Inception cohort of the Swiss Spinal Cord Injury Cohort Study (SwiSCI): Design, participant characteristics, response rates and non-response

Reciprocal association between pain and quality of life after newly acquired spinal cord injury

PURPOSE

Pain is highly prevalent in spinal cord injury (SCI) and a key determinant of quality of life (QoL). This is the first study to examine reciprocal associations between pain and QoL in patients undergoing their first inpatient rehabilitation after SCI.

METHODS

Longitudinal data, with three measurement time points (1 month and 3 months after SCI onset, and at discharge from inpatient rehabilitation) from the Inception Cohort of the Swiss Spinal Cord Injury Cohort Study. Participants were 381 individuals aged ≥ 16 years with a newly diagnosed traumatic or non-traumatic SCI. 75.1% were male and the average age was 53.2 years. Random intercept cross-lagged panel models were conducted to examine the reciprocal association between pain intensity and QoL, as measured with the International SCI QoL Basic Data Set three individual items (satisfaction with life, physical health, and psychological health) and total score (mean of the three individual items).

RESULTS

Both item and total QoL scores increased over time. 1 month: 5.3 (SD = 2.7), 3 months: 5.9 (SD = 2.3), discharge: 6.6 (SD = 2.0). Participants reported relatively low levels of pain intensity that remained stable over the course of inpatient rehabilitation. 1 month: 2.7 (SD = 2.3), 3 months: 2.6 (SD = 2.4), discharge: 2.7 (SD = 2.5). There were no significant cross-lagged associations between QoL and pain intensity across time.

CONCLUSION

Results indicate that pain intensity does not predict changes in QoL during first rehabilitation, and vice versa. Associations between pain intensity and QoL reported by previous studies may be attributable to individual characteristics and timely events that simultaneously influence pain and QoL.

The Swiss Spinal Cord Injury Cohort Study (SwiSCI) biobank: from concept to reality

OBJECTIVES

To describe the concept, establishment and the operationalization of the biobank of the Swiss Spinal Cord Injury Cohort Study (SwiSCI), the available biosamples, and demographic and clinical characteristics of study participants.

SETTING

The SwiSCI biobank is a platform for research within SwiSCI. It collects and processes serum, plasma, PBMCs, RNA, DNA, and urine from three rehabilitation centers. Samples are collected at admission to first rehabilitation and at discharge. Additionly, the biobank provides services to projects nested in SwiSCI or otherclinical trials among Spinal Cord Injury population.

METHODS

Descriptive statistics were used for an overview of available biosamples, study participant characteristics, and comparison of the participating centers.

RESULTS

Between the SwiSCI biobank establishment on June 27th, 2016, and October 19th, 2023, the SwiSCI Study has obtained informed consent from 524 individuals. Of these, 315 (60.1%) have agreed to donate biospecimens to the biobank. The average age of the contributors was 54 years (range: 38-65), with the majority being male (80%). Most participants suffered from traumatic injuries (66%) and were classified as paraplegic (64%). Approximately 80% presented with motor and sensory-incomplete SCI. The median Spinal Cord Independence Measure (SCIM) score was 31 (Interquartile Range: 19-58). The proportion of individuals providing paired biosamples at two distinct time points ranged from 63% (for RNA) to 65% (for urine and urine sediment).

CONCLUSIONS

The SwiSCI biobank is a unique platform designed to serve as a basis for collaborative SCI research, including multi-omics approaches. The longitudinal collection of biospecimens and cryopreservation of multiple aliquots for each participant are fundamental for scrutinizing the temporal associations, ensuring research reproducibility, and achieving an adequate sample size for future investigations.

The risk of malnutrition in patients with spinal cord injury during inpatient rehabilitation-A longitudinal cohort study

Background and aim

Patients with spinal cord injury (SCI) show an increased risk of malnutrition. Studies found that about 50% of patients with a recent SCI are affected by malnutrition when they enter a rehabilitation institution. However, there is a lack of data during the course and at discharge of initial rehabilitation as well as missing knowledge about the factors promoting such a risk. The aim of this study was to assess the risk of malnutrition in individuals with SCI 3 months post injury and at the end of inpatient rehabilitation and to identify factors associated with a high risk of malnutrition.

Methods

Retrospective, monocentric, longitudinal cohort study, using the data set of the Swiss Spinal Cord Injury Cohort Study and additional data from the patients' medical records. Individuals with SCI were assessed for the risk of malnutrition using the Spinal Nutrition Screening Tool 3 months post injury and at discharge from initial inpatient rehabilitation. Odds ratios (OR) for potential risk parameters were calculated.

Results

Of the 252 participants included, 62% were at risk for malnutrition 3 months post injury and 40% at discharge (p = 0.000). Moderate to high risk of malnutrition was found regardless of age and BMI. The highest odds for an increased risk at 3 months post injury was identified in ventilator-dependent persons (OR 10.2). At discharge from inpatient rehabilitation, pressure injury (OR 16.3) was the most prominent risk factor.

Conclusion

In the population with SCI the risk of malnutrition is widespread during inpatient rehabilitation, but also at discharge. Ventilated persons and persons with pressure injuries are clear risk groups and need special attention. Based on these findings and the known negative impact of malnutrition on clinical outcomes, the awareness of malnutrition should be increased in the population with SCI. Therefore, a regular and standardized screening of the malnutrition risk is highly recommended.

Age at Onset of Spinal Cord Injury is Associated with Increased Inpatient Care Needs, Reduced Independence at Discharge and a Higher Risk of Institutionalization after Primary Inpatient Rehabilitation

OBJECTIVE

To investigate the influence of age at onset of spinal cord injury on length of stay, inpatient therapy and nursing hours, independence at discharge and risk of institutionalization.

DESIGN

Retrospective cohort study.

PARTICIPANTS

A total of 250 patients with a newly acquired traumatic or non-traumatic spinal cord injury undergoing primary inpatient rehabilitation in a Swiss spinal cord injury specialized clinic between 2017 and 2019.

METHODS

Multiple regression analysis was used to determine if age, in addition to clinical characteristics (co-morbidities, secondary complications and spinal cord injury severity), affects inpatient rehabilitation parameters (length of stay, daily nursing hours and daily therapy hours), independence at discharge (Spinal Cord Independence Measure III) and place of discharge (private residence vs institution).

RESULTS

Chronological age correlated with the number of co-morbidities and secondary complications. Older age was associated with increased daily nursing care and reduced independence at discharge. However, both were also influenced by co-morbidities, secondary complications and severity of spinal cord injury. Length of stay and daily therapy hours were age-independent. Odds for institutionalization after discharge increased significantly, by 1.03-fold per year of age.

CONCLUSION

Age at onset of spinal cord injury predicted inpatient nursing care, independence at discharge and the risk of institutionalization after primary inpatient rehabilitation. Co-morbidities, secondary complications and severity of spinal cord injury were also important influencing factors.

Sex differences in urological management during spinal cord injury rehabilitation: results from a prospective multicenter longitudinal cohort study

STUDY DESIGN

Prospective, multicenter, longitudinal cohort study.

OBJECTIVES

To describe female-male differences in first-line urological management during spinal cord injury (SCI) rehabilitation.

SETTING

Inpatient specialized post-acute SCI rehabilitation in Switzerland.

METHODS

Data on bladder storage medication (antimuscarinic and beta-3 agonist) use, suprapubic catheter placement, demographic and SCI characteristics was collected within 40 days of SCI and at rehabilitation discharge from May 2013-September 2021. Prevalence and indicators of bladder storage medication and suprapubic catheter use at discharge were investigated with sex-stratified descriptive and logistic regression analyses.

RESULTS

In 748 patients (219 females, 29%), bladder storage medication use at discharge had a prevalence of 24% (95% CI: 18-29%) for females and 30% (95% CI: 26-34%) for males and was indicated by cervical AIS grade A, B, C and traumatic SCI in both sexes. Thoracic AIS grade A, B, C SCI (males), and lumbar/sacral AIS grade A, B, C SCI (females) predicted higher odds of bladder storage medication use (SCI characteristic*sex interaction, p < 0.01). Prevalence of suprapubic catheter use at discharge was 22% (95% CI: 17-28%) for females and 17% (95% CI: 14-20%) for males. Suprapubic catheter use was indicated by cervical AIS grade A, B, C SCI, and age >60 in both sexes. Females with thoracic grade A, B, C SCI tended to have higher odds of suprapubic catheter use (SCI characteristic*sex interaction, p = 0.013).

CONCLUSIONS

We identified sex differences in urological management especially in persons with AIS grade C or higher sub-cervical SCI. There is scope for well-powered, female-specific research in SCI in order to understand the underlying mechanisms and support patient-tailored management.

Australian arm of the International Spinal Cord Injury (Aus-InSCI) Community Survey: 2. Understanding the lived experience in people with spinal cord injury

STUDY DESIGN

Cross-sectional survey.

OBJECTIVES

To identify common problems across key domains of functioning, health and wellbeing, as well as evaluate self-reported quality of life (QoL) by people with SCI, examining differences by age, gender, injury characteristics and level of mobility.

SETTING

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

METHODS

Participants were 18 years or over with SCI and at least 12 months post-injury, recruited between Mar'18 and Jan'19. The Aus-InSCI questionnaire comprised 193 questions, including socio-demographics, SCI characteristics, body functions and structures, activities and participation, environmental and personal factors, and appraisal of health and well-being. General linear model was used to examine differences in functioning and QoL.

RESULTS

Participants (mean age 57 years, range 19-94 years) with tetraplegia and/or complete injuries had more health problems, activity/participation problems and environmental barriers. However, self-rated overall QoL did not differ for injury level or completeness. Participants with more recent injuries exhibited lower independence levels, more mental health problems and poorer satisfaction with self and their living conditions. Major activity/participation problems related to intimate relationships and accessing public transportation. Less than half of the working age population were engaged in paid work. The top two environmental barriers frequently related to accessing public places or homes and unfavourable climatic conditions.

CONCLUSIONS

This large, comprehensive community survey draws a detailed picture of the lived experience of people with SCI in Australia, identifying priority needs, gaps in services and barriers to achieving a full and satisfying life.

Longitudinal measurement invariance of the international spinal cord injury quality of life basic data set (SCI-QoL-BDS) during spinal cord injury/disorder inpatient rehabilitation

Purpose

This study aimed at testing the internal consistency and longitudinal measurement invariance of a brief quality of life questionnaire—the spinal cord injury quality of life basic data set (SCI-QoL-BDS)—among individuals with spinal cord injury/disorder undergoing first inpatient rehabilitation.

Methods

Longitudinal data from the Swiss spinal cord injury inception cohort study were used. Participants (n = 218) completed the SCI-QoL-BDS at one and three months post injury and at discharge. The SCI-QoL-BDS consists of three items assessing satisfaction with life as a whole, physical health, and psychological health. Internal consistency was examined at each time point and longitudinal measurement invariance was tested using longitudinal confirmatory factor analysis.

Results

Internal consistency coefficients ranged between .82 and .90. The confirmatory factor analysis revealed invariance of the factor structure and of all factor loadings across time. Additionally, all item intercepts except the one of satisfaction with physical health were invariant across time, suggesting partial intercept invariance of the SCI-QoL-BDS. Indeed, a response shift was observed in satisfaction with physical health. This item was evaluated more negatively in the early phase of inpatient rehabilitation, indicating the change of the evolving physical situation after the onset of a spinal cord injury.

Conclusion

The SCI-QoL-BDS is a consistent and valid measure to assess quality of life among individuals undergoing first spinal cord injury/disorder inpatient rehabilitation. However, we recommend using latent variable frameworks instead of mean scores when examining longitudinal changes in the measure to account for potential response shift.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11136-021-03027-5.

The Nottwil Standard-Development and Implementation of an International Classification of Functioning, Disability and Health-Based Clinical Standard Assessment for Post-acute Rehabilitation After Newly Acquired Spinal Cord Injury

Introduction: Assessments during rehabilitation of spinal cord injury (SCI) align with the World Health Organization's classifications and national quality requirements. This paper aims to report on the development and first implementation experiences of an institutional standard of assessments performed after newly acquired SCI.

Setting: Specialized SCI acute care and post-acute rehabilitation clinic in Switzerland.

Methods: A situation analysis of an interdisciplinary post-acute SCI rehabilitation program was performed. The results informed a subsequent consensus-based selection of assessments, and an information and implementation strategy. Linking to the ICF Core Set for SCI in post-acute settings and ICF Generic-30 Set was performed. The Nottwil Standard was piloted for 18 months.

Results: Situation analysis: A battery of 41 assessments were irregularly performed during initial rehabilitation after newly aquired SCI. Selection of assessments: A multidisciplinary group of clinicians agreed on 10 examinations, 23 assessments and two questionnaires that make up the Nottwil Standard. In total, 55 ICF categories are covered, including most of the ICF Generic-30 Set categories. The implementation strategy included Executive Board commitment, a structured improvement project, guidelines for documentation and assessments, a manual controlling system, and staff training on the Nottwil Standard. Pilot phase: 54 persons with paraplegia and 42 with tetraplegia (75 male; 21 female) were included. Twenty-seven assessments out of 33 assessments were performed in more than 80% of all observed patients' rehabilitation.

Conclusion: Implementation of a standard assessment schedule was feasible but required a well-structured process with good communication strategy and controlling mechanism, and full engagement of involved professions.

Internal consistency and convergent validity of the International Spinal Cord Injury Quality of Life Basic Data Set at discharge from first rehabilitation

STUDY DESIGN

This study is a cross-sectional analysis using data from the Swiss Spinal Cord Injury Cohort Study.

OBJECTIVES

To examine internal consistency and convergent validity of the International Spinal Cord Injury Quality of Life Basic Data Set (QoL-BDS) at discharge from first inpatient rehabilitation.

SETTING

The study was performed at four rehabilitation centers in Switzerland.

METHODS

Participants were Swiss residents aged over 16 years newly diagnosed with traumatic or non-traumatic spinal cord injury (SCI). Measures included the QoL-BDS, World Health Organization Quality of Life (WHOQOL) items, Hospital Anxiety and Depression Scale (HADS), and Spinal Cord Independence Measure III (SCIM).

RESULTS

A total of 495 participants were included. In all, 57% had a traumatic SCI, 71.1% a motor complete SCI, and 33.3% had tetraplegia. Mean age was 53 (SD = 16.4) years and 68% were male. No floor or ceiling effects were found. Inter-correlations were strong (0.73-0.80) and Cronbach's alpha was good (0.88). QoL-BDS mean scores were 6.4 (SD = 2.2) for life satisfaction, 5.8 (SD = 2.4) for physical health, 6.9 (SD = 2.4) for psychological health, and 6.4 (SD = 2.1) for total QoL. Correlations with reference measures were strongest for QoL-BDS total and WHOQOL general quality of life (r = 0.67), QoL-BDS physical health and WHOQOL health and daily activities (r = 0.64 and 0.53), and QoL-BDS psychological health and HADS depression and anxiety (r = -0.64 and -0.69). SCIM correlated weakly with all QoL-BDS items.

CONCLUSIONS

The QoL-BDS revealed no floor or ceiling effects and demonstrated good internal consistency and convergent validity in individuals with SCI assessed at discharge from first rehabilitation. This study supports the clinical routine use of the QoL-BDS.