Pub Date : 2025-11-14DOI: 10.1038/s41393-025-01147-0
Sabrina Imhof, Sibylle Achermann, Maria Rasenack, Inge Eriks Hoogland, Björn Zörner
Multicenter clinical trial. Timed walking tests are commonly used in clinical and research settings to evaluate walking function in people with spinal cord injury (PwSCI), but they usually do not capture the people’s subjective walking experience. The 12-item Multiple Sclerosis Walking Scale (12-WS) is widely used to assess self-perceived walking ability in people with multiple sclerosis (PwMS), but no comparable tool exists for SCI. This study aimed to assess the reliability and validity of the 12-WS in people with cervical or thoracic incomplete SCI (PwiSCI). Balgrist University Hospital, Zurich, Switzerland; Swiss Paraplegic Centre Nottwil, Switzerland. In this clinical trial, 67 PwiSCI (more than 6 months post-injury, AIS C/D) completed the 12-WS and different clinically established gait assessments. Participants completed the 12-WS a second time within a maximum interval of 8 weeks. Results were compared to a cohort of 22 PwMS. The test–retest reliability of the 12-WS was excellent (ICC = 0.91; p < 0.001). Internal consistency was high (Cronbach’s Alpha α = 0.95). SEM and MDC95 were 6.5 and 18.1%, respectively. Strong correlations were found with all gait assessments (ρ = ± 0.62 to ± 0.67; p < 0.001), except for two items (running and cognitive effort), which showed weaker associations. Results for iSCI were consistent with those for the MS cohort. The 12-WS is a reliable and valid patient-reported outcome measure for evaluating walking function in PwSCI. It complements objective gait assessments and supports a comprehensive evaluation of walking function.
{"title":"Reliability and validity of the 12-item multiple sclerosis walking scale in adults with chronic cervical or thoracic incomplete spinal cord injury","authors":"Sabrina Imhof, Sibylle Achermann, Maria Rasenack, Inge Eriks Hoogland, Björn Zörner","doi":"10.1038/s41393-025-01147-0","DOIUrl":"10.1038/s41393-025-01147-0","url":null,"abstract":"Multicenter clinical trial. Timed walking tests are commonly used in clinical and research settings to evaluate walking function in people with spinal cord injury (PwSCI), but they usually do not capture the people’s subjective walking experience. The 12-item Multiple Sclerosis Walking Scale (12-WS) is widely used to assess self-perceived walking ability in people with multiple sclerosis (PwMS), but no comparable tool exists for SCI. This study aimed to assess the reliability and validity of the 12-WS in people with cervical or thoracic incomplete SCI (PwiSCI). Balgrist University Hospital, Zurich, Switzerland; Swiss Paraplegic Centre Nottwil, Switzerland. In this clinical trial, 67 PwiSCI (more than 6 months post-injury, AIS C/D) completed the 12-WS and different clinically established gait assessments. Participants completed the 12-WS a second time within a maximum interval of 8 weeks. Results were compared to a cohort of 22 PwMS. The test–retest reliability of the 12-WS was excellent (ICC = 0.91; p < 0.001). Internal consistency was high (Cronbach’s Alpha α = 0.95). SEM and MDC95 were 6.5 and 18.1%, respectively. Strong correlations were found with all gait assessments (ρ = ± 0.62 to ± 0.67; p < 0.001), except for two items (running and cognitive effort), which showed weaker associations. Results for iSCI were consistent with those for the MS cohort. The 12-WS is a reliable and valid patient-reported outcome measure for evaluating walking function in PwSCI. It complements objective gait assessments and supports a comprehensive evaluation of walking function.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 1","pages":"53-59"},"PeriodicalIF":2.2,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145522855","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-14DOI: 10.1038/s41393-025-01142-5
Clara Häfliger, Sara Rubinelli, Nicola Diviani, Mirjam Brach, Claudia Zanini
This is a descriptive qualitative study. 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. Community-based research conducted in Switzerland. 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. 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. 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. No commercial sponsorship was involved in this study.
{"title":"“This trike is cool, but…”: a qualitative study on real-world adoption of an outdoor mobility device in people with spinal cord injury","authors":"Clara Häfliger, Sara Rubinelli, Nicola Diviani, Mirjam Brach, Claudia Zanini","doi":"10.1038/s41393-025-01142-5","DOIUrl":"10.1038/s41393-025-01142-5","url":null,"abstract":"This is a descriptive qualitative study. 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. Community-based research conducted in Switzerland. 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. 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. 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. No commercial sponsorship was involved in this study.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 2","pages":"192-198"},"PeriodicalIF":2.2,"publicationDate":"2025-11-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145522865","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-13DOI: 10.1038/s41393-025-01146-1
Mustafa Hüseyin Temel, Ebru Kübra Taşpolat, Fatih Bağcıer, Evrim Coşkun Çelik
Cross-sectional survey. This study aimed to investigate health literacy (HL) in individuals with spinal cord injury (SCI), focusing on its relationship with quality of life (QoL) and related factors. Rehabilitation Service, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey. Between May 2025 and October 2025, 61 SCI participants aged 18–70 were enrolled in the Başakşehir Çam and Sakura City Hospital. HL and QoL surveys were administered to the participants. This cross-sectional study collected demographic and survey data from participant records. This study used the Ferrans & Powers Quality of Life Index Spinal Cord Injury Version (QLI) to measure QoL. The Turkey Health Literacy Scale (TSOY-32) was utilized to evaluate HL levels. QLI assesses QoL through four core subdomains: Health and Functioning, Family, Social/ Economic, and Psychological/Spiritual. Among the 61 individuals with SCI, 80.3% were male. Falls were the leading cause of injury, accounting for 44.3% of the cases, and 55.7% of the participants had complete SCI. It was determined that 26.2% of individuals had insufficient HL, 27.9% had problematic/limited HL, 32.8% had adequate HL, and 13.1% had excellent HL levels. A significant positive relationship was found between HL and QoL. Individuals with excellent HL had significantly higher scores on the social and economic subdomains of the QLI compared to those in the insufficient and problematic/limited categories. The multivariable regression model was statistically significant (F (12,48) = 2.649, p = 0.008), explaining 16.5% of the variance in overall QoL (adjusted R² = 0.165). HL levels are positively associated with QoL. For these reasons, conducting studies aimed at enhancing HL in individuals with SCI, particularly through communication and education strategies, would be beneficial.
{"title":"The effect of health literacy on quality of life in individuals with chronic spinal cord injury","authors":"Mustafa Hüseyin Temel, Ebru Kübra Taşpolat, Fatih Bağcıer, Evrim Coşkun Çelik","doi":"10.1038/s41393-025-01146-1","DOIUrl":"10.1038/s41393-025-01146-1","url":null,"abstract":"Cross-sectional survey. This study aimed to investigate health literacy (HL) in individuals with spinal cord injury (SCI), focusing on its relationship with quality of life (QoL) and related factors. Rehabilitation Service, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey. Between May 2025 and October 2025, 61 SCI participants aged 18–70 were enrolled in the Başakşehir Çam and Sakura City Hospital. HL and QoL surveys were administered to the participants. This cross-sectional study collected demographic and survey data from participant records. This study used the Ferrans & Powers Quality of Life Index Spinal Cord Injury Version (QLI) to measure QoL. The Turkey Health Literacy Scale (TSOY-32) was utilized to evaluate HL levels. QLI assesses QoL through four core subdomains: Health and Functioning, Family, Social/ Economic, and Psychological/Spiritual. Among the 61 individuals with SCI, 80.3% were male. Falls were the leading cause of injury, accounting for 44.3% of the cases, and 55.7% of the participants had complete SCI. It was determined that 26.2% of individuals had insufficient HL, 27.9% had problematic/limited HL, 32.8% had adequate HL, and 13.1% had excellent HL levels. A significant positive relationship was found between HL and QoL. Individuals with excellent HL had significantly higher scores on the social and economic subdomains of the QLI compared to those in the insufficient and problematic/limited categories. The multivariable regression model was statistically significant (F (12,48) = 2.649, p = 0.008), explaining 16.5% of the variance in overall QoL (adjusted R² = 0.165). HL levels are positively associated with QoL. For these reasons, conducting studies aimed at enhancing HL in individuals with SCI, particularly through communication and education strategies, would be beneficial.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 1","pages":"46-52"},"PeriodicalIF":2.2,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145506702","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Systematic review and meta-analysis. To assess the risk of type 2 diabetes mellitus (T2DM) in individuals with spinal cord injury (SCI) and explore factors contributing to this variability. The studies included in this review were conducted across multiple countries, offering a diverse representation of global prevalence. A systematic search was conducted. A random-effects meta-analysis estimated the pooled prevalence and odds ratio of data extracted from eligible studies. Meta-regression and subgroup analysis were performed to assess the impact of covariates and study variables. 28 studies were included, with a total of 99,916 individuals. The pooled prevalence of T2DM in the SCI population was 14.2% (95% CI: 10.3–18%). Moreover, a meta-analysis of the odds ratio (OR) demonstrates the pooled random‐effects of 2.3 (95% CI: 1.5–3.5). Geographical differences were a key factor, with higher prevalence reported in the USA (18.9%) compared to other regions (8.2%) (p = 0.002). Age was also positively associated with T2DM prevalence (p = 0.007), with a significant rise observed in individuals over 50. Additionally, a significantly higher pooled prevalence of T2DM among the veteran population compared to non-veterans has been revealed (21 and 10.3%, respectively). Our findings confirm a significantly greater likelihood of T2DM in SCI individuals and a higher burden of T2DM compared to the general population. The correlation between aging and T2DM prevalence emphasizes the necessity for early screening in older SCI individuals.
{"title":"Evaluating the risk of type 2 diabetes mellitus after spinal cord injury: insights from a systematic review and meta-analysis","authors":"Ghazal Tavakoli, Alireza Ghaleh, Amir Ghanbari, Matin Baghani, Morvarid Saeinasab, Farshid Sefat, Milad Rahimzadegan","doi":"10.1038/s41393-025-01137-2","DOIUrl":"10.1038/s41393-025-01137-2","url":null,"abstract":"Systematic review and meta-analysis. To assess the risk of type 2 diabetes mellitus (T2DM) in individuals with spinal cord injury (SCI) and explore factors contributing to this variability. The studies included in this review were conducted across multiple countries, offering a diverse representation of global prevalence. A systematic search was conducted. A random-effects meta-analysis estimated the pooled prevalence and odds ratio of data extracted from eligible studies. Meta-regression and subgroup analysis were performed to assess the impact of covariates and study variables. 28 studies were included, with a total of 99,916 individuals. The pooled prevalence of T2DM in the SCI population was 14.2% (95% CI: 10.3–18%). Moreover, a meta-analysis of the odds ratio (OR) demonstrates the pooled random‐effects of 2.3 (95% CI: 1.5–3.5). Geographical differences were a key factor, with higher prevalence reported in the USA (18.9%) compared to other regions (8.2%) (p = 0.002). Age was also positively associated with T2DM prevalence (p = 0.007), with a significant rise observed in individuals over 50. Additionally, a significantly higher pooled prevalence of T2DM among the veteran population compared to non-veterans has been revealed (21 and 10.3%, respectively). Our findings confirm a significantly greater likelihood of T2DM in SCI individuals and a higher burden of T2DM compared to the general population. The correlation between aging and T2DM prevalence emphasizes the necessity for early screening in older SCI individuals.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 1","pages":"29-39"},"PeriodicalIF":2.2,"publicationDate":"2025-11-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145514023","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-12DOI: 10.1038/s41393-025-01134-5
Emma M. Smith, Noah Tregobov, William C. Miller
To evaluate the feasibility of the Collaborative Power Mobility Innovative Learning OpporTunity (CoPILOT) wheelchair training protocol and intervention among new powerchair users with spinal injuries, focusing on feasibility metrics and clinical outcomes. An evaluator-blind, parallel randomized controlled trial. Rehabilitation hospital/community setting in Vancouver, Canada. Participants were randomized to CoPILOT or control group (the Wheelchair Skills Program (WSP)). Trained occupational therapists conducted sessions. Data included demographics and feasibility metrics (process, resource, management, treatment safety), as well as primary (Power Mobility Indoor Driving Assessment—PIDA) and secondary outcomes: Wheelchair Skills Test Questionnaire for Powered Wheelchairs—WST-Q-P (capacity and performance subscales), the Wheeling While Talking—WheelTalk task, and the Wheelchair Use Confidence Scale for Powered Wheelchair Users—WheelCon-P (Mobility and Social sub scores). 10 participants (9 male), mean age (SD) was 56.9 years (17.40), and all had prior manual wheelchair use. Attendance (SD) averaged 7.75 sessions (3.49) for CoPILOT group and 8.8 (3.70) for the WSP group. Both groups had baseline and final PIDA scores above 90%. On the WST-Q-P capacity subscale, CoPILOT improved by 8.25% (SD = 19.75), whereas WSP improved by 10.8% (SD = 9.86); on the performance subscale, CoPILOT improved by 8.00% (SD = 19.88) compared to 19.8% (SD = 24.52) for WSP. WheelTalk times, rose by 36.16 s (SD = 45.71) in CoPILOT but declined by 33.46 s (SD = 36.58) in WSP. For WheelCon-P, Mobility sub score increased by 26.75 (SD = 15.33) in CoPILOT versus –18.2 (SD = 77.24) in WSP, and Social sub score changed by –5 (SD = 6.93) versus 4 (SD = 11.94), respectively. The retention rate was 90%, yet neither group achieved the ≥80% session-adherence goal. CoPILOT showed promise in improving wheelchair skills and safety for new powerchair users with spinal injuries. However, recruitment and adherence challenges indicate a need for improved engagement and delivery methods. Further robust RCTs could compare CoPILOT’s effectiveness with standard care. ClinicalTrials.gov ID: NCT02320786.
{"title":"A feasibility study of a shared control powered wheelchair training program for individuals with spinal cord injury","authors":"Emma M. Smith, Noah Tregobov, William C. Miller","doi":"10.1038/s41393-025-01134-5","DOIUrl":"10.1038/s41393-025-01134-5","url":null,"abstract":"To evaluate the feasibility of the Collaborative Power Mobility Innovative Learning OpporTunity (CoPILOT) wheelchair training protocol and intervention among new powerchair users with spinal injuries, focusing on feasibility metrics and clinical outcomes. An evaluator-blind, parallel randomized controlled trial. Rehabilitation hospital/community setting in Vancouver, Canada. Participants were randomized to CoPILOT or control group (the Wheelchair Skills Program (WSP)). Trained occupational therapists conducted sessions. Data included demographics and feasibility metrics (process, resource, management, treatment safety), as well as primary (Power Mobility Indoor Driving Assessment—PIDA) and secondary outcomes: Wheelchair Skills Test Questionnaire for Powered Wheelchairs—WST-Q-P (capacity and performance subscales), the Wheeling While Talking—WheelTalk task, and the Wheelchair Use Confidence Scale for Powered Wheelchair Users—WheelCon-P (Mobility and Social sub scores). 10 participants (9 male), mean age (SD) was 56.9 years (17.40), and all had prior manual wheelchair use. Attendance (SD) averaged 7.75 sessions (3.49) for CoPILOT group and 8.8 (3.70) for the WSP group. Both groups had baseline and final PIDA scores above 90%. On the WST-Q-P capacity subscale, CoPILOT improved by 8.25% (SD = 19.75), whereas WSP improved by 10.8% (SD = 9.86); on the performance subscale, CoPILOT improved by 8.00% (SD = 19.88) compared to 19.8% (SD = 24.52) for WSP. WheelTalk times, rose by 36.16 s (SD = 45.71) in CoPILOT but declined by 33.46 s (SD = 36.58) in WSP. For WheelCon-P, Mobility sub score increased by 26.75 (SD = 15.33) in CoPILOT versus –18.2 (SD = 77.24) in WSP, and Social sub score changed by –5 (SD = 6.93) versus 4 (SD = 11.94), respectively. The retention rate was 90%, yet neither group achieved the ≥80% session-adherence goal. CoPILOT showed promise in improving wheelchair skills and safety for new powerchair users with spinal injuries. However, recruitment and adherence challenges indicate a need for improved engagement and delivery methods. Further robust RCTs could compare CoPILOT’s effectiveness with standard care. ClinicalTrials.gov ID: NCT02320786.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"64 1","pages":"40-45"},"PeriodicalIF":2.2,"publicationDate":"2025-11-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145506699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-10DOI: 10.1038/s41393-025-01143-4
Thorsten Rudroff
Review article. Despite spinal cord pathology driving progressive disability in multiple sclerosis (MS), research has disproportionately focused on brain imaging. The clinical manifestations most relevant to MS patients—mobility impairment, fatigue, and autonomic dysfunction—derive primarily from spinal cord involvement, yet spinal cord metabolism remains virtually unexplored. To quantify the research gap in spinal cord metabolic imaging and evaluate scientific rationale, technological readiness, and implementation potential for establishing this approach as a cornerstone of MS research. I conducted a structured literature analysis of MS imaging publications (2014–2024) using defined PubMed searches, analyzed clinical trial registries for metabolic endpoints, and reviewed technological advances supporting clinical implementation. The analysis revealed a striking 949:1 publication ratio between brain and spinal cord metabolic imaging studies, with only three spinal cord metabolic investigations versus 2847 brain imaging studies. Our 2014 study using ¹⁸F-FDG PET during walking exercise demonstrated significantly reduced glucose uptake in MS patients’ thoracic and lumbar spinal cord regions, correlating strongly with functional disability. Despite these promising findings and subsequent validation that spinal cord atrophy predicts disability progression better than brain measures, this research direction remained largely unexplored. Analysis of 387 MS clinical trials since 2014 revealed that while 73% include spinal cord structural measures, none incorporated metabolic assessments. Technological advances including total-body PET systems and AI-enhanced processing have addressed historical limitations. Spinal cord metabolic imaging represents a transformative but neglected research opportunity that could revolutionize MS biomarker development and precision medicine approaches.
{"title":"Spinal cord metabolism in multiple sclerosis: a decade of missed opportunities and future directions","authors":"Thorsten Rudroff","doi":"10.1038/s41393-025-01143-4","DOIUrl":"10.1038/s41393-025-01143-4","url":null,"abstract":"Review article. Despite spinal cord pathology driving progressive disability in multiple sclerosis (MS), research has disproportionately focused on brain imaging. The clinical manifestations most relevant to MS patients—mobility impairment, fatigue, and autonomic dysfunction—derive primarily from spinal cord involvement, yet spinal cord metabolism remains virtually unexplored. To quantify the research gap in spinal cord metabolic imaging and evaluate scientific rationale, technological readiness, and implementation potential for establishing this approach as a cornerstone of MS research. I conducted a structured literature analysis of MS imaging publications (2014–2024) using defined PubMed searches, analyzed clinical trial registries for metabolic endpoints, and reviewed technological advances supporting clinical implementation. The analysis revealed a striking 949:1 publication ratio between brain and spinal cord metabolic imaging studies, with only three spinal cord metabolic investigations versus 2847 brain imaging studies. Our 2014 study using ¹⁸F-FDG PET during walking exercise demonstrated significantly reduced glucose uptake in MS patients’ thoracic and lumbar spinal cord regions, correlating strongly with functional disability. Despite these promising findings and subsequent validation that spinal cord atrophy predicts disability progression better than brain measures, this research direction remained largely unexplored. Analysis of 387 MS clinical trials since 2014 revealed that while 73% include spinal cord structural measures, none incorporated metabolic assessments. Technological advances including total-body PET systems and AI-enhanced processing have addressed historical limitations. Spinal cord metabolic imaging represents a transformative but neglected research opportunity that could revolutionize MS biomarker development and precision medicine approaches.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 12","pages":"642-647"},"PeriodicalIF":2.2,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41393-025-01143-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-10DOI: 10.1038/s41393-025-01139-0
Marissa Wirth, Sophia Raval, Reside Jacob, Kelsey Berryman, Brian Bartle, Alex W. K. Wong, Robert W. Motl, Charles H. Bombardier, Sherri L. LaVela
Cross-sectional cohort study. To examine lifestyle behaviors independently associated with loneliness among Veterans living with spinal cord injuries and disorders (SCI/D). The Veteran Health Administration SCI/D System of Care, including 25 regional SCI/D Centers and associated Hubs. A national random sample of community-dwelling Veterans with SCI/D who used VHA healthcare services between 2017–2022 participated in a survey. We assessed unadjusted associations with moderate/high loneliness vs no/low loneliness. Multivariable logistic regression model assessed factors independently associated with moderate/high loneliness. Among 2466 Veterans with SCI/D, 592 completed surveys (24%). Most participants were male (91%), white (81%), and on average 63 years old. The average injury duration was 18 years; 68% had paraplegia, and 80% had traumatic injuries. Lifestyle behavior factors, including poor sleep hygiene (OR 1.67; p = 0.02), fair/poor eating habits (OR 1.64; p = 0.50), and fewer days of leisure-time activities (OR 0.97; p = 0.01), and demographic and injury variables including having paraplegia (OR 1.99; p = 0.002), being unmarried (OR 2.02; p = 0.001), a greater number of SCI/D secondary conditions (OR 1.27; p = 0.002), and a greater number of poor physical health days (OR 1.02; p = 0.03) were each independently significantly associated with greater odds of moderate/high loneliness. The comprehensive approach of integrating and promoting healthy lifestyle behaviors such as a healthy diet, improved sleep hygiene, and promotion of leisure activities could have a positive effect on loneliness, especially in individuals with paraplegia, who are unmarried, have a greater number of SCI/D secondary conditions, and experience more days of poor physical health.
研究设计：横断面队列研究。目的：探讨脊髓损伤/障碍退伍军人生活方式行为与孤独感的独立关系。设置：退伍军人健康管理局SCI/D护理系统，包括25个区域SCI/D中心和相关中心。方法：对2017-2022年使用VHA医疗服务的社区SCI/D退伍军人进行全国随机抽样调查。我们评估了中度/高度孤独感与无/低孤独感的未调整关联。多变量logistic回归模型评估了与中/高度孤独感独立相关的因素。结果：2466例SCI/D退伍军人中，592例（24%）完成问卷调查。大多数参与者为男性（91%），白人（81%），平均年龄为63岁。平均受伤时间为18年；68%有截瘫，80%有外伤性损伤。生活方式行为因素，包括不良的睡眠卫生（OR 1.67, p = 0.02）、一般/不良的饮食习惯（OR 1.64, p = 0.50）、较少的休闲活动天数（OR 0.97, p = 0.01），以及人口统计学和伤害变量，包括截瘫（OR 1.99, p = 0.002）、未婚（OR 2.02, p = 0.001）、较多的SCI/D继发性疾病（OR 1.27, p = 0.002）和较多的身体健康状况不佳天数（OR 1.02, p = 0.001）；P = 0.03)均与较高的中度/高度孤独感相关。结论：综合整合和促进健康的生活方式行为，如健康饮食、改善睡眠卫生、促进休闲活动等，可对孤独感产生积极影响，特别是对于未婚、SCI/D继发疾病较多、身体健康状况不佳天数较多的截瘫患者。
{"title":"Lifestyle behaviors and loneliness in community-dwelling veterans living with spinal cord injuries and disorders","authors":"Marissa Wirth, Sophia Raval, Reside Jacob, Kelsey Berryman, Brian Bartle, Alex W. K. Wong, Robert W. Motl, Charles H. Bombardier, Sherri L. LaVela","doi":"10.1038/s41393-025-01139-0","DOIUrl":"10.1038/s41393-025-01139-0","url":null,"abstract":"Cross-sectional cohort study. To examine lifestyle behaviors independently associated with loneliness among Veterans living with spinal cord injuries and disorders (SCI/D). The Veteran Health Administration SCI/D System of Care, including 25 regional SCI/D Centers and associated Hubs. A national random sample of community-dwelling Veterans with SCI/D who used VHA healthcare services between 2017–2022 participated in a survey. We assessed unadjusted associations with moderate/high loneliness vs no/low loneliness. Multivariable logistic regression model assessed factors independently associated with moderate/high loneliness. Among 2466 Veterans with SCI/D, 592 completed surveys (24%). Most participants were male (91%), white (81%), and on average 63 years old. The average injury duration was 18 years; 68% had paraplegia, and 80% had traumatic injuries. Lifestyle behavior factors, including poor sleep hygiene (OR 1.67; p = 0.02), fair/poor eating habits (OR 1.64; p = 0.50), and fewer days of leisure-time activities (OR 0.97; p = 0.01), and demographic and injury variables including having paraplegia (OR 1.99; p = 0.002), being unmarried (OR 2.02; p = 0.001), a greater number of SCI/D secondary conditions (OR 1.27; p = 0.002), and a greater number of poor physical health days (OR 1.02; p = 0.03) were each independently significantly associated with greater odds of moderate/high loneliness. The comprehensive approach of integrating and promoting healthy lifestyle behaviors such as a healthy diet, improved sleep hygiene, and promotion of leisure activities could have a positive effect on loneliness, especially in individuals with paraplegia, who are unmarried, have a greater number of SCI/D secondary conditions, and experience more days of poor physical health.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 12","pages":"1-7"},"PeriodicalIF":2.2,"publicationDate":"2025-11-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145490381","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-08DOI: 10.1038/s41393-025-01131-8
Caroline A. Treanor, David B. Anderson, Benjamin M. Davies, Harvinder S. Chhabra, Mike Hutton, Laskhmikumar Venkatraghavan, Jed S. Lazarus, Anoushka Singh, Kieran J. Smith, Daniel J. Stubbs, Aditya Vedantam, Juan J. Zamorano, Carl M. Zipser, Thomas W. Wainwright, Jay Wardropper, Michael G. Fehlings
Protocol for the development of enhanced recovery after surgery (ERAS) recommendations for DCM surgery. To develop ERAS recommendations in collaboration with the ERAS Society to optimize care for individuals having surgery for degenerative cervical myelopathy (DCM)—the most common type of nontraumatic spinal cord injury. The study protocol was developed in line with the AGREE II checklist for clinical practice guidelines and the ERAS Society standards for guideline development. A multidisciplinary international guideline development group (GDG) including a representative from the ERAS society, clinical experts in the surgical care of people with DCM, and people with lived experience of having surgery for DCM has been established. The recommendations will follow the GRADE methodology and will therefore include the following steps. 1) Framing the health care questions. 2) Selecting and rating the importance of outcomes for each ERAS candidate interventiont. 3) Summarizing the evidence for each ERAS candidate intervention. 4) Judging the quality of evidence for each ERAS candidate intervention. 5) Judging the strength of the recommendations for each ERAS candidate intervention. 6) Developing recommendations statements for the included ERAS interventions and achieving consensus on the ERAS intervention statements to be included in the final guideline. Following the recommendation statements’ development, key stakeholders will be invited to externally review the guidelines. ERAS recommendations for DCM aim to reduce the incidence and severity of adverse events, optimize patient outcomes, improve the efficiency and quality of care, and patients’ experience and satisfaction with care.
{"title":"Protocol for the development of enhanced recovery after surgery (ERAS) recommendations for individuals undergoing surgery for degenerative cervical myelopathy","authors":"Caroline A. Treanor, David B. Anderson, Benjamin M. Davies, Harvinder S. Chhabra, Mike Hutton, Laskhmikumar Venkatraghavan, Jed S. Lazarus, Anoushka Singh, Kieran J. Smith, Daniel J. Stubbs, Aditya Vedantam, Juan J. Zamorano, Carl M. Zipser, Thomas W. Wainwright, Jay Wardropper, Michael G. Fehlings","doi":"10.1038/s41393-025-01131-8","DOIUrl":"10.1038/s41393-025-01131-8","url":null,"abstract":"Protocol for the development of enhanced recovery after surgery (ERAS) recommendations for DCM surgery. To develop ERAS recommendations in collaboration with the ERAS Society to optimize care for individuals having surgery for degenerative cervical myelopathy (DCM)—the most common type of nontraumatic spinal cord injury. The study protocol was developed in line with the AGREE II checklist for clinical practice guidelines and the ERAS Society standards for guideline development. A multidisciplinary international guideline development group (GDG) including a representative from the ERAS society, clinical experts in the surgical care of people with DCM, and people with lived experience of having surgery for DCM has been established. The recommendations will follow the GRADE methodology and will therefore include the following steps. 1) Framing the health care questions. 2) Selecting and rating the importance of outcomes for each ERAS candidate interventiont. 3) Summarizing the evidence for each ERAS candidate intervention. 4) Judging the quality of evidence for each ERAS candidate intervention. 5) Judging the strength of the recommendations for each ERAS candidate intervention. 6) Developing recommendations statements for the included ERAS interventions and achieving consensus on the ERAS intervention statements to be included in the final guideline. Following the recommendation statements’ development, key stakeholders will be invited to externally review the guidelines. ERAS recommendations for DCM aim to reduce the incidence and severity of adverse events, optimize patient outcomes, improve the efficiency and quality of care, and patients’ experience and satisfaction with care.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 12","pages":"674-680"},"PeriodicalIF":2.2,"publicationDate":"2025-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41393-025-01131-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145477358","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-07DOI: 10.1038/s41393-025-01138-1
Frederik Wilhelm Schneckmann, Alexander Klug, Tim Jakobi, Annika Werner, Anne Bauer, Matthias Münzberg, Stephan Kurz
A 10-year single-center retrospective chart review. To evaluate the differences between conservative and surgical treatment of long bone fractures in individuals with chronic SCI, focusing on wheelchair mobilization, overall hospital days, and complication rates. Spinal cord injury Department, BG Trauma Center Frankfurt am Main, Germany. The study, conducted between 2014 and 2023, compared conservative and surgical treatment for long bone fractures in individuals with chronic SCI using descriptive statistics. Fifty-eight fractures were included (31 surgical, 27 conservative). Baseline characteristics did not differ between groups (p > 0.05). Median time to first wheelchair mobilization was 14 days in both groups (median difference 0 days; 95% CI, –4 to 5; p = 0.38). LOS was comparable (median 45 vs. 46 days; difference –1 day; 95% CI, –7 to 6; p = 0.98). Complications occurred in 1 of 31 surgically treated cases (3.2%) versus 9 of 27 conservatively treated (33.3%), corresponding to a risk difference of –30.1% (95% CI, –48.3 to –11.9; p = 0.002). Non-surgical treatment had a higher complication rate than surgical treatment. Both approaches were equivalent in time to first wheelchair mobilization, and neither showed a significantly shorter hospital stay.
{"title":"Surgical and conservative treatment of lower limb fractures in patients with chronic spinal cord injury","authors":"Frederik Wilhelm Schneckmann, Alexander Klug, Tim Jakobi, Annika Werner, Anne Bauer, Matthias Münzberg, Stephan Kurz","doi":"10.1038/s41393-025-01138-1","DOIUrl":"10.1038/s41393-025-01138-1","url":null,"abstract":"A 10-year single-center retrospective chart review. To evaluate the differences between conservative and surgical treatment of long bone fractures in individuals with chronic SCI, focusing on wheelchair mobilization, overall hospital days, and complication rates. Spinal cord injury Department, BG Trauma Center Frankfurt am Main, Germany. The study, conducted between 2014 and 2023, compared conservative and surgical treatment for long bone fractures in individuals with chronic SCI using descriptive statistics. Fifty-eight fractures were included (31 surgical, 27 conservative). Baseline characteristics did not differ between groups (p > 0.05). Median time to first wheelchair mobilization was 14 days in both groups (median difference 0 days; 95% CI, –4 to 5; p = 0.38). LOS was comparable (median 45 vs. 46 days; difference –1 day; 95% CI, –7 to 6; p = 0.98). Complications occurred in 1 of 31 surgically treated cases (3.2%) versus 9 of 27 conservatively treated (33.3%), corresponding to a risk difference of –30.1% (95% CI, –48.3 to –11.9; p = 0.002). Non-surgical treatment had a higher complication rate than surgical treatment. Both approaches were equivalent in time to first wheelchair mobilization, and neither showed a significantly shorter hospital stay.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 12","pages":"648-652"},"PeriodicalIF":2.2,"publicationDate":"2025-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145471947","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2025-11-06DOI: 10.1038/s41393-025-01135-4
Zhiyang Shi, Shane N. Sweet, François Routhier, Jaimie Borisoff, Kelly P. Arbour-Nicitopoulos, Krista L. Best
A 3-city pilot randomized controlled trial. To evaluate the efficacy of an Active Living Lifestyles for manual Wheelchair users (ALLWheel) program for increasing participants’ leisure time physical activity, motivation, self-efficacy, and satisfaction of basic psychological needs from baseline to post-program (10 weeks) and at follow-up (3 months post-program). Rehabilitation centers and community. Forty adult community-dwelling manual wheelchair users with spinal cord injury were allocated to an intervention (n = 20) or control group (n = 20). The intervention group received a 10-week ALLWheel program. Leisure time physical activity, motivation, self-efficacy, and satisfaction of basic psychological needs were measured at baseline, post-intervention, and 3-month follow-up. Group differences were examined. The intervention and the control groups had a significant difference in total leisure time physical activity post-intervention, with a small effect size (Relative Treatment Effect = 0.38, p < 0.05). This difference was not significant at follow-up. The two groups had a significant difference in moderate-heavy leisure time physical activity post-intervention, with a small effect size (Relative Treatment Effect = 0.36, p < 0.05). This difference was not significant at follow-up. No significant group differences were found for the psychological outcomes post-intervention or at follow-up. The ALLWheel program had a small effect size for increasing adult wheelchair users’ total leisure time physical activity levels post-intervention, particularly for moderate-to-heavy intensity. However, this increase was not maintained at the 3-month follow-up. Additional refinement and testing of the ALLWheel program is warranted before moving to a larger-scale randomized control trial with active control groups.
{"title":"Active living lifestyles for manual wheelchair users (ALLWheel) program to enhance leisure time physical activity: a pilot randomized control trial","authors":"Zhiyang Shi, Shane N. Sweet, François Routhier, Jaimie Borisoff, Kelly P. Arbour-Nicitopoulos, Krista L. Best","doi":"10.1038/s41393-025-01135-4","DOIUrl":"10.1038/s41393-025-01135-4","url":null,"abstract":"A 3-city pilot randomized controlled trial. To evaluate the efficacy of an Active Living Lifestyles for manual Wheelchair users (ALLWheel) program for increasing participants’ leisure time physical activity, motivation, self-efficacy, and satisfaction of basic psychological needs from baseline to post-program (10 weeks) and at follow-up (3 months post-program). Rehabilitation centers and community. Forty adult community-dwelling manual wheelchair users with spinal cord injury were allocated to an intervention (n = 20) or control group (n = 20). The intervention group received a 10-week ALLWheel program. Leisure time physical activity, motivation, self-efficacy, and satisfaction of basic psychological needs were measured at baseline, post-intervention, and 3-month follow-up. Group differences were examined. The intervention and the control groups had a significant difference in total leisure time physical activity post-intervention, with a small effect size (Relative Treatment Effect = 0.38, p < 0.05). This difference was not significant at follow-up. The two groups had a significant difference in moderate-heavy leisure time physical activity post-intervention, with a small effect size (Relative Treatment Effect = 0.36, p < 0.05). This difference was not significant at follow-up. No significant group differences were found for the psychological outcomes post-intervention or at follow-up. The ALLWheel program had a small effect size for increasing adult wheelchair users’ total leisure time physical activity levels post-intervention, particularly for moderate-to-heavy intensity. However, this increase was not maintained at the 3-month follow-up. Additional refinement and testing of the ALLWheel program is warranted before moving to a larger-scale randomized control trial with active control groups.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 12","pages":"664-673"},"PeriodicalIF":2.2,"publicationDate":"2025-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145459697","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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