Journal of Spinal Cord Medicine最新文献

Study design: Analysis of data from two cohorts of Spinal Cord Injury Model Systems Database (SCIMS) participants, pre-pandemic (2017-2019, n = 6368) and during pandemic (2020, n = 1889).

Objectives: To examine differences in substance use during the pandemic compared to the years prior to the pandemic.

Setting: 19 SCIMS Centers.

Methods: Participant characteristics, wellness (depression, life satisfaction, resilience), participation, and substance use between the two cohorts were compared. Multiple logistic regression examined the association of the pandemic with substance use after accounting for other factors.

Results: Characteristics of the two cohorts were similar. Cannabis and sedative uses were not greatly different (28.8% vs 25.1%, and 8.3% vs 6.6%) but did reach statistical significance. Non-prescribed opioid use was double for the pandemic group (6.6% vs 3.3%). Alcohol use patterns were similar across the two cohorts. Measures of wellness were similar, while the pandemic group reported lower participation. The odds of use of cannabis, sedatives, and opioids were 1.3, 1.3, and 2.2 times greater, respectively, for the pandemic cohort after accounting for demographics, wellness, and participation. Greater use of non-prescribed opioids was reported during the pandemic in the South compared to prior to the pandemic (13.8% vs 6.1%).

Conclusions: The pandemic may have been associated with increased use of non-prescribed substances in the traumatic spinal cord injury population. Efforts to pursue longitudinal investigations would be warranted for definitive analysis of trends. The provision of demonstrably effective substance use treatment resources delivered via accessible methods will likely be needed in this population, particularly opioid treatment.

Context: Little is understood about community-based standing device use and the impact of standing on health outcomes (e.g. pressure injury) in those living with spinal cord injury (SCI). This project reports on the accuracy of a commercially available data logger for measuring standing time and seat angle.

Methods: A standing frame and a standing manual wheelchair were each instrumented with a commercially available data logger and each was tested by an non-disabled participant. Standing time in the standing frame was calculated from the data logger and compared to a user-recorded standing log over a two-month period in a laboratory environment. The standing wheelchair's seat angle was calculated using motion capture and compared to the calculated seat angle from the data logger. Average seat interface pressures were also captured during the testing of the standing wheelchair.

Results: The data logger demonstrated high accuracy (99.99999%) in classifying sitting and standing in the standing frame when compared to a user-recorded standing log. The wheelchair seat angle calculated from the data logger demonstrated a high level of agreement with the motion lab calculations of seat angle (ICC = 0.96 (0.95, 0.97)). The data logger seat angle results also demonstrated strong relationships to average seat pressure and rear dispersion index, measures relevant to pressure injuries.

Conclusions: The data logger appears to be an appropriate tool for determining standing time and seat angle in standing devices, which may aid clinicians and researchers to better understand the use and impact of standing technologies on health outcomes.

Context/objectives: To compare the assessment of the impact of secondary health conditions (SHCs) on the quality of life and wellbeing of Canadians living with spinal cord injury (SCI) using four preference-based outcome measures.

Design: Secondary analysis of data from a cross-sectional, online survey.

Setting: Community.

Participants: Community-dwelling adults (n = 364) living with traumatic or non-traumatic spinal cord injury at least one year post-injury (70% at least 10 years post-injury).

Outcome measures: A modified version of the Spinal Cord Injury Secondary Conditions Scale (SCI-SCS); three health-related instruments (EQ-5D-5L, Health Utilities Index Mark 3 (HUI3), and the Assessment of Quality of Life 8-dimension questionnaire (AQoL-8D)) and a capability wellbeing instrument (ICEpop CAPability measure for Adults (ICECAP-A)).

Results: Across unadjusted and controlled analyses (i.e. controlling for associations between index scores and sociodemographic and impairment characteristics), trends were observed that identified lower levels of quality of life/wellbeing with higher problem ratings for each of the SHCs. Despite the trends, there was considerable variation in mean index scores across instruments, with HUI3 scores the lowest of the health-related instruments and ICECAP-A scores the highest overall. Respiratory problems, depression/mood problems, pressure sores, and autonomic dysreflexia were associated with the lowest levels of quality of life and wellbeing.

Conclusions: Higher problem ratings for SHCs are negatively associated with scores derived from preference-based quality of life and wellbeing instruments. Variation in index scores across instruments - including across the health-related instruments alone - highlights the critical importance of assessing the relative merits of preference-based instruments when using (or considering using) these instruments/estimates in comparative effectiveness research and economic evaluation.

Context/objective: In-person hypnotic cognitive therapy (HYP-CT) is a promising treatment for chronic spinal cord injury-related pain. We describe the effects of HYP-CT delivered via Zoom (Z-HYP-CT) and compare the effects to historical controls who received hypnosis, cognitive therapy, or HYP-CT in-person.

Design: Open pilot trial of HYP-CT versus historical controls.

Setting: Telehealth study that recruited people with chronic SCI.

Participants: Adults with moderate to severe chronic SCI-related pain.

Interventions: Four weekly sessions of HYP-CT delivered via Zoom.

Outcome measures: The primary outcome was average pain intensity on a 0-10 numerical rating scale measured at end of treatment (4 weeks) and 12 weeks. Secondary outcomes included pain interference, depression, sleep, pain catastrophizing, and pain self-efficacy.

Results: 23 individuals with SCI-related pain participated in the open trial and were compared to 21 historical controls. Average age was 54 years, 70% were male, and the majority were White. The participants were 11.6-13.1 years post-SCI and average pain intensity was 4.8-5.4/10. After Z-HYP-CT mixed-effects linear regressions showed that pain intensity was significantly less at 4 weeks (-1.28, P < .0001) and 12 weeks (-1.50, P < .0001) relative to baseline. Pain interference, depression, and pain catastrophizing also decreased significantly at both time points. There were no significant differences between the effects of Z-HYP-CT versus historical controls on any outcome variable.

Conclusion: HYP-CT delivered via telehealth was associated with reduced pain intensity and other benefits that were comparable to the effect achieved by in-person historical controls. The effects of Z-HYP-CT should be evaluated using a randomized controlled design.

Case description: 56-year-old transgender woman with new spinal cord injury (SCI) on gender affirming hormonal therapy (GAHT) with estrogen and spironolactone.

Findings: After her injury, estrogen and spironolactone were discontinued, for blood clots and hypotension, respectively. Alternative options were explored.

Clinical relevance: Little is known about GAHT in SCI for transgender women. Shared decision making should be used to navigate risks, benefits, and alternative options.

Context/objective: Perceived job quality is a key indicator of sustainable work among persons with spinal cord injuries (PwSCI). This study aimed at (a) describing three indicators of perceived job quality (i.e. job satisfaction, job performance, and work stress) among working PwSCI, and (b) identifying whether and how different person-job match dimensions (i.e. interest congruence, demands-abilities fit, needs-supplies fit, and effort-reward imbalance) as well as sociodemographic and health-related factors (e.g. age, sex, SCI-related characteristics, pain problems, and depressive symptoms) are associated with perceived job quality.

Design: Cross-sectional, self-report survey.

Setting: Community.

Participants: 549 working-age PwSCI who participated in the 2017 community survey of the Swiss Spinal Cord Injury Cohort study and reported being engaged in paid work.

Outcome measures: Job satisfaction, job performance, and work stress.

Results: Higher interest congruence, better needs-supplies fit and lower effort-reward imbalance, as well as female sex, were associated with higher job satisfaction, while higher effort-reward imbalance, poorer demands-abilities fit (underqualification), and - surprisingly - better needs-supplies fit were associated with higher work stress. Moreover, underqualification, worse needs-supplies fit as well as pain, depressive symptoms, and language region were associated with lower job performance.

Conclusion: Integrating individuals in jobs that match their abilities, interests and needs, and which adequately reward their efforts may contribute to better job quality among PwSCI. Beyond that, common secondary health conditions and comorbidities such as pain and depressive symptoms should receive particular attention in interventions that aim to promote job quality and ultimately sustainable work in the SCI population.

Context/objective: To identify cardiometabolic (CM) measurements that cluster to confer increased cardiovascular disease (CVD) risk using principal component analysis (PCA) in a cohort of chronic spinal cord injury (SCI) and healthy non-SCI individuals.

Approach: A cross-sectional study was performed in ninety-eight non-ambulatory men with chronic SCI and fifty-one healthy non-SCI individuals (ambulatory comparison group). Fasting blood samples were obtained for the following CM biomarkers: lipid, lipoprotein particle, fasting glucose and insulin concentrations, leptin, adiponectin, and markers of inflammation. Total and central adiposity [total body fat (TBF) percent and visceral adipose tissue (VAT) percent, respectively] were obtained by dual x-ray absorptiometry (DXA). A PCA was used to identify the CM outcome measurements that cluster to confer CVD risk in SCI and non-SCI cohorts.

Results: Using PCA, six factor-components (FC) were extracted, explaining 77% and 82% of the total variance in the SCI and non-SCI cohorts, respectively. In both groups, FC-1 was primarily composed of lipoprotein particle concentration variables. TBF and VAT were included in FC-2 in the SCI group, but not the non-SCI group. In the SCI cohort, logistic regression analysis results revealed that for every unit increase in the FC-1 standardized score generated from the statistical software during the PCA, there is a 216% increased risk of MetS (P = 0.001), a 209% increased risk of a 10-yr. FRS ≥ 10% (P = 0.001), and a 92% increase in the risk of HOMA2-IR ≥ 2.05 (P = 0.01).

Conclusion: Application of PCA identified 6-FC models for the SCI and non-SCI groups. The clustering of variables into the respective models varied considerably between the cohorts, indicating that CM outcomes may play a differential role on their conferring CVD-risk in individuals with chronic SCI.

Context: Patients with cervical compressive myelopathy (CCM) often complain of body balance problems, such as fear of falling and bodily unsteadiness. However, no accepted patient-reported outcome measures (PROMs) for this symptomatology exist. The Falls Efficacy Scale-International (FES-I) is one of the most widely used PROMs for evaluating impaired body balance in various clinical fields.

Objective: To examine reliability, validity, and minimum clinically important difference (MCID) of the FES-I for the evaluation of impaired body balance in patients with CCM.

Methods: Patients who underwent surgery for CCM were retrospectively reviewed. The FES-I was administered preoperatively and at 1 year postoperatively. Further, cJOA-LE score (subscore for lower extremities in the Japanese Orthopaedic Association score for cervical myelopathy) and stabilometric data, obtained at the same time points of the FES-I administration, were analyzed. Reliability was examined through internal consistency with Cronbach's alpha. Convergent validity was studied using correlation analysis. The MCID was estimated using anchor- and distribution-based methods.

Results: Overall, 151 patients were included for analysis. Cronbach's alpha coefficient was the acceptable value of 0.97 at both baseline and 1 year postoperatively. As for convergent validity, the FES-I had significant correlations with the cJOA-LE score and stabilometric parameters both at baseline and 1 year postoperatively. The MCID calculated using anchor- and distribution-based methods was 5.5 and 10, respectively.

Conclusion: FES-I is a reliable and valid PROM to evaluate body balance problems for the CCM population. The established thresholds of MCID can help clinicians recognize the clinical significance of changes in patient status.

Objectives: To investigate the reliability and the construct validity of the Participation Scale (P-scale) in adults with Spinal Cord Injury (SCI).

Design: A cross-sectional study.

Setting: : SARAH Network of Rehabilitation Hospitals, Brazil.

Participants: : One hundred individuals with SCI.

Interventions: : Not applicable.

Outcome measures: : Sociodemographic and clinical characteristics were investigated. To assess reliability the P-scale was applied twice with a one-week interval. To assess construct validity the Functional Independence Measure, the Beck Depression Inventory, and the Accessibility Perception Questionnaire were administered.

Results: The mean age of the participants was 38.9 ± 12.80 years. The majority were male (70%) and had traumatic injuries (74%). The P-scale showed significant correlations with the Functional Independence Measure motor domain (r_s = -0.280) and cognitive domain (r_s = -0.520); with the Beck Depression Inventory score (r_s= 0.610); with the Accessibility Perception Questionnaire displacement domain (r_s= -0.620) and psycho-affective domain (r_s= 0.530). Mean scores obtained on the P-scale differed significantly between the groups with and without depressive symptoms (P = 0.001), neuropathic pain (P = 0.033), and functional dependence (P = 0.001). There was no difference between the paraplegic and quadriplegic groups. The P-scale had adequate internal consistency (Cronbach's alpha = 0.873), excellent test-retest reliability (ICC_2,1= 0.992; 95% CI = 0.987-0.994), and in the Bland-Altman plot analysis, only six values fell outside the limits of agreement.

Conclusion: Our results support the use of the P-scale to assess the participation of individuals with SCI in research and clinical practice.