RESUMO
OBJECTIVE: This study aimed to describe the temporal dynamics of and risk factors for non-adherence to outpatient follow-up care in the first 10 years after spinal cord injury. DESIGN: Retrospective single-centre cohort study using data from medical records and municipal resident registers. SUBJECTS/PATIENTS: Patients admitted to a specialized spinal cord injury centre in Switzerland discharged between 1 January 2010 and 31 December 2012 (n = 225). Time-to-event analysis was used to investigate the timing of the first non-adherence event, its association with spinal cord injury, and sociodemographic characteristics. RESULTS: 36% of patients were adherent to annual follow-up appointments; 2% formally transferred to another SCI centre; 44% were non-adherent for general reasons (patient's will to discontinue care [12%] or unknown reasons [32%]); and 18% were non-adherent due to death. Risk factors for non-adherence included older age, lack of long-term partner, and more than 2 h of travel time to the clinic. In the youngest age group (18-30 years), 55% were non-adherent after 10 years. CONCLUSION: A relevant proportion of individuals with spinal cord injury were lost to annual follow-up care. A holistic approach to patient engagement integrating solutions such as telemedicine and involvement of support networks could reduce the risk of non-adherence.
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Traumatismos da Medula Espinal , Humanos , Traumatismos da Medula Espinal/reabilitação , Masculino , Feminino , Adulto , Estudos Retrospectivos , Pessoa de Meia-Idade , Suíça , Seguimentos , Adolescente , Adulto Jovem , Fatores de Risco , Cooperação do Paciente , Idoso , Estudos de Coortes , Fatores de Tempo , Assistência ao ConvalescenteRESUMO
STUDY DESIGN: Retrospective study OBJECTIVES: To describe the presenting symptoms/signs, clinical course and outcomes in hospitalised people with spinal cord injury (SCI) and symptomatic COVID-19 infections. SETTING: One university hospital and two SCI centres in Switzerland. METHODS: Descriptive analysis of symptoms/signs, clinical course and outcomes of people with SCI with symptomatic COVID-19 infections and need for hospitalisation. RESULTS: Twenty-two people with SCI were included, 15 (68%) were male, median age 64.5 years (interquartile range, IQR, 52-73 years). Nine (41%) had tetraplegia, and eight (36%) were classified with motor-complete lesions. Frequent clinical symptoms were fever (59%), coughing (54%), fatigue (50%), and dyspnoea (27%). Most frequent complications were bacterial pulmonary superinfection (18%), and acute respiratory distress syndrome (18%). Fifteen persons (68%) needed oxygen therapy during the course of hospitalisation, and 7 (32%) people were ventilated. Median length of stay (LOS) was 23 days (IQR 15-35), varying by age for people under 60 years with a median LOS of 9 days (IQR 8-27), and for those older than 60 years with a median of 34 days (IQR 17-39), respectively. In total, 3 persons (14%) died during hospitalisation, all older with paraplegia. CONCLUSIONS: Typical symptoms like fever and coughing were not present in all people. People with tetraplegia did not demonstrate worse outcomes, on the contrary, they had shorter LOS, no difference in ventilation needs, and no higher mortality compared to people with paraplegia. Older people showed longer LOS. This study recommends close supervision of the SCI population to detect early signs and symptoms of COVID-19 infection.
Assuntos
COVID-19 , Traumatismos da Medula Espinal , Humanos , Masculino , Idoso , Pessoa de Meia-Idade , Feminino , Estudos Retrospectivos , COVID-19/complicações , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/terapia , Paraplegia/complicações , Quadriplegia/complicações , Progressão da DoençaRESUMO
STUDY DESIGN: Population-based prospective study. OBJECTIVES: To provide a population-based description of length of stay (LOS) and person-related risk factors following unplanned hospital admission due to a secondary health condition (SHC) in persons with spinal cord injury (SCI). SETTING: Specialized SCI hospital and rehabilitation center in Switzerland. METHODS: Descriptive analysis of LOS using routine clinical data of persons with SCI, who were acutely hospitalized between 01.01.2017-30.06.2018. Multivariable regression analysis was used to derive marginal predictions of LOS by acute SHCs and person characteristics. RESULTS: The study included 183 persons, 83% were male, and the median age was 57 years (interquartile range, IQR, 49-67 years). SCI cause was traumatic in 160 (88.4%) cases, 92 (50.3%) were persons with tetraplegia, 147 (80.3%) were classified as motor complete lesions (American Spinal Injury Association Impairment Scale (AIS) A or B) and median time since injury (TSI) was 24 (IQR 13-34) years. Median LOS was 19 (IQR 9-39) days, varying from 74 (IQR 39-92) days for pressure ulcers, 13 (IQR 8-24) days for urinary tract infections (UTI), to 27 (IQR 18-47) days for fractures. LOS was prolonged in persons with multiple co-morbidities or those developing complications during hospitalization. Sex, SCI etiology and lesion level were not associated with LOS. CONCLUSIONS: This population-based description identified substantial variation in LOS between acute SHCs and clinical complications as the main, potentially modifiable, person-related risk factors for extended hospital stay.
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Traumatismos da Medula Espinal , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Tempo de Internação , Estudos Prospectivos , Estudos Retrospectivos , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/terapia , Hospitalização , HospitaisRESUMO
INTRODUCTION: Study drop-out and attrition from treating clinics is common among persons with chronic health conditions. However, if attrition is associated with adverse health outcomes, it may bias or mislead inferences for health policy and resource allocation. METHODS: This retrospective cohort study uses data attained through the Swiss Spinal Cord Injury (SwiSCI) cohort study on persons with spinal cord injury (SCI). Vital status (VS) was ascertained either through clinic medical records (MRs) or through municipalities in a secondary tracing effort. Flexible parametric survival models were used to investigate risk factors for going lost to clinic (LTC) and the association of LTC with subsequent risk of mortality. RESULTS: 1924 individuals were included in the tracing study; for 1608 of these cases, contemporary VS was initially checked in the MRs. VS was ascertained for 704 cases of the 1608 cases initially checked in MRs; of the remaining cases (n=904), nearly 90% were identified in municipalities (n=804). LTC was associated with a nearly fourfold higher risk of mortality (HR=3.62; 95% CI 2.18 to 6.02) among persons with traumatic SCI. Extended driving time (ie, less than 30 min compared with 30 min and longer to reach the nearest specialised rehabilitation facility) was associated with an increased risk of mortality (HR=1.51, 95% CI 1.02 to 2.22) for individuals with non-traumatic SCI. CONCLUSION: The differential risk of LTC according to sociodemographic and SCI lesion characteristics underscores the importance of accounting for attrition in cohort studies on chronic disease populations requiring long-term care. In addition, given the associated risk of mortality, LTC is an issue of concern to clinicians and policy makers aiming to optimise the long-term survival of community-dwelling individuals with traumatic SCI. Future studies are necessary to verify whether it is possible to improve survival prospects of individuals LTC through more persistent outreach and targeted care.
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Mortalidade/tendências , Reabilitação/psicologia , Traumatismos da Medula Espinal/terapia , Sinais Vitais/fisiologia , Adolescente , Adulto , Idoso , Estudos de Coortes , Feminino , Humanos , Masculino , Prontuários Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Reabilitação/métodos , Reabilitação/tendências , Estudos Retrospectivos , Fatores de Risco , Traumatismos da Medula Espinal/mortalidade , SuíçaRESUMO
OBJECTIVE/BACKGROUND: Although shoulder pain is a problem in up to 86% of persons with a spinal cord injury (SCI), so far, no studies have empirically identified longitudinal patterns (trajectories) of musculoskeletal shoulder pain after SCI. The objective of this study was: (1) to identify distinct trajectories of musculoskeletal shoulder pain in persons with SCI, and (2) to determine possible predictors of these trajectories. DESIGN/METHODS: Multicenter, prospective cohort study in 225 newly injured persons with SCI. OUTCOME MEASURE: Shoulder pain was assessed on five occasions up to 5 years after discharge. Latent class growth mixture modeling was used to identify the distinct shoulder pain trajectories. RESULTS: Three distinct shoulder pain trajectories were identified: (1) a "No or Low pain" trajectory (64%), (2) a "High pain" (30%) trajectory, and (3) a trajectory with a "Decrease of pain" (6%). Compared with the "No or Low pain" pain trajectory, the "High pain" trajectory consisted of more persons with tetraplegia, shoulder pain before injury, limited shoulder range of motion (ROM), lower manual muscle test scores, or more spasticity at t1. Multiple logistic regression analysis showed two significant predictors for the "High pain" trajectory (as compared with the "No or Low pain" trajectory): having a tetraplegia (odds ratio (OR) = 3.2; P = 0.002) and having limited shoulder ROM (OR = 2.8; P = 0.007). CONCLUSION: Shoulder pain in people with SCI follows distinct trajectories. At risk for belonging to the "High pain" trajectory are persons with tetraplegia and those with a limited shoulder ROM at start of active rehabilitation.
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Avaliação de Resultados em Cuidados de Saúde/métodos , Medição da Dor/métodos , Dor de Ombro/diagnóstico , Dor de Ombro/reabilitação , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/reabilitação , Adolescente , Adulto , Distribuição por Idade , Causalidade , Comorbidade , Progressão da Doença , Humanos , Incidência , Estudos Longitudinais , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Medição da Dor/estatística & dados numéricos , Prognóstico , Recuperação de Função Fisiológica , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Distribuição por Sexo , Dor de Ombro/epidemiologia , Traumatismos da Medula Espinal/epidemiologia , Adulto JovemRESUMO
OBJECTIVE: The aims of this study were to provide a selection of biomedical domains based on the comprehensive International Classification of Functioning, Disability, and Health (ICF) core sets for spinal cord injury (SCI) and to present an overview of the corresponding measurement instruments. DESIGN: Based on the Biomedical Domain Set, the SCI literature, the International Spinal Cord Society international data sets, and the Spinal Cord Injury Rehabilitation Evidence project publications were used to derive category specifications for use in SCI research. Expert opinion was used to derive a priority selection. The same sources were used to determine candidate measurement instruments for the specification of body functions and body structures using an example, and guiding principles were applied to select the most appropriate biomedical measurement instrument(s) for use in an SCI research project. RESULTS: Literature searches were performed for 41 second-level ICF body functions categories and for four second-level ICF body structures categories. For some of these categories, only a few candidate measurement instruments were found with limited variation in the type of measurement instruments. CONCLUSIONS: An ICF-based measurement set for biomedical aspects of functioning with SCI was established. For some categories of the ICF core sets for SCI, there is a need to develop measurement instruments.
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Avaliação da Deficiência , Pessoas com Deficiência/classificação , Indicadores Básicos de Saúde , Traumatismos da Medula Espinal , Humanos , Avaliação de Resultados em Cuidados de Saúde/métodos , Traumatismos da Medula Espinal/classificação , Traumatismos da Medula Espinal/epidemiologia , Traumatismos da Medula Espinal/reabilitaçãoRESUMO
OBJECTIVE: To study the correlation between limited shoulder range of motion in persons with spinal cord injury at discharge and the performance of activities, wheeling performance, transfers and participation one year later. DESIGN: Multicentre prospective cohort study. SUBJECTS: A total of 146 newly injured subjects with spinal cord injury. METHODS: Shoulder range of motion was measured at discharge. One year later, Functional Independence Measure (FIM), transfer ability, wheelchair circuit and Physical Activity Scale for Individuals with Physical Disabilities (PASIPD) were assessed. Corrections were made for possible confounding factors (age, gender, level and completeness of injury, time since injury and shoulder pain). RESULTS: All subjects with limited shoulder range of motion at discharge had a lower FIM motor score and were less likely (total group 5 times, and subjects with tetraplegia 10 times less likely) to be able to perform an independent transfer one year later. Subjects with limited shoulder range of motion in the total group needed more time to complete the wheelchair circuit. No significant associations with the PASIPD were found in either group. CONCLUSION: Persons with spinal cord injury and limited shoulder range of motion at discharge are more limited in their activities one year later than those without limited shoulder range of motion.
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Amplitude de Movimento Articular/fisiologia , Articulação do Ombro/fisiopatologia , Traumatismos da Medula Espinal/fisiopatologia , Atividades Cotidianas , Avaliação da Deficiência , Feminino , Humanos , Masculino , Atividade Motora/fisiologia , Paraplegia/fisiopatologia , Estudos Prospectivos , Quadriplegia/fisiopatologia , Dor de Ombro/fisiopatologia , Traumatismos da Medula Espinal/reabilitação , Fatores de Tempo , Cadeiras de RodasRESUMO
OBJECTIVE: To investigate the prevalence and course of pass notive shoulder range of motion in people with a spinal cord injury and the relationships between shoulder range of motion limitations and personal and lesion characteristics. DESIGN: Multicentre longitudinal study. SUBJECTS: A total of 199 subjects with spinal cord injury admitted to specialized rehabilitation centres. METHODS: Assessments of shoulder range of motion at the start of active rehabilitation, 3 months later, at discharge and one year after discharge. RESULTS: Up to 70% (95% confidence interval (CI): 57-81) of the subjects with tetraplegia and 29% (95% CI: 20-38) of those with paraplegia experienced a limited range of motion of the shoulder during, or in the first year after, inpatient rehabilitation. Shoulder flexion was affected most. Up to 26% (95% CI: 20-37) of subjects had a shoulder range of motion limitation on both sides. Increased age, tetraplegia, spasticity of elbow extensors and longer duration between injury and start of active rehabilitation increased the risk. Presence of shoulder pain is associated with limited shoulder range of motion. CONCLUSION: Limited shoulder range of motion is common following spinal cord injury. Tetraplegia, increased age, spasticity of elbow extensors, longer duration between injury and start of active rehabilitation and shoulder pain are associated with an increased risk for shoulder range of motion problems and require extra attention.