Validity and reliability study of the Turkish version of Spinal Cord Independence Measure-III.

STUDY DESIGN: This is a multicenter, prospective study. OBJECTIVES: The objective of this study was to assess the validity and reliability of the Turkish version of Spinal Cord Independence Measure-III (SCIM-III). SETTING: This study was conducted in rehabilitation centers of three hospitals in Turkey. METHODS: Two-hundred and four (n=204) consecutive patients with spinal cord injury (SCI) were included in the study. Each patient was examined by two physicians. Neurologic impairment was measured according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) 2000 revised criteria. Backward and forward translation of SCIM-III was performed by native speakers in both languages. To measure the validity of SCIM-III, the scores were compared with patients' AIS grades, total motor scores and the Health Survey Short Form-36 (SF-36) subscale scores. SCIM-III was analyzed for test-retest reliability by the same rater on 49 patients during the follow-up evaluations. RESULTS: Total agreement values between raters changed between 75.9 and 100%. Kappa values were all above 0.6, and they were statistically significant. The Pearson's correlation values between the raters were very high and statistically significant. The Cronbach's α-values for the two consecutive raters were 0.865 and 0.896. Test-retest reliability was assessed by paired samples t-test, and no significant difference was observed. SCIM-III and SF-36 physical (r=0.339, P<0.005) and general health scores (r=0.200, P<0.005) showed correlation. All subscales of the SCIM-III, with the exception of self-care, had significant differences in comparison with the AIS grades. SCIM-III total and total motor scores showed correlation (r=0.585, P<0.001). CONCLUSION: The Turkish version of SCIM-III was found to be valid and reliable.

Intermittent catheterization in patients with traumatic spinal cord injury: obstacles, worries, level of satisfaction.

OBJECTIVES: The aim of this study is to examine the obstacles in people with traumatic spinal cord injury (SCI) face performing intermittent catheterization (IC), also their worries and level of satisfaction. METHODS: Two hundred sixty-nine patients performing IC for at least 3 months were asked to fill-out a questionnaire about their opinions on IC. RESULTS: In total, 69.5% of patients performed IC themselves, 10.4% had performed by their mothers, 7.8% by another caregiver and 7.4% by their spouse. For the 72 (26%) patients unable to apply IC, reasons were insufficient hand function (56.1%), being unable to sit appropriately (35.4%) and spasticity (8.5%). In all, 70% of male patients had insufficient hand function, 20% could not sit and 10% had spasticity while 56.3% of female patients could not sit, 37.5% had insufficient hand function and 63% had spasticity. Difference between sexes was found to be statistically significant (P<0.05). Worries patients had when starting IC were fear of being dependent on IC (50.2%), accidentally injuring self (43.8%), embarrassment (43.2%), causing an infection (40.2%), bleeding (32.7%), fear of feeling pain (30.2%) and hygiene (24.7%). More women felt embarrassment; other items were similar in both sexes. In all, 46.9% of patients had urinary incontinence in intervals. CONCLUSION: In total, 69.5% of patients performed IC themselves. Men's most common obstacle was insufficient hand function while women's was being unable to sit appropriately. Patients' most common worries were being dependent on IC for life. In all, 46.9% had incontinence in intervals; 47.9% said IC improved their life quality; and 97.4% preferred IC over continuous catheterization.

Neurogenic bladder in patients with traumatic spinal cord injury: treatment and follow-up.

STUDY DESIGN: Multi-center, cross-sectional study. OBJECTIVES: Our aim was to evaluate the treatment methods and follow-up of neurogenic bladder in patients with traumatic spinal cord injury retrospectively using a questionnaire. SETTING: Turkey. METHODS: Three hundred and thirty-seven patients who had spinal cord injury for at least 2 years were enrolled from six centers in the neurogenic bladder study group. They were asked to fill-out a questionnaire about treatments they received and techniques they used for bladder management. RESULTS: The study included 246 male and 91 female patients with a mean age of 42±14 years. Intermittent catheterization (IC) was performed in 77.9% of the patients, 3.8% had indwelling catheters, 13.8% had normal spontaneous micturition, 2.6% performed voiding maneuvers, 1.3% used diapers and 0.6% used condom catheters. No gender difference was found regarding the techniques used in bladder rehabilitation (P>0.05). Overall, 63.2% of patients used anticholinergic drugs; anticholinergic drug use was similar between genders (P>0.05). The most common anticholinergic drug used was oxybutynin (40.3%), followed by trospium (32.6%), tolterodine (19.3%) darifenacin (3.3%), propiverine (3.3%) and solifenacin (1.1%). The specialties of the physicians who first prescribed the anticholinergic drug were physiatrists (76.2%), urologists (22.1%) and neurologists (1.7%). Only four patients had previously received injections of botulinum-toxin-A into the detrusor muscle and three of them stated that their symptoms showed improvement. Most of the patients (77%) had regular follow-up examinations, including urine cultures, urinary system ultrasound and urodynamic tests, when necessary; the reasons for not having regular control visits were living distant from hospital (15.3%) and monetary problems (7.7%). Of the patients, 42.7% did not experience urinary tract infections (UTI), 36.4% had bacteriuria but no UTI episodes with fever, 15.9% had 1-2 clinical UTI episodes per year and 5% had ⩾3 clinical UTIs. The clinical characteristics of patients with and without UTI (at least one symptomatic UTI during 1 year) were similar (P>0.05). The frequency of symptomatic UTI was similar in patients using different bladder management techniques (P>0.05). CONCLUSION: The most frequently used technique for bladder rehabilitation in patients with SCI was IC (77.9%). In all, 63.2% of patients used anticholinergic drugs, oxybutynin being the most commonly used drug. Also, 77% of patients had regular control visits for neurogenic bladder; 42.7% did not experience any UTIs.

Sexual problems of women with spinal cord injury in Turkey.

OBJECTIVES: Spinal cord injury (SCI) is a traumatic event that affects many facets of the injured people's lives. One aspect is sexual functioning. The purpose of this study is to identify the sexual problems of women with SCI and determine their level of knowledge about sexuality. METHODS: Twenty-six women with SCI for longer than 6 months were evaluated. Demographic information, sexual experiences were surveyed. Patients were also asked if and how they received sexual health consultation after SCI. Female Sexual Function Index (FSFI) and Beck Depression Inventory were evaluated. RESULTS: In this study, average age of the women with SCI was 32.96±8.23 years (22-50 years). Eight patients had regular sexual intercourse while one married woman did not have any sexual relationship after SCI. Twenty-four of the patients in the study received no information about pregnancy or sexual health after SCI. All women were willing to receive information about sexuality after SCI. These patients expected the doctors to start the conversation about sexuality rather than asking about it. FSFI survey revealed that all the patients had sexual dysfunction. CONCLUSION: Sexual rehabilitation should thus be fully addressed in all spinal units and rehabilitation centers, along with other aspects of rehabilitation.

Elbow problems in paraplegic spinal cord injured patients: frequency and related risk factors--a preliminary controlled study.

STUDY DESIGN: Cross-sectional controlled study. OBJECTIVES: To evaluate the elbow joint with ultrasound in paraplegic patients, determine the related factors and compare it with healthy controls. SETTING: A training and research rehabilitation hospital in Istanbul. METHODS: A total of 30 paraplegic patients and 20 healthy controls were included in the study. Patients demographic data, pain in the elbow joint, level and duration of injury, ambulation status, type of wheelchair used, daily duration of wheelchair and other ambulation equipment usage, transfers being dependent or independent, daily number of push-ups were recorded. Elbow joints were evaluated with ultrasound for presence of fluid and thickness of the triceps tendon. RESULTS: Mean triceps tendon thickness values of the right side were larger in spinal cord injury (SCI) patients when compared with those of healthy controls'. Joint effusion on the right elbow joint was also found to be more common in SCI patients than in normal subjects. Triceps tendon thickness measurements were not found to be correlated with demographic and clinical factors. Seven paraplegic patients (23%) reported that they have pain in the elbow. CONCLUSION: In this preliminary study, our results showed that right elbow effusion was more frequent and right triceps tendon was thicker in SCI patients when compared with healthy subjects.

The effect of low-frequency TENS in the treatment of neuropathic pain in patients with spinal cord injury.

STUDY DESIGN: Prospective, randomized and controlled study. OBJECTIVES: The aim of the study was to investigate the effect of low-frequency transcutaneous electrical nerve stimulation (LF-TENS) in the treatment of neuropathic pain in patients with spinal cord injury (SCI). METHODS: A total of 33 SCI patients with neuropathic pain were included in the study. History, duration, localization and characteristics of pain were recorded. Visual analog scale (VAS) was used to investigate the effect of LF-TENS four times during the day. Patients were randomly assigned to study and control groups. The study group was treated with 30 min of LF-TENS daily for 10 days while the placebo group with 30 min of sham TENS. RESULTS: The mean age of the patients was 36.55±10.36 years. Out of 33 patients, 7 were tetraplegic and 26 were paraplegic. Twenty-three patients had complete SCI while 10 patients had incomplete injuries. Two groups were similar with respect to age, gender, duration, level and severity of injury. In the LF-TENS treatment group, a statistically significant reduction of the VAS values was observed, however, such an effect was not evident in the control group. CONCLUSION: This study revealed that in treatment of neuropathic pain of SCI patients, LF-TENS may be effective. PERSPECTIVE: This article presents LF-TENS may effectively complement pharmacological treatment in patients with SCI and neuropathic pain.

Effects of different bladder management methods on the quality of life in patients with traumatic spinal cord injury.

STUDY DESIGN: Multi-center, cross-sectional study. OBJECTIVES: To investigate the effects of different bladder management methods on the quality of life (QoL) in patients with spinal cord injury (SCI). SETTING: Turkey. METHODS: Consecutive SCI patients (n=195, 74.4% males), for whom at least 6 months had elapsed since the injury, were included and evaluated in five groups: normal spontaneous micturition (NSM), micturition with assisted maneuvers (MAM), aseptic intermittent catheterization by patient (IC-P), aseptic IC by an attendant/caregiver (IC-A) and indwelling catheterization. The King's Health Questionnaire was used to evaluate the patients' QoL. RESULTS: The bladder management groups were similar regarding age, time elapsed since injury, education level, marital and occupational status. There was no difference among the groups in general health perception, personal relationships and sleep/energy domain scores. While the NSM group had generally the lowest scores, that is, better QoL, the IC-A group had the highest scores, that is, poorer QoL, in most of the domains. When the patients were grouped according to the frequency of urinary incontinence or American Spinal Injury Association Impairment Scale grades, no difference was found in the domain scores of the groups except the symptom severity domain scores. No significant difference was found between paraplegic and tetraplegic patients in the King's Health Questionnaire domains. CONCLUSION: The QoL was notably affected in SCI patients in IC-A group and negative effects on emotional status, physical and social activity limitations were observed, as well.

The clinical characteristics of neuropathic pain in patients with spinal cord injury.

OBJECTIVES: The aim of the study was to evaluate the characteristics of neuropathic pain and observe intensity alterations in pain with regard to time during the day in spinal cord injury (SCI) patients. METHODS: A total of 50 SCI patients (M/F, 40/10; mean age, 35±12 years) with at-level and below-level neuropathic pain were included in the study. All patients were examined and classified according to the ASIA/ISCoS 2002 International Neurologic Examination and Classification Standards. The history, duration, localization and characteristics of the pain were recorded. Neuropathic pain of patients was evaluated with the McGill-Melzack Pain Questionnaire and LANSS (Leeds Assessment of Neuropathic Symptoms and Signs) Pain Scale. Visual analog scale (VAS) was used to measure the severity of pain four times during the day. Quality of life was analyzed with Short Form 36. RESULTS: Out of 50 patients, 10 were tetraplegic and 40 were paraplegic. In all, 28 patients had motor and sensory complete injuries (AIS A), whereas 22 patients had sensory incomplete (AIS B, C and D) injuries. The most frequently used words to describe neuropathic pain were throbbing, tiring, hot and tingling. Pain intensity was significantly higher in the night than in the evening, noon and morning (P<0.05) (VAS morning: 5.16±2.42, VAS noon: 5.24±2.52, VAS evening: 5.80±2.46 and VAS night: 6.38±2.19). CONCLUSION: Neuropathic pain is a serious complaint in SCI patients and affects their quality of life. Neuropathic pain intensity was higher in the night hours than other times of day. This situation reinforces the need for a continued research and education on neuropathic pain in SCI.

Investigation of cartilage degradation in patients with spinal cord injury by CTX-II.

STUDY DESIGN: Clinical cross-sectional study. OBJECTIVES: To investigate the cartilage degradation by turnover of C-telopeptide fragments of collagen type-II (CTX-II), a molecule specific for articular cartilage in spinal cord injured patients with respect to clinical functional status. SETTING: Physical Medicine and Rehabilitation Clinics, hospital settings. METHODS: In 68 patients with spinal cord injury (SCI) level and severity of lesion, duration of disease, American Spinal Injury Association Impairment Scale (AIS), motor and sensory score, presence of spasticity, functional ambulation score (FAS) and duration of daily ambulation were evaluated. Cartilage degradation was demonstrated by urinary CTX-II (uCTX-II) measured by enzyme-linked immunosorbent assay. T test, analysis of variance and Pearson correlation analysis were used for statistical calculations. RESULTS: uCTX-II level was significantly higher in patients with AIS grade A, non-functional ambulators or in patients who did not ambulate at all (P<0.05). Although AIS grade, lower extremity motor score, FAS score and duration of daily ambulation were found to be correlated (P<0.05) with uCTX-II, duration of disease, level of neurological lesion, presence of spasticity were not. CONCLUSION: This is the first study providing evidence that cartilage degradation is associated with elevated uCTX-II levels in non-ambulating or non-functional ambulating SCI patients. AIS grade A, FAS zero score and no time for daily ambulation were found to cause significant differences in CTX-II level. It may be important to initiate therapeutic programs as soon as possible after SCI to prevent cartilage atrophy.

Metabolic regulation of aortic chemoreceptor responses to CO2.

Modification of the unusually feeble responses of aortic chemoreceptors to CO2 was studied in cats which were anethetized, paralyzed, artificially ventilated and maintained at 38 degrees C. The inhibitor of oxidative phosphorylation, oligomycin, strikingly augmented the initial responses to CO2 of aortic chemoreceptors just as for carotid chemoreceptors, indicating that the basic mechanism of chemoreception might be regulated in part through energy metabolism.