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.

Context: The growing number of females entering the armed forces has led to an increase in the number of female Veterans with spinal cord injury and diseases (SCI/D) requiring mobility devices. Limited research exists that explores whether mobility devices meet their needs in terms of comfort, fit and design.

Objective: To characterize respondents with SCI/D who use mobility devices and determine if these devices are meeting their daily needs.

Design: Online survey.

Settings: Veterans Health Administration.

Participants: Female Veterans with SCI/D who received mobility devices in the past five years.Interventions: Participants completed an online survey regarding their challenges in obtaining and using mobility devices for their daily needs.

Results: 101 women with SCI/D participated in a nation-wide online survey. Respondents were mainly in their 50s and 59% were not currently employed due to their disability. Most used manual (35%) or power wheelchairs (34%). Many female Veterans felt their devices were not made with female users in mind and some felt they did not meet their needs. Opportunities to improve the assessment, follow-up, maintenance and repair processes were identified.

Conclusions: Given that some female Veterans with SCI/D felt their devices did not meet all their needs, it is important for researchers to engage women in user-centered design of mobility devices and for providers to be mindful of Veterans' daily needs within all steps of the provision process in order for mobility devices to support overall function and usability.

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.

Objective: To evaluate seminal plasma levels of Biglycan, Cystatin-S, β-2 microglobulin and inflammasome proteins and to investigate their role in seminal toxicity in men with spinal cord injury (SCI).

Study design: cross-sectional study.

Setting: Miami Project to Cure Paralysis - University of Miami / Miller School of Medicine and Federal University of Sao Paulo.

Participants: Eight men with spinal cord injury and eight men without spinal cord injury (controls).

Intervention: none. Outcome measures: semen analysis as per WHO 2010 guidelines; seminal plasma ELISA for IL-1β, IL-18 and caspase-1; and Western blotting for Biglycan, β-2microglobulin and Cystatin-S proteins.

Results: Proteins from the inflammasome complex are elevated in men with SCI, as previously described. In addition, β-2-microgobulin, Cystatin-S and two different isoforms of Byglican are elevated in men with SCI.

Conclusion: a different pathway to activate the inflammasome complex is present in men with spinal cord injury. This pathway can be a potential target for new interventions in the future.

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: Available diabetes risk calculators were developed for able-bodied individuals, but their metabolic profile is different from individuals with spinal cord injury.

Objectives: We aimed to develop a diabetes risk assessment tool specific to individuals with spinal cord injury.

Methods: We used national Veterans Affairs data to identify patients with at least a 2-year history of spinal cord injury and no prior history of diabetes with a Veterans Heath Affairs visit from 2005-2007, and followed the 11,054 individuals that met inclusion criteria for up to 17 years to assess diabetes development. We used least absolute shrinkage and selection operator (LASSO) Cox regression to develop prognostic diabetes prediction models and evaluated these models on discrimination and calibration.

Results: 2937 subjects developed diabetes during follow-up; median follow-up time was 8.7 years (IQR 3.3, 15.4). The first model selected 17 predictors and demonstrated median discrimination of 0.70 (IQR 0.69, 0.72) at 15 years. The second, more parsimonious model with 4 selected predictors demonstrated median discrimination of 0.69 (IQR 0.68, 0.71) at 15 years. Both models demonstrated good calibration across predicted risk, with better calibration in the 17-predictor model.

Conclusion: These spinal cord injury-specific risk calculators can be used by both patients and providers in assessing risk of diabetes development, and in shared decision making regarding surveillance and prevention.

Context: Determining walking prognosis during early recovery phases after spinal cord injury (SCI) is challenging.

Objective: We retrospectively examined the use of clinical prediction rules (CPRs) for a cohort of patients with SCI undergoing locomotor training during inpatient rehabilitation.

Methods: Patients participating in a randomized controlled trial received overground robotic exoskeleton (ORE) or usual care (UC) locomotor training during inpatient rehabilitation. Patient data extracted from the medical record (Admission ISNCSCI scores, age) were utilized to populate each of three CPRs. Admission and discharge Walking Index for spinal cord injury-II (WISCI-II) and CARE Tool (walking) items characterized walking ability.

Results: Eighty-nine inpatients with SCI [AIS B (20%), C (28%), and D (52%)] were included [males (79%), median age 56 years (IQR: 33, 66), tetraplegic (61%), median time since injury 23 days (17, 42) and median length of stay 36 days (28, 54)]. Accuracy of walking prediction by the CPRs was 71.9%, with 55.4% specificity and 100% sensitivity. Fifty-eight patients were predicted to walk independently 1-year post-injury, with the 33 (56.9%) walking independently by inpatient rehabilitation discharge [ORE (AIS C = 4, AIS D = 19) vs. UC (AIS D = 10)] being younger [median age = 46 vs. 62, P = 0.042], shorter time from injury to first locomotor training [median days = 29 vs. 40, p = 0.001], AIS D [88% vs. 54%, p = 0.009], and higher admission WISCI-II and CARE Tool scores [p < 0.05].

Conclusions: Integration of CPRs into clinical practice appears to differentiate those with higher versus lower walking potential and may guide therapists to better prioritize locomotor interventions earlier in recovery.

Context: Emerging research suggests that individuals with a spinal cord injury (SCI) may be at a higher risk of developing cognitive impairment. Early detection of cognitive impairment is essential to improving quality of life and tailored rehabilitation. However, the true incidence of cognitive impairment in this group is unclear, largely due to the difficulty in administering cognitive assessment tools which often have elements that are dependent on hand function e.g. drawing and writing.

Design: We conducted three semi-structured focus groups with a total of 9 participants with the aim of gaining a better understanding of patient perspectives on subjective cognitive difficulties following their SCI.

Setting: Online focus groups.

Participants: 9 participants who have sustained a spinal cord injury.

Interventions: Focus groups were transcribed verbatim and analyzed using reflexive thematic analysis.

Outcome measures: Transcript were coded to identify patterns which were analyzed using reflexive thematic analysis to produce five overarching themes.

Results: People with SCI reported various levels of cognitive difficulties following their injury, and shared strategies that they have implemented to cope with these challenges. All participants expressed a lack of information or assessments on cognitive impairments, highlighting that the focus of their care has predominantly been about the physical aspects of their SCI. Additionally, they observed a difference in the approach to SCI management across different centers within the UK.

Conclusion: Patients with a SCI report cognitive issues following their injury but there is a lack of information or testing by healthcare professionals. Patients advocated for a more consistent and standardized approach, particularly since cognitive impairment can increase care needs and reduce engagement with rehabilitation.

Objective: Patients with spinal cord injuries/disorders (SCI/D) have one of the highest risks of developing pressure injuries, but surgical closure of these wounds has significant pre-operative and post-operative requirements with a high rate of complications. Limited data exists on the outcomes of stage IV pressure injuries that are not managed with surgical closure. Our objective was to review outcomes of patients with stage IV pressure injuries that close by secondary intention.

Design: Retrospective case series review Setting: Veterans Affairs hospital.

Methods: Records of veterans hospitalized on an SCI/D inpatient unit during March 2022 to June 2023 were reviewed to determine if patients were admitted with a stage IV pressure injury. These charts were then further reviewed to determine wound characteristics, medical and surgical management, and wound outcomes.

Results: Charts of twenty-three Veterans with a total of 25 pressure injuries were reviewed.

Conclusions: Ninety-two percent of stage IV pressure injuries improved with complete healing in 36%, though over half of these wounds had imaging concerning for osteomyelitis and required surgical debridement and/or antibiotics. Additionally, these wounds improved or closed though 91.30% were prescribed a progressive sitting program.

Objectives: Neurogenic heterotopic ossification (NHO) is extra-skeletal bone formation induced by neurologic conditions such as spinal cord injury (SCI) and traumatic brain injury (TBI). The definite treatment of established NHO is surgery and the most common complication of surgery is recurrence. This study compared three common postsurgical tertiary prevention strategies: radiotherapy, pharmacological treatment, and no additional intervention.

Materials and methods: Comprehensive searches on PubMed, Embase, Web of Science, and Cochrane Library were conducted until June 2023. Studies' quality was assessed using the MINORS tool, and the rate of NHO recurrence was pooled and compared through random-effects meta-analysis (Dersimonian-Laird). Inclusion criteria involved patients who underwent NHO removal surgery with subcategories based on recurrence prevention strategy: pharmacologic, radiotherapy, and no additional treatment.

Results: In total, 18 studies (n = 937 subjects) were included. Overall prevalence of recurrence (95% CI) was 12.40% (7.49%, 19.82%) with pharmacologic therapy at 9.34% (2.26%, 31.43%), radiotherapy at 15.71% (8.92%, 26.19%), and no additional treatment at 13.55% (6.73%, 25.39%). While no significant differences were observed among the interventions (P > 0.05), pharmacologic therapy exhibited a trend as the most effective method, followed by radiotherapy and no additional treatment.

Conclusion: This study found no significant differences in recurrence rates among treatment groups but noted fewer NHO recurrences with combined pharmacology and surgery in recent studies (after 2000), suggesting potential efficacy of postoperative pharmacotherapy for high-risk patients, though limitations like non-controlled studies and heterogeneity warrant caution.