Biopsychosocial challenges of spinal cord injury survivors in Bangladesh: a qualitative investigation

Novel Risk Factors Associated With Current Suicidal Ideation and Lifetime Suicide Attempts in Individuals With Spinal Cord Injury

Management of Mental Health Disorders, Substance Use Disorders, and Suicide in Adults with Spinal Cord Injury: Clinical Practice Guideline for Healthcare Providers.

Systematic Review of Urological Followup After Spinal Cord Injury

This study investigates the interplay between distal adverse childhood experiences (ACEs) and proximal psychological risk factors in predicting suicidal ideation among men who have sex with men (MSM) using network analysis. A total of 1138 MSM completed self-reported questionnaires on demographics, ACEs, depression, anxiety, interpersonal needs, and suicidal ideation. We employed Gaussian graphical models to perform a network analysis that mapped the relationships between ACEs and proximal psychological variables and identified bridge nodes. Additionally, suicidal ideation was incorporated to reevaluate the network and explore the association between the identified bridge nodes and suicidal ideation. The results show that approximately 88.3% of participants reported experiencing ACEs, with an average occurrence of 3.4 types of ACEs. Suicidal ideation was reported by 31.3% of participants. Key bridging nodes in the psychosocial network included perceived burdensomeness, thwarted belongingness, feeling tired/having little energy, and excessive worrying. Perceived burdensomeness exhibited the strongest correlation with suicidal ideation, followed by thwarted belongingness. Moreover, neglect is strongly associated with suicidal ideation. Our findings suggest that ACEs are associated with suicidal ideation and may be linked to specific proximal psychological factors that correlate with and potentially exacerbate suicidal ideation. These findings provide support to the Interpersonal Theory of Suicide, which suggests that perceived burdensomeness and thwarted belongingness are vital psychological factors in the onset of suicidal ideation. Addressing and intervening in these bridging nodes could help reduce the influence of ACEs on suicide ideation within the MSM community.

While clean intermittent catheterization (CIC) is the gold standard for bladder management after spinal cord injury (SCI), many individuals with SCI, for reasons not fully understood, choose alternative bladder management. We hypothesized that CIC is associated with an increased time burden in individuals with SCI. To investigate the time required to perform neurogenic bladder management in individuals with SCI. An electronic nonvalidated questionnaire was designed to determine the self-reported time spent performing bladder management. It was sent to participants in the Neurogenic Bladder Research Group SCI Registry, a national quality of life study of individuals with SCI. Eighty-seven individuals responded to the survey. CIC was the most common bladder management (76%). Men and women performing independent CIC had similar average times with each catheterization episode (8.8 vs. 8.5 minutes, p = .864) as did women with a catheterizable stoma compared to women catheterizing per urethra (8.2 minutes, p = .913). Longer catheterization times were associated with cervical spine injury (mean 12.4 minutes per catheterization) and women requiring caregiver assistance (mean 20 minutes per catheterization). In addition, obese/overweight women had longer CIC times than normal weight women (14.5 minutes vs. 7 minutes; p = .036), while catheterization time was similar for all men regardless of body mass index. Individuals with indwelling catheters spent less than a third of the time on bladder management per day compared to those doing CIC (17 vs. 53 minutes per day, p < .001). Management of neurogenic bladder after SCI, especially in those performing CIC, is time consuming. This time burden may play a role in long-term bladder management decisions.

INTRODUCTION: Spinal cord injury (SCI) is a life-altering condition that significantly impacts physical health and community reintegration. Despite the global prevalence of SCI, wheelchair users often face barriers to reintegration, particularly in low-resource settings like Rwanda. This study explored the perceptions of wheelchair users with SCI regarding community reintegration, focusing on facilitators and barriers. METHODS: A qualitative phenomenological design was employed, with nine participants recruited via purposeful sampling from two Rwandan healthcare facilities. Semi-structured interviews were conducted in Kinyarwanda, transcribed verbatim, and translated into English. Thematic analysis was performed using Braun and Clarke’s framework to identify key themes. RESULTS: Four main themes emerged: (1) Family and societal attitudes, including negative stigma and diminished social support; (2) Environmental accessibility, with challenges such as inaccessible pathways, bathrooms, and public transportation; (3) Activity limitations, particularly in daily living tasks and wheelchair mobility; and (4) Participation restrictions, such as reduced involvement in communal and religious activities. Participants reported dependence on caregivers, social isolation, and environmental barriers as major hindrances to reintegration. CONCLUSION: The study highlights multifaceted challenges faced by wheelchair users with SCI in Rwanda, emphasizing the need for comprehensive interventions. Recommendations include pre- and post-discharge education, community awareness campaigns, home assessments for accessibility modifications, and policy changes to improve infrastructure. Addressing these barriers is crucial for enhancing community reintegration and quality of life for individuals with SCI.

Cervical spinal cord injury (SCI) causes devastating loss of upper limb function and independence. Restoration of upper limb function can have a profound impact on independence and quality of life. In low-cervical SCI (level C5-C8), upper limb function can be restored via reinnervation strategies such as nerve transfer surgery. The translation of recovered upper limb motor function into functional independence in activities of daily living (ADLs), however, remains unknown in low cervical SCI (i.e., tetraplegia). The objective of this study was to evaluate the association of patterns in upper limb motor recovery with functional independence in ADLs. This will then inform prioritization of reinnervation strategies focused to maximize function in patients with tetraplegia. This retrospective study performed a secondary analysis of patients with low cervical (C5-C8) enrolled in the SCI Model Systems (SCIMS) database. Baseline neurological examinations and their association with functional independence in major ADLs-i.e., eating, bladder management, and transfers (bed/wheelchair/chair)-were evaluated. Motor functional recovery was defined as achieving motor strength, in modified research council (MRC) grade, of ≥ 3 /5 at one year from ≤ 2/5 at baseline. The association of motor function recovery with functional independence at one-year follow-up was compared in patients with recovered elbow flexion (C5), wrist extension (C6), elbow extension (C7), and finger flexion (C8). A multi-variable logistic regression analysis, adjusting for known factors influencing recovery after SCI, was performed to evaluate the impact of motor function at one year on a composite outcome of functional independence in major ADLs. Composite outcome was defined as functional independence measure score of 6 or higher (complete independence) in at least two domains among eating, bladder management, and transfers. Between 1992 and 2016, 1090 patients with low cervical SCI and complete neurological/functional measures were included. At baseline, 67% of patients had complete SCI and 33% had incomplete SCI. The majority of patients were dependent in eating, bladder management, and transfers. At one-year follow-up, the largest proportion of patients who recovered motor function in finger flexion (C8) and elbow extension (C7) gained independence in eating, bladder management, and transfers. In multi-variable analysis, patients who had recovered finger flexion (C8) or elbow extension (C7) had higher odds of gaining independence in a composite of major ADLs (odds ratio [OR] = 3.13 and OR = 2.87, respectively, p < 0.001). Age 60 years (OR = 0.44, p = 0.01), and complete SCI (OR = 0.43, p = 0.002) were associated with reduced odds of gaining independence in ADLs. After cervical SCI, finger flexion (C8) and elbow extension (C7) recovery translate into greater independence in eating, bladder management, and transfers. These results can be used to design individualized reinnervation plans to reanimate upper limb function and maximize independence in patients with low cervical SCI.

Introduction: Spinal cord injury (SCI) results in significant changes in a person's life; it has a tremendous psychological impact not only at the individual level but also on their caregiver. There is still little known about the positive psychological changes following SCI. The aim of this study was to determine the psychological and social factors affecting post-traumatic psychological growth after SCI. Methodology: This multi-center cross-sectional study was conducted on 66 patients with traumatic SCI between November 2020 and May 2021 using PWB-PTCQ, HADS, and social support scale. Data were analyzed using the SPSS program. Result: This study included 66 patients from multilabel territorial centers. The Mean ± SD of the patients’ age was 32.1 ± 14.5 years, and 34 (51.5%) of them were aged &lt;32 years. Male patients were more dominant compared to their female counterparts; 48 (72.7%) versus 18 (27.3%), respectively. The most common type of injury was ASIA-A 24 (36.4%), and the most common nature of stress was financial 33 (53.2%). Conclusion: Anxiety and depression were less common among our patients with SCI, whereas there were high life stressors, and financial stress was the dominant type of stress among patients. The most affected dimension of PTG was a sense of mastery, whereas relationships and personal growth were the least affected among patients with SCI. Achieving PTG was significantly affected by depression, education level, and life stressors. There was a regression relation between PTG with depression and anxiety, thus PTG can predict depression and anxiety in patients with SCI.

Qualitative study using individual in-depth interviews. The objective of this study was to explore the factors influencing the choice of bladder management for male patients with spinal cord injury (SCI). Public hospitals in Malaysia. Semistructured (one-on-one) interviews of 17 patients with SCI; 7 were in-patients with a recent injury and 10 lived in the community. All had a neurogenic bladder and were on various methods of bladder drainage. Interviews were audio-recorded, transcribed verbatim and analyzed using thematic analyses. The choice of bladder management was influenced by treatment attributes, patients' physical and psychological attributes, health practitioners' influences and social attributes. Participants were more likely to choose a treatment option that was perceived to be convenient to execute and helped maintain continence. The influence of potential treatment complications on decision making was more variable. Health professionals' and peers' opinions on treatment options had a significant influence on participants' decision. In addition, patients' choices depended on their physical ability to carry out the task, the level of family support received and the anticipated level of social activities. Psychological factors such as embarrassment with using urine bags, confidence in self-catheterization and satisfaction with the current method also influenced the choice of bladder management method. The choice of bladder management in people with SCI is influenced by a variety of factors and must be individualized. Health professionals should consider these factors when supporting patients in making decisions about their treatment options.

To examine the course of mental health and psychological factors over time in persons with a recent spinal cord injury and to determine whether change in psychological factors is associated with change in mental health. Prospective cohort study in the Netherlands with 3 measurement time-points. A total of 60 persons with recently acquired spinal cord injury. Standardized validated measurement instruments were used to assess mental health, self-efficacy, mastery, optimism, illness cognitions, purpose in life, and social comparison. Descriptive statistics and multilevel analysis were used. Multilevel regression analyses showed that neither mental health nor psychological factors, except for social comparison-upward identification, showed statistically significant change over time. However, increasing scores for self-efficacy, mastery, acceptance cognitions, and purpose in life were significantly associated with increasing mental health. In contrast, increasing scores for optimism, social comparison, helplessness cognitions, and disease benefits cognitions were not significantly associated with increasing mental health in persons with spinal cord injury. Most psychological factors showed stability up to 6 months post-discharge. Purpose in life, acceptance cognitions, self-efficacy, and mastery showed more variability and seem to be most promising as targets for interventions, which may lead to an improvement in mental health in persons with spinal cord injury.

Introduction: The rehabilitation of people with traumatic spinal cord injury (SCI) should encourage resilience, which is a complex issue that involves self-esteem, social support, life meaningfulness and life satisfaction in order to prevent suicidal ideation. Objective: To analyze resilience and its relationship with suicidal ideation, self-esteem, social support, life meaningfulness and life satisfaction in people with SCI. Methods: Quantitative, cross-sectional, descriptive, correlational and comparative study carried out with 204 Brazilian adults with SCI. Data were collected with previously validated instruments using an online platform. Results: Among the participants, 74% were male, with a mean age of 36.1 years (SP=9.24), 64.7% were retired or receiving benefits, and with an average time of injury of 8.6 (SP=7, 73). Suicidal ideation (p≤0.001), self-esteem (p≤0.001), social support, life satisfaction (p≤0.001) and life meaningfulness (p≤0.001) were strongly associated with resilience. Discussion: The variables related to mental health were shown to be influenced by resilience, indicating that participants with higher levels of resilience have better results in the assessment of emotional factors. Implications for practice: It is recommended that psychological and social factors be considered in the rehabilitation of people with SCI.

Despite significant progress in bladder management, urinary tract infections (UTIs) are still common among individuals with spinal cord injury (SCI), and could negatively impact their health and quality of life. However, there are no data available on bladder management and frequency of UTIs among elite athletes with SCI. Athletes were assessed during the London 2012 Paralympic Games and 2013 Paracycling World Championships. Athletes completed the standard form of the International Standards to Document remaining Autonomic Functions after SCI, along with the standardized Autonomic Function Questionnaire. A total of 61 (age=35.5±7.7 years (mean±s.d.); time since injury=16.0±7.6 years) elite athletes from 15 countries with traumatic SCI and who used clean intermittent catheterization were included in this study. The majority (75%) were from developed nations. Athletes catheterized on average 6±2 times per day. We found that individuals who reused catheters experienced more frequent UTIs (P<0.001). We also demonstrated that 83% of individuals from developed nations never reused a single-use catheter, whereas only 27% of individuals from developing nations used a new catheter each time (P<0.001). We also noted a twofold increase in the frequency of UTIs in individuals from developing nations (P=0.027). This study demonstrates that catheter reuse is intimately linked to UTI frequency and provides novel insight on bladder function and management in elite athletes with SCI. Reasons for catheter reuse may be due to a lack of health education and/or a lack of bladder-management resources. (Support: Craig Neilsen Foundation, ICORD, IPC).

Context/Objective Urinary tract infections (UTIs) are one of the most frequent secondary complications among people with spinal cord injury (SCI). The prevention and management of UTIs is prioritized by stakeholders across Canada. The purpose of this study was to gain an in-depth understanding of the urinary bladder (bladder) management experiences of people with SCI in Alberta communities, especially how UTIs are experienced and managed. Design Convergent mixed methods parallel databases variant. Setting Communities across Alberta, Canada. Participants 39 survey participants and 19 interview participants, all with SCI. Methods One-on-one phone semi-structured interviews analyzed using thematic analysis. Quantitative surveys included demographic, multichoice, and Likert Scale questions analyzed using descriptive analysis. Both methods explored people with SCI’s experiences with bladder management and UTIs. Qualitative and quantitative results were integrated through a comparison joint display table and meta-inferences. Outcome Measures Qualitative themes and descriptive statistics further integrated as mixed core-statements. Results Bladder routine is central to daily life and maintaining bladder health, avoiding UTIs, is the priority. Several health inequities are related to (1) financial barriers dictating how bladder is managed, (2) low perceived support for appropriate bladder management, (3) low healthcare access to appropriate UTI management and (4) low providers’ capacity to support bladder management and build trust with persons with SCI. Conclusion Action is required to address identified health inequities, including improvement of financial support, like appropriate catheter coverage, decrease barriers to access appropriate care and improvement of providers’ capacity to address SCI bladder care.

Objective To examine changes in quality of life (QoL) after an eight-week period of robotic exoskeleton training in a homogeneous group of patients with chronic complete spinal cord injury (SCI). Design Prospective single-group pre-post study. Setting Rehabilitation center. Participants Patients with a chronic (>6 months) motor complete SCI (T1-L1). Intervention Twenty-four training sessions with the ReWalk exoskeleton over an eight-week period. Main outcome measure QoL, assessed with the sum score of the Short Form-36 with Walk Wheel modification (SF-36ww). Secondary outcome measures were the eight SF-36ww subdomains, satisfaction with bladder and bowel management, lower extremity joint passive range of motion (pROM), and lower extremity spasticity. Results Twenty-one participants completed the training. QoL significantly improved after the training period (average SF-36 sum score 621 ± 90) compared to baseline (571 ± 133) (t(20)=-2.5, P=.02). Improvements were seen on the SF-36ww subdomains for pain (P=.003), social functioning (P=.03), mental health (P=.02), and general health perception (P=.01). Satisfaction with bladder management (range 1-5) improved from median 3 at baseline to 4 after exoskeleton training (P=0.01). No changes in satisfaction with bowel management (P=.11), pROM (hip-extension (P=.49), knee-extension (P=.36), ankle dorsiflexion (P=.69)), or spasticity (P=.94) were found. Conclusion Even in patients with chronic motor complete SCI and a relatively high level of QoL at baseline, a short-term exoskeleton training improved their QoL, pain and satisfaction with bladder management; findings that warrant further controlled studies in this specific SCI population.

Previous surveys of gastrointestinal symptoms after spinal cord injury have not used validated questionnaires and have not focused on the full spectrum of such symptoms and their relationship to factors, such as level of spinal cord injury and psychologic dysfunction. This study was designed to detail the spectrum and prevalence of gastrointestinal symptoms in spinal cord injury and to determine clinical and psychologic factors associated with such symptoms. Established spinal cord injury patients (>12 months) randomly selected from a spinal cord injury database completed the following three questionnaires: 1) Rome II Integrative Questionnaire, 2) Hospital Anxiety and Depression Scale, and 3) Burwood Bowel Dysfunction after spinal cord injury. A total of 110 patients participated. The prevalence of abdominal bloating and constipation were 22 and 46 percent, respectively. Bloating was associated with cervical (odds ratio = 9.5) and lumbar (odds ratio = 12.1) level but not with thoracic level of injury. Constipation was associated with a higher level of injury (cervical odds ratio = 5.6 vs. lumbar) but not with psychologic factors. In contrast, abdominal pain (33 percent) and fecal incontinence (41 percent) were associated with higher levels of anxiety (odds ratio = 6.8, and odds ratio = 2.4) but not with the level of injury. There is a high prevalence and wide spectrum of gastrointestinal symptoms in spinal cord injury. Abdominal bloating and constipation are primarily related to specific spinal cord levels of injury, whereas abdominal pain and fecal incontinence are primarily associated with higher levels of anxiety. Based on our findings, further physiologic and psychologic research studies in spinal cord injury patients should lead to more rational management strategies for the common gastrointestinal symptoms in spinal cord injury.