Cannabis Use in Individuals With Spinal Cord Injury or Moderate to Severe Traumatic Brain Injury in Colorado

Objectives

To describe the prevalence of cannabis use in an adult sample with spinal cord injury (SCI) or traumatic brain injury (TBI) in Colorado, and to describe the self-reported reasons and side effects of cannabis use in this sample.

Association of Internet Use and Depression Among the Spinal Cord Injury Population

Objective

To examine the relation between the frequency of Internet use and depression among people with spinal cord injury (SCI).

Design

Cross-sectional survey.

Setting

SCI Model Systems.

Participants

People with SCI (N=4618) who were interviewed between 2004 and 2010.

Interventions

Not applicable.

Main Outcome Measures

The frequency of Internet use and the severity of depressive symptoms were measured simultaneously by interview. Internet use was reported as daily, weekly, monthly, or none. The depressive symptoms were measured by the Patient Health Questionnaire-9 (PHQ-9), with 2 published criteria being used to screen for depressive disorder. The diagnostic method places more weight on nonsomatic items (ie, items 1, 2, and 9), and the cut-off method that determines depression by a (PHQ-9) score ≥10 places more weight on somatic factors. The average scores of somatic and nonsomatic items represented the severity of somatic and nonsomatic symptoms, respectively.

Results

Our multivariate logistic regression model indicated that daily Internet users were less likely to have depressive symptoms (odds ratio=.77; 95% confidence interval, .64–.93), if the diagnostic method was used. The linear multivariate regression analysis indicated that daily and weekly Internet usage were associated with fewer nonsomatic symptoms; no significant association was observed between daily or weekly Internet usage and somatic symptoms.

Conclusions

People with SCI who used the Internet daily were less likely to have depressive symptoms.     

Sensitivity of the SCI-FI/AT in Individuals With Traumatic Spinal Cord Injury

Objective

To examine the ability of the Spinal Cord Injury-Functional Index/Assistive Technology (SCI-FI/AT) measure to detect change in persons with spinal cord injury (SCI).

Factors Influencing Incidence of Wheelchair Repairs and Consequences Among Individuals with Spinal Cord Injury

ObjectiveTo investigate the frequency and consequences of wheelchair repairs, looking at the relationship to usage, components, out-of-pocket costs, number of days affecting the user, and factors associated with the need for repairs or consequences.DesignSurvey, cross-sectional.SettingNine spinal cord injury (SCI) Model Systems centers.ParticipantsWheelchair users with SCI (N=533).InterventionsNot applicable.Main Outcome MeasuresCost and incidence of wheelchair repairs and consequences and wheelchair usage within the past 6 months.ResultsA total of 310 participants (56%) reported repairs, 127 (42%) of whom experienced at least 1 adverse consequence lasting a median of 5 days (interquartile range [IQR], 2-17.3 days). Repair rates were highest for the seating system, electronics, and tires. Participants were most often stranded at home or forced to use a backup chair. Median out-of-pocket costs were $150 (IQR, $50-$620). Active users, based on type of mobility and terrain, experienced more repairs and consequences than less active users. Repairs were more common among those who were Black (odds ratio [OR], 2.42) or power wheelchair (PWC) users (OR, 1.84), whereas consequences were more common among those who were Black (OR, 2.27), PWC (OR, 2.08) or power assist users (OR, 2.76), and those who had public insurance (OR, 1.70).ConclusionsWheelchair repairs continue to affect more than 50% of wheelchair users with significant financial and personal cost. High repair rates limited participation inside and outside of the home. Consequences lasted longer than 2 weeks for many and may be minimized by a working backup chair. Disparities exist based on participant and wheelchair factors; repairs and adverse consequences appear to hit those most vulnerable with the least financial resources. Costs may be a barrier to repair completion for some individuals. This ongoing problem of high repair rates and their associated effects requires action such as higher standards, access to quicker service, and better training of users on wheelchair maintenance and repair.     

Symptoms of Depression Over Time in Adults With Pediatric-Onset Spinal Cord Injury

Objective

To investigate the prevalence of depressive symptoms in adults with pediatric-onset spinal cord injury (SCI) and explore potential risk factors that may be associated with elevated symptoms.

Design

Longitudinal, cohort survey over a period of 2 to 9 years. Follow-up occurred approximately every year, a total of 868 interviews were conducted, and most participants contributed to at least 3 waves of data (72%; range, 2–8; mean, 4.34±2.16).

Setting

Community.

Participants

Adults (N=214; 133 men; mean age at first interview, 29.52±5.21y; range, 24–42y) who sustained an SCI prior to age 19 (mean age at injury, 13.93±4.37y; range, 0–18y). Participants tended to have complete injuries (71%) and tetraplegia (58%).

Interventions

Not applicable.

Main Outcome Measures

Participants completed measures assessing psychosocial functioning, physical independence, participation, and depression at each time point. Multilevel growth modeling analyses were used to explore depression symptoms across time.

Results

Depression symptoms at initial status were typically minimal (3.07±.24; 95% confidence interval, 2.6–3.54) but fluctuated significantly over time (P<.01). Several factors emerged as significant predictors of depressive symptoms in the final model, including less community participation (P<.01), incomplete injury (P=.02), hazardous drinking (P=.02), bladder incontinence (P=.01), and pain (P=.03). Within individuals, as bowel accidents (P<.01) and pain increased (P<.01), depression scores increased; however, marriage resulted in decreases in depression scores for individuals (P=.02).

Conclusions

These findings suggest that most patients with pediatric-onset SCI are psychologically resilient, but strategies to minimize secondary health complications and foster community participation and engagement should be considered.     

Preventative Services Use and Risk Reduction for Potentially Preventative Hospitalizations Among People With Traumatic Spinal Cord Injury

ObjectiveTo examine the risk of potentially preventable hospitalizations (PPHs) for adults (18 years or older) with traumatic spinal cord injury (TSCI) to identify the most common types of preventable hospitalizations and their associative risk factors.DesignCohort study.SettingUsing 2007-2017 U.S. claims data from the Optum Clinformatics Data Mart, we identified adults (18 years or older) with diagnosis of TSCI (n=5380). Adults without TSCI diagnosis were included as controls (n=1,074,729). Using age and sex, we matched individuals with and without TSCI (n=5173) with propensity scores to address potential selection bias. Generalized linear regression was applied to examine the risk of TSCI on PPHs. Models were adjusted for age; sex; race and ethnicity; Elixhauser comorbidity count; any cardiometabolic, psychological, and musculoskeletal chronic conditions; U.S. Census Division; socioeconomic variables; and use of certain preventative care services. Adjusted odds ratios were compared within a 4-year follow-up period.ParticipantsAdults with and without TSCI (N=5,173).InterventionNot applicable.Main Outcomes MeasuresAny PPH and specific PPHsResultsAdults with TSCI had higher risk for any PPH (odds ratio [OR], 1.67; 95% CI,1.20-2.32), as well as PPHs because of urinary tract infection (UTI) (OR, 3.78; 95% CI, 2.47-5.79), hypertension (OR, 3.77; 95% CI, 1.54-9.21), diabetes long-term complications (OR, 2.54; 95% CI, 1.34-4.80), and pneumonia (OR, 1.71; 95% CI. 1.21-2.41). Annual wellness visit was associated with reduced PPH risk compared with cases and controls without annual wellness visit (OR, 0.57; 95% CI, 0.46-0.71) and among people with TSCI (OR, 0.69; 95% CI, 0.55-0.86) compared with cases without annual wellness visit.ConclusionsAdults with TSCI are at a heightened risk for PPH. They are also more susceptible to certain PPHs such as UTIs, pneumonia, and heart failure. Encouraging the use of preventative or health-promoting services, especially for respiratory and urinary outcomes, may reduce PPHs among adults with TSCI.     

Longitudinal Changes in Physical Capacity Over 20 Years in Athletes With Spinal Cord Injury

Shiba S, Okawa H, Uenishi H, Koike Y, Yamauchi K, Asayama K, Nakamura T, Tajima F. Longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury.

Objective

To investigate the longitudinal changes in physical capacity over 20 years in athletes with spinal cord injury (SCI).

Design

Longitudinal study (20-y follow-up).

Setting

Laboratory setting.

Participants

Persons with SCI (N=7).

Interventions

Not applicable.

Main Outcome Measures

Maximum oxygen consumption V?o₂max) measured in 1986-1988 and in 2006.

Results

Subjects with SCI maintained stable V?o₂max in 2006. Six of the 7 continued various wheelchair sports activities, while 1 person quit sports activities 1 year after the baseline study. The latter person showed reduced V?o₂max by 53%, while 2 persons who continued strenuous wheelchair sports activities showed increased V?o₂max by 43% and 45% after 20 years.

Conclusion

The results indicated that physical capacity reflected the level of sports activity in subjects with SCI who maintained sports activities.     

外伤性与非外伤性脊髓损伤发病及康复特点

目的比较外伤性与非外伤性脊髓损伤的发病及康复特点。方法对226例脊髓损伤患者进行回顾性分析。结果外伤性脊髓损伤占73.4%,平均年龄(33.96±12.18)岁,低于非外伤性脊髓损伤(43.98±11.4)岁;完全性损伤占65.4%,高于非外伤性38.7%;住院时间(189.74±157.88)d,长于非外伤性损伤(142.53±85.72)d;住院费用(55270.39±47967.59)元,高于非外伤性(40838.94±34786.85)元;出院日常生活能力评分(54.25±24.16),低于非外伤性损伤(74.88±25.61)。结论外伤性脊髓损伤在本院收治的脊髓损伤患者中占多数,与非外伤性相比,年龄偏低,住院时间长,费用偏高,出院日常生活能力评分偏低。     

Functional Changes in Persons Aging with Spinal Cord Injury

Declines in general physical function and the effect of these changes on activities of daily living and needs for assistance were assessed in 150 individuals with spinal cord injury (SCI). The sample consisted of outpatients returning for follow-up at the spinal cord injury clinic at Rancho Los Amigos National Rehabilitation Center in Downey, CA. The average duration of injury of the sample was 13 years (range 1–37), and average age was 38 years (range 18–64). Twenty-four percent of those sampled experienced a decline or change in their physical function within the last 5 years. Individuals experiencing declines were significantly older than those without changes, averaging 45 years versus 36 years. The group with change also had a longer duration of injury, averaging 18 years versus 11 years compared to the group reporting no declines. Fatigue was the most frequently reported problem, followed by pain and weakness. Over half of the group with changes required additional assistance with activities of daily living (ADLs). Family members were the primary helpers for both ADLs and instrumental activities of daily living (IADLs) for those persons experiencing changes. The use of assistive technology, primarily equipment for bathing, toileting, and low technology devices, increased with time. The increased vulnerability to loss of function in persons with advancing age and duration of injury in this population with SCI suggests the need for early preventative measures, routine assessments to detect changes, and access to health care and supportive services to alleviate or minimize the effect of these changes.     

The Relationship Between Wheelchair Mobility Patterns and Community Participation Among Individuals With Spinal Cord Injury

Participation is considered the most meaningful outcome of rehabilitation. The purpose of this study was to investigate whether there were correlations between wheelchair activity recorded with a data logger and community participation as measured by the Participation Survey/Mobility. Data from 16 participants were included in this study. Data collected during a two week period using a data logging device were analyzed to determine the mobility characteristics of participants. Among manual wheelchair users, significant positive correlations were found between average speed traveled and the community participation content areas of transportation (r_s = .837, p = .019) and socialization (r_s = .772, p = .042). In addition, for manual wheelchair users there was a trend toward a significant correlation between average speed traveled and total community participation score (r_s = .714, p = .071). Among power wheelchair users, there was a trend toward a significant negative correlation between average speed traveled and the community participation content area of leisure activity (r_s =??.635, p = .066). Understanding the relationship between wheelchair speed and community participation can be useful information to enable clinicians to recommend the most appropriate mobility devices designed to enhance community participation.     

Life Satisfaction in Individuals With Long-Term Traumatic Spinal Cord Injury: An Investigation of Associated Biopsychosocial Factors

ObjectiveTo investigate relationships between self-reported biological, psychological, and social factors and global, vocational, and home life satisfaction in individuals with traumatic spinal cord injury (SCI) an average of more than 30 years postinjury.DesignCross-sectional analyses of self-report assessment data.SettingSpecialty and university hospitals in the southeastern and midwestern United States.ParticipantsIndividuals with a history of traumatic SCI (n=546) who responded to the most recent data collection period of the SCI Longitudinal Aging Study (2018-2019) and who were at least 2 years postinjury and at least 18 years or older at initial study enrollment.InterventionsNot applicable.Main Outcome MeasuresGlobal life satisfaction, home life satisfaction, and vocational life satisfaction as measured by the Life Situation Questionnaire-Revised.ResultsTaken together, the biopsychosocial variables explained 55.1% of the variance in global life satisfaction. Less severe depressive symptoms, greater emotional social support, and greater instrumental social support were significantly associated with greater global life satisfaction. Together, the independent variables explained 50.7% of the variance in home life satisfaction. Being in a relationship, having less severe depressive symptoms, having greater emotional social support, and having greater instrumental social support were significantly associated with home life satisfaction. Together, the independent variables explained 44.8% of the variance in vocational satisfaction. Being White, non-Hispanic, having more years of education, being in a relationship, having less severe depressive symptoms, and having greater emotional social support were significantly associated with greater vocational satisfaction.ConclusionThese results support the need to assess psychological symptoms and available social support as potential modifiable factors related to several domains of life satisfaction in this aging population. Improving psychological symptoms and strengthening available social support may relate to improved life satisfaction.     

Assessing Ventilatory Threshold in Individuals With Motor-Complete Spinal Cord Injury

Objective

To assess the feasibility of measuring ventilatory threshold (VT) in higher-level motor-complete spinal cord injury (SCI) using 4 different analysis methods based on noninvasive gas exchange.