Satisfaction with life, health and well-being: comparison between non-traumatic spinal cord dysfunction, traumatic spinal cord injury and Australian norms

Healthcare providers perspective of chronic pain management in persons with traumatic spinal cord injury accessing the public system in a region of South Africa

PURPOSE

Persons with traumatic spinal cord injury (PWTSCI) have expressed a lack of education from healthcare providers and poor shared-decision making between providers and clients. The aim was to explore the healthcare providers' perspective on factors influencing the optimal management of chronic pain.

METHODS

Healthcare providers were recruited from two institutions at tertiary healthcare level. Interviews explored current chronic pain management practices, influencing factors and recommendations for improvement. Data saturation occurred after interviewing 11 participants. Thematic analysis was used through a socio-ecological model.

RESULTS

The challenges to optimal pain management include appropriate assessment and management of psychological health (intrapersonal level), substance abuse amongst patients (intrapersonal level), access to medication for providers and lack of knowledge by providers (interpersonal and organizational level). To improve chronic pain management, an interdisciplinary team approach should be operationalized at policy and organizational level, monitoring and adjustment of interventions should take place (interpersonal), and family members/caregivers should be involved in the planning and monitoring (interpersonal).

CONCLUSION

Factors, at the interpersonal, intrapersonal, organizational and policy levels, influence optimal chronic pain management in the traumatic spinal cord injury (TSCI) population. To mitigate challenges, guidelines for chronic pain management should be developed, particularly for low-resourced developing countries.

Quality of life and subjective well-being comparison between traumatic, nontraumatic chronic spinal cord injury, and healthy individuals in China

Background

Differentiating between traumatic and non-traumatic spinal cord injuries (NT-SCI) is critical, as these classifications may significantly impact patients' health outcomes and overall well-being, potentially resulting in differences in treatment protocols and therapeutic efficacy.

Objective

This study aims to compare the quality of life (QoL) and satisfaction with life (SWL) among individuals with traumatic spinal cord injuries (T-SCI), NT-SCI, and the healthy population in China.

Method

A quantitative, cross-sectional survey was conducted between July and December 2020 in the Rehabilitation and Physiotherapy Department of Tongji Hospital, Hubei University of Science and Technology. The World Health Organization Quality of Life Brief Version (WHOQOL-BREF) and the Satisfaction with Life Scale (SWLS) were administered to evaluate QoL and subjective well-being (SWB). An independent t-test was performed to assess differences within the SCI population, while Pearson's correlation coefficient was utilized to explore relationships between the WHOQOL-BREF domains and the SWLS. Multiple linear regression analysis was applied to identify key determinants influencing World Health Organization Quality of Life (WHOQOL) domain scores and overall SWLS score.

Result

Participants with NT-SCI exhibited significant differences in overall health as measured by the WHOQOL-BREF domains compared to those with T-SCI (p < 0.05). Both the NT-SCI and T-SCI groups demonstrated lower mean scores across all four WHOQOL-BREF domains compared to healthy individuals. No significant differences were observed between the NT-SCI and T-SCI groups in the SWLS, although both groups scored lower than the healthy population. Additionally, SWB was moderately positively correlated with QoL (p < 0.01). Collectively, the predictor variables explained 22.28% of the variance in physical health, 6.43% in psychological health, 28.67% in social health, and 25.68% in environmental health. Furthermore, the independent variables accounted for approximately 22.67% of the variance in the SWLS.

Conclusions

Individuals with NT-SCI experience significantly worse overall health outcomes compared to those with T-SCI, although both groups report QoL and life satisfaction than healthy individuals. No significant differences in life satisfaction were found between two groups. Additionally, SWB shows a moderate positive correlation with QoL, highlighting the close relationship between mental and physical health in SCI populations.

The interrelationship between pain, life satisfaction and mental health in adults with traumatic spinal cord injury, in the context of a developing country

STUDY DESIGN

Cross-sectional, analytical study design using a conveneient sampling strategy.

OBJECTIVES

To examine the interrelationship between pain, life satisfaction and indices of negative mental well-being amongst the traumatic spinal cord injury (TSCI) population.

SETTING

Western Cape Rehabilitation Center in Cape Town, South Africa.

METHODS

Participants (n = 70) were adults (mean age of 36.3, SD = 9.2) with TSCI. Participants completed the following instruments: 10 satisfaction items from the World Health Organization Quality of Life Brief Version, short forms of the Center for Epidemiological Studies Depression Scale and the trait scale of the State-Trait Anxiety Inventory, a one-item measure of pain intensity taken from the International Spinal Cord Injury Pain Basic Data Set and the interference scale of the Brief Pain Inventory.

RESULTS

Correlational analysis (Pearson r) demonstrated that all the indices of mental well-being as well as the two indices of pain was significantly negatively related to life satisfaction. In addition, life satisfaction mediated the relationship between pain intensity and depression as well as anxiety. Life satisfaction only mediated the relationship between pain interference and depression but not anxiety.

CONCLUSIONS

An improvement in life satisfaction may lead to improvements in pain interference, pain intensity as well as psychological distress, amongst persons suffering from TSCI Future research should focus on assessing measures/treatment which may improve life satisfaction in the TSCI population.

Australian arm of the International Spinal Cord Injury (Aus-InSCI) Community Survey: 3. Drivers of quality of life in people with spinal cord injury

STUDY DESIGN

Cross-sectional population-based survey for the Australian cohort of the International Spinal Cord Injury (InSCI) Community Survey.

OBJECTIVES

To differentiate subgroups of people with spinal cord injury (SCI) who self-report good and poor overall quality of life (QoL) using domains of the International Classification of Functioning (ICF), and to evaluate how these factors contribute to QoL when considered together, while controlling confounders.

SETTING

Australian survey data from four state-wide SCI services, one government insurance agency, and three not-for-profit consumer organisations.

METHODS

Explanatory factors for QoL were compared between participants reporting poor vs. good QoL. Path models estimated total, direct and mediated contributions from each explanatory factor to QoL ratings after accounting for confounders.

RESULTS

Most participants (62%) reported good or very good QoL, 12% reported poor or very poor QoL. When explanatory factors were considered together, the strongest total effects on QoL involved social integration (+0.36 SDs), subjective social position (+0.29), secondary health condition burden (-0.28), activity/participation problem burden (-0.26), day-to-day assistance (-0.26), mental health (+0.18), pain (-0.16), self-efficacy (+0.15), vitality (+0.14) and environmental barriers (-0.11). Effects of social integration, mental health, vitality, self-efficacy, pain and activity/participation problems were partly or wholly direct.

CONCLUSION

Opportunities to improve QoL in people with SCI exist at every level of the health system. Virtually all aspects of the ICF framework make a substantive difference to QoL outcomes. Social and psychological factors and ability to complete desired activities have key direct effects and influence effects of secondary health condition burden and environmental barriers.

The effect of the COVID-19 pandemic on the health-related quality of life in home-based patients with spinal cord injuries in Japan

CONTEXT

The COVID-19 pandemic has forced people to maintain social distance and to refrain from going out. As a result, home-based patients with spinal cord injuries (SCI) are not only less able to go out, but they may have difficulty in easily receiving long-term care services. There are concerns that their health-related quality of life (HRQOL) may have deteriorated. We aimed to clarify the effect of the COVID-19 pandemic on HRQOL in home-based patients with SCI.In June 2020, when the COVID-19 pandemic was finally settling down in Japan, we conducted a mail survey of 266 patients with SCI regarding changes in the frequency of going out, the long-term care services, and their HRQOL due to the COVID-19 pandemic. They had all been discharged from our hospital (Rehabilitation medical center) by 2019, and were expected to be living at home. We received answers from 135 patients about their HRQOL.

FINDINGS

Respondent characteristics indicated that many of them were elderly (74.1% were over 60 years of age) and many had cervical SCI (70.5%). Worsened HRQOL since the impact of the COVID-19 pandemic was reported by 40% of respondents. The most commonly reported dimension was pain/discomfort. Significantly, many had been injured comparatively recently and had reduced frequency of going out and receiving home-visit nursing or rehabilitation services than patients whose HRQOL was unchanged.

CONCLUSION/ CLINICAL RELEVANCE

This study clarifies the negative effect of the COVID-19 pandemic on HRQOL in home-based patients with SCI. Many respondents had worsened HRQOL, in particular pain/discomfort. It was suggested that the decrease in the frequency of going out may be one of the factors that affected the deterioration of their HRQOL.

Clinical Presentation and Causes of Non-traumatic Spinal Cord Injury: An Observational Study in Emergency Patients

Introduction: Diagnosing non-traumatic spinal cord injury (NTSCI) is often challenging. However, clear discrimination from non-spinal pathologies, e.g., "myelopathy-mimics" (MMs), is critical in preventing long-term disability and death. In this retrospective study we (1) investigated causes of NTSCI, (2) identified clinical markers associated with NTSCI and (3) discuss implications for NTSCI management. Methods: Our sample consisted of 5.913 consecutive neurological and neurosurgical patients who were treated in our emergency department during a one-year period. Patients with a new or worsened bilateral sensorimotor deficit were defined as possible NTSCI. We then compared clinical and imaging findings and allocated patients into NTSCIs and MMs. Results: Of ninety-three included cases, thirty-six (38.7%) were diagnosed with NTSCI. Fifty-two patients (55.9%) were classified as MMs. In five patients (5.4%) the underlying pathology remained unclear. Predominant causes of NTSCI were spinal metastases (33.3%), inflammatory disorders (22.2%) and degenerative pathologies (19.4%). 58.6% of NTSCI patients required emergency treatment. Presence of a sensory level (p = <0.001) and sphincter dysfunction (p = 0.02) were the only significant discriminators between NTSCI and MMs. Conclusion: In our study, one-third of patients presenting with a new bilateral sensorimotor deficit had NTSCI. Of these, the majority required emergency treatment. Since there is a significant clinical overlap with non-spinal disorders, a standardized diagnostic work-up including routine spinal MRI is recommended for NTSCI management, rather than an approach that is mainly based on clinical findings.