Pub Date : 2024-03-22DOI: 10.1038/s41393-024-00984-9
Libak Abou, Oriol Martinez-Navarro, Anna Kratz
Cross-sectional study. To examine the differences in satisfaction with social roles and activities among ambulatory individuals, manual wheelchair users, and power wheelchair users with spinal cord injuries (SCIs). Community setting. Participants completed surveys of their demographics and clinical data as well as the Spinal Cord Injury – Quality of Life Satisfaction with Social Roles and Activities- Short Form. Participants’ mobility status was categorized into (1) ambulatory individuals, (2) independent manual wheelchair users, and (3) power wheelchair/scooter users. One-way ANOVA and ANCOVA were used, respectively, to examine unadjusted and adjusted differences in satisfaction with social roles and activities across mobility status. Adjustment covariates included age, sex, time since SCI, and SCI injury level. A total of 129 participants (mean age = 47.4 ± 13.6 years, 73% male) were included in the analyses. Unadjusted (F = 3.8, p = 0.03) and adjusted models (F = 3.4, p = 0.04) evidenced significant differences in satisfaction with social roles and activities according to mobility status. Pairwise Bonferroni Post-Hoc analysis indicated that manual wheelchair users were more satisfied with their social roles and activities when compared to ambulatory individuals (mean difference = 2.8, p < 0.05). Due to the current challenges associated with walking recovery after SCIs, clinicians may want to discuss the use of wheelchairs with individuals with limited walking ability when the goal is to improve participation and quality of life. Emphasizing alternative means of mobility may enhance satisfaction with social roles and activities.
{"title":"Satisfaction with social roles and activities across mobility status among persons with spinal cord injury","authors":"Libak Abou, Oriol Martinez-Navarro, Anna Kratz","doi":"10.1038/s41393-024-00984-9","DOIUrl":"10.1038/s41393-024-00984-9","url":null,"abstract":"Cross-sectional study. To examine the differences in satisfaction with social roles and activities among ambulatory individuals, manual wheelchair users, and power wheelchair users with spinal cord injuries (SCIs). Community setting. Participants completed surveys of their demographics and clinical data as well as the Spinal Cord Injury – Quality of Life Satisfaction with Social Roles and Activities- Short Form. Participants’ mobility status was categorized into (1) ambulatory individuals, (2) independent manual wheelchair users, and (3) power wheelchair/scooter users. One-way ANOVA and ANCOVA were used, respectively, to examine unadjusted and adjusted differences in satisfaction with social roles and activities across mobility status. Adjustment covariates included age, sex, time since SCI, and SCI injury level. A total of 129 participants (mean age = 47.4 ± 13.6 years, 73% male) were included in the analyses. Unadjusted (F = 3.8, p = 0.03) and adjusted models (F = 3.4, p = 0.04) evidenced significant differences in satisfaction with social roles and activities according to mobility status. Pairwise Bonferroni Post-Hoc analysis indicated that manual wheelchair users were more satisfied with their social roles and activities when compared to ambulatory individuals (mean difference = 2.8, p < 0.05). Due to the current challenges associated with walking recovery after SCIs, clinicians may want to discuss the use of wheelchairs with individuals with limited walking ability when the goal is to improve participation and quality of life. Emphasizing alternative means of mobility may enhance satisfaction with social roles and activities.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 5","pages":"264-269"},"PeriodicalIF":2.2,"publicationDate":"2024-03-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140194548","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 : 2024-03-20DOI: 10.1038/s41393-024-00978-7
Jing Chen
{"title":"Correspondence to “Relationship between employment and quality of life and self-perceived health in people with spinal cord injury: an international comparative study based on the InSCI community survey”","authors":"Jing Chen","doi":"10.1038/s41393-024-00978-7","DOIUrl":"10.1038/s41393-024-00978-7","url":null,"abstract":"","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 5","pages":"270-271"},"PeriodicalIF":2.2,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140176545","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 : 2024-03-20DOI: 10.1038/s41393-024-00982-x
Karin Postma, Tijn van Diemen, Marcel W. M. Post, Janneke M. Stolwijk-Swüste, Rita J. G. van den Berg-Emons, Rutger Osterthun
Longitudinal cohort study. Examine the longitudinal association between mobility and level of physical activity (PA) and explore which other factors are also associated with level of PA in ambulatory people with Spinal Cord Injury (SCI) during the first-year post-inpatient rehabilitation. Three SCI-specialized rehabilitation centers and the Dutch community. Forty-seven adults with recent SCI and ambulatory function were included. All had motor incomplete lesions, 49% had tetraplegia, and the mean age was 55 ± 13 years. Duration of accelerometry-based all-day PA and self-reported level of mobility, exertion of walking, pain, fatigue, depressive mood symptoms, fear of falling, exercise self-efficacy, and attitude toward PA were measured just before discharge from inpatient rehabilitation and 6 and 12 months after discharge. All data were longitudinally analyzed using generalized estimating equations analyses. Models were corrected for age, lesion level, and time since injury. Mobility was longitudinally associated with level of PA (beta: 4.5, P < 0.001, R2: 41%). In addition, lower levels of exertion of walking (beta: −5.6, P < 0.001), fear of falling (beta: −34.1, P < 0.001), and higher levels of exercise self-efficacy (beta: 2.3, P = 0.038) were associated with higher levels of PA. Exertion of walking and fear of falling were associated with level of PA independent of mobility. Mobility, exertion of walking, fear of falling, and exercise self-efficacy seem to be correlates of level of PA in ambulatory people with SCI during the first year after inpatient rehabilitation. Targeting these factors using an interdisciplinary approach may enhance levels of PA in this population.
研究设计研究目的：纵向队列研究：研究脊髓损伤（SCI）患者在住院后第一年康复期间的行动能力与体力活动（PA）水平之间的纵向联系，并探讨哪些其他因素也与体力活动水平有关：环境：三家脊髓损伤专业康复中心和荷兰社区：方法：纳入 47 名近期接受过脊髓损伤且具有活动功能的成年人。所有患者均为运动性不完全损伤，49%为四肢瘫痪，平均年龄为 55 ± 13 岁。在出院前以及出院后 6 个月和 12 个月，测量了以加速度计为基础的全天 PA 持续时间，以及自我报告的活动能力水平、行走时的体力消耗、疼痛、疲劳、抑郁情绪症状、跌倒恐惧、运动自我效能以及对 PA 的态度。所有数据均采用广义估计方程进行纵向分析。模型对年龄、病变程度和受伤后时间进行了校正：结果：活动能力与体力活动水平有纵向关系（β：4.5，P 2：41%）。此外，行走时的用力程度较低（β：-5.6，P在住院康复后的第一年中，行动能力、行走时的体力消耗、对跌倒的恐惧以及运动自我效能似乎与行动不便的 SCI 患者的 PA 水平相关。采用跨学科方法针对这些因素进行治疗，可提高这类人群的运动量水平。
{"title":"Correlates of physical activity in ambulatory people with spinal cord injury during the first year after inpatient rehabilitation","authors":"Karin Postma, Tijn van Diemen, Marcel W. M. Post, Janneke M. Stolwijk-Swüste, Rita J. G. van den Berg-Emons, Rutger Osterthun","doi":"10.1038/s41393-024-00982-x","DOIUrl":"10.1038/s41393-024-00982-x","url":null,"abstract":"Longitudinal cohort study. Examine the longitudinal association between mobility and level of physical activity (PA) and explore which other factors are also associated with level of PA in ambulatory people with Spinal Cord Injury (SCI) during the first-year post-inpatient rehabilitation. Three SCI-specialized rehabilitation centers and the Dutch community. Forty-seven adults with recent SCI and ambulatory function were included. All had motor incomplete lesions, 49% had tetraplegia, and the mean age was 55 ± 13 years. Duration of accelerometry-based all-day PA and self-reported level of mobility, exertion of walking, pain, fatigue, depressive mood symptoms, fear of falling, exercise self-efficacy, and attitude toward PA were measured just before discharge from inpatient rehabilitation and 6 and 12 months after discharge. All data were longitudinally analyzed using generalized estimating equations analyses. Models were corrected for age, lesion level, and time since injury. Mobility was longitudinally associated with level of PA (beta: 4.5, P < 0.001, R2: 41%). In addition, lower levels of exertion of walking (beta: −5.6, P < 0.001), fear of falling (beta: −34.1, P < 0.001), and higher levels of exercise self-efficacy (beta: 2.3, P = 0.038) were associated with higher levels of PA. Exertion of walking and fear of falling were associated with level of PA independent of mobility. Mobility, exertion of walking, fear of falling, and exercise self-efficacy seem to be correlates of level of PA in ambulatory people with SCI during the first year after inpatient rehabilitation. Targeting these factors using an interdisciplinary approach may enhance levels of PA in this population.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 5","pages":"249-254"},"PeriodicalIF":2.2,"publicationDate":"2024-03-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140176544","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 : 2024-03-18DOI: 10.1038/s41393-024-00980-z
Tanya A. Barretto, Wolfram Tetzlaff, Judy Illes
In May 2023, a disclaimer posted on ClinicalTrials.gov dismisses accountability for the accuracy of registered information. For spinal cord injury, inconsistencies in intervention classification, phase designation, and lack of study protocols and results threaten the integrity of the database and put users at risk. An investment in what the resource should be rather than what it is not will give it the authority commensurate with the requirements for its regulatory use and informed decision-making for prospective trial participants.
{"title":"Ethics and accountability for clinical trials","authors":"Tanya A. Barretto, Wolfram Tetzlaff, Judy Illes","doi":"10.1038/s41393-024-00980-z","DOIUrl":"10.1038/s41393-024-00980-z","url":null,"abstract":"In May 2023, a disclaimer posted on ClinicalTrials.gov dismisses accountability for the accuracy of registered information. For spinal cord injury, inconsistencies in intervention classification, phase designation, and lack of study protocols and results threaten the integrity of the database and put users at risk. An investment in what the resource should be rather than what it is not will give it the authority commensurate with the requirements for its regulatory use and informed decision-making for prospective trial participants.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 4","pages":"192-194"},"PeriodicalIF":2.2,"publicationDate":"2024-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-00980-z.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140159016","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 : 2024-03-16DOI: 10.1038/s41393-024-00974-x
Anne M. Bryden, Brian Gran
Longitudinal qualitative study, based on a constructivist grounded theory and transformative approach. This study investigated experiences of individuals with spinal cord injury (SCI) while navigating rehabilitation, resources for recovery, and community reintegration during the first year after injury. An acute inpatient rehabilitation facility in the Midwest United States. In-depth, semi-structured interviews were conducted with 20 individuals with newly-acquired SCI. Interviews were conducted approximately every other month for one year, beginning at acute inpatient rehabilitation. Data were analyzed and interpreted using a constructivist grounded theory approach and transformative paradigm, which examines power and social structures within and across institutions and gives voice to people at risk for marginalization. Participants experienced variable post-injury trajectories, with an average of four transitions within and across healthcare institutions in the first three months. Half of the cohort was discharged to a skilled nursing facility (SNF). Emergent themes included discharge (un)readiness; length of stay uncertainty and insurance impacts; challenges choosing a SNF including time-sensitive decisions; and early cessation of therapy in the SNF. Participants experienced resource navigation challenges such as communication/information access barriers and contending with many concerns at once. The experiences of this cohort reveal significant challenges to attaining sufficient and appropriate rehabilitation. Acute inpatient rehabilitation is a critical aspect of recovery, but does not ensure sufficient intervention for maximization of functional skills and community reintegration. Innovative rehabilitation models need to be developed for positive impacts on successful transition to independent living in the community.
{"title":"Seeking sufficient and appropriate care during the first year after spinal cord injury: a qualitative study","authors":"Anne M. Bryden, Brian Gran","doi":"10.1038/s41393-024-00974-x","DOIUrl":"10.1038/s41393-024-00974-x","url":null,"abstract":"Longitudinal qualitative study, based on a constructivist grounded theory and transformative approach. This study investigated experiences of individuals with spinal cord injury (SCI) while navigating rehabilitation, resources for recovery, and community reintegration during the first year after injury. An acute inpatient rehabilitation facility in the Midwest United States. In-depth, semi-structured interviews were conducted with 20 individuals with newly-acquired SCI. Interviews were conducted approximately every other month for one year, beginning at acute inpatient rehabilitation. Data were analyzed and interpreted using a constructivist grounded theory approach and transformative paradigm, which examines power and social structures within and across institutions and gives voice to people at risk for marginalization. Participants experienced variable post-injury trajectories, with an average of four transitions within and across healthcare institutions in the first three months. Half of the cohort was discharged to a skilled nursing facility (SNF). Emergent themes included discharge (un)readiness; length of stay uncertainty and insurance impacts; challenges choosing a SNF including time-sensitive decisions; and early cessation of therapy in the SNF. Participants experienced resource navigation challenges such as communication/information access barriers and contending with many concerns at once. The experiences of this cohort reveal significant challenges to attaining sufficient and appropriate rehabilitation. Acute inpatient rehabilitation is a critical aspect of recovery, but does not ensure sufficient intervention for maximization of functional skills and community reintegration. Innovative rehabilitation models need to be developed for positive impacts on successful transition to independent living in the community.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 5","pages":"241-248"},"PeriodicalIF":2.2,"publicationDate":"2024-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-00974-x.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140140850","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 : 2024-03-15DOI: 10.1038/s41393-024-00976-9
Sven Hoekstra, Frank Ettema, Max van der Bijll, Vera van der Sterren, Ellen van Binsbergen, Ludwine van Orsouw, Wendy Achterberg, Hein Daanen, Thomas Janssen, Sonja de Groot
A three-arm randomized controlled trial. To investigate the effects of the Wim Hof Method (WHM), with (WHM-C) and without cold exposure (WHM-NC), on mental and physical health in persons with chronic spinal cord injury (SCI). Rehabilitation centre (assessments and once-weekly intervention sessions) and home-based (daily intervention sessions). Sixty adults with chronic SCI will be randomised (1:1:1) to one of three groups: participants in the intervention groups (i.e., WHM-C and WHM-NC) will engage in a 7-week intervention, with one weekly practice session at the rehabilitation centre and a daily WHM session at home. WHM-NC will consist of breathing exercises and mindset, while participants in WHM-C will partake in breathing exercises, mindset and cold exposure. Participants allocated to usual care (UC) will not receive the WHM intervention. The primary outcome is mental health reported via the Mental Health Inventory (MHI)-5, while secondary outcomes include circulating inflammatory and metabolic marker concentration, pulmonary function, body composition, sleep quality, spasticity, chronic pain and psychological stress. Ethics approval has been obtained from the medical ethics committee of the Máxima Medical Centre (Veldhoven, the Netherlands; identifier: w22.069). If shown efficacious in improving mental health, as well as physical health, in persons with chronic SCI, the low cost and accessibility of the WHM allows it to be directly implemented in SCI rehabilitation. NCT05704322.
{"title":"The effect of breathing exercises and mindset with or without cold exposure on mental and physical health in persons with a spinal cord injury—a protocol for a three-arm randomised-controlled trial","authors":"Sven Hoekstra, Frank Ettema, Max van der Bijll, Vera van der Sterren, Ellen van Binsbergen, Ludwine van Orsouw, Wendy Achterberg, Hein Daanen, Thomas Janssen, Sonja de Groot","doi":"10.1038/s41393-024-00976-9","DOIUrl":"10.1038/s41393-024-00976-9","url":null,"abstract":"A three-arm randomized controlled trial. To investigate the effects of the Wim Hof Method (WHM), with (WHM-C) and without cold exposure (WHM-NC), on mental and physical health in persons with chronic spinal cord injury (SCI). Rehabilitation centre (assessments and once-weekly intervention sessions) and home-based (daily intervention sessions). Sixty adults with chronic SCI will be randomised (1:1:1) to one of three groups: participants in the intervention groups (i.e., WHM-C and WHM-NC) will engage in a 7-week intervention, with one weekly practice session at the rehabilitation centre and a daily WHM session at home. WHM-NC will consist of breathing exercises and mindset, while participants in WHM-C will partake in breathing exercises, mindset and cold exposure. Participants allocated to usual care (UC) will not receive the WHM intervention. The primary outcome is mental health reported via the Mental Health Inventory (MHI)-5, while secondary outcomes include circulating inflammatory and metabolic marker concentration, pulmonary function, body composition, sleep quality, spasticity, chronic pain and psychological stress. Ethics approval has been obtained from the medical ethics committee of the Máxima Medical Centre (Veldhoven, the Netherlands; identifier: w22.069). If shown efficacious in improving mental health, as well as physical health, in persons with chronic SCI, the low cost and accessibility of the WHM allows it to be directly implemented in SCI rehabilitation. NCT05704322.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 5","pages":"237-240"},"PeriodicalIF":2.2,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140140851","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}
Prospective Comparative Study. This study aims to compare the functional outcomes of Robotic-assisted rehabilitation by Lokomat system Vs. Conventional rehabilitation in participants with Dorsolumbar complete spinal cord injury (SCI). University level teaching hospital in a hilly state of northern India. 15 participants with Dorsolumbar SCI with ASIA A neurology were allocated to robotic rehabilitation and 15 participants to conventional rehabilitation after an operative procedure. Pre-and Post-rehabilitation parameters were noted in terms of ASIA Neurology, Motor and sensory function scores, WISCI II score (Walking Index in SCI score), LEMS (Lower Extremity Motor Score), SCI M III score (Spinal Cord Independence Measure III score), AO Spine PROST (AO Patient Reported Outcome Spine Trauma), McGill QOL score (Mc Gill Quality of Life score), VAS score (Visual Analogue Scale) for pain and Modified Ashworth scale for spasticity in lower limbs. On comparing robotic group with conventional group there was a statistically significant improvement in Robotic-assisted rehabilitation group in terms of Motor score (p = 0.034), WISCI II score (p = 0.0001), SCIM III score (p = 0.0001), AO PROST score (p = 0.0001), Mc GILL QOL score (p = 0.0001), Max velocity (p = 0.0001) and Step length (p = 0.0001). Whereas LEMS score (p = 0.052), ASIA neurology (p = 0.264 (ASIA A); 1.000 (ASIA B); 0.053 (ASIA C)), VAS score (p = 0.099), Sensory score (p = 0.422) and Modified Ashworth scale for spasticity (p = 0.136) were not statically significant when comparing between two groups. Robot-assisted rehabilitation is superior than conventional rehabilitation in people living with SCI with AIS A neurology. Differences in the patient group, type of a lesion its and severity, duration from onset to initiation of rehabilitation, devices employed, administration of the therapies and regulation of interventions are likely the cause of variations in the findings seen in the literature for robotic assisted training. Level of Evidence: III.
研究设计前瞻性比较研究：本研究旨在对背腰部完全性脊髓损伤（SCI）患者使用 Lokomat 系统进行机器人辅助康复治疗与传统康复治疗的功能效果进行比较：方法：15 名患有背腰部 SCI 的 ASIA A 级神经病患者在手术后被分配接受机器人康复治疗，15 名患者接受传统康复治疗。康复前后的参数包括：ASIA神经学、运动和感觉功能评分、WISCI II评分（SCI步行指数评分）、LEMS（下肢运动评分）、SCI M III评分（脊髓独立性测量III评分）、AO脊柱PROST（AO脊柱创伤患者报告结果）、McGill QOL评分（Mc Gill生活质量评分）、疼痛VAS评分（视觉模拟量表）和下肢痉挛改良Ashworth量表。结果：机器人组与传统组相比，机器人辅助康复组在运动评分（p = 0.034）、WISCI II 评分（p = 0.0001）、SCIM III 评分（p = 0.0001）、AO PROST 评分（p = 0.0001）、Mc Gill QOL 评分（p = 0.0001）、最大速度（p = 0.0001）和步长（p = 0.0001）方面均有显著改善。而 LEMS 评分（p = 0.052）、ASIA 神经评分（p = 0.264 (ASIA A)；1.000 (ASIA B)；0.053 (ASIA C)）、VAS 评分（p = 0.099）、感觉评分（p = 0.422）和改良阿什沃斯痉挛量表（p = 0.136）在两组间比较无统计学意义：结论：对于神经内科AIS A级SCI患者，机器人辅助康复优于传统康复。患者群体、病变类型及其严重程度、从发病到开始康复的持续时间、所使用的设备、治疗方法的管理和干预措施的调节等方面的差异，很可能是导致机器人辅助训练的文献研究结果存在差异的原因：证据等级：III.
{"title":"Effect on functional outcome of robotic assisted rehabilitation versus conventional rehabilitation in patients with complete spinal cord injury: a prospective comparative study","authors":"Chandra Kumar Khande, Vishal Verma, Anil Regmi, Syed Ifthekar, P. Venkata Sudhakar, Siddharth Shekhar Sethy, Pankaj Kandwal, Bhaskar Sarkar","doi":"10.1038/s41393-024-00970-1","DOIUrl":"10.1038/s41393-024-00970-1","url":null,"abstract":"Prospective Comparative Study. This study aims to compare the functional outcomes of Robotic-assisted rehabilitation by Lokomat system Vs. Conventional rehabilitation in participants with Dorsolumbar complete spinal cord injury (SCI). University level teaching hospital in a hilly state of northern India. 15 participants with Dorsolumbar SCI with ASIA A neurology were allocated to robotic rehabilitation and 15 participants to conventional rehabilitation after an operative procedure. Pre-and Post-rehabilitation parameters were noted in terms of ASIA Neurology, Motor and sensory function scores, WISCI II score (Walking Index in SCI score), LEMS (Lower Extremity Motor Score), SCI M III score (Spinal Cord Independence Measure III score), AO Spine PROST (AO Patient Reported Outcome Spine Trauma), McGill QOL score (Mc Gill Quality of Life score), VAS score (Visual Analogue Scale) for pain and Modified Ashworth scale for spasticity in lower limbs. On comparing robotic group with conventional group there was a statistically significant improvement in Robotic-assisted rehabilitation group in terms of Motor score (p = 0.034), WISCI II score (p = 0.0001), SCIM III score (p = 0.0001), AO PROST score (p = 0.0001), Mc GILL QOL score (p = 0.0001), Max velocity (p = 0.0001) and Step length (p = 0.0001). Whereas LEMS score (p = 0.052), ASIA neurology (p = 0.264 (ASIA A); 1.000 (ASIA B); 0.053 (ASIA C)), VAS score (p = 0.099), Sensory score (p = 0.422) and Modified Ashworth scale for spasticity (p = 0.136) were not statically significant when comparing between two groups. Robot-assisted rehabilitation is superior than conventional rehabilitation in people living with SCI with AIS A neurology. Differences in the patient group, type of a lesion its and severity, duration from onset to initiation of rehabilitation, devices employed, administration of the therapies and regulation of interventions are likely the cause of variations in the findings seen in the literature for robotic assisted training. Level of Evidence: III.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 5","pages":"228-236"},"PeriodicalIF":2.2,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140140849","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 : 2024-03-14DOI: 10.1038/s41393-024-00975-w
Juan José Fernández-Pérez, Gülser Cinbaz, Julio Gómez-Soriano
{"title":"Toward a better understanding and terminology of transcutaneous spinal cord stimulation techniques","authors":"Juan José Fernández-Pérez, Gülser Cinbaz, Julio Gómez-Soriano","doi":"10.1038/s41393-024-00975-w","DOIUrl":"10.1038/s41393-024-00975-w","url":null,"abstract":"","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 4","pages":"195-196"},"PeriodicalIF":2.2,"publicationDate":"2024-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140132650","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 : 2024-03-07DOI: 10.1038/s41393-024-00967-w
Su Ji Lee, Ji Cheol Shin
Retrospective cohort study. To investigate the potential of technetium-99m-mercaptoacetyltriglycine (99mTc-MAG-3) renal scintigraphy for predicting maximal detrusor pressure in the early stages of spinal cord injury (SCI). Tertiary rehabilitation facility. Medical records of individuals with SCI admitted between January 2020 and April 2023 who underwent both 99mTc-MAG-3 renal scintigraphy and urodynamic study within 90 days of SCI onset were retrospectively reviewed. Pearson’s coefficient analysis was performed to determine the relationship between 99mTc-MAG-3 renal scintigraphy findings and urodynamic study findings. A multivariate linear regression analysis was performed to determine the best predictors of maximal detrusor pressure. A multivariate logistic regression analysis was performed to determine risk factors for high detrusor pressure. Ninety-four participants were enrolled in this study. Pearson’s correlation analysis showed that effective renal plasma flow (ERPF) and ERPF (% predicted) were significantly correlated with maximal detrusor pressure. The multivariate linear regression analysis demonstrated that ERPF (% predicted) was a significant predictor of maximal detrusor pressure. The multivariate logistic regression analysis showed that ERPF (% predicted) was significantly associated with high detrusor pressure. The receiver operating characteristic curve demonstrated that the predictive model had an area under the curve of 0.725, with an ERPF (% predicted) cut-off of 64.05%, sensitivity 1.000, and specificity 0.429. These results suggest that 99mTc-MAG-3 renal scintigraphy may be useful for predicting high detrusor pressure in early SCI and may guide the timing of urodynamic studies in individuals with early SCI for appropriate management of neurogenic lower urinary tract dysfunction.
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Pub Date : 2024-03-07DOI: 10.1038/s41393-024-00972-z
Margaret A. Fitzpatrick, Pooja Solanki, Marissa Wirth, Frances M. Weaver, Katie J. Suda, Stephen P. Burns, Nasia Safdar, Eileen Collins, Charlesnika T. Evans
Qualitative study. To explore how knowledge, perceptions, and beliefs about urinary tract infections (UTIs) among persons with neurogenic bladder (NB) may impact health behaviors and provider management and enhance person-centeredness of interventions to improve UTI management. Three Veterans Affairs (VA) medical centers. Adults with NB due to spinal cord injury/disorder (SCI/D) or multiple sclerosis (MS) with UTI diagnoses in the prior year participated in focus groups. Transcripts were coded using deductive codes linked to the Health Belief Model and inductive codes informed by grounded theory. Twenty-three Veterans (SCI/D, 78%; MS: 18.5%) participated in discussions. Three themes emerged: (1) UTI knowledge; (2) factors affecting the intervention environment; and (3) factors affecting modes of delivery. Knowledge gaps included UTI prevention, specific symptoms most indicative of UTI, and antibiotic side effects. Poor perceptions of providers lacking knowledge about NB and ineffective patient–provider communication were common in the Emergency Department and non-VA facilities, whereas participants had positive perceptions of home-based care. Participants perceived lower severity and frequency of antibiotic risks compared to UTI risks. Participant preferences for education included caregiver involvement, verbal and written materials, and diverse settings like peer groups. Identifying patient perspectives enhances person-centeredness and allows for novel interventions improving patient knowledge and behaviors about UTIs. Partnering with trusted providers and home-based caregivers and improving NB knowledge and communication in certain care settings were important. Patient education should address mental risk representations and incorporate preferences for content delivery to optimize self-efficacy and strengthen cues to action.
研究设计定性研究目的探讨神经源性膀胱（NB）患者对尿路感染（UTI）的知识、看法和信念会如何影响健康行为和医疗服务提供者的管理，以及如何加强以人为本的干预措施以改善 UTI 管理。使用与健康信念模型相关联的演绎代码和基础理论的归纳代码对讨论记录进行编码。讨论中出现了三个主题：(1) UTI 知识；(2) 影响干预环境的因素；(3) 影响提供方式的因素。知识缺口包括尿毒症的预防、尿毒症最常见的具体症状以及抗生素的副作用。在急诊科和非退伍军人医疗机构中，参与者普遍认为医疗服务提供者缺乏有关 NB 的知识，患者与医疗服务提供者之间的沟通效率低下，而参与者则对家庭护理有积极的看法。与尿毒症风险相比，参与者认为抗生素风险的严重性和频率较低。参与者对教育的偏好包括护理人员的参与、口头和书面材料，以及同侪团体等多样化的环境。与可信赖的医疗服务提供者和居家护理人员合作，以及在特定护理环境中改善 NB 知识和沟通都很重要。患者教育应针对心理风险表征，并结合对内容提供的偏好，以优化自我效能并加强行动提示。
{"title":"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, Pooja Solanki, Marissa Wirth, Frances M. Weaver, Katie J. Suda, Stephen P. Burns, Nasia Safdar, Eileen Collins, Charlesnika T. Evans","doi":"10.1038/s41393-024-00972-z","DOIUrl":"10.1038/s41393-024-00972-z","url":null,"abstract":"Qualitative study. To explore how knowledge, perceptions, and beliefs about urinary tract infections (UTIs) among persons with neurogenic bladder (NB) may impact health behaviors and provider management and enhance person-centeredness of interventions to improve UTI management. Three Veterans Affairs (VA) medical centers. Adults with NB due to spinal cord injury/disorder (SCI/D) or multiple sclerosis (MS) with UTI diagnoses in the prior year participated in focus groups. Transcripts were coded using deductive codes linked to the Health Belief Model and inductive codes informed by grounded theory. Twenty-three Veterans (SCI/D, 78%; MS: 18.5%) participated in discussions. Three themes emerged: (1) UTI knowledge; (2) factors affecting the intervention environment; and (3) factors affecting modes of delivery. Knowledge gaps included UTI prevention, specific symptoms most indicative of UTI, and antibiotic side effects. Poor perceptions of providers lacking knowledge about NB and ineffective patient–provider communication were common in the Emergency Department and non-VA facilities, whereas participants had positive perceptions of home-based care. Participants perceived lower severity and frequency of antibiotic risks compared to UTI risks. Participant preferences for education included caregiver involvement, verbal and written materials, and diverse settings like peer groups. Identifying patient perspectives enhances person-centeredness and allows for novel interventions improving patient knowledge and behaviors about UTIs. Partnering with trusted providers and home-based caregivers and improving NB knowledge and communication in certain care settings were important. Patient education should address mental risk representations and incorporate preferences for content delivery to optimize self-efficacy and strengthen cues to action.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 5","pages":"221-227"},"PeriodicalIF":2.2,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140054133","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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