The epidemiology of traumatic spinal cord injury in Alberta, Canada.

OBJECTIVES: To describe the incidence and pattern of traumatic spinal cord injury and cauda equina injury (SCI) in a geographically defined region of Canada. METHODS: The study period was April 1, 1997 to March 31, 2000. Data were gathered from three provincial sources: administrative data from the Alberta Ministry of Health and Wellness, records from the Alberta Trauma Registry, and death certificates from the Office of the Medical Examiner. RESULTS: From all three data sources, 450 cases of SCI were identified. Of these, 71 (15.8%) died prior to hospitalization. The annual incidence rate was 52.5/million population (95% CI: 47.7, 57.4). For those who survived to hospital admission, the incidence rate was 44.3/million/year (95% CI: 39.8, 48.7). The incidence rates for males were consistently higher than for females for all age groups. Motor vehicle collisions accounted for 56.4% of injuries, followed by falls (19.1%). The highest incidence of motor vehicle-related SCI occurred to those between 15 and 29 years (60/million/year). Fall-related injuries primarily occurred to those older than 60 years (45/million/year). Rural residents were 2.5 times as likely to be injured as urban residents. CONCLUSION: Prevention strategies for SCI should target males of all ages, adolescents and young adults of both sexes, rural residents, motor vehicle collisions, and fall prevention for those older than 60 years.

Depression following traumatic spinal cord injury.

OBJECTIVES: To describe the epidemiology of depression following traumatic spinal cord injury (SCI) and identify risk factors associated with depression. METHODS: This population-based cohort study followed individuals from date of SCI to 6 years after injury. Administrative data from a Canadian province with a universal publicly funded health care system and centralized databases were used. A Cox proportional hazards model was developed to identify risk factors. RESULTS: Of 201 patients with SCI, 58 (28.9%) were treated for depression. Individuals at highest risk were those with a pre-injury history of depression [hazard rate ratio (HRR) 1.6; 95% CI: 1.1-2.3], a history of substance abuse (HRR 1.6; 95% CI: 1.2-2.3) or permanent neurological deficit (HRR 1.6; 95% CI: 1.2-2.1). CONCLUSION: Depression occurs commonly and early in persons who sustain an SCI. Both patient and injury factors are associated with the development of depression. These should be used to target patients for mental health assessment and services during initial hospitalization and following discharge into the community.

Direct health care costs after traumatic spinal cord injury.

BACKGROUND: The objective was to quantify direct health care costs attributable to traumatic spinal cord injury (SCI). METHODS: This population-based cohort study followed individuals with SCI from date of injury to 6 years postinjury. SCI cases were matched to a comparison group randomly selected from the general population. Administrative data from a Canadian province with a universal publicly funded health care system and centralized health databases were used. Costs included hospitalizations, physician services, home care, and long-term care. RESULTS: Attributable costs in the first year were $121,600 (2002 $CDN) per person with a complete SCI, and $42,100 per person with an incomplete injury. In the subsequent 5 years, annual costs were $5,400 and $2,800 for persons with complete and incomplete SCIs, respectively. CONCLUSION: Direct costs in the first year after SCI are substantial. In the subsequent 5 years, individuals with SCI will continue to accrue greater costs than the general public.

Measurement reliability of functional tasks for persons who self-propel a manual wheelchair.

OBJECTIVE: To evaluate the reliability of 4 functional tasks relevant to wheelchair seating. DESIGN: Within-subject and between-rater comparisons. SETTING: Rehabilitation center in Canada. PARTICIPANTS: Two separate convenience samples of 10 male wheelchair users. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The 4 functional tasks were timed forward wheeling, ramp ascent, forward vertical reach distance, and ramp descent, scored by an ordinal performance scale. To determine test-retest reliability, the participants performed each task twice on the same day. To determine interrater reliability, 5 experienced therapists independently scored each participant. The ramp descent task was replaced with a 1-stroke push distance task due to difficulties with the interpretation of the ordinal performance scale. RESULTS: Testing of all tasks was completed within 45 minutes, allowing for rest periods. There were no adverse incidents. One individual with C6 quadriplegia 4 months after spinal cord injury was unable to complete the ramp ascent. Estimates for test-retest reliability of all 4 functional tasks were excellent (r=.99). Interrater reliability was calculated for all tasks except the 1-stroke push and found to be excellent (intraclass correlation coefficient=.99). CONCLUSIONS: The final 4 functional tasks are practical, safe, and reliable tests that may be used for clinical evaluation of wheelchair seating. Further research involving comparative assessments of wheelchair seating options is required to determine the discriminative ability of the tests.

Wheelchair back-support options: functional outcomes for persons with recent spinal cord injury.

OBJECTIVE: To evaluate the functional outcomes for people with a recent spinal cord injury (SCI) when using 3 different back-support options. DESIGN: Repeated-measures within-subject comparison. SETTING: Rehabilitation center. PARTICIPANTS: Twenty-seven manual wheelchair users with recent SCI. INTERVENTIONS: Three types of wheelchair back supports--a standard sling upholstery, a Jay J2 back, and a Pindot PaxBac--were used by each participant to evaluate performance of 4 functional tasks. MAIN OUTCOME MEASURES: Functional tasks included timed forward wheeling, ramp ascent, distance for forward vertical reach, and 1-stroke push. Product satisfaction was also rated. RESULTS: For most participants, best performance for each task varied with back support used. Significant differences in functional performance were found for the reaching activity (P=.01), with greater reach when the J2 was used. Satisfaction ratings also differed significantly (P=.017), with participants indicating greater satisfaction with the J2. Participants' choice of back support varied and did not consistently correspond with best performance. CONCLUSIONS: Except for reaching, performance of functional activities did not differ depending on back support used. Objective evaluation of reaching ability may assist in product decision making. Inclusion of a consistent battery of functional tasks could provide a standardized reference point for clients' subjective evaluations.