Pub Date : 2024-07-29DOI: 10.1038/s41393-024-01021-5
Margaret A. Fitzpatrick, Marissa Wirth, Stephen P. Burns, Charlesnika T. Evans
{"title":"Response to ‘Knowledge, perceptions, and beliefs about urinary tract infections in persons with neurogenic bladder and impacts on interventions to promote person-centered care’","authors":"Margaret A. Fitzpatrick, Marissa Wirth, Stephen P. Burns, Charlesnika T. Evans","doi":"10.1038/s41393-024-01021-5","DOIUrl":"10.1038/s41393-024-01021-5","url":null,"abstract":"","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 10","pages":"607-607"},"PeriodicalIF":2.1,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141793518","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 : 2024-07-29DOI: 10.1038/s41393-024-01022-4
Jakob N. Deitrich, Ashraf S. Gorgey
Cross-sectional study. To examine the association between serum testosterone levels (T levels) and bone mineral density after spinal cord injury (SCI). Medical research center. Body composition assessments were measured in 53 men with chronic SCI. Serum T levels were measured after an overnight fast. Total and regional bone mineral density (BMD) and bone mineral content (BMC) were measured using dual-energy X-ray absorptiometry. Participants were classified into three groups based on their body weight [<65 kg, 65–80 kg, >80 kg] or serum T levels into low (400 ng/dl), mid-normal (401–544 ng/dl) and normal (>545 ng/dl) ranges. Serum T level was negatively related to body weight (r = −0.33, P = 0.016), fat mass (r = −0.46, P < 0.001) and percentage fat mass (r = −0.48, P < 0.001). There were no significant relationships between serum T levels and any of the bone health measurements. Body weight was related to total, regional (P < 0.01 for both) and knee BMD (P < 0.05). T level was only related to total and regional BMD in the group with body weight of 65–80 kg. Testosterone has no direct relationship with BMD except within a specific weight group. However, body weight or fat mass negatively influences circulating T levels in men with SCI. The relationship between serum T levels and BMD is mediated by body weight in men with SCI.
{"title":"Bodyweight influences the relationship between serum testosterone and bone mineral density in men with spinal cord injury","authors":"Jakob N. Deitrich, Ashraf S. Gorgey","doi":"10.1038/s41393-024-01022-4","DOIUrl":"10.1038/s41393-024-01022-4","url":null,"abstract":"Cross-sectional study. To examine the association between serum testosterone levels (T levels) and bone mineral density after spinal cord injury (SCI). Medical research center. Body composition assessments were measured in 53 men with chronic SCI. Serum T levels were measured after an overnight fast. Total and regional bone mineral density (BMD) and bone mineral content (BMC) were measured using dual-energy X-ray absorptiometry. Participants were classified into three groups based on their body weight [<65 kg, 65–80 kg, >80 kg] or serum T levels into low (400 ng/dl), mid-normal (401–544 ng/dl) and normal (>545 ng/dl) ranges. Serum T level was negatively related to body weight (r = −0.33, P = 0.016), fat mass (r = −0.46, P < 0.001) and percentage fat mass (r = −0.48, P < 0.001). There were no significant relationships between serum T levels and any of the bone health measurements. Body weight was related to total, regional (P < 0.01 for both) and knee BMD (P < 0.05). T level was only related to total and regional BMD in the group with body weight of 65–80 kg. Testosterone has no direct relationship with BMD except within a specific weight group. However, body weight or fat mass negatively influences circulating T levels in men with SCI. The relationship between serum T levels and BMD is mediated by body weight in men with SCI.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 10","pages":"555-561"},"PeriodicalIF":2.1,"publicationDate":"2024-07-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141856612","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 : 2024-07-26DOI: 10.1038/s41393-024-01018-0
Sami Ullah, Ahmad Zaheer Qureshi, Talal Ali AlWehaibi, Farooq Azam Rathore, Waqas Sami, Saeed Bin Ayaz, Nurah Hamad AlKeid, Maryam Saif Alibrahim, Ahmed Mushabbab AlHabter, Wafa Bani Alketheeri, Mohammad Salman Bashir
People with spinal cord injury (SCI) are the deciding force behind the rehabilitation program to improve their quality of life (QoL) based on their personal preferences. Here we aimed to determine the preferences perceived most vital by Saudi SCI population to improve their QoL, and explore if these preferences are affected by gender, education, and duration, level, or extent of injury. Participants ranked seven priorities of bodily functions as Rank I-VII with “I” being “Most important,” and “VII” being “Least important.” Inpatient rehabilitation facility. 120 participants (>18 years of age) of either sex with SCI without polytrauma, acquired brain injury, neurodegenerative disease, and dementia. Ranking scale of seven priorities of bodily functions as Rank I-VII with “I” being “Most important,” and “VII” being “Least important.” Of 101 individuals (mean age: 35.2 ± 14.8 years) finally included, 70.3% were males, 66.3% had onset of SCI since ≥ 3 years, 48.5% had a complete injury, and 75% had paraplegia. Most (26.7%) participants ranked walking as the first priority followed by hand/arm function (20.8%). Sexual function was the least important priority (39.6%). Hand/arm function was significantly more important for individuals with tetraplegia (p < 0.001). Trunk strength and balance was significantly less important for individuals with complete injury (p = 0.037). Participants with the onset of injury < 3 years and a complete injury reported bladder/bowel function as significantly more important (p = 0.011). Walking was significantly more important for people with incomplete injury and for people with injury duration ≥ 3 years (p = 0.022, p = 0.002 respectively). The top priority in our sample of Saudi people with SCI was walking followed by hand/arm function while the least desired function was regaining sexual function. Walking was a prioritized function for people with injury duration ≥ 3 years and people with a complete injury while hand/arm function was highly prioritized by people with tetraplegia.
背景/目标：脊髓损伤（SCI）患者是康复计划的决定力量，他们可以根据自己的个人偏好改善生活质量（QoL）。在此，我们旨在确定沙特 SCI 患者认为对改善其 QoL 最为重要的偏好，并探讨这些偏好是否会受到性别、教育程度、受伤时间、程度或范围的影响：设计：参与者将身体功能的七项优先事项分为 I 至 VII 级，其中 "I "为 "最重要"，"VII "为 "最不重要"：住院康复机构：120 名患有 SCI 且无多发性创伤、后天性脑损伤、神经退行性疾病和痴呆症的男女患者（年龄大于 18 岁）：结果：101 名患者（平均年龄：35 岁）中，有 7 名患者的身体机能优先级为 I 至 VII 级，其中 "I "级为 "最重要"，"VII "级为 "最不重要"：在最终纳入的 101 名参与者（平均年龄：35.2 ± 14.8 岁）中，70.3% 为男性，66.3% 自≥ 3 岁起就患有 SCI，48.5% 完全损伤，75% 截瘫。大多数参与者（26.7%）将行走列为首要任务，其次是手/臂功能（20.8%）。性功能是最不重要的优先事项（39.6%）。手/臂功能对四肢瘫痪者的重要性明显更高（p 结论：四肢瘫痪者的首要任务是行走：在我们的沙特 SCI 患者样本中，最优先考虑的功能是行走，其次是手/臂功能，而最不需要的功能是恢复性功能。受伤时间≥ 3 年和完全性损伤的患者优先考虑的功能是行走，而四肢瘫痪患者则高度优先考虑手/臂功能。
{"title":"Functional priorities of individuals with spinal cord injury: a Saudi Arabian perspective","authors":"Sami Ullah, Ahmad Zaheer Qureshi, Talal Ali AlWehaibi, Farooq Azam Rathore, Waqas Sami, Saeed Bin Ayaz, Nurah Hamad AlKeid, Maryam Saif Alibrahim, Ahmed Mushabbab AlHabter, Wafa Bani Alketheeri, Mohammad Salman Bashir","doi":"10.1038/s41393-024-01018-0","DOIUrl":"10.1038/s41393-024-01018-0","url":null,"abstract":"People with spinal cord injury (SCI) are the deciding force behind the rehabilitation program to improve their quality of life (QoL) based on their personal preferences. Here we aimed to determine the preferences perceived most vital by Saudi SCI population to improve their QoL, and explore if these preferences are affected by gender, education, and duration, level, or extent of injury. Participants ranked seven priorities of bodily functions as Rank I-VII with “I” being “Most important,” and “VII” being “Least important.” Inpatient rehabilitation facility. 120 participants (>18 years of age) of either sex with SCI without polytrauma, acquired brain injury, neurodegenerative disease, and dementia. Ranking scale of seven priorities of bodily functions as Rank I-VII with “I” being “Most important,” and “VII” being “Least important.” Of 101 individuals (mean age: 35.2 ± 14.8 years) finally included, 70.3% were males, 66.3% had onset of SCI since ≥ 3 years, 48.5% had a complete injury, and 75% had paraplegia. Most (26.7%) participants ranked walking as the first priority followed by hand/arm function (20.8%). Sexual function was the least important priority (39.6%). Hand/arm function was significantly more important for individuals with tetraplegia (p < 0.001). Trunk strength and balance was significantly less important for individuals with complete injury (p = 0.037). Participants with the onset of injury < 3 years and a complete injury reported bladder/bowel function as significantly more important (p = 0.011). Walking was significantly more important for people with incomplete injury and for people with injury duration ≥ 3 years (p = 0.022, p = 0.002 respectively). The top priority in our sample of Saudi people with SCI was walking followed by hand/arm function while the least desired function was regaining sexual function. Walking was a prioritized function for people with injury duration ≥ 3 years and people with a complete injury while hand/arm function was highly prioritized by people with tetraplegia.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 9","pages":"539-545"},"PeriodicalIF":2.1,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141767477","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}
{"title":"Correction: Classification of upper-limb dysfunction severity and prediction of independence in activities of daily living after cervical spinal-cord injury","authors":"Kazumasa Jimbo, Kazuhiro Miyata, Hiroshi Yuine, Kousuke Takahama, Tomohiro Yoshimura, Honoka Shiba, Taichi Yasumori, Naohisa Kikuchi, Hideki Shiraishi","doi":"10.1038/s41393-024-01017-1","DOIUrl":"10.1038/s41393-024-01017-1","url":null,"abstract":"","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 9","pages":"553-553"},"PeriodicalIF":2.1,"publicationDate":"2024-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-01017-1.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141749121","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 : 2024-07-17DOI: 10.1038/s41393-024-01016-2
Jiri Kriz, Zuzana Nasincova, Veronika Gallusova, Tomas Vyskocil, Martin Gregor, Krystof Slaby, Kristyna Sediva
A psychometric study. To introduce a novel simple tool designed to evaluate the intensity of the phasic (dynamic) component of spastic motor behavior in spinal cord injury (SCI) people and to assess its reliability and validity. The study was developed in the Spinal Cord Unit at University Hospital Motol and Paraple Centre in Prague, Czech Republic. The Muscle Excitability Scale (MES) is designed to rate muscle motor response to exteroceptive and proprioceptive stimuli. The impairment rating ranges from zero muscle/muscle group spasm or clonus to generalized spastic response. The selected 0 to 4 scale allows for comparing the MES results with those of the Modified Ashworth Scale (MAS). After long-term use and repeated revisions, a psychometric analysis was conducted. According to the algorithm, two physiotherapists examined 50 individuals in the chronic stage after SCI. The inter-rater reliability of MES for both legs showed κ = 0.52. The intra-rater reliability of MES for both legs showed κ = 0.50. The inter-rater reliability of simultaneously assessed MAS for both legs was higher, with κ = 0.69. The intra-rater reliability of MAS for both legs showed κ = 0.72. Spearman’s rank correlation coefficient between MES and spasm frequency of Penn Spasm Frequency Scale (PSFS) was low, while the correlation coefficient between MES and the severity part of PSFS was moderate. The MES is a complementary tool for assessing the dynamic component of spastic motor behavior in SCI people. It allows a more comprehensive clinical characterization of spastic reflexes when used along with the MAS.
研究设计心理测量研究：介绍一种新颖的简单工具，用于评估脊髓损伤（SCI）患者痉挛性运动行为的阶段性（动态）成分的强度，并评估其可靠性和有效性：研究在捷克共和国布拉格莫托尔大学医院脊髓科和 Paraple 中心进行：肌肉兴奋性量表（MES）旨在评估肌肉运动对外部感觉和本体感觉刺激的反应。损伤评级范围从零肌肉/肌群痉挛或阵挛到全身痉挛反应。所选的 0 至 4 级评分可将 MES 的结果与改良阿什沃斯量表（MAS）的结果进行比较。经过长期使用和反复修订，我们进行了心理测量分析。根据该算法，两名物理治疗师对 50 名处于 SCI 后慢性期的患者进行了检查：双腿 MES 的评分者间信度为 κ = 0.52。双腿 MES 的评分者内部信度为 κ = 0.50。同时评估两条腿的 MAS 的评分者间可靠性更高，κ = 0.69。双腿 MAS 的评分者内部可靠性为 κ = 0.72。MES 与宾州痉挛频率量表（PSFS）的痉挛频率之间的斯皮尔曼等级相关系数较低，而 MES 与 PSFS 的严重程度部分之间的相关系数适中：结论：MES 是评估 SCI 患者痉挛运动行为动态成分的辅助工具。结论：MES 是评估 SCI 患者痉挛性运动行为动态成分的补充工具，与 MAS 一起使用时，能更全面地描述痉挛性反射的临床特征。
{"title":"Muscle Excitability Scale for the assessment of spastic reflexes in spinal cord injury: development and evaluation","authors":"Jiri Kriz, Zuzana Nasincova, Veronika Gallusova, Tomas Vyskocil, Martin Gregor, Krystof Slaby, Kristyna Sediva","doi":"10.1038/s41393-024-01016-2","DOIUrl":"10.1038/s41393-024-01016-2","url":null,"abstract":"A psychometric study. To introduce a novel simple tool designed to evaluate the intensity of the phasic (dynamic) component of spastic motor behavior in spinal cord injury (SCI) people and to assess its reliability and validity. The study was developed in the Spinal Cord Unit at University Hospital Motol and Paraple Centre in Prague, Czech Republic. The Muscle Excitability Scale (MES) is designed to rate muscle motor response to exteroceptive and proprioceptive stimuli. The impairment rating ranges from zero muscle/muscle group spasm or clonus to generalized spastic response. The selected 0 to 4 scale allows for comparing the MES results with those of the Modified Ashworth Scale (MAS). After long-term use and repeated revisions, a psychometric analysis was conducted. According to the algorithm, two physiotherapists examined 50 individuals in the chronic stage after SCI. The inter-rater reliability of MES for both legs showed κ = 0.52. The intra-rater reliability of MES for both legs showed κ = 0.50. The inter-rater reliability of simultaneously assessed MAS for both legs was higher, with κ = 0.69. The intra-rater reliability of MAS for both legs showed κ = 0.72. Spearman’s rank correlation coefficient between MES and spasm frequency of Penn Spasm Frequency Scale (PSFS) was low, while the correlation coefficient between MES and the severity part of PSFS was moderate. The MES is a complementary tool for assessing the dynamic component of spastic motor behavior in SCI people. It allows a more comprehensive clinical characterization of spastic reflexes when used along with the MAS.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 9","pages":"532-538"},"PeriodicalIF":2.1,"publicationDate":"2024-07-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-01016-2.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141634611","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 : 2024-07-16DOI: 10.1038/s41393-024-01002-8
Elin K. Sober-Williams, Rebekah H. Y. Lee, David G. T. Whitehurst, Christopher B. McBride, Rhonda Willms, Victoria E. Claydon
Systematic review and meta-analysis. Many individuals with spinal cord injury (SCI) experience autonomic dysfunction, including profound impairments to bowel and cardiovascular function. Neurogenic bowel dysfunction (NBD) is emerging as a potential determinant of quality of life (QoL) after SCI. For individuals with high-level lesions ( > T6), bowel care-related autonomic dysreflexia (B-AD; profound episodic hypertension) further complicates bowel care. We aimed to evaluate the extent of bowel dysfunction after SCI, and the impact of bowel dysfunction on QoL after SCI. We searched five databases to identify research assessing the influence of NBD or B-AD on QoL after SCI. Metrics of bowel dysfunction (fecal incontinence [FI], constipation, time to complete, and B-AD) and QoL data were extracted and synthesised. Where possible, meta-analyses were performed. Our search identified 2042 titles, of which 39 met our inclusion criteria. Individuals with SCI identified problems with NBD (74.7%), FI (56.9%), and constipation (54.6%), and 49.3% of individuals with SCI > T6 experienced B-AD. Additionally, 40.3% of individuals experienced prolonged defecation ( > 30 min). Moderate/severe deterioration in QoL due to NBD was reported by 55.5% of individuals with SCI, with negative impacts on physical, emotional, and social health-related QoL associated with inflexibility of bowel routines, fear of accidents, and loss of independence. Bowel dysfunction and bowel care challenges are prevalent and disabling for individuals with SCI, with a profoundly negative impact on QoL. Improving bowel management is a key target to improve QoL for those living with SCI.
研究设计系统综述和荟萃分析：许多脊髓损伤（SCI）患者会出现自主神经功能障碍，包括肠道和心血管功能严重受损。神经源性肠功能障碍（NBD）正在成为影响 SCI 后生活质量（QoL）的潜在决定因素。对于高位病变（> T6）患者，与肠道护理相关的自主反射障碍（B-AD；极度发作性高血压）使肠道护理更加复杂。我们旨在评估 SCI 后肠道功能障碍的程度以及肠道功能障碍对 SCI 后 QoL 的影响：我们搜索了五个数据库，以确定评估 NBD 或 B-AD 对 SCI 后 QoL 影响的研究。我们提取并综合了肠道功能障碍的指标（大便失禁 [FI]、便秘、排便时间和 B-AD）和 QoL 数据。在可能的情况下，还进行了荟萃分析：我们的搜索发现了 2042 篇论文，其中 39 篇符合我们的纳入标准。SCI患者发现了NBD（74.7%）、FI（56.9%）和便秘（54.6%）等问题，49.3%的SCI > T6患者出现了B-AD。此外，40.3%的患者排便时间过长（> 30 分钟）。55.5%的 SCI 患者表示，排便障碍导致 QoL 中度/严重恶化，对身体、情感和社会健康相关 QoL 造成负面影响，包括排便程序不灵活、害怕发生意外以及丧失独立性：结论：肠道功能障碍和肠道护理方面的挑战对于患有 SCI 的人来说是普遍存在的，而且会造成残疾，对 QoL 产生深远的负面影响。改善肠道管理是提高 SCI 患者 QoL 的关键目标。
{"title":"Bowel burdens: a systematic review and meta-analysis examining the relationships between bowel dysfunction and quality of life after spinal cord injury","authors":"Elin K. Sober-Williams, Rebekah H. Y. Lee, David G. T. Whitehurst, Christopher B. McBride, Rhonda Willms, Victoria E. Claydon","doi":"10.1038/s41393-024-01002-8","DOIUrl":"10.1038/s41393-024-01002-8","url":null,"abstract":"Systematic review and meta-analysis. Many individuals with spinal cord injury (SCI) experience autonomic dysfunction, including profound impairments to bowel and cardiovascular function. Neurogenic bowel dysfunction (NBD) is emerging as a potential determinant of quality of life (QoL) after SCI. For individuals with high-level lesions ( > T6), bowel care-related autonomic dysreflexia (B-AD; profound episodic hypertension) further complicates bowel care. We aimed to evaluate the extent of bowel dysfunction after SCI, and the impact of bowel dysfunction on QoL after SCI. We searched five databases to identify research assessing the influence of NBD or B-AD on QoL after SCI. Metrics of bowel dysfunction (fecal incontinence [FI], constipation, time to complete, and B-AD) and QoL data were extracted and synthesised. Where possible, meta-analyses were performed. Our search identified 2042 titles, of which 39 met our inclusion criteria. Individuals with SCI identified problems with NBD (74.7%), FI (56.9%), and constipation (54.6%), and 49.3% of individuals with SCI > T6 experienced B-AD. Additionally, 40.3% of individuals experienced prolonged defecation ( > 30 min). Moderate/severe deterioration in QoL due to NBD was reported by 55.5% of individuals with SCI, with negative impacts on physical, emotional, and social health-related QoL associated with inflexibility of bowel routines, fear of accidents, and loss of independence. Bowel dysfunction and bowel care challenges are prevalent and disabling for individuals with SCI, with a profoundly negative impact on QoL. Improving bowel management is a key target to improve QoL for those living with SCI.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 9","pages":"495-506"},"PeriodicalIF":2.1,"publicationDate":"2024-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-01002-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141627650","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 : 2024-07-12DOI: 10.1038/s41393-024-01014-4
Jinlong Zhang, Cheng Wang, Chengqi He, Yonghong Yang
Cross-sectional study. Deep vein thrombosis (DVT) presents a significant risk of complication in patients with spinal cord injury (SCI), necessitating accurate screening methods. While the Caprini Risk Assessment Model (Caprini RAM) has seen extensive use for DVT screening, its efficacy remains under scrutiny. First Affiliated Hospital of China University of Science and Technology. We created and evaluated three nomograms for their effectiveness in DVT screening. Model 1 incorporated variables such as age, D-dimer level, red blood cell (RBC) counts, platelet counts, presence of type 2 diabetes mellitus, high blood pressure, mode and level of injury, degree of impairments, and Caprini scores. Model 2 was derived from Caprini scores alone, and Model 3 focused on independent risk factors. We assessed these models using the area under the curve (AUC) of the receiver operating characteristic (ROC), calibration curves, and decision curve analysis (DCA), employing bootstrap resampling tests (500 iterations) to determine their accuracy, discriminative ability, and clinical utility. Internal validation was performed on a separate cohort. Nomogram was established with well-fitted calibration curves for model 1, 2 and 3(AUC = 0.808, 0.751 and 0.797; 95%CI = 0.76–0.86, 0.70–0.80 and 0.75–0.84; respectively), indicating model 1 outperformed the others in prediction DVT risk, followed by model 3 and 2. These findings were consistent in the validation cohort, with DCA further corroborating our conclusions. A nomogram integrating clinical data with Caprini RAM provides a superior option for DVT screening in SCI patients within rehabilitation settings, outperforming Caprini RAM.
{"title":"Development and validation of a novel screening tool for deep vein thrombosis in patients with spinal cord injury: A five-year cross-sectional study","authors":"Jinlong Zhang, Cheng Wang, Chengqi He, Yonghong Yang","doi":"10.1038/s41393-024-01014-4","DOIUrl":"10.1038/s41393-024-01014-4","url":null,"abstract":"Cross-sectional study. Deep vein thrombosis (DVT) presents a significant risk of complication in patients with spinal cord injury (SCI), necessitating accurate screening methods. While the Caprini Risk Assessment Model (Caprini RAM) has seen extensive use for DVT screening, its efficacy remains under scrutiny. First Affiliated Hospital of China University of Science and Technology. We created and evaluated three nomograms for their effectiveness in DVT screening. Model 1 incorporated variables such as age, D-dimer level, red blood cell (RBC) counts, platelet counts, presence of type 2 diabetes mellitus, high blood pressure, mode and level of injury, degree of impairments, and Caprini scores. Model 2 was derived from Caprini scores alone, and Model 3 focused on independent risk factors. We assessed these models using the area under the curve (AUC) of the receiver operating characteristic (ROC), calibration curves, and decision curve analysis (DCA), employing bootstrap resampling tests (500 iterations) to determine their accuracy, discriminative ability, and clinical utility. Internal validation was performed on a separate cohort. Nomogram was established with well-fitted calibration curves for model 1, 2 and 3(AUC = 0.808, 0.751 and 0.797; 95%CI = 0.76–0.86, 0.70–0.80 and 0.75–0.84; respectively), indicating model 1 outperformed the others in prediction DVT risk, followed by model 3 and 2. These findings were consistent in the validation cohort, with DCA further corroborating our conclusions. A nomogram integrating clinical data with Caprini RAM provides a superior option for DVT screening in SCI patients within rehabilitation settings, outperforming Caprini RAM.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 9","pages":"523-531"},"PeriodicalIF":2.1,"publicationDate":"2024-07-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141601855","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 : 2024-07-06DOI: 10.1038/s41393-024-01012-6
Zijian Huang, Akhila L. Veerubhotla, James P. DeLany, Dan Ding
Cross-sectional validation study. To develop a raw acceleration signal-based random forest (RF) model for predicting total energy expenditure (TEE) in manual wheelchair users (MWUs) and evaluate the preliminary field validity of this new model, along with four existing models published in prior literature, using the Doubly Labeled Water (DLW) method. General community and research institution in Pittsburgh, USA. A total of 78 participants’ data from two previous studies were used to develop the new RF model. A seven-day cross-sectional study was conducted to collect participants’ free-living physical activity and TEE data, resting metabolic rate, demographics, and anthropometrics. Ten MWUs with spinal cord injury (SCI) completed the study, with seven participants having valid data for evaluating the preliminary field validity of the five models. The RF model achieved a mean absolute error (MAE) of 0.59 ± 0.60 kcal/min and a mean absolute percentage error (MAPE) of 23.6% ± 24.3% on the validation set. For preliminary field validation, the five assessed models yielded MAE from 136 kcal/day to 1141 kcal/day and MAPE from 6.1% to 50.2%. The model developed by Nightingale et al. in 2015 achieved the best performance (MAE: 136 ± 96 kcal/day, MAPE: 6.1% ± 4.7%), while the RF model achieved comparable performance (MAE: 167 ± 99 kcal/day, MAPE: 7.4% ± 5.1%). Two existing models and our newly developed RF model showed good preliminary field validity for assessing TEE in MWUs with SCI and the potential to detect lifestyle change in this population. Future large-scale field validation studies and model iteration are recommended.
{"title":"Preliminary field validity of ActiGraph-based energy expenditure estimation in wheelchair users with spinal cord injury","authors":"Zijian Huang, Akhila L. Veerubhotla, James P. DeLany, Dan Ding","doi":"10.1038/s41393-024-01012-6","DOIUrl":"10.1038/s41393-024-01012-6","url":null,"abstract":"Cross-sectional validation study. To develop a raw acceleration signal-based random forest (RF) model for predicting total energy expenditure (TEE) in manual wheelchair users (MWUs) and evaluate the preliminary field validity of this new model, along with four existing models published in prior literature, using the Doubly Labeled Water (DLW) method. General community and research institution in Pittsburgh, USA. A total of 78 participants’ data from two previous studies were used to develop the new RF model. A seven-day cross-sectional study was conducted to collect participants’ free-living physical activity and TEE data, resting metabolic rate, demographics, and anthropometrics. Ten MWUs with spinal cord injury (SCI) completed the study, with seven participants having valid data for evaluating the preliminary field validity of the five models. The RF model achieved a mean absolute error (MAE) of 0.59 ± 0.60 kcal/min and a mean absolute percentage error (MAPE) of 23.6% ± 24.3% on the validation set. For preliminary field validation, the five assessed models yielded MAE from 136 kcal/day to 1141 kcal/day and MAPE from 6.1% to 50.2%. The model developed by Nightingale et al. in 2015 achieved the best performance (MAE: 136 ± 96 kcal/day, MAPE: 6.1% ± 4.7%), while the RF model achieved comparable performance (MAE: 167 ± 99 kcal/day, MAPE: 7.4% ± 5.1%). Two existing models and our newly developed RF model showed good preliminary field validity for assessing TEE in MWUs with SCI and the potential to detect lifestyle change in this population. Future large-scale field validation studies and model iteration are recommended.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 9","pages":"514-522"},"PeriodicalIF":2.1,"publicationDate":"2024-07-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141538620","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 : 2024-07-03DOI: 10.1038/s41393-024-00998-3
Jia Li, Matthew Farrow, Kerollos Ibrahim, Dana M. McTigue, John Kramer, Bobo Tong, Catherine Jutzeler, Linda Jones, Ceren Yarar-Fisher
Secondary analysis of a randomized, multi-center, placebo-controlled study(Sygen®). To evaluate racial differences in serological markers in individuals with spinal cord injury(SCI) across the first year of injury. Hospitals in North America. Serological markers (e.g.,cell count, liver, kidney, and pancreatic function, metabolism, and muscle damage) were assessed among 316 participants (247 White, 69 Black) at admission, weeks 1, 2, 4, 8, and 52 post-injury. Linear mixed models were employed to explore the main effects of time, race (Black vs. White), and their interaction, with adjustment of covariates such as study center, polytrauma, injury (level, completeness), treatment group, and sex. A main effect of race was observed where White individuals had higher alanine transaminase, blood urea nitrogen(BUN), BUN/Creatinine ratio, sodium, and chloride, while Black individuals had higher calcium, total serum protein, and platelets. For markers with interaction effects, post-hoc comparisons showed that at week 52, White individuals had higher mature neutrophils, hematocrit, hemoglobin, mean corpuscular hemoglobin, albumin, and triglycerides, and Black individuals had higher amylase. Eosinophils, monocytes, red blood cells, aspartate aminotransferase, bilirubin, cholesterol, partial thromboplastin time, urine specific gravity, urine pH, CO2, and inorganic phosphorus did not differ between races. Our results revealed racial differences in serological markers and underscores the importance of considering race as a determinant of physiological responses. Future studies are warranted to explore the causes and implications of these racial disparities to facilitate tailored clinical management and social policy changes that can improve health equity.
{"title":"Racial differences in serological markers across the first year of injury in spinal cord injury: a retrospective analysis of a multi-center interventional study","authors":"Jia Li, Matthew Farrow, Kerollos Ibrahim, Dana M. McTigue, John Kramer, Bobo Tong, Catherine Jutzeler, Linda Jones, Ceren Yarar-Fisher","doi":"10.1038/s41393-024-00998-3","DOIUrl":"10.1038/s41393-024-00998-3","url":null,"abstract":"Secondary analysis of a randomized, multi-center, placebo-controlled study(Sygen®). To evaluate racial differences in serological markers in individuals with spinal cord injury(SCI) across the first year of injury. Hospitals in North America. Serological markers (e.g.,cell count, liver, kidney, and pancreatic function, metabolism, and muscle damage) were assessed among 316 participants (247 White, 69 Black) at admission, weeks 1, 2, 4, 8, and 52 post-injury. Linear mixed models were employed to explore the main effects of time, race (Black vs. White), and their interaction, with adjustment of covariates such as study center, polytrauma, injury (level, completeness), treatment group, and sex. A main effect of race was observed where White individuals had higher alanine transaminase, blood urea nitrogen(BUN), BUN/Creatinine ratio, sodium, and chloride, while Black individuals had higher calcium, total serum protein, and platelets. For markers with interaction effects, post-hoc comparisons showed that at week 52, White individuals had higher mature neutrophils, hematocrit, hemoglobin, mean corpuscular hemoglobin, albumin, and triglycerides, and Black individuals had higher amylase. Eosinophils, monocytes, red blood cells, aspartate aminotransferase, bilirubin, cholesterol, partial thromboplastin time, urine specific gravity, urine pH, CO2, and inorganic phosphorus did not differ between races. Our results revealed racial differences in serological markers and underscores the importance of considering race as a determinant of physiological responses. Future studies are warranted to explore the causes and implications of these racial disparities to facilitate tailored clinical management and social policy changes that can improve health equity.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 8","pages":"486-494"},"PeriodicalIF":2.1,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498983","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 : 2024-06-27DOI: 10.1038/s41393-024-01009-1
Paul Lin, Neil Kamdar, Gianna M. Rodriguez, Christine Cigolle, Denise Tate, Elham Mahmoudi
Retrospective case/control longitudinal cohort study Prevalent traumatic spinal cord injury (TSCI) is associated with Alzheimer’s disease and related dementia (ADRD). We examined the hazard ratio for ADRD after incident TSCI and hypothesized that ADRD hazard is greater among adults with incident TSCI compared with their matched control of adults without TSCI. Using 2010–2020 U.S. national private administrative claims data, we identified adults aged 45 years and older with probable (likely and highly likely) incident TSCI (n = 657). Our controls included one-to-ten matched cohort of people without TSCI (n = 6553). We applied Cox survival models and adjusted them for age, sex, years of living with certain chronic conditions, exposure to six classes of prescribed medications, and neighborhood characteristics of place of residence. Hazard ratios were used to compare the results within a 4-year follow-up. Our fully adjusted model without any interaction showed that incident TSCI increased the risk for ADRD (HR = 1.30; 95% CI, 1.01–1.67). People aged 45–64 with incident TSCI were at high risk for ADRD (HR = 5.14; 95% CI, 2.27–11.67) and no significant risk after age 65 (HR = 1.20; 95% CI, .92–1.55). Our sensitivity analyses confirmed a higher hazard ratio for ADRD after incident TSCI at 45–64 years of age compared with the matched controls. TSCI is associated with a higher hazard of ADRD. This study informs the need to update clinical guidelines for cognitive screening after TSCI to address the heightened risk of cognitive decline and to shed light on the causality between TSCI and ADRD.
{"title":"Incident traumatic spinal cord injury and risk of Alzheimer’s disease and related dementia: longitudinal case and control cohort study","authors":"Paul Lin, Neil Kamdar, Gianna M. Rodriguez, Christine Cigolle, Denise Tate, Elham Mahmoudi","doi":"10.1038/s41393-024-01009-1","DOIUrl":"10.1038/s41393-024-01009-1","url":null,"abstract":"Retrospective case/control longitudinal cohort study Prevalent traumatic spinal cord injury (TSCI) is associated with Alzheimer’s disease and related dementia (ADRD). We examined the hazard ratio for ADRD after incident TSCI and hypothesized that ADRD hazard is greater among adults with incident TSCI compared with their matched control of adults without TSCI. Using 2010–2020 U.S. national private administrative claims data, we identified adults aged 45 years and older with probable (likely and highly likely) incident TSCI (n = 657). Our controls included one-to-ten matched cohort of people without TSCI (n = 6553). We applied Cox survival models and adjusted them for age, sex, years of living with certain chronic conditions, exposure to six classes of prescribed medications, and neighborhood characteristics of place of residence. Hazard ratios were used to compare the results within a 4-year follow-up. Our fully adjusted model without any interaction showed that incident TSCI increased the risk for ADRD (HR = 1.30; 95% CI, 1.01–1.67). People aged 45–64 with incident TSCI were at high risk for ADRD (HR = 5.14; 95% CI, 2.27–11.67) and no significant risk after age 65 (HR = 1.20; 95% CI, .92–1.55). Our sensitivity analyses confirmed a higher hazard ratio for ADRD after incident TSCI at 45–64 years of age compared with the matched controls. TSCI is associated with a higher hazard of ADRD. This study informs the need to update clinical guidelines for cognitive screening after TSCI to address the heightened risk of cognitive decline and to shed light on the causality between TSCI and ADRD.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 8","pages":"479-485"},"PeriodicalIF":2.1,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470733","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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