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Zanini C, Brach M, Lustenberger N, Scheel-Sailer A, Koch HG, Stucki G, Rubinelli S. Engaging in the prevention of pressure injuries in spinal cord injury: A qualitative study of community-dwelling individuals' different styles of prevention in Switzerland. J Spinal Cord Med 2020; 43:247-256. [PMID: 30540555 PMCID: PMC7054934 DOI: 10.1080/10790268.2018.1543094] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Context: Spinal cord injury (SCI) is a complex chronic condition with multiple self-management requirements and a high prevalence of complications. Pressure injuries (PIs) are among the most common ones and represent a frequent reason for re-hospitalization. This study aimed to identify styles of prevention that individuals with SCI adopt to deal with the risk of developing PIs.Design: Qualitative explorative interview study. Data was collected through semi-structured interviews, which were transcribed verbatim and analyzed following the principles of thematic analysis.Setting: Switzerland.Participants: The participants were a purposive sample of community-dwelling Swiss residents with SCI for at least five years.Interventions: Not applicable.Outcome measures: Not applicable.Results: Although all participants (N = 20) showed at least a basic knowledge of prevention of PIs by describing some preventive measures, they had different prevention styles characterized by different behavioral patterns (i.e. complying with all recommended measures, performing only a selection of them or delegating them to others) and different beliefs and attitudes towards prevention.Conclusion: By identifying the style of prevention of an individual, it is possible to develop tailored interventions that have an impact on the factors which seem to play a role in determining the adoption of preventive behaviors (i.e. perceived susceptibility to PIs, attitudes towards prevention, and self-efficacy). Such interventions would constitute a concrete effort to support individuals with SCI during their self-management. Besides alleviating a frequent and disabling medical complication and contributing to an enhanced quality of life, these interventions might also help decrease healthcare costs.
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Affiliation(s)
- Claudia Zanini
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Mirjam Brach
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | | | | | | | - Gerold Stucki
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
| | - Sara Rubinelli
- Department of Health Sciences and Health Policy, University of Lucerne and Swiss Paraplegic Research, Lucerne/Nottwil, Switzerland.,Swiss Paraplegic Research, Nottwil, Switzerland
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Fouasson-Chailloux A, Gross R, Dauty M, Gadbled G, Touchais S, Le Fort M, Perrouin-Verbe B. Surgical management of lower limb fractures in patients with spinal cord injury less associated with complications than non-operative management: A retrospective series of cases. J Spinal Cord Med 2019; 42:39-44. [PMID: 28488465 PMCID: PMC6340277 DOI: 10.1080/10790268.2017.1325560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVES To evaluate the difference in terms of overall complications between surgical and non-surgical management of lower limb fractures in patients with chronic spinal cord injury (SCI). DESIGN A 13-year retrospective study including patients with chronic spinal cord lesion admitted for sublesional lower limb fractures. SETTING University hospital SCI reference departments (Rehabilitation department and orthopedic department). PARTICIPANTS Forty patients with SCI were included, 24 men and 16 women. Fifty-six distinct fracture occurrences were responsible for a total of 59 lower limb fractures. We compared the number of overall complications between surgical and non-surgical management of fractures. RESULTS Non-surgical management was realized for 19 fractures and surgery for 40. Characteristics of operated and non-operated patients at the time of each fracture occurrence did not differ concerning age (P = 0.430), sex (P = 0.890), lesion levels (P = 0.410) and AIS classification (P = 0.790). Data analysis highlighted 20 complications directly due to the fracture site for 16 distinct fractures. Seven medical complications were found in 5 distinct fracture events. Only 10 (25.0%) of 40 surgical managements had at least one medical or post-surgical complication, whereas 12 (63.2%) of 19 non-operative managements had at least one complication. Therefore, the overall rate of complications was significantly higher after non-surgical treatment (P = 0.044). CONCLUSION Lower extremity fractures due to osteoporosis in patients with SCI are responsible for local and general complications. When possible, surgery may be the best management to propose because of fewer overall complications.
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Affiliation(s)
- Alban Fouasson-Chailloux
- Physical Medicine and Rehabilitation Department, University Hospital of Nantes, France,Laboratoire d'ingénierie ostéoarticulaire et dentaire, LIOAD INSERM U 791, Groupe STEP “Skeletal Tissue engineering and physiopathology,” University of Nantes, France,Correspondence to: Dr. Alban Fouasson-Chailloux, MPR Locomotrice et Respiratoire, CHU de Nantes, 85 rue St Jacques, 44093 Nantes Cedex 1, France.
| | - Raphael Gross
- Physical Medicine and Rehabilitation Department, University Hospital of Nantes, France
| | - Marc Dauty
- Physical Medicine and Rehabilitation Department, University Hospital of Nantes, France,Laboratoire d'ingénierie ostéoarticulaire et dentaire, LIOAD INSERM U 791, Groupe STEP “Skeletal Tissue engineering and physiopathology,” University of Nantes, France
| | - Guillaume Gadbled
- Department of Orthopedic Surgery, University Hospital of Nantes, France
| | - Sophie Touchais
- Department of Orthopedic Surgery, University Hospital of Nantes, France
| | - Marc Le Fort
- Physical Medicine and Rehabilitation Department, University Hospital of Nantes, France
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DiMarco AF, Geertman RT, Tabbaa K, Polito RR, Kowalski KE. Case report: Minimally invasive method to activate the expiratory muscles to restore cough. J Spinal Cord Med 2018; 41:562-566. [PMID: 29017400 PMCID: PMC6117599 DOI: 10.1080/10790268.2017.1357916] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
CONTEXT Spinal cord stimulation (SCS) via disc electrodes surgically placed via laminotomy incisions has been shown to restore an effective cough in subjects with spinal cord injury (SCI). The purpose of this study was to evaluate a new method of expiratory muscle activation utilizing spinal cord wire leads, which can be implanted with minimally invasive techniques. METHODS In a subject with SCI, parallel wire leads with two electrode contacts were inserted percutaneously through a needle, advanced to the T9, T11 spinal levels and connected to an implanted radiofrequency receiver. Stimulus parameters were set at values resulting in near maximum airway pressure generation (Paw) (40V, 50Hz, 0.2ms). Paw was measured at functional residual capacity (FRC) and total lung capacity (TLC) as an index of expiratory muscle strength. RESULTS Paw during spontaneous efforts was 20 cmH2O (8.6% predicted). Bipolar (T9-T11) SCS resulted in Paw of 84 and 103 cmH2O, at FRC and TLC respectively. Monopolar (T9 only) SCS resulted in Paw of 61 and 86 cmH2O, at FRC and TLC respectively. This subject experienced much greater ease in raising secretions with use of SCS and no longer required other methods of secretion management. CONCLUSION SCS via wire leads, which can be implanted using minimally invasive techniques, may provide a new useful method to restore an effective cough and possibly reduce the morbidity and mortality associated with respiratory tract infections in patients with SCI.
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Affiliation(s)
- Anthony F. DiMarco
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University, Cleveland, Ohio, USA,MetroHealth Research Institute, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA,Correspondence to: Anthony F. DiMarco, Department of Physical Medicine & Rehabilitation, Case Western Reserve University, MetroHealth Medical Center, Rammelkamp Center for Education & Research, 2500 MetroHealth Drive, R551, Cleveland, OH44109-1998, USA.
| | - Robert T. Geertman
- Department of Neurosurgery, Case Western Reserve University, Cleveland, Ohio, USA
| | - Kutaiba Tabbaa
- Department of Anesthesiology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Rebecca R. Polito
- MetroHealth Research Institute, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA
| | - Krzysztof E. Kowalski
- Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA,MetroHealth Research Institute, Case Western Reserve University, MetroHealth Medical Center, Cleveland, Ohio, USA,Research Service, Louis Stokes Cleveland VA Medical Center, East Boulevard, Cleveland, Ohio, USA
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DiMarco AF, Geertman RT, Tabbaa K, Polito RR, Kowalski KE. Economic Consequences of an Implanted Neuroprosthesis in Subjects with Spinal Cord Injury for Restoration of an Effective Cough. Top Spinal Cord Inj Rehabil 2018; 23:271-278. [PMID: 29339903 DOI: 10.1310/sci2303-271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective: To determine if an implanted neuroprosthesis for restoration of an effective cough is less costly than conventional methods of respiratory management. Methods: Nonrandomized clinical trial of participants (N = 14) with spinal cord injury (SCI) using the Cough Stimulator device in the inpatient hospital setting for Cough Stimulator implantation and outpatient hospital or residence for follow-up. A neuroprosthesis was implanted for restoration of an effective cough. The annual costs associated with respiratory management, without (pre implantation) and with (post implantation) the neuroprosthesis, were examined over a 4-year period. Results: The total cost related to implantation of the Cough Stimulator was $59,891, with no maintenance costs over subsequent years. The incidence of respiratory tract infections and the need for caregiver support fell significantly following implantation. The costs associated with respiratory tract infections fell significantly from a mean of $36,406 ± 11,855/year to $13,284 ± 7,035/year (p < .05) pre and post implantation, respectively. Costs fell further to $8,817 ± 5,990 and $4,467 ± 4,404 following the 2nd and 3rd years post implantation (p < .05), respectively. The costs associated with caregiver support fell significantly from $25,312 ± 8,019/year to $2,630 ± 2,233/year (p < .05) pre and post implantation, respectively, and remained low in subsequent years (p < .05). Other costs related to secretion management fell significantly and remained low in subsequent years (p < .05). Break-even analysis demonstrated that this point was reached in the first year. Conclusion: The results of this investigation demonstrate that implantation and use of the Cough Stimulator resulted in significant reductions in the overall costs of respiratory management in this patient population.
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Affiliation(s)
- Anthony F DiMarco
- Department of Physical Medicine and Rehabilitation, Case Western Reserve University.,MetroHealth Research Institute, Case Western Reserve University
| | | | - Kutaiba Tabbaa
- Department of Anesthesiology, Case Western Reserve University
| | | | - Krzysztof E Kowalski
- Department of Medicine, Case Western Reserve University.,MetroHealth Research Institute, Case Western Reserve University.,Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
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White BA, Dea N, Street JT, Cheng CL, Rivers CS, Attabib N, Kwon BK, Fisher CG, Dvorak MF. The Economic Burden of Urinary Tract Infection and Pressure Ulceration in Acute Traumatic Spinal Cord Injury Admissions: Evidence for Comparative Economics and Decision Analytics from a Matched Case-Control Study. J Neurotrauma 2017; 34:2892-2900. [DOI: 10.1089/neu.2016.4934] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
| | - Nicolas Dea
- Service de Neurochirurgie, Université de Sherbrooke, Sherbrooke, Québec, Canada
| | - John T. Street
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Najmedden Attabib
- Dalhousie University, Halifax, Nova Scotia; Horizon Health Network, Division of Neurosurgery, Saint John Regional Hospital, Saint John, New Brunswick, Canada
| | - Brian K. Kwon
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charles G. Fisher
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Marcel F. Dvorak
- Vancouver Spine Surgery Institute, Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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Ronca E, Scheel-Sailer A, Koch HG, Gemperli A. Health care utilization in persons with spinal cord injury: part 2-determinants, geographic variation and comparison with the general population. Spinal Cord 2017; 55:828-833. [PMID: 28462934 DOI: 10.1038/sc.2017.38] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Revised: 03/11/2017] [Accepted: 03/14/2017] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Cross-sectional survey. OBJECTIVES To investigate annual rates and geographic variation of health care utilization in persons with spinal cord injury (SCI), and to identify factors associated with health care utilization. SETTING Community setting, entire country of Switzerland. METHODS Annual rates of planned and emergency visits to the general practitioner (GP), planned and emergency outpatient clinic visits and in-patient hospitalizations were compared between individuals with chronic SCI, over 16 years of age residing in Switzerland between late 2011 and early 2013 and a population sample (2012) of the Swiss general population. Risk factors for increased health service utilization were identified by means of regression models adjusted for spatial variation. RESULTS Of 492 participants (86.2% response rate), 94.1% visited a health care provider in the preceding year, with most persons visiting GPs (88.4%) followed by outpatient clinics (53.1%) and in-patient hospitals (35.9%). The increase in utilization as compared with the general population was 1.3-, 4.0- and 2.9-fold for GP, outpatient clinic and in-patient hospital visit, respectively. GP utilization was highest in persons with low income (incidence rate ratio (IRR) 1.85) and old age (IRR 2.62). In the first 2 years post injury, health service visits were 1.7 (GP visits) to 5.8 times (emergency outpatient clinic visits) more likely compared with those later post injury. CONCLUSIONS People with SCI more frequently use health services as compared with the general population, across all types of medical service institutions. GP services were used most often in areas where availability of specialized outpatient clinic services was low.
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Affiliation(s)
- E Ronca
- Rehabilitation Services and Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | | | - H G Koch
- Swiss Paraplegics Association, Nottwil, Switzerland
| | - A Gemperli
- Rehabilitation Services and Care Unit, Swiss Paraplegic Research, Nottwil, Switzerland.,Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
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Squair JW, White BAB, Bravo GI, Martin Ginis KA, Krassioukov AV. The Economic Burden of Autonomic Dysreflexia during Hospitalization for Individuals with Spinal Cord Injury. J Neurotrauma 2016; 33:1422-7. [PMID: 27002855 DOI: 10.1089/neu.2015.4370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
We sought to determine the economic burden of autonomic dysreflexia (AD) from the perspective of the Canadian healthcare system in a case series of individuals with spinal cord injury (SCI) presenting to emergency care. In doing so, we sought to illustrate the potential return on investments in the translation of evidence-informed practices and developments in the prevention, diagnosis, and management of AD. Activity-based costing methodology was employed to estimate the direct healthcare or hospitalization costs of AD following presentation to the emergency department. Differences in trends were noted between patients who were promptly diagnosed, managed, and discharged, and patients whose experience followed a less direct or ideal path to discharge. We recorded 29 emergency room visits for conditions ultimately diagnosed as AD. Overall, median length of stay was 3 days (interquartile range [IQR] = 1.25-5.75), but extended up to 103 consecutive days. Cost analysis revealed median healthcare costs of $5029 (IQR = $2397-9522) for hospital admissions for AD, with the highest estimated hospital cost for a single admission > $190,000. Emergency room admissions resulting from AD can result in dramatic healthcare costs. Delayed diagnosis and inefficient management of AD may lead to further complications, adding to the strain on already limited healthcare resources. Prompt recognition of AD; broader translation of evidence-informed practices; and novel diagnosis, self-management, and/or therapeutic/pharmaceutical applications may prove to mitigate the burden of AD and improve patient well-being.
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Affiliation(s)
- Jordan W Squair
- 1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada .,2 MD/PhD Training Program, Faculty of Medicine, University of British Columbia , Vancouver, British Columbia, Canada
| | - Barry A B White
- 1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada .,3 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | - Grace I Bravo
- 4 Department of Paediatrics, Western University , Ottawa, Canada
| | | | - Andrei V Krassioukov
- 1 International Collaboration on Repair Discoveries, University of British Columbia , Vancouver, British Columbia, Canada .,6 Department of Medicine, Division of Physical Medicine and Rehabilitation, University of British Columbia , Vancouver, British Columbia, Canada .,7 GF Strong Rehabilitation Centre , Vancouver Health Authority, Vancouver, British Columbia, Canada
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Guilcher SJT, Craven BC, McColl MA, Lemieux-Charles L, Casciaro T, Jaglal SB. Application of the Andersen's health care utilization framework to secondary complications of spinal cord injury: a scoping review. Disabil Rehabil 2011; 34:531-41. [PMID: 22087755 DOI: 10.3109/09638288.2011.608150] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE The purpose of this scoping review was to identify research priority areas related to secondary complications and associated health care use for individuals with spinal cord injury (SCI). METHOD DATA SOURCES Peer-reviewed journals were identified using CINAHL, MEDLINE, PubMed, Embase, Social Sciences Abstracts, Social Works Abstract and PsycInfo search engines. Key references were hand searched. STUDY SELECTION A total of 289 abstracts were identified from the initial search strategy. We removed studies that did not measure health care and those that did not involve analytical investigation. DATA EXTRACTION The selected 31 studies were reviewed in detail using a coding template based on the domains and sub-components of the Andersen model (i.e. environmental, population characteristics, health behavior and outcome). RESULTS Most studies measured predisposing characteristics (e.g., age, gender) and need characteristics (e.g., level of injury). There was a notable absence of environmental characteristics (e.g., health system, neighborhood variables), enabling characteristics and health behaviors (beyond diet and nutrition). CONCLUSIONS We identified a gap in the SCI literature. Future research should focus on longitudinal study designs with more representation of non-traumatic spinal cord injury, as well as utilizing more advanced statistical analyses (i.e., multivariate level) to adjust for confounding variables.
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Affiliation(s)
- Sara J T Guilcher
- Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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DeJong G, Hoffman J, Meade M, Bombardier C, Deutsch A, Nemunaitis G, Roach M, Tate D, Boninger M, Chen Y, Hsieh J, Jette A, Wierbicky J, Chiodo A, Forchheimer M. Postrehabilitative Health Care for Individuals with SCI: Extending Health Care into the Community. Top Spinal Cord Inj Rehabil 2011. [DOI: 10.1310/sci1702-46] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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DeVivo M, Farris V. Causes and Costs of Unplanned Hospitalizations Among Persons with Spinal Cord Injury. Top Spinal Cord Inj Rehabil 2011. [DOI: 10.1310/sci1604-53] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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