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}
Pub Date : 2025-11-05DOI: 10.1038/s41393-025-01141-6
Samuel David Williamson, Anders Orup Aaby, Anine Overgaard Ejersbo, Marianne Rahbek Vestergaard, Sophie Lykkegaard Ravn
Scoping review. Spasticity is a common and often challenging sequela of spinal cord injury (SCI) associated with pain, contractures, and reduced quality of life. While passive movement (PM) is primarily used to maintain joint mobility, clinical observations and participant reports suggest that both manual and automated techniques can contribute to the management of spasticity in SCI. However, the evidence base concerning PM’s impact on spasticity outcomes in SCI populations remains unclear. This review aims to identify the scope and synthesize the empirical evidence of PM interventions for managing spasticity in individuals with SCI. Seven databases (Embase, Medline, PsycInfo, Web of Science, Scopus, CENTRAL, and CINAHL) were systematically searched. Eligible studies were peer-reviewed, reported original data, included adult participants (≥18 years) with SCI, presented a therapeutic intervention consisting solely of PM techniques, and reported any spasticity outcome. Data were extracted and analyzed by two independent reviewers. The initial search identified 1628 unique studies, of which 13 were included for analysis. The PM interventions included passive cycling and robotic PM interventions (n = 8), continuous passive motion (n = 4), and manual passive range of motion (PROM) (n = 1). While a minority of studies demonstrated sustained improvements in spasticity outcomes, the majority reported short-term reductions observed in small sample groups, single-session experiments, or using suboptimal research designs. This review assembled the existing evidence on PM interventions for managing spasticity in individuals with SCI. Despite finding consistent short-term improvements, further high-quality research is needed to determine clinical efficacy and inform future rehabilitation practices.
研究设计：范围审查。目的：痉挛是脊髓损伤（SCI）的一种常见且具有挑战性的后遗症，与疼痛、挛缩和生活质量下降有关。虽然被动运动（PM）主要用于维持关节活动，但临床观察和参与者报告表明，手动和自动技术都有助于脊髓损伤痉挛的管理。然而，关于PM对脊髓损伤人群痉挛结果影响的证据基础仍不清楚。本综述旨在确定PM干预治疗脊髓损伤患者痉挛的范围和综合经验证据。方法：系统检索Embase、Medline、PsycInfo、Web of Science、Scopus、CENTRAL、CINAHL 7个数据库。符合条件的研究经过同行评审，报告了原始数据，包括SCI的成年参与者（≥18岁），提出了仅由PM技术组成的治疗干预，并报告了任何痉挛结果。数据由两名独立审稿人提取和分析。结果：最初的搜索确定了1628个独特的研究，其中13个被纳入分析。PM干预包括被动骑车和机器人PM干预（n = 8），连续被动运动（n = 4）和手动被动运动范围（n = 1）。虽然少数研究表明痉挛结果持续改善，但大多数研究报告在小样本组，单次实验或使用次优研究设计中观察到短期减少。结论：本综述收集了PM干预治疗脊髓损伤患者痉挛的现有证据。尽管发现了持续的短期改善，但需要进一步的高质量研究来确定临床疗效并为未来的康复实践提供信息。
{"title":"Passive movement interventions and spasticity outcomes in individuals with spinal cord injury during rehabilitation: a scoping review","authors":"Samuel David Williamson, Anders Orup Aaby, Anine Overgaard Ejersbo, Marianne Rahbek Vestergaard, Sophie Lykkegaard Ravn","doi":"10.1038/s41393-025-01141-6","DOIUrl":"10.1038/s41393-025-01141-6","url":null,"abstract":"Scoping review. Spasticity is a common and often challenging sequela of spinal cord injury (SCI) associated with pain, contractures, and reduced quality of life. While passive movement (PM) is primarily used to maintain joint mobility, clinical observations and participant reports suggest that both manual and automated techniques can contribute to the management of spasticity in SCI. However, the evidence base concerning PM’s impact on spasticity outcomes in SCI populations remains unclear. This review aims to identify the scope and synthesize the empirical evidence of PM interventions for managing spasticity in individuals with SCI. Seven databases (Embase, Medline, PsycInfo, Web of Science, Scopus, CENTRAL, and CINAHL) were systematically searched. Eligible studies were peer-reviewed, reported original data, included adult participants (≥18 years) with SCI, presented a therapeutic intervention consisting solely of PM techniques, and reported any spasticity outcome. Data were extracted and analyzed by two independent reviewers. The initial search identified 1628 unique studies, of which 13 were included for analysis. The PM interventions included passive cycling and robotic PM interventions (n = 8), continuous passive motion (n = 4), and manual passive range of motion (PROM) (n = 1). While a minority of studies demonstrated sustained improvements in spasticity outcomes, the majority reported short-term reductions observed in small sample groups, single-session experiments, or using suboptimal research designs. This review assembled the existing evidence on PM interventions for managing spasticity in individuals with SCI. Despite finding consistent short-term improvements, further high-quality research is needed to determine clinical efficacy and inform future rehabilitation practices.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 12","pages":"633-641"},"PeriodicalIF":2.2,"publicationDate":"2025-11-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.comhttps://www.nature.com/articles/s41393-025-01141-6.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145453194","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 : 2025-11-04DOI: 10.1038/s41393-025-01136-3
Samantha J. Borg, Victoria McCreanor, Timothy Geraghty, Karen Luetsch, Steven M. McPhail, Susanna Cramb, Rania Shibl, Melanie Proper, Bill Loveday, Cate M. Cameron
Population-based data linkage of state-based opioid dispensing, hospital administrative and death registry data. This study aimed to provide a detailed overview of opioid dispensing in the 2-years following SCI. Community. Linked data were obtained for adults admitted to Queensland hospitals with a newly diagnosed traumatic or non-traumatic SCI from 1 January 2014–31 December 2017. Community opioid dispensing data was obtained for 3 months pre-SCI and up to two years after their Index Hospital Admission for SCI. Chronic dispensing (≥90 cumulative dispensing days) and high end dose (median daily dose of 50 or more oral morphine equivalents in the last 3 months of dispensing) were calculated from dispensing data. Of the 298 included cases (180 traumatic; 118 non-traumatic), 1 or more opioids were dispensed to 19% of the cohort in the 3 months pre-SCI (40% non-traumatic SCI; 6% traumatic SCI) and to 53% post-SCI (56% non-traumatic SCI; 52% traumatic SCI). Those who were dispensed opioids pre-SCI were 3.7 times more likely to have been dispensed opioids in the observation period (95% confidence interval: 1.90, 7.24, p < 0.001). Thirty percent of the cohort have been dispensed opioids chronically. High opioid end doses were significantly more likely among those with non-traumatic SCI. Whilst it was positive that many were not dispensed an opioid post-SCI, the high prevalence of high opioid doses and chronic duration is concerning. The reliance on opioids for pain management suggests stronger approaches to coordinated and improved multi-disciplinary long-term pain management is needed.
{"title":"Community opioid dispensing prevalence and patterns in adults with spinal cord injury in Queensland: a retrospective data linkage study","authors":"Samantha J. Borg, Victoria McCreanor, Timothy Geraghty, Karen Luetsch, Steven M. McPhail, Susanna Cramb, Rania Shibl, Melanie Proper, Bill Loveday, Cate M. Cameron","doi":"10.1038/s41393-025-01136-3","DOIUrl":"10.1038/s41393-025-01136-3","url":null,"abstract":"Population-based data linkage of state-based opioid dispensing, hospital administrative and death registry data. This study aimed to provide a detailed overview of opioid dispensing in the 2-years following SCI. Community. Linked data were obtained for adults admitted to Queensland hospitals with a newly diagnosed traumatic or non-traumatic SCI from 1 January 2014–31 December 2017. Community opioid dispensing data was obtained for 3 months pre-SCI and up to two years after their Index Hospital Admission for SCI. Chronic dispensing (≥90 cumulative dispensing days) and high end dose (median daily dose of 50 or more oral morphine equivalents in the last 3 months of dispensing) were calculated from dispensing data. Of the 298 included cases (180 traumatic; 118 non-traumatic), 1 or more opioids were dispensed to 19% of the cohort in the 3 months pre-SCI (40% non-traumatic SCI; 6% traumatic SCI) and to 53% post-SCI (56% non-traumatic SCI; 52% traumatic SCI). Those who were dispensed opioids pre-SCI were 3.7 times more likely to have been dispensed opioids in the observation period (95% confidence interval: 1.90, 7.24, p < 0.001). Thirty percent of the cohort have been dispensed opioids chronically. High opioid end doses were significantly more likely among those with non-traumatic SCI. Whilst it was positive that many were not dispensed an opioid post-SCI, the high prevalence of high opioid doses and chronic duration is concerning. The reliance on opioids for pain management suggests stronger approaches to coordinated and improved multi-disciplinary long-term pain management is needed.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"63 12","pages":"681-689"},"PeriodicalIF":2.2,"publicationDate":"2025-11-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145446055","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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