Satisfaction with sexual life among persons with traumatic spinal cord injury and meningomyelocele

Purpose. To study satisfaction with sexual life and self-assessed sufficiency of sexual counselling in persons with traumatic spinal cord injury (SCI) and meningomyelocele (MMC).

Method. A postal questionnaire on aspects of health and functioning was answered by 190 persons with traumatic SCI who had been treated in the Spinal Injuries Unit in Sahlgrenska University Hospital, Göteborg, Sweden and 41 persons with MMC who were admitted to the Young Adult Teams in Göteborg, Borås and Skövde, Sweden.

Results. On a numerical scale from 0 (dissatisfied) to 10 (satisfied) the median of satisfaction with sexual life was 3 for the men and 4 for the women among the persons with traumatic SCI. In the MMC group the median of satisfaction with sexual life was 5 for the men and 8 for the women. Sexual dissatisfaction increased with increasing age in both groups. Inconvenience caused by urinary and faecal incontinence, as well as neuropathic pain increased sexual dissatisfaction in the men with traumatic SCI. A total of 69% of the men with traumatic SCI and 56 – 59% of the participants in other subgroups reported that the sexual counselling they had received was sufficient.

Conclusions. The results corroborate findings from earlier studies that satisfaction with sexual life is rather low among persons with SCI. Especially ageing men with traumatic SCI who have sustained injury at an older age are a challenge for rehabilitation. The high satisfaction with sexual life in the women in comparison with the men with MMC is a finding not reported earlier. Our results suggest that adequate treatment of incontinence and pain might improve even sexual satisfaction. Sexual counselling should be given to all individuals with SCI and to their partners. Sexual counselling for young adults with MMC is an important part of the rehabilitation process.     

Satisfaction with sexual life among persons with traumatic spinal cord injury and meningomyelocele

PURPOSE: To study satisfaction with sexual life and self-assessed sufficiency of sexual counselling in persons with traumatic spinal cord injury (SCI) and meningomyelocele (MMC). METHOD: A postal questionnaire on aspects of health and functioning was answered by 190 persons with traumatic SCI who had been treated in the Spinal Injuries Unit in Sahlgrenska University Hospital, G?teborg, Sweden and 41 persons with MMC who were admitted to the Young Adult Teams in G?teborg, Bor?s and Sk?vde, Sweden. RESULTS: On a numerical scale from 0 (dissatisfied) to 10 (satisfied) the median of satisfaction with sexual life was 3 for the men and 4 for the women among the persons with traumatic SCI. In the MMC group the median of satisfaction with sexual life was 5 for the men and 8 for the women. Sexual dissatisfaction increased with increasing age in both groups. Inconvenience caused by urinary and faecal incontinence, as well as neuropathic pain increased sexual dissatisfaction in the men with traumatic SCI. A total of 69% of the men with traumatic SCI and 56-59% of the participants in other subgroups reported that the sexual counselling they had received was sufficient. CONCLUSIONS: The results corroborate findings from earlier studies that satisfaction with sexual life is rather low among persons with SCI. Especially ageing men with traumatic SCI who have sustained injury at an older age are a challenge for rehabilitation. The high satisfaction with sexual life in the women in comparison with the men with MMC is a finding not reported earlier. Our results suggest that adequate treatment of incontinence and pain might improve even sexual satisfaction. Sexual counselling should be given to all individuals with SCI and to their partners. Sexual counselling for young adults with MMC is an important part of the rehabilitation process.     

Self-concept among persons with long-term spinal cord injury

Seventy-one persons with spinal cord injury who had been injured at least four years before, completed the Tennessee Self-Concept Scale and a questionnaire examining demographic factors and activity levels. Compared to scale norms, respondents had significantly higher Personal Self, Moral-Ethical Self, and Social Self scores and significantly lower Physical Self scores. Perceived independence, provision of one's own transportation, assistance needed, and living arrangements were significantly related to self-concept. Findings were discussed in relationship to past and future research and practice in rehabilitation of individuals with spinal cord injury.     

Perceptions of participation and predictors of perceived problems with participation in persons with spinal cord injury.

OBJECTIVE: To describe how persons with spinal cord injury perceived their participation in life situations and to determine the relationship between their participation and perceived problems therewith. The purpose was also to evaluate the influence of age, sex, level of injury, time since injury, marital status and access to social support on perceived problems with participation. DESIGN: Cross-sectional. SUBJECTS: One hundred sixty-one persons with spinal cord injury. METHODS: A postal questionnaire including socio-demographic characteristics and a Swedish version of the Impact on Participation and Autonomy questionnaire. RESULTS: A majority of the respondents perceived their participation as sufficient in most activities addressed. Still, a majority of the respondents perceived one or more severe problems with their participation. Access to social support was the most influencing variable in predicting perceived severe problems with participation as compared with certain personal and health-related factors. CONCLUSION: The results suggest that it is important to consider access to social support along with other factors in the person-environment interaction and their influence on severe problems with participation in enhancing clients' participation in rehabilitation.     

Correlates of life satisfaction among persons with spinal cord injury.

OBJECTIVE: To analyze the correlates of life satisfaction for individuals with spinal cord injury (SCI). STUDY DESIGN: Survey; follow-up of subjects studied prospectively since onset of injury. PARTICIPANTS: A total of 2,183 persons with SCI, from 1 to 20 years postinjury, self-selected for annual research (and clinical) follow-up by one of 18 model systems of SCI care. RESULTS: Life satisfaction, as measured with the Satisfaction With Life Scale (SWLS), is associated with several demographic, social, functional, and clinical characteristics. Stepwise linear regression analysis resulted in a predictor model that included the following: sex (beta weight: .07; p < .001); number of rehospitalizations in the last year (-.05; p < .05); years since injury (.13; p < .0001); sociocognitive disability as measured with the Functional Independence Measure (.06; p < .01); and three handicap components, as measured with the modified Craig Handicap Assessment and Reporting Technique: mobility (.26; p < .0001); occupation (.10; p < .001); and social integration (.11; p < .0001). Impairment (level of injury) contributed indirectly, through its impact on motor disability. Racial/ethnic group membership, motor disability, and education contributed indirectly, through their effects on handicap. CONCLUSIONS: Life satisfaction after SCI can be reliably measured by means of the SWLS. Correlates of subjective well-being parallel those suggested by earlier studies and those for the population at large. The effects of life satisfaction on social participation, health, and other aspects of life need further study.     

Computer and internet use by persons after traumatic spinal cord injury

Goodman N, Jette AM, Houlihan B, Williams S. Computer and internet use by persons after traumatic spinal cord injury.

Objective

To determine whether computer and internet use by persons post spinal cord injury (SCI) is sufficiently prevalent and broad-based to consider using this technology as a long-term treatment modality for patients who have sustained SCI.

Design

A multicenter cohort study.

Setting

Twenty-six past and current U.S. regional Model Spinal Cord Injury Systems.

Participants

Patients with traumatic SCI (N=2926) with follow-up interviews between 2004 and 2006, conducted at 1 or 5 years postinjury.

Interventions

Not applicable.

Results

Results revealed that 69.2% of participants with SCI used a computer; 94.2% of computer users accessed the internet. Among computer users, 19.1% used assistive devices for computer access. Of the internet users, 68.6% went online 5 to 7 days a week. The most frequent use for internet was e-mail (90.5%) and shopping sites (65.8%), followed by health sites (61.1%). We found no statistically significant difference in computer use by sex or level of neurologic injury, and no difference in internet use by level of neurologic injury. Computer and internet access differed significantly by age, with use decreasing as age group increased. The highest computer and internet access rates were seen among participants injured before the age of 18. Computer and internet use varied by race: 76% of white compared with 46% of black subjects were computer users (P<.001), and 95.3% of white respondents who used computers used the internet, compared with 87.6% of black respondents (P<.001). Internet use increased with education level (P<.001): eighty-six percent of participants who did not graduate from high school or receive a degree used the internet, while over 97% of those with a college or associate's degree did.

Conclusions

While the internet holds considerable potential as a long-term treatment modality after SCI, limited access to the internet by those who are black, those injured after age 18, and those with less education does reduce its usefulness in the short term for these subgroups.     

A study of spirituality and life satisfaction among persons with spinal cord injury.

The purpose of this study was to investigate the relationship of spirituality and life satisfaction among persons with spinal cord injury. A nationwide sample of 230 persons with long-term spinal cord injury completed the Satisfaction With Life Scale (SWLS), the Quality of Life Index (QLI), and a demographic data form. Data analysis also indicated that there was a significant positive correlation between life satisfaction and psychological/spiritual factors of the QLI instrument. Nurses are mandated by the International Council of Nurses, the Joint Commission on Accreditation of Healthcare Organizations, and the Patient's Bill of Rights (Maddox, 2001) to provide spiritual care for clients. Rehabilitation nurses have the opportunity to support spirituality and life satisfaction as we assist our clients with disabilities to redefine their lives and explore new life opportunities.     

Use of the SF-36 among persons with spinal cord injury

The purpose of this study was to explore the applicability of the SF-36 for assessing health-related quality of life among persons with spinal cord injuries. A sample of 215 persons who had experienced new, traumatic spinal cord injury and who had been discharged from their initial hospitalizations for at least 1 yr were included in the study. Correlations between the SF-36's physical and mental component scores appraised and the relationship of each component to level of neurologic impairment was assessed. As expected, the two components measured separate and distinct constructs; only physical component scores were associated with impairment severity.     

A validity study of the WHOQOL-BREF assessment in persons with traumatic spinal cord injury

OBJECTIVE: To examine the distribution of the scores, internal consistency, structure, and discriminant validity of the abbreviated version of the World Health Organization Quality of Life (WHOQOL-BREF) assessment in persons with traumatic spinal cord injury (SCI). DESIGN: Validation study using multitrait analysis and known-groups methods. SETTING: Community and hospital. PARTICIPANTS: Persons with SCI (N=111) and non-SCI respondents (N=169). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: The WHOQOL-BREF assessment. RESULTS: The frequency distribution of the 4 domains of the WHOQOL-BREF assessment was nearly symmetric and showed no floor or ceiling effects. All domains showed good internal consistency (Cronbach alpha range, .74-.78), with the exception of the social relationships domain (alpha=.54). The 4-domain structure of the WHOQOL-BREF assessment was confirmed using multitrait analysis. The discriminant validity of the WHOQOL-BREF assessment in persons with SCI was satisfactory. CONCLUSIONS: The WHOQOL-BREF assessment is suitable for measuring QOL as perceived by a person with SCI.     

Measuring fatigue in persons with spinal cord injury

Anton HA, Miller WC, Townson AF. Measuring fatigue in persons with spinal cord injury.

Objective

To evaluate the psychometric properties of the Fatigue Severity Scale (FSS) in persons with spinal cord injury (SCI).

Design

A 2-week methodologic study was conducted to assess the internal consistency, reliability, and construct validity of the FSS.

Setting

A tertiary spinal cord rehabilitation facility.

Participants

Forty-eight community-living subjects at least 1 year post-SCI with American Spinal Injury Association (ASIA) grade A or B SCI and no medical conditions causing fatigue. The sample was predominantly male (n=31 [65%]) with tetraplegia (n=26 [54%]) and ASIA grade A injuries (n=30 [63%]). The average duration since injury was 14.9 years.

Interventions

Not applicable.

Main Outcome Measures

The ASIA Impairment Scale, the FSS, a visual analog scale for fatigue (VAS-F), the vitality scale of the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), and the Center for Epidemiologic Studies Depression Scale (CES-D).

Results

Mean FSS score ± standard deviation at baseline was 4.4±1.4, with 54% (n=26) scoring greater than 4. The internal consistency of the FSS was excellent (Cronbach α=.89). Two-week test-retest reliability was adequate (intraclass correlation coefficient, .84; 95% confidence interval, .74-.90). The magnitude of the relationship was as hypothesized for the VAS-F (r=.67) and CES-D (r=.58) and lower than hypothesized for the vitality subscore (r=−.48) of the SF-36.

Conclusions

The FSS has acceptable reliability with regard to internal consistency, test-retest reliability, and validity in persons with motor complete SCI.     

Symptom burden in persons with spinal cord injury

OBJECTIVE: To determine (1) the frequency, severity, and reported course of 7 symptoms in persons with spinal cord injury (SCI) and (2) the association between these symptoms and patient functioning. DESIGN: Postal survey. SETTING: Community. INTERVENTION: A survey that included measures of the frequency, severity, and recalled course of pain, fatigue, numbness, weakness, shortness of breath, vision loss, and memory loss, as well as a measure of community integration and psychologic functioning was mailed to a sample of persons with SCI. One hundred forty-seven usable surveys were returned (response rate, 43% of surveys mailed). MAIN OUTCOME MEASURES: The frequency and average severity of each symptom was computed, and the frequencies of each type of reported course were noted. Analyses estimated the associations among the symptoms, and between symptom severity and measures of patient functioning. RESULTS: The most common symptoms were pain, weakness, fatigue, and numbness. All symptoms were reported to remain the same or to get worse more often than they were reported to improve once they began. Pain, weakness, fatigue, and memory loss were the symptoms most closely associated with patient functioning. CONCLUSIONS: Patients with SCI must deal with a number of secondary complications in addition to any disability caused by the injury itself. Of 7 symptoms studied, pain, weakness, and fatigue appeared to be most common and most closely linked to patient social and mental health functioning. Research is needed to identify the causal relationships between perceived symptoms and quality of life in patients with SCI and to identify effective treatments for those symptoms shown to impact patient functioning.     

A typology of alcohol use patterns among persons with recent traumatic brain injury or spinal cord injury: implications for treatment matching

OBJECTIVE: To describe empirically valid and clinically meaningful types of alcohol use among persons with recent traumatic brain or spinal cord injury. DESIGN: Cross-sectional cohort survey. SETTING: Acute inpatient rehabilitation program in a level I trauma center. PARTICIPANTS: A total of 218 (87%) of 250 consecutive initial admissions who met inclusion criteria and completed interviews. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Alcohol and drug use questionnaires, alcohol problem questions, admission toxicology results, readiness to change, and treatment preference questions. RESULTS: Participants were on average 37 years old, 84% were men, and 82% were white. Four types were identified by using k-means cluster analysis based on preinjury alcohol consumption, alcohol problems, and alcohol dependence. Cluster groups differed on extrinsic variables such as drug use, readiness to change, and interest in treatment or in attending Alcoholics Anonymous. The 4 types corresponded to those with a history of (1) alcohol abuse; (2) alcohol dependence; (3) alcohol dependence in remission, partial remission, or relapsed; and (4) normal or nondrinkers. CONCLUSION: More effective care may be possible if clinicians match common patient types to specific interventions such as education, motivational interventions, formal substance abuse treatment, and relapse prevention.     

Recent trends in mortality and causes of death among persons with spinal cord injury

OBJECTIVE: To identify and quantify trends in mortality and causes of death among persons with spinal cord injury. DESIGN: Cohort study. SETTING: Model spinal cord injury care systems and Shriner's Hospitals spinal cord injury units throughout the United States. PATIENTS: A total of 28,239 consecutive persons admitted to the model system or to a Shriner's Hospital within 1 year of injury. MAIN OUTCOME MEASURE: Length of survival and cause of death. RESULTS: Among persons who were admitted to the model system within 1 day of injury, the odds of dying during the first postinjury year were reduced by 67% for persons injured between 1993 and 1998 relative to persons injured between 1973 and 1977 after adjusting for trends in age, gender, race, neurologic level of injury, Frankel grade, ventilator status, etiology of injury, sponsor of care, and model system where treatment occurred. However, mortality rates after the first anniversary of injury, which had also been declining from 1973 to 1992, increased 33% for persons injured between 1993 and 1998 relative to persons injured between 1988 and 1992. Respiratory disease was the only cause of death after the first anniversary of injury for which the relative odds increased meaningfully during the latest time period (76% increase over 1988-1992 compared to all other causes). CONCLUSION: While great improvements in life expectancy have been achieved since the Model SCI Systems program began, current data support the need for renewed efforts to improve the prevention and treatment of the complications of spinal cord injury.     

Effect of co-morbid traumatic brain injury on functional outcome of persons with spinal cord injuries

OBJECTIVE: This study was undertaken to determine if persons who sustain a spinal cord injury (SCI) and co-morbid brain injury (dual diagnosis [DDS]) evidence smaller functional gains and experience significantly longer rehabilitation lengths of stay than persons with only an SCI. DESIGN: This retrospective comparison study was performed at a 100-bed rehabilitation hospital specializing in acute SCI and traumatic brain injury rehabilitation. Summary scale outcome data of persons who sustained an SCI were compared with outcome data of a group of persons with a DDS. Comparisons were established by matching groups principally on level of SCI and admission Motor FIM trade mark score and secondarily on education, sex, and age. Outcome measures included admission Motor and Cognitive FIM score, discharge Motor and Cognitive FIM score, Motor and Cognitive FIM change, length of stay, and rehabilitation charges. RESULTS: Persons with a DDS evidenced a significantly more impaired Cognitive FIM score at admission and discharge from rehabilitation. Persons with a DDS also achieved a significantly lower Motor FIM change than persons with SCI. There were no significant differences between DDS and SCI groups regarding Cognitive FIM change, length of stay, or rehabilitation charges. Injury severity as defined by the Glasgow Coma Scale or intracranial lesions did not predict response to treatment in the DDS group. CONCLUSION: Persons with a DDS achieved smaller functional gains during rehabilitation than peers with SCI. Brain injuries seem to limit functional gains, although the relationship between brain injury severity and functional change is not linear. Prospective studies are needed to identify factors limiting functional gains in rehabilitation and assist in developing specific treatment programs for persons with SCI and brain injury.     

Anemia after traumatic spinal cord injury

The incidence and natural history of anemia in patients with spinal cord injuries (SCI) were investigated in a prospective study of 68 patients consecutively admitted to a regional acute SCI unit. Fifty had SCI and 18 had spine injuries (SI) without neurologic deficit. Thirty-six of 41 males (88%) and six of nine females (67%) with SCI were anemic on at least one occasion. In the first two weeks after injury, in females and in males, there was no significant difference in mean hemoglobin level between SI and SCI patients. At six weeks, no male with SI was anemic, and males with SCI had significantly lower mean hemoglobin levels than those with SI (121.6 g/L vs 145.4 g/L, p less than .001). Identified early causes of anemia were blood loss due to bony soft tissue or visceral injury, gastrointestinal bleeding, and surgery. In the postacute phase (more than six weeks after injury), anemia occurred in 25 of 41 male and three of nine female SCI patients, and its occurrence was associated with the presence of an identified chronic disease, especially urinary tract infection.