The Changing Prevalence of Pressure Injury among Ontarians with SCI/D at Rehabilitation Admission: Opportunities for Improvement.

BACKGROUND: Despite preventability, 20-50% of patients with acute spinal cord injury/disease (SCI/D) develop hospital-acquired pressure injuries (PIs). The Spinal Cord Injury Implementation and Evaluation Quality Care Consortium (SCI IEQCC) aimed to mitigate PI risk through patient-reported daily skin checks alongside usual care. METHODS: This quality improvement initiative utilized an interrupted time series design, encompassing adults ≥ 18 years admitted for inpatient rehabilitation across five Ontario sites from 2020 to 2023. Patient demographics, etiology, and impairment data were obtained from a national registry, while participating sites gathered data on PI onset, location, and severity. Run charts depicted temporal trends, and statistical analyses, including chi-square and logistic regression, compared patients with and without PIs. RESULTS: Data from 1767 discharged SCI/D patients revealed that 26% had ≥1 PI, with 59% being prevalent and 41% incident. Most severe PIs (stages III and IV and unstageable) were acquired prior to admission. Process indicator fidelity was reasonable at 68%. Patients with PIs experienced longer hospital stays, lower Functional Independence Measure (FIM) changes, and FIM efficiency during rehabilitation. CONCLUSIONS: PI prevalence is increasing, particularly sacral injuries at admission, while incident cases have decreased since 2021 due to regular skin checks. This trend calls for proactive health system interventions to reduce costs and improve patient outcomes.

Wheelchair propulsion test: development and measurement properties of a new test for manual wheelchair users.

OBJECTIVE: To develop and assess some of the measurement properties of a simple and inexpensive test that can be used to evaluate the wheelchair mobility of manual wheelchair users. DESIGN: The initial phase of the study was developmental and descriptive. For the assessment of reliability and validity, correlations and comparisons were carried out using within-participant and subgroup comparisons. SETTING: Rehabilitation center. PARTICIPANTS: Manual wheelchair users (N=58), a sample of convenience. INTERVENTION: The Wheelchair Propulsion Test (WPT) consists of wheeling 10m while time is recorded with a stopwatch, and the number of cycles and propulsion methods are recorded by observation. The WPT was administered once to each participant. Participants in subgroups involved in the assessment of reliability, construct, and concurrent validity had an additional WPT on the same occasion. MAIN OUTCOME MEASURES: Derived measures-speed (m/s), push frequency (cycles per second) and effectiveness (meters per cycle)-from the WPT and, for concurrent validity, an instrumented rear wheel. RESULTS: Regarding intra- and interrater reliability, intraclass correlation coefficients ranged from .72 to .96. Content validity was qualitatively good. For construct validity, on univariate or multivariate analyses, we found statistically significant relations between WPT measures and age, sex, duration of wheelchair use, type of wheelchair frame, and rolling surface. For concurrent validity, the WPT and instrumented wheel variables were highly correlated (r range, .92-.99), and there were no clinically significant differences between them. CONCLUSIONS: The WPT appears to be a simple and inexpensive test with good measurement properties that can be used for people who use hand and/or foot propulsion. However, further study is needed before widespread implementation can be recommended.

Restoring Epigenetic Reprogramming with Diet and Exercise to Improve Health-Related Metabolic Diseases.

Epigenetic reprogramming predicts the long-term functional health effects of health-related metabolic disease. This epigenetic reprogramming is activated by exogenous or endogenous insults, leading to altered healthy and different disease states. The epigenetic and environmental changes involve a roadmap of epigenetic networking, such as dietary components and exercise on epigenetic imprinting and restoring epigenome patterns laid down during embryonic development, which are paramount to establishing youthful cell type and health. Nutrition and exercise are among the most well-known environmental epigenetic factors influencing the proper developmental and functional lifestyle, with potential beneficial or detrimental effects on health status. The diet and exercise strategies applied from conception could represent an innovative epigenetic target for preventing and treating human diseases. Here, we describe the potential role of diet and exercise as therapeutic epigenetic strategies for health and diseases, highlighting putative future perspectives in this field.