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.

Myelopathy disability index: establishing criteria for mild, moderate and severe impairment in patients with degenerative cervical myelopathy.

PURPOSE: To find the cut-off values in the Myelopathy Disability Index (MDI) that will allow us to classify the severity of Degenerative Cervical Myelopathy (DCM) into mild, moderate and severe. METHODS: Cross-sectional study with prospective data collection, with a total of 64 patients diagnosed with Degenerative Cervical Myelopathy (DCM). Anthropometric, diagnostic, neurological, functional and quality of life variables were collected. A Receiver Operating Curve (ROC) was performed. The cut-off points were validated by comparing the functional status of patients in the 3 groups and their Nurick scores. RESULTS: Sixty-four patients (23 women) with a mean age of 61.97 (SD 11.57) participated in this study. The majority of patients were Nurick I (28.13%) and Nurick II (32.81%). The medium MDI was 7.36 (SD 6.66) and the mJOA was 14.08 (SD 2.57). The mild-moderate cut-off value was between 4 and 5, with an Area Under the Curve (AUC) of 0.805, sensitivity of 0.853 and specificity of 0.6. For moderate-severe, the cut-off value obtained was between 7 and 8, with an AUC of 0.862, sensitivity of 0.857 and specificity of 0.684. Patients with greater severity had significantly lower functionality, with a P-value of 0.004 in the 30 Metre Walking Test and 0.005 in the Nine-Hole Peg Test. Established severity groups were also significantly related to the different categories of the Nurick score (P-value = 0.000). CONCLUSION: MDI values between 0 and 4 correspond to mild DCM, between 5 and 7 would be moderate DCM and from 8 to 30 indicate severe DCM.

Encouraging People with Spinal Cord Injury to Take Part in Physical Activity in the COVID-19 Epidemic through the mHealth ParaSportAPP.

BACKGROUND: Although mHealth tools have great potential for health interventions, few experimental studies report on their use by people with spinal cord injuries in physical activity. OBJECTIVE: The main objective of this study was to analyze the effect of the ParaSportAPP on different physical and psychological variables in people with paraplegia. METHODS: Fourteen of these subjects made up the final sample. All the participants performed two pre-tests (control period) and a post-test with 8 months between the evaluations (COVID-19 broke out between pre-test 2 and the post-test). The ParaSportAPP was installed on their smartphones when they performed pre-test 2. The same tests were performed in the same order in all the evaluations: (i) the questionnaires PASIPD, HADS, RS-25; SCIM III and AQoL-8D, (ii) respiratory muscle strength, (iii) spirometry and (iv) cardiopulmonary exercise test. RESULTS: The results showed no differences in any of the variables studied between the measurement times. CONCLUSIONS: Although none of the variables experienced improvements, the ParaSportAPP mobile application was able to lessen the impact of the pandemic on the variables studied.

Diseño y usabilidad de ParaSportAPP: una mHealth destinada a promocionar la actividad física en personas con lesión medular / Design e usabilidade do ParaSportAPP: uma mHealth para promover a actividade física em pessoas comlesões da medula espinal / Design and usability of ParaSportAPP: an mHealth aimed at promoting physical activity in people with spinalcord injury

Objetivo: Diseñar y evaluar la usabilidad de una mHealth destinada a aumentar los niveles de actividad física en personas con paraplejia usuarias de sillade ruedas manual. Método: En primer lugar, se diseñó la mHealth ParaSportAPP mediante un comité de expertos en ejercicio físico y lesión medular. Posteriormente, una vezcreada la mHealth, se instaló ParaSportAPP en los teléfonos inteligentes de 15 personas con lesión medular dorsal usuarias de silla de ruedas. 8 mesesdespués de la instalación de la mHealth, se citó de nuevo a los participantes del estudio y cumplimentaron la Escala de Usabilidad del Sistema. Resultados: Se creó una mHealth con 79 ejercicios físicos diferentes y con dos modos distintos de transmitirlos al usuario. Además, la aplicación es capazde registrar los ejercicios físicos realizados al margen de los proporcionados por la misma y ofrece un informe a modo de feedback sobre el ejercicio físicorealizado durante el día. Asimismo, los resultados hallados mostraron una puntuación media de 77.5 (18.85) en la Escala de Usabilidad del Sistema.Conclusiones: Se ha conseguido diseñar y crear una mHealth funcional y con buenos niveles de usabilidad centrada en promocionar la actividad física enpersonas con lesión medular dorsal.(AU)

Aim: To design and evaluate the usability of an mHealth aimed at increasing physical activity levels in people with paraplegia who use manualwheelchairs. Method: Firstly, the ParaSportAPP mHealth was designed by a committee of experts in physical exercise and spinal cord injury. Subsequently, once themHealth was created, ParaSportAPP was installed on the smartphones of 15 wheelchair users with dorsal spinal cord injury. 8 months after theinstallation of the mHealth, the participants were summoned again and completed the System Usability Scale. Results: An mHealth was created with 79 different physical exercises and with two different ways of transmitting them to the user. In addition, theapplication is able to record the physical exercises performed in addition to those provided by the application itself and offers a feedback report on thephysical exercise performed during the day. The results also showed an average score of 77.5 (18.85) on the System Usability Scale. Conclusions: It has been possible to design and create a functional mHealth with good levels of usability focused on promoting physical activity in peoplewith dorsal spinal cord injury.(AU)

Objectivo: Conceber e avaliar a usabilidade de uma mHealth destinada a aumentar os níveis de actividade física em pessoas com paraplegia que utilizamcadeiras de rodas manuais. Método: Primeiro, o ParaSportAPP mHealth foi concebido por um comité de peritos em exercício físico e lesões da medula espinal. Subsequentemente,uma vez criada a mHealth, o ParaSportAPP foi instalado nos smartphones de 15 utilizadores de cadeiras de rodas com lesão da espinal medula dorsal. 8meses após a instalação do mHealth, os participantes do estudo foram novamente convocados e completaram a Escala de Usabilidade do Sistema. Resultados: Foi criada uma mHealth com 79 exercícios físicos diferentes e com duas formas diferentes de os transmitir ao utilizador. Além disso, o pedidoé capaz de registar os exercícios físicos realizados para além dos fornecidos pelo próprio pedido e oferece um relatório como feedback sobre o exercíciofísico realizado durante o dia. Além disso, os resultados encontrados mostraram uma pontuação média de 77.5 (18.85) na Escala de Usabilidade doSistema. Conclusões: Tem sido possível conceber e criar uma mHealth funcional com bons níveis de usabilidade centrada na promoção da actividade física empessoas com lesões da espinal-medula dorsal.(AU)

Impact of COVID-19 on the self-reported physical activity of people with complete thoracic spinal cord injury full-time manual wheelchair users.

CONTEXT: The emergence of COVID-19 caused a new public health crisis, leading to major changes in daily life routines, often including physical activity (PA) levels. The main goal of this study was to analyze the differences in self-reported physical activity of people with complete spinal cord injuries between the time prior to the COVID-19 lockdown and the lockdown period itself. METHODS: A sample of 20 participants with complete thoracic spinal cord injuries completed the Physical Activity Scale for Individuals with Physical Disabilities before and during the COVID-19 lockdown. RESULTS: The results showed differences between the pre-lockdown and lockdown measurements in total self-reported PA (z=-3.92; P<0.001; d=1.28), recreational PA (z=-3.92; P<0.001; d=1.18) and occupational PA (z=-2.03; P=0.042; d=0.55). Nevertheless, no differences were found in housework PA between the two time periods. Furthermore, the results showed differences in total minutes (z=-3.92; P<0.001; d=1.75), minutes spent on recreational activities (z=-3.82; P<0.001; d=1.56) and minutes spent on occupational activities (z=-2.032; P=0.042; d=0.55) of moderate/vigorous intensity. CONCLUSIONS: Individuals with thoracic spinal cord injuries who were full-time manual wheelchair users displayed lower levels of PA during the pandemic than in the pre-pandemic period. The results suggest that the prohibition and restrictions on carrying out recreational and/or occupational activities are the main reasons for this inactivity. Physical activity promotion strategies should be implemented within this population to lessen the effects of this physical inactivity stemming from the COVID-19 pandemic.

Validación al español de la versión en inglés del Neurogenic Bowel Dysfunction score (NBD score) en pacientes con lesión neurológica de origen central / Spanish validation of the Neurogenic Bowel Dysfunction score -NBD score- in patients with central neurological injury

Objetivo: validar al español el Neurogenic Bowel Dysfunction score (NBD score) que cuantifica la severidad de la disfunción intestinal en pacientes con discapacidad por lesión neurológica central y la satisfacción con el manejo intestinal.Material59 pacientes, 30 pacientes afectados de discapacidad intestinal por lesión medular y 29 pacientes afectados de discapacidad intestinal por accidente vascular cerebral.ResultadosEl resultado de la fiabilidad del constructo de la traducción al español del NBD Score para todo el grupo de pacientes muestra una α de Cronbach para todas las variables de 0,970 y el resultado de la fiabilidad del NBD score para todo el grupo en el test-retest, mediante el coeficiente de correlación interclase fue 0,970 (95% IC 0,954-0,980).ConclusionesLa versión traducida al español del NBD score es una herramienta válida para ser utilizada en nuestro medio, permitirá un acercamiento más real a la situación de discapacidad de cada paciente en relación con la disfunción intestinal neurógena y conocer la intensidad de la afectación y la eficacia en su manejo mediante las diferentes propuestas terapéuticas. (AU)

Objective: to validate into Spanish the Neurogenic Bowel Dysfunction score (NBD score) that quantifies intestinal dysfunction severity in patients with disabilities due to central neurological injury and satisfaction with bowel management.Material59 patients, 30 patients affected by intestinal disability due to spinal cord injury and 29 patients with intestinal disability due to stroke.ResultsThe result of the reliability of the construction of the Spanish translation of the NBD score for the whole group of patients shows a Cronbach's α for all the variables of 0.970 and the result of the reliability of the NBD score for the whole group in test-retest, using the interclass correlation coefficient, was 0.970 (95% CI 0.954-0.980).ConclusionsThe Spanish version of the NBD score is a valid tool for use in our environment; it will allow a more real approach to the disability situation of each patient in relation to neurogenic intestinal dysfunction and knowledge of the degree and the involvement and effectiveness of management through different therapeutic proposals. (AU)

Validation of Using Smartphone Built-In Accelerometers to Estimate the Active Energy Expenditures of Full-Time Manual Wheelchair Users with Spinal Cord Injury.

This study aimed to investigate the validity of using built-in smartphone accelerometers to estimate the active energy expenditures of full-time manual wheelchair users with spinal cord injury (SCI). Twenty participants with complete SCI completed 10 5-min daily activities that involved the upper limbs, during which their oxygen consumption and upper limb activity were registered using a portable gas analyzer and a smartphone (placed on the non-dominant arm), respectively. Time series of 1-min averaged oxygen consumption and 55 accelerometer variables (13 variables for each of the four axes and three additional variables for the correlations between axes) were used to estimate three multiple linear models, using a 10-fold cross-validation method. The results showed that models that included either all variables and models or that only included the linear variables showed comparable performance, with a correlation of 0.72. Slightly worse general performance was demonstrated by the model that only included non-linear variables, although it proved to be more accurate at estimating the energy expenditures (EE) during specific tasks. These results suggest that smartphones could be a promising low-cost alternative to laboratory-grade accelerometers to estimate the energy expenditure of wheelchair users with spinal cord injury during daily activities.

Spanish validation of the Neurogenic Bowel Dysfunction score -NBD score- in patients with central neurological injury. / Validación al español de la versión en inglés del Neurogenic Bowel Dysfunction score (NBD score) en pacientes con lesión neurológica de origen central.

OBJECTIVE: to validate into Spanish the Neurogenic Bowel Dysfunction score (NBD score) that quantifies intestinal dysfunction severity in patients with disabilities due to central neurological injury and satisfaction with bowel management. MATERIAL: 59 patients, 30 patients affected by intestinal disability due to spinal cord injury and 29 patients with intestinal disability due to stroke. RESULTS: The result of the reliability of the construction of the Spanish translation of the NBD score for the whole group of patients shows a Cronbach's α for all the variables of 0.970 and the result of the reliability of the NBD score for the whole group in test-retest, using the interclass correlation coefficient, was 0.970 (95% CI 0.954-0.980). CONCLUSIONS: The Spanish version of the NBD score is a valid tool for use in our environment; it will allow a more real approach to the disability situation of each patient in relation to neurogenic intestinal dysfunction and knowledge of the degree and the involvement and effectiveness of management through different therapeutic proposals.

Stress and autonomic response to sleep deprivation in medical residents: A comparative cross-sectional study.

The aim of this study was to evaluate the stress suffered by medical residents as the result of being on call for 24 hours, from a multidimensional approach. Two groups of medical residents selected according to their work shift, participated in the study: one group (n = 40) was sleep-deprived after having been actively on-call for 24 hours, and another contrast group (n = 18) had performed a normal work day and were not sleep-deprived. All participants completed pre-post measures during a 24 h cycle. These were administered on both occasions at 8 am. The measures included HRV, cortisol, cognitive performance and transitory mood. The effect of the group x phase interaction was significant for all variables analysed, indicating that doctors in the 24h on-call shift group showed significant deterioration in all physiological, performance and mood indicators in comparison with the participants in the group not on call. These results suggest the need to review medical on-call systems, in order to reduce the stress load, which has a direct effect on working conditions.

Validación española del cuestionario International Spinal Cord Injury Pulmonary Function Basic Data Set para valorar la repercusión de la lesión medular en el sistema respiratorio / Spanish validation of the International Spinal Cord Injury Pulmonary Function Basic Data Set questionnaire for the study of the repercussion of spinal cord injury in the respiratory system

Introducción y objetivo: La disfunción del sistema respiratorio y las complicaciones respiratorias en la lesión medular repercuten en la morbimortalidad. El objetivo de este trabajo fue: 1) traducir y validar al español el cuestionario de consenso internacional: International Spinal Cord Injury Pulmonary Function Basic Data Set, y 2) determinar la influencia de la lesión medular crónica en el sistema respiratorio, en términos de funcionalismo respiratorio. Material y método: Traducción y validación al español del cuestionario de consenso internacional de la función pulmonar para la lesión medular. Se realizó un estudio de fiabilidad del cuestionario y un estudio descriptivo transversal para determinar el estado del sistema respiratorio en los lesionados medulares. Resultados: El 91,9% no presentaban ninguna enfermedad respiratoria antes de la lesión medular. El 54,8% tenían historia tabáquica. El 27,4% presentaron complicaciones respiratorias. Los resultados de pruebas de función respiratoria fueron FVC 67%, FEV1 72% y PEF 70%. En cuanto a la fiabilidad y concordancia, fue del 98%. Conclusión: El cuestionario de consenso internacional sobre la función pulmonar en su versión española es una herramienta útil para el estudio de la afectación respiratoria en la lesión medular (AU)

Introduction and objective: The dysfunction of the respiratory system and the breathing complications in persons with injured spinal cord has an effect on the morbidity and the mortality of the disease. The objectives were: 1) to translate to Spanish and validate the questionnaire of international consensus: International Spinal Cord Injury Pulmonary Function Basic Data Set, and 2) to determine the influence of chronic spinal cord injury in the respiratory system in terms of respiratory functionalism. Materials and method: Translation to Spanish and validation of the questionnaire of international consensus intended for the study of the pulmonary function in spinal cord injury disease. We tested the reliability of that questionnaire. We conducted a descriptive transversal study to determine the degree of involvement of the respiratory system in spinal cord injury. Results: A percentage of 91.9 did not have any respiratory pathology before spinal cord injury and 54.8% of patients smoked. A percentage of 27.4 of patients presented breathing complications one year after the injury. Results of the respiratory function tests were: FVC 67%, FEV1 72% and PEF 70%. Concordance and reliability were 98%. Conclusion: The Spanish version of the questionnaire of international consensus about the pulmonary function is a useful tool for the study of the respiratory involvement in spinal cord injury (AU)

[Spanish validation of the International Spinal Cord Injury Pulmonary Function Basic Data Set questionnaire for the study of the repercussion of spinal cord injury in the respiratory system]. / Validación española del cuestionario International Spinal Cord Injury Pulmonary Function Basic Data Set para valorar la repercusión de la lesión medular en el sistema respiratorio.

INTRODUCTION AND OBJECTIVE: The dysfunction of the respiratory system and the breathing complications in persons with injured spinal cord has an effect on the morbidity and the mortality of the disease. The objectives were: 1) to translate to Spanish and validate the questionnaire of international consensus: International Spinal Cord Injury Pulmonary Function Basic Data Set, and 2) to determine the influence of chronic spinal cord injury in the respiratory system in terms of respiratory functionalism. MATERIALS AND METHOD: Translation to Spanish and validation of the questionnaire of international consensus intended for the study of the pulmonary function in spinal cord injury disease. We tested the reliability of that questionnaire. We conducted a descriptive transversal study to determine the degree of involvement of the respiratory system in spinal cord injury. RESULTS: A percentage of 91.9 did not have any respiratory pathology before spinal cord injury and 54.8% of patients smoked. A percentage of 27.4 of patients presented breathing complications one year after the injury. Results of the respiratory function tests were: FVC 67%, FEV1 72% and PEF 70%. Concordance and reliability were 98%. CONCLUSION: The Spanish version of the questionnaire of international consensus about the pulmonary function is a useful tool for the study of the respiratory involvement in spinal cord injury.