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Differential Expression of Vascular-Related MicroRNA in Circulating Endothelial Microvesicles in Adults With Spinal Cord Injury: A Pilot Study. 脊髓损伤成人循环内皮微囊中血管相关微RNA的差异表达:一项试点研究
IF 2.9 Q1 REHABILITATION Pub Date : 2023-01-01 Epub Date: 2023-04-03 DOI: 10.46292/sci22-00032
Andrew J Park, Hannah K Fandl, Vinicius P Garcia, Geoff B Coombs, Noah M DeSouza, Jared J Greiner, Otto F Barak, Tanja Mijacika, Zeljko Dujic, Philip N Ainslie, Christopher A DeSouza

Background: Spinal cord injury (SCI) is associated with an increased risk and prevalence of cardiopulmonary and cerebrovascular disease-related morbidity and mortality. The factors that initiate, promote, and accelerate vascular diseases and events in SCI are poorly understood. Clinical interest in circulating endothelial cell-derived microvesicles (EMVs) and their microRNA (miRNA) cargo has intensified due to their involvement in endothelial dysfunction, atherosclerosis, and cerebrovascular events.

Objectives: The aim of this study was to determine whether a subset of vascular-related miRNAs is differentially expressed in EMVs isolated from adults with SCI.

Methods: We assessed eight adults with tetraplegia (7 male/1 female; age: 46±4 years; time since injury: 26±5 years) and eight uninjured (6 male/2 female; age: 39±3 years). Circulating EMVs were isolated, enumerated, and collected from plasma by flow cytometry. The expression of vascular-related miRNAs in EMVs was assessed by RT-PCR.

Results: Circulating EMV levels were significantly higher (~130%) in adults with SCI compared with uninjured adults. The expression profile of miRNAs in EMVs from adults with SCI were significantly different than uninjured adults and were pathologic in nature. Expression of miR-126, miR-132, and miR-Let-7a were lower (~100-150%; p < .05), whereas miR-30a, miR-145, miR-155, and miR-216 were higher (~125-450%; p < .05) in EMVs from adults with SCI.

Conclusion: This study is the first examination of EMV miRNA cargo in adults with SCI. The cargo signature of vascular-related miRNAs studied reflects a pathogenic EMV phenotype prone to induce inflammation, atherosclerosis, and vascular dysfunction. EMVs and their miRNA cargo represent a novel biomarker of vascular risk and a potential target for intervention to alleviate vascular-related disease after SCI.

背景:脊髓损伤(SCI)会增加心肺和脑血管疾病相关的发病率和死亡率。人们对引发、促进和加速脊髓损伤血管疾病和事件的因素知之甚少。由于循环内皮细胞衍生的微囊泡(EMVs)及其携带的微RNA(miRNA)参与内皮功能障碍、动脉粥样硬化和脑血管事件,临床对它们的兴趣日益浓厚:本研究旨在确定与血管相关的miRNA子集是否在从患有SCI的成年人体内分离出的EMV中有不同程度的表达:我们评估了 8 名四肢瘫痪的成人(7 男/1 女;年龄:46±4 岁;受伤后时间:26±5 年)和 8 名未受伤的成人(6 男/2 女;年龄:39±3 岁)。通过流式细胞术从血浆中分离、计数和收集循环中的 EMV。通过 RT-PCR 评估了血管相关 miRNA 在 EMV 中的表达:结果:与未受伤的成年人相比,患有 SCI 的成年人的循环 EMV 水平明显更高(约 130%)。与未受伤的成人相比,患有 SCI 的成人 EMV 中 miRNAs 的表达谱明显不同,且具有病理性质。在患有 SCI 的成人 EMV 中,miR-126、miR-132 和 miR-Let-7a 的表达量较低(约 100-150%;p < .05),而 miR-30a、miR-145、miR-155 和 miR-216 的表达量较高(约 125-450%;p < .05):这项研究首次对患有 SCI 的成人 EMV 中的 miRNA 货物进行了检测。所研究的血管相关 miRNA 的载货特征反映了 EMV 的致病表型,容易诱发炎症、动脉粥样硬化和血管功能障碍。EMV及其miRNA载体代表了一种新的血管风险生物标志物,也是缓解SCI后血管相关疾病的潜在干预目标。
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引用次数: 0
Commentary: Spinal Cord Stimulation to Improve Autonomic Regulation After Spinal Cord Injury: Can Reflex Control Be Restored. 评论:脊髓刺激改善脊髓损伤后的自主神经调节:反射控制能否恢复。
IF 2.9 Q1 REHABILITATION Pub Date : 2023-01-01 Epub Date: 2023-05-22 DOI: 10.46292/sci22-00048
Ryan Solinsky, J Andrew Taylor
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引用次数: 0
Exercises With Optimal Scapulothoracic Muscle Activation for Individuals With Paraplegia. 针对截瘫患者的肩胛胸肌最佳激活运动。
IF 2.9 Q1 REHABILITATION Pub Date : 2023-01-01 Epub Date: 2023-12-30 DOI: 10.46292/sci21-00059
Linda M Riek, Amy Aronson, Kacie Giust, Samantha Putnam, Hannah Froese, Sean Rutherford, Mary Kathryn White

Background: Individuals with paraplegia and coexisting trunk and postural control deficits rely on their upper extremities for function, which increases the risk of shoulder pain. A multifactorial etiology of shoulder pain includes "impingement" of the supraspinatus, infraspinatus, long head of the biceps tendons, and/or subacromial bursa resulting from anatomic abnormalities, intratendinous degeneration, and altered scapulothoracic kinematics and muscle activation. Targeting serratus anterior (SA) and lower trapezius (LT) activation during exercise, as part of a comprehensive plan, minimizes impingement risk by maintaining optimal shoulder alignment and kinematics during functional activities. To prevent excessive scapular upward translation, minimizing upper trapezius (UT) to SA and LT activation is also important.

Objectives: To determine which exercises (1) maximally activate SA and minimize UT:SA ratio and (2) maximally activate LT and minimize UT:LT ratio.

Methods: Kinematic and muscle activation data were captured from 10 individuals with paraplegia during four exercises: "T," scaption (sitting), dynamic hug, and SA punch (supine). Means and ratios were normalized by percent maximum voluntary isometric contraction (MVIC) for each muscle. One-way repeated measures analysis of variance determined significant differences in muscle activation between exercises.

Results: Exercises were rank ordered: (1) maximum SA activation: SA punch, scaption, dynamic hug, "T"; (2) maximum LT activation: "T," scaption, dynamic hug, SA punch; 3) minimum UT:SA ratio: SA punch, dynamic hug, scaption, "T"; and (4) minimum UT:LT ratio: SA punch, dynamic hug, "T," scaption. Exercise elicited statistically significant changes in percent MVIC and ratios. Post hoc analyses revealed multiple significant differences between exercises (p < .05).

Conclusion: SA punch produced the greatest SA activation and lowest ratios. Dynamic hug also produced optimal ratios, suggesting supine exercises minimize UT activation more effectively. To isolate SA activation, individuals with impaired trunk control may want to initiate strengthening exercises in supine. Participants maximally activated the LT, but they were not able to minimize UT while upright.

背景:截瘫患者同时伴有躯干和姿势控制障碍,其功能依赖于上肢,这增加了肩部疼痛的风险。肩部疼痛的多因素病因包括冈上肌腱、冈下肌腱、肱二头肌长头肌腱和/或肩峰下滑囊的 "撞击",这些 "撞击 "是由解剖异常、肌腱内变性以及肩胛胸运动学和肌肉激活的改变造成的。作为综合计划的一部分,在锻炼过程中针对前锯肌和斜方肌下部进行激活,可在功能活动中保持最佳的肩关节排列和运动学,从而将撞击风险降至最低。为了防止肩胛骨过度上移,最大限度地减少斜方肌上部(UT)对斜方肌上部和斜方肌下部的激活也很重要:目的:确定哪些练习(1)能最大限度地激活 SA 并最大限度地降低 UT:SA 比率;(2)能最大限度地激活 LT 并最大限度地降低 UT:LT 比率:方法:采集 10 名截瘫患者在四种练习中的运动学和肌肉激活数据:方法:采集了 10 名截瘫患者在四种运动中的运动学和肌肉激活数据:"T"、肩胛(坐位)、动态拥抱和 SA 冲拳(仰卧位)。平均值和比率按每块肌肉的最大自主等长收缩百分比(MVIC)进行归一化。单向重复测量方差分析确定了不同练习之间肌肉激活的显著差异:结果:练习按以下顺序排列:(1) 最大 SA 激活:T"、肩胛、动态拥抱、SA 冲拳;(3) 最小 UT:SA 比值:3) 最小 UT:SA 比率:SA 冲拳、动态拥抱、猛击、"T";以及 (4) 最小 UT:LT 比率:SA 冲拳、动态拥抱、"T":SA冲拳、动态拥抱、"T"、肩胛。运动引起了 MVIC 百分比和比率的显著统计学变化。事后分析显示,不同运动之间存在多个显著差异(P < .05):结论:SA 冲拳产生最大的 SA 激活和最低的比率。动态拥抱也产生了最佳比率,这表明仰卧练习能更有效地减少UT激活。为了隔离SA激活,躯干控制能力受损的人可能需要在仰卧状态下开始加强练习。参与者最大限度地激活了LT,但他们无法在直立时最大限度地减少UT。
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引用次数: 0
A Look at Spinal Cord Injury in Canada: Rick Hansen Spinal Cord Injury Registry (RHSCIR) - 2021 SCI Data Summary. 加拿大脊髓损伤概况:里克-汉森脊髓损伤登记处(Rick Hansen Spinal Cord Injury Registry,RHSCIR)--2021 年 SCI 数据摘要。
IF 2.4 Q1 REHABILITATION Pub Date : 2023-01-01 Epub Date: 2023-11-17 DOI: 10.46292/sci23-00031S
Vanessa K Noonan

The Rick Hansen Spinal Cord Injury Registry (RHSCIR) is a prospective registry of individuals who sustain a spinal cord injury (SCI) from 18 acute and 14 rehabilitation (rehab) Canadian hospitals specializing in SCI care. The data summary provides demographic and clinical details on 1148 people with either a traumatic spinal cord injury (tSCI) or a nontraumatic spinal cord injury (ntSCI) who were treated at a RHSCIR hospital in 2021. Information about the patient demographics, cause and severity of injury, care pathway, length of hospital stay, secondary complications, and social impacts after SCI were included. Data from the summary can provide researchers, healthcare providers, and decision makers with knowledge and evidence that may support strategies to improve SCI care services within their institutions.

瑞克-汉森脊髓损伤登记处(Rick Hansen Spinal Cord Injury Registry,RHSCIR)是一个前瞻性登记处,登记的对象是加拿大 18 家专门从事脊髓损伤(SCI)治疗的急诊医院和 14 家康复(rehab)医院的脊髓损伤(SCI)患者。数据摘要提供了 2021 年在 RHSCIR 医院接受治疗的 1148 名外伤性脊髓损伤 (tSCI) 或非外伤性脊髓损伤 (ntSCI) 患者的人口统计学和临床详情。其中包括患者人口统计学、损伤原因和严重程度、护理路径、住院时间、继发性并发症以及 SCI 后的社会影响等信息。摘要中的数据可为研究人员、医疗服务提供者和决策者提供知识和证据,从而为其机构内改善 SCI 护理服务的策略提供支持。
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引用次数: 0
Identifying Patterns of Primary Care Antibiotic Prescribing for a Spinal Cord Injury (SCI) Cohort Using an Electronic Medical Records (EMR) Database. 利用电子病历 (EMR) 数据库识别脊髓损伤 (SCI) 群体的初级保健抗生素处方模式。
IF 2.4 Q1 REHABILITATION Pub Date : 2023-01-01 Epub Date: 2023-11-17 DOI: 10.46292/sci23-00047S
Arrani Senthinathan, Melanie Penner, Karen Tu, Andrew M Morris, B Catharine Craven, Zhiyin Li, Jun Guan, Susan B Jaglal

Background: Individuals with a spinal cord injury (SCI) are considered higher users of antibiotics. However, to date there have been no detailed studies investigating outpatient antibiotic use in this population.

Objectives: (1) To describe primary care antibiotic prescribing patterns in adults with SCI rostered to a primary care physician (PCP), and (2) to identify patient or PCP factors associated with number of antibiotics prescribed and antibiotic prescription duration.

Methods: A retrospective cohort study using linked health administrative and electronic medical records (EMR) databases from January 1, 2013 to December 31, 2015 among 432 adults with SCI in Ontario, Canada. Negative binomial regression analyses were conducted to identify patient or physician factors associated with number of antibiotics prescribed and prescription duration.

Results: During the study period, 61.1% of the SCI cohort received an antibiotic prescription from their PCP. There were 59.8% of prescriptions for urinary tract infections (UTI) and 24.6% of prescriptions for fluoroquinolones. Regression analysis found catheter use was associated with increased number of antibiotics prescribed (relative risk [RR] = 3.1; 95% CI, 2.3-4.1; p < .001) and late career PCPs, compared to early-career PCPs, prescribed a significantly longer duration (RR = 1.8; 95% CI, 1.1-3.1; p = .02).

Conclusion: UTIs were the number one prescription indication, and fluoroquinolones were the most prescribed antibiotic. Catheter use was associated with number of antibiotics, and PCP's years of practice was associated with duration. The study provided important information about primary care antibiotic prescribing in the SCI population and found that not all individuals received frequent antibiotics prescriptions.

背景:脊髓损伤(SCI)患者被认为是抗生素的高使用者。目的:(1) 描述在初级保健医生(PCP)名册上的脊髓损伤成人的初级保健抗生素处方模式;(2) 确定与处方抗生素数量和抗生素处方持续时间相关的患者或初级保健医生因素:这是一项回顾性队列研究,使用的是 2013 年 1 月 1 日至 2015 年 12 月 31 日期间链接的健康管理和电子病历 (EMR) 数据库,研究对象是加拿大安大略省的 432 名患有 SCI 的成年人。研究人员进行了负二项回归分析,以确定与处方抗生素数量和处方持续时间相关的患者或医生因素:在研究期间,61.1% 的 SCI 患者收到了初级保健医生开具的抗生素处方。59.8%的处方用于治疗尿路感染(UTI),24.6%的处方用于治疗氟喹诺酮类药物。回归分析发现,导尿管的使用与处方抗生素数量的增加有关(相对风险 [RR] = 3.1;95% CI,2.3-4.1;p < .001),与职业生涯早期的初级保健医生相比,职业生涯晚期的初级保健医生处方抗生素的时间明显更长(RR = 1.8;95% CI,1.1-3.1;p = .02):结论:UTI 是处方的首要适应症,氟喹诺酮类是处方最多的抗生素。导尿管的使用与抗生素的数量有关,初级保健医生的执业年限与抗生素的使用时间有关。该研究提供了有关 SCI 患者初级保健抗生素处方的重要信息,并发现并非所有患者都会经常收到抗生素处方。
{"title":"Identifying Patterns of Primary Care Antibiotic Prescribing for a Spinal Cord Injury (SCI) Cohort Using an Electronic Medical Records (EMR) Database.","authors":"Arrani Senthinathan, Melanie Penner, Karen Tu, Andrew M Morris, B Catharine Craven, Zhiyin Li, Jun Guan, Susan B Jaglal","doi":"10.46292/sci23-00047S","DOIUrl":"10.46292/sci23-00047S","url":null,"abstract":"<p><strong>Background: </strong>Individuals with a spinal cord injury (SCI) are considered higher users of antibiotics. However, to date there have been no detailed studies investigating outpatient antibiotic use in this population.</p><p><strong>Objectives: </strong>(1) To describe primary care antibiotic prescribing patterns in adults with SCI rostered to a primary care physician (PCP), and (2) to identify patient or PCP factors associated with number of antibiotics prescribed and antibiotic prescription duration.</p><p><strong>Methods: </strong>A retrospective cohort study using linked health administrative and electronic medical records (EMR) databases from January 1, 2013 to December 31, 2015 among 432 adults with SCI in Ontario, Canada. Negative binomial regression analyses were conducted to identify patient or physician factors associated with number of antibiotics prescribed and prescription duration.</p><p><strong>Results: </strong>During the study period, 61.1% of the SCI cohort received an antibiotic prescription from their PCP. There were 59.8% of prescriptions for urinary tract infections (UTI) and 24.6% of prescriptions for fluoroquinolones. Regression analysis found catheter use was associated with increased number of antibiotics prescribed (relative risk [RR] = 3.1; 95% CI, 2.3-4.1; <i>p</i> < .001) and late career PCPs, compared to early-career PCPs, prescribed a significantly longer duration (RR = 1.8; 95% CI, 1.1-3.1; <i>p</i> = .02).</p><p><strong>Conclusion: </strong>UTIs were the number one prescription indication, and fluoroquinolones were the most prescribed antibiotic. Catheter use was associated with number of antibiotics, and PCP's years of practice was associated with duration. The study provided important information about primary care antibiotic prescribing in the SCI population and found that not all individuals received frequent antibiotics prescriptions.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"29 Suppl","pages":"153-164"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10759849/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139089034","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Using Risk Scores to Estimate Lower Extremity Fragility Fracture Risk among Individuals with Chronic Spinal Cord Injury: A Preliminary Model. 使用风险评分估算慢性脊髓损伤患者的下肢脆性骨折风险:初步模型
IF 2.4 Q1 REHABILITATION Pub Date : 2023-01-01 Epub Date: 2023-11-17 DOI: 10.46292/sci23-00063S
B Catharine Craven, Lora M Giangregorio, Isabelle Côté, Lindsie Blencowe, Masae Miyatani, Mohammad Alavinia

Objectives: To develop SCI-FX, a risk score to estimate 5-year lower extremity fragility fracture risk among patients living with chronic spinal cord injury (cSCI).

Methods: Adults with traumatic cSCI (n = 90) participated in a 2-year prospective longitudinal cohort study describing bone mineral density (BMD) change and fracture incidence conducted at the Lyndhurst Centre (University Health Network), University of Waterloo, and Physical Disability Rehabilitation Institute of Québec City. Prior publication and clinical intuition were used to identify fragility fracture risk factors including prior fragility fracture, years post-injury, motor complete injury (AIS A/B), benzodiazepine use, opioid use, and parental osteoporosis. We conducted bivariate analyses to identify variables associated with fracture. Multiple logistic regressions were performed using fragility fracture incidence as the dependent variable and all variables from the univariate analyses with a highly liberal p value at 0.2. Using the odds ratios (ORs) from the multiple logistic regression model, a point system for fragility fracture risk score was developed, and the odds of fracture for each point was estimated.

Results: All initial variables, with the exception of benzodiazepine exposure, were included in the final model.

Conclusion: We identified a simple preliminary model for clinicians to estimate 5-year fracture risk among patients with cSCI based on their total score.

目的在慢性脊髓损伤(cSCI)患者中开发SCI-FX--一种用于估算5年下肢脆性骨折风险的风险评分:患有外伤性 cSCI 的成年人(n = 90)参加了一项为期 2 年的前瞻性纵向队列研究,该研究描述了林德赫斯特中心(大学健康网络)、滑铁卢大学和魁北克市肢体残疾康复研究所的骨矿物质密度 (BMD) 变化和骨折发生率。我们利用之前发表的文章和临床直觉来确定脆性骨折的风险因素,包括之前的脆性骨折、受伤后年数、运动性完全损伤(AIS A/B)、苯二氮卓类药物的使用、阿片类药物的使用和父母骨质疏松症。我们进行了双变量分析,以确定与骨折相关的变量。将脆性骨折发生率作为因变量,并对单变量分析中的所有变量进行多重逻辑回归,P 值高度自由,为 0.2。利用多元逻辑回归模型中的几率比(ORs),建立了脆性骨折风险评分点系统,并估算了每个点的骨折几率:除苯二氮卓类药物暴露外,所有初始变量均被纳入最终模型:结论:我们为临床医生确定了一个简单的初步模型,可根据总分估算 cSCI 患者的 5 年骨折风险。
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引用次数: 0
Is It Really the Foley? A Systematic Review of Bladder Management and Infection Risk. 真的是 Foley 吗?膀胱管理与感染风险的系统回顾。
IF 2.4 Q1 REHABILITATION Pub Date : 2023-01-01 Epub Date: 2023-02-15 DOI: 10.46292/sci22-00009
Matthew Davis, Lavina Jethani, Emily Robbins, Mahmut Kaner

Background: The belief that intermittent catheterization results in fewer infections than indwelling catheters is commonly expressed in the spinal cord injury literature. Some practice guidelines strongly recommend intermittent over indwelling catheterization due to concerns about infections and other complications. However, studies on this topic are of low quality. Guidelines from the Consortium for Spinal Cord Medicine suggest the data regarding infection risk are mixed, and they do not recommend one bladder management method over the other.

Objectives: To compare risk of bias in studies reporting higher rates of urinary tract infection (UTI) with indwelling catheters to studies that found equal rates of UTI between indwelling and intermittent catheterization, and to describe implications in clinical decision-making.

Methods: A systematic search of PubMed, CINAHL, Embase, and SCOPUS databases from January 1, 1980, to September 15, 2020, was conducted. Eligible studies compared symptomatic UTI rates between indwelling and intermittent catheterization. We used a risk of bias assessment tool to evaluate each study.

Results: Twenty-four studies were identified. Only three of these reported significantly higher UTI risk with indwelling catheters, and all three demonstrated a critical risk of bias. More than half of the studies reported differences in UTI risk of less than 20% between the two methods. Studies with larger (nonsignificant) differences favoring intermittent catheterization were more susceptible to bias from confounding.

Conclusion: The hypothesis that indwelling catheters cause more UTIs than intermittent catheterization is not supported by the scientific literature. Most studies failed to demonstrate a significant difference in UTI risk, and studies with nonsignificant trends favoring intermittent catheterization were more susceptible to bias from confounding. Perceived risk of infection should not influence a patient's choice of catheter type.

背景:脊髓损伤文献普遍认为间歇性导尿比留置导尿感染更少。出于对感染和其他并发症的担忧,一些实践指南强烈建议采用间歇性导尿,而不是留置导尿。但是,有关这一主题的研究质量不高。脊髓医学联合会(Consortium for Spinal Cord Medicine)的指南表明,有关感染风险的数据好坏参半,他们并不推荐一种膀胱管理方法而非另一种:比较报告留置导尿管尿路感染(UTI)发生率较高的研究与发现留置导尿管和间歇导尿管UTI发生率相同的研究的偏倚风险,并说明其对临床决策的影响:方法:系统检索了从 1980 年 1 月 1 日至 2020 年 9 月 15 日的 PubMed、CINAHL、Embase 和 SCOPUS 数据库。符合条件的研究比较了留置导尿和间歇导尿的症状性 UTI 发生率。我们使用偏倚风险评估工具对每项研究进行了评估:结果:共确定了 24 项研究。其中只有三项研究报告了留置导尿管的 UTI 风险明显更高,而且这三项研究都存在严重的偏倚风险。半数以上的研究报告两种方法的 UTI 风险差异不到 20%。差异较大(不显著)的研究更倾向于间歇性导尿,更容易受到混杂因素的影响:结论:科学文献并不支持留置导尿管比间歇导尿管导致更多 UTI 的假设。大多数研究未能证明 UTI 风险存在显著差异,而倾向于间歇导管术的无显著趋势的研究更容易受到混杂因素的影响。对感染风险的认识不应影响患者对导管类型的选择。
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引用次数: 0
Opioid Dependence and Associated Health Care Utilization and Cost in Traumatic Spinal Cord Injury Population: Analysis Using Marketscan Database. 创伤性脊髓损伤人群中的阿片类药物依赖及相关医疗使用和成本:使用 Marketscan 数据库进行分析。
IF 2.9 Q1 REHABILITATION Pub Date : 2023-01-01 Epub Date: 2023-02-15 DOI: 10.46292/sci22-00026
Riley L Wilkinson, Camilo Castillo, April Herrity, Dengzhi Wang, Mayur Sharma, Nick Dietz, Shawn Adams, Nicholas Khattar, Miriam Nuno, Doniel Drazin, Maxwell Boakye, Beatrice Ugiliweneza

Background: Postinjury pain is a well-known debilitating complication of spinal cord injury (SCI), often resulting in long-term, high-dose opioid use with the potential for dependence. There is a gap in knowledge about the risk of opioid dependence and the associated health care utilization and cost in SCI.

Objectives: To evaluate the association of SCI with postinjury opioid use and dependence and evaluate the effect of this opioid dependence on postinjury health care utilization.

Methods: Using the MarketScan Database, health care utilization claims data were queried to extract 7187 adults with traumatic SCI from 2000 to 2019. Factors associated with post-SCI opioid use and dependence, postinjury health care utilization, and payments were analyzed with generalized linear regression models.

Results: After SCI, individuals were more likely to become opioid users or transition from nondependent to dependent users (negative change: 31%) than become nonusers or transition from dependent to nondependent users (positive change: 14%, p < .0001). Individuals who were opioid-dependent users pre-SCI had more than 30 times greater odds of becoming dependent after versus not (OR 34; 95% CI, 26-43). Dependent users after injury (regardless of prior use status) had 2 times higher utilization payments and 1.2 to 6 times more health care utilization than nonusers.

Conclusion: Opioid use and dependence were associated with high health care utilization and cost after SCI. Pre-SCI opioid users were more likely to remain users post-SCI and were heavier consumers of health care. Pre- and postopioid use history should be considered for treatment decision-making in all individuals with SCI.

背景:众所周知,损伤后疼痛是脊髓损伤(SCI)的一种使人衰弱的并发症,通常会导致长期、大剂量使用阿片类药物,并可能产生依赖性。关于 SCI 中阿片类药物依赖的风险以及相关的医疗利用率和成本,目前还存在知识空白:评估 SCI 与伤后阿片类药物使用和依赖的关联,并评估这种阿片类药物依赖对伤后医疗使用的影响:使用 MarketScan 数据库查询医疗保健使用索赔数据,提取 2000 年至 2019 年期间 7187 名患有外伤性 SCI 的成年人。通过广义线性回归模型分析了与SCI后阿片类药物使用和依赖、受伤后医疗保健使用和支付相关的因素:结果:在 SCI 后,个人成为阿片类药物使用者或从非依赖性使用者转变为依赖性使用者的可能性(负变化:31%)高于成为非使用者或从依赖性使用者转变为非依赖性使用者的可能性(正变化:14%,P < .0001)。SCI前为阿片类药物依赖者,SCI后成为依赖者的几率是未成为依赖者的30多倍(OR 34;95% CI,26-43)。受伤后有依赖性的使用者(无论之前的使用状况如何)比未使用者多支付 2 倍的医疗费用,多使用 1.2 到 6 倍的医疗服务:结论:阿片类药物的使用和依赖与损伤后的高医疗使用率和高医疗费用有关。SCI 前阿片类药物使用者更有可能在 SCI 后继续使用阿片类药物,而且医疗费用更高。在对所有 SCI 患者进行治疗决策时,应考虑其使用阿片类药物的前后历史。
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引用次数: 0
A Scoping Review of Epidural Spinal Cord Stimulation for Improving Motor and Voiding Function Following Spinal Cord Injury. 硬膜外脊髓刺激改善脊髓损伤后运动和排尿功能的范围综述。
IF 2.9 Q1 REHABILITATION Pub Date : 2023-01-01 Epub Date: 2023-05-15 DOI: 10.46292/sci22-00061
Nina D'hondt, Karmi Margaret Marcial, Nimish Mittal, Matteo Costanzi, Yasmine Hoydonckx, Pranab Kumar, Marina F Englesakis, Anthony Burns, Anuj Bhatia

Objectives: To identify and synthesize the existing evidence on the effectiveness and safety of epidural spinal cord stimulation (SCS) for improving motor and voiding function and reducing spasticity following spinal cord injury (SCI).

Methods: This scoping review was performed according to the framework of Arksey and O'Malley. Comprehensive serial searches in multiple databases (MEDLINE, Embase, Cochrane Central, Cochrane Database of Systematic Reviews, LILACS, PubMed, Web of Science, and Scopus) were performed to identify relevant publications that focused on epidural SCS for improving motor function, including spasticity, and voiding deficits in individuals with SCI.

Results: Data from 13 case series including 88 individuals with complete or incomplete SCI (American Spinal Injury Association Impairment Scale [AIS] grade A to D) were included. In 12 studies of individuals with SCI, the majority (83 out of 88) demonstrated a variable degree of improvement in volitional motor function with epidural SCS. Two studies, incorporating 27 participants, demonstrated a significant reduction in spasticity with SCS. Two small studies consisting of five and two participants, respectively, demonstrated improved supraspinal control of volitional micturition with SCS.

Conclusion: Epidural SCS can enhance central pattern generator activity and lower motor neuron excitability in individuals with SCI. The observed effects of epidural SCS following SCI suggest that the preservation of supraspinal transmission is sufficient for the recovery of volitional motor and voiding function, even in patients with complete SCI. Further research is warranted to evaluate and optimize the parameters for epidural SCS and their impact on individuals with differing degrees of severity of SCI.

目的确定并综合有关硬膜外脊髓刺激(SCS)改善脊髓损伤(SCI)后运动和排尿功能以及减轻痉挛的有效性和安全性的现有证据:本次范围界定综述是根据 Arksey 和 O'Malley 的框架进行的。在多个数据库(MEDLINE、Embase、Cochrane Central、Cochrane 系统性综述数据库、LILACS、PubMed、Web of Science 和 Scopus)中进行了全面的序列检索,以确定相关出版物,这些出版物主要关注硬膜外 SCS 用于改善 SCI 患者的运动功能(包括痉挛)和排尿障碍:结果:共纳入了 13 个病例系列的数据,包括 88 名完全或不完全 SCI 患者(美国脊柱损伤协会损伤量表 [AIS] A 至 D 级)。在 12 项针对 SCI 患者的研究中,大多数研究(88 项研究中的 83 项)显示,硬膜外 SCS 可在不同程度上改善患者的自主运动功能。有两项研究(包括 27 名参与者)显示,SCS 可显著减轻痉挛。两项分别由 5 名和 2 名参与者参与的小型研究表明,使用 SCS 后,脊髓上对自主排尿的控制有所改善:结论:硬膜外 SCS 可增强脊髓损伤患者的中枢模式发生器活动和下运动神经元兴奋性。硬膜外 SCS 在脊髓损伤后观察到的效果表明,即使是完全性脊髓损伤患者,保留脊髓上传导也足以恢复自主运动和排尿功能。有必要开展进一步研究,以评估和优化硬膜外 SCS 的参数及其对不同严重程度 SCI 患者的影响。
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引用次数: 0
Communicating Standing and Walking Data after Spinal Cord Injury: A Patient-Engaged, Qualitative Study. 脊髓损伤后站立和行走数据的交流:患者参与的定性研究。
IF 2.4 Q1 REHABILITATION Pub Date : 2023-01-01 Epub Date: 2023-11-17 DOI: 10.46292/sci23-00019S
Katherine Chan, Lovisa Cheung, Chris Taylor, Chelsea Wong, Grace Inglis, Kristen Walden, Kristin E Musselman

Background: The Standing and Walking Assessment Tool has been implemented by physical therapists across Canada, but there is no standardized communication tool to inform inpatients living with spinal cord injury (SCI) about their standing and walking ability.

Objectives: To identify how inpatients with SCI are currently receiving feedback on their standing and walking ability, and to determine if and how they would like to receive information on their standing and walking.

Methods: Ontario's Patient Engagement Framework informed study protocol development. Inpatients with SCI were recruited from a rehabilitation centre in Canada. Purposeful sampling considering severity of SCI and sex was adopted. Three to four months following discharge from inpatient rehabilitation, a semi-structured interview was conducted to explore participants'experiences and preferences regarding feedback on standing and walking ability during inpatient SCI rehabilitation. Interviews were audio-recorded and transcribed verbatim. A conventional content analysis was completed.

Results: Fifteen individuals with SCI (5 female, 10 male) participated. Four themes emerged from the transcripts: (1) motivation for standing and walking, (2) current standing and walking practice, (3) participant preferences for feedback on standing and walking ability, and (4) perceptions of preexisting tools.

Conclusion: Information on standing and walking ability was shared with inpatients with SCI in a variety of ways. Participants identified various preferences for the nature, format, and frequency of feedback concerning standing and walking ability during inpatient rehabilitation, which suggests the need for an individualized approach to communicating this information.

背景:加拿大各地的理疗师都在使用站立和行走评估工具,但目前还没有标准化的交流工具来告知脊髓损伤(SCI)住院患者他们的站立和行走能力:确定脊髓损伤住院患者目前如何获得有关其站立和行走能力的反馈信息,并确定他们是否以及如何希望获得有关其站立和行走能力的信息:方法:根据安大略省患者参与框架制定研究方案。从加拿大一家康复中心招募了患有 SCI 的住院患者。根据 SCI 的严重程度和性别进行有目的的抽样。从住院康复中心出院三到四个月后,我们进行了一次半结构化访谈,以了解参与者在 SCI 住院康复期间对站立和行走能力反馈的经验和偏好。对访谈进行了录音和逐字记录。结果:15 名 SCI 患者(5 名女性,10 名男性)参加了访谈。访谈记录中出现了四个主题:(1) 站立和行走的动机;(2) 当前的站立和行走实践;(3) 参与者对站立和行走能力反馈的偏好;(4) 对现有工具的看法:结论:与 SCI 住院患者分享站立和行走能力信息的方式多种多样。参与者对住院康复期间有关站立和行走能力的反馈的性质、形式和频率有不同的偏好,这表明有必要采用个性化的方法来传达这些信息。
{"title":"Communicating Standing and Walking Data after Spinal Cord Injury: A Patient-Engaged, Qualitative Study.","authors":"Katherine Chan, Lovisa Cheung, Chris Taylor, Chelsea Wong, Grace Inglis, Kristen Walden, Kristin E Musselman","doi":"10.46292/sci23-00019S","DOIUrl":"10.46292/sci23-00019S","url":null,"abstract":"<p><strong>Background: </strong>The Standing and Walking Assessment Tool has been implemented by physical therapists across Canada, but there is no standardized communication tool to inform inpatients living with spinal cord injury (SCI) about their standing and walking ability.</p><p><strong>Objectives: </strong>To identify how inpatients with SCI are currently receiving feedback on their standing and walking ability, and to determine if and how they would like to receive information on their standing and walking.</p><p><strong>Methods: </strong>Ontario's Patient Engagement Framework informed study protocol development. Inpatients with SCI were recruited from a rehabilitation centre in Canada. Purposeful sampling considering severity of SCI and sex was adopted. Three to four months following discharge from inpatient rehabilitation, a semi-structured interview was conducted to explore participants'experiences and preferences regarding feedback on standing and walking ability during inpatient SCI rehabilitation. Interviews were audio-recorded and transcribed verbatim. A conventional content analysis was completed.</p><p><strong>Results: </strong>Fifteen individuals with SCI (5 female, 10 male) participated. Four themes emerged from the transcripts: (1) motivation for standing and walking, (2) current standing and walking practice, (3) participant preferences for feedback on standing and walking ability, and (4) perceptions of preexisting tools.</p><p><strong>Conclusion: </strong>Information on standing and walking ability was shared with inpatients with SCI in a variety of ways. Participants identified various preferences for the nature, format, and frequency of feedback concerning standing and walking ability during inpatient rehabilitation, which suggests the need for an individualized approach to communicating this information.</p>","PeriodicalId":46769,"journal":{"name":"Topics in Spinal Cord Injury Rehabilitation","volume":"29 Suppl","pages":"1-14"},"PeriodicalIF":2.4,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10759847/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139089027","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Topics in Spinal Cord Injury Rehabilitation
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