International Spinal Cord Injury Community Survey: Socioeconomic and Healthcare Satisfaction in Spain.

STUDY DESIGN: Survey study. OBJECTIVES: People living with spinal cord injury (SCI) are major healthcare and rehabilitation services consumers and have unmet healthcare needs. This study aimed to describe the socioeconomic characteristics of people living with SCI in Spain and to determine the level of use and satisfaction with the public healthcare system. METHODS: We conducted a survey (the Spanish version of the International Spinal Cord Injury Community Survey) consisting of 134 questions. We analyzed the age, sex, neurological classification of the injury on the American Spinal Injury Association Impairment Scale, time of injury, socio-occupational and socioeconomic status, and level of use and satisfaction with the public health system. RESULTS: 472 people responded to the survey [68.9% male; mean age 51.2 years (standard deviation: 13.9 years); 61.7% with paraplegia and 38.3% with tetraplegia]. 89.2% of those surveyed were unemployed and 77.1% received a disability pension. The number of medical visits was 2.3/year, and 19.8% of the patients required at least 1 hospital admission during the previous year. 94.7% of the people with SCI considered the health care received as good or very good. CONCLUSIONS: Respondents with SCI in Spain considered they had good access to primary and specialized care and were satisfied with the healthcare system. Notably, we observed a high average of annual visits to medical professionals but a low rate of hospitalizations. Technical aids and state services related to disability should be the most important elements to be improved.

Desarrollo de la versión española de la Wisconsin Gait Scale. Análisis de consistencia de los parámetros temporo-espaciales con la valoración de la marcha en pacientes con ictus / Development of the Spanish version of the Wisconsin Gait Scale. Reliability and consistency analysis of spatial and temporal parameters with gait assessment in stroke patients

Antecedentes y objetivo: Realizar la adaptación transcultural de la escala Wisconsin Gait Scale (WGS) al castellano y comprobar las características de fiabilidad, validez y sensibilidad al cambio. Material y método: Estudio descriptivo transversal. Pacientes con ictus. Llevado a cabo entre septiembre 2017 y marzo 2019. Desarrollamos la versión española mediante la metodología traducción-retrotraducción, y valoramos la equivalencia cultural en los ítems problemáticos. La versión española de la WCS fue aplicada a 25 pacientes con Ictus, valorados en la Unidad de Análisis de movimiento del hospital. Todos fueron evaluados por dos evaluadores independientes, realizando posteriormente el análisis instrumentado de marcha mediante el Elite-System (BTS), SMART-System. Se comprobó la fiabilidad interobservador (coeficiente correlación intraclase), consistencia interna (alpha Cronbach), la validez mediante comprobación de su relación con parámetros espaciotemporales y la sensibilidad al cambio. Resultados: Tras la traducción-retrotraducción el comité determinó la equivalencia cultural con excepción de dos ítems, en los que existieron discrepancias, alcanzando el consenso para la versión final.La fiabilidad interobservador presentó un coeficiente intraclase de 0,99 para el total y > 0,7 para cada ítem; comprobándose la consistencia interna con alpha Cronbach > 0,8; confirmando la validez del instrumento al demostrar la relación entre la WGS y los parámetros temporo-espaciales (p < 0,05); la sensibilidad al cambio se objetivó significativa al comparar los resultados de la escala al inicio y al mes (coeficiente de correlación 0,92). Conclusión: La versión española de la WGS es un instrumento culturalmente equivalente a la versión original, proporcionando un medio objetivo para documentar el análisis observacional de la marcha en pacientes post ictus por los equipos de rehabilitación.(AU)

Background and objective: We aimed to perform a cross-cultural adaptation of the Wisconsin Gait Scale (WGS) to Spanish and ensure its reliability, validity and sensitivity. Material and method: A cross-sectional descriptive study was conducted in patients with stroke between September 2017 and March 2019. We developed the Spanish version through the translation-back-translation method, and reached a consensus on the problematic items. The Spanish version of the WGS was applied in 25 post-stroke patients, assessed in the Hospital Movement Analysis Unit. All patients were evaluated by 2 independent evaluators, subsequently performing the instrumented gait analysis using the Elite System (BTS), SMART System. Interobserver confirmation (intraclass correlation coefficient), internal consistency (Cronbach's alpha), and validation were verified by checking their relationship with spatial and temporal parameters and sensitivity to change (Pearson's correlation). Results: After the translation-back-translation, the committee found cultural equivalence in all but 2 items and reached a consensus on the final version.Interobserver reliability had an intraclass coefficient of 0.99 for the total score, and > 0.7 for each item; Cronbach's alpha was > 0.8; the validity between the WGS and the spatial and temporal parameters was significant (p < 0.05). Sensitivity to change was significant on comparison of the results of the scale at baseline and at 1 month (correlation coefficient 0.92). Conclusion: The Spanish version of the WGS is a culturally equivalent instrument to the original version, providing an objective means to document observational analysis of gait in post-stroke patients by rehabilitation teams.(AU)

[Development of the Spanish version of the Wisconsin Gait Scale. Reliability and consistency analysis of spatial and temporal parameters with gait assessment in stroke patients]. / Desarrollo de la versión española de la Wisconsin Gait Scale. Análisis de consistencia de los parámetros temporo-espaciales con la valoración de la marcha en pacientes con ictus.

BACKGROUND AND OBJECTIVE: We aimed to perform a cross-cultural adaptation of the Wisconsin Gait Scale (WGS) to Spanish and ensure its reliability, validity and sensitivity. MATERIAL AND METHOD: A cross-sectional descriptive study was conducted in patients with stroke between September 2017 and March 2019. We developed the Spanish version through the translation-back-translation method, and reached a consensus on the problematic items. The Spanish version of the WGS was applied in 25 post-stroke patients, assessed in the Hospital Movement Analysis Unit. All patients were evaluated by 2 independent evaluators, subsequently performing the instrumented gait analysis using the Elite System (BTS), SMART System. Interobserver confirmation (intraclass correlation coefficient), internal consistency (Cronbach's alpha), and validation were verified by checking their relationship with spatial and temporal parameters and sensitivity to change (Pearson's correlation). RESULTS: After the translation-back-translation, the committee found cultural equivalence in all but 2 items and reached a consensus on the final version. Interobserver reliability had an intraclass coefficient of 0.99 for the total score, and > 0.7 for each item; Cronbach's alpha was > 0.8; the validity between the WGS and the spatial and temporal parameters was significant (p < 0.05). Sensitivity to change was significant on comparison of the results of the scale at baseline and at 1 month (correlation coefficient 0.92). CONCLUSION: The Spanish version of the WGS is a culturally equivalent instrument to the original version, providing an objective means to document observational analysis of gait in post-stroke patients by rehabilitation teams.

A randomized controlled trial to assess the efficacy and cost-effectiveness of urinary catheters with silver alloy coating in spinal cord injured patients: trial protocol.

BACKGROUND: Patients with non-acute spinal cord injury that carry indwelling urinary catheters have an increased risk of urinary tract infection (UTIs). Antiseptic Silver Alloy-Coated Silicone Urinary Catheters seems to be a promising intervention to reduce UTIs; however, actual evidence cannot be extrapolated to spinal cord injured patients. The aim of this trial is to make a comparison between the use of antiseptic silver alloy-coated silicone urinary catheters and the use of standard urinary catheters in spinal cord injured patients to prevent UTIs. METHODS/DESIGN: The study will consist in an open, randomized, multicentre, and parallel clinical trial with blinded assessment. The study will include 742 spinal cord injured patients who require at least seven days of urethral catheterization as a method of bladder voiding. Participants will be online centrally randomized and allocated to one of the two study arms (silver alloy-coated or standard catheters). Catheters will be used for a maximum period of 30 days or removed earlier if the clinician considers it necessary. The main outcome will be the incidence of UTIs by the time of catheter removal or at day 30 after catheterization, the event that occurs first. Intention-to-treat analysis will be performed, as well as a primary analysis of all patients. DISCUSSION: The aim of this study is to assess whether silver alloy-coated silicone urinary catheters improve ITUs in spinal cord injured patients. ESCALE is intended to be the first study to evaluate the efficacy of the silver alloy-coated catheters in spinal cord injured patients. TRIAL REGISTRATION: NCT01803919.