Journal of Spinal Cord Medicine最新文献

Context: Cardiometabolic disease (CMD) frequently occurs in individuals with spinal cord injury (SCI), with growing awareness surrounding the expansive scope of this problem. As CMD has significant morbidity and mortality, early guidelines-based screening and management have been established. However, the extent to which these guidelines have been adopted are unclear.

Objective: Describe physicians' screening and management pattern for CMD in patients with SCI, as compared to SCI-specific CMD screening guidelines, and elucidate variables linked to screening and management patterns.

Methods: SCI medicine-boarded physicians were surveyed on screening timing for CMD following acute SCI, along with their practice pattern and comfort level managing common CMD risk factors.

Results: Of the forty-seven SCI medicine physicians that responded, 62% felt the ideal timing for CMD screening is 6 months after the acute injury. Of these same physicians, few were screening for insulin resistance and lipid dysregulation prior to 6 months after injury. In addition, less than half felt comfortable writing new prescriptions for anti-glycemic and anti-lipid medications. Furthermore, no association was found between the amount of CMD education with screening or management patterns. Finally, VA-based providers were more likely to screen for CMD within 6 months of injury and were more comfortable managing/starting anti-glycemic medications and statins.

Conclusions: Despite the presence of SCI-specific CMD guidelines, gaps in screening and management practices still exist, most notably with insulin resistance and lipid dysregulation. VA-based providers generally screen and manage CMD risk factors more effectively, and further CMD education could consider emulating VA training modules.

Background: Spinal cord injury (SCI) is a devastating condition affecting an individual's life, particularly through lower extremity paralysis, which limits walking and daily activities.

Objectives: This study investigated the effects of weight support feedback walker (WSFW) gait training on walker dependence, lower limb muscle activation, and gait ability in patients with incomplete SCI (ISCI).

Methods: Eleven subjects capable of walking > 20 m with and without a walker were randomly assigned to WSFW gait training (n = 6) or conventional walker (CW) gait training groups (n = 5). All subjects underwent standard physical therapy for 4 weeks. Additionally, the WSFW group participated in WSFW gait training, whereas the CW group participated in CW gait training conducted for 30 min per day, thrice per week, for 4 weeks. Walker dependence (the average force pressing WSFW with the user's arm during walker gait), lower extremity muscle activity (rectus femoris, biceps femoris, and medial gastrocnemius), and gait ability (gait elements: velocity, cadence, step length, and step length asymmetry) were measured to investigate the effects of training.

Results: The WSFW group showed significant decrease in walker dependence compared to the CW group (P < 0.05). Some lower extremity muscle activation (left side biceps femoris) and velocity of the gait elements were increased in the WSFW group compared with those in the CW group (P < 0.05).

Conclusion: WSFW gait training could help patients with ISCI transfer their body weight to the paralyzed lower extremity. However, a randomized controlled trial with several subjects is essential to verify the effects of WSFW training.

Context: Spinal cord injury (SCI) can impair bodily functions and limit an individual's ability to maintain or gain steady employment. Vocational rehabilitation programs have been shown to effectively facilitate individuals with a SCI to return to work, however, further research is needed on the implementation, outcomes, and feasibility of such programs including with the integration of healthcare.

Objective: The objective of this single-group study was to assess the effectiveness of a comprehensive vocational rehabilitation program, as measured by improvements in employment, work confidence, life satisfaction, and quality of life for individuals with a SCI.

Methods: Four individuals with a SCI participated in the vocational rehabilitation program. Participants were assigned responsibilities within their department of interest and attended weekly meetings with the vocational rehabilitation team to address barriers, discuss resources and education, and set professional goals. Completion of pre and post-test assessments was required to evaluate the program's impact on participants' work readiness and overall well-being.

Results: Each participant worked with an interdisciplinary team on an individualized work-plan (over 100 h of employment) with necessary accommodations for successful rehabilitation. Participants reported beneficial changes in multiple post-program assessment categories including physical, social, and emotional functions, with all reporting a general improvement in physical strength upon completion of the program.

Conclusion: Our findings suggest that a comprehensive vocational rehabilitation program can be effective in facilitating individuals with SCI to gain greater functional independence and confidently pursue employment. Further studies are crucial to advance the knowledge required to implement a successful rehabilitative program.

Context: Antimicrobial Stewardship Programs (ASPs) are crucial to optimizing antibiotic use. ASPs are implemented in the Veterans Health Administration (VAs), but they do not target the needs of populations at high risk for resistant infections, such as spinal cord injury and disorder (SCI/D).

Objective: The goal of this study was to assess key ASP leader and SCI/D clinicians' perceived level of implementation and impact of 33 Antimicrobial Stewardship (AS) strategies.

Method: SCI/D clinicians and ASP leaders across 24 VA facilities with SCI/D units were surveyed. Participants rated their perceived level of impact ("high", "mild", "low") and perceived level of implementation ("not", "partially", "fully") for 33 AS strategies in SCI/D units in VAs. Strategies were grouped into core elements which they support. We conducted a Fisher's exact test to assess differences between respondent perceptions based on role (SCI/D clinicians versus ASP leaders).

Results: AS strategy implementation varied across VA facilities. Of the AS strategies, pre-authorization was perceived to be highly impactful (78%) and fully implemented (82%). SCI/D clinicians and ASP leaders rated AS strategies differently such that SCI/D clinicians were less aware of implementation of AS strategies related to reporting requirements; further, SCI/D clinicians rated strategies which guide treatment duration and which limit C. difficile antibiotic exposure as more impactful than ASP leaders. Ratings for facility-wide and SCI/D unit ratings did not significantly differ for impact or implementation.

Conclusion: Implementation practices varied across VA facilities. Future work should implement highly impactful AS strategies according to facility and unit needs.

Objective: To examine change in pain interference and depression over a 10-year time period in individuals with long-term traumatic spinal cord injury (SCI) and to identify the extent to which changes in pain interference over time predicts change in depressive symptoms.

Design: Longitudinal analyses of self-report assessment data.

Setting: Specialty and university hospitals in the Southeastern and Midwestern United States.

Participants: Adults with a history of traumatic SCI (n = 504) who responded to the three most recent data collection periods of the SCI Longitudinal Aging Study (2008 [Time 1], 2013 [Time 2], and 2018 [Time 3]). The participants averaged 59 years of age and 32 years since injury onset at Time 3.

Interventions: Not applicable.

Main outcome measures: Patient Health Questionnaire (PHQ-9) assessed depressive symptom severity. The 7-item Pain Interference scale from the Brief Pain Inventory assessed pain interference.

Results: Over the three study timepoints, the sample averaged moderate levels of pain interference and mild depressive symptom severity. Unconditional linear growth models, reflecting changes in central tendency, indicated that pain interference significantly decreased and depressive symptom severity significantly increased over time. Multiple independent variables random coefficient modeling based on correlations suggested that change in pain interference was positively associated with change in depressive symptom severity over the 10-year study follow-up.

Conclusion: Average depressive symptom severity worsened over time. Change in pain interference was positively associated with change in depressive symptom severity. These results point to the complexity of aging related changes in depressive symptoms and pain interference. They further support the need for continued assessment of mood and pain experiences, particularly among individuals reaching aging milestones with SCI.

Objective: To subvert issues of low sample sizes and high attrition rates and generate epidemiologically-sound evidence, collaborative research-through international consortia and multi-centric studies-and meta-analysis approaches are encouraged in spinal cord injury (SCI) research. We investigated the use of systematic reviews and meta-analyses (SRMA) methodology in SCI research and evaluated the quality of evidence across publications we identified.

Methods: We searched the Web of Science Core Collection database by topic without time or language restrictions through 16 December 2022. We identified additional relevant articles through Embase.com. SRMA including human and animal SCI populations were eligible for inclusion. We analyzed data using Bibliometrix and VOSviewer. We used the JBI tool (former Joanna Briggs Institute) to assess methodological quality of a subset of 50 randomly selected articles.

Results: We based our analysis on data from 1'224 documents authored by 5'237 scholars and published in 424 sources between 1985 and 2022. The use of SRMA methodology in the field gained momentum in 2009 and a steady increase followed with an annual growth rate of ≈15%. Our findings indicate major research themes in the field include recovery, SCI management, rehabilitation, and quality of life. Over the past 30 years there has been a shift from SRMA concerning functional recovery, secondary health complications, and quality of life toward biomarkers and neuro-regeneration. The major methodological issues across articles we evaluated included opaquely described search strategies, poorly reported critical appraisals, and insufficiently addressing publication bias. In addition, only one-fifth of articles reported review protocol registration.

Conclusions: Our bibliometric analysis clearly shows a rapid increase of SRMA applications in SCI research. We discuss the most important methodological concerns we identified among a randomly selected set of articles and provide guidance for improving adherence to methodological and reporting SRMA guidelines.

Context: At present, there is a lack of information concerning patients' perspectives on their quality of life (QoL) after a recently acquired spinal cord injury/disorder (SCI/D).

Objective: To explore patients' perspectives on their QoL during their first inpatient rehabilitation after the onset of SCI/D.

Methods: Qualitative study. Semi-structured face-to-face interviews were conducted with 20 participants aged 18 years or older at least three months after the onset of SCI/D and two weeks before they were discharged from their first rehabilitation. Audio-recorded interviews were transcribed and analyzed according to the thematic content analysis. Interviewees rated their QoL with the SCI QoL data set.

Results: The interviewees judged their satisfaction with life as a whole, their physical and mental health, as relatively high with values between six and eight (with 10 meaning complete satisfaction). They highlighted social aspects, health topics, and the experience of autonomy as relevant to their concept of QoL. The aspects that positively influenced QoL included the level of well-being in the current social and institutional environment, the increased level of energy, strength, and autonomy in daily life, and an improved mental state derived from general positive personal attitudes. In contrast, the social restrictions during the COVID-19 pandemic, physical issues including pain, a lack of progress associated with psychological dissatisfaction, and limitations in personal independence decreased patients' QoL.

Conclusion: Since the interviewees described different aspects from the areas of social, health and autonomy as important for their QoL, exploring and addressing these areas should be used to achieve an individualized first rehabilitation.

Introduction: Interventions provided in the early phases after spinal cord injury (SCI) may improve neurological recovery and provide for best possible functional outcomes. Knowing this relies on early and clear documentation of the level and grade of the spinal cord injury. Guidelines advocate for early documentation of neurological status within 72 h of injury to allow early prognostication and to help guide initial management. It is unclear whether this is current practice in New South Wales (NSW).

Methods: Patients with acute SCI who were admitted to two SCI referral centers during 2018-2019 in NSW were included. Data relating to documentation of neurological status, timing of imaging, surgery and transfer to spinal cord injury center were collected and summarized using descriptive statistics.

Results: Only 18 percent of patients had an acceptable neurological examination according to the International Standards for Classification of Spinal Cord Injury (ISNCSCI) within 72 h of injury (either not done, or unable to determine the neurological level of injury). At the first neurological examination, the neurological level of injury and grade was unable to be determined in 26.8% of patients and 29.9% of patients respectively. At discharge from acute care and transfer to rehabilitation, the neurological level was undetermined in 28.9% of patients and grade undetermined in 26.8%. ISNCSCI examination was most commonly performed by spinal rehabilitation doctors after patients were discharged from the intensive care unit (ICU).

Conclusions: Documentation of neurological level and grade of SCI within 72 h of injury is not being performed in the large majority of this cohort, which may impede evaluation of neurological improvement in response to acute treatment, and hinder prognostication.