Journal of Spinal Cord Medicine最新文献

Context/objective: There is a growing global interest in quantifying spinal cord lesions and spared neural tissue using magnetic resonance imaging (MRI) in individuals with spinal cord injury (SCI). The primary objective of this study was to assess the relationships between spinal cord lesion characteristics assessed on MRI and bowel, bladder, and overall independence following SCI.

Design: Retrospective, exploratory study.

Participants: 93 individuals with cervical SCI who were enrolled in a local United States Model Systems SCI database from 2010 to 2017.

Methods: Clinical and MRI data were obtained for potential participants, and MRIs of eligible participants were analyzed. Explanatory variables, captured on MRIs, included intramedullary lesion length (IMLL), midsagittal ventral tissue bridge width (VTBW), midsagittal dorsal tissue bridge width (DTBW), and axial damage ratio (ADR).

Outcome measures: Bowel and bladder management scale of the Functional Independence Measure (FIM) and FIM total motor score.

Results: When accounting for all four variables, only ADR was significantly associated with bowel independence (OR = 0.970, 95% CI: 0.942-0.997, P = 0.030), and both ADR and IMLL were strongly associated with bladder independence (OR = 0.967, 95% CI: 0.936-0.999, P = 0.046 and OR = 0.948, 95% CI: 0.919-0.978, P = 0.0007, respectively). 32% of the variation in overall independence scores were explained by all four predictive variables, but only ADR was significantly associated with overall independence after accounting for all other predictive variables (β = -0.469, 95% CI: -0.719, -0.218, P = 0.0004).

Conclusions: Our results suggest that the MRI-measured extent of spinal cord lesion may be predictive of bowel, bladder, and overall independence following cervical SCI.

Study design: This study is a randomized, investigator-blinded, controlled trial with a non-inferiority design.

Objective: To investigate the effectiveness of neuromodulation by transcutaneous electrical stimulation of the somatic afferent nerves of the foot in neurogenic detrusor overactivity (NDO) in persons with spinal cord injury (SCI) and compare its effectiveness with oral oxybutynin.

Setting: The study was conducted in a rehabilitation in-patient ward of a tertiary care hospital.

Methods: Twenty-nine persons with SCI with NDO, either sex, aged 18 years and above were randomized into two groups, one group receiving oral oxybutynin (5 mg thrice a day for two weeks) and the other transcutaneous electrical stimulation (5 Hz, 200 µs pulse, biphasic, amplitude up to 60 mA, 30 min/day for two weeks). Bladder capacity was evaluated by clinical bladder evaluation (i.e. bladder capacity measured by adding leak volume, voiding volume if any, and post-void residue using a catheter) and cystometric bladder capacity by one-channel cystometry. Maximum cystometric pressure was evaluated by one-channel water cystometry. Data were analyzed with Fisher's Exact, t-test, and Wilcoxon rank sum tests.

Results: Bladder capacity improved significantly in the oxybutynin and neuromodulation groups as measured by one-channel water cystometry (136 ml vs. 120.57 ml) and clinical evaluation (138.93 ml vs. 112 ml). The increase in the neuromodulation group achieved the pre-decided non-inferiority margin of 30 ml over the oxybutynin group when measured by one-channel water cystometry but not by clinical evaluation. Maximum cystometric pressure did not significantly improve in either group when compared with the baseline.

Conclusion: Transcutaneous neuromodulation and oxybutynin effectively increased bladder capacity in persons with SCI with NDO. Neuromodulation by once-a-day transcutaneous electrical stimulation was non-inferior to thrice-a-day oxybutynin when evaluated by one-channel water cystometry.Trial registration: Clinical Trials Registry India identifier: CTRI/2018/05/013735.

Objectives: This project used a systematic and integrated knowledge translation (IKT) approach to co-create theory- and evidence-based best practices for physical activity counseling for adults with spinal cord injury (SCI).

Methods: Guided by the IKT Guiding Principles, we meaningfully engaged research users throughout this project. A systematic approach was used. An international, multidisciplinary expert panel (n = 15), including SCI researchers, counselors, and people with SCI, was established. Panel members participated in two online meetings to discuss the best practices by drawing upon new knowledge regarding counselor-client interactions, current evidence, and members' own experiences. We used concepts from key literature on SCI-specific physical activity counseling and health behavior change theories. An external group of experts completed an online survey to test the clarity, usability and appropriateness of the best practices.

Results: The best practices document includes an introduction, the best practices, things to keep in mind, and a glossary. Best practices focused on how to deliver a conversation and what to discuss during a conversation. Examples include: build rapport, use a client-centred approach following the spirit of motivational interviewing, understand your client's physical activity barriers, and share the SCI physical activity guidelines. External experts (n = 25) rated the best practices on average as clear, useful, and appropriate.

Conclusion: We present the first systematically co-developed theory- and evidence-based best practices for SCI physical activity counseling. The implementation of the best practices will be supported by developing training modules. These new best practices can contribute to optimizing SCI physical activity counseling services across settings.

Context/objective: Community-acquired pressure injuries (CAPrI) are a common and costly complication of spinal cord injury (SCI). The majority of PrIs occur in the community, but there is little guidance in CAPrI prevention. This study describes how provider and veteran perspectives of CAPrI prevention converge and diverge.

Design: The Farmer triangulation method was used to compare two models from previous qualitative research describing provider and veteran perspectives of CAPrI prevention based on the framework of CAPrI risks, resources, and preventive activities. The previous qualitative research revealed the provider model of CAPrI prevention using semi-structured interviews with interprofessional SCI providers at the Veteran Health Administration (VA) (n = 30). A qualitative descriptive design using photovoice (n = 30) with or without guided tours (n = 15) revealed the Veteran model of CAPrI prevention.

Setting: The previous qualitative research was conducted at three geographically different VA spinal cord injury/disorder centers in the United States (north, south, west).

Participants: 30 interprofessional SCI providers; 30 Veterans living with SCI at three VA SCI Centers in the United States.

Interventions: n/a.

Outcome measures: Provider-Veteran perspectives of CAPrI prevention that demonstrated agreement, partial agreement, divergence, and silence.

Results: Providers and veterans agreed on what is basic care, and the importance of family, caregiver and health provider/system supports, but they viewed motivation, veteran role, informal supports, and adequacy of supports differently.

Conclusion: Understanding how SCI providers and veterans living with SCI view prevention in the community informs how to promote preventive care in the context of veterans' lives.

Context/objective: The risk for cardiovascular disease is amplified following spinal cord injury, but whether risk differs between the sexes remains unknown. Here, we evaluated sex differences in the prevalence of heart disease among individuals with spinal cord injury, and compared sex differences with able-bodied individuals.

Design: The design was a cross-sectional study. Multivariable logistic regression analysis was conducted, using inverse probability weighting to account for the sampling method and to adjust for confounders.

Setting: Canada.

Participants: Individuals who participated in the national Canadian Community Health Survey.

Interventions: Not applicable.

Outcome measures: Self-reported heart disease.

Results: Among 354 individuals with spinal cord injury, the weighted prevalence of self-reported heart disease was 22.9% in males and 8.7% in females, with an inverse-probability weighted odds ratio of 3.44 (95% CI 1.70-6.95) for males versus females. Among 60,605 able-bodied individuals, the prevalence of self-reported heart disease was 5.8% in males and 4.0% in females, with an inverse probability weighted odds ratio of 1.62 (95% CI 1.50-1.75) for males versus females. The effect of male sex on increasing heart disease prevalence was about two times higher among individuals with spinal cord injury than able-bodied individuals (relative difference in inverse probability weighted odds ratios = 2.12, 95% CI 1.08-4.51).

Conclusion: Males with spinal cord injury exhibit a significantly higher prevalence of heart disease, compared with females with spinal cord injury. Moreover, relative to able-bodied individuals, spinal cord injury amplifies sex-related differences in heart disease. Overall, this work will inform targeted cardiovascular prevention strategies, and may also inform a better understanding of cardiovascular disease progression in both able-bodied and individuals with spinal cord injury.

Objective: The purpose of this study is to investigate predictors of pressure injury (PrI) outcomes at one year after discharge for Veterans with spinal cord injury (SCI) hospitalized with a Stage 3 or 4 PrI.

Design/setting/participants: This is a retrospective medical record review from one VA Health Care System SCI unit. Participants were Veterans with traumatic or non-traumatic SCI admitted with one Stage 3 or 4 pelvic PrI treated medically (e.g. without flap surgery). Logistic models were used to select the significant predictors of PrI healing outcomes.

Outcome measure: One year after discharge wound outcomes (healed vs non-healed) for Veterans with SCI hospitalized with a Stage 3 or 4 PrI.

Results: A total of 62 hospitalizations were included for analyses resulting in 33 healed and 29 non-healed PrIs. Three significant predictors of non-healed PrI outcomes included use of pressure mapping during hospitalization, greater PrI depth, and usage of alginate dressings. Two significant predictors of healed PrI outcomes included the use of animal-based tissue and hydrocolloid dressings. Area under curve of this logistic regression model was 79.98%.

Conclusion: The clinical decision of having a patient pressure mapped predicts that the PrI may not heal at one year of discharge. Pressure mapping protocol correlated with another variable that could not serve as a predictor by itself, including using powered pressure relief techniques. The three PrI treatment predictors may represent characteristics of the PrI itself, rather than the efficacy of the product. Further investigation on these clinical decision-making factors is warranted to ensure efficient and cost-effective treatment strategies for individuals with SCI hospitalized with PrIs.

Objective: To assess COVID-19 vaccination status among individuals with spinal cord injury (SCI).

Design: A cross-sectional study.

Setting: Twelve hospitals from all regions of Thailand.

Participants: One hundred and eighty people with SCI were randomly selected from the Thai SCI registry database.

Intervention: Not applicable.

Outcome measures: The primary outcome, which was the COVID-19 vaccination status, and the secondary outcomes, which were the number of vaccination doses, satisfaction and dissatisfaction aspects, and barriers to vaccination, were recorded using a specifically developed questionnaire over the telephone during February to March 2022. Data were analyzed using descriptive analyses, bivariate, and multivariable analyses.

Results: Of the 96 people with SCI who were able to respond, the prevalence of receiving at least one dose was 77% but the prevalence of receiving a booster dose was 20%. Being non-traumatic SCI correlated negatively with having received any vaccination doses when compared to traumatic SCI. Most of the participants were satisfied with the government provision of COVID-19 vaccines. The major barriers to vaccination were problems related to a negative attitude toward the vaccination, followed by transportation difficulties and wheelchair-inaccessible vaccination sites.

Conclusions: Seventy-seven percent of people with SCI participating in this study received at least one dose of the COVID-19 vaccine, whereas only 20% of them received a booster dose of the COVID-19 vaccination. To increase the prevalence of vaccination, healthcare providers should deliver the fact regarding COVID-19 vaccination to reduce negative attitudes, as well as remove physical barriers to vaccination places for people with SCI.

Context: Neuropathic pain is a common and debilitating condition following SCI. While treatments for neuropathic pain intensity have been reviewed, the impact on pain interference has not been summarized.

Objective: To systematically review the effect of neuropathic pain interventions on pain interference in individuals with spinal cord injury.

Methods: This systematic review included randomized controlled trials and quasi-experimental (non-randomized) studies which assessed the impact of an intervention on pain interference in individuals with spinal cord injury and neuropathic pain. Articles were identified by searching MEDLINE (1996 to April 11, 2022), EMBASE (1996 to April 11, 2022), PsycInfo (1987 to April, week 2, 2022). Studies were assessed for methodologic quality using a modified GRADE approach and were given quality of evidence (QOE) scores on a 4-point scale ranging from very low to high.

Results: Twenty studies met the inclusion criteria. These studies fell into the following categories: anticonvulsants (n = 2), antidepressants (n = 1), analgesics (n = 1), antispasmodics (n = 1), acupuncture (n = 2), transcranial direct current stimulation (n = 1), active cranial electrotherapy stimulation (n = 2), transcutaneous electrical nerve stimulation (n = 2), repetitive transcranial magnetic stimulation (n = 1), functional electrical stimulation (n = 1), meditation and imagery (n = 1), self-hypnosis and biofeedback (n = 1), and interdisciplinary pain programs (n = 4).

Conclusion: When considering studies of moderate to high quality, pregabalin, gabapentin, intrathecal baclofen, transcranial direct current stimulation, and transcutaneous electrical nerve stimulation (in 1 of 2 studies) were shown to have beneficial effects on pain interference. However, due to the low number of high-quality studies further research is required to confirm the efficacy of these interventions prior to recommending their use to reduce pain interference.

Context: Following spinal cord injury (SCI), early spasms are associated with decreased functional recovery. It has also been hypothesized that early spasticity might sign underlying maladaptive neuroplasticity, which could translate in worse neurological outcomes.

Objective: In this context, this paper aims to evaluate if early-onset spasms are also associated with neurological outcomes after SCI.

Methods: A retrospective review of 196 cases from a prospective SCI database was conducted. The presence of early spasms during the acute hospitalization was assessed by a single physiatrist. The characteristics and long-term neurological outcomes of individuals with and without early spasms were first compared. Multivariate regression analyses were then performed to determine the relationship between early spasms and neurological outcomes.

Results: 30.1% (N = 59) of patients presented early spasms. These patients had several distinguishing characteristics including higher odds of tetraplegia (vs. paraplegia) and more severe injuries. At the bivariate level, patients with early spasms had higher odds of improving at least 1 AIS grade between baseline and follow-up. However, this was not significant at the multivariate level.

Conclusions: Early spasms are not significantly associated with poorer neurological outcomes, contrasting with the unwritten consensus that early spasticity translates maladaptive neuroplasticity.