Inpatient Spinal Cord Injury Rehabilitation Research Articles

Social work and case management treatment time during inpatient spinal cord injury rehabilitation

BackgroundThere is a lack of published evidence regarding the amount and type of social work and case management (SW/CM) services that an individual with traumatic spinal cord injury (SCI) receives during acute inpatient rehabilitation. Such information is needed to assist in resource planning, benchmarking, and research on interventions and outcomes.MethodsAs part of the SCIRehab study social workers and case managers at six inpatient rehabilitation facilities documented details (including time spent) about the interventions provided to 600 patients with traumatic SCI during acute inpatient rehabilitation. Associations between patient and injury characteristics and time spent on these activities were examined.ResultsPatients received a mean total of 10 hours of SW/CM services, with a mean of 72.8 total minutes per week. The majority of the patients received SW/CM time spent on interdisciplinary conferencing on the patient's behalf (96%), discharge planning and services (89%), financial planning (67%), community/in-house services (66%), supportive counseling (56%), and initial assessment (54%). A minority of the patients received peer advocacy (12%), classes (24%), and education topics (30%). Total hours per stay and minutes per week varied by level of injury group. The most time per week was dedicated to patients with high tetraplegia ASIA Impairment Scale (AIS) A–C and the least to patients with C5–C8 AIS A–C. The patient and injury characteristics studied did not explain the variance seen in time spent on specific SW/CM services.ConclusionsThese descriptive data may be helpful in resource planning to anticipate and address individual patient needs and to plan for department-level training and hiring. These data also may pave the way to studying relationships of interventions with patient outcomes.

Occupational therapy treatment time during inpatient spinal cord injury rehabilitation

BackgroundOccupational therapy (OT) is a critical component of the rehabilitation process after spinal cord injury (SCI), the constitution of which has not been studied or documented in full detail previously.ObjectiveTo describe the type and distribution of SCI rehabilitation OT activities, including the amount of time spent on evaluation and treatment, and to discuss predictors (patient and injury characteristics) of the amount of time dedicated to OT treatment activities.MethodsSix inpatient rehabilitation centers enrolled 600 patients with traumatic SCI in the first year of the SCIRehab. Occupational therapists documented 32 512 therapy sessions including time spent and specifics of each therapeutic activity. Analysis of variance and contingency tables/chi-square tests were used to test differences across neurologic injury groups for continuous and categorical variables.ResultsSCIRehab patients received a mean total of 52 hours of OT over the course of their rehabilitation stay. Statistically significant differences among four neurologic injury groups were seen in time spent on each OT activity. The activities that consumed the most OT time (individual and group sessions combined) were strengthening/endurance exercises, activities of daily living (ADLs), range of motion (ROM)/stretching, education, and a grouping of ‘therapeutic activities’ that included tenodesis training, fine motor activities, manual therapy, vestibular training, edema management, breathing exercise, cognitive retraining, visual/perceptual training desensitization, and don/doff adaptive equipment. Seventy-seven percent of OT work occurred in individual treatment sessions, with the most frequent OT activity involving ADLs. The variation in time (mean minutes per week) spent on OT ROM/stretching, ADLs, transfer training, assessment, and therapeutic activities can be explained in part by patient and injury characteristics, such as admission Functional Independence Measure (FIM) score, neurologic injury group, and the medical severity of illness score.ConclusionOT treatment patterns for patients with traumatic SCI show much variation in activity selection and time spent on activities, within and among neurologic level of injury groups. Some of the variation can be explained by patient and injury characteristics. Almost all patients with SCI participated in strengthening/endurance and ROM/stretching exercises during OT treatment and these two activities are where the most time was spent when therapy provided in individual and group settings was combined. ADL work consumed the most time in individual therapy sessions.

Inpatient and Postdischarge Rehabilitation Services Provided in the First Year After Spinal Cord Injury: Findings From the SCIRehab Study

Whiteneck GG, Gassaway J, Dijkers MP, Lammertse DP, Hammond F, Heinemann AW, Backus D, Charlifue S, Ballard PH, Zanca JM. Inpatient and postdischarge rehabilitation services provided in the first year after spinal cord injury: findings from the SCIRehab study. Objective To examine the amount and type of therapy services received in inpatient and postdischarge settings during the first year after spinal cord injury (SCI). Design Prospective observational longitudinal cohort design. Data were obtained from systematic recording of interventions by clinicians and from patient interview. Setting Inpatient and postdischarge rehabilitation programs. Participants Patients (N=493) with traumatic SCI admitted to 6 rehabilitation centers participating in the SCIRehab study. Interventions Not applicable. Main Outcome Measures Hours of therapy by physical therapy (PT), occupational therapy (OT), speech therapy, recreation therapy, psychology, social work/case management, and nursing education during initial inpatient rehabilitation and postdischarge up to the first anniversary of injury. Inpatient data were collected prospectively by the treating clinicians; postdischarge service data were collected by patient self-report during follow-up interviews. Results Of the total hours spent on these rehabilitation interventions during the first year after injury, 44% occurred after discharge from inpatient rehabilitation. Participants received 56% of their PT hours after discharge and 52% of their OT hours, but only a minority received any postdischarge services from other rehabilitation disciplines. While wide variation was found in the total hours of inpatient treatment across all disciplines, the variation in the total hours of postdischarge services was greater, with the interquartile range of postdischarge services being twice that of the inpatient services. Conclusions SCI rehabilitation is often given in a care continuum, with inpatient rehabilitation being only the beginning. Reductions in inpatient SCI rehabilitation length of stay are well documented, but the postdischarge services that may replace some inpatient treatment appear to be greater than previously reported. The availability and impact of postdischarge care should be studied in greater detail to capture the wide array of postdischarge services and outcomes.

Obesity and Inpatient Rehabilitation Outcomes for Patients With a Traumatic Spinal Cord Injury

Stenson KW, Deutsch A, Heinemann AW, Chen D. Obesity and inpatient rehabilitation outcomes for patients with a traumatic spinal cord injury. Objective To examine the effect of obesity on change in FIM self-care and mobility ratings and community discharge for patients with traumatic spinal cord injury (SCI). Design Retrospective cohort study analyzing National Model Systems SCI Database data. Setting Fourteen Model Systems SCI programs. Participants Patients (N=1524) with a new traumatic SCI discharged from Model Systems rehabilitation centers between October 2006 and October 2009. Interventions None. Main Outcome Measures Change in FIM self-care and mobility ratings, discharge destination. Separate analyses were conducted by neurologic category: paraplegia incomplete, paraplegia complete, tetraplegia incomplete, and tetraplegia complete. Results Of all patients with traumatic SCI, approximately 25% were obese at admission. Patients who were obese were more likely to be married and slightly older than nonobese patients. In patients with paraplegia incomplete, obese patients had lower FIM self-care (−1.9; 95% confidence interval [CI], −3.4 to −.4) and mobility score gains (−1.5; 95% CI, −2.9 to −.1) than normal-weight patients. For patients with paraplegia complete, obese patients had significantly lower self-care (−2.2; 95% CI, −3.5 to −.8) and mobility score gains (−2.7; 95% CI, −3.9 to −1.5). For patients with tetraplegia incomplete and tetraplegia complete, FIM self-care and mobility ratings for obese patients were not significantly different from ratings for normal-weight patients. Within each neurologic category, the percentage of patients discharged to the community was not significantly different for nonobese and obese patients. Conclusions Obesity appears to be a barrier to meeting self-care and mobility functional goals for patients with paraplegia in inpatient SCI rehabilitation.

Comparing Content of Therapy for People With a Spinal Cord Injury in Postacute Inpatient Rehabilitation in Australia, Norway, and the Netherlands

Research reports have described the contents of therapy in spinal cord injury (SCI) rehabilitation only as the total number of therapy hours. We developed the Spinal Cord Injury-Interventions Classification System (SCI-ICS) as a tool to classify therapy to improve mobility and self-care into 3 levels (body functions, basic activities, and complex activities) and 25 categories. The purposes of this study were: (1) to compare specific contents and amount of therapy provided, with the aim of improving mobility and self-care for people with SCI in Australia, Norway, and the Netherlands and (2) to evaluate the use of the SCI-ICS outside the Netherlands. This was a prospective, descriptive study. Physical therapists, occupational therapists, and sports therapists in 6 centers recorded all therapy provided to all people with a recent SCI in inpatient rehabilitation during 4 designated weeks. Each treatment session was classified using 1 or more SCI-ICS codes. Duration of each intervention was specified. Seventy-three therapists recorded 2,526 treatments of 79 people with SCI (Netherlands, 48; Australia, 20; Norway, 11). Most therapy time was spent on exercises (overall mean=84%) and on categories at body function and basic activity level of the SCI-ICS. Therapy time significantly differed among countries for 13 of 25 categories. Mean time in minutes per treatment (Netherlands, 28; Australia, 43; Norway, 39) and in hours per patient per week (Netherlands, 4.3; Australia, 5.8; Norway, 6.2) differed significantly. The short period and small number of patients may have influenced the results. Therapy in inpatient SCI rehabilitation in all 3 countries focused on mobility and self-care exercises at body function and basic activity level, but differences were present in focus on the various categories and therapy time. The SCI-ICS can be used reliably to describe therapy in different countries.

Is circuit class physiotherapy possible during inpatient spinal cord injury rehabilitation? A feasibility trial

Elizabeth A Lynch, Sarah C Watson Aims: This article describes a feasibility study to determine whether circuit classes could be successfully provided to patients with recently acquired spinal cord injury (SCI) undergoing inpatient rehabilitation. Methods: Eleven patients with SCI participated in a physiotherapy circuit class run in addition to regular inpatient rehabilitation, over a two month period. All patients chose to attend the circuit classes for the duration of their availability. On completion of the trial, a purpose-designed questionnaire was administered to investigate patient satisfaction. Feedback was also collected from staff regarding their experience of the circuit class. Findings: No adverse events occurred during any circuit classes. Patients reported high levels of satisfaction with the class, reporting that classes were challenging, motivating, confidence building and a source of peer-support. Staff reported that circuit classes helped build clinical skills and confidence, and allowed the provision of effective therapy to SCI patients. All patients and staff recommended that circuit classes continue. Conclusions: This small feasibility study demonstrated that it is both possible and desirable to implement circuit class physiotherapy to a cohort of people with recently acquired SCI undergoing inpatient rehabilitation.

Is manual wheelchair satisfaction related to active lifestyle and participation in people with a spinal cord injury?

Cross-sectional study. To describe the satisfaction of the manual wheelchair user with hand rim wheelchair-related aspects (for example, dimensions, weight and comfort) and wheelchair service-related aspects and to determine the relationship between wheelchair users' satisfaction, personal and lesion characteristics, and active lifestyle and participation in persons with a spinal cord injury (SCI). Eight Dutch rehabilitation centers with a specialized SCI unit. The Dutch version of the Quebec user evaluation of satisfaction with assistive technology (D-QUEST) was filled out by 109 participants 1 year after discharge from inpatient SCI rehabilitation. Relationships between the D-QUEST scores and personal and lesion characteristics, and active lifestyle and participation (physical activity scale for individuals with physical disabilities (PASIPD), Utrecht activity list (UAL), mobility range and social behavior subscales of the SIP68 (SIPSOC)) were determined. A high level of satisfaction was found with wheelchair-related aspects. The participants were less satisfied with the service-related aspects. Participants with an incomplete lesion were slightly more satisfied regarding both aspects than those with a complete lesion. A higher satisfaction regarding wheelchair dimensions and a higher overall satisfaction were related to a more active lifestyle. Persons who were more satisfied with the simplicity of use of the wheelchair had a better participation score. Dutch persons with SCI are in general quite satisfied with their hand rim wheelchair. Some aspects of the wheelchair (dimensions and simplicity of use) are important to optimize as these are related to an active lifestyle and participation.

Poster 42: Importance of the Continuity of Staffing in Inpatient Spinal Cord Injury Rehabilitation

Poster 42: Importance of the Continuity of Staffing in Inpatient Spinal Cord Injury Rehabilitation

Poster 41: What Team? Continuity of Staffing in Inpatient Spinal Cord Injury Rehabilitation

Poster 41: What Team? Continuity of Staffing in Inpatient Spinal Cord Injury Rehabilitation

Occurrence and predictors of pressure ulcers during primary in-patient spinal cord injury rehabilitation

Multicenter prospective cohort study. To determine the occurrence and predictors for pressure ulcers in patients with spinal cord injury (SCI) during primary in-patient rehabilitation. Eight Dutch rehabilitation centres with specialized SCI units. The occurrence, location and stage of pressure ulcers were registered between admission and start of functional rehabilitation (called acute rehabilitation phase) and between start of functional rehabilitation and discharge. Possible risk factors for the occurrence of pressure ulcers during functional rehabilitation (personal and lesion characteristics, complications and functional independence) were measured at the start of functional rehabilitation and were entered as predictors in univariate and multivariate logistic regression analysis with pressure ulcers during functional rehabilitation as the dependent variable. Data for 193 patients (86%) were available. The occurrence of pressure ulcers, including stage 1, was 36.5% during acute rehabilitation phase and 39.4% during functional rehabilitation. Most pressure ulcers were located at the sacrum (43%), followed by heel (19%) and ischium (15%). The significant risk factors for pressure ulcers during functional rehabilitation were motor completeness of the lesion, tetraplegia, pressure ulcer during acute rehabilitation phase, pneumonia and/or pulmonary disease, low score on the Functional Independence Measure (FIM) self-care, continence, transfers, locomotion and total FIM motor score. Having had a pressure ulcer during acute rehabilitation phase was the strongest risk factor. The occurrence of pressure ulcers was comparable with other studies. A few significant risk factors were found, of which having had a pressure ulcer during acute rehabilitation phase being the strongest predictor.

A Descriptive Study on Vitamin D Levels in Individuals With Spinal Cord Injury in an Acute Inpatient Rehabilitation Setting

To determine the prevalence of inadequate or severely deficient levels of vitamin D in patients with spinal cord injury (SCI) admitted to an inpatient rehabilitation service and to describe any associations between patient demographics and injury characteristics and vitamin D levels. Retrospective case series. Academic inpatient SCI rehabilitation program. One hundred patients with SCI who were consecutively admitted to acute inpatient rehabilitation from January to December 2007. Data were retrospectively abstracted from the patient's medical chart. VitD-25(OH). The prevalence of VitD-25(OH) inadequacy or severe deficiency was 93% in this sample of patients with SCI. The mean VitD-25(OH) level was 16.29 +/- 7.73 ng/mL, with a range from 7.00 to 36.80 ng/mL. Twenty-one percent of the sample had VitD-25(OH) levels that were considered as severely deficient (< or =10 ng/mL). African-American subjects had statistically significant lower mean VitD-25(OH) levels compared with Caucasian subjects (12.96 versus 17.79 ng/mL; P = .003). Persons with an incomplete injury had significant lower mean VitD-25(OH) levels compared with complete injuries (14.64 versus 18.15 ng/mL; P = .023). Inadequate or severely deficient levels of VitD-25(OH) were highly prevalent in patients with SCI admitted to an acute inpatient rehabilitation service. Evaluation of serum VitD-25(OH) levels are recommended in patients with SCI because low levels may contribute to osteoporosis.

Prospective analysis of body mass index during and up to 5 years after discharge from inpatient spinal cord injury rehabilitation

To investigate the prevalence of overweight/obesity and the course of the body mass index (BMI) in persons with spinal cord injury during and after inpatient rehabilitation. Multi-centre longitudinal study. A total of 184 persons with spinal cord injury. BMI was determined at the start of active rehabilitation, 3 months later, at discharge, and 1, 2 and 5 years after discharge. The percentage of persons who were overweight/obese (BMI ≥ 22 kg/m2) increased over the years from 56% to 75%. The absolute BMI did not significantly increase during rehabilitation, but showed a significant increase the year after discharge from inpatient rehabilitation (p < 0.001). From examining the personal or lesion characteristics, age was the only factor that was related to the absolute BMI. BMI increased by 1 kg/m2 for each 10-year increase in age. Men, persons with paraplegia and older people had more chance of being overweight/obese compared with women, persons with tetraplegia and younger people. The BMI of people with spinal cord injuries gradually increases during and after inpatient rehabilitation, with significant increases in the first year after discharge. It is recommended that emphasis is placed on weight-management protocols (diet and exercise) to encourage a healthy lifestyle.

Development and validation of prognostic models designed to predict wheelchair skills at discharge from spinal cord injury rehabilitation

Objective: To develop and validate a statistical model to predict wheelchair skills at discharge (t 2) from personal and lesion characteristics and wheelchair skills at the start of spinal cord injury inpatient rehabilitation (t1). Design: Prospective cohort study Setting: Eight Dutch rehabilitation centres. Subjects: One hundred and forty-two patients with a spinal cord injury. Main measures: Models were developed with the performance time and ability score at t2 as dependent variables and t1 scores of performance time and ability score, age, gender, body mass index, level and completeness of the lesion as independent variables. The statistical models were evaluated by comparing individual estimated scores with actual measured scores. Results: The main independent variables to predict wheelchair skills at discharge were the t1 performance time and ability score, age, gender and lesion level. The intraclass correlation coefficient between the estimated and actual ability score was 0.79 and for the performance time 0.86. However, the 95% limits of agreement and their confidence intervals were relatively wide for both ability score (—2.3 to 3.4, range 0—8) and performance time (—12.5 to 8.2, range 11—40 seconds). Conclusion: The prognostic models developed in this study to predict future wheelchair skills might help planning the course of rehabilitation. The models should be used with caution in daily clinical practice, but may add useful information to clinical expertise and knowledge of the individual patient.

SCIRehab Project Series: The Social Work/Case Management Taxonomy

Context: Social work and case management (SW/CM) are integral components of acute inpatient spinal cord injury (SCI) rehabilitation. However, evidence is sparse regarding the impact of SW/CM interventions on outcomes. To advance research on SW/CM clinical practice in SCI rehabilitation, SW/CM providers and researchers first must have standard classifications for SW/CM interventions.Background/Objective: To develop a taxonomy (classification) of the various interventions and services that comprise SW/CM.Methods: A group of SW/CM clinicians compiled a list of activities performed as routine practice at the participating rehabilitation facilities. These activities were grouped and defined systematically.Results: The resulting taxonomy includes 8 major activity topics (financial planning, discharge planning, discharge services, supportive counseling, information about and referral to peer/advocacy groups, education about SCI and other relevant topics, information about and referral to community/in-house services, and team conferences), which were further stratified into specific content areas. Interactions with the patient, family, or other team members and resources, along with descriptions of the interactions that are applicable to each of the 8 activity topics, were included as well.Conclusion: An intervention taxonomy is required to study the SW/CM interventions and the potential association with positive rehabilitation outcomes for patients with SCI. The SW/CM taxonomy developed for the SCIRehab project, which will be used with 1,500 patients admitted to 6 SCIRehab centers over 2.5 years, will provide an infrastructure for such research.

Clinical Taxonomy Development and Application in Spinal Cord Injury Research: The SCIRehab Project

Background/Objective: Applying practice-based evidence research methodology to spinal cord injury (SCI) rehabilitation requires taxonomy (typology or classification) of rehabilitation interventions provided by every discipline contributing to SCI rehabilitation. The rehabilitation field currently lacks such taxonomy. Methods: SCIRehab project researchers and clinicians representing 7 rehabilitation disciplines from 6 US inpatient SCI rehabilitation facilities worked in discipline groups during 2 face-to-face meetings and weekly discipline-specific teleconferences for 9 months to identify key contributions of each discipline to SCI rehabilitation and to develop a classification of treatment interventions used by each discipline. These clinician groups were charged with designing documentation systems that collected enough details to describe treatment adequately while not imposing an unrealistic data collection burden on clinicians. Completed documentation systems were programmed onto handheld personal digital assistants (PDAs) to facilitate data entry by clinicians at the point of care.Results: Seven discipline-specific SCI rehabilitation taxonomies were developed that describe and quantify intervention activities (major categories of treatment offered by the discipline) and the activity-specific details (variables deemed important to fully describe the interventional process). Much treatment information is unique to each discipline; some is common across disciplines.Conclusions: The taxonomies provide a format with which clinicians document actual interventions performed with or for patients. The SCIRehab project has developed the first comprehensive multidisci-plinary taxonomy for describing the details of the SCI rehabilitation process and designed a PDA-based documentation system based on that taxonomy that allows clinicians to describe the specifics of their interactions with their patients.

SCIRehab Project Series: The Therapeutic Recreation Taxonomy

Background/Objective: Outcomes research of therapeutic recreation (TR) activities and interventions for spinal cord injury (SCI) rehabilitation is made more difficult by a lack of uniform descriptions and the absence of a formal treatments classification system (taxonomy). The objective of this study was to describe a taxonomy developed by Certified Therapeutic Recreation Specialists.Methods: TR lead clinicians and researchers from 6 SCI rehabilitation centers developed a TR documentation system to describe the details of each TR session involving patients with SCI enrolled in the SCIRehab study. The SCIRehab study uses the practice-based evidence methodology, a rigorous observational methodology that examines current practice without introducing additional treatments, to capture details of each TR session for 1,500 SCI rehabilitation patients at 6 US inpatient SCI rehabilitation facilities. This may be the first attempt to document the many details of the TR rehabilitation process for patients with SCI.Results: The TR taxonomy consists of 6 activities (eg, leisure education and counseling, outings, and leisure skill work in center) and activity-specific interventions, as well as time spent on each activity. Activity descriptions are enhanced with additional details that focus on assistance needs for each activity, patient ability to direct care, and patient/family involvement, which may help to determine TR activity selection.Conclusion: Development and application of a TR taxonomy, which is comprehensive for patients with SCI and efficient to use, are feasible despite significantly different TR programs at the 6 SCIRehab centers.

False-Negative Triple-Phase Bone Scans in Spinal Cord Injury to Detect Clinically Suspect Heterotopic Ossification: A Case Series

Background/Objective: Heterotopic ossification (HO) is a complication seen in patients after spinal cord injury (SCI). Triple-phase nuclear bone scanning is the most sensitive test for the detection of HO. This retrospective study assesses whether patients with clinically suspected HO but negative triple-phase nuclear bone scans develop delayed positive nuclear bone scans.Methods: Case series: A cohort of patients with SCI and clinically suspected HO who underwent triple phase nuclear bone scans over a period of 2 years was identified from retrospective chart review of an acute inpatient SCI rehabilitation service. A subgroup of 7 patients with initially negative but subsequently positive triple-phase nuclear bone scans was identified, and the following data were collected: date, mechanism, admission level, and admission completeness of injury as well as date, number, and results of bone scans. Laboratory studies were also collected during the time of imaging.Results: Over a 2-year period, 343 patients were admitted to the SCI rehabilitation service; 60 patients were suspected of having HO and underwent a total of 85 triple-phase nuclear bone scans. Seven patients were identified with initially negative but subsequently positive bone scans.Conclusions: In patients with clinically suspicious HO but negative bone scans, follow-up scans are indicated to identify initial false-negative studies.

Predictors of Ventilator Weaning in Individuals With High Cervical Spinal Cord Injury

Background/Objective: To evaluate which tests best predict the ability of patients with ventilator-dependent tetraplegia to wean from the ventilator.Methods: Retrospective review of patients.Participants: Twenty-six ventilator-dependent patients with tetraplegia admitted to a university inpatient spinal cord-injury rehabilitation unit with American Spinal Injury Association (ASIA) injury levels C2 to C6, A or B.Results: Failure to wean off the ventilator completely was predicted by absence of motor unit recruitment of one hemidiaphragm or at least moderate decreased recruitment with needle electromyography (EMG) in both hemidiaphragms. Phrenic nerve conduction studies would have predicted that all patients who weaned off the ventilator would have failed. Fluoroscopic examination of the diaphragm and bedside spirometry were not as good predictors of ability to wean, failing to predict accurately in 44% and 19% of cases, respectively. ASIA examination was also not entirely predictive, and any outliers that may have been expected to wean based on ASIA examination (ie, C4 or lower neurological levels) were predicted not to wean by needle electromyography.Conclusions: Negative inspiration force diaphragm needle EMG best predicted the ability to wean from the ventilator. Bedside spirometry (negative inspiratory force and forced vital capacity) is an accurate bedside measure of a patient's readiness to wean. Fluoroscopic examination of the diaphragm and phrenic nerve conduction studies were not helpful in determining weaning potential in ventilator-dependent patients with cervical spine injury.

The longitudinal relationship between lipid profile and physical capacity in persons with a recent spinal cord injury

A multicenter prospective cohort study. To determine the longitudinal relationship between physical capacity and lipid profile in persons with spinal cord injury (SCI) during and 1 year after rehabilitation. Eight Dutch rehabilitation centers with a specialized SCI unit. A total of 206 subjects with SCI (78 with tetraplegia) participated. The longitudinal relationship between lipid profiles (total cholesterol (TC), high- (HDL) and low-density lipoprotein (LDL) and triglycerides (TG) and physical capacity (peak power output (POpeak), peak oxygen uptake (VO2peak), and muscle strength) was investigated during inpatient SCI rehabilitation (start, 3 months later, discharge) and 1 year after discharge. A correction was made for the possible confounding variables age, body mass index, gender, time since injury, lesion level and completeness. HDL and the ratios LDL/HDL and TC/HDL showed a significant and favorable relationship with VO2peak, POpeak and muscle strength. TG was positively related to POpeak and muscle strength. More favorable lipid profiles were seen in people with a higher physical capacity after correction for personal and lesion characteristics. Therefore, improving the physical capacity by being active during daily life or in sport may further improve the lipid profile and thus reduce the risk for coronary heart disease.

Social problem-solving abilities predict pressure sore occurrence in the first 3 years of spinal cord injury.

Objective: To test the hypothesis that social problem-solving abilities of persons with recent-onset spinal cord injury (SCI) would be predictive of pressure sore occurrence in the 1st 3 years following discharge from initial inpatient rehabilitation. Design: Prospective study of persons with recently incurred SCI and their subsequent pressure sore evaluations over a 3-year period in annual clinic evaluations. Setting: Inpatient SCI rehabilitation center and outpatient clinic. Participants: 188 persons with recent-onset SCI approaching discharge from initial inpatient SCI rehabilitation, with outpatient pressure sore evaluations for those who returned for pressure sore evaluations. Main Outcome Measure: Pressure sore occurrence as determined in annual outpatient evaluations conducted over the 1st 3 years of SCI. Results: 2 separate statistical models indicated that social problem-solving abilities significantly contributed to the prediction of pressure sore occurrence. Conclusions: Social problem-solving abilities are implicated in the development of pressure sores. Persons with ineffective problem-solving abilities may be at risk for pressure sores; these individuals might require strategic monitoring and training from clinical programs.