The association between bladder-emptying methods and health-related quality of life among Iranian individuals with spinal cord injury

Objectives: In this study, we compared the health-related quality of life (HRQoL) among patients with spinal cord injury (SCI) using different bladder emptying methods including normal spontaneous micturition (NSM), micturition with assisted maneuvers (MAM), aseptic intermittent catheterization by patient (IC-P), aseptic IC by an attendant/caregiver (IC-A) and indwelling catheterization.

Design: Cross-sectional.

Setting: Tertiary rehabilitation center.

Participants: Patients referred to Brain and Spinal Cord Injury Research Center between 2012 and 2014.

Outcome measures: HRQoL was assessed by Short Form Health Survey (SF-36). Hierarchical regression analysis with adjustment for probable confounders (demographic and injury-related variables) was performed to assess the relationship between bladder-emptying method and total SF-36 score.

Results: Patients with injury at cervical sections had significantly lower scores in domain of physical functioning (PF), physical component summary (PCS) and total score (P: 0.001, <0.0001 and 0.027, respectively). Longer time since injury was associated with better scores of PCS, Mental component summary (MCS) and total score (P: 0.002, <0.0001 and 0.003, respectively). Regression analysis showed that the effect of bladder-emptying method on total score of SF-36 was significant (P < 0.0001) and this relationship remained significant after adjustment for probable confounders in the second step of hierarchical regression analysis (R: 0.923, R²: 0.852, Adjusted R²: 0.847, P?<?0.0001). Patients with NSM had the highest scores in SF-36 instrument and individuals with indwelling catheterization had the poorest HRQoL in all domains.

Conclusion: This study shows that the type of bladder management method affects HRQoL significantly in patients with SCI. Intermittent catheterization are recommended to be administered instead of indwelling catheterization to improve HRQoL.     

Cross-sectional associations of pulmonary function with systemic inflammation and oxidative stress in individuals with chronic spinal cord injury

Context/Objective: Systemic inflammation, and to a lesser extent oxidative stress, have been associated with reduced pulmonary function. Our objective was to evaluate the associations between biomarkers of inflammation (C-reactive protein (CRP), interleukin-6 (IL-6)) and novel makers of global oxidative stress (fluorescent oxidation products (FLOx)) with spirometric and lung volume measures in individuals with chronic spinal cord injury (SCI).

Design: Cross-sectional study.

Setting: Veterans Affairs Medical Center.

Participants: One-hundred thirty-seven men with chronic SCI participating in an epidemiologic study.

Methods: Participants provided a blood sample, completed health questionnaires, and underwent pulmonary function testing, including helium dilution measurement of functional residual capacity (FRC). General linear models were used to model associations between increasing quartiles of inflammation or oxidative stress with each outcome measure, after adjustment for a number of potential confounders.

Outcome Measures: Percent-predicted forced vital capacity in one second (FEV₁), percent-predicted forced vital capacity (FVC), FEV₁/FVC, percent-predicted residual volume (RV), percent-predicted FRC, and percent-predicted total lung capacity (TLC).

Results: After adjustment for a number of confounders, participants with higher levels of CRP and IL-6 had lower percent-predicted FEV₁ and FVC measurements. There were no clear patterns of association with any of the oxidative stress biomarkers or other outcome measures.

Conclusion: Increased systemic inflammation was associated with reductions in FEV₁ and FVC independent of a number of covariates. Although the mechanism is uncertain, these results suggest that reductions in pulmonary function in SCI are associated with systemic inflammation.     

Correlation between ankle brachial index, symptoms, and health-related quality of life in patients with peripheral vascular disease

Introduction: In the absence of quality of life measurement, other measures such as ABIs and patient symptoms provide a basis for determining the need for invasive therapy for patients with peripheral vascular disease (PVD). The accuracy of these surrogates in representing HRQL is, however, untested. The purpose of this study was to determine the correlation of these measures to HRQL. Methods: 115 PVD patients (114 male:1 female; median-age 64yrs) referred for vascular evaluation, were enrolled in an IRB-approved, prospective study. All patients completed Short Form-36 (SF-36) and Walking Impairment Questionnaire (WIQ- validated, PVD specific HRQL measure). 102 patients had measurement of ABIs and all had documented PVD symptoms. Pearsons correlation and student’s t test were used to examine univariate associations. Linear regression was used to assess the significance of the association of ABIs or symptoms in explaining the variance in HRQL scores. Results: The average ABI was 0.54 (0.00-0.98). The maximal correlation between SF-36 and ABIs was Physical Component Summary score (r = 0.29, p = 0.003). WIQ scores also exhibited modest correlation with ABIs (maximal correlation noted [r = 0.30, p = 0.002] for stair climbing). Both SF-36 and WIQ exhibited a highly significant association with symptoms: in all cases patients with surgical indications (lifestyle-limiting claudication or chronic critical limb-ischemia) had reduced HRQL scores compared with non-surgical patients (non-lifestyle-limiting claudication). Multivariate analysis suggested that in each case, SF-36 and WIQ summary scores were better predicted by symptoms than ABI’s (see table). Conclusions: HRQL in PVD patients correlates weakly with ABIs, but exhibits a closer association with vascular symptoms. This suggests that sole reliance on ABIs may not accurately reflect the impact of PVD on HRQL, or the potential benefit of vascular surgery in improving HRQL.     

Inflammatory Sacroiliitis in a Man With Spinal Cord Injury

Abstract

Background: Inflammatory sacroiliitis associated with spinal cord injury (SCI) as an unusual cause of elevated erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) level has not been reported previously to our knowledge.

Objective: To represent a case of SCI associated with bilateral sacroiliitis causing ESR and CRP level elevation.

Methods: Case report of a man with T9 paraplegia.

Findings: ESR and CRP levels were high. Pelvic radiography was nearly normal, except for mildly blurred sacroiliac joints with normal margins. A 3-phase bone scan revealed bilateral sacroiliitis and heterotopic ossification at medial side of the left knee. Past history was significant for a recent urinary tract infection. Indomethacin and etidronate were prescribed. Significant decreases in ESR and CRP level were seen 1 month later.

Conclusions: Sacroiliitis might be an unusual cause of elevated ESR and CRP levels in patients with SCI. Sensory and motor deficits may obscure the typical clinical presentation; therefore, imaging studies are essential for the diagnosis.     

Correlation between ankle-brachial index, symptoms, and health-related quality of life in patients with peripheral vascular disease

OBJECTIVE: Improving health-related quality of life (HRQL) is the main goal of surgery to treat peripheral vascular disease (PVD); however, HRQL is rarely measured directly. Rather, most surgeons use other measures, such as patient symptoms and ankle-brachial index (ABI) to determine the need for intervention in PVD. The accuracy of these surrogates in representing HRQL has been untested. The purpose of this study was to determine the correlation of these measures with HRQL in patients undergoing evaluation for intervention in symptomatic PVD. METHODS: Patients (n=108) referred to the vascular surgery service with symptoms of PVD were enrolled in a prospective study of HRQL. Patients completed two validated HRQL questionnaires: the short form-36 (SF-36) and the Walking Impairment Questionnaire (WIQ). All patients had symptoms consistent with PVD, including claudication (n=69; 63.9%), ischemic rest pain (n=17; 15.7%), or tissue loss (n=22; 20.4%). ABI was measured at presentation. RESULTS: The mean ABI was 0.53 (range, 0.00-0.98). The maximal correlation between SF-36 score and ABI was reflected in the Physical Component Summary score (r=0.25). WIQ score also exhibited modest correlation with ABI, with maximal correlation noted for stair climbing (r=0.26). Both SF-36 and WIQ scores exhibited a highly significant association with symptoms. Patients with more severe symptoms, such as lifestyle-limiting claudication or limb-threatening ischemia, had lower HRQL scores compared with patients with non-lifestyle-limiting claudication. Multivariate analysis demonstrated that SF-36 and WIQ physical summary scores are better predicted by symptoms than by ABI (P<.01). CONCLUSIONS: HRQL in patients with PVD correlates weakly with ABI, but exhibits a closer association with vascular symptoms. However, neither variable fully expresses patient HRQL. These data suggest that sole reliance on these surrogates may not accurately reflect the effect of PVD on HRQL, or the potential benefit of vascular surgery in improving HRQL.     

Life Satisfaction In Adults With Pediatric-Onset Spinal Cord Injuries

Abstract

Objective: To determine the level of life satisfaction of adults with pediatric-onset spinal cord injuries (SCI) and the factors associated with life satisfaction.

Method: A structured interview including standardized measures.

Participants: Participants were individuals who sustained SCI at age 18 years or younger, were 24 years of age or older at interview, did not have significant brain injury, and were living in the United States or Canada.

Outcome measures: A structured interview, the Functional Independence Measure (FIM), the Craig Handicap Assessment and Reporting Technique (CHART), the Short-Form 12 (SF-12), and the Satisfaction with Life Scale (SWLS).

Results: Two hundred sixteen individuals were interviewed. Mean age at injury was 14 years, mean age at interview was 29 years, and mean duration of injury was 14 years. The mean SWLS score was 23.6, and the median score was 25. There was not a significant difference between men and women, but those with tetraplegia were significantly less satisfied than were those with paraplegia. A regression model identified age at injury, community mobility (CHART), marital status, use of street drugs, perceived mental health (SF-12), and medical complications as predictors of life satisfaction. Other factors strongly associated with SWLS were employment, income, independent living, FIM total plus physical and sociocognitive domain scores, perceived physical health (SF-12), and CHART total plus the subscales of physical independence, cognitive independence, and occupation.

Conclusions: Life satisfaction in adults with pediatric-onset SCI is associated with demographic, injury-related, and functional limitation factors, as well as with health status and community integration outcomes.     

Complementary alternative medicine practices and beliefs in spinal cord injury and non-spinal cord injured individuals

Context/Objective: To compare the beliefs and practices of individuals with spinal cord injury (SCI), their friends and family members (F&F SCI), and healthcare professionals (HCP) regarding complementary alternative medicine (CAM).

Design: A questionnaire regarding CAM practices and beliefs was administered to participants on paper or online.

Setting: An academic rehabilitation hospital.

Participants: Ninety-six individuals voluntarily participated in the study. Participants included 28 patients with SCI, 36 F&F SCI, and 32 HCP.

Interventions: Not applicable

Outcome Measures: The questionnaire assessed participants’ prior or current use of 14 CAM modalities, their willingness to use CAM in the future or recommend its use, and their beliefs and opinions of CAM.

Results: Participants with SCI and their family and friends, were more likely than HCP to have used CAM (P?≤?0.01 and P?≤?0.03, respectively) and recommend its use (P?≤?0.04 and P?≤?0.03, respectively). All three groups showed statistical significance in their willingness to ever use certain CAM modalities (P?≤?0.03 for SCI, P?≤?0.04 for F&F SCI, and P?≤?0.02 for HCP). SCI, F&F SCI, and HCP groups had similar beliefs and opinions regarding CAM.

Conclusion: Patients with SCI as well as their friends and family, have significantly more experience with CAM and are more likely to recommend its use than HCP, suggesting that they are interested and find benefit in alternative healthcare. This warrants further investigation of the integration of CAM into general health practices for those with SCI.     

Identifying and classifying quality of life tools for neurogenic bladder function after spinal cord injury: A systematic review

Objective: To identify and classify quality of life (QoL) tools for assessing the influence of neurogenic bladder after spinal cord injury/disease (SCI).

Design: Systematic Review

Methods: Medline/Pubmed, CINAHL, and PsycInfo were searched using terms related to SCI, neurogenic bladder and QoL. Studies that assessed the influence neurogenic bladder on QoL (or related construct) in samples consisting of?≥50% individuals with SCI were included. Two independent reviewers screened titles and abstracts of 368 identified references; 118 full-text articles were assessed for eligibility, and 42 studies were included. Two reviewers independently classified outcomes as objective (societal viewpoint) or subjective (patient perspective) using a QoL framework.

Results: Ten objective QoL measures were identified, with the Medical Outcomes Short Form (SF-36/SF-12) used most frequently. Fourteen subjective QoL measures were identified; 8 were specific to neurogenic bladder. Psychometric evidence for SCI-specific neurogenic bladder QoL tools was reported for the Quality of Life Index (QLI), Qualiveen, Bladder Complications Scale, Spinal Cord Injury-Quality of Life (SCI-QOL) Bladder Management Difficulties, and the SCI-QOL Bladder Management Difficulties-Short Form. The QLI and Qualiveen showed sensitivity to neurogenic bladder in experimental designs.

Conclusion: Several objective and subjective tools exist to assess the influence of neurogenic bladder on QoL in SCI. The QLI and Qualiveen, both subjective tools, were the only validated SCI-specific tools that showed sensitivity to neurogenic bladder. Further validation of existing subjective SCI-specific outcomes is needed. Research to validate objective measures of QoL would be useful for informing practice and policy related to resource allocation for bladder care post-SCI.     

Biomarkers for recurrent pressure injury risk in persons with spinal cord injury

Objective: To investigate potential linkages between pressure injury (PrI) recurrence following spinal cord injury (SCI) and muscle-based and circulatory biomarkers, specifically fatty metabolites and inflammatory cytokines.

Design: Observational study.

Setting: Tertiary Care Center.

Participants: 30 individuals with complete or incomplete SCI. Study participants either had never developed a PrI (Group I) or had a history of recurrent PrI (Group II).

Interventions: Not applicable.

Outcome Measures: Gluteal muscle histology, immunohistochemistry, muscle-based and circulatory fatty metabolites and inflammatory cytokines.

Results: Gluteal intramuscular adipose tissue (IMAT) was greater than 15% in most Group II (83%) individuals. Muscle tissue histology confirmed intramuscular structural differences. Fatty acid binding protein 4 (FABP4) and fatty acid binding protein 3 (FABP3) were reliably detected in muscle and blood and significantly correlated with IMAT (P?<?0.001). FABP4 was significantly higher in Group II muscle and blood (P?<?0.05). FABP3 was significantly higher in Group I muscle (P?<?0.05). Circulatory FABP3 levels were lower for Group I. Inflammatory biomarkers were more reliably detected in blood. Colony-Stimulating Factor-1 was slightly higher in Group II muscle. Circulatory interleukin-13 was significantly higher (P?<?0.01) in Group I. Vascular endothelial growth factor (VEGF-A) was significantly increased (P?<?0.05) in Group I muscle and blood.

Conclusion: Identifying individuals with SCI at highest risk for recurrent PrI may impact patient management. IMAT content evaluation illustrates that muscle quality is a key biomarker. Low circulatory inflammatory biomarker expression potentially limits clinical significance for between group differences. Circulatory levels of FABP4 hold great potential as a recurrent PrI risk biomarker.     

Utilization and access to healthcare services among community-dwelling people living with spinal cord injury

Objective: Describe the utilization, accessibility, and satisfaction of primary and preventative health-care services of community-dwelling individuals with spinal cord injury (SCI).

Design: Cross sectional, in-person or telephonic survey, utilizing a convenience sample.

Setting: Community.

Participants: Individuals with SCI greater than 12-months post injury.

Interventions: N/A.

Outcome measures: Demographic, injury related, and 34-item questionnaire of healthcare utilization, accessibility, and satisfaction with services.

Results: The final sample consisted of 142 participants (50 female, 92 male). Ninety-nine percent of respondents had a healthcare visit in the past 12-months with primary care physicians (79%), with SCI physiatrists (77%) and urologists (50%) being the most utilized. 43% of the sample reported an ER visit within the past 12-months, with 21% reporting multiple visits. People who visited the ER had completed significantly less secondary education (P?=?0.0386) and had a lower estimate of socioeconomic status (P?=?0.017). The majority of individuals (66%) were satisfied with their primary care physician and 100% were satisfied with their SCI physiatrist. Individuals who did not visit an SCI physiatrist were significantly more likely to live in a rural area (P?=?0.0075), not have private insurance (P?=?0.0001), and experience a greater decrease in income post injury (P?=?0.010).

Conclusion: The delivery of care for people with SCI with low socioeconomic status may be remodeled to include patient-centered medical homes where care is directed by an SCI physiatrist. Further increased telehealth efforts would allow for SCI physiatrists to monitor health conditions remotely and focus on preventative treatment.     

Mental disorder prevalence among U.S. Department of Veterans Affairs outpatients with spinal cord injuries

Objectives: Depression and other mental disorders are more prevalent among individuals living with spinal cord injury (SCI) than in the community at large, and have a strong association with quality of life. Yet little is known about the prevalence and predictors of mental disorders among U.S. military Veterans living with SCI. The primary aim of this study was to present an estimate of mental disorder point prevalence in this population. The secondary aim was to examine the relationship of mental disorders to demographics, injury characteristics, and other clinically relevant features such as impairment from mental health problems and life satisfaction.

Design: Cross-sectional.

Setting: A SCI & Disorders Center at a U.S. Veterans Affairs Medical Center.

Participants/Methods: Administrative and medical records of 280 Veterans who attended annual comprehensive SCI evaluations were evaluated. Demographics, injury characteristics, self-reported mental and emotional functioning (i.e. SF-8 Health Survey), and clinician-determined mental disorder diagnoses were attained.

Results: Overall, 40% of patients received at least one mental disorder diagnosis, most commonly depressive disorders (19%), posttraumatic stress disorder (12%), and substance or alcohol use disorders (11%). Several patient characteristics predicted mental disorders, including age, racial minority identity, non-traumatic SCI etiology, and incomplete (i.e. AIS D) vs. complete injury. Mental disorders were associated with greater impairment from health and mental health-related problems and less satisfaction with life.

Conclusions: Mental disorders are common among outpatients receiving VA specialty care for SCI. These findings highlight the importance of having adequate and effective available mental health services available for Veterans with SCI.     

Aps Funded Research Projects

Abstract

Objectives: Determine the unique effects of age across a variety of outcome domains following spinal cord injury (SCI).

Design: Cross-sectional; 61 32 individuals with traumatic onset SCI in the National Spinal Cord Injury Statistical Center (NSCISC) database.

Outcome Measures: Functional Independence Measure (FIM) , Sat isfaction With Life Scale (SWLS) , the Craig Hand icap Assessment and Reporting Technique (CHART), and the Short Form-12 (SF-12).

Results: Older age was most consistently associated with decreased self-reported outcomes across most domains assessed. More specifically, a significant linear decline with age was found for functional independence (FIM) , overall life satisfaction (SWLS) , perceived physical health (SF-12 physical health), and overall handicap (CHART-total score), particularly in the areas of physical independence, mobility, occupational functioning, and social integration (CHART subscales). However, regression analyses, controlling for numerous demographic and medical characteristics, indicated that the amount of unique variance that could be specifically attributed to age was relatively small. Age was unrelated to self-reported mental health (S F-1 2 mental health subscale) and economic functioning (CHART -economic self-sufficiency subscale). Pain interference in day-to-day activities (ie, a single item from SF-12) significantly increased with age.

Spinal Cord Med. 2003;26:37-44     

Hemodynamic Parameters and Timing of Surgical Decompression in Acute Cervical Spinal Cord Injury

Abstract

Background/Objectives: To evaluate the relationship between the severity of cervical spinal cord injury (SCI) (American Spinal Injury Association [ASIA] grade), presence of neurogenic shock, and timing of surgical intervention. This is a post-hoc analysis from the Sygen multicenter randomized controlled trial.

Methods: Blood pressure (BP) and heart rate (HR) data were collected when patients were first assessed in the emergency room (Time A) and at the time of randomization (Time B). Individuals were subdivided by ASIA grade and by the level of the systolic BP (SBP).

Results: Only individuals with cervical SCI from the Sygen trial (n = 577) were evaluated. Severe complete SCI (ASIA grade = A) was established in 57% of these patients. A total of 74 (13%) patients with neurogenic shock (SBP < 90 mmHg) at Time A were identified. The SBP increased significantly from Time A to Time B (P < 0.0001). The median time from SCI to surgical intervention, for ASIA A, was 80.9 hours for patients with initial SBP < 90 mmHg and 58 hours for patients with initial SBP > 90 mmHg (P = 0.025). Multivariable analysis after adjusting for confounders revealed a statistically significant difference in the time to surgical intervention based on SBP for ASIA A (P = 0.026), yet not for ASIA B or C/D.

Conclusions: The presence of neurogenic shock was associated with a delay in the timing of surgical intervention in patients with cervical SCI. Detailed evaluation of autonomic dysfunctions following SCI including cardiovascular instability could improve our understanding of the complexities of clinical presentations and possible neurological outcomes.     

Bone Loss at the Os Calcis Compared with Sone Loss at the Knee in Individuals with Spinal Cord Injury

Abstract

Background/Objective: The objective of this study was to document acute bone loss at the os calcis and compare it with bone lossat the knee following spinal cord injury (SCI) as a potential proxy for bone loss in individuals with SCI.

Methods: Bone mineral density (BMD) was measured by dual energy x-ray absorptiometry (DEXA) at the knee and os calcis, whichalso was assessed by ultrasound in 6 individuals-5 with complete SCI and 1 with incomplete SCI-at means of 33.5 and 523 daysfollowing injury.

Results: Bone mineralwas progressively greater as measured from proximal to distal sites. The net average BMD of the knee declined24% (P = 0.017). The distalfemurlost 27% (P = 0.03 8) and the proximal tibia lost 32% (P = 0 .015) , whereas the os calcis lost3 8% (P = 0.001) as measured by DEXA and 49% (P<0.001) as estimated from ultrasound. The mean loss of 24'7'o at the kneewas significantly different from the loss percentages at the os calcis as measured by both techniques: DEXA (P = 0.036) andultrasound (P = 0.043). Differences between annualized loss rates at the knee and the os calcis measured by both techniques alsowere significant: DEXA (P = 0.032) vs ultrasound (P = 0.038). However, annualized loss rates demonstrated the same trend fordifferentiallass at the sites examined in the 5 individuals with complete injuries but not for the 1 participant with an incomplete injury.The loss rates were similar for the complete and incomplete participants at the os calcis, but not at the knee.

Conclusion: The BMD of the os calcis declined 3 8% by DEXA and 49% by ultrasound compared with 24% at the knee whenmeasured 1 to 1.5 years after injury. BMD of the os calcis and distal femur measured by DEXA in persons with complete SCI werehighly correlated (r = 0.84, P < 0.0001 ).     

Health-Related Quality of Life in a National Cohort of Patients With Pulmonary Arterial Hypertension or Chronic Thromboembolic Pulmonary Hypertension

BackgroundPatients with pulmonary arterial hypertension (PAH) and chronic thromboembolic pulmonary hypertension (CTEPH) experience impaired health-related quality of life (HRQL). The objective of this study was to evaluate HRQL in a nation-wide sample.MethodsThis is a prospective, multicenter, non-interventional study of HRQL including 139 (89%) PAH and 17 (11%) CTEPH patients (women 70.5%; mean age, 52.2) recruited from 21 Spanish hospitals. 55% had idiopathic PAH, 34% other PAH and 11% CTEPH. HRQL was measured using the Short Form 36 Health Survey (SF-36) and EuroQoL-5D (baseline and after 6 months).ResultsHRQL in the patients with PAH or CTEPH was impaired. The physical component of SF-36 and the EuroQol-5D correlated with the functional class (FC). Mean EuroQol-5D visual analogical scale (EQ-5D VAS) scores were 73.5 ± 18.4, 62.9 ± 20.7 and 51.3 ± 16.0 (P<.0001) in patients with FC I, II and III, respectively. Every increase of one FC represented a loss of 4.0 on the PCS SF-36 and a loss of 9.5 on the EQ-5D VAS. Eight patients who died or received a transplant during the study period presented poorer initial HRQL compared with the rest of the population. No significant changes in HRQL were observed in survivors after 6 months of follow-up.ConclusionsHRQL is impaired in this population, especially in PAH/CTEPH patients near death. HRQL measurements could help predict the prognosis in PAH and CTPH and provide additional information in these patients.     

Breathlessness and Exercise in Spinal Cord Injury

Abstract

Objective: To determine the impact of medical complications on adult outcomes of individuals with pediatric-onset spinal cord injury (SCI).

Method: Structured interview including standardized measures.

Participants: Individuals who sustained SCI at age 1 8 years or younger and were 24 years of age or older at interview.

Outcome Measures: A structured interview covering employment, independent living and driving, and marriage. Standardized measures include the Craig Handicap Assessment and Reporting Technique (CHART), the Short Form (SF-12), and the Satisfaction with Life Scale (SWLS).

Results: Two hundred sixteen individuals were interviewed, with a mean age at injury of 14 years and a mean age at follow-up of 29 years. Of all the complications, pressure ulcers, severe urinary tract infection (UTI), and spasticity had the greatest impact on adult outcomes. Pressure ulcers were statistically related to all main outcomes. Severe UTI was statistically associated with all the outcomes except for marriage. Spasticity was associated with all the measured outcomes, except for marriage and life satisfaction. Life satisfaction was most significantly associated with severe UTI, pressure ulcers, pain, and respiratory complications.

Conclusion: Medical complications significantly affect adult outcomes of individuals with pediatric-onset SCI.     

Functional independence of persons with long-standing motor complete spinal cord injury in the Netherlands

Context/Objective: Since life expectancy of persons with spinal cord injury (SCI) has improved, it is relevant to know whether this group is able to maintain functional abilities many years after onset of SCI. Objectives of this study were (1) to examine associations between time since injury (TSI) and functional independence in persons with long-standing SCI and (2) to explore associations between functional independence and level of injury, comorbidities, mental health, waist circumference and secondary health conditions (SHCs).

Design: TSI-stratified cross-sectional study. Strata were 10–19, 20–29 and 30+ years.

Setting: Community.

Participants: 226 persons with long-standing SCI. Inclusion criteria: motor complete SCI; age at injury 18–35 years; TSI?≥?10 years; current age 28–65 years; wheelchair dependency.

Interventions: Not applicable.

Outcome measures: The Spinal Cord Independence Measure III (SCIM) was administered by a trained research assistant. Level of injury, comorbidities, mental health, waist circumference and SHCs were assessed by a rehabilitation physician.

Results: Mean TSI was 23.6 (SD 9.1) years. No significant differences in SCIM scores were found between TSI strata. SCIM scores were lower for persons with tetraplegia, autonomic dysreflexia, hypotension, more than four SHCs and a high waist circumference. In linear regression analyses, TSI nor age was associated with the SCIM total score. Only level of injury (β?=?–0.7; P?<?.001) and waist circumference (β?=?–0.1; P?=?.042) were independent determinants (explained variance 55%).

Conclusion: We found no association between TSI and functional independence in persons with long-standing motor complete SCI. This study confirms the possible effect of overweight on functional independence.     

Body mass index changes over 3 years and effect of obesity on community mobility for persons with chronic spinal cord injury

Objective: To identify the prevalence of obesity in persons with chronic spinal cord injury (SCI), determine change in body mass index (BMI) over time, and identify impact of obesity on community mobility.

Design: Prospective three year longitudinal study.

Setting: Outpatient clinic of rehabilitation center.

Participants: Convenience sample of 222 persons with paraplegia between 2–20 years post SCI.

Outcome Measures: BMI at baseline and three years; community mobility (daily wheelchair propulsion distance and velocity, average number of daily transfers and depression raises).

Results: Participants were 34.1 (27.3, 40.3) years of age and median duration of SCI was 8.7 (3.2, 15.1) years. The SCI adjusted BMI classification identified 44% of participants as obese. BMI increased over time with 13% moving into a higher weight category. Median change in BMI was 0.46 (?0.92, 1.50) kg/m^{2 Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of obesity in the United States, 2009–2010. NCHS Data Brief. 2012;(82):1–8. [Google Scholar]} (z?=??2.684, P?=?0.007), and increased at a rate of 0.15?kg/m²/yr. Average BMI was negatively correlated with daily wheelchair propulsion distance (r?=??0.179, P?=?0.009), however there was no significant relationship with velocity, number of daily transfers or depression raises.

Conclusion: The majority of participants with chronic SCI were overweight (23%) or obese (44%) and BMI increased by 0.46?kg/m² over three years. Those with higher BMIs pushed their wheelchairs shorter distances, but other mobility measures were not impacted by body weight. Continued mobility activities with increasing body weight can increase risk for shoulder injury. Identifying persons who are obese allows for directed and timely health and mobility intervention.     

C-Reactive Protein and Erythrocyte Sedimentation Rate in Patients With Heterotopic Ossification After Spinal Cord Injury

Abstract

Background/Objective: Formation of heterotopic ossification (HO) in soft tissue afterspinal cord injury (SCI) is associated with various degrees of inflammation. Recent studies have shown that inhibition of inflammatory reaction with nonsteroidal anti-inflammatory drugs is an effective prevention of HO after SCI. The goal of this study was to monitor the activity of the most widely used indicators of acute inflammation-namely, erythrocyte Sedimentation rate (ESR) and C-reactive protein (CRP)-in patients with HO.

Methods: In a retrospective study, the results of 37 patie nts with HO were evaluated. There were 25 patients with tetraplegia and 12 with paraplegia. The age (mean ± SD) of the patients was 2 8 ± 8 years (range = 19-46 years). The patients were admitted to the rehabilitation center 2 to 5 weeks after SCI. HO was confirmed by bone scintigraphy. Blood samples were obtained from the patients at the time of diagnosis of HO and du ring the therapy. ESR was measured with the Westergren method, and serum CRP was determined by enzyme-linked immunosorbent assay.

Results: In the acute stage of HO, both tests were e levated in all patients. ln the later stages when clinical signs and symptoms of inflammat ion were resolving, both tests showed a gradual decline. When clinical sig ns and symptoms of inflammation (fever, acute soft tissue swelling, and erythema) were not present, the concentration of CRP was normal in 91 .2% of patients, whereas only 1 7 .6% of patients had normal ESR. Mean serum concentrations of CRP were 8.9 ±5.6 mg/L in the inflammatory phase and 0.9 ± 0.6 mg/L in the noninflammatory phase.

Conclusion: The data indicate that serum CRP is a useful and more specific test than is ESR for monitaring the inflammatory activity of HO after SCI. The normalization of CRP was seen during the first 3 to 4 weeks of etidronate therapy, indicating a resolution of acute-phase inflammatory reaction.