Spinal cord最新文献

Study design: Retrospective cohort study.

Objectives: The primary objective was to examine changes in gabapentinoid prescribing among individuals with acute spinal cord injury. The secondary objective was to examine the effects of gabapentinoid prescriptions on neurological recovery.

Setting: Intensive Care Unit, Vancouver General Hospital, British Columbia, Canada.

Methods: Individuals admitted between 2010 and 2019 with cervical spinal cord injuries were identified from the Rick Hansen Spinal Cord Injury Registry (RHSCIR). The primary outcome was first gabapentinoid prescription following injury, and exposure was year of injury. The secondary outcome was recovery in sensorimotor function, measured by changes in American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades between admission and discharge. We analyzed associations between gabapentinoid prescriptions and year of injury using Cox regression, and neurological recovery using multivariable logistic regression.

Results: Of 257 individuals with cervical spinal cord injury, 79% (n = 204) were prescribed a gabapentinoid within 30 days of injury. Rates of gabapentinoid prescription in the 30 days following injury increased from 41% in 2010/2011 to 93% in 2018/2019. In a subgroup analysis of individuals with incomplete injuries, early (i.e., hyperacute; <5 days post-injury) gabapentinoid use was significantly associated with greater neurological recovery (adjusted OR = 2.9, 95% CI, 1.1 to 7.9).

Conclusions: Gabapentinoid prescribing in acute spinal cord injury shifted markedly between 2010 and 2019, and was associated with improved neurological recovery in individuals with incomplete injuries. Further study is warranted to assess prescribing practices at other acute care hospitals and to characterize long-term safety.

Introduction: People with spinal cord injury can experience various psychosocial challenges when adjusting to their injury. It is essential they have access to evidence-based resources that can enhance their adjustment. During the development of the Spinal Cord Injury Health Maintenance Tool preliminary lived experience feedback highlighted the need to include an additional module on mental health.

Study design: Qualitative study.

Objectives: To co-design a new Mental Health module with people with spinal cord injury during the digitisation of the Spinal Cord Injury Health Maintenance Tool.

Setting: Community in Sydney, Australia.

Methods: A focus group of four participants with lived experience and expert review process performed collaboratively with a spinal cord injury key informant group.

Results: Four key informants engaged in the collaboration. Four key themes summarised how this second round of lived experience progressed the mental health resource: 1) Mental health is front and centre highlighted the necessity of including mental health in any self-management plan for spinal cord injury; 2) Striking the right balance acknowledged the serious impact of mental health issues but without undue negativity; 3) The glass is half full emphasised the need for a greater focus on a strengths-based approach; and 4) Variety's the spice of life required the Mental Health module to respond to individual circumstances.

Conclusions: Lived experience feedback ensured that the tone, scope and content of this module were revised to place greater emphasis on a strengths-based orientation, while still acknowledging the serious and severe outcomes associated with compromised mental health.

Study design: Validity and Reliability Analysis.

Objective: Evaluate the structural validity, reliability and criterion validity of the Wheelchair Mobility Activity Log (WC-MAL) using Rasch analysis.

Methods: Sixty individuals with SCI and using a manual wheelchair participated in the study. The WC-MAL was employed remotely. Rasch analysis evaluated the structural validity of the instrument. The intra-rater reliability of the WC-MAL score was analysed using the random model Intraclass Correlation Coefficient (ICC) and the Standard Error of Measurement was calculated to estimate the precision of individual scores. For concurrent criterion validity, the data from the tachometer were used as the "gold standard" to assess wheelchair mobility, with the WC-MAL serving as the comparator. Pearson's correlation coefficient was used to evaluate the relationship between the tachometer data and WC-MAL Frequency Scale scores.

Results: The Rasch analysis led to the exclusion of three items (1, 3, and 10) from the original instrument, improving model fit and refining WC-MAL 2.0. WC-MAL 2.0 demonstrated good discriminant ability with a Person Separation Reliability of 0.91-0.93 and explained variance between 59.3 and 61%. The WC-MAL 2.0 showed no local dependency, maintained unidimensionality across all scales, and exhibited no uniform Differential Item Functioning. The WC-MAL 2.0 demonstrated excellent inter-rater reliability (ICC0.84-0.91), strong internal consistency (Cronbach's alpha 0.84-0.91), and strong correlations between the Frequency Scale and tachometer data (r = 0.78, p < 0.001), supporting its criterion validity.

Conclusion: The WC-MAL 2.0 is a suitable instrument with adequate validity and reliability for assessing wheelchair performance in individuals with SCI.

Study design: Forward and backward translation processes were conducted first, followed by cognitive interviews for validation within a cross-sectional study design.

Objective: To translate the second edition (2021) of the International Standards to document Autonomic Function after Spinal Cord Injury (ISAFSCI) from English to Japanese using established translation guidelines.

Setting: Department of Rehabilitation Medicine, University of Washington. Cognitive interviews were conducted in person or via secure video conferencing.

Methods: The second edition (2021) of the ISAFSCI was translated into Japanese by two groups of bilingual Japanese healthcare professionals, and then back translated to English independently. After iterative review and confirmation by the developer, a pre-final version was created. Cognitive interviews were conducted with 15 Japanese healthcare professionals practicing spinal cord injury (SCI) care.

Results: All aspects of the ISAFSCI were translated including survey items (n = 114) and instructional items (n = 111). During back-translation, 10.7% of items showed language discrepancies. These were resolved through a second round of expert committee review and developer evaluation. Cognitive interviews revealed that most items were well understood. Modifications (n = 19) were required to clarify expressions related to autonomic function and anatomical terminology.

Conclusion: Following a rigorous translation process, the Japanese version of the second ISAFSCI edition 2021 demonstrated linguistic clarity, cultural relevance, and broad comprehensibility among Japanese healthcare professionals. In addition to its clinical and research utility, this survey could address the knowledge gap about autonomic dysfunction after SCI by promoting awareness and education in the Japanese healthcare community.

Study design: Prospective mixed methods implementation study.

Objectives: To: (1) implement a SCI-specific care pathway for body composition assessment (ATSCI-Nut); (2) pilot test the feasibility (reach, adoption, adherence, appropriateness, and acceptability) of the care pathway in patients with new traumatic SCI; (3) explore patient experiences with the care pathway and the effect of providing body composition information on dietary choices and (4) explore clinician experiences with the new care pathway.

Setting: Victorian Spinal Cord Service, Australia METHODS: Participants included individuals with acute SCI who received the ATSCI-Nut pathway and consented to data collection. Feasibility outcomes (reach, adoption and intervention fidelity) were collected from medical records. Acceptability and appropriateness were explored via patient semi-structured interviews and clinician focus groups.

Results: Twenty-three patients were eligible, 21 (91%) consented. Adherence to the ATSCI-Nut pathway initial assessment and review components during weeks 2-8 and >8 weeks was 86, 71 and 69%, respectively. Adherence to completing bioimpedance spectroscopy (BIS) measurements at specified time-points was 69%. However, only 43% of participants had all BIS measurements completed at specified time-points. Two themes were common to patients and clinicians: physiological and body composition changes directing focus of rehabilitation, and barriers and enablers to optimal care. One additional theme arose from patient interviews: impact of SCI on self-image and lifestyle.

Conclusions: The ATSCI-Nut pathway is a feasible and acceptable model to deliver body composition assessment despite mixed adherence to the pathway overall. However, barriers to optimal patient care and pathway adaptations need to be explored to improve adherence.

Study design: Three-wave prospective.

Objectives: Examine the impact of the North American Spinal Cord Injury Consortium's Spinal Cord Injury Research Advocacy Course (SCI-RAC) using the RE-AIM framework.

Setting: North America.

Methods: The RE-AIM domains for reach, effectiveness, and maintenance were assessed. Reach measures included participant enrollment (number and representativeness) and course completion. Primary effectiveness measures included changes in knowledge of the spinal cord injury (SCI) research process and perceived capacity to advocate/partner in research. Satisfaction and learning experiences were secondary effectiveness measures. Participant enrollment, perceived capacity to advocate/partner, and five satisfaction and learning experiences questions on overall knowledge and application were repeated as maintenance measures.

Results: Of the 248 participants who completed the pre-survey, 20% (n = 50) and 9% (n = 22) completed the course (and the post-survey) and 6-month surveys, respectively. Most participants who completed SCI-RAC were white (67%) and of high socioeconomic status (30%). No associations were found between demographics, perceived capacity to partner, and course completion. Significant improvements were observed in participants' knowledge of the SCI research process (Glass' delta= 0.50, p < 0.001) and perceived capacity to partner (e.g., capability: Glass' delta=0.59, p < 0.001). Participants reported high levels of satisfaction and positive learning experiences.

Conclusions: SCI-RAC showed initial improvements in course participants' knowledge and perceived capacity to partner, and participants were satisfied with the course. Findings suggest that NASCIC may want to review their recruitment strategies to reach more equity-owed groups and consider offering SCI-RAC alongside interventions that connect researchers and research users to continue improving the practice of SCI research partnerships.

Study design: Psychometric study.

Objectives: To evaluate the data completeness, data distribution and ceiling/floor effects, internal consistency and convergent validity of the Swedish versions of the Spinal Cord Independence Measure IV (s-SCIM IV) and the Spinal Cord Independence Measure Self-report (s-SCIM-SR).

Setting: Swedish inpatient and outpatient spinal cord injury (SCI) rehabilitation.

Methods: The translation process was based on established guidelines with researchers, clinicians and consumers. s-SCIM IV and FIM^TM assessments were performed by observation and/or interview, s-SCIM-SR through self-report using paper forms.

Results: In total, 101 participants (82% men) were included. There were no missing data for s-SCIM IV and 92% had answered all items in s-SCIM-SR. No ceiling or floor effects were observed. Cronbach´s alpha for the total s-SCIM IV scale was 0.91 (subscales 0.68-0.93) and for the total s-SCIM-SR scale 0.91 (subscales 0.62-0.93), with the lowest alphas for Respiration and Sphincter Management in both outcome measures. s-SCIM IV and s-SCIM-SR correlated strongly with each other and with FIM^TM.

Conclusions: Our results support the data completeness, lack of ceiling/floor effects, internal consistency (except the Respiration and Sphincter Management subscale) and convergent validity of the s-SCIM IV and s-SCIM-SR. Based on this initial psychometric testing, these outcome measures can be considered suitable to assess physical independence in inpatient and outpatient rehabilitation and long-term follow-up after SCI, for both clinical and research purposes. The now available Swedish versions of SCIM will enable a uniform national assessment of SCI-specific physical independence and facilitate research and international collaborations and comparisons.

Study design: Cross-sectional study OBJECTIVE: To evaluate alternative scoring approaches for the modified Spinal Cord Injury Secondary Conditions Scale (SCI-SCS) using severity- and mortality-based weights, and to examine their associations with functioning and self-reported health in individuals with SCI.

Setting: Community METHODS: We analyzed data from 10,347 participants in the International Spinal Cord Injury Survey (InSCI). Eight scoring approaches were constructed from 14 secondary health conditions and a depression item, varying by severity coding and by whether mortality weights were applied equally or condition-specifically. Associations with functioning (ICF-based composite score) and self-reported health were assessed using Pearson and Spearman correlations, with additional country-level analyses to explore variability.

Results: All scoring approaches were negatively correlated with both outcomes, indicating that higher secondary health condition burden was associated with worse functioning and poorer health. The score combining the modified SCI-SCS with condition-specific mortality weights showed the highest correlations, though differences from the unweighted score were small. Both scores demonstrated moderate associations with the outcomes. Country-level analyses revealed variability, partly related to sample size, but overall patterns were consistent.

Conclusion: The modified SCI-SCS demonstrated moderate and robust associations with functioning and self-reported health, supporting its use as a pragmatic proxy of overall health status in individuals with SCI. Weighting by mortality risks yielded only marginal gains, suggesting that the unweighted score remains a suitable option for research and practice. These findings advance the use of self-reported measures to capture health burden in SCI and encourage further validation with independent outcomes and across diverse contexts.

Study design: A systematic review and thematic synthesis of qualitative studies.

Objective: To systematically explore and synthesize the telerehabilitation experiences and needs of patients with spinal cord injury (SCI).

Methods: Six databases were searched. Findings were reported in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) guidelines and the Joanna Briggs Institute (JBI) Reviewer's Manual standards. Two reviewers independently screened studies, extracted data, and assessed quality using the JBI Critical Appraisal Tool for Qualitative Research. Data were synthesized using thematic synthesis, a core analytical approach for integrating findings from qualitative research to identify cross-study patterns.

Results: The search identified 15 eligible studies, including 12 qualitative studies and 3 mixed-methods studies (only qualitative data were extracted). A total of 286 participants were included comprising SCI patients, medical staff, and nursing staff. The synthesis yielded four core themes: participants' attitudes toward telerehabilitation, perceived benefits, perceived barriers, and needs and expectations. For spinal cord injury patients with SCI, telerehabilitation offer multiple benefits alongside distinct challenges and unmet needs.

Conclusion: Telerehabilitation provides a promising option and novel experience for home-based rehabilitation in SCI patients. Professionals should take full account of patients' perspectives, offer diverse and effective support, address individual needs, enhance the practicality, technical performance, and accessibility of telerehabilitation, and continuously work to improve patient outcomes.

Study design: Cohort study.

Objectives: Although the effectiveness of methylprednisolone sodium succinate (MPSS) in spinal cord injury (SCI) is controversial, it is hypothesized that the effectiveness and safety profile of MPSS may vary in select cervical SCI sub-populations. The objective of this study is to clarify the effect of MPSS and its impact on adverse events in patients with cervical SCI, stratified by baseline neurological status.

Setting: Three large prospective, multicenter data sets of patients with acute SCI.

Methods: Patients with acute cervical SCI were enrolled. The primary outcomes were upper extremity motor scores (UEMS) and lower extremity motor scores (LEMS) at 1 year. Patients were grouped by baseline American Spinal Injury Association Impairment Scale (AIS) grade.

Results: 908 patients meeting inclusion criteria were analyzed. In AIS grade A patients, the use of MPSS resulted in significantly improved LEMS (mean difference [MD], 3.0; 95% CI, 0.3-5.6; p = 0.02), but not UEMS (MD, 0.5; 95% CI, -2.5-3.5; p = 0.74), at 1 year. In contrast, no significant benefit was observed in patients with AIS grades B, C, or D. In AIS grade A patients, the MPSS group had a lower incidence of cardiopulmonary adverse events (42.5 vs. 62.8%; p < 0.001) and gastrointestinal/genitourinary adverse events (13.7 vs. 22.4%; p = 0.04).

Conclusions: MPSS was associated with improved lower extremity motor recovery in AIS grade A cervical SCI patients. No significant effect was seen in patients with incomplete injuries. MPSS was not associated with an overall increase in adverse events, suggesting it may be selectively beneficial in severe cervical SCI.