Risk factors for venous thromboembolism in patients with spinal cord injury: A systematic review and meta-analysis.

CONTEXT: Patients with spinal cord injury (SCI) are at high risk for venous thromboembolism (VTE). The risk factors for VTE in patients with SCI are complex. OBJECTIVE: This meta-analysis was conducted to clarify the risk factors for VTE in patients with SCI. METHODS: The Cochrane Library, PubMed, EBSCO, Web of Science, China National Knowledge Infrastructure (CNKI), China Biomedical Literature Database (CBM), Wanfang Med Data Database, and VIP Database were searched to identify studies reporting on risk factors for VTE in patients with SCI. RESULTS: The meta-analysis included 25 studies. Findings showed that risk of VTE in patients with SCI was significantly associated with middle- and old-age (OR = 2.08, 95%CI, 1.47, 2.95), male sex (OR = 1.41, 95%CI, 1.26, 1.59), complete paralysis (OR = 3.69, 95%CI, 2.60, 5.24), personal/family history of venous thrombosis (OR = 1.95, 95%CI, 1.35, 2.81), history of smoking (OR = 2.67, 95%CI, 1.79, 3.98), lack of compression therapy (OR = 2.44, 95%CI, 1.59, 3.73), presence of lower limb/pelvic fracture (OR = 3.47, 95%CI, 1.79, 6.75), paraplegia (OR = 1.81, 95%CI, 1.49, 2.19), and diabetes (OR = 4.24, 95%CI, 2.75, 6.52). CONCLUSION: The meta-analysis identified 9 risk factors for VTE in patients with SCI. Healthcare providers should be aware of the risk factors for VTE when rehabilitating patients with SCI.

Bone Mineral Density at the Distal Femur and Proximal Tibia and Related Factors During the First Year of Spinal Cord Injury.

BACKGROUND: Spinal cord injury (SCI) can lead to disuse osteoporosis. The most vulnerable sites for fragility-induced fractures are the distal femur (DF) and proximal tibia (PT). The aim of this study was to evaluate changes in bone mineral density (BMD) at the DF and PT, as well as related factors, during the first year of SCI. PATIENTS AND METHODS: Thirty-six SCI patients within 12 months of their injury were selected, as were 36 healthy controls. The dual-energy X-ray absorptiometry was used to measure BMDs at the DF, PT, and hip of all subjects. According to the duration of SCI when receiving DXA scan, 36 SCI patients were divided into three subgroups. The BMDs of overall patients and subgroups were compared to those of controls. Biochemical markers of bone metabolism were detected in SCI patients. RESULTS: The BMDs at the DF, PT, and hips of overall SCI patients were significantly lower than those of controls. The percentage difference of BMD between SCI patients and controls at the DF and PT was higher than at the hip. The BMD at the PT of SCI within 6 weeks post-injury was lower than that of controls. The BMDs at the DF and PT of SCI during 6 weeks-3 months post-injury were lower than those of controls. Whereas there was no difference in the BMD at the hip during the first 3 months of SCI. Age and 25OHD were the influencing factors of DF BMD. Age and gender were found to influence PT BMD. CONCLUSION: The rapid loss of BMD at the PT and DF during the first year of SCI occurred significantly earlier than that of the hip. It is recommended to monitor the BMD of DF and PT in early-stage SCI patients, combined with detection of biochemical markers of bone metabolism.

Validation of a novel cone tool for pinprick sensation examination in patients with spinal cord injury.

STUDY DESIGN: Psychometrics study. OBJECTIVE: The objective of this study was to introduce a novel tool for pinprick sensation examination and validate its usefulness in patients with spinal cord injury (SCI). SETTING: China Rehabilitation Research Center, Capital Medical University School of Rehabilitation Medicine, China. METHODS: A set of cone tools with different tapers (22.5°, 45°, 67.5°, 90°, 112.5°, 135°, 157.5°, and 180°) was made. The cone tool was validated first in 91 able-bodied individuals and then in 30 patients with SCI. The reliability and validity of the cone tool were analyzed by comparing the results of a pinprick sensation examination with the results of the International Standards for the Neurological Classification of SCI (ISNCSCI), the cone tool, and the thermal analyzer. RESULTS: The intraclass correlation coefficient (ICC) of the cone tool in able-bodied individuals was between 0.48 and 0.94 while that of the cone tool and the ISNCSCI tool ranged between 0.43 and 0.78. Pinprick sensation in patients with SCI can be graded into five levels using four tapers (22.5°, 45°, 67.5°, and 90°): normal, slight impairment, moderate impairment, severe impairment, and complete loss of sensation. CONCLUSION: This easy-to-use cone tool can produce a reliable semi-quantitative pinprick test result and is useful for pinprick sensation examination in patients with SCI.

Surface electromyography as a measure of trunk muscle activity in patients with spinal cord injury: a meta-analytic review.

CONTEXT: Surface electromyography (SEMG) may be a sensitive marker for distinguishing the activity of trunk muscles, which are critical to functional mobility recovery in patients with spinal cord injury (SCI). OBJECTIVES: This manuscript presents a systematic review and meta-analysis of the published literature on the effect of SEMG as a measure of trunk muscle activity in patients with SCI. METHODS: A comprehensive search of the research literature included Pubmed, Medline, CNKI, WANFANG DATA, Web of Science, Elsevier, Wiley-Blackwell, Karger, OVID, and a review of reference lists within found articles. Case-control, cohort, and cross-sectional studies were included in the review. RESULTS: Eleven studies were included in this meta-analysis. Trunk muscle activities for the sitting condition were greater in patients with SCI than normal subjects. SEMG activity of trunk muscles for the sitting condition and posterior transfer was greater in patients with high level (HL)-SCI compared to those with low level (LL)-SCI. In addition, across studies, the level of trunk muscle activity for various difficulty settings was different for a given SCI group. CONCLUSION: This systematic review evaluated the value of trunk muscles for patients with SCI. We recommend use of SEMG as an assessment tool for improving the comparability and interpretability of trunk muscle activity of SCI therapeutic strategies.