Perspectives on life following a traumatic spinal cord injury

A Scoping Review on the Influence of Housing on the Health and Well-Being of People with a Spinal Cord Injury/Dysfunction

BACKGROUND/OBJECTIVES

Despite the growing recognition of housing as a significant concern for individuals with a spinal cord injury/dysfunction (SCI/D), there is limited research available on this topic. This scoping review aimed to identify and describe the literature on housing across the continuum for people with an SCI/D.

METHODS

This review utilized Arksey and O'Malley's scoping review framework. Five databases were searched including MEDLINE (Ovid), Embase (Ovid), CINAHL Plus (EBSCO), PsycINFO (Ovid), and Web of Science (Core Collection). In addition, Google's Advanced Search function was used to search the gray literature, and reference lists from the included studies were scanned. A preliminary assessment of the Theory of Access (TOA) constructs and their relationships was conducted using Penchansky and Thomas' Theory of Access and Saurman's additional updates. An adapted version of this theory was developed by the research team to identify the types of studies that assess the TOA's six constructs and was used to identify knowledge gaps to advance research in this field.

RESULTS

The search yielded 25,861 records, with 36 studies meeting the inclusion criteria. Data analysis revealed the participants' sociodemographic and impairment characteristics, as well as essential information pertaining to housing across the continuum for individuals with an SCI/D, both of which were inconsistently reported across the studies. Several studies (n = 18) reported on the influence of home adaptations on the health and well-being of individuals with an SCI/D. When framed within the TOA, issues of accessibility presented the most substantial barriers for the SCI/D community, followed by acceptability and availability.

CONCLUSIONS

The findings of this scoping review suggest that housing is an understudied topic and that further research is required to generate evidence to better support the housing needs of individuals with an SCI/D globally.

Does stronger primary care improve access to health services for persons with spinal cord injury? Evidence from eleven European countries

OBJECTIVE

To determine the association between the strength of primary care and perceived access to follow-up care services among persons with chronic spinal cord injury (SCI).

DESIGN

Data analysis of the International Spinal Cord Injury (InSCI) cross-sectional, community-based questionnaire survey conducted in 2017-2019. The association between the strength of primary care (Kringos et al., 2003) and access to health services was established using univariable and multivariable logistic regression analysis, adjusted for socio-demographic and health status characteristics.

SETTING

Community in eleven European countries: France, Germany, Greece, Italy, Lithuania, the Netherlands, Norway, Poland, Romania, Spain and Switzerland.

PARTICIPANTS

6658 adults with chronic SCI.

INTERVENTION

None.

OUTCOME MEASURES

Share of persons with SCI that reported unmet healthcare needs as a measure of access.

RESULTS

Twelve percent of the participants reported unmet healthcare needs: the highest in Poland (25%) and lowest in Switzerland and Spain (7%). The most prevalent access restriction was service unavailability (7%). Stronger primary care was associated with lower odds of reporting unmet healthcare needs, service unavailability, unaffordability and unacceptability. Females, persons of younger age and lower health status, had higher odds of reporting unmet needs.

CONCLUSIONS

In all investigated countries, persons with chronic SCI face access barriers, especially with service availability. Stronger primary care for the general population was also associated with better health service access for persons with SCI, which argues for further primary care strengthening.

Epidemiological characteristics and factors influencing hospitalization burden among trauma patients: a retrospective analysis

PURPOSE

This investigation aimed to understand the epidemiological characteristics and hospitalization burden and its possible influencing factors of patients with different injury mechanisms.

METHODS

All trauma patients admitted via the emergency department at a trauma center from November 1, 2020, to April 30, 2022, were identified. The hospitalization burden, including the number of hospitalizations, deaths and in-hospital mortality, length of stay (LOS), and medical costs, was calculated. Univariate and multivariate logistic regression models were used to analyze the factors influencing the hospitalization burden of trauma. The receiver-operating characteristic (ROC) curves were drawn to evaluate the predictive value of the multivariate model.

RESULTS

16 485 trauma patients with 16 552 hospitalizations were included, with an in-hospital mortality rate of 1.269‰, median LOS of 7 days, and median hospitalization costs of 54 725.28 CNY. The median age was 52 years. 62.54% were hospitalized due to falls. The upper and lower extremities were the most common injury regions. There are differences between the demographic, injury, and hospitalization characteristics and factors influencing hospitalization burden across injury mechanisms, but there were also common influencing factors. Injury region, surgery, transfusion, and ICU treatment are influential factors for prolonged LOS. Age, injury region, surgery, and transfusion were influential factors for high hospitalization costs.

CONCLUSIONS

This study provided primary evidence on the hospitalization burden of trauma. Considering demographics, injury and hospitalization characteristics as additional discriminators could further intervene in LOS and medical costs. Targeted efforts to use more early prevention measures could potentially lower future hospitalization burden.

"I am not the same as before": a mixed-methods study on depression in people with spinal injury in Qatar

Incidence of spinal injury is high in the Middle East and North African region (MENA) due to the high incidence of road traffic crashes. A spinal injury may trigger mental health issues. Compared to the general population, people with spinal injury are at higher risk for developing major depression, anxiety, post-traumatic stress disorders, substance abuse, and suicide.

Objectives

The objectives of the study were to determine depression prevalence; identify relationships between depression and cause and site of spinal injury, sociodemographic factors, and social support; and explore the lived experiences of depression in people with spinal injury in Qatar.

Methods

A sequential cross-sectional mixed methods study was conducted. In the quantitative component, the universal sample consisted of 106 consenting individuals presenting with spinal injury at Hamad General Hospital, Doha, Qatar between January and December 2020. The Patient Health Questionnaire-9 was used to assess levels of depression and the Medical Outcomes Study Social Support Survey was used to assess perceived social support. The cause and site of injury were obtained from patient records. In the qualitative component, semi-structured in-depth interviews were conducted with 12 purposively selected participants from the quantitative component.

Results

Spinal injury had a negative impact on participants physical, mental, social, and spiritual wellbeing. In total, 69% of participants had some level of depression: 28% mild, 25.5% minimal, and 15% moderate to severe. Depression was not associated with socio-demographic factors, or the cause or site of spinal injury. Higher levels of emotional/informational support and positive social interaction were associated with milder depression. Social support and religious faith were critical in assisting participants to cope with their new situation.

Conclusions

Depression is prevalent among people with spinal injury attending health services. Early detection, referral, and treatment of depression are recommended. Strategies to enhance emotional/informational support and positive social interaction should be developed and tested with people with spinal injury.

Exploring the Experience of Living with Pain after Spinal Cord Injury: A Qualitative Study

A spinal cord injury is a life-changing experience that results in functional limitations and an increased risk of secondary health conditions. People with spinal cord injury identify pain as the most devastating health problem following their injury that not only affects their social life but their mental well-being as well. This study is aimed at exploring the lived experience of living with pain by community-dwelling manual wheelchair users with spinal cord injuries. An explorative qualitative design was used to explore their experiences. In-depth interviews were recorded and transcribed, and the data were analysed using inductive thematic content analysis in the MAXQDA v2020. Fifteen manual wheelchair users with paraplegia participated in this study, and four themes were identified from their experience of living with pain: pain constantly lurks, pain is worse than the direct consequences of the SCI, pain is restrictive, and life continues despite the pain. Categories and subcategories included the participants being one with the pain; pain interfering with sleep; feelings of anger, isolation, and suicidal ideation; and uncertainties about what the future holds living with pain. Living with pain after SCI is a challenging feat, and effective management of pain is necessary to improve not only functioning and mobility but also mental health and life satisfaction.

Enhancements to a Telewellness Program for People With Physical Disabilities: Mindfulness, Exercise, and Nutrition To Optimize Resilience (MENTOR 2.0)

Introduction

This study evaluated the National Center on Health, Physical Activity and Disability (NCHPAD) Mindfulness, Exercise, and Nutrition To Optimize Resilience (MENTOR) program for people with physical disabilities.

Methods

This retrospective evaluation of MENTOR 2.0, an 8-week online group health promotion program, was based on improvements from its first implementation (MENTOR 1.0). Baseline and postassessments included the Godin Leisure-Time Exercise Questionnaire (GLTEQ), NCHPAD Wellness Assessment (NWA), Connor-Davidson Resilience Scale, and Mindfulness Attention Awareness Scale. Estimates and corresponding 95% CIs from linear mixed models were provided to compare baseline and postassessment scores and effect sizes using Cohen d.

Results

Among 116 participants (mean age, 53 y; 63% female), postassessment scores increased significantly in the overall NWA and in all 15 NWA domains (effect size, 0.30-0.69). The overall NWA score was 7.59 (95% CI, 5.63-9.56) units higher at postassessment compared with baseline. Scores for GLTEQ health contribution increased significantly among participants with low baseline scores (31.37 [95% CI, 12.97-49.77]) (effect size, 0.50). Mindfulness and resilience scores both showed improvement (0.16 [95% CI, 0.01-0.31]; effect size, 0.15) and (0.72 [95% CI, -0.25 to 1.68]; effect size 0.09), respectively, but only the change in mindfulness was significant.

Conclusion

MENTOR 2.0 advanced the evaluation of this online telewellness program for people with physical disabilities by demonstrating consistent results with MENTOR 1.0. We reported improvements in GLTEQ, especially among those with lower baseline scores; in multiple areas of wellness, including physical, mental, and emotional/spiritual health; and in mindfulness and resilience, although the improvements in these 2 constructs were small.

Addressing Disability Inequities: Let's Stop Admiring the Problem and Do Something about It

The healthcare system and public health community are often underprepared to support the needs of people with disabilities and to include them equitably in wellness programs (e.g., exercise, leisure, nutrition, stress management) offered to the general community. Consequently, the vast majority of people with disabilities are unable to make the transition from "patient" to "participant," which contributes to many of the health disparities reported in this population. People with disabilities have a disproportionately higher rate of acquiring secondary conditions such as obesity, cardiovascular comorbidity, pain, fatigue, depression, deconditioning, and type 2 diabetes, often resulting from poor access to home and community-based health promotion/wellness programs that include physical activity, nutrition, stress reduction, and sleep hygiene, among others. Achieving health equity in people with disabilities requires a multi-stage approach that includes person-centered referral to wellness programs, empowering people with disabilities to become self-managers of their own health and ensuring that community-based programs and services are inclusive. A three-stage model for addressing health and wellness needs across the home and community settings is described, which is currently being used in a large federally funded center in the US with potential generalizability across the world.

Factor Analysis Affecting Degree of Depression in Family Caregivers of Patients with Spinal Cord Injury: A Cross-Sectional Pilot Study

This study was conducted to determine the degree of depression in family caregivers of spinal-cord-injury patients and to identify factors influencing family caregivers' depression. The final study subjects were 30 (family caregivers: 6 males and 24 females). The CES-D of family caregivers; general characteristics of spinal-cord-injury patients and family caregivers; and information on physical health, household income, leisure, social activity, family relationship, and life-in-general status of family caregiver were collected. A frequency analysis, normality test, Mann-Whitney test, Kruskal-Wallis test, Spearman Correlation analysis, hierarchical regression analysis, and spider network through a path model analysis were performed. As for the general characteristics, when the patient was economically active, the caregiver's depression was mean ± SD; 2.04 ± 0.71; otherwise, it was mean ± SD 2.86 ± 0.74, indicating that the caregiver of the non-economic activity patient was more depressed (p = 0.013). In Model 1 of the multiple regression analysis to understand the effect on the depression of the caregiver, it was confirmed that the depression of the caregiver decreased as the family caregiver had more leisure and social activities (B = -0.718, p = 0.001). In Model 2, it was found that the depression of caregivers increased when the patient did not engage in economic activity (B = 0.438, p = 0.016). In the spider-web form through the path model analysis, as the family's economic level increased, physical health increased by B = 0.755 (p < 0.001), and the increase in physical health (B = 0.424, p = 0.042) was, in turn, a factor in the increase of engagement in leisure and social activities. Various policies will be needed for the successful return to society of spinal-cord-injury patients by ensuring that their leisure and social activities and establishing measures to support their economical income.

Perception of facing life's challenges in patients with spinal cord injury in Iran: a qualitative study

BACKGROUND

Spinal cord injury (SCI) is one of the most serious types of physical trauma and has become a major life-threatening condition in the recent decade. It is essential that the life perception and experiences of patients with SCI be studied and evaluated in different cultural contexts so that their needs and the challenges they face can be properly determined. The present study aims to explore the how patients with SCI in the south of Iran perceive facing life's challenges.

METHODS

The present study is a qualitative research with a descriptive phenomenological design. Participants were identified through purposive sampling of patients with spinal cord injury admitted to two state hospitals affiliated with a university of medical sciences in western Iran. The researchers collected data using semi-structured, in-depth interviews with 25 SCI patients conducted between August and October 2021. Data was analyzed according to Colaizzi's method using MAXQDA v. 2007.

RESULTS

Analysis of the data led to the emergence of three themes and nine sub-themes. The three main themes were emotional shock (crisis making and mental rumination, persistent depressive disorder, pitying behaviors, fear of the future), loss of dignity (poor self- care, sexual dysfunction, loss of job and educational status), and lack of effective support (lack of financial institutions and sponsors, lack of social support).

CONCLUSION

Patients with spinal cord injuries face various issues in their care and social lives. Attention to their psycho-emotional needs along with comprehensive health support play key roles in generating a sense of self efficacy and promoting the mental well-being and dignity of patients with spinal cord injuries. Accordingly, healthcare administrators and caregivers are recommended to provide more comprehensive health support to SCI patients to meet their needs more effectively.

Influences on Participation in Life After Spinal Cord Injury: Qualitative Inquiry Reveals Interaction of Context and Moderators

Background

Greater understanding of the influences on participation in life after spinal cord injury (SCI) can inform rehabilitation theory and practice. Careful qualitative inquiry can reveal subjective meanings associated with the relevant experiences, strategies, and perceptions of those with lived experience of SCI. A search of literature, followed by a thematic synthesis of qualitative studies, was undertaken to bring together these insights in a meaningful way.

Methods

The research question guiding the literature review and synthesis was, What do people with SCI perceive to be the influences on their participation in life? Three critical databases were searched for qualitative studies examining influences on participation in life after SCI. Peer-reviewed studies published after 2006, involving adults with SCI living in countries with advanced economies, were included. Data were extracted from 24 articles and subjected to three-level thematic synthesis—the coding of primary data from the studies, the development of descriptive themes based on an organization of those codes, and the generation of analytical themes.

Results

The synthesis yielded five analytical themes, supported by 17 descriptive themes. The analytical themes were (1) external contextual influences, (2) personal physical context, (3) personal psychological context, (4) potential moderators of participation outcomes, and (5) temporal dimensions of participating in life after SCI.

Interpretation

These themes highlight the complex interactions that shape participation from the perspective of people with SCI. Closer examination of the potential moderators may provide insights into effective rehabilitation interventions.

Conclusions

Synthesis of qualitative inquiry provides valuable insights into the perceptions of influences on participation in life from the point of view of people with SCI. The findings of this synthesis are instructive for rehabilitation theory and practice. It can complement what we learn from using the ICF to understand participation.

Preventative Services Use and Risk Reduction for Potentially Preventative Hospitalizations among People with Traumatic Spinal Cord Injury

OBJECTIVE

To examine the risk of potentially preventable hospitalizations (PPHs) for adults (18 years or older) with traumatic spinal cord injury (TSCI) to identify the most common types of preventable hospitalizations and their associative risk factors.

DESIGN

Cohort study.

SETTING

Using 2007-2017 U.S. claims data from the Optum Clinformatics Data Mart, we identified adults (18 years or older) with diagnosis of TSCI (n=5380). Adults without TSCI diagnosis were included as controls (n=1,074,729). Using age and sex, we matched individuals with and without TSCI (n=5173) with propensity scores to address potential selection bias. Generalized linear regression was applied to examine the risk of TSCI on PPHs. Models were adjusted for age; sex; race and ethnicity; Elixhauser comorbidity count; any cardiometabolic, psychological, and musculoskeletal chronic conditions; U.S. Census Division; socioeconomic variables; and use of certain preventative care services. Adjusted odds ratios were compared within a 4-year follow-up period.

PARTICIPANTS

Adults with and without TSCI (N=5,173).

INTERVENTION

Not applicable.

MAIN OUTCOMES MEASURES

Any PPH and specific PPHs RESULTS: Adults with TSCI had higher risk for any PPH (odds ratio [OR], 1.67; 95% CI,1.20-2.32), as well as PPHs because of urinary tract infection (UTI) (OR, 3.78; 95% CI, 2.47-5.79), hypertension (OR, 3.77; 95% CI, 1.54-9.21), diabetes long-term complications (OR, 2.54; 95% CI, 1.34-4.80), and pneumonia (OR, 1.71; 95% CI. 1.21-2.41). Annual wellness visit was associated with reduced PPH risk compared with cases and controls without annual wellness visit (OR, 0.57; 95% CI, 0.46-0.71) and among people with TSCI (OR, 0.69; 95% CI, 0.55-0.86) compared with cases without annual wellness visit.

CONCLUSIONS

Adults with TSCI are at a heightened risk for PPH. They are also more susceptible to certain PPHs such as UTIs, pneumonia, and heart failure. Encouraging the use of preventative or health-promoting services, especially for respiratory and urinary outcomes, may reduce PPHs among adults with TSCI.

Polymeric Fibers as Scaffolds for Spinal Cord Injury: A Systematic Review

Spinal cord injury (SCI) is a complex neurological condition caused by trauma, inflammation, and other diseases, which often leads to permanent changes in strength and sensory function below the injured site. Changes in the microenvironment and secondary injuries continue to pose challenges for nerve repair and recovery after SCI. Recently, there has been progress in the treatment of SCI with the use of scaffolds for neural tissue engineering. Polymeric fibers fabricated by electrospinning have been increasingly used in SCI therapy owing to their biocompatibility, complex porous structure, high porosity, and large specific surface area. Polymer fibers simulate natural extracellular matrix of the nerve fiber and guide axon growth. Moreover, multiple channels of polymer fiber simulate the bundle of nerves. Polymer fibers with porous structure can be used as carriers loaded with drugs, nerve growth factors and cells. As conductive fibers, polymer fibers have electrical stimulation of nerve function. This paper reviews the fabrication, characterization, and application in SCI therapy of polymeric fibers, as well as potential challenges and future perspectives regarding their application.

Exploring well-being services from the perspective of people with SCI: A scoping review of qualitative research

OBJECTIVE

Well-being after spinal cord injury is affected by a range of factors, many of which are within the influence of rehabilitation services. Although improving well-being is a key aim of rehabilitation, the literature does not provide a clear path to service providers who seek to improve well-being. This study aimed to inform service design by identifying the experience and perspective of people with SCI about interventions targeting their well-being.

METHOD

The scoping review of qualitative literature used thematic analysis to identify and categorize themes related to service activities, valued aspects, limitations and perceived outcomes.

RESULTS

Thirty-eight studies were selected, related to a range of service types. Most studies did not adopt a well-being conceptual framework to design and evaluate the services. People with SCI particularly valued being treated with dignity, positive expectations, increased autonomy and peer support. Improvements to well-being were reported, including many years post-SCI. However, people with SCI reported limited opportunities to engage in such services.

CONCLUSIONS

Rehabilitation services can improve well-being across the lifetime of people with SCI, but gaps in service provision are reported. The review identified valued aspects of services that may inform service design, including staff approach and positive expectations, having own skills and worth valued, peer support and interaction, autonomy in valued occupations, and long-term opportunities for gains.