Spinal cord最新文献

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.

Study design: This is a descriptive qualitative study.

Objectives: To explore factors influencing the adoption of innovative assistive outdoor devices in persons living with Spinal Cord Injury (SCI), using a tricycle designed for people with reduced mobility as a case in point.

Setting: Community-based research conducted in Switzerland.

Methods: Twenty-five participants with SCI used a tricycle for a period of six weeks. Data were collected via diaries, and semi-structured interviews conducted before and after the trial. Thematic analysis of the interviews was performed using MAXQDA software, combining deductive and inductive approaches.

Results: Participants valued the tricycle's innovative design, therapeutic potential, and recreational use, especially in outdoor settings. However, challenges such as difficulty in maneuvering, incompatibility with routines, and perceived impracticality limited its acceptance. Contradictory feedback highlighted the variability in user needs, emphasizing that "one size does not fit all." Customization and user support were critical but did not fully address all limitations, as the tricycle was often deemed unsuitable for daily use.

Conclusions: Novel outdoor mobility devices require an extended usability and lifestyle integration to meet diverse user needs. For individuals with SCI, compatibility, simplicity, and adaptability are crucial. Co-creation with users and flexible designs are essential to ensure new devices align with their lived experiences.

Sponsorship: No commercial sponsorship was involved in this study.