Spinal Cord Injury Or Disease Research Articles

Investigating adaptive sport participation for adults aged 50 years or older with spinal cord injury or disease: A descriptive cross-sectional survey

Context Spinal cord injury or disease (SCI/D) can lead to health challenges that are exacerbated with aging. Adaptive sport is understood to provide health benefits for the SCI/D population. Prior literature investigating adaptive sport in this population pertains to adults with SCI/D who are <50 years of age. However, most Canadians with SCI/D are >50 years of age. Objectives This study aimed to: (1) Compare demographics of those who do and do not participate in adaptive sport; (2) Describe the characteristics of adaptive sport that adults aged ≥50 years with SCI/D participate in; and (3) Identify barriers and facilitators to adaptive sport participation in this age group. Methods This descriptive, cross-sectional survey was carried out using an online survey. Analytical statistics were used to address objective one, while descriptive statistics were employed for objectives two and three. Participants Responses from 72 adults aged ≥50 years, residing in Canada, living with a SCI/D for >6 months were included in the analysis. Results Findings revealed that adaptive sport participants aged ≥50 years with SCI/D were more likely to identify as men, be younger individuals (50–59 years), and report greater satisfaction with physical health (P < 0.05). Adaptive sport participants most commonly played individual sports at the recreational level. Common barriers pertained to physical capacity, travel, and COVID-19; common facilitators included social support, desire to improve health, and having friends/peers who also participate. Conclusion Future research should investigate strategies to enhance facilitators and mitigate barriers to adaptive sport participation in order to improve access.

The social dimension of quality of life following spinal cord injury or disease: an international ICF-linking study.

International Classification of Functioning, Disability and Health (ICF) linking study. Analyze cognitive interview data using the ICF as an analytic framework, to examine aspects of social life relevant to quality of life (QoL) according to people with spinal cord injury or disease (SCI/D). This study builds upon results of an international study about the cross-cultural validity of the International SCI QoL Basic Data Set (QoL-BDS). Four specialized outpatient clinics in SCI/D rehabilitation, from the US, Brazil and Australia. Analysis of qualitative data from 39 cognitive interviews with SCI/D patients at least one year post onset. Participants were asked to define their concept of QoL, overall life satisfaction, physical health and psychological health, and other relevant matters. Four independent researchers coded text fragments related to the items, and fragments were linked to ICF chapters d6-d9, following established linking rules. The proportion of text referring to social life was 35.8% (definition QoL), 24.9% (QoL life as whole), 6.0% (physical health) and 34.9% (psychological health). The most frequent ICF categories were d760 Family relationships, d770 Intimate relationships and d920 Recreation and leisure. Most frequent responded social topics to the 'other issues' item were d770 Intimate relationships, d760 Formal relationships, and d870 Economic self-sufficiency. The importance of social life aspects to the QoL was highlighted based on responses of SCI/D patients, clearly demonstrated through the ICF linking process. Adding a satisfaction with social life item to the QoL-BDS has made this instrument a more comprehensive measure.

Reducing endocrine metabolic disease risk in adults with chronic spinal cord injury: strategic activities conducted by the Ontario-Quebec RIISC team

Purpose The Rehabilitation Interventions for Individuals with a Spinal Cord Injury in the Community (RIISC) team aimed to develop and evaluate innovative rehabilitation interventions to identify endocrine metabolic disease (EMD) risk, intending to reduce the frequency and severity of EMD related morbidity and mortality among adults living with chronic spinal cord injury or disease (SCI/D). Materials and Methods An interprovincial team from Ontario and Quebec reviewed available EMD literature and evidence syntheses and completed an inventory of health services, policies and practices in SCI/D care. The review outcomes were combined with expert opinion to create an EMD risk model to inform health service transformation. Results EMD risk and mortality are highly prevalent among adults with chronic SCI/D. In stark contrast, few rehabilitation interventions target EMD outcomes. The modelled solution proposes: 1) abandoning single-disease paradigms and examining a holistic perspective of the individual’s EMD risk, and 2) developing and disseminating practice-based research approaches in outpatient community settings. Conclusions RIISC model adoption could accelerate EMD care optimization, and ultimately inform the design of large-scale longitudinal pragmatic trials likely to improve health outcomes. Linking the RIISC team activities to economic evaluations and policy deliverables will strengthen the relevance and impact among policymakers, health care providers and patients.

Providing Insights into the Challenges of Implementing Activity-Based Therapy in Canada: A Comparative Analysis Using Focus Group Interviews with Key Interest Groups.

Activity-based therapy (ABT) has emerged as a therapeutic approach that may promote neurorecovery and reduce secondary complications in people living with spinal cord injury or disease (SCI/D). In spite of the numerous health benefits, adoption of ABT into practice has been limited across the Canadian care continuum. This study aimed to understand the challenges of implementing ABT in Canada for people living with SCI/D through the perspectives of key interest groups. Researchers, hospital therapists, community trainers, administrators, persons living with SCI/D, and advocates, funders, and policy experts who had knowledge of and/or experience with ABT participated in focus group interviews to share their perspectives on the barriers to ABT practice. Interviews were analyzed using conventional content analysis followed by a comparative analysis across groups. The 48 participants identified six key challenges: (1) challenge of gaps in knowledge/training, (2) challenge of standardizing ABT, (3) challenge of determining the optimal timing of ABT, (4) challenge of defining, characterizing, and achieving high dosage and intensity, (5) challenge of funding ABT, and (6) challenge of measuring participation and performance in ABT. A comparative analysis found some challenges were emphasized by certain groups, such as the cost of ABT for persons with SCI/D, lack of education and training in ABT for therapists and trainers, minimal evidence to develop guidelines for researchers and advocates, and funding ABT programs for administrators. Participants highlighted several challenges that limit ABT practice. Strategies to address these challenges will support successful implementation of ABT in Canada.

Developing and Evaluating Data Infrastructure and Implementation Tools to Support Cardiometabolic Disease Indicator Data Collection.

Assessment of aerobic exercise (AE) and lipid profiles among individuals with spinal cord injury or disease (SCI/D) is critical for cardiometabolic disease (CMD) risk estimation. To utilize an artificial intelligence (AI) tool for extracting indicator data and education tools to enable routine CMD indicator data collection in inpatient/outpatient settings, and to describe and evaluate the recall of AE levels and lipid profile assessment completion rates across care settings among adults with subacute and chronic SCI/D. A cross-sectional convenience sample of patients affiliated with University Health Network's SCI/D rehabilitation program and outpatients affiliated with SCI Ontario participated. The SCI-HIGH CMD intermediary outcome (IO) and final outcome (FO) indicator surveys were administered, using an AI tool to extract responses. Practice gaps were prospectively identified, and implementation tools were created to address gaps. Univariate and bivariate descriptive analyses were used. The AI tool had <2% error rate for data extraction. Adults with SCI/D (n = 251; 124 IO, mean age 61; 127 FO, mean age 55; p = .004) completed the surveys. Fourteen percent of inpatients versus 48% of outpatients reported being taught AE. Fifteen percent of inpatients and 51% of outpatients recalled a lipid assessment (p < .01). Algorithms and education tools were developed to address identified knowledge gaps in patient AE and lipid assessments. Compelling CMD health service gaps warrant immediate attention to achieve AE and lipid assessment guideline adherence. AI indicator extraction paired with implementation tools may facilitate indicator deployment and modify CMD risk.

Poster (Knowledge Generation) ID 1987820

Background Anti-inflammatory diets have shown effective in reducing pro-inflammatory cytokines, and neuropathic pain and depression in individuals with spinal cord injury or disease (SCI/D). However, work to date has focused on community-dwelling individuals with SCI/D, and the diet’s efficacy in an inpatient population, and the feasibility of offering it in a hospital, are unknown. The inpatient setting may be ideal for introducing an anti-inflammatory diet, as immune-related health complications peak acutely after SCI, and forming new dietary habits may be easier in an inpatient setting. Thus, it is necessary to investigate the feasibility of an anti-inflammatory diet in the inpatient SCI/D setting. Objectives Phase 1: Understand the nutritional value of the current meal plans in selected inpatient SCI/D hospitals and their compliance with our anti-inflammatory diet. Phase 2: Understand the opinions that inpatients with SCI/D have regarding their currently offered meal choices and their readiness to learn about, and adopt, an anti-inflammatory diet. Phase 3: Understand the barriers and facilitators for implementing an anti-inflammatory diet in an inpatient setting from the perspective of hospital administrators. Proposed Design/Methods This study will take place in the SCI inpatient settings in two Ontario hospitals. Four to five inpatients from each site will be interviewed in Phase 1 and 2, and four to five Food Services administrators from each site will be interviewed in Phase 3. Menu plans, as well as individual food logs will be analyzed for nutritional value and compliance to an anti-inflammatory diet. Interviews will be subject to thematic analysis.

Poster (Clinical/Best Practice Implementation) ID 1981325

Background Many barriers prevent those with spinal cord injury or disease (SCI/D) from adhering to recommended exercise guidelines, thus increasing risks of secondary health conditions. Mainstream technology options, such as virtual reality (VR), have the potential to facilitate needed exercise participation. However, further research on VR exercise modalities is needed to determine feasibility, effectiveness and to ultimately guide practice recommendations. Objectives The goal of this pilot feasibility study was to determine whether VR exergaming is non-inferior to the current standard of care (SoC) upper extremity aerobic exercise for individuals with SCI/D. Methods/Overview 25 participants with SCI/D completed 10-minute exercise sessions with either VR or the SoC, and after a rest break, then completed 10 minutes of exercise with the other modality. Primary outcomes of heart rate (HR) and rate of perceived exertion (RPE) were collected at baseline, 5 minutes into exercise, and at 10 min (end of the exercise session) for each modality. Secondary exploratory measures included a Numeric Pain Rating Scale measured pre- and post- each exercise session, and a post-study likeability survey. Results There were no significant differences in HR or RPE between virtual reality exergaming and the standard of care, and 100% of participants preferred the VR over SoC for the exercise. Conclusions VR exergaming was non-inferior to the SoC for short duration upper extremity exercise in those with SCI/D. Implementing VR for patients with SCI/D should be studied further to observe the longer term effect on cardiovascular health and to determine feasibility and compliance for home use.

Student Competition (Knowledge Generation) ID 1985735

Background Individuals with chronic spinal cord injury or disease (SCI/D) are at an increased risk of lower extremity fractures. Novel interventions, including nutraceuticals and pharmacotherapy, are being explored to reduce fracture-related morbidity and mortality. Objective This retrospective cohort study aims to evaluate the effectiveness of Denosumab injections with dietary calcium and vitamin D supplements on proximaltibia bone mineral density (BMD) in adults with low bone mass and chronic SCI/D. Design/Methods Adult patients with SCI/D over age 18 years, with a baseline distal femur or proximal tibia Z-score &amp;lt;-2.0 or T-score &amp;lt;-2.5 exposed to at least three doses of Denosumab 60mcg/1ml vial injections will consent to chart abstraction. The cumulative Denosumab dose will be the exposure variable. Calcium intake and vitamin D serum levels will be recorded as effect modifiers. Age, sex, and BMI will be recorded as potential confounders. The primary outcome will be the change in proximal tibia BMD from baseline and secondarily the incidence of lower extremity fracture(s). Results/Findings Demographic and impairment characteristics of the study population will be reported using appropriate descriptive statistics. The associations between mean BMD change and Denosumab exposure will be calculated and adjusted for confounders using an appropriate univariate/multivariate model based on sample size and data distribution. Conclusion This retrospective cohort study will determine the effectiveness of Denosumab injections (with calcium and vitamin D) for maintaining or increasing proximal tibia BMD among patients with chronic SCI/D. The study findings will have a significant impact on Denosumab prescribing practices.

Poster (Clinical/Best Practice Implementation) ID 1984967

Background Assessment of physical activity (PA) prescription recall and serum screening for dyslipidemia are critical to describe and mitigate Cardiometabolic Disease (CMD) risk among adults with spinal cord injury or disease (SCI/D). Objectives To report: 1) the frequency of PA prescription recall; and, 2) the frequency of lipid profile assessment and interpretation recall among inpatients with SCI/D during rehabilitation. Methods Adults with SCI/D completed the SCI-HIGH CMD intermediary outcome indicators. A Kinesiologist collected data via interview and chart abstraction among UHN inpatients. Survey responses were scored using Reachlite’s optical character recognition software. Descriptive statistics were used to characterize the participant’s age, sex, impairment characteristics, and report recall rates and the frequency of lipid screening/interpretation. Based on the participant’s needs, either educational materials to increase future adherence to PA guidelines and/or a Mediterranean diet were provided. Results Adult inpatients (n=124), mean age 59 years, 64% paraplegic, and 36% female participated. In total, 14% of participants (16/117) reported being taught the benefits of PA for their heart health; of whom 69% (11/16) recalled exercise instruction. Similarly, 15% of inpatients (17/114) recalled lipid screening during rehabilitation, although chart abstraction revealed that 30% (37/124) had completed lipid screening. Clinical interpretation of their lipid values was recalled by 30% of inpatients. Conclusion There is a significant opportunity to advance PA instruction and lipid profile education and management among inpatients with SCI/D to reduce CMD risk. Inclusion of PA and lipid management instructions in patient-oriented discharge summaries may enhance patient recall/adherence.

Workshop (Clinical/Best Practice Implementation) ID 1985360

Background The Paralyzed Veterans of America inaugural Clinical Practice Guideline (CPG) for Bone Health and Osteoporosis Management for individuals with spinal cord injury or disease (SCI/D) was published for clinicians in 2022. To disseminate knowledge, we developed a series of nine podcasts and handouts, “The Bare Bones Series” (TBBS), linked with each CPG chapter. The intent was to share the CPG content with people with lived experience of SCI/D (PLEX). Objectives This workshop will: 1) introduce TBBS and intended use of the CPG framework; and 2) provide participants the opportunity to apply their learning from the podcast episodes “Get Moving and Loading” and “Snap and Crack” through discussion of two case based scenarios. Methods The aim, content, intended use and targeted audience for TBBS will be highlighted. TBBS was developed and hosted by two PLEX, project team members, and 11 guests who were the CPG chapter authors. Podcast handouts contain infographics, key concepts and recommendations for action. Attendees including clinicians, PLEX, family and friends, will review 3 of 9 episodes. The panelists (Chair, PLEX and project team) will discuss the CPG content and actions to take to improve bone health and reduce fracture risk in PLEX with SCI/D. TBBS will be shared through social media, stakeholder and community events, and conference presentations across North America. Conclusions Workshop attendance will aid participants in advocating for bone health assessments, understanding fracture risk, and promoting a dialogue with their care team about how to prevent fracture, and reduce fracture related morbidity and mortality.

Poster (Clinical/Best Practice Implementation) ID 1984972

Background Heart disease is the most common cause of death after spinal cord injury or disease (SCI/D), with Cardiometabolic Disease (CMD) risk a primary contributor. Objectives 1) To report the frequency of Physical Activity guideline adherence; 2) To report the frequency of serum lipid screening recall and their recollection of the result interpretation; among adults living with SCI/D in the community. Methods A Kinesiologist collected the SCI-High outcome data via in person or phone 1:1 interviews, and chart abstraction among UHN outpatients. A Provincial Intake Coordinator collected data via phone interview among outpatients affiliated with SCI Ontario. Survey responses were scored using Reachlite’s optical character recognition software. Descriptive statistics characterize the participant’s age, sex, impairment characteristics, and adherence to physical activity guidelines and the frequency of lipid screening/interpretation recall. Best practice education materials were used to increase future PA guideline adherence, prompt lipid screening, and healthy food choices. Results Adult outpatients (n=127, 67% male), mean age 61 years, and 55% paraplegic consented to participate. In total, 48% (60/126) of outpatients reported engaging in some form of aerobic exercise; of whom 50% (30/60) of these individuals were meeting current PA guidelines. About 51% of outpatients recalled lipid screening within the last year, 33% indicated they had not had an assessment. Clinical interpretation of lipid values was recalled by 71% (53/75) of outpatients. Conclusion Physical activity guideline adherence and routine lipid assessments are integral to CMD risk modification – substantial education resources and recall aids may help to modify CMD risk after SCI/D.

Student Competition (Knowledge Generation) ID 1975184

Background/Objectives Implementing activity-based therapy (ABT) across the continuum of care in Canada has proved challenging. The objective of this study was to understand and compare multi-group perspectives on the challenges that hinder implementation of ABT in Canada for people living with spinal cord injury or disease (SCI/D). Methods Individuals from six key interest groups (i.e., researchers; persons living with SCI/D; administrators; physical and occupational therapists; community-based exercise trainers; and funders, advocates, and policy experts) who had knowledge of and/or experience with ABT were recruited to participate in focus group interviews that were held over web conferencing. Participants were asked about the barriers and facilitators to practicing ABT. Interview transcripts were analyzed using conventional content analysis followed by a comparative analysis across groups. Results Forty-eight individuals participated in interviews lasting 30-80 minutes. Six themes were identified: 1) Challenge of defining ABT and addressing gaps in knowledge/training. 2) Challenge of standardizing ABT. 3) Challenge of determining the optimal timing of ABT. 4) Challenge of defining, characterizing and achieving high dosage and intensity. 5) Challenge of funding ABT. 6) Challenge of measuring participation and performance in ABT. While all groups acknowledged these six challenges, therapists and community trainers viewed knowledge/training gaps and achieving high dosage and intensity as key challenges. Researchers and advocates emphasized funding as a key challenge. Conclusion Participants highlighted the challenges that limit adoption of ABT into practice within hospital and community settings. Future research should explore avenues to address these challenges to support successful implementation of ABT in Canada.

Tracking activity-based therapy for people living with spinal cord injury or disease: insights gained through focus group interviews with key stakeholders

Purpose The development of a tool to track participation in activity-based therapy (ABT) for people with spinal cord injury or disease (SCI/D) was identified as a priority of the Canadian ABT Community of Practice. The objective of this study was to understand multi-stakeholder perspectives on tracking ABT participation across the continuum of care. Materials and methods Forty-eight individuals from six stakeholder groups (persons living with SCI/D; hospital therapists; community trainers; administrators; researchers; and funders, advocates and policy experts) were recruited to participate in focus group interviews. Participants were asked open-ended questions concerning the importance of and parameters around tracking ABT. Transcripts were analyzed using conventional content analysis. Results Themes reflected the Who, What, Where, When, Why and How of tracking ABT. Participants described the importance of involving hospital therapists, community trainers and individuals with SCI/D in tracking ABT to capture both subjective and objective parameters across the continuum of care and injury trajectory. Digital tracking tools were favoured, although paper-based versions were regarded as a necessity in some circumstances. Conclusions Findings highlighted the importance of tracking ABT participation for individuals with SCI/D. The information may guide the development of ABT practice guidelines and support the implementation of ABT in Canada.

Labour market participation among rehabilitated individuals with spinal cord injury in Brazil: a cross-sectional study.

Cross-sectional study. To document the labour market participation rate and investigate the impact of social and economic characteristics on this outcome among individuals with spinal cord injury or disease (SCI/D) who participated in a multidisciplinary rehabilitation programme in Brazil. A specialised rehabilitation centre in southern Brazil. An interview was performed with former rehabilitation clients with SCI/D. A total of 111 community-dwelling individuals with SCI/D who had been previously rehabilitated in a large regional rehabilitation centre were considered. Employment status and demographic, injury, work, and economic characteristics were self-reported via interview. Descriptive statistical analyses were performed. The labour market participation rate was 21.6% (24 individuals). Five respondents were employed in formal work activities, and the other 19 were involved in informal activities (self-employed). Since the onset of injury, a shorter time was associated with nonparticipation in occupational work. Individuals with a higher level of education were more likely to be working. Household income was higher among the participants who had returned to work than among those who had not returned. There is a relatively low labour market participation rate among rehabilitated individuals with SCI/D in southern Brazil. The rehabilitation services should emphasise vocational training, access to education, and employment support for individuals with SCI/D from early onset after the injury. Public policies must be revised to support labour market participation among individuals with SCI/D in Brazil.

Perceptions of Adults With Spinal Cord Injury or Disease Before and After Riding in an Autonomous Shuttle

Abstract Date Presented 04/02/2022 This study quantified changes in perceptions of adults with a spinal cord injury or disease (SCI/D) before and after an autonomous shuttle (AS) ride. Sixteen adults with an SCI/D and 16 age- and gender-matched controls completed surveys before and after a 15-minute AS ride. Perceived barriers to AS decreased after riding for both groups. Understanding perceptions regarding an AS may promote increased acceptance, adoption, and transportation equity for individuals with SCI/D. Primary Author and Speaker: Sherrilene Classen Contributing Authors: Justin Mason, Hannah Burns, Jordan Joseph, Emily Fox, Heidi E, Hannah Snyder, Lou Demark, Carolyn S. Hanson

A qualitative photo-elicitation study exploring the impact of falls and fall risk on individuals with subacute spinal cord injury.

Individuals living with chronic spinal cord injury or disease (SCI/D) are at an increased risk of falling. However, little is known about the impact of falls and fall risk in the subacute phase of SCI/D, despite this being a time when fall prevention initiatives are delivered. Hence, we explored the impact of falls and fall risk in individuals with subacute SCI/D as they transitioned from inpatient rehabilitation to community living. This qualitative photo-elicitation study used an inductive thematic analysis. Eight individuals (7 male) undergoing inpatient rehabilitation at a Canadian tertiary rehabilitation hospital due to a new SCI/D participated. Six months following discharge, photo-elicitation interviewing was used to understand the impact of falls and fall risk. Over 7-14 days, participants completed a photo-assignment that involved taking photographs in response to questions, such as what increases/decreases your likelihood of falling? A semi-structured interview followed, in which participants described their photographs and discussed their experiences with falls, fall risk and fall prevention training. Four themes were identified. 1) Risk factors and strategies identified through lived experience. Participants discovered their fall risk factors and fall prevention strategies through "trial and error". 2) Influences on the individual's perception of their fall risk. Prior experience with falls, including falls experienced by themselves as well as friends and family, influenced their perception of fall risk. 3) Experiencing life differently due to increased fall risk. A high fall risk reduced participation, increased negative emotions and decreased independence and quality of life. 4) Falls training in rehabilitation can be improved. Prior experiences with falls training varied; however, participants expressed a desire for comprehensive and individualized training. Although participants' experiences with falls and fall prevention varied, falls and the risk of falling can have a significant impact on the first year of living with a SCI/D.

Activity-based therapy for individuals with spinal cord injury/disease: perspectives of acute care therapists

Study designAn exploratory descriptive study was conducted.ObjectiveTo determine if and how occupational therapists (OTs) and physical therapists (PTs) in acute care hospital settings use activity-based therapy (ABT) and its associated technologies.SettingAcute care hospital settings in Canada.MethodsSemi-structured interviews were conducted with physical and occupational therapists, licensed in Canada, who worked in an acute care neurological setting with individuals with spinal cord injury or disease (SCI/D). To analyze the data, interpretive description was used. NVivo 12 was used for data management.ResultsFive physical therapists and two occupational therapists were interviewed (n = 7). Two therapists declined after reading a description of the study. Through analysis, the following themes were identified as affecting the delivery of ABT as part of SCI/D rehabilitation in the acute care setting: (1) Impact of patient acuity on ABT participation, (2) ABT approach unique to the acute care setting, and (3) Influence of acute care work environment and therapy practice. Throughout these themes, therapists referred to dosage as a limiting factor affecting ABT delivery.ConclusionsOur research reveals that implementing ABT in an acute care setting is challenging considering the high dosage of movement practice required for ABT. To increase dosage and the use of ABT in acute care, strategies could include early patient education on ABT, strategic use of social supports, and use of portable technology already incorporated in acute care.

Using activity-based therapy for individuals with spinal cord injury or disease: Interviews with physical and occupational therapists in rehabilitation hospitals

Objective: To understand if and how physical therapists (PTs) and occupational therapists (OTs) use activity-based therapy (ABT) and its associated technologies for the rehabilitation of individuals living with spinal cord injury or disease (SCI/D) in Canadian rehabilitation hospital settings. Design: Qualitative study. Setting: Through rehabilitation hospitals participating in the Rick Hansen Spinal Cord Injury Registry, we recruited licensed OTs and PTs to participate in focus groups. Participants: Twelve PTs and ten OTs from nine sites across eight provinces participated. Outcome Measures: To inform the development of a semi-structured interview guide, we used the Theoretical Domains Framework. To analyze the data, we used interpretive description. Results: We identified three themes that influenced therapists’ use of ABT and associated technologies for SCI/D rehabilitation. (1) Therapists’ decision-making approach to ABT and technology. Therapist roles, site-specific dynamics and goal setting influenced decision-making. Assuming roles such as mentor, liaison and advocate led to more ABT use. Site-specific dynamics concerned levels of ABT knowledge, teamwork, and staffing. In hospital rehabilitation, there was competition between discharge and neurorecovery goals. (2) Therapist perceived individual factors. Patient factors either increased (i.e. patients’ motivation, self-advocacy) or prevented (i.e. mourning period, tolerance) the likelihood that ABT was introduced by therapists. (3) ABT and equipment access. Technology was used for ABT in a variety of ways. Access was affected by visible (e.g. equipment cost) and invisible barriers (e.g. departmental relations). Conclusions: The use of ABT and its associated technologies in Canadian rehabilitation hospitals is variable. Ongoing education could be offered, and site-specific implementation strategies could be developed, to promote ABT use.

Rasch Analysis of the International Quality of Life Basic Data Set Version 2.0

ObjectiveTo examine the internal construct validity of the International Spinal Cord Injury Quality of Life Basic Data Set Version 2.0 (QoL-BDS V2.0) and compare this with the internal construct validity of the original version of the QoL-BDS. DesignInternational cross-sectional psychometric study. SettingSpinal rehabilitation units, clinics, and community. ParticipantsThe study involved 5 sites and 4 countries, 2 of whose primary language is not English. Each site included a consecutive sample of inpatients with spinal cord injury or disease (SCI/D) and a convenience sample of individuals with SCI/D living in the community (N=565). Main Outcome MeasuresThe QoL-BDS V2.0 consists of the 3 original items on satisfaction with life as a whole, physical health, psychological health of the QoL-BDS, and an additional item on satisfaction with social life. All 4 items are answered on a 0-10 numeric rating scale. Rasch analysis was performed on versions 1.0 and 2.0 of the QoL-BDS to examine the ordering of the items’ response options, item scaling, reliability, item fit, local item independence, differential item functioning, and unidimensionality. ResultsThe sample included 565 participants with 57% outpatients and 43% inpatients. Mean age was 51.4 years; 71% were male; 65% had a traumatic injury, 40% had tetraplegia, and 67% were wheelchair users. Item thresholds were collapsed for ordering, and subsequent analyses showed good internal construct validity for the QoL-BDS V2.0 with a person separation reliability of 0.76 and Cronbach α of 0.81. Infit and outfit statistics ranged 0.62-0.91. No local dependencies and multidimensionality were found. Differential item functioning was observed only for country and inpatients vs outpatients but not for other participants’ characteristics. Differences in internal construct validity between the 3-item and 4-item versions were minimal. ConclusionsThe results of this Rasch analysis support the internal construct validity of the QoL-BDS V2.0.

Identifying cases of spinal cord injury or disease in a primary care electronic medical record database

Objective To identify cases of spinal cord injury or disease (SCI/D) in an Ontario database of primary care electronic medical records (EMR). Design A reference standard of cases of chronic SCI/D was established via manual review of EMRs; this reference standard was used to evaluate potential case identification algorithms for use in the same database. Setting Electronic Medical Records Primary Care (EMRPC) Database, Ontario, Canada. Participants A sample of 48,000 adult patients was randomly selected from 213,887 eligible patients in the EMRPC database. Interventions N/A. Main Outcome Measure(s) Candidate algorithms were evaluated using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and F-score. Results 126 cases of chronic SCI/D were identified, forming the reference standard. Of these, 57 were cases of traumatic spinal cord injury (TSCI), and 67 were cases of non-traumatic spinal cord injury (NTSCI). The optimal case identification algorithm used free-text keyword searches and a physician billing code, and had 70.6% sensitivity (61.9–78.4), 98.5% specificity (97.3–99.3), 89.9% PPV (82.2–95.0), 94.7% NPV (92.8–96.3), and an F-score of 79.1. Conclusions Identifying cases of chronic SCI/D from a database of primary care EMRs using free-text entries is feasible, relying on a comprehensive case definition. Identifying a cohort of patients with SCI/D will allow for future study of the epidemiology and health service utilization of these patients.