Spinal cord最新文献

Study design: Cross-sectional observational study.

Objectives: Deep-tissue injury (DTI) originates in subcutaneous soft tissue and progresses outward without early skin changes, making diagnosis difficult in people with spinal-cord injury (SCI). We evaluated the incidence of DTI with magnetic resonance imaging (MRI) and sought associated risk factors.

Setting: Kibikogen Rehabilitation Center for Employment Injuries, Japan.

Methods: Fifty-six wheelchair-dependent adults with SCI of at least 1 month's duration underwent pelvic sagittal STIR MRI screening. DTI-positive sites were defined by signal changes in subcutaneous fat or muscle. Ultrasonography, body composition, seating-related variables, and laboratory data were collected concurrently. Univariate and multivariate logistic-regression analyses identified independent risk factors.

Results: MRI detected subclinical DTI in 33 of 112 ischial regions (29.5%). Ultrasonography was concordant in only 15 sites (45.5%). Multivariable analysis showed that longer daily wheelchair use (p = 0.018), greater subcutaneous-tissue thickness at the ischial tuberosities (p = 0.028), and less-frequent pressure-relief manoeuvres (p = 0.031; protective) were independently associated with DTI. BMI, peak interface pressure, and routine haematologic or nutritional markers were not significant.

Conclusions: MRI screening revealed subclinical DTI in nearly one-third of wheelchair-dependent patients with SCI and outperformed ultrasonography for early detection. Extended sitting time, thicker subcutaneous fat at the ischial tuberosity, and infrequent pressure relief emerged as modifiable risk factors. A risk-based MRI surveillance strategy may enable timely preventive interventions and reduce progression to overt pressure ulcers.

Study design: Retrospective cohort study.

Objectives: To identify clinical and demographic factors associated with functional recovery and length of hospital stay in individuals with spinal cord injury undergoing inpatient rehabilitation.

Setting: Physical Medicine and Rehabilitation Center at Ankara Bilkent City Hospital, Turkey.

Methods: Medical records of patients with spinal cord injury admitted for inpatient rehabilitation between January 2020 and September 2023 were retrospectively reviewed. Demographic characteristics, injury-related variables, neurological level, ASIA classification, SCIM III scores, complications, assistive rehabilitation interventions, bladder management, and functional status were collected. Univariate analyses (Mann-Whitney U, Kruskal-Wallis, Chi-square) were performed, followed by multivariate regression to identify independent predictors of functional outcomes.

Results: A total of 342 patients were included (mean age 38.9 ± 16.2 years). The mean length of stay was 41.6 ± 20.3 days. Univariate analyses showed that age, time since injury, neurological level, multiple hospitalizations, SCIM III scores, complications, advanced rehabilitation technologies, and bladder catheterization were significantly associated with both functional status and hospitalization duration (p < 0.05). Multivariate regression demonstrated that age (β = -0.24, 95% CI: -0.35 to -0.13, p < 0.001), presence of complications (β = -0.31, 95% CI: -0.46 to -0.17, p < 0.001), and bladder catheterization (β = -0.19, 95% CI: -0.32 to -0.07, p = 0.004) were independent predictors of discharge SCIM III scores.

Conclusions: Age, neurological integrity, complications, and bladder management are key determinants of functional outcomes in SCI rehabilitation, while these factors also influence length of stay. Early complication prevention, optimized bladder care, and tailored rehabilitation strategies may enhance recovery and shorten hospitalization.

Sponsorship: No commercial sponsorship was received for this study.

Study design: Guidelines update.

Objectives: To provide management recommendations and strategies for cognitive impairment (CI) in people with spinal cord injury (SCI) for healthcare professionals (HCPs).

Setting: SCI Units, NSW, Australia.

Methods: The development encompassed multiple stages, commencing with establishment of the multidisciplinary advisory committee, followed by expert consultations. A rapid review and e-Delphi surveys were undertaken for the seven identified themes to achieve consensus for a new section on CI in an existing psychosocial guide. The intended primary end-user for this guide consists of the HCPs providing treatment to people with SCI in the acute, rehabilitation, and community settings. The secondary end-user includes consumer organisations, health planners, and policy makers.

Results: The expert consultation resulted in developing seven key themes to provide a foundational structure to the guidance about CI. For the first round of the Delphi survey, 40 (out of 49) statements received agreement levels exceeding 95% and were accepted without revisions. In the second round, two statements were deleted, and seven statements were amended based on the feedback received. After the final round, a total of 47 statements were accepted and formed 20 recommendations under seven themes as the final version of the cognitive guide.

Conclusion: This updated guidance for managing CI in people with SCI emphasises the importance of person-centred care and the identification of barriers and facilitators for improved communication between the multidisciplinary HCPs and patients with SCI and their family members. This will ultimately enhance overall rehabilitation outcomes including self-efficacy, adjustment, and quality of life.

Study design: Randomized, placebo-controlled, double-blind, parallel-group, superiority trial.

Objective: Sufficient vitamin D levels (serum 25(OH)D > 75 nmol/L) are essential for bone health. The prevalence of insufficient 25(OH)D levels and osteoporosis is high in individuals with spinal cord injury (SCI). This study presents secondary outcomes from the VitD-SCI trial, which evaluated the effect of two D3 supplementation doses over a 12-month period on bone mineral density (BMD) in individuals with chronic SCI.

Setting: Swiss SCI clinic.

Methods: Forty-two individuals living with SCI for at least three years (seven females, mean age 48 ± 10 years, 18 ± 13 years since SCI onset) and having insufficient 25(OH)D levels were included. Participants were randomized to receive placebo, medium-dose (24'000 IU once every four weeks), or high-dose (24'000 IU once every two weeks) D3 supplementation for 12 months. At baseline and 12 months, 25(OH)D levels and BMD (measured at the radius, femoral neck, distal femur, and proximal tibia) were assessed.

Results: Thirty-three percent of participants who received supplementation achieved sufficient 25(OH)D levels. No effect of D3 supplementation on BMD was observed when comparing baseline to 12 months, regardless of the measurement site. None of the investigated parameters, including lesion level or smoking status, modified the effect under examination.

Conclusion: Twelve months of D3 supplementation showed no effect on BMD in individuals with chronic SCI. This study highlights the complexity of SCI-specific physiological mechanisms that may interfere with the response to D3 supplementation and its impact on bone health in this population.

Study design: Cohort study.

Objectives: To determine the prevalence and to identify predictors of prescription opioid use among persons with non-traumatic spinal cord dysfunction within one year after discharge from inpatient rehabilitation.

Setting: Ontario, Canada.

Methods: We conducted a retrospective cohort study using administrative data to determine predictors of receiving prescription opioids during the one year after discharge from inpatient rehabilitation among persons with non-traumatic spinal cord dysfunction between April 1, 2004 and March 31, 2015. We modelled the outcome using a Poisson multivariable regression and reported relative risks with 95% confidence intervals.

Results: We identified 3468 individuals with non-traumatic spinal cord dysfunction (50.35% male) with 66.58% who were aged ≥66. Over half of the cohort (59.46%) received opioids during the observation period. Being female, previous opioid use before rehabilitation, increasing comorbidity level, low functional status, and having a previous diagnosis of osteoarthritis were significant risk factors for receiving opioids after discharge, as shown in an adjusted multivariable analysis. Increasing length of rehabilitation stay was protective against opioid receipt after discharge. Risk of receiving opioids varied with age. Younger individuals had a significantly higher risk of future opioid use, a risk that peaked around 30-40 years of age (aRR 1.54, 95% CI 1.42-1.67 for age 40, as compared to age 80). Risk of opioid use following discharge decreased as age increased beyond 40 years, as compared to age 80.

Conclusions: Many individuals with non-traumatic spinal cord dysfunction in Ontario are prescribed opioids after discharge from inpatient rehabilitation. This may be problematic due to the number of severe complications that may arise from opioid use and their use in this population warrants future research.