Relationship between employment and quality of life and self-perceived health in people with spinal cord injury: an international comparative study based on the InSCI Community Survey.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: Work-related disability is common in persons with spinal cord injury (SCI). The aims of this study are to examine the associations of employment with self-perceived health (SPH) and quality of life (QoL) across 22 countries and to explore the covariates around employment and SPH and QoL. SETTING: Community. METHODS: We analyzed 9494 community-dwelling persons with SCI aged 18-65. We performed an adjusted regression and path analysis. The independent variable was 'employment' and the dependent variables were two single items: QoL (very poor to very good) and SPH (excellent to poor). Covariates included the Gross Domestic Product (GDP), education, time since SCI, age, gender, years of employment after SCI, SCI level (paraplegia, tetraplegia), and completeness of SCI. RESULTS: Participants' mean age was 47, 74% were male, and 63% had paraplegia. We found an association between employment and QoL and SPH. While the magnitude of the effect of employment on QoL did not differ across GDP quartiles, its perceived effect on QoL was found to be significant in the highest GDP quartile. Employment was predictive of good SPH in two GDP quartiles (Q1 and Q4), but significant across all quartiles when predicting poor perceptions, with the magnitude of effect varying significantly. CONCLUSIONS: Employment is closely related to QoL and SPH depending on the GDP. We may positively influence the QoL and SPH in the SCI population to promote better employment outcomes by considering the infrastructure and economy.

Upper Extremity Functional Status in Patients with Chronic Tetraplegia in Universiti Malaya Medical Centre.

Background: Persons with tetraplegia rank improved upper extremity (UE) function as the most important rehabilitation outcome because it allows them greater independence in activities of daily living (ADL). The aim of this study was to describe UE status in patients with tetraplegia using the International Spinal Cord Injury Upper Extremity Basic Data Set version 1.1 (ISCI-UE 1.1) and to determine differences in UE status between tetraplegic individuals with traumatic and non-traumatic SCIs. Methods: This cross-sectional study was conducted among patients with tetraplegia who attended the SCI rehabilitation clinic of a tertiary hospital from September 2021 to August 2022. Both upper limbs were assessed using ISCI-UE 1.1. Results: One hundred patients were included in this study, of whom 80 were men. The mean (SD) age of the patients was 54.30 (16.95) years old. In these patients, most SCIs (62%) were of traumatic origin. Two hundred UEs were evaluated, of which 109 showed good hand function (level 5) and 10 had the poorest hand function (level 1). Meanwhile, 130 UEs showed good shoulder function (level D) and 10 had the poorest shoulder function (level A). A statistically significant association with UE status (reach-and-grasp ability and shoulder function) was found in both the non-traumatic and traumatic SCI groups, with better hand and shoulder functions in the non-traumatic SCI group (right-hand, P = 0.004 and left hand, P = 0.001; right shoulder, P < 0.001 and left shoulder, P = 0.002). Conclusion: ISCI-UE 1.1 is a feasible tool for documenting UE function in patients with tetraplegia. Compared with the individuals with traumatic SCI in this study, those with non-traumatic SCI demonstrated better upper extremity functionality.

What are the effects of information provision for stroke survivors and their caregivers? A Cochrane Review summary with commentary.

BACKGROUND: Stroke can lead to permanent and severe disability. Provision of information to stroke survivors and their carers could help them cope with consequences of stroke and aware of secondary prevention. OBJECTIVE: The aim of this Cochrane review was to assess the effects of active or passive information provision for stroke survivors or their carers. METHODS: The population addressed in this review included stroke survivors, their carers, or both. The intervention studied was provision of active or passive information compared to standard care or where information and another therapy were compared with the other therapy alone, or where the comparison was between active and passive information provision. The primary outcomes were knowledge about stroke and stroke services, and anxiety. CONCLUSIONS: The authors concluded that the active provision of information may improve stroke survivors stroke-related knowledge and quality of life. It may reduce the cases and symptoms of anxiety and probably depression. The effect of active information provision to carers and passive information provision is still unclear; however, passive information may worsen stroke patients' symptoms of anxiety and depression.

Postural effects on blood pressure, intraocular pressure, and ocular perfusion pressure in patients with spinal cord injury.

BACKGROUND: Reduced ocular perfusion pressure (OPP) from hypotension and consistent OPP variability due to blood pressure (BP) fluctuations are predisposing factors for glaucoma. Low resting BP and orthostatic hypotension (OH) in spinal cord injury (SCI) patients may increase the risk of glaucoma post-injury. This study investigated BP, intraocular pressure (IOP), and OPP changes between supine and sitting positions in SCI and normal individuals. METHODS: Twenty SCI cases (high paraplegia, T1-T6 n = 6; low paraplegia, T7-L3 n = 14) and matched controls (1:1) were included. Systolic and diastolic BP (SBP and DBP) were measured digitally, and IOP with rebound tonometry. Measurements were taken one minute apart in both positions. Mean arterial pressure (MAP) was calculated, and OPP was determined using position-specific formulas. RESULTS: No SCI subjects exhibited OH. Both groups experienced significant BP increment (P < 0.05) from supine to sitting. SBP increased by 4.4 ± 8.4 mmHg (SCI) and 3.6 ± 6.2 mmHg (normal), while DBP increased by 4.2 ± 5.1 mmHg (SCI) and 6.7 ± 5.5 mmHg (normal). IOP and OPP decreased significantly (P < 0.05) after postural change in both groups, yet differences between them were not significant. Analysis by injury level revealed lower parameter values in high paraplegia than in low paraplegia, with the latter group showing a more significant reduction in OPP after postural change. CONCLUSION: Postural changes differently affect BP, IOP, and OPP in SCI compared to normal individuals, with variations based on the level of SCI. While not directly assessing glaucoma, the study offers insights into ocular hemodynamics in SCI compared to normals.

Accessory respiratory muscles performance among people with spinal cord injury while singing songs with different musical parameters.

People with spinal cord injury (SCI) experience respiratory dysfunctions which include hypersecretions, bronchospasm, and respiratory muscles weakness. Singing therapy has been implemented as part of respiratory muscle training (RMT) to improve their muscle strength. Singing different types and genres of songs may elicit specific recruitment of respiratory muscles, attributed to the variation of the songs' characteristics including tempo, pitch, and rhythmic complexity. This study aims to determine the effect of singing songs with different characteristics on the accessory respiratory muscle performance among people with SCI. Thirteen male SCI participants of ASIA A and B (C4 -T11) were recruited. Respiratory muscle signals were retrieved by placing two mechanomyography (MMG) sensors on the sternocleidomastoid (SCM) and rectus abdominis (RA) muscles. Eight music experts categorized several songs into four categories based on their pitch, tempo, and rhythmic complexity. Each participant sang one song from each category. Findings showed statistically significant difference in RA and SCM responses among all categories (P < 0.01). The SCM muscle is most active while singing high pitch songs. While the RA is most active during slow tempo and easy rhythmic complexity. This shows that different accessory respiratory muscle is activated by people with SCI while singing songs with different characteristics. Clinicians could benefit from this knowledge while prescribing singing therapy or exercise among people with SCI in the future.

The association between health service systems and pressure injury problems of individuals with chronic spinal cord injury in Malaysia, Indonesia, and Thailand: a cross-sectional study.

OBJECTIVES: To determine whether a health service system is an independent influencing factor of having pressure injury (PI) problems in individuals with chronic spinal cord injury (SCI) living in three countries. DESIGN: A cross-sectional study. METHODS: Data from the International Spinal Cord Injury Community Survey (InSCI) were analyzed. The PI problems were assessed using the Spinal Cord Injury Secondary Condition Scales (dichotomized to "having problem" and "not having problem". Health service systems were categorized as an inpatient-oriented SCI specialized system and a primary care-oriented system. A directed acyclic graph was applied to create a multivariable logistic regression model to determine the independent influencing factors of PI problems. RESULTS: Of 790 included participants, 277 (35%) had PI problems. Being recruited from countries with inpatient-oriented SCI specialized systems (Model 1) and visiting rehabilitation medicine/SCI physicians at least once a year (Model 2) is an independent negative correlating factor of PI problems (odds ratio = 0.569 [95%CI: 0.374-0.866] and 0.591 [95%CI: 0.405-0.864], respectively). CONCLUSION: SCI-specialized health service systems might be a protective factor of PI problems in middle-income country contexts. This result suggests the importance of having SCI-specialized services in middle-income countries to reduce the prevalence of PI problems.