Methodologies to measure access to care post-discharge in adults with serious injury-related disability: a scoping review.

PURPOSE: This scoping review examined the methodologies used to measure access to care in serious injury-related disability populations, for whom access to care post-discharge has significant implications for patient outcomes and rehabilitation trajectories. METHODS: Four electronic databases were searched for literature published between 1 January 2000 and 15 February 2022. Relevant articles needed to relate to access to care in adult community-dwelling trauma and rehabilitation populations. RESULTS: The initial search identified 679 articles. Following de-duplication, the title/abstract screening was completed on 533 articles, and 56 full-text articles were reviewed. Thirty-eight articles met the eligibility criteria and were included in this review. Of the 38 studies included, there was large heterogeneity in the methodologies used to measure access to care. Two articles used multidimensional measures of access to care. CONCLUSIONS: There is an urgent need to establish the use of multidimensional measures as standard practice in access-to-care research. Failure to account for the multidimensional nature of access to care limits the full realisation of access for people with serious injury-related disability and prevents the implementation of processes that could improve access to health, rehabilitation, and support services and enhance the quality of care for individuals with a serious injury-related disability.

A consistently comprehensive approach to rehabilitation research will provide clearer insight into users' experiences and how to optimise their engagement with services.Multidimensional measures of access to care need to be developed, validated, and used to capture the complexity of access to rehabilitation care and what is important to users.More comprehensive evidence can strengthen consensus on the gold standard of what must be included in the measurement of access to rehabilitation care, to improve service reach and relevance.

A case of unusual substance abuse causing myeloneuropathy.

STUDY DESIGN: Case report. OBJECTIVES: Examine an unusual drug related case of myeloneuropathy as well as the pathophysiology of nitrous oxide induced subacute combined degeneration. SETTING: Major metropolitan teaching hospital - Princess Alexandra Hospital, Queensland, Australia. METHODS: Review case notes, investigations, relevant medical literature and epidemiological data. RESULTS: A 23-year-old female developed a myeloneuropathy and encephalopathy after an 8-month history of nitrous oxide abuse. Her presentation was complicated by acute renal failure, deep vein thrombosis (DVT) and pulmonary embolism (PE) as well as severe cognitive deficits. After eight months of multidisciplinary rehabilitation the patient is able to walk short distances with mobility aids and is able to manage self cares. However, she still requires a wheelchair for long distances and will have significant residual neurological deficits. CONCLUSION: The abuse of nitrous oxide has potentially serious outcomes that require discussion of issues related to harm minimisation and health promotion.

Outcome of the acute abdomen in patients with previous spinal cord injury.

BACKGROUND: Patients with spinal cord injury (SCI) have always posed difficulties for the diagnosis of an acute abdomen. The aim of the present study was to define this problem retrospectively at Princess Alexandra Hospital and to assess the results of treatment for these patients. METHODS: A retrospective review was conducted of 133 SCI patients admitted with an acute abdomen in the 16 years prior to this analysis at the Spinal Injuries Unit (SIU) of Princess Alexandra Hospital. There were 21 patients who conformed to the study criteria. All the patients had sustained traumatic SCI at or above the level of T11, more than 1 month prior to admission. RESULTS: There were 13 male and eight female patients. The time lapse between SCI and the onset of an acute abdomen ranged from 1.5 months to 27 years. The age range was 26-79 years. The majority of patients had C6 injuries (six patients). There were 18 patients with injury levels above T6 and three patients with injuries below this level. The time taken to diagnose the cause of the acute abdomen ranged between I day and 3 months. Investigations were found to be useful in making the diagnoses in 61.9% of cases. There were 14 patients who had surgical interventions. Five patients had surgical complications and there were two deaths in the study. The length of follow up was 1-132 months. The mortality in the study was 9.5%. CONCLUSION: An aggressive approach to the diagnosis and treatment of the acute abdomen in SCI patients with suspicious symptoms is recommended. A high index of suspicion should be maintained in those patients with pre-existing SCI who present with abdominal trauma.

A comprehensive approach to the management of male infertility following spinal cord injury.

OBJECTIVES: To review the outcomes of management of male infertility following spinal cord injury in a specialised fertility clinic. STUDY DESIGN: Retrospective review of medical records. SETTING: The Fertility Clinic of a 45-bed spinal cord injury service in New South Wales, Australia. METHODS: The medical and fertility clinic records of 113 males who attended the clinic between 1987 and 1997 were reviewed. RESULTS: The rates of semen retrieval using vibroejaculation and electroejaculation were 67% and 97% respectively. Thirty-one individuals (37%) and their partners sought assistance with the primary aim of achieving a pregnancy. Intravaginal insemination (IVI) undertaken at home following vibroejaculation resulted in a pregnancy rate per cycle of 22%. Electroejaculation and IVI proved less successful with a pregnancy rate per cycle of only 5%, although with intrauterine insemination (IUI) this rate improved to 30%. Micromanipulation in vitro fertilisation (IVF) procedures, primarily intracytoplasmic sperm injection, were used in 18 couples resulting in a pregnancy rate per cycle of 19%. In the 31 couples there have been a total of 17 pregnancies in 97 cycle attempts for an overall pregnancy rate per cycle of 18% and a cumulative pregnancy rate per couple of 55%. Twelve of the pregnancies have resulted in 14 live births (including two sets of twins), there were three pregnancies ongoing at the date of review and there have been two spontaneous abortions. CONCLUSION: The benefits of a specialised fertility clinic offering a comprehensive, client-focused approach with education, fertility assessment and a range of semen retrieval and assisted reproduction options, are highlighted.

Neurological level effect on the discharge functional status of spinal cord injured persons after rehabilitation.

OBJECTIVE: To determine the relation between neurological level and functional status, measured by individual Functional Independence Measure (FIM) item scores, at discharge after rehabilitation in individuals with acute spinal cord injury (SCI). DESIGN: A cohort of spinal cord injured individuals (ASIA Impairment Scale grades A, B, and C) were classified in groups for analysis of variance (ANOVA) according to neurological level at discharge (C1-4, C5, C6, C7-8, T1-6, T7 and below). SETTING: A 20-bed SCI rehabilitation unit. PATIENTS: One hundred twelve individuals admitted between January 1993 and December 1996. INTERVENTION: Multidisciplinary rehabilitation program. MAIN OUTCOME MEASURES: FIM item scores at discharge after rehabilitation. RESULTS: ANOVA and post hoc testing showed significant differences and a systematic change in discharge FIM item scores between adjacent neurological groupings for the tetraplegic and T1-6 paraplegic groups for all the self-care items and between the high and low paraplegic groups for the mobility items. A systematic relation was also seen between lesion level and discharge FIM score for the sphincter control items but not for the locomotion and cognitive items. CONCLUSIONS: The finding of an inverse relationship between FIM score and neurological level for certain motor items supports clinical observations that functional performance in spinal cord injured individuals is reduced with greater neurological impairment. However, results for the locomotion and cognitive subscale items indicate a need for other measures, in addition to the FIM, for outcome measurement in SCI.

Painful neuromata following upper limb amputation.

Painful neuromata occurring after upper limb amputation are a significant cause of stump pain and limit the success of prosthetic training and use. There is little information in the literature regarding incidence, consequences or outcomes of painful neuromata subsequent to upper limb amputation. This article reports an analysis of thirty-two consecutive upper limb amputees. Of these 25% had moderate-to-severe stump pain and clinical signs suggestive of neuromata. All patients with neuromata were limited in their ability to use a prosthesis prior to surgery and following failure of conservative measures, were referred for surgical opinion. Six patients have undergone surgical management. The results of surgery, with respect to pain and prosthetic usage, are discussed.