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García-Rudolph A, Wright MA, Yepes C, Murillo N, Conesa L, Soriano I, Bautista R, Opisso E, Tormos JM, Medina J. Effectiveness and efficiency of telerehabilitation on functionality after spinal cord injury: A matched case-control study. PM R 2023. [PMID: 38155582 DOI: 10.1002/pmrj.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 12/30/2023]
Abstract
BACKGROUND Telerehabilitation in spinal cord injury (teleSCI) is a growing field that can improve access to care and health outcomes in patients with spinal cord injury (SCI). The clinical effectiveness of teleSCI is not known. OBJECTIVES To compare independence in activities of daily living and mobility capacity in patients following teleSCI and matched controls undergoing traditional rehabilitation. DESIGN Matched case-control study. SETTING TeleSCI occurring in home setting (cases) versus traditional rehabilitation on inpatient unit (controls). PARTICIPANTS Forty-two consecutive patients with SCI followed with teleSCI were compared to 42 historical rehabilitation inpatients (controls) matched for age, time since injury to rehabilitation admission, level of injury (paraplegia/tetraplegia), complete or incomplete injury, and etiology (traumatic/nontraumatic). The teleSCI group (n = 42) was also compared to the complete cohort of historical controls (n = 613). INTERVENTIONS The teleSCI group followed home-based telerehabilitation (3.5 h/day, 5 days/week, 67 days average duration) and historical controls followed in-person rehabilitation. MAIN OUTCOME MEASURE(S) The Functional Independence Measure (FIM), the Spinal Cord Independence Measure (SCIM) and the Walking Index for Spinal Cord Injury (WISCI). We formally compared gains, efficiency and effectiveness. International Standards for Neurological Classification of Spinal Cord Injury and the American Spinal Injury Association Impairment Scale (AIS) were used. RESULTS The teleSCI group (57.1% nontraumatic, 71.4% paraplegia, 73.8% incomplete, 52.4% AIS grade D) showed no significant differences compared with historical controls in AIS grades, neurological levels, duration, gains, efficiency and effectiveness in FIM, SCIM, or WISCI, although the teleSCI cohort had significantly higher admission FIM scores compared with the complete cohort of historical controls. CONCLUSIONS TeleSCI may provide similar improvements in mobility and functional outcomes as traditional rehabilitation in medically stable patients (predominantly with paraplegia and motor incomplete SCI) when provided with appropriate support and equipment.
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Affiliation(s)
- Alejandro García-Rudolph
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Mark Andrew Wright
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Carlos Yepes
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Narda Murillo
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Lucas Conesa
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Ignasi Soriano
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Raquel Bautista
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Eloy Opisso
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Josep Maria Tormos
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
| | - Josep Medina
- Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
- Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain
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Solomon RM, Dhakal R, Halpin SJ, Hariharan R, O’Connor RJ, Allsop M, Sivan M. Telerehabilitation for individuals with spinal cord injury in low-and middle-income countries: a systematic review of the literature. Spinal Cord 2022; 60:395-403. [PMID: 35411024 PMCID: PMC9106582 DOI: 10.1038/s41393-022-00797-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 03/25/2022] [Accepted: 03/25/2022] [Indexed: 11/09/2022]
Abstract
Abstract
Study design
Systematic review.
Objective
To systematically review the evidence for the effectiveness of telerehabilitation as an intervention for people with spinal cord injury (SCI) in low-and middle-income countries (LMICs).
Setting
Not applicable.
Methods
MEDLINE (Ovid), Embase (Ovid), Pubmed and Global Health databases were used to identify studies published between 1946–2020 meeting the following criteria: (1) patients with SCI diagnosis; (2) in LMIC; (3) an outcome measuring clinical functional ability, quality of life or all-cause mortality reduction. The risk of bias in studies was graded using revised Cochrane risk-of-bias tool in randomised trials (RoB 2) and risk-of-bias tool in non-randomised trials (ROBINS-I). Evidence levels were graded with Grading of Recommendations, Assessment, Development and Evaluations (GRADE).
Results
In total, 107 articles were identified from the initial search. After screening, five studies were included. Some significant improvements to quality of life and pressure ulcer management were observed, alongside some improvement in functional ability with suggested improvement to depression scores. Telerehabilitation alleviated participants’ sense of social isolation, improved satisfaction scores and assisted them to remember techniques for SCI management. Telerehabilitation was valued by health professionals. There was no reduction in all-cause mortality.
Conclusion
There is insufficient evidence to recommend telerehabilitation as an intervention to treat and manage SCI in LMICs, although there is an indication of potential patient benefit. Further research is required to better understand the causal mechanisms underpinning the use of telerehabilitation and establish its efficacy, in the context of resource-limited settings.
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Chen G, Wang T, Zhong L, He X, Huang C, Wang Y, Li K. Telemedicine for Preventing and Treating Pressure Injury after Spinal Cord Injury: A Systematic Review and Meta-analysis (Preprint). J Med Internet Res 2022; 24:e37618. [PMID: 36069842 PMCID: PMC9494222 DOI: 10.2196/37618] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 07/02/2022] [Accepted: 08/09/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions
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Affiliation(s)
- Guilian Chen
- Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Tong Wang
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
| | - Lirong Zhong
- Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Xinghui He
- Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Chunxia Huang
- Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Yingmin Wang
- Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou, China
| | - Kun Li
- School of Nursing, Sun Yat-Sen University, Guangzhou, China
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Current Approaches in Telehealth and Telerehabilitation for Spinal Cord Injury (TeleSCI). CURRENT PHYSICAL MEDICINE AND REHABILITATION REPORTS 2022; 10:77-88. [PMID: 35493027 PMCID: PMC9039273 DOI: 10.1007/s40141-022-00348-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/14/2022] [Indexed: 12/04/2022]
Abstract
Purpose of Review Telehealth and telerehabilitation in spinal cord injury (teleSCI) is a growing field that can improve access to care and improve health outcomes in the spinal cord injury population. This review provides an overview of the recent literature on the topic of teleSCI and provides insights on current evidence, future directions, and considerations when using teleSCI for clinical care. Recent Findings TeleSCI is used most often for preventive health; management of chronic pain, anxiety, and depression; and rehabilitation-related interventions. As video telehealth becomes mainstream, growth in wearable monitors, bio and neurofeedback mechanisms, and app-based care is expected. Summary TeleSCI is growing in prevalence, demonstrates positive impact on health outcomes, and requires ongoing study to identify, refine, and implement best practices.
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Hossain MS, Harvey LA, Islam MS, Rahman MA, Muldoon S, Biering-Sorensen F, Jan S, Liu H, Li Q, Cameron ID, Taylor V, Lindley RI, Billot L, Herbert RD. A community-based intervention to prevent serious complications and death 2 years after discharge in people with spinal cord injury in Bangladesh (CIVIC): a randomised trial. Spinal Cord 2021; 59:649-658. [PMID: 32917948 PMCID: PMC8189918 DOI: 10.1038/s41393-020-00546-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 08/14/2020] [Accepted: 08/19/2020] [Indexed: 11/16/2022]
Abstract
STUDY DESIGN Randomised controlled trial. OBJECTIVES To determine the effectiveness of a sustainable community-based intervention designed to prevent serious complications and death 2 years after discharge in people with spinal cord injury in Bangladesh. SETTING Bangladesh. METHODS A pragmatic randomised controlled trial was undertaken. People who had sustained a spinal cord injury in the preceding 2 years, were wheelchair-dependent, and were about to be discharged from hospital in Bangladesh were recruited and randomised to an Intervention or Control group using a concealed allocation procedure stratified by level of lesion (tetraplegia/paraplegia). Participants in the Intervention group received 36 phone calls and three home visits over the first 2 years following discharge. All participants received usual post-discharge care. Survival status and date of death were determined by blinded assessors 2 years after randomisation. RESULTS Between July 2015 and March 2018, 410 participants were randomised (204 to Intervention, 206 to Control). There was no loss to follow up. At 2 years, 15 (7.4%) participants in the Intervention group and 16 (7.8%) participants in the Control group had died (hazard ratio from unadjusted Cox model = 0.93 [95% CI, 0.46 to 1.89]; p from log rank test 0.85). There were no clinically important or statistically significant average causal effects of intervention on the incidence or severity of complications. CONCLUSION A program of community-based care for people with recent spinal cord injury in Bangladesh involving frequent phone contact and occasional in-person contact with a health professional after discharge from hospital is no better at preventing death at 2 years than usual care.
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Affiliation(s)
- Mohammad Sohrab Hossain
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia.
| | - Md Shofiqul Islam
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
| | - Md Akhlasur Rahman
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
| | - Stephen Muldoon
- Muldoon Rehabilitation, 72 Liscreevin Road, Lisnarick, Co Fermanagh, BT94 1PZ, Northern Ireland
| | - Fin Biering-Sorensen
- Department for Spinal Cord Injuries, University of Copenhagen, Havnevej 25, DK-3100, Hornbæk, Denmark
| | - Stephen Jan
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Hueiming Liu
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Qiang Li
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, University of Sydney, Kolling Institute, Royal North Shore Hospital, St Leonards, 2065, NSW, Australia
| | - Valerie Taylor
- Centre for the Rehabilitation of the Paralysed, Chapain, Savar, Dhaka, 1343, Bangladesh
| | - Richard I Lindley
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Laurent Billot
- The George Institute for Global Health, Faculty of Medicine, University of New South Wales, PO Box M201, Missenden Road, Camperdown, 2050, NSW, Australia
| | - Robert D Herbert
- Neuroscience Research Australia (NeuRA), Barker Street, Randwick, 2031, NSW, Australia
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Smith TB, Workman C, Andrews C, Barton B, Cook M, Layton R, Morrey A, Petersen D, Holt-Lunstad J. Effects of psychosocial support interventions on survival in inpatient and outpatient healthcare settings: A meta-analysis of 106 randomized controlled trials. PLoS Med 2021; 18:e1003595. [PMID: 34003832 PMCID: PMC8130925 DOI: 10.1371/journal.pmed.1003595] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 03/25/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Hospitals, clinics, and health organizations have provided psychosocial support interventions for medical patients to supplement curative care. Prior reviews of interventions augmenting psychosocial support in medical settings have reported mixed outcomes. This meta-analysis addresses the questions of how effective are psychosocial support interventions in improving patient survival and which potential moderating features are associated with greater effectiveness. METHODS AND FINDINGS We evaluated randomized controlled trials (RCTs) of psychosocial support interventions in inpatient and outpatient healthcare settings reporting survival data, including studies reporting disease-related or all-cause mortality. Literature searches included studies reported January 1980 through October 2020 accessed from Embase, Medline, Cochrane Library, CINAHL, Alt HealthWatch, PsycINFO, Social Work Abstracts, and Google Scholar databases. At least 2 reviewers screened studies, extracted data, and assessed study quality, with at least 2 independent reviewers also extracting data and assessing study quality. Odds ratio (OR) and hazard ratio (HR) data were analyzed separately using random effects weighted models. Of 42,054 studies searched, 106 RCTs including 40,280 patients met inclusion criteria. Patient average age was 57.2 years, with 52% females and 48% males; 42% had cardiovascular disease (CVD), 36% had cancer, and 22% had other conditions. Across 87 RCTs reporting data for discrete time periods, the average was OR = 1.20 (95% CI = 1.09 to 1.31, p < 0.001), indicating a 20% increased likelihood of survival among patients receiving psychosocial support compared to control groups receiving standard medical care. Among those studies, psychosocial interventions explicitly promoting health behaviors yielded improved likelihood of survival, whereas interventions without that primary focus did not. Across 22 RCTs reporting survival time, the average was HR = 1.29 (95% CI = 1.12 to 1.49, p < 0.001), indicating a 29% increased probability of survival over time among intervention recipients compared to controls. Among those studies, meta-regressions identified 3 moderating variables: control group type, patient disease severity, and risk of research bias. Studies in which control groups received health information/classes in addition to treatment as usual (TAU) averaged weaker effects than those in which control groups received only TAU. Studies with patients having relatively greater disease severity tended to yield smaller gains in survival time relative to control groups. In one of 3 analyses, studies with higher risk of research bias tended to report better outcomes. The main limitation of the data is that interventions very rarely blinded personnel and participants to study arm, such that expectations for improvement were not controlled. CONCLUSIONS In this meta-analysis, OR data indicated that psychosocial behavioral support interventions promoting patient motivation/coping to engage in health behaviors improved patient survival, but interventions focusing primarily on patients' social or emotional outcomes did not prolong life. HR data indicated that psychosocial interventions, predominantly focused on social or emotional outcomes, improved survival but yielded similar effects to health information/classes and were less effective among patients with apparently greater disease severity. Risk of research bias remains a plausible threat to data interpretation.
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Affiliation(s)
- Timothy B. Smith
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
- * E-mail:
| | - Connor Workman
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Caleb Andrews
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Bonnie Barton
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Matthew Cook
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Ryan Layton
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Alexandra Morrey
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Devin Petersen
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
| | - Julianne Holt-Lunstad
- Department of Psychology, Brigham Young University, Provo, Utah, United States of America
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Lee S, Kim J, Kim J. Substantiating Clinical Effectiveness and Potential Barriers to the Widespread Implementation of Spinal Cord Injury Telerehabilitation: A Systematic Review and Qualitative Synthesis of Randomized Trials in the Recent Past Decade. TELEMEDICINE REPORTS 2021; 2:64-77. [DOI: http:/doi.org/10.1089/tmr.2020.0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/04/2023]
Affiliation(s)
- Seungbok Lee
- Yonsei Enabling Science Technology and Research Clinic, Yonsei University, Wonju, Republic of Korea
| | - Jeonghyun Kim
- Department of Physical Medicine and Rehabilitation, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jongbae Kim
- Yonsei Enabling Science Technology and Research Clinic, Yonsei University, Wonju, Republic of Korea
- Department of Occupational Therapy, Yonsei University College of Health Sciences, Wonju, Republic of Korea
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Lee S, Kim J, Kim J. Substantiating Clinical Effectiveness and Potential Barriers to the Widespread Implementation of Spinal Cord Injury Telerehabilitation: A Systematic Review and Qualitative Synthesis of Randomized Trials in the Recent Past Decade. TELEMEDICINE REPORTS 2021; 2:64-77. [PMID: 35720743 PMCID: PMC8989076 DOI: 10.1089/tmr.2020.0026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/23/2020] [Indexed: 05/07/2023]
Abstract
Introduction: Telemedicine across many specialties in clinical practice has been established in the literature regarding technology platforms, privacy issues, cost, and clinical effectiveness. However, the lack of data in these areas applicable to spinal cord injury telerehabilitation (teleSCI) still exists. The gaps in these knowledge areas continue to hinder its widespread implementation and serve as pathways for focused efforts in teleSCI research. Objective: This systematic review aims to substantiate the clinical effectiveness and potential barriers to teleSCI implementation by verifying the statistical significance of various clinical outcomes from randomized trials published within the recent past decade. Methods: A qualitative synthesis of randomized studies, conducted across various regions, was systematically reviewed after identifying relevant records from database search engines. Applied filters in the search included publication dates (2010-2020), humans, full-text, and no language preference. The 13 studies were selected per Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram, and the risk of bias across studies was evaluated by using the Physiotherapy Evidence Database scale of quality assessment. Results: Quantitative outcome measurements demonstrated positive impact across studies: 79.1% (34/43) of all measurements were statistically significant for positive outcomes and 18.6% (8/43) yielded no effect but were significant. Primary outcomes addressed various spinal cord injury (SCI) management areas; 38.5% (5/13) of studies also assessed secondary outcomes. Interventional platforms were conventional technologies used in telemedicine. One study (7.7%) achieved data encryption; no studies presented cost-analysis data. Conclusion: The majority of studies demonstrated significant positive outcomes to validate teleSCI clinical effectiveness through conventional technology. These results further expand our understanding of teleSCI's impact and its demonstrated potential for improving SCI individuals' lives. However, heterogeneity of selected studies limits the conclusive recommendations to address potential barriers to its widespread implementation. Moreover, the development of new data is warranted to promote "buy-in" of widespread teleSCI implementation.
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Affiliation(s)
- Seungbok Lee
- Yonsei Enabling Science Technology and Research Clinic, Yonsei University, Wonju, Republic of Korea
| | - Jeonghyun Kim
- Department of Physical Medicine and Rehabilitation, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jongbae Kim
- Yonsei Enabling Science Technology and Research Clinic, Yonsei University, Wonju, Republic of Korea
- Department of Occupational Therapy, Yonsei University College of Health Sciences, Wonju, Republic of Korea
- Address correspondence to: Jongbae Kim, PhD, Yonsei Enabling Science Technology and Research Clinic, Yonsei University, 1 Yonseidae-gil, Baekun Hall Suite 131, Wonju, Gangwon-do 220-710, Republic of Korea,
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Liu H, Hossain MS, Islam MS, Rahman MA, Costa PD, Herbert RD, Jan S, Cameron ID, Muldoon S, Chhabra HS, Lindley RI, Biering-Sorensen F, Ducharme S, Taylor V, Harvey LA. Understanding how a community-based intervention for people with spinal cord injury in Bangladesh was delivered as part of a randomised controlled trial: a process evaluation. Spinal Cord 2020; 58:1166-1175. [PMID: 32541882 PMCID: PMC7606133 DOI: 10.1038/s41393-020-0495-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Revised: 05/21/2020] [Accepted: 05/26/2020] [Indexed: 11/09/2022]
Abstract
Design Mixed methods study Setting Community, Bangladesh Objectives To understand how a community-based intervention for people with spinal cord injury (SCI) in Bangladesh was delivered as part of a randomised controlled trial and to gauge the perceptions of participants and healthcare professionals to the intervention. Methods A community-based intervention was administered to 204 participants as part of a large randomised controlled trial (called the CIVIC trial). Case-managers followed-up participants with regular telephone calls and home visits over the first 2 years after discharge. The following data were collected alongside the trial: (i) chart audit of telephone calls and home visits (ii) recordings of 20 telephone calls (iii) interviews with 14 Intervention participants and four healthcare professionals including three case-managers. Results Participants received the target number of telephone calls and home visits. Pressure injuries were identified as a problem during at least one telephone call by 43% of participants. Participants and case-managers valued regular telephone calls and home visits, and believed that calls and visits prevented complications and alleviated social isolation. Participants trusted case-managers and were confident in the care and advice provided. Case-managers expressed concerns that people with SCI in Bangladesh face many problems impacting on well-being and motivation stemming from poverty, limited employment opportunities, societal attitudes and inaccessible environments. Conclusion A community-based intervention involving regular telephone calls and home visits was administered as intended and was well received by the recipients of the care. Nonetheless, people with SCI in Bangladesh face economic and social problems which cannot be fully addressed by this type of intervention alone.
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Affiliation(s)
- Hueiming Liu
- George Institute for Global Health, Sydney, NSW, Australia
| | - Mohammad Sohrab Hossain
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School/Northern, University of Sydney, St Leonards, NSW, Australia.,Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Md Shofiqul Islam
- Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Md Akhlasur Rahman
- Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Punam D Costa
- Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Robert D Herbert
- Neuroscience Research Australia, Barker Street, Randwick, NSW, Australia
| | - Stephen Jan
- George Institute for Global Health, Sydney, NSW, Australia
| | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School/Northern, University of Sydney, St Leonards, NSW, Australia
| | - Stephen Muldoon
- Muldoon Rehabilitation, 72 Liscreevin Road, Lisnarick, Co Fermanagh, BT, Northern Ireland, Northern Ireland
| | | | - Richard I Lindley
- George Institute for Global Health, Sydney, NSW, Australia.,Westmead Applied Research Centre, University of Sydney, Sydney, NSW, Australia
| | - Fin Biering-Sorensen
- Clinic for Spinal Cord Injuries, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Stanley Ducharme
- Boston Medical Centre and Boston University School of Medicine, 725 Albany street, Boston, MA, USA
| | - Valerie Taylor
- Centre for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School/Northern, University of Sydney, St Leonards, NSW, Australia.
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Jang WH, Lee SB, Kim DW, Lee YH, Uhm YJ, Yang SW, Kim JH, Kim JB. ICT-Based Health Care Services for Individuals with Spinal Cord Injuries: A Feasibility Study. SENSORS 2020; 20:s20092491. [PMID: 32354052 PMCID: PMC7249337 DOI: 10.3390/s20092491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 04/15/2020] [Accepted: 04/24/2020] [Indexed: 11/16/2022]
Abstract
In the Republic of Korea, 90.5% of those living with spinal cord injury (SCI) are faced with medical complications that require chronic care. Some of the more common ones include urinary tract infections, pressure sores, and pain symptomatology. These and other morbidities have been recognized to deteriorate the individual's health, eventually restricting their community participation. Telerehabilitation, using information and communication technology, has propelled a modern-day movement in providing comprehensive medical services to patients who have difficulty in mobilizing themselves to medical care facilities. This study aims to verify the effectiveness of health care and management in the SCI population by providing ICT-based health care services. We visited eight individuals living with chronic SCI in the community, and provided ICT-based health management services. After using respiratory and urinary care devices with the provision of home visit occupational therapy, data acquisition was achieved and subsequently entered into a smart device. The entered information was readily accessible to the necessary clinicians and researchers. The clients were notified if there were any concerning results from the acquired data. Subsequently, they were advised to follow up with their providers for any immediate medical care requirements. Digital hand-bike ergometers and specialized seating system cushions are currently in development. The ICT-based health care management service for individuals with SCI resulted in a favorable expected level of outcome. Based on the results of this study, we have proposed and are now in preparation for a randomized clinical trial.
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Affiliation(s)
- Wan-ho Jang
- Department of Occupational Therapy, The Graduate School, Yonsei University, Wonju 26493, Korea; (W.-h.J.); (D.-w.K.); (Y.-h.L.)
| | - Seung-bok Lee
- Clinical Team, Yonsei Enabling Science and Technology Research Center, Wonju 26493, Korea; (S.-b.L.); (S.-w.Y.)
| | - Dong-wan Kim
- Department of Occupational Therapy, The Graduate School, Yonsei University, Wonju 26493, Korea; (W.-h.J.); (D.-w.K.); (Y.-h.L.)
| | - Yun-hwan Lee
- Department of Occupational Therapy, The Graduate School, Yonsei University, Wonju 26493, Korea; (W.-h.J.); (D.-w.K.); (Y.-h.L.)
| | - Yun-jeong Uhm
- Department of Ergonomic Therapy, The Graduate School of Health and Environment, Yonsei University, Wonju 26493, Korea;
| | - Seung-wan Yang
- Clinical Team, Yonsei Enabling Science and Technology Research Center, Wonju 26493, Korea; (S.-b.L.); (S.-w.Y.)
| | - Jeong-hyun Kim
- Usability Center, Yonsei Enabling Science Technology Research Center, Wonju 26493, Korea;
| | - Jong-bae Kim
- Department of Occupational Therapy, College of Health Science, Yonsei University, Wonju 26493, Korea
- Correspondence:
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Alve YA, Bontje P, Begum S. Intra- and interpersonal agency: Resuming occupational participation among persons with spinal cord injury after discharge from in-patient rehabilitation. Scand J Occup Ther 2019; 27:66-79. [PMID: 31230503 DOI: 10.1080/11038128.2019.1628298] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: This research aim was to understand and describe how changes occur in occupational participation among persons with spinal cord injury (SCI) following discharge from a rehabilitation center in Bangladesh.Materials and methods: Using a selected ethnographical research design, nineteen participants were selected following a purposive sampling technique, then interviewed and observed on three occasions. Data analysis consisted of an iterative approach combining thematic narrative and narrative slopes analyses.Results: Eight themes determined the transitional progress, regression and stability, in which, three of the eight themes characterized the ascending slopes, namely developing affirmative attitudes, adapting the occupational environments and working on identities. Three themes characterized the descending slopes, which were reducing confidence created difficulties, becoming bored in daily life, and declining health reduced social connections. The final two themes characterized periods of stability, namely, maintaining daily life through skills and helplessness to participate in occupations.Conclusions and significance: Each of participants' transitions unfolded in unique, complex patterns. The processes directions of the transitions were understood as waning and waxing of agency. This agency could be individual, and shared with or dedicated by others, when participants and other persons combined their skills or when participants were supported by others.
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Affiliation(s)
- Yeasir Arafat Alve
- Department of Occupational Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan.,Department of Occupational Therapy, Bangladesh Health Professions Institute, Centre for the Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh
| | - Peter Bontje
- Department of Occupational Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan
| | - Salma Begum
- Department of Occupational Therapy, Graduate School of Human Health Sciences, Tokyo Metropolitan University, Tokyo, Japan.,Department of Occupational Therapy, Proyash Institute of Special Education and Research, Dhaka, Bangladesh
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Jesus TS, Landry MD, Hoenig H. Global Need for Physical Rehabilitation: Systematic Analysis from the Global Burden of Disease Study 2017. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060980. [PMID: 30893793 PMCID: PMC6466363 DOI: 10.3390/ijerph16060980] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 02/19/2019] [Accepted: 03/15/2019] [Indexed: 12/29/2022]
Abstract
Background: To inform global health policies and resources planning, this paper analyzes evolving trends in physical rehabilitation needs, using data on Years Lived with Disability (YLDs) from the Global Burden of Disease Study (GBD) 2017. Methods: Secondary analysis of how YLDs from conditions likely benefiting from physical rehabilitation have evolved from 1990 to 2017, for the world and across countries of varying income levels. Linear regression analyses were used. Results: A 66.2% growth was found in estimated YLD Counts germane to physical rehabilitation: a significant and linear growth of more than 5.1 billion YLDs per year (99% CI: 4.8–5.4; r2 = 0.99). Low-income countries more than doubled (111.5% growth) their YLD Counts likely benefiting from physical rehabilitation since 1990. YLD Rates per 100,000 people and the percentage of YLDs likley benefiting from physical rehabilitation also grew significantly over time, across locations (all p > 0.05). Finally, only in high-income countries did Age-standardized YLD Rates significantly decrease (p < 0.01; r2 = 0.86). Conclusions: Physical rehabilitation needs have been growing significantly in absolute, per-capita and in percentage of total YLDs. This growth was found globally and across countries of varying income level. In absolute terms, growths were higher in lower income countries, wherein rehabilitation is under-resourced, thereby highlighting important unmet needs.
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Affiliation(s)
- Tiago S Jesus
- Global Health and Tropical Medicine & WHO Collaborating Center on Health Workforce Policy and Planning, Institute of Hygiene and Tropical Medicine-NOVA University of Lisbon, Rua da Junqueira 100, 1349-008 Lisbon, Portugal.
| | - Michel D Landry
- Physical Therapy Division, Department of Orthopeadic Surgery, School of Medicine, Duke University, Durham, NC 27705, USA.
- Duke Global Health Institute (DGHI), Duke University, Durham, NC 27710, USA.
| | - Helen Hoenig
- Physical Medicine and Rehabilitation Service, Durham Veterans Administration Medical Center, Durham, NC 27705, USA.
- Division of Geriatrics, Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Post-discharge mortality in patients with traumatic spinal cord injury in a Brazilian hospital: a retrospective cohort. Spinal Cord 2018; 57:134-140. [PMID: 30089892 DOI: 10.1038/s41393-018-0183-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2018] [Revised: 06/24/2018] [Accepted: 07/03/2018] [Indexed: 11/08/2022]
Abstract
STUDY DESIGN Retrospective cohort. OBJECTIVE To evaluate the survival outcomes in patients with traumatic spinal cord injury (TSCI). SETTING A teaching hospital in Brazil. METHODS A total of 434 patients diagnosed with TSCI (2004-2014) were included. Overall survival, standardized mortality ratios (SMR), and causes of death were assessed by Student's t-test, χ2 test, Kaplan-Meier analysis, and Cox proportional-hazards regression. RESULTS The mean follow-up was 4.8 years (±3.3 years). Individuals with tetraplegia had a median survival of 11 years, with participants in the paraplegia group not reaching median survival. The overall mortality rate was 37 per 1000 person-years. Age-adjusted SMR was 28.8 (95% CI: 22.8-36). There were 77 deaths with 56 defined causes, of which pneumonia was the most frequent (35.7%). Combined infectious etiologies caused 55.3% of deaths. Multivariate analysis revealed higher mortality among individuals with tetraplegia vs. paraplegia in the first 2 years post injury (HR = 8.28, 95% CI: 2.76-24.80), after 2 years post injury (HR = 2.35, 95% CI: 1.31-4.24), and in all years combined (HR = 3.36, 95% CI: 2.04-5.52). CONCLUSION Mortality among patients with TSCI was 28.8 times higher than in the reference population. In more than half of the cases, the cause of death was linked to infectious diseases. Pneumonia caused two times more deaths in individuals with tetraplegia than in individuals with paraplegia, with a higher impact in the first 2 years post injury. Reported findings indicate the need for a surveillance and prevention program with emphasis on vaccination and respiratory rehabilitation.
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Hossain MS, Harvey LA, Liu H, Islam MS, Rahman MA, Muldoon S, Biering-Sorensen F, Cameron ID, Chhabra HS, Lindley RI, Jan S. Protocol for process evaluation of CIVIC randomised controlled trial: Community-based InterVentions to prevent serIous Complications following spinal cord injury in Bangladesh. BMJ Open 2018; 8:e024226. [PMID: 30012798 PMCID: PMC6082451 DOI: 10.1136/bmjopen-2018-024226] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Revised: 06/14/2018] [Accepted: 06/25/2018] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION People with spinal cord injuries in low-income and middle-income countries are highly vulnerable to life-threatening complications in the period immediately after discharge from hospital. We are conducting a randomised controlled trial in Bangladesh to determine whether all-cause mortality at 2 years can be reduced if health professionals regularly ring and visit participants in their homes following discharge. We will conduct a process evaluation alongside the trial to explain the trial results and determine the feasibility of scaling this intervention up in low-income and middle-income countries if it is found to be effective. METHODS AND ANALYSIS Our process evaluation is based on the Realist and Reach, Effectiveness, Adoption, Implementation and Maintenance frameworks. We will use a mixed methods approach that uses both qualitative and quantitative data. For example, we will audit a sample of telephone interactions between intervention participants and the healthcare professionals, and we will conduct semistructured interviews with people reflective of various interest groups. Quantitative data will also be collected to determine the number and length of interactions between the healthcare professionals and participants, the types of issues identified during each interaction and the nature of the support and advice provided by the healthcare professionals. All quantitative and qualitative data will be analysed iteratively before the final analysis of the trial results. These data will then be triangulated with the final results of the primary outcome. ETHICS AND DISSEMINATION Ethics approval was obtained from the institutional ethics committee at the site in Bangladesh and from the University of Sydney, Australia. The study will be conducted in compliance with all stipulations of its protocol, the conditions of ethics committee approval and the relevant regulatory bodies. The results of the trial will be disseminated through publications in peer-reviewed scientific journals and presentations at scientific conferences. TRIAL REGISTRATION NUMBER ACTRN12615000630516.
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Affiliation(s)
- Mohammad Sohrab Hossain
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School/Northern, University of Sydney, Sydney, New South Wales, Australia
- George Institute for Global Health, Sydney, New South Wales, Australia
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School/Northern, University of Sydney, Sydney, New South Wales, Australia
- George Institute for Global Health, Sydney, New South Wales, Australia
| | - Hueiming Liu
- George Institute for Global Health, Sydney, New South Wales, Australia
| | | | | | | | | | - Ian D Cameron
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Sydney Medical School/Northern, University of Sydney, Sydney, New South Wales, Australia
- George Institute for Global Health, Sydney, New South Wales, Australia
| | | | - Richard I Lindley
- George Institute for Global Health, Sydney, New South Wales, Australia
| | - Stephen Jan
- George Institute for Global Health, Sydney, New South Wales, Australia
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Self-management interventions for skin care in people with a spinal cord injury: part 2-a systematic review of use of theory and quality of intervention reporting. Spinal Cord 2018; 56:837-846. [PMID: 29795415 PMCID: PMC6128816 DOI: 10.1038/s41393-018-0136-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 03/18/2018] [Accepted: 03/20/2018] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Systematic review. OBJECTIVES To examine use of theory and quality of reporting in skin care self-management interventions for people with SCI. SETTING International. METHODS The Theory Coding Scheme (TCS) and the Template for Intervention Description and Replication (TIDieR) checklist were applied by two independent researchers to 17 interventions identified in a systematic review of self-management interventions for skin care in people with SCI. RESULTS Six (35%) of the 17 interventions reviewed were reported to have a theoretical basis. Theories used included three of the most commonly featured in health behavior research (the Health Belief Model, Social Cognitive Theory, and the Transtheoretical Model). In these six interventions, theory was used to design content but not to select participants or tailor strategies. None of the interventions were used to test theories in the SCI population, or to propose theoretical refinements. Reporting quality was found to vary by TIDieR item, with 6-100% of interventions including recommended information. Information on two intervention fidelity items was missing in 53 and 82% of descriptions. CONCLUSIONS Use of theory and reporting quality in SCI self-management research remains suboptimal, potentially slowing down advancements in this area of research. Rehabilitation researchers should direct their efforts toward improving these practices to help build a science of SCI self-management that is cumulative and reproducible by clinicians, scientists, and policy makers. SPONSORSHIP This work was funded through a postdoctoral fellowship awarded to the first author by the Rick Hansen Institute.
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Baron JS, Sullivan KJ, Swaine JM, Aspinall A, Jaglal S, Presseau J, White B, Wolfe D, Grimshaw JM. Self-management interventions for skin care in people with a spinal cord injury: part 1-a systematic review of intervention content and effectiveness. Spinal Cord 2018; 56:823-836. [PMID: 29802393 PMCID: PMC6128818 DOI: 10.1038/s41393-018-0138-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Revised: 04/02/2018] [Accepted: 04/04/2018] [Indexed: 11/24/2022]
Abstract
Study design Systematic review. Objectives To review the content and effectiveness of skin care self-management interventions for people with SCI. Setting International. Methods We searched electronic bibliographic databases, trial registers, and relevant reference lists. Eligibility criteria for the reviews of intervention content and effectiveness were identical with the exception of study design. The review of intervention content included non-randomized and randomized controlled trials (RCTs). The review of effectiveness included RCTs. A Behavior Change Technique (BCT) taxonomy of 93 BCTs was used to code intervention content. Intervention effects on outcomes of interest are summarized descriptively. Effect sizes were calculated, and the Cochrane risk of bias tool applied. Results In all, 15 studies testing 17 interventions were included in the review of intervention content. Interventions in these studies included 28 BCTs. The most common were “instructions on how to perform behavior” (16 interventions), “credible source” (12 interventions), and “social support (unspecified)” (9 interventions). Ten RCTs were included in the review of intervention effectiveness and they measured knowledge, self-efficacy, and skills relating to skin care/pressure ulcer (PU) prevention, skin care behaviors, skin status (PU prevalence, severity, and time to PU), and health-care utilization for skin problems. Evidence to support intervention effects on these outcomes was limited, particularly for clinical outcomes. Risk of bias assessments was often inconclusive due to poor reporting. Conclusions There is potential to design SCI skin care interventions that include currently untested BCTs. Further research and better consistency in outcome measurements and reporting are required to synthesize evidence on effectiveness.
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Affiliation(s)
- Justine S Baron
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.
| | - Katrina J Sullivan
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada
| | - Jillian M Swaine
- Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia.,Institute for Health Research, University of Notre Dame Australia, Fremantle, WA, Australia
| | - Arlene Aspinall
- Rick Hansen Institute, Vancouver, BC, Canada.,Vancouver General Hospital, Vancouver, BC, Canada
| | - Susan Jaglal
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada.,Toronto Rehabilitation Institute, Toronto, ON, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Barry White
- Rick Hansen Institute, Vancouver, BC, Canada
| | - Dalton Wolfe
- Parkwood Institute Research, Lawson Health Research Institute, London, ON, Canada.,University of Western Ontario, London, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
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Irgens I, Rekand T, Arora M, Liu N, Marshall R, Biering- Sørensen F, Alexander M. Telehealth for people with spinal cord injury: a narrative review. Spinal Cord 2018. [DOI: 10.1038/s41393-017-0033-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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