (6) managing SHCs. Participants described their informal networks as a "secondary team"; a critical and essential force in dealing with SHCs. CONCLUSIONS: While networks are smaller for persons with SCI compared with the general population, these ties seems to be strong, which is essential when the roles involve a level of trust, certainty, tacit knowledge, and flexibility. These informal networks serve as essential key players in filling the gaps that exist within the formal health care system.
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Servicios de Salud Comunitaria/organización & administración , Redes Comunitarias/organización & administración , Accesibilidad a los Servicios de Salud/organización & administración , Apoyo Social , Traumatismos de la Médula Espinal/psicología , Adulto , Anciano , Servicios de Salud Comunitaria/estadística & datos numéricos , Redes Comunitarias/estadística & datos numéricos , Consejo/organización & administración , Consejo/normas , Femenino , Accesibilidad a los Servicios de Salud/normas , Encuestas Epidemiológicas , Humanos , Masculino , Persona de Mediana Edad , Calidad de la Atención de Salud , Traumatismos de la Médula Espinal/rehabilitaciónRESUMEN
CONTEXT/OBJECTIVES: To describe the relationships between secondary health conditions and health preference in a cohort of adults with chronic spinal cord injury (SCI). STUDY DESIGN: Cross-sectional telephone survey. SETTING: Community. PARTICIPANTS: Community-dwelling adult men and women (N = 357) with chronic traumatic and non-traumatic SCI (C1-L3 AIS A-D) who were at least 1 year post-injury/onset. INTERVENTIONS: Not applicable. OUTCOME MEASURES: Health Utilities Index-Mark III (HUI-Mark III) and SCI Secondary Conditions Scale-Modified (SCS-M). RESULTS: SCS-M responses for different secondary health conditions were used to create "low impact = absent/mild" and "high impact = moderate/significant" secondary health condition groups. Analysis of covariance was used to examine differences in HUI-Mark III scores for different secondary health conditions while controlling for impairment. The mean HUI-Mark III was 0.24 (0.27, range, -0.28 to 1.00). HUI-Mark III scores were lower (P < 0.001) in high impact groups for spasms, bladder and bowel dysfunction, urinary tract infections, autonomic dysreflexia, circulatory problems, respiratory problems, chronic pain, joint pain, psychological distress, and depression compared with the low impact groups. As well, HUI-Mark III scores were lower (P < 0.05) in high impact groups for pressure sores, unintentional injuries, contractures, heterotopic bone ossification, sexual dysfunction, postural hypotension, cardiac problems, and neurological deterioration than low-impact groups. CONCLUSION: High-impact secondary health conditions are negatively associated with health preference in persons with SCI. Although further work is required, the HUI-Mark III data may be a useful tool for calculating quality-adjusted life years, and advocating for additional resources where secondary health conditions have substantial adverse impact on health.
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Servicios de Salud/estadística & datos numéricos , Evaluación de Resultado en la Atención de Salud , Prioridad del Paciente/psicología , Traumatismos de la Médula Espinal/psicología , Traumatismos de la Médula Espinal/rehabilitación , Adulto , Anciano , Anciano de 80 o más Años , Canadá , Enfermedad Crónica , Estudios Transversales , Femenino , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Paraplejía/psicología , Paraplejía/rehabilitación , Cuadriplejía/psicología , Cuadriplejía/rehabilitación , Años de Vida Ajustados por Calidad de Vida , Encuestas y Cuestionarios , Teléfono , Adulto JovenRESUMEN
OBJECTIVE: To evaluate the effects of functional electrical stimulation (FES)-assisted walking on body composition, compared to a non-FES exercise program in individuals with a spinal cord injury (SCI). DESIGN: Parallel-group randomized controlled trial. METHODS: Individuals with chronic (≥ 18 months) incomplete SCI (level C2 to T12, AIS C or D) were recruited and randomized to FES-assisted walking (intervention), or aerobic and resistance training (control) sessions thrice-weekly for 16 weeks. Whole body and leg lean mass and whole body fat mass, measured with dual-energy X-ray absorptiometry, and lower-limb muscle cross-sectional area (CSA) and fat CSA, measured with peripheral computed tomography were assessed at baseline, 4 months, and 12 months. Intention-to-treat analyses using repeated measures general linear models were used to assess between-group differences. RESULTS: Thirty-four individuals were randomized (17 per group); 27 remained at 12 months. There were no significant main effects of FES-assisted walking on body composition variables in intention-to-treat analyses with group means. There was a significant group-by-time interaction for muscle area from baseline to 12 months (P = 0.04). Intention-to-treat analysis of muscle area change scores between baseline and 12 months revealed a significant difference between groups (mean (SD) muscle area change score 212 (517) mm(s) for FES, -136 (268) mm(s) for control, P = 0.026). There were 13 side effects or adverse events deemed related to study participation (7 intervention, 5 control); most were resolved with modifications to the protocol. One fainting episode resulted in a hospital visit and study withdrawal. CONCLUSIONS: Thrice-weekly FES-assisted walking exercise over 4 months did not result in a change in body composition in individuals with chronic, motor incomplete C2 to T12 SCI (AIS classification C and D). However, longer-term follow-up revealed that it might maintain muscle area.
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Composición Corporal/fisiología , Terapia por Estimulación Eléctrica/métodos , Modalidades de Fisioterapia , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/rehabilitación , Caminata/fisiología , Adulto , Anciano , Terapia por Estimulación Eléctrica/efectos adversos , Ejercicio Físico/fisiología , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Músculo Esquelético/anatomía & histología , Músculo Esquelético/fisiología , Paraplejía/fisiopatología , Paraplejía/rehabilitación , Cuadriplejía/fisiopatología , Cuadriplejía/rehabilitación , Entrenamiento de Fuerza/métodosRESUMEN
OBJECTIVES: To describe and compare patient demographics, inpatient lengths of stay (LOS), and walking-related functional outcomes of individuals with spinal cord injuries (SCIs) of traumatic (TSCI) and non-traumatic (NTSCI) etiologies. To contrast these features between individuals who walked from those who did not walk at discharge from inpatient rehabilitation. DESIGN: Prospective observational study; comparisons between TSCI and NTSCI, walkers and non-walkers. Information collected as a pilot project within a provincial SCI informatics strategy. SETTING: Rehabilitation hospital specialized for SCIs. PARTICIPANTS: Adults with NTSCI (n = 31) or TSCI (n = 59) admitted to inpatient rehabilitation, 2007-2009. OUTCOME MEASURES: Lower-extremity motor scores (LEMS), spinal cord independence measure version III (SCIM-III) total and mobility subscores, functional independence measure (FIM), Length of Stay (LOS) at inpatient facilities. RESULTS: Groups (NTSCI vs. TSCI) did not differ in the proportion of individuals that achieved "walker" status (SCIM-III mobility indoors (MI) score ≥ 3 at rehab discharge) (P = 0.41, 48.9% overall). Inpatient LOS at both acute care and rehabilitation facilities did not differ between groups; however, TSCI non-walkers had longer inpatient rehabilitation LOS than TSCI walkers. Among walkers, improvement was shown on all three mobility subscores of the SCIM-III between admission and discharge from rehabilitation; highest significance was shown on the SCIM-III MI. Walking status at discharge (SCIM-III MI) was most strongly correlated with LEMS at rehab admission (r = 0.71, P < 0.001). CONCLUSION: Walking outcomes are comparable among individuals with NTSCI vs. TSCI admitted for specialized SCI rehabilitation. Routine use of SCIM-III mobility items for assessment of walking outcome is recommended for inpatient rehabilitation.
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Modalidades de Fisioterapia , Enfermedades de la Médula Espinal/fisiopatología , Enfermedades de la Médula Espinal/rehabilitación , Traumatismos de la Médula Espinal/fisiopatología , Traumatismos de la Médula Espinal/rehabilitación , Caminata/fisiología , Adulto , Anciano , Vías Eferentes/fisiopatología , Femenino , Humanos , Pacientes Internos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Estudios Prospectivos , Recuperación de la Función/fisiología , Centros de Rehabilitación , Enfermedades de la Médula Espinal/complicaciones , Traumatismos de la Médula Espinal/etiología , Resultado del TratamientoRESUMEN
OBJECTIVE: To describe the methodology used to conduct a scoping review of spinal cord injury (SCI) rehabilitation service delivery in Canada, and to explain the reporting process intended to advance future service delivery. EVIDENCE ACQUISITION: A SCI rehabilitation framework derived from the International Classification of Function, Disability and Health was developed to describe the goals and interprofessional processes of rehabilitation. An adapted Arksey and O'Malley (2005) methodological framework was used to conduct a scoping review of SCI rehabilitation services in Canada. Data were obtained from multiple relevant sources via survey (N = 3572 data fields) from 13 of 15 Canadian tertiary SCI rehabilitation sites, systematic reviews, white papers, literature reviews, clinical practice resources, and clinicians. Multidisciplinary teams of content experts (N = 17), assisted with data interpretation and validation by articulating practice trends, gaps, and priorities. EVIDENCE SYNTHESIS: The findings will be presented in an atlas, which includes aggregate national data regarding impairment and demographic characteristics, service utilization, available resources (staff and capital equipment), specialized services, local expertise, and current best practice indicators, outcome measures, and clinical guidelines. Data were collated and synthesized relative to specific rehabilitation goals. The current state of SCI rehabilitation service delivery (specific to each rehabilitation goal) is summarized in a report card within three domains, knowledge generation, clinical application, and policy change, and specifies key 2020 priorities. CONCLUSION: These findings should prompt critical evaluation of current Canadian SCI rehabilitation service delivery while specifying enhancements in knowledge generation, clinical application and policy change domains likely to assist with achievement of best practices by 2020.
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Atención a la Salud/organización & administración , Investigación sobre Servicios de Salud/métodos , Programas Nacionales de Salud/organización & administración , Centros de Rehabilitación/organización & administración , Traumatismos de la Médula Espinal/rehabilitación , Bibliometría , Canadá , Atención a la Salud/estadística & datos numéricos , Política de Salud , Humanos , Modelos Organizacionales , Programas Nacionales de Salud/estadística & datos numéricos , Objetivos Organizacionales , Centros de Rehabilitación/estadística & datos numéricos , Literatura de Revisión como AsuntoRESUMEN
BACKGROUND: Pulse wave velocity (PWV), which reflects arterial stiffness, is an important predictor of future coronary artery disease. The test-retest reliability of PWV has not been investigated in people with spinal cord injury (SCI). PURPOSE: To report the test-retest (day-to-day) reliability of PWV measurements among people with SCI, and to determine the smallest real difference (SRD) of PWV values. PARTICIPANTS: Twenty men (n = 19) and a woman (n = 1) with SCI (C4-T10; AIS A-D; ≥ 1-year post-injury; 10 with paraplegia and 10 with tetraplegia; time post-injury: 11.8 ± 8.7 years; age: 43.0 ± 12.6 years). METHODS: On two occasions within a 2-week period, aortic PWV (between the common carotid and femoral artery), arm PWV (between the brachial and radial artery), and leg PWV (between femoral and posterior tibial artery) were assessed at the same time of day using Doppler flowmeters. RESULTS: No statistically significant differences were found between days 1 and 2 in aortic PWV (day 1: 941 ± 185 cm/seconds, day 2: 917 ± 160 cm/seconds, P = 0.257), leg PWV (day 1: 1088 ± 141 cm/seconds, day 2: 1122 ± 165 cm/seconds, P = 0.099) and arm PWV (day 1: 1283 ± 185 cm/seconds, day 2: 1358 ± 256 cm/seconds, P = 0.180). The aortic and leg PWVs had high test-retest reliability (intraclass correlation coefficient: ICC = 0.920 and 0.913, respectively; P < 0.001 for both) and arm PWV had moderate test-retest reliability (ICC = 0.598, P = 0.03). SRDs for each PWV were 104 cm/seconds (aortic PWV), 97 cm/seconds (leg PWV) and 143 cm/seconds (arm PWV). CONCLUSION: The test-retest reliability of PWV assessment is high among patients with chronic SCI. Changes in aortic PWV values above 104 cm/seconds with repeated testing like represent true changes in health status.