Journal of Spinal Cord Medicine最新文献

Introduction: Spina bifida (SB) affects almost all activities in daily life and therefore also health-related quality of life (HRQOL). To assess the HRQOL of adults with SB, a self-reported QUAlity of Life Assessment of Spina bifida in Adults (QUALAS-A) was validated in English. The purpose of this study was to develop and validate a German version of QUALAS-A.

Methods: German-speaking adults > = 18 years were recruited at a tertiary center and through an SB association. Two urologists translated the QUALAS-A into German. Face and content validity were assessed by adults with SB. Back-translation into English was performed. QUALAS-A-G was administered online as part of a larger study of sexuality in SB. Internal consistency was verified using Cronbach's alpha. Factor analysis, convergent validity, and differences between groups based on continence were established.

Results: A total of 45 adults with SB participated (median age of 29 years old). Domain scores demonstrated no floor and minimal ceiling effects. Cronbach's alpha determined good internal consistency (0.58-0.70). The factor analysis converged to a somewhat different three-factor structure compared to the original version, but otherwise had similar properties to the original. Construct validity revealed moderate associations (r = 0.36-0.65) between QUALAS-A-G domains, indicating they measure different aspects of HRQOL. Adults who were continent of both urine and stool reported higher QUALAS-A-G scores than those who were incontinent.

Conclusion: We demonstrated QUALAS-A-G to be reliable and valid in German-speaking adults with SB. The QUALAS-A-G could be a useful tool for communication between adults with SB and medical staff.

Objectives: To evaluate cardiometabolic disease (CMD) in outpatients with spinal cord injury/disease (SCI/D). The study aims were to (1) estimate the prevalence of CMD risk factors in a cohort of Canadian adults with SCI/D; (2) assess whether the frequency of CMD screening aligns with evidence-based guidelines; and (3) gain a preliminary understanding of the barriers to CMD screening and/or treatment within a rehabilitation program setting.

Design: Quality improvement initiative involving chart review extracting the presence of and frequency of screening for four CMD risk factors (obesity, hypertension, dyslipidemia, diabetes mellitus). Values were compared to evidence-based guidelines for CMD risk identification and management. Root cause analysis and focused interviews were conducted with clinic staff to identify barriers.

Setting: Academic, tertiary rehabilitation hospital.

Participants: Consecutive outpatients with SCI/D from October 2020 to December 2021 (n = 73).

Results: 43.8% of outpatients sampled had established CMD (≥3 risk factors) and 94.5% had at least one risk factor. Obesity was the most prevalent (82.2%), followed by dyslipidemia (71.7%), hypertension (46.5%), and diabetes mellitus (34.8%). Hypertension and obesity screening were completed at 14.3% and 10.4% of appointments. The frequency of dyslipidemia and diabetes mellitus screening could not be determined. Eighteen barriers to timely CMD screening and treatment intensification were identified.

Conclusions: The prevalence of CMD risk factors in outpatients with SCI/D was high. While approximately two of every five outpatients had established CMD, adherence to screening guidelines was poor. These findings reinforce the need for strategies to improve screening and reduce preventable harm from CMD in this vulnerable population.

Objective: To determine whether ESWT is able to safely and positively influence specific ADL activities in people with SCI and spasticity, measured by Goal Attainment Scaling (GAS).

Study design: Multiple single-case experimental design with a randomized baseline length.

Setting: Rehabilitation centre.

Subjects: This study included 11 participants with SCI, aged >18 years (mean (SD) 63 (12.2) years), mean (SD) duration after injury 9 (8.1) years, with hindering spasticity in the upper or lower limb.

Methods: During the 3-week treatment phase, radial ESWT in the plantar flexors of the calf (n = 6) or in the flexors of the wrist/hand (n = 5) was applied weekly, followed by a 12-week follow-up phase. The primary outcome measure consisted of the Goal Attainment Scaling (GAS), in which three individual goals were set. Secondary outcome measures included range of joint motion, pain (0-10), 10-m walking test and Van-Lieshout-hand-function-test-for-Tetraplegia (short form).

Results: At descriptive level, in total, 28 of the 33 GAS items improved after ESWT and these effects generally were maintained during the follow-up phase. The results of all secondary outcome measures varied. No serious adverse events occurred.

Conclusions: In this study, ESWT resulted in improved performance of specific ADL items in most persons with SCI. More research is needed to confirm these results in a larger cohort.

Study design: Observational prospective multicenter study.

Objectives: The aim of this study is to evaluate the efficacy of bowel management and subjects' satisfaction by the Monitoring the Efficacy of Neurogenic Bowel Treatment On Response (MENTOR) tool and the impact of demographic and clinical factors on bowel management.

Methods: Consecutive patients with SCI were recruited by nine Italian Spinal Units. The MENTOR tool is a three-dimensional questionnaire assessing objective bowel score measures, patient's subjective perceptions, and "special attention symptoms"; the combination of these results defines the allocation of each subject into one of three categories reflecting the possible therapeutic recommendations (red for "recommend change", yellow for "further discussion", and green for "monitoring").

Results: We recruited 352 subjects with subacute or chronic SCI. The NBD average score was 11.7 ± 7.2 with 69.9% that expresses "good" or "adequate" satisfaction. 33.1% had one or more "special attention symptoms (SAS)". About the MENTOR tool color: 34.6% of the current treatment was adequate (green), 29.7% needed a revaluation (yellow), and 35% required a change (red). While in "green" patients the subjective perception coincided with the score, 24% of "yellow" patients and 34.4% of "red" patients answered they were well managed. None of the clinical or demographic characteristics was associated with patients' satisfaction or belonging to the three color zones.

Conclusions: Effective bowel management in subjects with SCI did not correlate with patient characteristics or satisfaction. Many patients have inappropriate bowel management despite their satisfaction and the chronicity of the injury. This disparity calls for a periodic assessment with an objective tool such as MENTOR to identify the individual that requires intervention.

Context: Emerging data suggests that patients with a spinal cord injury (SCI) have a higher risk of developing cognitive impairment. The true incidence of cognitive impairment in this group is unclear due to the difficulty in administering commonly used assessment tools, which are dependent on functional abilities e.g. drawing and writing.

Methods: A 16-question online survey, that aims to understand current practices on the assessment of cognition and the limitations of currently available tools, was sent via a Research Network Group to British Association of Spinal Cord Injury Specialists (BASCIS) registered clinicians at each of the 12 Spinal Injuries Centers in the UK and Ireland.

Results: 41 responses from 11 different SCI centers, with most from clinicians who have worked with SCI patients for over 10 years. 68% felt that there was a higher incidence of cognitive impairment in those with an SCI. However, 15% reported not using tools to screen for cognitive impairment, primarily due to lack of time, lack of guidelines, and physical disabilities affecting the ability to complete tests. When used, the most commonly utilized tools were those that rely on intact hand function.

Conclusions: Clinicians report a higher incidence of cognitive impairment in those with an SCI. However, currently used tools are not always appropriate, and patients with impaired hand function may be under-represented or undiagnosed. Further work is needed for a more standardized assessment tool to ensure that these patients receive appropriate diagnosis and management, particularly since cognitive impairment in this group can increase care needs and reduce engagement with rehabilitation.

Context/objective: The objective of this study was to examine the implications of shelter-in-place (SIP) during the COVID-19 pandemic on secondary health conditions (SHC), loneliness, social isolation, social connectedness, anxiety, and positive affect and well-being (PAWB) among community-dwelling adults with spinal cord injury (SCI).

Design: An online exploratory cross-sectional descriptive design.

Participants: 131 community-dwelling adults with SCI.

Outcome measures: UCLA Loneliness Scale, SCI-QOL - Anxiety and PAWB.

Results: Respondents were approximately 33 years old, mostly male and Caucasian. More than half reported being married, living with their spouse in a home with modifications, or living in a household of three or more people. More than half reported experiencing more pain during SIP but not experiencing more of any other SHC than before SIP. On average, participants experienced a moderate level of loneliness, severe anxiety, and higher levels of PAWB during SIP.

Conclusion: Respondents reported that they experienced more pain, loneliness, and anxiety while at the same time reporting higher PAWB. Future research should focus on understanding the nuances of the seemingly counterintuitive relationship described here to develop better ways to support community-dwelling adults with SCI during public health emergencies and SIP.

Context: Healthcare institutions acknowledge the value of diverse workforces for enhancing programs and meeting the varied needs of individuals with Spinal Cord Injury. This survey conducted at the 2023 Academy of Spinal Cord Injury Professions (ASCIP) conference assesses healthcare professionals' views on workplace Diversity, Equity, and Inclusion (DEI) and their support for integrating related educational content in future events.

Methods: : The survey was distributed digitally to ASCIP attendees, ensuring anonymity and voluntary participation. It aimed to collect data on demographic backgrounds, perceptions of DEI at work, and the relevance of educational topics regarding Inclusion, Diversity, Equity, and Access (IDEA) for upcoming conference agendas.

Results: : Seventy percent of respondents felt able to achieve success and express their genuine feelings in the workplace, with their opinions valued. While economic disparities were often discussed (56%) in relation to patient care, other aspects like religion, cultural racism, racial inequalities, and LGBTQ + issues were less frequently addressed. Approximately 55% reported that their organizations had recently started or were initiating DEI efforts.

Conclusions: : There is a clear need for inclusive work environments and patient care that values the diverse intersectionality of the community served. Strong support exists for further educational initiatives on IDEA concepts, highlighting a significant opportunity to enhance early-stage DEI programs in healthcare settings.

Context: Intensive walking practice often demands capabilities that go beyond the limits for both patients and therapists. As a solution, robot-assisted exoskeletons have been developed to deliver efficient rehabilitation sessions.

Objective: The primary aim was to evaluate the effect of adding exoskeleton training, the FreeGait®, to conventional treatment on walking status in patients with motor incomplete spinal cord injury. The secondary aim was to assess its impact on mobility, functional independence, and health-related quality of life.

Methods: This study compared exoskeleton gait training with conventional therapy (RBCT) versus conventional therapy alone (CT). Fourteen participants with motor incomplete spinal cord injury were included, with seven in each group. Both groups had 40-minute conventional therapy sessions 5 days a week. Additionally, the RBCT performed exoskeleton walking and balance exercises 3 days a week. The WISCI II (primary outcome), 10MWT, gait speed, TUG, BBS, SCIM III, and WHOQOL-BREF were used for evaluation (see text for acronyms).

Results: Walking status and mobility-related measures showed significant improvements in the RBCT (p < 0.05), whereas no significant differences were observed in the CT (p > 0.05). There was a significant difference in the physical health domain of the WHOQOL-BREF only in the RBCT. However, no significant differences were found in the WHOQOL-BREF total score in both groups (p > 0.05). Furthermore, no significant difference was observed between the groups in terms of change (p > 0.05).

Conclusions: Gait training with the new exoskeleton combined with conventional therapy, positively contributes to walking status, mobility, and functional independence.Trial registration: ClinicalTrials.gov identifier: NCT06137456.

Background: Spinal cord injuries (SCIs) are major sources of socioeconomic burdens and are still rising globally. SCIs also cause several personal sufferings in both physical and psychological aspects. Individuals' reactions following a traumatic incident can vary based on the severity and nature of the damage, as well as their psychological dispositions. Locus of control (an individual's belief in his/her ability to control the outcome of events surrounding them) is an important factor in determining individuals' quality of life (QoL) in the aftermath of an incident.

Methods: We conducted a cross-sectional study to investigate the association between locus of control and general health in patients with lumbar SCI. This study was carried out on 108 patients with lumbar SCI using the Rotter's Locus of Control Scale and the General Health questionnaires, as well as demographic data.

Results: Patients with an internal locus of control had a significantly better general health score than those with an external locus of control (32 vs. 38.5; P < 0.0001). There was a moderate positive correlation between general health and locus of control score (R = 0.575; P < 0.0001). Also, employed patients had a significantly more internal locus of control score compared to unemployed patients (7 vs. 8; P = 0.004).

Conclusion: Scores of locus of control and general health are significantly correlated, and internal locus of control could lead to better general mental health in patients with lumbar SCI. Although there is a need for more studies with better study designs to approve of this association, the results of this study emphasize the importance of interventions targeting locus of control, improving socio-economic conditions, and rehabilitation measures in improving the general health of these patients.

Context/objective: Pressure injury (PrI) recurrence is common among persons with spinal cord injury and disorders (SCI/D) who undergo reconstructive flap surgery for pelvic stage 4 PrI (S4PrI). This paper describes the development and implementation of the Minneapolis Spinal Cord Optimization, Rehabilitation and Empowerment (SCORE), a preoperative interdisciplinary tool for risk assessment and mitigation, and reports its effect on the one-year flap failure rate (significant breakdown).

Design: Retrospective review.

Setting: Minneapolis Veterans Affairs Health Care System (MVAHCS) SCI/D Center, a tertiary care center.

Participants: 141 Veterans with SCI/D and pelvic S4PrI underwent 204 interdisciplinary assessments for flap surgery.

Interventions: The Minneapolis SCORE was developed by the MVAHCS SCI/D Center and first implemented in 2012. The eight domains of the tool and continuous improvements in tool implementation for risk assessment and mitigation are described.

Outcome measures: Per-year incidence rate of flap failures within one year of surgery from 2009 to 2019.

Results: 48.3% (28/58) of S4PrI assessments during 2009-2011 (pre-SCORE) led to flap surgery the same year, increasing to 59.6% (87/146) of assessments after SCORE implementation during 2012-2019. The one-year flap failure rate abruptly decreased from 40.5% (15/37) of the 2009-2012 surgeries to 7.7% (6/78) of the 2013-2019 surgeries (P < .0001). Characteristics of patients by time period, operative status, and flap outcome are presented.

Conclusion: After an initial learning curve in tool implementation and subsequent tool refinement, the use of the Minneapolis SCORE before flap surgeries was associated with improved flap integrity at one year. Successful use of the tool requires collaborative problem-solving between the patient and interdisciplinary team.