Pub Date : 2024-05-29DOI: 10.1038/s41393-024-00999-2
Arrani Senthinathan, Mina Tadrous, Swaleh Hussain, Sandra McKay, Rahim Moineddin, Cherry Chu, Susan B. Jaglal, John Shepherd, Lauren Cadel, Vanessa K. Noonan, B. Catharine Craven, Karen Tu, Sara J. T. Guilcher
Descriptive repeated-cross sectional retrospective longitudinal cohort study. To investigate the impact of the COVID-19 pandemic on homecare services in individuals with traumatic or non-traumatic Spinal Cord Injury (SCI). Health administrative database in Ontario, Canada. A repeated cross-sectional study using linked health administrative databases from March 2015 to June 2022. Monthly homecare utilization was assessed in 3381 adults with SCI using Autoregressive Integrated Moving Average (ARIMA) models. Compared to pre-pandemic levels, between March 2020 to June 2022, the traumatic group experienced a decrease in personal and/or homemaking services, as well as an increase in nursing visits from April 2020–March 2022 and June 2022. Case management increased at various times for the traumatic group, however therapies decreased in May 2020 only. The non-traumatic group experienced a decrease in personal and/or homemaking services in July 2020, as well as an increase in nursing visits from March 2020 to February 2021 and sporadically throughout 2020. Case management also increased at certain points for the non-traumatic group, but therapies decreased in April 2020, July 2020, and September 2021. The traumatic group had decreases in personal and/or homemaking services. Both groups had increases in nursing services, increases in case management, and minimal decreases in therapies at varying times during the pandemic. Investigation is warranted to understand the root cause of these changes, and if they resulted in adverse outcomes.
{"title":"Examining the impact of the COVID-19 pandemic on homecare services among individuals with traumatic and non-traumatic spinal cord injuries","authors":"Arrani Senthinathan, Mina Tadrous, Swaleh Hussain, Sandra McKay, Rahim Moineddin, Cherry Chu, Susan B. Jaglal, John Shepherd, Lauren Cadel, Vanessa K. Noonan, B. Catharine Craven, Karen Tu, Sara J. T. Guilcher","doi":"10.1038/s41393-024-00999-2","DOIUrl":"10.1038/s41393-024-00999-2","url":null,"abstract":"Descriptive repeated-cross sectional retrospective longitudinal cohort study. To investigate the impact of the COVID-19 pandemic on homecare services in individuals with traumatic or non-traumatic Spinal Cord Injury (SCI). Health administrative database in Ontario, Canada. A repeated cross-sectional study using linked health administrative databases from March 2015 to June 2022. Monthly homecare utilization was assessed in 3381 adults with SCI using Autoregressive Integrated Moving Average (ARIMA) models. Compared to pre-pandemic levels, between March 2020 to June 2022, the traumatic group experienced a decrease in personal and/or homemaking services, as well as an increase in nursing visits from April 2020–March 2022 and June 2022. Case management increased at various times for the traumatic group, however therapies decreased in May 2020 only. The non-traumatic group experienced a decrease in personal and/or homemaking services in July 2020, as well as an increase in nursing visits from March 2020 to February 2021 and sporadically throughout 2020. Case management also increased at certain points for the non-traumatic group, but therapies decreased in April 2020, July 2020, and September 2021. The traumatic group had decreases in personal and/or homemaking services. Both groups had increases in nursing services, increases in case management, and minimal decreases in therapies at varying times during the pandemic. Investigation is warranted to understand the root cause of these changes, and if they resulted in adverse outcomes.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 7","pages":"406-413"},"PeriodicalIF":2.1,"publicationDate":"2024-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141172043","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 : 2024-05-28DOI: 10.1038/s41393-024-00997-4
Samantha J. Borg, David N. Borg, Mohit Arora, James W. Middleton, Ruth Marshall, Andrew Nunn, Timothy Geraghty
Cross-sectional survey. Appropriate and timely lifelong access to healthcare following a spinal cord injury (SCI) is critical, yet unmet healthcare needs in this population are common. Poor experiences with healthcare providers can be a barrier to health-seeking behaviour, and we hypothesised that there would be an association between unmet healthcare needs and care experiences. This study aimed to: (1) describe healthcare provider utilisation in the past year, unmet care needs and satisfaction with healthcare services; (2) explore the association between experiences with healthcare providers and unmet healthcare needs; and (3) explore the association between healthcare provider utilisation and participant characteristics, including unmet healthcare needs. Community. Analysis of data for 1579 Australians aged ≥ 18, who were ≥ 1-year post-SCI and living in the community. Bayesian penalised regression was used to model six binary outcomes: unmet healthcare needs; the use of general practitioners (GPs), allied health practitioners, rehabilitation specialists; medical specialists; and hospitalisations in the past 12-months. Unmet needs were reported by 17% of participants, with service cost the common deterrent. There was evidence of an effect for provider experiences on unmet healthcare needs, but no evidence that unmet healthcare needs was associated with the use of GPs, allied health practitioners, and rehabilitation or medical specialists. Unmet healthcare needs were reported in the context of high healthcare use and large proportions of secondary conditions in a cohort with long-term SCI. Improved health access for people with SCI include better primary-secondary care collaboration is needed.
{"title":"Unmet healthcare needs, access to services and experiences with health providers among persons with spinal cord injury in Australia","authors":"Samantha J. Borg, David N. Borg, Mohit Arora, James W. Middleton, Ruth Marshall, Andrew Nunn, Timothy Geraghty","doi":"10.1038/s41393-024-00997-4","DOIUrl":"10.1038/s41393-024-00997-4","url":null,"abstract":"Cross-sectional survey. Appropriate and timely lifelong access to healthcare following a spinal cord injury (SCI) is critical, yet unmet healthcare needs in this population are common. Poor experiences with healthcare providers can be a barrier to health-seeking behaviour, and we hypothesised that there would be an association between unmet healthcare needs and care experiences. This study aimed to: (1) describe healthcare provider utilisation in the past year, unmet care needs and satisfaction with healthcare services; (2) explore the association between experiences with healthcare providers and unmet healthcare needs; and (3) explore the association between healthcare provider utilisation and participant characteristics, including unmet healthcare needs. Community. Analysis of data for 1579 Australians aged ≥ 18, who were ≥ 1-year post-SCI and living in the community. Bayesian penalised regression was used to model six binary outcomes: unmet healthcare needs; the use of general practitioners (GPs), allied health practitioners, rehabilitation specialists; medical specialists; and hospitalisations in the past 12-months. Unmet needs were reported by 17% of participants, with service cost the common deterrent. There was evidence of an effect for provider experiences on unmet healthcare needs, but no evidence that unmet healthcare needs was associated with the use of GPs, allied health practitioners, and rehabilitation or medical specialists. Unmet healthcare needs were reported in the context of high healthcare use and large proportions of secondary conditions in a cohort with long-term SCI. Improved health access for people with SCI include better primary-secondary care collaboration is needed.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 7","pages":"396-405"},"PeriodicalIF":2.1,"publicationDate":"2024-05-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-00997-4.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141162714","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 : 2024-05-15DOI: 10.1038/s41393-024-00996-5
Peter Francis Raguindin, Oche Adam Itodo, Inge Eriks-Hoogland, Taulant Muka, Mirjam Brach, Gerold Stucki, Jivko Stoyanov, Marija Glisic
Longitudinal study. To explore whether individuals with traumatic spinal cord injury (TSCI) and non-traumatic SCI (NTSCI) experience different trajectories in changes of cardiometabolic disease (CMD) factors during initial rehabilitation stay. Multicenter Swiss Spinal Cord Injury Cohort (SwiSCI) study. Individuals without history of cardiovascular diseases were included. CMD factors and Framingham risk score (FRS) were compared between TSCI and NTSCI. Linear mixed models’ analysis was employed to explore the trajectory in CMD factors changes over rehabilitation period and a multivariate linear regression analysis was used at discharge from inpatient rehabilitation to explore factors associated with CMD risk profile in TSCI and NTSCI. We performed age and sex-stratified analyses. We analyzed 530 individuals with SCI (64% with TSCI and 36% NTSCI). The median age was 53 years (IQR:39-64) with 67.9% (n = 363) of the study cohort being male. The median rehabilitation duration was 4.4 months (IQR 2.4-6.4). At admission to rehabilitation, FRS (9.61 vs. 5.89) and prevalence of hypertension (33.16% vs. 13.62%), diabetes (13.68% vs. 4.06%), and obesity (79.05% vs. 66.67%) were higher in NTSCI as compared to TSCI, No difference was observed in cardiometabolic syndrome between the groups (around 40% in both groups). Overall, we observed longitudinal increases in total cholesterol, HDL-C and HDL/total cholesterol ratio, and a decrease in fasting glucose over the rehabilitation period. No differences in longitudinal changes in cardiovascular risk factors were observed between TSCI and NTSCI. There was no deterioration in cardiometabolic risk factors over rehabilitation period, at discharge from initial rehabilitation stay. Both TSCI and NTSCI experienced high burden of cardiometabolic syndrome components with NTSCI experiencing more disadvantageous risk profile. The effectiveness of therapeutic and lifestyle/behavioral strategies to decrease burden of cardiometabolic disease and its components in early phase should be explored in future studies.
{"title":"Does cardiometabolic risk profile differ among individuals with traumatic and non-traumatic spinal cord injury (SCI): the evidence from the multicenter SCI cohort in Switzerland (SwiSCI)","authors":"Peter Francis Raguindin, Oche Adam Itodo, Inge Eriks-Hoogland, Taulant Muka, Mirjam Brach, Gerold Stucki, Jivko Stoyanov, Marija Glisic","doi":"10.1038/s41393-024-00996-5","DOIUrl":"10.1038/s41393-024-00996-5","url":null,"abstract":"Longitudinal study. To explore whether individuals with traumatic spinal cord injury (TSCI) and non-traumatic SCI (NTSCI) experience different trajectories in changes of cardiometabolic disease (CMD) factors during initial rehabilitation stay. Multicenter Swiss Spinal Cord Injury Cohort (SwiSCI) study. Individuals without history of cardiovascular diseases were included. CMD factors and Framingham risk score (FRS) were compared between TSCI and NTSCI. Linear mixed models’ analysis was employed to explore the trajectory in CMD factors changes over rehabilitation period and a multivariate linear regression analysis was used at discharge from inpatient rehabilitation to explore factors associated with CMD risk profile in TSCI and NTSCI. We performed age and sex-stratified analyses. We analyzed 530 individuals with SCI (64% with TSCI and 36% NTSCI). The median age was 53 years (IQR:39-64) with 67.9% (n = 363) of the study cohort being male. The median rehabilitation duration was 4.4 months (IQR 2.4-6.4). At admission to rehabilitation, FRS (9.61 vs. 5.89) and prevalence of hypertension (33.16% vs. 13.62%), diabetes (13.68% vs. 4.06%), and obesity (79.05% vs. 66.67%) were higher in NTSCI as compared to TSCI, No difference was observed in cardiometabolic syndrome between the groups (around 40% in both groups). Overall, we observed longitudinal increases in total cholesterol, HDL-C and HDL/total cholesterol ratio, and a decrease in fasting glucose over the rehabilitation period. No differences in longitudinal changes in cardiovascular risk factors were observed between TSCI and NTSCI. There was no deterioration in cardiometabolic risk factors over rehabilitation period, at discharge from initial rehabilitation stay. Both TSCI and NTSCI experienced high burden of cardiometabolic syndrome components with NTSCI experiencing more disadvantageous risk profile. The effectiveness of therapeutic and lifestyle/behavioral strategies to decrease burden of cardiometabolic disease and its components in early phase should be explored in future studies.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 7","pages":"387-395"},"PeriodicalIF":2.1,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-00996-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140940999","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 : 2024-04-23DOI: 10.1038/s41393-024-00990-x
Sanna-Mari Saarimäki, Paula Reiterä, Anni Täckman, Jari Arokoski, Aki Vainionpää, Mauri Kallinen, Susanna Tallqvist, Eerika Koskinen, Harri Hämäläinen, Anna-Maija Kauppila, Heidi Anttila, Sinikka Hiekkala
Cross-sectional survey of the Finnish population with spinal cord injury (SCI). To explore the frequencies of perceived environmental barriers (EB) that made participation harder for the Finnish population with SCI and to compare the occurrence of perceived EBs by gender, age, time since injury, and injury severity. Participants were recruited from the registers of the three SCI outpatient clinics responsible for the lifelong care of people with SCI in Finland. The self-administered Nottwil Environmental Factors Inventory Short Form (NEFI-SF) collected in the Finnish Spinal Cord Injury Study (FinSCI) (n = 1772) was used. Nonparametric tests and multinomial logistic regression models were utilized. 880 individuals responded to the NEFI-SF items (response rate 50%). Climate was perceived as a barrier by 72% and a serious one by 44% of the respondents. The rates regarding public access were 59% and 24%, private home access 46% and 18%, and long-distance transport 45% and 20%. Four out of ten respondents reported that finances, lack of assistive devices for short-distance transport, and political decisions restricted their participation. The NEFI-SF total scores were higher (meaning more perceived restrictions by EBs) for those more severely injured. Climate, access to public and private places, challenges with transport, finances, and political decisions were the EBs most frequently perceived to restrict participation by the Finnish population with SCI. Most EBs that were prominent causes of restrictions are modifiable. Greater accessibility to the built environment, equal services to all, and positive special treatment could reduce their effects.
{"title":"Environmental barriers perceived by the Finnish population with spinal cord injury: a cross-sectional survey","authors":"Sanna-Mari Saarimäki, Paula Reiterä, Anni Täckman, Jari Arokoski, Aki Vainionpää, Mauri Kallinen, Susanna Tallqvist, Eerika Koskinen, Harri Hämäläinen, Anna-Maija Kauppila, Heidi Anttila, Sinikka Hiekkala","doi":"10.1038/s41393-024-00990-x","DOIUrl":"10.1038/s41393-024-00990-x","url":null,"abstract":"Cross-sectional survey of the Finnish population with spinal cord injury (SCI). To explore the frequencies of perceived environmental barriers (EB) that made participation harder for the Finnish population with SCI and to compare the occurrence of perceived EBs by gender, age, time since injury, and injury severity. Participants were recruited from the registers of the three SCI outpatient clinics responsible for the lifelong care of people with SCI in Finland. The self-administered Nottwil Environmental Factors Inventory Short Form (NEFI-SF) collected in the Finnish Spinal Cord Injury Study (FinSCI) (n = 1772) was used. Nonparametric tests and multinomial logistic regression models were utilized. 880 individuals responded to the NEFI-SF items (response rate 50%). Climate was perceived as a barrier by 72% and a serious one by 44% of the respondents. The rates regarding public access were 59% and 24%, private home access 46% and 18%, and long-distance transport 45% and 20%. Four out of ten respondents reported that finances, lack of assistive devices for short-distance transport, and political decisions restricted their participation. The NEFI-SF total scores were higher (meaning more perceived restrictions by EBs) for those more severely injured. Climate, access to public and private places, challenges with transport, finances, and political decisions were the EBs most frequently perceived to restrict participation by the Finnish population with SCI. Most EBs that were prominent causes of restrictions are modifiable. Greater accessibility to the built environment, equal services to all, and positive special treatment could reduce their effects.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 6","pages":"348-355"},"PeriodicalIF":2.1,"publicationDate":"2024-04-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-00990-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140667631","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 : 2024-04-22DOI: 10.1038/s41393-024-00991-w
Elliot J. Roth, Linda Lovell, Alexander Barry
Qualitative Cohort Study. Many people with long-term spinal cord injury (SCI) develop adaptation strategies to succeed. Understanding the factors that support their capacity to adapt and develop is important to enhance quality of life of others with SCI. This study aims to learn how these factors influence how people with SCI attain and maintain optimal quality of life as time since injury grows. IL, USA. A qualitative approach using one-on-one structured interviews with 16 individuals with long-term SCI was used to elicit perspectives of topics of importance. Analysis of these topics was done for the entire group, and for subgroups based on injury duration, i.e., 1–5 years, 5–15 years, and 15+ years post-injury. Deductive and inductive analyses of transcripts were performed. Five important themes emerged: 1. Injury, Medical Care, and Rehabilitation; 2. Built Environment and Accessibility; 3. Relationships and Support Systems; 4. Intrapersonal Thoughts and Emotions; and 5. Handling Challenges and Adversity. Topics of importance evolved over time. Most important were: 1–5 years: injury and recovery process; 5–15 years: navigating the community and how to handle difficult situations; and 15+ years: self-reflection and understanding how to handle challenges positively. Recognition of the factors (e.g. resilience, self-acceptance, built environment) that contribute to quality of life in people with SCI, and their prevalence over time, enables development of strategies to facilitate personal fulfillment and favorable adaptation at each stage. This trial was posted on clinicaltrials.gov under NCT04544761.
{"title":"Perspectives on factors influencing quality of life in persons with long-term spinal cord injury: a qualitative study","authors":"Elliot J. Roth, Linda Lovell, Alexander Barry","doi":"10.1038/s41393-024-00991-w","DOIUrl":"10.1038/s41393-024-00991-w","url":null,"abstract":"Qualitative Cohort Study. Many people with long-term spinal cord injury (SCI) develop adaptation strategies to succeed. Understanding the factors that support their capacity to adapt and develop is important to enhance quality of life of others with SCI. This study aims to learn how these factors influence how people with SCI attain and maintain optimal quality of life as time since injury grows. IL, USA. A qualitative approach using one-on-one structured interviews with 16 individuals with long-term SCI was used to elicit perspectives of topics of importance. Analysis of these topics was done for the entire group, and for subgroups based on injury duration, i.e., 1–5 years, 5–15 years, and 15+ years post-injury. Deductive and inductive analyses of transcripts were performed. Five important themes emerged: 1. Injury, Medical Care, and Rehabilitation; 2. Built Environment and Accessibility; 3. Relationships and Support Systems; 4. Intrapersonal Thoughts and Emotions; and 5. Handling Challenges and Adversity. Topics of importance evolved over time. Most important were: 1–5 years: injury and recovery process; 5–15 years: navigating the community and how to handle difficult situations; and 15+ years: self-reflection and understanding how to handle challenges positively. Recognition of the factors (e.g. resilience, self-acceptance, built environment) that contribute to quality of life in people with SCI, and their prevalence over time, enables development of strategies to facilitate personal fulfillment and favorable adaptation at each stage. This trial was posted on clinicaltrials.gov under NCT04544761.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 6","pages":"343-347"},"PeriodicalIF":2.1,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-00991-w.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140677773","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 : 2024-04-22DOI: 10.1038/s41393-024-00995-6
Sonja de Groot, Jacinthe J. E. Adriaansen, Janneke M. Stolwijk-Swüste, Rutger Osterthun, Rita J. G. van den Berg-Emons, Marcel W. M. Post
Secondary analysis of cross-sectional data from the ALLRISC cohort study. To investigate the prevalence of obesity and its association with time since injury (TSI) and physical activity (PA) in wheelchair users with long-standing (TSI > 10 years) spinal cord injury (SCI). Community, The Netherlands. Wheelchair users with SCI (N = 282) in TSI strata (10–19, 20–29, and ≥30 years) and divided in meeting SCI-specific exercise guidelines or not. Waist circumference (WC) and body mass index (BMI) were assessed. Participants were classified as being obese (WC > 102 cm for men, WC > 88 cm for women; BMI ≥ 25 kg/m2) or not. Logistic regression analyses were performed to investigate the associations between obesity and TSI and PA. Almost half of the participants (45–47%) were classified as obese. TSI was significantly associated with obesity, the odds of being obese were 1.4 higher when having a 10 years longer TSI. Furthermore, the odds of being obese were 2.0 lower for participants who were meeting the exercise guidelines. The prevalence of obesity is high in people with long-standing SCI. Those with a longer TSI and individuals who do not meet the exercise guidelines are more likely to be obese and need to be targeted for weight management interventions.
对ALLRISC队列研究的横断面数据进行二次分析。调查长期（TSI > 10 年）脊髓损伤（SCI）的轮椅使用者的肥胖发生率及其与受伤后时间（TSI）和体力活动（PA）的关系。荷兰，社区。将患有 SCI 的轮椅使用者（N = 282）分为 TSI 层（10-19 年、20-29 年和≥30 年），并区分是否符合 SCI 特定运动指南。对腰围（WC）和体重指数（BMI）进行了评估。参与者被分为是否肥胖（男性腰围为 102 厘米，女性腰围为 88 厘米；体重指数≥ 25 kg/m2）。为研究肥胖与 TSI 和 PA 之间的关系，我们进行了逻辑回归分析。近一半的参与者（45%-47%）被归类为肥胖。TSI与肥胖有明显的关联，TSI长10年，肥胖的几率就高1.4。此外，符合运动指南的参与者肥胖的几率要低 2.0。在长期患有 SCI 的人群中，肥胖的发生率很高。TSI时间较长的人和不符合运动指南的人更容易肥胖，因此需要针对他们采取体重管理干预措施。
{"title":"Obesity in wheelchair users with long-standing spinal cord injury: prevalence and associations with time since injury and physical activity","authors":"Sonja de Groot, Jacinthe J. E. Adriaansen, Janneke M. Stolwijk-Swüste, Rutger Osterthun, Rita J. G. van den Berg-Emons, Marcel W. M. Post","doi":"10.1038/s41393-024-00995-6","DOIUrl":"10.1038/s41393-024-00995-6","url":null,"abstract":"Secondary analysis of cross-sectional data from the ALLRISC cohort study. To investigate the prevalence of obesity and its association with time since injury (TSI) and physical activity (PA) in wheelchair users with long-standing (TSI > 10 years) spinal cord injury (SCI). Community, The Netherlands. Wheelchair users with SCI (N = 282) in TSI strata (10–19, 20–29, and ≥30 years) and divided in meeting SCI-specific exercise guidelines or not. Waist circumference (WC) and body mass index (BMI) were assessed. Participants were classified as being obese (WC > 102 cm for men, WC > 88 cm for women; BMI ≥ 25 kg/m2) or not. Logistic regression analyses were performed to investigate the associations between obesity and TSI and PA. Almost half of the participants (45–47%) were classified as obese. TSI was significantly associated with obesity, the odds of being obese were 1.4 higher when having a 10 years longer TSI. Furthermore, the odds of being obese were 2.0 lower for participants who were meeting the exercise guidelines. The prevalence of obesity is high in people with long-standing SCI. Those with a longer TSI and individuals who do not meet the exercise guidelines are more likely to be obese and need to be targeted for weight management interventions.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 7","pages":"378-386"},"PeriodicalIF":2.1,"publicationDate":"2024-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140677615","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 : 2024-04-18DOI: 10.1038/s41393-024-00992-9
Saeed Vaheb, Yousef Mokary, Hamed Ghoshouni, Omid Mirmosayyeb, Elham Moases Ghaffary, Vahid Shaygannejad, Mohammad Yazdan Panah
Systematic review and meta-analysis. The current study aimed to assess the efficacy and safety of Onabotulinum toxin A (OBTX-A) treatment for neurogenic detrusor overactivity (NDO) in spinal cord injury (SCI) patients. Iran. All relevant articles of clinical trials and cohort studies indexed in PubMed/MEDLINE, Embase, Scopus, and Web of Science databases up to September 6, 2022, that addressed OBTX-A treatment for NDO following SCI were included. The quality of eligible studies was evaluated using Cochrane criteria. Also, the weighted mean difference (WMD) was measured with a random-effect model. Regarding the overall efficacy after OBTX-A treatment in the short term, volume per void (VV) (WMD = 118.8, 95% CI: 90.9–146.7, p < 0.01), incontinence-quality of life (IQoL) (WMD = 24.3, 95% CI: 15.8–32.8, p < 0.01), and maximum cystometric capacity (MCC) (WMD = 144.5, 95% CI: 132.3 to 156.7, p < 0.01) significantly increased, while maximum detrusor pressure during storage (MDP) (WMD = –30.5, 95% CI: –35.9 to –25.1, p < 0.01) showed a significant decrease. Furthermore, compared to the placebo group at the 200-unit dose, there was a significant increase in MCC (WMD = 113.5, 95% CI: 84.7 to 142.3, p < 0.01) and a significant decrease in MDP (WMD = −27.2, 95% CI: −39.2 to −15.1, p < 0.01). Urinary tract infection (UTI), hematuria, and autonomic dysreflexia were the most common side effects, occurring at rates of 29.6%, 14.8%, and 13.4%, respectively. Our findings highlighted the effectiveness and safety of OBTX-A as a promising treatment of NDO following SCI.
研究设计系统综述和荟萃分析.目的本研究旨在评估奥那曲毒素 A（OBTX-A）治疗脊髓损伤（SCI）患者神经源性逼尿肌过度活动（NDO）的疗效和安全性.研究地点伊朗.方法纳入了截至 2022 年 9 月 6 日在 PubMed/MEDLINE、Embase、Scopus 和 Web of Science 数据库中收录的所有涉及奥那曲毒素 A 治疗脊髓损伤后 NDO 的临床试验和队列研究的相关文章。采用 Cochrane 标准对符合条件的研究进行质量评估。结果关于 OBTX-A 短期治疗后的总体疗效，每次排尿量（VV）（WMD = 118.8，95% CI：90.9-146.7，p < 0.01）、尿失禁生活质量（IQoL）（WMD = 24.3，95% CI：15.8-32.8, p <0.01）和最大膀胱容量（MCC）（WMD = 144.5, 95% CI: 132.3 to 156.7, p <0.01）显著增加，而储尿期最大逼尿肌压力（MDP）（WMD = -30.5, 95% CI: -35.9 to -25.1,p<0.01）显著降低。此外，与服用 200 单位剂量的安慰剂组相比，MCC 有明显增加（WMD = 113.5，95% CI：84.7 至 142.3，p < 0.01），MDP 有明显下降（WMD = -27.2，95% CI：-39.2 至 -15.1，p < 0.01）。尿路感染 (UTI)、血尿和自主神经反射障碍是最常见的副作用，发生率分别为 29.6%、14.8% 和 13.4%。
{"title":"Onabotulinum toxin A improves neurogenic detrusor overactivity following spinal cord injury: a systematic review and meta-analysis","authors":"Saeed Vaheb, Yousef Mokary, Hamed Ghoshouni, Omid Mirmosayyeb, Elham Moases Ghaffary, Vahid Shaygannejad, Mohammad Yazdan Panah","doi":"10.1038/s41393-024-00992-9","DOIUrl":"10.1038/s41393-024-00992-9","url":null,"abstract":"Systematic review and meta-analysis. The current study aimed to assess the efficacy and safety of Onabotulinum toxin A (OBTX-A) treatment for neurogenic detrusor overactivity (NDO) in spinal cord injury (SCI) patients. Iran. All relevant articles of clinical trials and cohort studies indexed in PubMed/MEDLINE, Embase, Scopus, and Web of Science databases up to September 6, 2022, that addressed OBTX-A treatment for NDO following SCI were included. The quality of eligible studies was evaluated using Cochrane criteria. Also, the weighted mean difference (WMD) was measured with a random-effect model. Regarding the overall efficacy after OBTX-A treatment in the short term, volume per void (VV) (WMD = 118.8, 95% CI: 90.9–146.7, p < 0.01), incontinence-quality of life (IQoL) (WMD = 24.3, 95% CI: 15.8–32.8, p < 0.01), and maximum cystometric capacity (MCC) (WMD = 144.5, 95% CI: 132.3 to 156.7, p < 0.01) significantly increased, while maximum detrusor pressure during storage (MDP) (WMD = –30.5, 95% CI: –35.9 to –25.1, p < 0.01) showed a significant decrease. Furthermore, compared to the placebo group at the 200-unit dose, there was a significant increase in MCC (WMD = 113.5, 95% CI: 84.7 to 142.3, p < 0.01) and a significant decrease in MDP (WMD = −27.2, 95% CI: −39.2 to −15.1, p < 0.01). Urinary tract infection (UTI), hematuria, and autonomic dysreflexia were the most common side effects, occurring at rates of 29.6%, 14.8%, and 13.4%, respectively. Our findings highlighted the effectiveness and safety of OBTX-A as a promising treatment of NDO following SCI.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 6","pages":"285-294"},"PeriodicalIF":2.1,"publicationDate":"2024-04-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140628311","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 : 2024-04-16DOI: 10.1038/s41393-024-00993-8
Marc Hohenhaus, Jan-Helge Klingler, Christoph Scholz, Ralf Watzlawick, Ulrich Hubbe, Jürgen Beck, Marco Reisert, Urs Würtemberger, Nico Kremers, Katharina Wolf
Prospective diagnostic study. Anatomical evaluation and graduation of the severity of spinal stenosis is essential in degenerative cervical spine disease. In clinical practice, this is subjectively categorized on cervical MRI lacking an objective and reliable classification. We implemented a fully-automated quantification of spinal canal compromise through 3D T2-weighted MRI segmentation. Medical Center - University of Freiburg, Germany. Evaluation of 202 participants receiving 3D T2-weighted MRI of the cervical spine. Segments C2/3 to C6/7 were analyzed for spinal cord and cerebrospinal fluid space volume through a fully-automated segmentation based on a trained deep convolutional neural network. Spinal canal narrowing was characterized by relative values, across sever segments as adapted Maximal Canal Compromise (aMCC), and within the index segment as adapted Spinal Cord Occupation Ratio (aSCOR). Additionally, all segments were subjectively categorized by three observers as “no”, “relative” or “absolute” stenosis. Computed scores were applied on the subjective categorization. 798 (79.0%) segments were subjectively categorized as “no” stenosis, 85 (8.4%) as “relative” stenosis, and 127 (12.6%) as “absolute” stenosis. The calculated scores revealed significant differences between each category (p ≤ 0.001). Youden’s Index analysis of ROC curves revealed optimal cut-offs to distinguish between “no” and “relative” stenosis for aMCC = 1.18 and aSCOR = 36.9%, and between “relative” and “absolute” stenosis for aMCC = 1.54 and aSCOR = 49.3%. The presented fully-automated segmentation algorithm provides high diagnostic accuracy and objective classification of cervical spinal stenosis. The calculated cut-offs can be used for convenient radiological quantification of the severity of spinal canal compromise in clinical routine.
{"title":"Quantification of cervical spinal stenosis by automated 3D MRI segmentation of spinal cord and cerebrospinal fluid space","authors":"Marc Hohenhaus, Jan-Helge Klingler, Christoph Scholz, Ralf Watzlawick, Ulrich Hubbe, Jürgen Beck, Marco Reisert, Urs Würtemberger, Nico Kremers, Katharina Wolf","doi":"10.1038/s41393-024-00993-8","DOIUrl":"10.1038/s41393-024-00993-8","url":null,"abstract":"Prospective diagnostic study. Anatomical evaluation and graduation of the severity of spinal stenosis is essential in degenerative cervical spine disease. In clinical practice, this is subjectively categorized on cervical MRI lacking an objective and reliable classification. We implemented a fully-automated quantification of spinal canal compromise through 3D T2-weighted MRI segmentation. Medical Center - University of Freiburg, Germany. Evaluation of 202 participants receiving 3D T2-weighted MRI of the cervical spine. Segments C2/3 to C6/7 were analyzed for spinal cord and cerebrospinal fluid space volume through a fully-automated segmentation based on a trained deep convolutional neural network. Spinal canal narrowing was characterized by relative values, across sever segments as adapted Maximal Canal Compromise (aMCC), and within the index segment as adapted Spinal Cord Occupation Ratio (aSCOR). Additionally, all segments were subjectively categorized by three observers as “no”, “relative” or “absolute” stenosis. Computed scores were applied on the subjective categorization. 798 (79.0%) segments were subjectively categorized as “no” stenosis, 85 (8.4%) as “relative” stenosis, and 127 (12.6%) as “absolute” stenosis. The calculated scores revealed significant differences between each category (p ≤ 0.001). Youden’s Index analysis of ROC curves revealed optimal cut-offs to distinguish between “no” and “relative” stenosis for aMCC = 1.18 and aSCOR = 36.9%, and between “relative” and “absolute” stenosis for aMCC = 1.54 and aSCOR = 49.3%. The presented fully-automated segmentation algorithm provides high diagnostic accuracy and objective classification of cervical spinal stenosis. The calculated cut-offs can be used for convenient radiological quantification of the severity of spinal canal compromise in clinical routine.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 7","pages":"371-377"},"PeriodicalIF":2.1,"publicationDate":"2024-04-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-00993-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140561965","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 : 2024-04-12DOI: 10.1038/s41393-024-00994-7
Kathryn Burns, Ryan Solinsky
Cross-sectional study. Determine how well common clinical assessments of level and completeness of injury are correlated with symptoms of autonomic blood pressure instability and secondary medical complications after spinal cord injury (SCI). Academic medical center, United States. Eighty-two individuals with (n = 48) and without (n = 34) SCI had symptoms of autonomic blood pressure instability quantified with the Autonomic Dysfunction Following SCI (ADFSCI) survey. Health histories quantified the secondary medical complications through number of urinary tract infections and hospitalizations in the past year, time to complete bowel program, and lifetime pressure injuries. Regression models were completed to identify strengths of associated correlations. ADFSCI scores were significantly higher in individuals with SCI than controls. Neurological level of injury and ASIA impairment scale were both minimally correlated to symptoms of autonomic blood pressure instability, accounting for only 11.5% of variability in regression models. Secondary medical complications had similar, minimal correlations to level and motor/sensory completeness of SCI (R2 = 0.07 and R2 = 0.03 respectively). Contrasting this, symptoms of blood pressure instability on ADFSCI far outperformed the common clinical motor/sensory bedside exam, with moderately strong correlations to the ranked number of secondary medical complications after SCI (R2 = 0.31). Neurological level of injury and motor/sensory completeness provided limited insights into which individuals with SCI would have blood pressure instability or secondary medical complications. Interestingly, symptoms of blood pressure instability outperform the clinical motor/sensory bedside exam, with higher correlations to secondary medical complications after SCI.
{"title":"Autonomic impairment is not explained by neurological level of injury or motor-sensory completeness","authors":"Kathryn Burns, Ryan Solinsky","doi":"10.1038/s41393-024-00994-7","DOIUrl":"10.1038/s41393-024-00994-7","url":null,"abstract":"Cross-sectional study. Determine how well common clinical assessments of level and completeness of injury are correlated with symptoms of autonomic blood pressure instability and secondary medical complications after spinal cord injury (SCI). Academic medical center, United States. Eighty-two individuals with (n = 48) and without (n = 34) SCI had symptoms of autonomic blood pressure instability quantified with the Autonomic Dysfunction Following SCI (ADFSCI) survey. Health histories quantified the secondary medical complications through number of urinary tract infections and hospitalizations in the past year, time to complete bowel program, and lifetime pressure injuries. Regression models were completed to identify strengths of associated correlations. ADFSCI scores were significantly higher in individuals with SCI than controls. Neurological level of injury and ASIA impairment scale were both minimally correlated to symptoms of autonomic blood pressure instability, accounting for only 11.5% of variability in regression models. Secondary medical complications had similar, minimal correlations to level and motor/sensory completeness of SCI (R2 = 0.07 and R2 = 0.03 respectively). Contrasting this, symptoms of blood pressure instability on ADFSCI far outperformed the common clinical motor/sensory bedside exam, with moderately strong correlations to the ranked number of secondary medical complications after SCI (R2 = 0.31). Neurological level of injury and motor/sensory completeness provided limited insights into which individuals with SCI would have blood pressure instability or secondary medical complications. Interestingly, symptoms of blood pressure instability outperform the clinical motor/sensory bedside exam, with higher correlations to secondary medical complications after SCI.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 7","pages":"367-370"},"PeriodicalIF":2.1,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140561738","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 : 2024-04-12DOI: 10.1038/s41393-024-00986-7
Ana Clara Portela Hara, Nicole C. Aching, Lucas M. Marques, Sara P. Barbosa, Daniel R. Souza, Felipe Fregni, Linamara R. Battistella, Marcel Simis
Using a cross-sectional design, we extracted sociodemographic and clinical data from 488 Spinal Cord Injury (SCI) patients during their initial assessment before receiving intensive rehabilitation treatment. The primary objectives of this study were to ascertain the prevalence of cognitive impairment in the study sample and specify the key clinical and demographic predictors of cognitive functioning in SCI patients. Lucy Montoro Rehabilitation Institute (LMRI), University of Sao Paulo, Sao Paulo, Brazil. We utilized independent univariate and multivariate regression models with the Montreal Cognitive Assessment (MoCA) scale, adapted for individuals with visual impairment. Moreover, we consider scores from the execution tasks (visuospatial/executive) as the dependent variable. Our findings demonstrate that approximately 80% of the evaluated study sample exhibited cognitive impairment. Through the multivariate regression models, we show that several factors, including age, education, depression levels, and the use of analgesics and/or opioids, are significant predictors of total cognitive scores. These factors are independent of the clinical features associated with SCI, such as age, sex, education, and time since the injury. The results indicate a high prevalence of significant cognitive impairment within the sample, with age, education, depression levels, and the use of analgesics and/or opioids emerging as the primary predictors of total cognitive scores, independent of the clinical features correlated to SCI. These findings hold significant implications for both clinical research and practice, offering valuable guidance for comprehensive management throughout hospitalization and rehabilitation.
{"title":"The role of clinical and demographic predictors for understanding the cognitive impairment in Spinal Cord Injury (SCI) patients","authors":"Ana Clara Portela Hara, Nicole C. Aching, Lucas M. Marques, Sara P. Barbosa, Daniel R. Souza, Felipe Fregni, Linamara R. Battistella, Marcel Simis","doi":"10.1038/s41393-024-00986-7","DOIUrl":"10.1038/s41393-024-00986-7","url":null,"abstract":"Using a cross-sectional design, we extracted sociodemographic and clinical data from 488 Spinal Cord Injury (SCI) patients during their initial assessment before receiving intensive rehabilitation treatment. The primary objectives of this study were to ascertain the prevalence of cognitive impairment in the study sample and specify the key clinical and demographic predictors of cognitive functioning in SCI patients. Lucy Montoro Rehabilitation Institute (LMRI), University of Sao Paulo, Sao Paulo, Brazil. We utilized independent univariate and multivariate regression models with the Montreal Cognitive Assessment (MoCA) scale, adapted for individuals with visual impairment. Moreover, we consider scores from the execution tasks (visuospatial/executive) as the dependent variable. Our findings demonstrate that approximately 80% of the evaluated study sample exhibited cognitive impairment. Through the multivariate regression models, we show that several factors, including age, education, depression levels, and the use of analgesics and/or opioids, are significant predictors of total cognitive scores. These factors are independent of the clinical features associated with SCI, such as age, sex, education, and time since the injury. The results indicate a high prevalence of significant cognitive impairment within the sample, with age, education, depression levels, and the use of analgesics and/or opioids emerging as the primary predictors of total cognitive scores, independent of the clinical features correlated to SCI. These findings hold significant implications for both clinical research and practice, offering valuable guidance for comprehensive management throughout hospitalization and rehabilitation.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 6","pages":"336-342"},"PeriodicalIF":2.1,"publicationDate":"2024-04-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140561964","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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