Secondary Conditions Scale Research Articles

Effectiveness of telehealth in patients with spinal cord injury: A randomized controlled trial

Background: Spinal cord injury (SCI) impacts every aspect of an injured individual’s life and necessitates ongoing surveillance to prevent subsequent complications. The tele-assessment of different diseases has demonstrated encouraging outcomes, and there is limited literature available about SCI. The present study aimed to document the effectiveness of telehealth on clinical outcomes, quality of life improvement, accessibility, psychological health, patient satisfaction and engagement, and caregiver perspective for patients with SCI. Methods: This study was carried out in a tertiary care centre. Fifty-six patients with acute SCI were randomized into group “S” (study group), who were followed with telehealth telephonically and through video conferencing plus in-person visits to the hospital at second and sixth months, and group “C” (control group) with in-person visit to the hospital only. Patients were assessed for clinical effectiveness (spinal cord independence measure-III, SCI Secondary Conditions Scale, and pressure ulcer scale for healing), psychological health (World Health Organization Quality of Life, patient health questionnaire, and purdue posttraumatic stress disorder), and patient and caregiver’s perspectives (patient satisfaction questionnaire-18, Patient Health Engagement Scale, and Caregiver Strain Index). The outcome measures were compared between the groups at baseline and follow-up using an independent sample t test at a significance level of P <0.05. Results: The mean age of patients was 38.00 ± 14.15 years with predominantly males. The telehealth group showed statistically significant (P = 0.042) improvement in total spinal cord independence measure III (SCI-III) score at 6-month follow-up. The SCI Secondary Conditions Scale, which shows the presence of secondary conditions, had a significantly lower score in the S group at the 6-month follow-up (P = 0.01). The World Health Organization Quality of Life domain 1 was higher in the S group at 6-month follow-up (P < 0.05). Of patients, 50% in the telehealth group were satisfied according to the Modified Reintegration to Normal Living Index scale at monthly follow-up compared with 28.6% in the control group (P < 0.05). The Patient Health Engagement Scale showed that 42.9% of patients reached the final stage of the eudaimonic project in the S group at 6-month follow-up compared with only 14.3% in the control group. Conclusions: Telehealth is an effective tool in the continued care of SCI patients post-hospital discharge. Our findings indicate that patients in the telehealth group report improved physical quality of life, enhanced quality of daily living, and decreased occurrence of medical complications. We suggest that multiple centres at the national level should collaborate to further evaluate telehealth. In the future, we should promote telehealth in the rehabilitation of SCI patients.

Impact of secondary health conditions on the quality of life and wellbeing of Canadians living with spinal cord injury: A comparison of preference-weighted index scores derived from generic standardized instruments

Context/objectives To compare the assessment of the impact of secondary health conditions (SHCs) on the quality of life and wellbeing of Canadians living with spinal cord injury (SCI) using four preference-based outcome measures. Design Secondary analysis of data from a cross-sectional, online survey. Setting Community. Participants Community-dwelling adults (n = 364) living with traumatic or non-traumatic spinal cord injury at least one year post-injury (70% at least 10 years post-injury). Outcome measures A modified version of the Spinal Cord Injury Secondary Conditions Scale (SCI-SCS); three health-related instruments (EQ-5D-5L, Health Utilities Index Mark 3 (HUI3), and the Assessment of Quality of Life 8-dimension questionnaire (AQoL-8D)) and a capability wellbeing instrument (ICEpop CAPability measure for Adults (ICECAP-A)). Results Across unadjusted and controlled analyses (i.e. controlling for associations between index scores and sociodemographic and impairment characteristics), trends were observed that identified lower levels of quality of life/wellbeing with higher problem ratings for each of the SHCs. Despite the trends, there was considerable variation in mean index scores across instruments, with HUI3 scores the lowest of the health-related instruments and ICECAP-A scores the highest overall. Respiratory problems, depression/mood problems, pressure sores, and autonomic dysreflexia were associated with the lowest levels of quality of life and wellbeing. Conclusions Higher problem ratings for SHCs are negatively associated with scores derived from preference-based quality of life and wellbeing instruments. Variation in index scores across instruments – including across the health-related instruments alone – highlights the critical importance of assessing the relative merits of preference-based instruments when using (or considering using) these instruments/estimates in comparative effectiveness research and economic evaluation.

Evaluating a pilot community-based self-management program for adults with spinal cord injury

Objective: To evaluate outcomes and perceptions of participating in a pilot spinal cord injury (SCI) specific community-based self-management program. Design: A program evaluation conducted through the review of retrospective data. Setting: An outpatient vocational rehabilitation service in Singapore. Participants: Adults with SCI who completed a self-management intervention. Intervention: A self-management educational program was delivered by healthcare professionals with involvement of peer mentors. Up to six self-selected topics were covered using a multi-modal teaching approach. Outcome Measures: Retrospective data collected at baseline, post-intervention, and three-month follow-up were analyzed. Outcome measures included the University of Washington Self-Efficacy scale (UW-SES), SCI Secondary Conditions Scale (SCI-SCS), Community Integration Questionnaire (CIQ), and employment. Post-program survey findings were also reviewed. Results: Data from fifteen participants revealed positive changes over time for the UW-SES (η² = .27), SCI-SCS (η² = .21), and CIQ (η² = .23). Self-efficacy scores increased from baseline to post-intervention with a large effect size (Hedge’s g = 0.89), and from baseline to follow-up with a medium effect size (Hedge’s g = 0.50). Participants reported overall perceived benefit and satisfaction with the program’s design and relevance. They valued access to useful information, effective instructional methods, program customization, and participant empowerment and affirmation. Suggestions for program refinement included: more peer support, psycho-emotional support, and continued program adaptability and accessibility. Conclusion: A SCI-specific community-based self-management program was associated with short-term improvements in self-efficacy and was well-received. Further research is required to determine its effectiveness, essential program features that promote successful outcomes, and cost-effectiveness of program implementation.

Health System's Role in Facilitating Health Service Access among Persons with Spinal Cord Injury across 22 Countries.

(1) Background: Despite efforts to improve access to health services, between- and within-country access inequalities remain, especially for individuals with complex disabling conditions like spinal cord injury (SCI). Persons with SCI require regular multidisciplinary follow-up care yet experience more access barriers than the general population. This study examines health system characteristics associated with access among persons with SCI across 22 countries. (2) Methods: Study data are from the International Spinal Cord Injury Survey with 12,588 participants with SCI across 22 countries. Cluster analysis was used to identify service access clusters based on reported access restrictions. The association between service access and health system characteristics (health workforce, infrastructure density, health expenditure) was determined by means of classification and regression trees. (3) Results: Unmet needs were reported by 17% of participants: lowest (10%) in Japan, Spain, and Switzerland (cluster 1) and highest (62%) in Morocco (cluster 8). The country of residence was the most important factor in facilitating access. Those reporting access restrictions were more likely to live in Morocco, to be in the lowest income decile, with multiple comorbidities (Secondary Conditions Scale (SCI-SCS) score > 29) and low functioning status (Spinal Cord Independence Measure score < 53). Those less likely to report access restriction tended to reside in all other countries except Brazil, China, Malaysia, Morocco, Poland, South Africa, and South Korea and have fewer comorbidities (SCI-SCS < 23). (4) Conclusions: The country of residence was the most important factor in facilitating health service access. Following the country of residence, higher income and better health were the most important facilitators of service access. Health service availability and affordability were reported as the most frequent health access barriers.

Responsiveness of the International Spinal Cord Injury Quality of Life Basic Data Set V2.0: An international longitudinal study

Context/Objective Examine the sensitivity of the International Spinal Cord Injury Quality of Life Basic Data Set V2.0 (QoL-BDS V2.0) to reflect changes in mobility and secondary health conditions (SHCs) between inpatient rehabilitation and one-year follow-up. Design International longitudinal study. Questionnaires were administered at baseline (Median 6 weeks, inter-quartile range 4–10 weeks post-onset) and after 12 months. Setting Spinal cord rehabilitation institutions in the US, Brazil, Australia and the Netherlands. Participants : Individuals with recent onset of spinal cord injury or disease (SCI/SCD) admitted to inpatient rehabilitation. Outcome measures The QoL-BDS V2.0, comprises four items on satisfaction with ‘life as a whole’, ‘physical health’, ‘psychological health’, and ‘social life’. Mobility level was measured with a single item and SHCs with the SCI Secondary Conditions Scale (SCI-SCS). Results Of the 160 participants, 61% had SCI, 48% had tetraplegia and 82% were wheelchair-users. Scores on ‘life as a whole’, ‘physical health’ and the total scale were significantly higher at follow-up compared to baseline in the total sample and the SCD subgroup, but not in the SCI subgroup. Increases in ‘physical health’, ‘psychological health’, ‘social life’ and the total score were significantly associated with improvements in the SCI-SCS or mobility scores. Participants with improved SCI-SCS and mobility at follow-up showed significantly more improvement in satisfaction with social life and the total score compared to participants without such favorable changes. Conclusion The results of this study provide partial evidence of responsiveness of the QoL-BDS V2.0 total score as a measure of QoL among individuals with SCI/SCD.

Predictors of quality of life of individuals living in Brazil with spinal cord injury/disease.

A cross-sectional, descriptive study. To investigate the demographic, clinical behavioral, and rehabilitation predictors of the quality of life (QoL) of people with spinal cord injury/disease (SCI/D) in a middle-income country. Ninety-five participants living in the community were evaluated with the following instruments: World Health Organization Quality of Life - Bref; International SCI Core DataSet; Clinical Interview; Spinal Cord Secondary Conditions Scale and Patient Health Questionnaire; Numerical Pain Intensity Scale; Short-Form 12 Health Survey - Item 8 (how much pain hinders activities); Patient Health Questionnaire 2, Numerical Fatigue Scale. Data were analyzed via Spearman correlation, univariate analysis, and multiple regression to explain the effects associated with quality-of-life predictors. The main factors that decreased quality of life were fatigue (by 11.5%), depression (by 5.5-12.8%), pain (by 1.3 in total life quality, in the physical domain by 8.6-9.6%), sores (15.6% in the physical domain only). The practice of sports increased the total quality of life by 14.4%, in the physical domain by 11.9%, in the psychological domain by 17.2%, and in the social domain by 23.7%. Fatigue, risk of depression, pain, and the presence of sores are predictors of poor quality of life, and sports are a predictor of a better quality of life, for people with spinal cord injury. Multidisciplinary rehabilitation, in addition to policies, to increase accessibility and social inclusion, and incentives or subsidies for the practice of sports could improve QoL following SCI/D.

Examining Lifetime Abuse Experiences of People with Spinal Cord Injury

<h3>Research Objectives</h3> To examine lifetime abuse among people with SCI and its relation to demographic and disability characteristics and physical and psychological health. <h3>Design</h3> Cross-sectional survey study. <h3>Setting</h3> Online survey with alternate formats offered. <h3>Participants</h3> A diverse national sample of 346 people with SCI. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> Lifetime abuse was examined using the Abuse Assessment Screen-Disability (AAS-D) which assesses physical, sexual, and disability-related abuse. We measured physical health with the SF-36 General Health Scale and the SCI Secondary Conditions Scale. We used the PHQ-8, GAD-7, PTSD Checklist-Civilian, and the Satisfaction with Life Scale to assess psychological health and well-being. <h3>Results</h3> More than a third of participants reported abuse. Physical abuse was most frequently reported (30%) followed by disability-related (17%) and sexual (9%) abuse. Few demographic or disability characteristics were related to abuse; however, women were significantly more likely to have experienced sexual abuse than men (20% versus 2%). Sexual abuse was also reported more often by those employed. Physical abuse was reported more often by those formerly married and was inversely related to income. Disability-related abuse was not related to any demographic characteristics but was significantly related to self-reported care needs. All three types of abuse were related to physical and psychological health. Entering all three abuse types in regression models, only disability abuse uniquely predicted all four measures of psychological health and well-being. <h3>Conclusions</h3> The SCI literature on abuse is extremely limited. Our results suggest a sizeable number of people with SCI have experienced abuse, and this experience may have health ramifications. Disability-related abuse, which differentially affects those with greater care needs, should not be underestimated in scope or impact. <h3>Author(s) Disclosures</h3> None.

Examining Loneliness and Its Correlates in a Sample of People with Spinal Cord Injury

<h3>Research Objectives</h3> To examine loneliness among individuals with SCI and explore its relation to demographic, disability, health-related, and social characteristics. <h3>Design</h3> Cross-sectional survey study. <h3>Setting</h3> Online survey with alternate formats offered. <h3>Participants</h3> A diverse national sample of 346 people with SCI. <h3>Interventions</h3> Not applicable. <h3>Main Outcome Measures</h3> We measured loneliness using the UCLA Loneliness Scale-v3. Measures of health included the SF-36 General Health Scale, the SCI Secondary Conditions Scale, and pain and pain interference items. Measures of social connections and social participation included the CHART Social Integration Scale, an 8-item MOS Social Support Scale, and the SCI-QoL Satisfaction with Participation Scale. <h3>Results</h3> Confirmatory factor analysis supported the bi-factor structure of the UCLA-v3 found in other populations. Loneliness scores in our sample were high (Mean=46.15, SD=13.87, range 20-79) with a majority of participants reporting that they "sometimes" or "often" feel alone, left out, isolated, lacking in companionship, that others are around them but not with them, and that their interests and ideas are not shared by those around them. Women reported greater loneliness than men, and loneliness was inversely related to time since injury. Loneliness was higher among those reporting poorer health, more severe secondary health conditions, and greater pain and pain interference. Social support and social participation were most strongly related to loneliness and accounted for the greatest variance in regression models. <h3>Conclusions</h3> The construct of loneliness appears similar to that in other populations based on a similar factor structure on the UCLA-v3. Our findings suggest that loneliness is a significant problem for people with SCI and underscores a pressing need for intervention development to address this issue in this at-risk population. <h3>Author(s) Disclosures</h3> None.

Factors enabling comorbidities and secondary conditions in older adults with spinal cord injury

Objective: To examine the role of personal, social, and environmental factors predicting comorbidities and secondary conditions among older adults with spinal cord injury (SCI). Design: Cross-sectional study utilizing survey methods were used to collect the data analyzed with two distinct general linear models. Setting: Community-dwelling participants who resided in rural and urban areas. Participants: One hundred and eighty-three (183) participants with SCI ages 45 and over at least five years post injury. Interventions: Not applicable. Measures: Spinal Cord Injury Secondary Conditions Scale (SCI-SCS); Comorbidities Questionnaire; Spinal Cord Injury Functional Index Assistive Technology (SCI-FI/AT) Basic – Mobility; Spinal Cord Injury Quality of Life (SCI-QOL) Satisfaction with Social Roles and Activities Scale (SSRA); Cohen’s Social Network-Social Integration Index, the Medical Outcomes Study (MOS) Social Support Emotional/Informational Support Scale, and the Facilitators and Barriers Survey for Mobility (FABS-Mv2). Questions were also asked from the Behavioral Risk Factor Surveillance System (BRFSS). Results: Common predictors of comorbidities and secondary conditions included age, basic mobility, primary health care payer and parking limitations. An interaction between parking and neurological classification was observed for comorbidities. Neurological classification and employment were significantly associated with comorbidities while for secondary conditions, sex, years since injury, education, satisfaction with social roles and the home environment were critical factors. Conclusions: Our study shows the effects of demographic and injury factors, physical functioning, satisfaction with social roles, access to home environment adaptations and health resources in predicting comorbidities and secondary conditions among older adults with SCI.

First contact of care for persons with spinal cord injury: a general practitioner or a spinal cord injury specialist?

BackgroundAlthough general practitioners (GPs) are generally considered as the first point of contact for care, this may be different for persons with complex conditions, such as those with spinal cord injury (SCI). The objective of this study is to understand the differences in long-term care provision by GPs and SCI-specialists, by examining (1) the first contact of care for SCI health problems, (2) the morbidity profile and use of health-care services in relation to first contact, and (3) the factors associated with the choice of first contact.MethodsIn this cross-sectional study based on data derived from the Swiss Spinal Cord Injury Cohort Study Community Survey 2017, the main outcome measure was the reported first contact for SCI-specific care. This information was analysed using the chi-square test and logistic regression analysis of groups based on patient characteristics, use of health-care services and secondary health conditions assessed using the Spinal Cord Injury Secondary Conditions Scale (SCI-SCS).ResultsOut of 1294 respondents, 1095 reported their first contact for SCI-specific care; 56% indicated SCI-specialists and 44% specified GPs. On average, participants who first contacted a GP reported higher number of GP consultations (5.1 ± 5.2 vs. 3.9 ± 7.2), planned visits to ambulatory clinics (3.7 ± 7.3 vs. 3.6 ± 6.7) and hospital admissions (GP, 1.9 ± 1.7 vs. 1.5 ± 1.3), but lower number of visits to SCI-specialists (1.7 ± 1.8 vs. 2.6 ± 1.7) and of hospital days (22.8 ± 43.2 vs. 31.0 ± 42.8). The likelihood to contact a GP first was significantly higher in persons ≥75 years old (OR = 4.44, 95% CI = 1.85–10.69), Italian speakers (OR = 5.06, 95% CI = 2.44–10.47), had incomplete lesions (OR = 2.39, 95% CI = 1.71–3.35), experiencing pain (OR = 1.47, 95% CI = 1.04–2.09) or diabetes mellitus (OR = 1.85, 95% CI = 1.05–3.27), but lower for those situated closer to SCI centres (OR = 0.69, 95% CI = 0.51–0.93) or had higher SCI-SCS scores (OR = 0.92, 95% CI = 0.86–0.99).ConclusionAge, language region, travel distance to SCI centres, lesion completeness, and occurrence of secondary conditions play a significant role in determining the choice of first contact of care, however there is still some unwarranted variation that remains unclear and requires further research.

Using the interviewer-administered version of Work Rehabilitation Questionnaire (WORQ) in Russia: cross-cultural adaptation and psychometric properties in traumatic spinal cord injury

Purpose (1) To perform a cross-cultural adaptation of Work Rehabilitation Questionnaire to Russian (WORQ-R); (2) to report the psychometric properties of WORQ-R in patients with traumatic spinal cord injury (TSCI). Materials and methods WORQ is designed to evaluate the work functioning of individuals who are engaged in vocational rehabilitation. We performed a formal cross-cultural adaptation of WORQ from English to Russian utilizing a standardized 3-step approach. We examined the psychometric properties of WORQ-R in terms of its reliability and construct validity through the use of classical and modern test theory in the TSCI population. Results The adaptation process achieved equivalence between Russian and English versions of WORQ. WORQ-R proved to cover major issues concerning functioning in vocational rehabilitation and was simple to understand. The internal consistency of WORQ-R was good (Cronbach’s Alpha = 0.83). Rasch analysis confirmed the unidimensionality of the WORQ-scale and high reliability (PSI = 0.97) based on a testlet solution. WORQ-R score showed a strong negative correlation with the Functional Independence Measure, moderate negative correlation with the Spinal Cord Independence Measure Version III and the SF-36, moderate positive correlation with the Spinal Cord Injury Secondary Conditions Scale. Conclusions WORQ-R showed good validity and reliability in persons with TSCI allowing vocational professionals to have comprehensive information on vocational functioning. IMPLICATIONS FOR REHABILITATION SCI is a disabling condition that causes impairments in body structure and function leading to activity limitations and participation restrictions. WORQ is a generic tool that allows for an assessment of work-related aspects of functioning in different populations of persons with disabilities. This study demonstrates the psychometric properties of the Russian version of WORQ in the SCI population. WORQ-R is recommended as a tool to describe the biopsychosocial and related vocational background to gain a better understanding of needs among SCI persons in terms of vocational rehabilitation.

Considerations on the psychometric properties and validity of the Spinal Cord Injury Secondary Conditons Scale.

Cross-sectional validation study. Explore psychometric properties of Spinal Cord Injury Secondary Conditions Scale (SCI-SCS). Two Scandinavian rehabilitation centres. Included were 224 consecutive patients attending regular follow-up at least 1 year after a traumatic SCI. Mean age was 49.6 (SD 14.9) years. SCI-SCS floor and ceiling effect examined. Construct validity was investigated by confirmatory factor analysis and correlation analysis, and reliability by Cronbach's alpha. SCI-SCS showed no floor or ceiling effect. Two out of four earlier reported latent factors ("Genitourinary and bowel", "Muscle structures and pain") were confirmed. The global Cronbach's alpha of SCI-SCS was 0.65 and 0.22-0.61 for the four latent factors. The SCI-SCS sum score showed low correlation to quality of life (QoL) measured by EQ5 VAS (rs = -0.47, p < 0.001). Likewise, the sum score correlations to QoL-general and QoL-physical health (International SCI QoL Basic Dataset) were low (rs = -0.36, p < 0.001 and rs = -0.37, p < 0.001, respectively). The scale item Muscle Spasms correlated moderately to ratings on Spasm Frequency (rs = 0.59, p < 0.001) and Spasm Intensity (rs = 0.56, p < 0.001) scales. Chronic Pain and Joint and Muscle Pain correlated to patient reported number of pain sites and level of pain (International SCI Pain Basic Dataset 1.0) (rs = 0.31 p < 0.001 and rs = 0.47, p < 0.001, respectively). SCI-SCS is a relevant instrument for giving clinicians and researchers an overview of the individual recent experiences with secondary conditions. However, the instrument could benefit from a clearer definition of the construct secondary conditions, a scale revision and a consideration of whether to add other experienced secondary conditions.

Web-Based Health Coaching for Spinal Cord Injury: Results From a Mixed Methods Feasibility Evaluation.

BackgroundIndividuals with spinal cord injury (SCI) are at high risk of experiencing secondary conditions like pressure injuries. Self-management programs may reduce the risk of complications, but traditional programs have proven to be insufficiently tailored to the needs of people with SCI. To overcome barriers to self-management support, a web-based, self-management program was developed for Canadians with SCI called SCI & U.ObjectiveThis study aims to evaluate the feasibility and potential impact of the SCI & U program in the context of a mixed methods pilot study.MethodsThe study followed an explanatory, sequential mixed methods design. Participants (N=11) were Canadians with SCI who had been living in the community for more than 1 year. Each took part in a self-paced, six-session self-management program guided by a trained peer health coach. During sessions, participants could discuss a health topic with their coach from a predefined list (eg, skin or bowel management). Quantitative data were gathered before and after program participation to assess program feasibility and impact. Feasibility measures included attrition rates, frequency of topics selected, and recorded goals, whereas impact measures included measures of self-efficacy (University of Washington Self-Efficacy Scale [UW-SES]), mood (Personal Health Questionnaire Depression Scale [PHQ-8]), secondary conditions (Spinal Cord Injury Secondary Conditions Scale [SCI-SCS]), and resilience (Spinal Cord Injury Quality of Life Resilience Scale [SCI-QOL-R]). Qualitative measures were based on postintervention interviews; these were designed to confirm and expand on quantitativeResultsOf the 11 participants, 10 completed pre- and postassessments, and 6 coaching sessions. Sessions lasted between 31 and 81 min (average 55, SD 13), and the duration of the program ranged from 35 to 88 days (average 56, SD 23). Diet and exercise were selected as topics 40% (20/50 sessions with topics) of the time, whereas topics such as mental health, bladder management, pain, and bowel management were chosen less frequently. Results gathered before and after the pilot study demonstrated improvements with moderate effect sizes on the UW-SES and the electronic health literacy scale (ie, Hedges g>0.5). Effect sizes for measures of resilience (SCI-QOL-R), depression (PHQ-8), and secondary conditions (SCI-SCS) were small (ie, Hedges g>0.3). Qualitative results confirmed a common focus on diet and exercise, and defined coaches as sources of accountability, information, reassurance and affirmation, and emotional and technical support.ConclusionsResults demonstrated that a web-based self-management program is feasible and acceptable by Canadians with SCI. Results also indicated a web-based, peer-led self-management program may impact resilience, self-efficacy, mood, and secondary complications. Finally, results illuminated the role of the coach in facilitating behavior change. Future work seeks to validate results in the context of a randomized controlled trial.

Impact of spasticity on functioning in spinal cord injury: an application of graphical modelling.

To identify the impact of moderate-to-severe spasticity on functioning in people living with spinal cord injury. Secondary analysis of cross-sectional survey data using graphical modelling. Individuals (n = 1,436) with spinal cord injury aged over 16 years with reported spasticity problems. Spasticity and 13 other impairments in body functions were assessed using the spinal cord injury Secondary Conditions Scale. Impairments in mental functions were assessed using the Mental Health subscale of the 36-item Short Form (SF-36). Independence in activities was measured with the Spinal Cord Injury Independence Measure Self-Report. Restrictions in participation were measured with the Utrecht Scale for Evaluation Rehabilitation - Participation. Fifty-one percent of participants reported moderate-to-severe spasticity. Graphical modelling showed that Chronic pain, Contractures, Tiredness, Doing housework, and Respiratory functions were associated with spasticity and were the top 5 potential targets for interventions to improve the experience of spasticity. The associations and intervention targets were dependent on the level and completeness of the lesion. This is the first application of graphical modelling in studying spasticity in people living with spinal cord injury. The results can be used as a basis for studies aiming to optimize rehabilitation interventions in people with moderate-to-severe spasticity.

Validation and psychometric evaluation of the Italian version of the Spinal Cord Injury Secondary Conditions Scale.

Validation cross-sectional study. To adapt the Spinal Cord Injury Secondary Conditions Scale (SCI-SCS) to Italian and to assess the validity and reliability of this instrument. Multicentre study in outpatient clinics of three urban spinal units across Italy. After a five-step translation/validation process, the Italian SCI-SCS was administered in a toolset composed of a sociodemographic questionnaire, the Modified Barthel Index, the Short-Form 8, the Patient Health Questionnaire 9, and the General Anxiety Disorder 7. The Italian SCI-SCS construct validity was assessed through exploratory factor analysis (EFA). The internal consistency and test-retest reliability of the instrument were evaluated using Cronbach's α and the intraclass correlation coefficient (ICC) for the total scale and its subscales. Pearson's correlation coefficient with all administered instruments was calculated to evaluate the concurrent validity. One-hundred fifty-six participants were recruited from February to October 2018. EFA suggested a three-factor structure explaining 45% of the total variance. After experts' consideration about the clinical relevance of its components, a final version of the Italian SCI-SCS with four different subscales and 15 items was proposed. The total scale Cronbach's α was 0.73. The ICC agreement for test-retest reliability was 0.91. Correlations of the Italian SCI-SCS with the administered instruments were statistically significant (p < 0.05), highlighting congruent hypothesized relations. Findings of this study provided a first psychometric evaluation of the SCI-SCS. The modified Italian version of this tool may represent a valuable instrument for the longitudinal assessment of the impact of secondary conditions in people with SCI.

A pilot investigation of anterior tilt use among power wheelchair users

Purpose To examine the influence of use of the anterior tilt-in-space power seat function on performance of functional activities, physical health, and user satisfaction on among power wheelchair users. Materials and methods Ten full-time power wheelchair users with a seat elevator on their current chair participated in a mixed-methods, repeated measures study. At Visit 1 participants completed the Wheelchair Outcome Measure, Functional Mobility Assessment, Wheelchair Users Shoulder Pain Index, Fatigue Severity Scale, and the Spinal Cord Injury Secondary Conditions Scale. Physical assessments were performed to examine transfer quality (transfer assessment instrument), functional reach, activities of daily living (performance assessment of self-care skills), seated balance (function in sitting test), spasticity, respiratory function, and speech production. Approximately 3 days later (Visit 2), participants were trained on use and provided a power wheelchair with anterior tilt to trial for two weeks. After two weeks (Visit 3), the Visit 1 protocol was repeated and a semistructured interview conducted. Results Participants lived with disabilities of cerebral palsy, spinal muscular atrophy and multiple sclerosis. With use of anterior tilt, significant improvements were seen among safety of meal preparation, p = 0.033, dz = 0.91 and functional reach in the vertical direction, p = 0.000, dz = 2.62. Subjectively, participants found anterior tilt helpful in performance of reaching tasks in but found the safety equipment restrictive. Conclusion Preliminary results indicate that use of the anterior tilt may help to improve performance of functional activities. Additional research is needed to examine the long-term influence of the technology. Implications for rehabilitation The anterior tilt seat function changes the seat angle orientation in relation to the ground in the sagittal plane and angles the seat forward. As a result, the individual using the assistive technology is positioned in a semistanding position. Preliminary results of this study indicate that with use of anterior tilt, safety of meal preparation and functional reach in the vertical direction significantly improved. Subjectively, participants found anterior tilt helpful in performance of reaching tasks but found the safety equipment restrictive. Additional research is needed to examine the long-term influence of anterior tilt on functional activities, physical health and user satisfaction on among a large and diverse group of power wheelchair users.

Sexual abuse in people with spinal cord damage

Objectives: There are few studies of sexual abuse in people with spinal cord damage (SCD). Objective of this study was to determine the prevalence and impact of sexual abuse in SCD. Design: Survey (web and paper-based). Setting: Australia (August 2013–June 2014). Participants: People with SCD (n = 136); able-bodied controls (n = 220). Interventions: None. Outcome measures: Spinal Cord Injury Secondary Conditions Scale, International SCI Quality of Life Basic Dataset, and the Physical Disability Sexual and Body Esteem scale. Questions regarding demographic and clinical characteristics, sex, sexual orientation, relationship status, disability, sexual interest and satisfaction, and sexual abuse. Results: Most SCD participants were male (n = 92, 67%), the average age was 46 years (SD = 14) and they were median of 11 years (IQR 4–21) after SCD. Of these, 19% (n = 26) reported sexual abuse. Females were much more likely to report being abused (odds ratio 3.3, 95%CI 1.5–7.4; χ 2=10.9, P = 0.001). Participants reporting sexual abuse were younger (P = 0.01) and more likely to have been abused before their SCD (69%). There was no significant difference between those with SCD who reported sexual abuse and those who did not regarding their quality of life as a whole (P > 0.1). There was no difference regarding the reporting of sexual abuse between able-bodied and those with SCD (P = 0.1). Conclusion: Sexual abuse was relatively common and was not associated with an adverse relationship with the covariates assessed. Further research is needed to better determine the prevalence of sexual abuse in people with SCD and its impact.

Health status, quality of life and socioeconomic situation of people with spinal cord injuries six years after discharge from a hospital in Bangladesh.

Cross-sectional analysis of a mixed retrospective and prospective inception cohort study. To determine health status, quality of life and socioeconomic situation of people with spinal cord injuries (SCI) 6 years after discharge from a hospital in Bangladesh. Bangladesh. All patients alive 6 years after discharge from a hospital in Bangladesh were interviewed using the SF12 health survey, the SCI Secondary Conditions Scale, the Centre for Epidemiologic Studies Depression Scale (CESD), and the participation in society items of World Health Organisation Disability Assessment Schedule (WHODAS 2.0). Additional questions determined participants' socioeconomic and employment status. The cohort comprised 260 participants: 145 used wheelchairs for mobility and 115 were able to walk at discharge. The median (IQR) Mental and Physical Component scores for the SF12 were 54 (49-57) and 44 (40-51) points, respectively. The median scores for the SCI Secondary Conditions Scale, CESD and WHODAS 2.0 were 8 (4-13), 7 (4-13) and 12 (6-17) points, respectively. Fourteen percent of all participants and 23% of those who used wheelchairs had a pressure ulcer at the time of interview. Forty-four percent of participants were unemployed and 65% were living below the poverty line (median (IQR) income, USD 0 (0-91)) per month. Many people with SCI in Bangladesh are unemployed and living in poverty with a reduced quality of life and participation. Pressure ulcers are a common complication.

Trajectories of Self-Efficacy and Depressed Mood and Their Relationship in the First 12 Months Following Spinal Cord Injury

ObjectivesTo establish self-efficacy and depressive mood trajectories in adults with spinal cord injury (SCI), determine their interrelationship over time, and determine the influence that appraisals and comorbid physical conditions have on the development of self-efficacy. DesignA prospective cohort design. SettingInpatient rehabilitation and community settings. ParticipantsAdults (N=88) admitted consecutively into 3 SCI units (mean age, 42.6 years, 70.4% male, 61% paraplegia). InterventionsMultidisciplinary inpatient SCI rehabilitation. Main Outcome MeasuresThe Moorong Self-Efficacy Scale and Hospital Anxiety and Depression Scale were used to model self-efficacy and depressive mood trajectories. Appraisals were assessed using the Appraisals of Disability Scale and frequency/type of secondary conditions using the Secondary Conditions Scale. Growth mixture modeling was used to determine trajectories. Dual trajectory probability analysis was used to determine concurrent changes in self-efficacy and depressive mood. Linear mixed modeling incorporating repeated measures determined the contribution of appraisals and physical complications to self-efficacy trajectories. ResultsModeling identified 4 trajectories of self-efficacy and depressive mood. The majority (around 60%) of the sample was estimated to have moderate to high self-efficacy and low levels of depressive mood. Dual trajectory analysis revealed that robust self-efficacy was strongly connected to low depressive mood over time, while low self-efficacy was strongly linked to clinically elevated depressive mood. Low self-efficacy was related to higher severity of secondary conditions and negative appraisals. ConclusionsFindings highlight the importance of self-efficacy not only as a strategic clinical measure for assessing adjustment following SCI but also in relation to the implications it raises for improving SCI rehabilitation.

Chronic pain, depression and quality of life in individuals with spinal cord injury: Mediating role of participation.

To test the hypotheses that: (i) pain is associated with depressive symptoms and quality of life; and (ii) participation restriction, satisfaction, and frequency mediate these relationships. Population-based, cross-sectional study. Community-dwelling individuals with spinal cord injury (n = 1,549). Hypotheses were tested in individuals with at least moderate chronic pain on the spinal cord injury - Secondary Conditions Scale (n = 834), applying structural equation modelling to data for spinal cord injury subgroups related to lesion severity (paraplegia, tetraplegia, complete, incomplete) and time since injury (≤ 10 vs ≥ 10 years). Model parameters included pain intensity (numerical rating scale), participation frequency, restriction, satisfaction (Utrecht Scale of Evaluation of Rehabilitation-Participation; USER-Participation), depressive symptoms (5-item Mental Health Index of the Short Form Health Survey; MHI-5), and 5 selected quality of life items (World Health Organization Quality of Life Scale; WHOQoL-BREF). Structural equation models confirmed associations of pain with depressive symptoms and quality of life, as well as the mediating role of participation restriction and low satisfaction with participation. These findings were apparent in individuals with tetraplegia or complete lesion and in those ≤ 10 years since paraplegia or incomplete injury. Unrestricted or satisfactory participation was found to be a crucial resource for individuals living less than 10 years with a more severe spinal cord injury, since it represents buffering potential for the negative effects of chronic pain on mental health and quality of life.