Pain medication misuse in the South African spinal cord injury context.

Background: Pain after spinal cord injury (SCI) is debilitating and has been reported to be difficult to treat, despite pharmacological interventions. Pain medication misuse (PMM) and associated individual factors among people with spinal cord injury (PWSCI) are scarce. Aim: To determine PMM and the associated factors in PWSCI. Setting: Homes of community-dwelling manual wheelchair users with SCI in South Africa. Methods: Community-dwelling PWSCI (n = 122) were consecutively sampled and the Pain Medication Questionnaire (PMQ) was used to determine PMM. Descriptive statistics, Fisher's exact test, independent t-tests, and simple linear regression tests were performed using SPSS v27. Testing was conducted at the 0.05 level of significance. Results: Eighty-five per cent of the participants reported the presence of pain and 48.1% of them used pain medication. Forty-four percent of people who used pain medication scored ≥ 30, indicative of serious aberrant drug-taking behaviours. Opioids were mainly used for neuropathic pain and in combination with other types of medications such as anticonvulsants and non-steroidal anti-inflammatories (44.0%). Pain severity and the type of pain medication were found to be predictors of PMM (p < 0.01 respectively). Conclusion: Pain relief after SCI remains difficult to achieve, with an evident high risk of PMM, which may lead to long-lasting side effects, dependency, or overdose. Contribution: This study has shown the need for the assessment of the potential risk of dependency before prescribing pain medication, particularly opioids to PWSCI.

Development of a pain self-management intervention framework for people with spinal cord injury.

BACKGROUND:  Pain is the most common reason for medical visits to primary health care practitioners. Pain self-management interventions are encouraged and there is no known self-management intervention framework available that clinicians and people with spinal cord injury (PWSCI) can use to guide treatment selection. AIM:  This study aimed to develop a pain self-management intervention framework for PWSCI. SETTING:  Online and facilitated in Gauteng, South Africa. METHODS:  A three-round modified e-Delphi method was used to reach an 80% consensus among a 21-expert panel. Fifty-nine interventions were distributed via REDCap and a final online audio meeting was held to either include or exclude interventions in the final framework. SPSS v27 was used to analyse descriptive data and content analysis was used for qualitative responses. RESULTS:  The final developed pain self-management framework consists of 56 interventions and includes interventions from multiple health professions to encompass medical, psychological, therapeutic and social interventions. Interventions are also specified for nociceptive and/or neuropathic pain and grouped according to the biopsychosocial model. CONCLUSION:  The interprofessional framework may be used as a guideline for PWSCI to alleviate pain, as well as assist health professionals in clinical decision-making, by providing them with the freedom to choose acceptable and adequate interventions that may be appropriate to treat the affected individual's pain.Contribution: Pain management is a basic need at the primary healthcare level and PWSCI need access to the broad range of interventions available to manage their pain. The framework highlights the variety of appropriate interventions to guide both health professionals and PWSCI with pain relief options.

Determining the management of pain in people with spinal cord injury by physiotherapists in South Africa.

Background: Pain after spinal cord injury (SCI) is common, and physiotherapy plays a pivotal role in alleviating pain for people with SCI. Objective: To determine the modalities that physiotherapists in South Africa use to treat SCI-related pain and the factors that guide the selection of treatment modalities. Method: A quantitative, cross-sectional design using a self-developed online survey was distributed to physiotherapists belonging to the South African Society of Physiotherapy and the Physiotherapy Association of South Africa. Data were analysed using SPSS v26, where descriptive data were analysed using frequency, percentages, means and standard deviations, and Fisher's exact tests for inferential analyses. Open-ended questions underwent thematic analysis. Results: Forty-six responses were received. The most-used modalities were transcutaneous electrical nerve stimulation (29.8%), exercises (27.7%) and joint mobilisations (29.8%). Most physiotherapists used standardised measurements to objectively assess pain characteristics, with the visual analog scale being the most used (70.2%). Except for the cost of treatment, the factors that guided the selection of the modalities included the pain type, onset, duration, location and intensity, pain interference, duration of treatment, patient's preferences, other treatments that the patient was receiving for pain and psychosocial factors (87.2%). Conclusions: Local physiotherapists use pain management modalities that are supported by the evidence to treat SCI-related pain. Clinical implications: This study highlights the common modalities used by physiotherapists to treat SCI-related pain, as well as the selection criteria for the modalities. Owing to the low response rate, we caution against generalising these findings across the SCI pain management field.

An evaluation of the structure and process of stroke rehabilitation in primary, secondary and tertiary hospitals in Ghana.

Background: Evidence shows that quality indicators such as the structure and process of stroke rehabilitation can influence patient outcomes. However, not much attention has been paid to the study of these issues in low- and middle-income countries such as Ghana. Objectives: Our study evaluated the structure and process of stroke rehabilitation in primary, secondary and tertiary hospitals in the Greater Accra Region of Ghana. Method: A cross-sectional survey was conducted involving 111 healthcare professionals. The World Health Organization (WHO) situational analysis and Measure of Processes of Care for Service Providers for Adults (MPOC-SP[A]) questionnaires were administered to gather information on the structure and process of stroke rehabilitation. Descriptive statistics were used to summarise data, and chi-square and Kruskal-Wallis tests were used to establish associations and comparisons, respectively. Results: A stroke unit was only available in the tertiary hospital. Although all three hospitals had a multidisciplinary team approach to care, the constituents differed. Length of hospital-stay, duration of treatment and basis for discharge from acute care were not associated with the hospitals. Therapy sessions, access to computed tomography (CT) and magnetic resonance imaging (MRI) scanning were dependent on the hospitals. Conclusion: The structure and process of stroke rehabilitation across the three hospitals were similar in some constructs and different in others. Clinical implications: Data gathered will help to provide information on the available structure and processes of stroke rehabilitation, which could help assess the quality of care provided.

The presence of pain in community-dwelling South African manual wheelchair users with spinal cord injury.

Background: Pain after spinal cord injury (SCI) is common and is likely to continue throughout life with varying levels of severity. Objective: To determine the presence of pain, the sociodemographic and injury profile of community-dwelling manual wheelchair users. Method: This quantitative correlational study used a sociodemographic and injury profile sheet and the Douleur Neuropathique 4 Questions (DN4) questionnaire to document demographic, SCI profiles as well as pain characteristics. Pain severity was determined using the Numeric Rating Scale. Data were analysed using the Statistical Package for the Social Sciences (SPSS) v27 at 0.05 level of significance. Results: The pain rate was 104; 85% of 122 participants and mainly in those with complete SCI (77.9%). Neuropathic pain was more common (76; 62.5%) and significantly associated (p < 0.05) with higher pain severity. Pain was mainly in one area of the body (59; 48.4%) but occurring in up to five areas. The most painful area had a mean severity of 6.7/10; was more common in the lower limbs below the injury level (48; 39.4%); and was burning in nature (40; 32.7%). Conclusions: Pain after SCI is as problematic in the South African context as it is globally. With the rising SCI prevalence in the country, understanding pain and its presentation is important for holistic management of a person with SCI. Clinical implications: In-depth assessment of pain should be conducted and appropriate management interventions for specific pain types be prescribed to effectively reduce pain.

Associations between health behaviour, secondary health conditions and quality of life in people with spinal cord injury.

BACKGROUND: The development of secondary health conditions (SHCs) after spinal cord injury (SCI) is common and can affect an individual's emotional well-being, and his or her health-related quality of life (QOL). Little is known about relationships between performing health-benefiting behaviours and the presence (or absence) of SHCs and QOL, particularly in South Africa. OBJECTIVES: This research study was conducted in order to determine the associations between health behaviour, SHCs and QOL in people with SCI (PWSCI). METHOD: This cross-sectional study included 36 PWSCI discharged from a private rehabilitation facility in Pretoria, South Africa. The PWSCI completed questionnaires pertaining to lifestyle, independence, presence of SHCs, social support and QOL. Data were analysed using descriptive and inferential statistics such as correlation tests and chi-square test of independence (x2 ) using the SPSS v25. Moderate, moderately high and high correlations are reported (Pearson r ≥ 0.4). Results were significant if p < 0.05. RESULTS: Participation in health-benefiting behaviour was associated with increased QOL (r = 0.457, p < 0.01) and increased social support from family and friends (r = 0.425, p < 0.01), which was associated with increased QOL (r = 0.671, p < 0.001). Not participating in specific neuromusculoskeletal health behaviours was found to be associated with the overall presence of SHCs (r = -0.426, p < 0.01). CONCLUSIONS: Participating in health-benefiting behaviour can reduce the development of SHCs and subsequently increase QOL in PWSCI. Health professionals must focus on minimising the development of SHCs by providing specific education on good health-benefiting behaviour.

The relationship between physical fitness and community participation in people with spinal cord injury.

BACKGROUND: People with spinal cord injury (PWSCI) who use wheelchairs for mobility tend to be physically inactive because of their limited mobility. Poor endurance and exercise tolerance, associated with poor physical fitness, can make it challenging to meet the physical demands of activities such as manoeuvring a wheelchair over gravel roads. This may lead to poor community participation in activities PWSCI were involved in pre-morbidly. To date, no studies have been conducted in South Africa on what the relationship is between physical fitness and community participation in PWSCI. AIM: The purpose of this study was to establish the relationship between physical fitness and community participation in PWSCI. METHODOLOGY: An exploratory cross-sectional survey was conducted on PWSCI living in the Greater Tshwane Metropolitan City. Physical fitness was measured using the 6 minute push test (6MPT) and the Borg scale. Community participation was measured using the Reintegration to Normal Living Index (RNLI). The data were analysed using the Spearman's Rank correlation at a 5% level of significance. RESULTS: Moderate to poor associations were found between the 6MPT and the Borg scale with the RNLI (r = 0.637; p < 0.001 and r = -0.325; p = 0.013, respectively). These results indicate that the participants who were able to push further in 6 min and had better endurance were more satisfied with their perceived community participation. CONCLUSION: This study shows that there is a relationship between physical fitness and community participation in PWSCI. Information gained from this study lays the foundation for more studies in this area, and for possible improvement in rehabilitation practice.