Secondary health conditions in persons with a spinal cord injury for at least 10 years:design of a comprehensive long-term cross-sectional study

Purpose: To describe the prevalence of secondary health conditions (SHCs) (urinary tract and bowel problems, pressure ulcers, spasticity, musculoskeletal and neuropathic pain, sexual dysfunction, respiratory and cardiovascular disorders) in persons with long-term spinal cord injury (SCI), and to explore the impact of SHCs on fitness, active lifestyle, participation and well-being. Methods: A time since injury (TSI)-stratified cros-ssectional study among 300 persons between 28- and 65-year-old with a SCI for at least 10 years. Strata of TSI are 10-19, 20-29, and 30 or more years. All eight Dutch rehabilitation centres with a SCI unit will participate. Participants will be invited for a 1-day visit to the rehabilitation centre for an aftercare check-up by the local SCI rehabilitation physician (neurological impairment, SHCs and management), physical tests by a trained research assistant (lung function, wheelchair skills, physical capacity), and they will be asked to complete a self-report questionnaire in advance. Results: Not applicable. Conclusion: This study will provide knowledge on the health status and functioning of persons aging with SCI living in the Netherlands. This knowledge will help us to develop predictive models for the occurrence of SHCs and to formulate guidelines to improve health care for persons with long-term SCI.</p

Feasibility of a classification system for physical therapy, occupational therapy, and sports therapy interventions for mobility and self-care in spinal cord injury rehabilitation

Objective: To test the feasibility of a classification system developed to record the contents of treatment sessions intended to improve mobility and self-care by persons with a spinal cord injury (SCI) in clinical rehabilitation. Design: Descriptive study. Setting: Three Dutch SCI facilities. Participants: Participants (N = 36) as well as physical therapists (n = 20), occupational therapists (n = 14), and sports therapists (n = 2). Interventions: Not applicable. Main Outcome Measures: Questionnaires to assess the clarity of the classification system, time needed to record 1 treatment session, and the distribution of categories and interventions. The classification system consisted of 28 categories at 3 levels of functioning: basic functions (eg, muscle power), basic activities (eg, transfers), and complex activities (eg, walking and moving around outside). Results: Therapists used 1625 codes to record 856 treatment sessions of 142 patients. For 93% of the treatment sessions, the coding caused little or no doubt. The therapists were able to classify 86.3% of the treatment sessions within 3 minutes. The classification system was rated as useful and easy to use. Conclusions: The findings support the suitability of our classification system as a tool to record the contents of SCI treatment sessions in different settings and by different therapists

Social support and life satisfaction in spinal cord injury during and up to one year after inpatient rehabilitation

Objective: To describe the course of social support in persons with recently acquired spinal cord injury, and to examine direct and indirect relationships between social support and life satisfaction over time. Design: A multi-centre prospective cohort study with measurements at the start of active rehabilitation, at discharge from inpatient rehabilitation and one year after discharge. Subjects: One hundred and ninety individuals with spinal cord injury from 8 Dutch rehabilitation centres. Methods: Social support was measured with the Social Support List-12. Life satisfaction was measured as the sum score of current life satisfaction and current life satisfaction compared with life satisfaction before spinal cord injury. Distress was operationalized as functional dependence and measured with the Functional Independence Measure. Random coefficient analysis was used for the analyses. Results: Everyday social support and support in problem situations decreased, and esteem support remained stable over time. Everyday support and support in problem situations were directly associated with life satisfaction over time. Significant interaction effects between social support and distress on life satisfaction were found. Conclusion: Different types of social support showed different courses over time. Social support was associated with life satisfaction after spinal cord injury, in particular in persons with relatively high levels of distress

Upper and Lower Urinary Tract Outcomes in Adult Myelomeningocele Patients: A Systematic Review

<div><h3>Background</h3><p>The introduction of sophisticated treatment of bladder dysfunction and hydrocephalus allows the majority of SB patients to survive into adulthood. However, no systematic review on urological outcome in adult SB patients is available and no follow-up schemes exist.</p> <h3>Objectives</h3><p>To systematically summarize the evidence on outcome of urinary tract functioning in adult SB patients.</p> <h3>Methods</h3><p>A literature search in PubMed and Embase databases was done. Only papers published in the last 25 years describing patients with open SB with a mean age >18 years were included. We focused on finding differences in the treatment strategies, e.g., clean intermittent catheterization and antimuscarinic drugs versus early urinary diversion, with regard to long-term renal and bladder outcomes.</p> <h3>Results</h3><p>A total of 13 articles and 5 meeting abstracts on urinary tract status of adult SB patients were found describing a total of 1564 patients with a mean age of 26.1 years (range 3–74 years, with a few patients <18 years). All were retrospective cohort studies with relatively small and heterogeneous samples with inconsistent reporting of outcome; this precluded the pooling of data and meta-analysis. Total continence was achieved in 449/1192 (37.7%; range 8–85%) patients. Neurological level of the lesion and hydrocephalus were associated with incontinence. Renal function was studied in 1128 adult patients. In 290/1128 (25.7%; range 3–81.8%) patients some degree of renal damage was found and end-stage renal disease was seen in 12/958 (1.3%) patients. Detrusor-sphincter dyssynergy and detrusor-overactivity acted as adverse prognostic factors for the development of renal damage.</p> <h3>Conclusions</h3><p>These findings should outline follow-up schedules for SB patients, which do not yet exist. Since renal and bladder deterioration continues beyond adolescence, follow-up of these individuals is needed. We recommend standardization in reporting the outcome of urinary tract function in adult SB patients.</p> </div

Diagnostic accuracy of Tc-99m DMSA scintigraphy and renal ultrasonography for detecting renal scarring and relative function in patients with spinal dysraphism

Aims To study additional benefits of performing Tc-99m dimercaptosuccinic acid (Tc-99m-DMSA) scintigraphy as part of the follow-up of adults with spinal dysraphism (SD), compared with ultrasonography, with regard to finding renal scarring and difference in split renal function. Methods Between January 2011 and April 2013 every patient visiting our specialized outpatient clinic for adults with SD was invited to undergo both renal ultrasonography and Tc-99m-DMSA scintigraphy. Outcomes of both modalities were compared, with focus on renal scarring. The relation between renal scarring and hypertension was also assessed. Results In total, 122 patients (with 242 renal units) underwent both renal scintigraphy and ultrasonography. More scars were seen on DMSA scintigraphy than on ultrasonography: 45.9% vs. 10.3% of renal units;

Renal function adult studies (MMC patients) in chronological order.

<p>AMD = antimuscarinic drugs; CKD = chronic kidney disease; N/A = not available; DOA = Detrusor overactivity; DSD = detrusor sphincter dyssynergia; ESRD = end-stage renal disease; GFR = glomerular filtration rate; LPP = leak point pressure; Mixed: occult and open SB; VUR = vesico-ureteral reflux; rUTIs = recurrent urinary tract infections; N.S. = not significant.</p>a<p>in 12/193 patients renal function was unknown;</p>b<p>no reference values of renal function;</p>c<p>no urodynamic data available;</p>e<p> <b>exemption; only median age is stated, whereas in all other studies, mean age is given.</b></p>f<p>other denominator; only studies with known CKD’s are taken into account for this figure (see Results-section for more details).</p

Functional independence of persons with long-standing motor complete spinal cord injury in the Netherlands

Context/Objective: Since life expectancy of persons with spinal cord injury (SCI) has improved, it is relevant to know whether this group is able to maintain functional abilities many years after onset of SCI. Objectives of this study were (1) to examine associations between time since injury (TSI) and functional independence in persons with long-standing SCI and (2) to explore associations between functional independence and level of injury, comorbidities, mental health, waist circumference and secondary health conditions (SHCs). Design: TSI-stratified cross-sectional study. Strata were 10–19, 20–29 and 30+ years. Setting: Community. Participants: 226 persons with long-standing SCI. Inclusion criteria: motor complete SCI; age at injury 18–35 years; TSI ≥ 10 years; current age 28–65 years; wheelchair dependency. Interventions: Not applicable. Outcome measures: The Spinal Cord Independence Measure III (SCIM) was administered by a trained research assistant. Level of injury, comorbidities, mental health, waist circumference and SHCs were assessed by a rehabilitation physician. Results: Mean TSI was 23.6 (SD 9.1) years. No significant differences in SCIM scores were found between TSI strata. SCIM scores were lower for persons with tetraplegia, autonomic dysreflexia, hypotension, more than four SHCs and a high waist circumference. In linear regression analyses, TSI nor age was associated with the SCIM total score. Only level of injury (β = –0.7; P <.001) and waist circumference (β = –0.1; P =.042) were independent determinants (explained variance 55%). Conclusion: We found no association between TSI and functional independence in persons with long-standing motor complete SCI. This study confirms the possible effect of overweight on functional independence

Life satisfaction in people with spinal cord injury during the first five years after discharge from inpatient rehabilitation

To describe the course of life satisfaction in persons with spinal cord injury (SCI) during the first 5 years after discharge from inpatient rehabilitation and to examine its determinants.Multi-centre prospective cohort study with four measurements, the first at discharge from inpatient rehabilitation, the last 5 years after discharge. Data of 162 persons with SCI were analyzed. Life satisfaction was measured as the sum score of 'current life satisfaction' and 'current life satisfaction compared to life satisfaction before SCI'. Lesion characteristics, functional independence, secondary impairments, pain, social support and self-efficacy were analyzed as possible determinants of life satisfaction. Random coefficient analysis was used for the analyses.No significant changes in life satisfaction were found between discharge and 2 years later, however there were significant increases from two to 5 years post discharge. High functional independence, low pain, high everyday social support and high self-efficacy were significant determinants of a positive course of life satisfaction after discharge.Increases in life satisfaction were found in persons with SCI in the long run. High functional status, low pain, good social skills and high self-efficacy were related to high life satisfaction

Survival in spina bifida patients.

<p>If ‘survival into adulthood’ is given, the exact ages were not specified in the article.</p>*<p>Patients treated before 1975.</p>†<p>Patients treated after 1975.</p>‡<p>Two different papers, same study.</p><p>N/A = not available</p

SECONDARY HEALTH CONDITIONS IN PERSONS WITH SPINAL CORD INJURY:A LONGITUDINAL STUDY FROM ONE TO FIVE YEARS POST-DISCHARGE

<p>Objective: To assess the occurrence of secondary health conditions and their potential risk factors in persons with spinal cord injury from 1 to 5 years after discharge from initial inpatient rehabilitation.</p><p>Design: Multicentre longitudinal study.</p><p>Subjects: A total of 139 wheelchair-dependent persons with spinal cord injury.</p><p>Methods: The occurrence of secondary health conditions and their potential risk factors were assessed in a clinical interview with a rehabilitation physician at 1 and 5 years after discharge from inpatient rehabilitation and by a telephone interview 2 years after discharge. Self-report questionnaires were used for the assessment of musculoskeletal and neuropathic pain.</p><p>Results: Neuropathic pain (83.7-92.1%), musculoskeletal pain (62.3-87.1%) and urinary tract infection (56.5-58.9%) were the most frequently reported secondary health conditions. The occurrence of several secondary health conditions was higher among women and individuals with a complete lesion, tetraplegia, and with a higher body mass index.</p><p>Conclusion: Secondary health conditions are common in the first years post-discharge following spinal cord injury, and their course seems to be relatively stable. These results emphasize the number of health issues that must be considered during post-injury care of persons with spinal cord injury living in the community, and the importance of a well-coordinated interdisciplinary approach from specialized rehabilitation centres.</p>