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1.
Liang Qin Liu Julie Moody Michael Traynor Sue Dyson Angela Gall 《The journal of spinal cord medicine》2014,37(6):703-718
Context
Electrical stimulation (ES) can confer benefit to pressure ulcer (PU) prevention and treatment in spinal cord injuries (SCIs). However, clinical guidelines regarding the use of ES for PU management in SCI remain limited.Objectives
To critically appraise and synthesize the research evidence on ES for PU prevention and treatment in SCI.Method
Review was limited to peer-reviewed studies published in English from 1970 to July 2013. Studies included randomized controlled trials (RCTs), non-RCTs, prospective cohort studies, case series, case control, and case report studies. Target population included adults with SCI. Interventions of any type of ES were accepted. Any outcome measuring effectiveness of PU prevention and treatment was included. Methodological quality was evaluated using established instruments.Results
Twenty-seven studies were included, 9 of 27 studies were RCTs. Six RCTs were therapeutic trials. ES enhanced PU healing in all 11 therapeutic studies. Two types of ES modalities were identified in therapeutic studies (surface electrodes, anal probe), four types of modalities in preventive studies (surface electrodes, ES shorts, sacral anterior nerve root implant, neuromuscular ES implant).Conclusion
The methodological quality of the studies was poor, in particular for prevention studies. A significant effect of ES on enhancement of PU healing is shown in limited Grade I evidence. The great variability in ES parameters, stimulating locations, and outcome measure leads to an inability to advocate any one standard approach for PU therapy or prevention. Future research is suggested to improve the design of ES devices, standardize ES parameters, and conduct more rigorous trials. 相似文献2.
Shao J Zhu W Chen X Jia L Song D Zhou X Yan W Zhang Y 《The journal of spinal cord medicine》2011,34(6):555-562
Background
A relatively high early mortality rate (<30 days post-injury) for cervical spinal cord injury (SCI) has been observed.Objective
To investigate this early mortality rate observed after cervical SCI and analyze the associated influential factors.Methods
Medical records for 1163 patients with cervical SCI were reviewed, and the number of patients with early mortality was documented. Through logistic regression analysis, the effects of age, gender, occupation, cause of injury, severity of injury, highest involved spinal cord segment, nutritional condition during hospitalization, surgical treatment, tracheotomy, etc., on early mortality were assessed. Implementation of early treatment (i.e. surgery, tracheotomy, and nutritional support) and its effect on patient prognosis were also analyzed.Results
Early mortality occurred in 109 of 1163 patients (9.4%). Four factors affected the early mortality rate, including level and severity of SCI, whether or not surgery was performed, the time interval between SCI and surgery, malnutrition, and tracheotomy. Patients with an American Spinal Injury Association grade of A, a high cervical SCI (C1–C3), and/or no surgical intervention were statistically more likely to have early mortality (P < 0.001).Conclusion
Severe cervical SCI, upper-level cervical cord injury, malnutrition, and inappropriate tracheotomy are risk factors for early mortality in patients with cervical SCI. Surgery can reduce early mortality. Early tracheotomy should be performed in patients with complete upper-level cervical SCI, but patients with incomplete cervical SCI or complete low-level cervical SCI should initially be treated surgically to maintain smooth airway flow. 相似文献3.
Objective:
To identify risks factors associated with pressure ulcers (PrU) after spinal cord injury (SCI) by examining race and indicators of socioeconomic status (measured by income and education). We hypothesize African Americans will have a greater risk for PrUs than whites, but this relationship will be mediated by the 2 socioeconomic status indicators.Design:
Cohort study.Setting:
A large rehabilitation hospital in the southeastern US.Participants:
1,466 white and African American adults at least 1-year post-traumatic SCI.Outcome Measures:
(a) PrUs in the past year, (b) current PrU, (c) surgery to repair a PrU since injury.Results:
In preliminary analyses, race was significantly associated with having a current PrU and with having surgery to repair a PrU since injury. In multivariable analyses, the relationships of PrU with having a current PrU and with having surgery to repair a PrU were both mediated by income and education such that the relationships were no longer significant. Lower income was associated with increased odds of each PrU outcome. After controlling for other variables in the model, education was associated with increased odds of having a current PrU.Conclusion:
These findings help clarify the relationships between race and socioeconomic status with PrUs after SCI. Specifically, a lack of resources, both financial and educational, is associated with worse PrU outcomes. These results can be used by both providers and policy makers when considering prevention and intervention strategies for PrUs among people with SCI. 相似文献4.
Background
Although social support is an important protective factor for individuals with spinal cord injuries (SCIs), individuals often encounter significant barriers to obtaining support after experiencing a SCI. It has been suggested that the Internet may serve to help individuals with disabilities overcome common barriers in obtaining support, yet research examining the efficacy of Internet-based support for individuals with SCI has been mixed.Objective
To develop a more nuanced understanding of how individuals with SCI can or might use the Internet for support.Design
Using an ethnographic approach, we conducted semi-structured interviews with nine individuals with SCI to explore perceived needs and barriers to information-seeking and online support.Setting
Participants were recruited from Veterans Administration medical center outpatient and inpatient units providing specialty care to individuals with SCIs and from a community SCI Center of Excellence.Results
Individuals with SCI gain emotional, problem-focused, and reciprocal support from online sources.Conclusions
Online resources can provide important opportunities for social support for individuals with SCI. 相似文献5.
Leslie R. M. Hausmann Larissa Myaskovsky Christian Niyonkuru Michelle L. Oyster Galen E. Switzer Kelly H. Burkitt Michael J. Fine Shasha Gao Michael L. Boninger 《The journal of spinal cord medicine》2015,38(1):102-110
Context
Despite evidence that healthcare providers have implicit biases that can impact clinical interactions and decisions, implicit bias among physicians caring for individuals with spinal cord injury (SCI) has not been examined.Objective
Conduct a pilot study to examine implicit racial bias of SCI physicians and its association with functioning and wellbeing for individuals with SCI.Design
Combined data from cross-sectional surveys of individuals with SCI and their SCI physicians.Setting
Four national SCI Model Systems sites.Participants
Individuals with SCI (N = 162) and their SCI physicians (N = 14).Outcome measures
SCI physicians completed online surveys measuring implicit racial (pro-white/anti-black) bias. Individuals with SCI completed questionnaires assessing mobility, physical independence, occupational functioning, social integration, self-reported health, depression, and life satisfaction. We used multilevel regression analyses to examine the associations of physician bias and outcomes of individuals with SCI.Results
Physicians had a mean bias score of 0.62 (SD = 0.35), indicating a strong pro-white/anti-black bias. Greater physician bias was associated with disability among individuals with SCI in the domain of social integration (odds ratio = 4.80, 95% confidence interval (CI) = 1.44, 16.04), as well as higher depression (B = 3.24, 95% CI = 1.06, 5.41) and lower life satisfaction (B = −4.54, 95% CI= −8.79, −0.28).Conclusion
This pilot study indicates that SCI providers are susceptible to implicit racial bias and provides preliminary evidence that greater implicit racial bias of physicians is associated with poorer psychosocial health outcomes for individuals with SCI. It demonstrates the feasibility of studying implicit bias among SCI providers and provides guidance for future research on physician bias and patient outcomes. 相似文献6.
Naaz Kapadia Kei Masani B. Catharine Craven Lora M. Giangregorio Sander L. Hitzig Kieva Richards Milos R. Popovic 《The journal of spinal cord medicine》2014,37(5):511-524
Background
Multi-channel surface functional electrical stimulation (FES) for walking has been used to improve voluntary walking and balance in individuals with spinal cord injury (SCI).Objective
To investigate short- and long-term benefits of 16 weeks of thrice-weekly FES-assisted walking program, while ambulating on a body weight support treadmill and harness system, versus a non-FES exercise program, on improvements in gait and balance in individuals with chronic incomplete traumatic SCI, in a randomized controlled trial design.Methods
Individuals with traumatic and chronic (≥18 months) motor incomplete SCI (level C2 to T12, American Spinal Cord Injury Association Impairment Scale C or D) were recruited from an outpatient SCI rehabilitation hospital, and randomized to FES-assisted walking therapy (intervention group) or aerobic and resistance training program (control group). Outcomes were assessed at baseline, and after 4, 6, and 12 months. Gait, balance, spasticity, and functional measures were collected.Results
Spinal cord independence measure (SCIM) mobility sub-score improved over time in the intervention group compared with the control group (baseline/12 months: 17.27/21.33 vs. 19.09/17.36, respectively). On all other outcome measures the intervention and control groups had similar improvements. Irrespective of group allocation walking speed, endurance, and balance during ambulation all improved upon completion of therapy, and majority of participants retained these gains at long-term follow-ups.Conclusions
Task-oriented training improves walking ability in individuals with incomplete SCI, even in the chronic stage. Further randomized controlled trials, involving a large number of participants are needed, to verify if FES-assisted treadmill training is superior to aerobic and strength training. 相似文献7.
Context/objective
Pressure ulcers (PrUs) are a serious, costly and potentially life-long complication of spinal cord injury (SCI). Co-morbid conditions increase PrU risk, adding to the health behavior challenges faced by people with SCI. Little is known about medical co-morbidities, health beliefs, risk, protective behaviors, and readiness to improve skin care behaviors in people with SCI. This study describes the potentially modifiable medical and behavioral risk factors among veterans with SCI and severe (Stage III/IV) PrUs.Design
Cross-sectional observational design.Setting
6 VA SCI Centers.Participants
Convenience sample from a larger intervention study of 148 veterans hospitalized for PrUs.Interventions
Not applicable.Outcome measures
Knowledge, PrU risk, skin protective behaviors, health beliefs, and practices, health locus of control, skin worsening.Results
Most ulcers were stage IV (73%) and about half had 2+ PrUs. Participants reported a mean of 6.7 co-morbid conditions (respiratory, gastrointestinal, renal disease/urinary tract infection, autonomic dysreflexia, diabetes, bowel/bladder incontinence). Potential intervention opportunities include proactive assistance with management of multiple chronic conditions, substance abuse, nutrition, adherence to skin protective behaviors, readiness to change, and access to resources. Overall knowledge about PrUs was low, especially for how to prevent PrUs and what to do if skin breakdown occurs.Conclusion
Future research should address whether comprehensive models that include patient self-management, decision support and health care system, and proactive behavior change assistance for patients help reduce PrU incidence and recurrence in persons with SCI.Trial Registration
http://clinicaltrials.gov/ct2/show/ NCT00105859相似文献8.
Laura E. Edsberg Jennifer T. Wyffels Rajna Ogrin B. Catharine Craven Pamela Houghton 《The journal of spinal cord medicine》2015,38(4):456-467
Objective
To determine whether the biochemistry of chronic pressure ulcers differs between patients with and without chronic spinal cord injury (SCI) through measurement and comparison of the concentration of wound fluid inflammatory mediators, growth factors, cytokines, acute phase proteins, and proteases.Design
Survey.Setting
Tertiary spinal cord rehabilitation center and skilled nursing facilities.Participants
Twenty-nine subjects with SCI and nine subjects without SCI (>18 years) with at least one chronic pressure ulcer Stage II, III, or IV were enrolled.Outcome measures
Total protein and 22 target analyte concentrations including inflammatory mediators, growth factors, cytokines, acute phase proteins, and proteases were quantified in the wound fluid and blood serum samples. Blood samples were tested for complete blood count, albumin, hemoglobin A1c, total iron binding capacity, iron, percent (%) saturation, C-reactive protein, and erythrocyte sedimentation rate.Results
Wound fluid concentrations were significantly different between subjects with SCI and subjects without SCI for total protein concentration and nine analytes, MMP-9, S100A12, S100A8, S100A9, FGF2, IL-1b, TIMP-1, TIMP-2, and TGF-b1. Subjects without SCI had higher values for all significantly different analytes measured in wound fluid except FGF2, TGF-b1, and wound fluid total protein. Subject-matched circulating levels of analytes and the standardized local concentration of the same proteins in the wound fluid were weakly or not correlated.Conclusions
The biochemical profile of chronic pressure ulcers is different between SCI and non-SCI populations. These differences should be considered when selecting treatment options. Systemic blood serum properties may not represent the local wound environment. 相似文献9.
Anna L. Kratz Edmund Chadd Mark P. Jensen Matthew Kehn Thilo Kroll 《The journal of spinal cord medicine》2015,38(4):446-455
Objective
To examine the psychometric properties of the Community Integration Questionnaire (CIQ) in large samples of individuals with spinal cord injury (SCI).Design
Longitudinal 12-month survey study.Setting
Nation-wide, community dwelling.Participants
Adults with SCI: 627 at Time 1, 494 at Time 2.Interventions
Not applicable.Outcome measures
The CIQ is a 15-item measure developed to measure three domains of community integration in individuals with traumatic brain injury: home integration, social integration, and productive activity. SCI consumer input suggested the need for two additional items assessing socializing at home and internet/email activity.Results
Exploratory factor analyses at Time 1 indicated three factors. Time 2 confirmatory factor analysis did not show a good fit of the 3-factor model. CIQ scores were normally distributed and only the Productive subscale demonstrated problems with high (25%) ceiling effects. Internal reliability was acceptable for the Total and Home scales, but low for the Social and Productive activity scales. Validity of the CIQ is suggested by significant differences by sex, age, and wheelchair use.Conclusions
The factor structure of the CIQ was not stable over time. The CIQ may be most useful for assessing home integration, as this is the subscale with the most scale stability and internal reliability. The CIQ may be improved for use in SCI by including items that reflect higher levels of productive functioning, integration across the life span, and home- and internet-based social functioning. 相似文献10.
Background
Sedentarism is common among people with spinal cord injury (SCI). However, new technologies such as functional electrical stimulation cycles with internet connectivity may provide incentive by removing some of the limitations and external barriers.Objective
To determine the effectiveness of a long-term home-based functional electrical stimulation lower extremities cycling (FES-LEC) program on exercise adherence, body composition, energy expenditure, and quality of life (QOL) in an adult with chronic tetraplegia.Participant
A 53-year-old man, 33 years post-motor complete C4 SCI participated in FES-LEC in his home, three sessions per week for 24 weeks.Methods
Exercise adherence was calculated as the percentage of performed cycling sessions relative to the recommended number of cycling sessions. Body composition was measured by dual-energy X-ray absorptiometry. Energy expenditure was measured using a COSMED K4b2 and QOL via the World Health Organization Quality of Life (WHO-QOL) Brief Questionnaire. Testing was performed before and after the 24-week exercise program.Results
The participant cycled 59 out of a recommended 72 sessions which is an exercise adherence rate of 82%. Body composition displayed increases in total body lean mass (LM) with an increase of 3.3% and an increase in leg LM of 7.1%. Energy expenditure increased by 1.26 kcal/minute or greater than 200%. The physical and psychological domain scores of QOL increased by 25 and 4.5%, respectively.Conclusion
This case study provides encouragement concerning the practicality of a home-based FES-LEC program for those with SCI. 相似文献11.
Kevin N. Alschuler Mark P. Jensen Sarah J. Sullivan-Singh Soo Borson Amanda E. Smith Ivan R. Molton 《The journal of spinal cord medicine》2013,36(5):483-491
Context/objective
To describe the relationship of pain and fatigue with physical and psychological functioning in adults with spinal cord injury (SCI).Design
Cross-sectional survey.Setting
Community-based survey.Participants
Convenience sample of individuals with SCI.Intervention
Not applicable.Outcome measures
Physical functioning (Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Functioning item bank items), depression (Patient Health Questionnaire-9 (PHQ-9)), pain severity (0–10 Numerical Rating Scale (NRS)), and fatigue (0–10 NRS).Results
Pain and fatigue were independently associated with depression, but only pain was associated with physical functioning. Additionally, depression was more severe among middle-aged participants relative to younger or older participants. Physical functioning declined with increasing age, as well as with higher level of injury.Conclusions
The findings support the need for continued development of effective treatments for both pain and fatigue in order to prevent and mitigate the negative effects these symptoms can have on functioning. 相似文献12.
13.
Karen M. Smith Danielle N. Naumann Laura McDiarmid Antony Mary Ann McColl Alice Aiken 《The journal of spinal cord medicine》2014,37(5):582-588
Context/Objective
Actionable Nuggets™ for spinal cord injury (SCI) are a knowledge translation tool facilitating evidence-based primary care practice, originally developed in 2010 and refined in 2013. Evaluation results from these two phases of development have informed the design of SkillScribe™, an innovative electronic platform intended to offer reflective continuing medical education (CME) programming through mobile devices in order to support the key features of the Actionable Nuggets™ approach. This brief article describes the ongoing development of Actionable Nuggets™ for SCI on SkillScribe™ by: (1) summarizing the work to date on Actionable Nuggets™; (2) describing evaluation results of Actionable Nuggets™; (3) placing SkillScribe™ in the context of adult education.Design
Developmental Research Design.Setting
Canadian primary care.Participants
Primary care physicians; specialist physicians.Interventions
Twenty educational modules on SCI.Outcome measures
Pre- and post-test knowledge survey, feedback and use statistics, impact assessment survey, qualitative analysis of evaluation data.Results
In both hard copy and electronic form, physicians report that Actionable Nuggets™ are an acceptable and useful approach to providing CME for low-prevalence, high-impact conditions like SCI. The key elements of this tool are that they: offer evidence-based information in small, focused “nuggets”; position information where physicians most frequently seek it; offer information in a format that permits direct translation into action in primary care; allow time for reflection; attach practice tools; and offer CME credit.Conclusion
Actionable Nuggets™ for SCI, delivered using a convenient and portable electronic medium, with time-released content and interactive testing has the potential to improve the primary care of patients with SCI. 相似文献14.
Drew B. Fineberg Pierre Asselin Noam Y. Harel Irina Agranova-Breyter Stephen D. Kornfeld William A. Bauman Ann M. Spungen 《The journal of spinal cord medicine》2013,36(4):313-321
Objective
To use vertical ground reaction force (vGRF) to show the magnitude and pattern of mechanical loading in persons with spinal cord injury (SCI) during powered exoskeleton-assisted walking.Research design
A cross-sectional study was performed to analyze vGRF during powered exoskeleton-assisted walking (ReWalk™: Argo Medical Technologies, Inc, Marlborough, MA, USA) compared with vGRF of able-bodied gait.Setting
Veterans Affairs Medical Center.Participants
Six persons with thoracic motor-complete SCI (T1–T11 AIS A/B) and three age-, height-, weight- and gender-matched able-bodied volunteers participated.Interventions
SCI participants were trained to ambulate over ground using a ReWalk™. vGRF was recorded using the F-Scan™ system (TekScan, Boston, MA, USA).Outcome measures
Peak stance average (PSA) was computed from vGRF and normalized across all participants by percent body weight. Peak vGRF was determined for heel strike, mid-stance, and toe-off. Relative linear impulse and harmonic analysis provided quantitative support for analysis of powered exoskeletal gait.Results
Participants with motor-complete SCI, ambulating independently with a ReWalk™, demonstrated mechanical loading magnitudes and patterns similar to able-bodied gait. Harmonic analysis of PSA profile by Fourier transform contrasted frequency of stance phase gait components between able-bodied and powered exoskeleton-assisted walking.Conclusion
Powered exoskeleton-assisted walking in persons with motor-complete SCI generated vGRF similar in magnitude and pattern to that of able-bodied walking. This suggests the potential for powered exoskeleton-assisted walking to provide a mechanism for mechanical loading to the lower extremities. vGRF profile can be used to examine both magnitude of loading and gait mechanics of powered exoskeleton-assisted walking among participants of different weight, gait speed, and level of assist. 相似文献15.
Flora M. Hammond Julie Gassaway Nichola Abeyta Erma S. Freeman Donna Primack Scott E. D. Kreider Gale Whiteneck 《The journal of spinal cord medicine》2012,35(6):611-623
Objective
To investigate associations of social work/case management (SW/CM) services during inpatient rehabilitation following spinal cord injury (SCI) and patient characteristics with outcomes.Design
Prospective observational cohort of individuals with SCI receiving inpatient rehabilitation.Setting
Six inpatient rehabilitation centers.Participants
1032 individuals with traumatic SCI.Interventions
Not applicable.Main outcome measure(s)
Type of residence at the time of rehabilitation discharge. Employment/school status, presence of a pressure ulcer, Patient History Questionnaire, Satisfaction with Life Scale, Craig Handicap Assessment and Reporting Technique (CHART) subscales, and rehospitalization at 1-year post-injury.Results
The intensity of specific SW/CM services is associated with multiple outcomes examined. More sessions dedicated to discharge planning for a home discharge and financial planning were associated positively with more discharge to home, while more sessions focused on planning for discharge to a location other than home, e.g. nursing home or long-term acute care facilities, have negative associations with societal participation outcomes (CHART Social Integration, Occupation, and Mobility scores) as well as with residing at home at the time of the 1-year injury anniversary.Conclusion(s)
The intensity and type of SW/CM services are associated with outcomes at rehabilitation discharge and at 1-year post-injury. Discharge to home may require assistance from SW/CM in the area of discharge planning and financial planning, while discharge to non-home residence demands directed SW/CM services for such placement.Note
This is the eighth of nine articles of this SCIRehab series. 相似文献16.
Avraam Ploumis Jayne M. Donovan Mobolaji O. Olurinde Dana M. Clark Jason C. Wu Douglas J. Sohn Kevin C. O'Connor 《The journal of spinal cord medicine》2015,38(2):193-198
Context/objective
Only sparse evidence exists regarding the effectiveness of oral alendronate (ALN) in the prevention of heterotopic ossification (HO) in patients with spinal cord injury (SCI). The objective of this study is to investigate the protective effect of oral ALN intake on the appearance of HO in patients with SCI.Study design
Retrospective database review.Setting
A Spinal Cord Unit at a Rehabilitation Hospital.Participants
Two hundred and ninety-nine patients with SCI during acute inpatient rehabilitation.Interventions
Administration of oral ALN.Outcome measures
The incidence of HO during rehabilitation was compared between patients with SCI receiving oral ALN (n = 125) and patients with SCI not receiving oral ALN (n = 174). The association between HO and/or ALN intake with HO risk factors and biochemical markers of bone metabolism were also explored.Results
HO developed in 19 male patients (6.35%), however there was no significant difference in the incidence of HO in patients receiving oral ALN or not. The mean odds ratio of not developing versus developing HO given ALN exposure was 0.8. Significant correlation was found between abnormal serum alkaline phosphatase (ALP) levels and HO appearance (P < 0.001) as well as normal serum ALP and ALN intake (P < 0.05).Conclusion
Even though there was no direct prevention of HO in patients with SCI by oral ALN intake, abnormal serum ALP was found more frequently in patients with HO development and without oral ALN intake. This evidence could suggest that ALN may play a role in preventing HO, especially in patients with acute SCI with increasing levels of serum ALP. 相似文献17.
18.
Mahmoud Joghtaei Amir Massoud Arab Hamed Hashemi-Nasl Mohammad Taghi Joghataei Mohammad Osman Tokhi 《The journal of spinal cord medicine》2015,38(2):170-177
Objective
Stiffness and viscosity represent passive resistances to joint motion related with the structural properties of the joint tissue and of the musculotendinous complex. Both parameters can be affected in patients with spinal cord injury (SCI). The purpose of this study was to measure passive knee stiffness and viscosity in patients with SCI with paraplegia and healthy subjects using Wartenberg pendulum test.Design
Non-experimental, cross-sectional, case–control design.Setting
An outpatient physical therapy clinic, University of social welfare and Rehabilitation Science, Iran.Patients
A sample of convenience sample of 30 subjects participated in the study. Subjects were categorized into two groups: individuals with paraplegic SCI (n = 15, age: 34.60 ± 9.18 years) and 15 able-bodied individuals as control group (n = 15, age: 30.66 ± 11.13 years).Interventions
Not applicable.Main measures
Passive pendulum test of Wartenberg was used to measure passive viscous-elastic parameters of the knee (stiffness, viscosity) in all subjects.Results
Statistical analysis (independent t-test) revealed significant difference in the joint stiffness between healthy subjects and those with paraplegic SCI (P = 0.01). However, no significant difference was found in the viscosity between two groups (P = 0.17). Except for first peak flexion angle, all other displacement kinematic parameters exhibited no statistically significant difference between normal subjects and subjects with SCI.Conclusions
Patients with SCI have significantly greater joint stiffness compared to able-bodied subjects. 相似文献19.
20.
Huston T Gassaway J Wilson C Gordon S Koval J Schwebel A 《The journal of spinal cord medicine》2011,34(2):196-204