Canadian Spinal Cord Injury Research Articles

Early versus late surgery for traumatic spinal cord injury: the results of a prospective Canadian cohort study

A multicenter Canadian cohort study. The objective of this study is to evaluate the impact of early versus late surgical decompression on motor neurological recovery after traumatic spinal cord injury (SCI). Canadian acute care and SCI rehabilitation facilities. A prospective cohort study of patients within the Ontario Spinal Cord Injury Registry program was performed. We considered SCI patients with an admission American Spinal Injury Association (ASIA) Impairment Scale (AIS) grade of A through D, with magnetic resonance imaging-confirmed spinal cord compression. Grouped analysis was performed comparing the cohort of patients who received early surgery (<24 h after SCI) to those receiving delayed surgery (<24 h after SCI). The primary outcome was the change in ASIA motor score (AMS) occurring between hospital admission and rehabilitation discharge. A total of 35 (41.7%) patients underwent early surgery and 49 (58.3%) underwent late surgery. At admission, there was a greater proportion of patients within the early surgery group with more severe AIS grade A injuries. Of the 55 patients with neurological exam available at rehabilitation discharge, a greater proportion had at least a two-grade AIS improvement in the early-surgery group (P=0.01). The mean improvement in AMS at rehabilitation discharge was 20 points amongst early-surgery patients and 15 points amongst late-surgery patients (P=0.46). In the analysis investigating AMS improvement, adjusted for preoperative status and neurological level, there was a positive effect estimate for early surgical therapy that was statistically significant (P=0.01). The results here add weight to the growing body of literature, which supports the principle of early intervention in the setting of spinal trauma and SCI.

Incidence and Prevalence of Spinal Cord Injury in Canada: A National Perspective

Background: Despite decades of research, there are no national estimates of the incidence or prevalence of spinal cord injury (SCI) in Canada. Our objective was to utilize the best available data to estimate the incidence and prevalence of traumatic SCI (TSCI) and non-traumatic SCI (NTSCI) in Canada for 2010. Methods: Initial incidence (number of TSCIs at injury scene) and discharge incidence (number discharged into the community) were calculated using published TSCI rates from Alberta and NTSCI rates from Australia. Prevalence was estimated by applying TSCI and NTSCI discharge incidence rates to historical Canadian population demographics using a cohort survival model and age-specific mortality rates for tetraplegia and paraplegia. Results: The estimated 2010 initial incidence of TSCI is 1,785 cases per year, and the discharge incidence is 1,389 (41 per million). The estimated discharge incidence for NTSCI is 2,286 cases (68 per million). The prevalence of SCI in Canada is estimated to be 85,556 persons (51% TSCI and 49% NTSCI). Conclusions: This study provides the first estimates of the incidence and prevalence of SCI in Canada. More population-based studies are needed, particularly for NTSCI, as an increasing number of Canadians are expected to be affected by SCI.

Understanding age effects associated with changes in secondary health conditions in a Canadian spinal cord injury cohort

Longitudinal cohort. To determine whether changes in secondary health conditions (SHC) associated with spinal cord injury (SCI) were effectively modeled from a longitudinal or cross-sectional perspective, and whether the changes in SHCs were attributable to age or years post-injury (YPI). Toronto Rehabilitation Institute, Lyndhurst Centre. Telephone survey methods were used to collect data on (1) demographics, (2) impairment, (3) health status, and (4) self-reported SHCs at two time intervals (1995-1997; 2003-2004) from 344 adults with SCI. Generalized estimating equations were applied to model the longitudinal and cross-sectional effects. Health status decreased over time (P<0.0005), whereas the number of SHCs increased (P<0.0001). Regardless of age or YPI, the longitudinal component of aging better predicted SHC occurrence and was associated with spasticity [odds ratio, OR=1.055 (95% confidence interval, CI, 1.018 to 1.093, P<0.01)], kidney problems [OR=1.154 (95% CI, 1.084 to 1.229, P<0.0001)], cardiac problems [OR=1.168 (95% CI, 1.060 to 1.286, P<0.01)], high blood pressure [OR=1.121 (95% CI, 1.058 to 1.188, P<0.0001)], chronic pain [OR=1.058 (95% CI, 1.021 to 1.096, P<0.01)], and arthritis/joint pain [OR=1.113 (95% CI, 1.075 to 1.152, P<0.0001)]. Within a relatively short period of time, persons with SCI experienced substantive declines in health. The findings suggest that a longitudinal perspective is more sensitive for predicting the risk of self-reported SHCs than a cross-sectional one.

Physiatrists' opinions and practice patterns for bone health after SCI

Self-report survey. To ascertain physiatrists' opinions and current practice patterns for bone health management after spinal cord injury (SCI). Physiatrists who work in teaching rehabilitation centers in Canada. A 4-page 17-question survey (available in French and English) was sent to working physiatrists in all major Canadian SCI rehabilitation centers. We had an 85% response rate (22 responses). Physiatrists reported that they should be managing bone health issues after SCI in conjunction with family physicians, and most respondents assess and treat for bone health after SCI. However, just over one-third of the physiatrists reported that the current treatment options are not effective for low bone mass; there was more support for pharmacological treatments than there was for rehabilitation modalities. Bone health after SCI is an important health concern that is being managed by physiatrists; however, more discussion and research is needed to ascertain the effectiveness of assessment and treatment options for low bone mass.

Secondary Health Complications in an Aging Canadian Spinal Cord Injury Sample

This study describes self-reported incidence of secondary health complications (SHCs) and their associations with age, years postinjury (YPI), and impairment among a Canadian spinal cord-injured (SCI) cohort. Cross-sectional telephone survey methods were used to collect data on (1) sociodemographics, (2) impairment, (3) health status, and (4) self-reported SHCs on 781 adults >or=1 yr post-SCI living in Ontario, Canada. Logistic regression analyses were used to determine associations between self-reported incidences of SHCs with the following covariates: (1) age, (2) YPI, and (3) impairment. The odds ratios for cardiac complications, high blood pressure (HBP), and respiratory complications increased per year with age, whereas autonomic dysreflexia (AD), bladder infections, heterotopic ossification, psychological distress, and drug addiction decreased. The odds ratios for pressure ulcers, AD, and heterotopic ossification increased per YPI, whereas HBP, bowel problems, psychological distress, and depression decreased. Complete injuries were associated with bladder infections, pressure ulcers, and AD. Paraplegia was associated with HBP and bowel problems, and tetraplegia was associated with AD. The findings provide some clarification on factors associated with the occurrence of SHCs after SCI and are useful for informing health-promotion planners, clinicians, and stakeholders regarding the odds of SHCs with aging or among specific impairment groups.

Epidemiology of Traumatic Spinal Cord Injury in Canada

Retrospective review. To describe the incidence, clinical features, and treatment of traumatic spinal cord injury (SCI) treated at a Canadian tertiary care center. Understanding the current epidemiology of acute traumatic SCI is essential for public resource allocation and primary prevention. Recent reports suggest that the mean age of patients with SCI may be increasing. We retrospectively reviewed hospital records on all patients with traumatic SCI between January 1997 and June 2001 (n = 151). Variables assessed included age, gender, length of hospitalization, type and mechanism of injury, associated spinal fractures, neurologic deficit, and treatment. Annual age-adjusted incidence rates were 42.4 per million for adults aged 15-64 years, and 51.4 per million for those 65 years and older. Motor vehicle accidents accounted for 35% of SCI. Falls were responsible for 63% of SCI among patients older than 65 years and for 31% of injuries overall. Cervical SCI was most common, particularly in the elderly, and was associated with fracture in only 56% of cases. Thoracic and lumbar SCI were associated with spinal fractures in 100% and 85% of cases, respectively. In-hospital mortality was 8%. Mortality was significantly higher among the elderly. Treatment of thoracic and lumbar fractures associated with SCI was predominantly surgical, whereas cervical fractures were equally likely to be treated with external immobilization alone or with surgery. A large proportion of injuries was seen among older adults, predominantly as a result of falls. Prevention programs should expand their focus to include home safety and avoidance of falls in the elderly.

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Telephone-based counseling is an efficacious intervention strategy for maintaining leisure-time physical activity (LTPA) intentions and increasing LTPA behavior among adults with spinal cord injury (SCI). However, no research has examined the real-world application of this intervention strategy within the SCI community.To assess the individual-level impact of a previously tested telephone-based counseling intervention among adults within the SCI community by using the first 2 components of the Reach, Effectiveness, Adoption, Implementation, and Maintenance framework.A prospective study.General community, tertiary care.Community-dwelling adults with SCI (n = 65; 57% men; mean [standard deviation], 50.4 ± 12.8 years; mean (standard deviation) years after injury, 14.5 ± 12.7 years) living in Canada who enrolled in a national telephone-based counseling service. Of the 65 clients who enrolled, 53 participated in the effectiveness evaluation component of the Get In Motion service.A 6-month, individualized telephone-counseling program with a trained exercise counselor. The program was based on a previously tested intervention that used aspects of the Health Action Process Approach model, with a particular focus on developing and strengthening clients' social cognitions for engaging in self-managed LTPA.On enrollment, all 65 clients completed demographics and staging questionnaires. The 53 clients who participated in the effectiveness evaluation also completed a validated LTPA intentions item, and the 7-day, self-report LTPA Questionnaire for People with SCI over the telephone at baseline, and 2, 4, and 6 months.In terms of the reach of Get In Motion, a total of 65 clients enrolled in the service between June 2008 and June 2011, and were representative of the larger Canadian SCI population on most measured demographic characteristics. Evaluation of the effectiveness of the service showed that, as hypothesized, intentions for engaging in LTPA remained high throughout enrollment (P = .44), with a trend for more clients engaging in moderate-to-heavy–intensity LTPA at 6 months (52%) versus baseline (35%) (P = .09).Telephone-based counseling is a promising strategy for promoting community-based LTPA behavior among Canadian adults with SCI. Continued evaluation of all 5 Reach, Effectiveness, Adoption, Implementation, and Maintenance framework components of Get In Motion will help establish the real-world impact of this intervention strategy on community-based LTPA participation within the SCI population.