| 1. |
- Aesoy, M. S., et al.
(author)
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Epidemiology of persistent iatrogenic spinal cord injuries in Western Norway
- 2016
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In: Brain and Behavior. - : Wiley. - 2162-3279. ; 6:10
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Journal article (peer-reviewed)abstract
- Objectives: Iatrogenic spinal cord injuries (SCIs) caused by invasive procedures or surgical interventions have previously been reported as case studies. The primary objective of this study was to investigate and analyze the incidence, etiology, and prognosis of iatrogenic SCI in Western Norway. Methods: Medical records of all 183 patients admitted to the SCU between 01.01.2004 and 31.12.2013 were reviewed. Gender, age, diagnosis, iatrogenic medical procedure, symptoms and findings before and after injury, mechanism of injury, level of injury, and ASIA Impairment Scale (AIS) score prior iatrogenic SCI, at admittance and discharge were recorded, as were the length of the period prior to admittance and the length of stay. Results: Twenty-three (12.5%; 14 men, nine women) of 183 patients met the criteria for iatrogenic SCI. The annual incidence rate was estimated 2,3 per 1,000,000 (SD +/-1.0). Mean age at iatrogenic SCI was 55.5 years (range 16-79 years). Intervention for cervical spinal stenosis was the leading cause of iatrogenic SCI, followed by operations on the aorta and spine. Iatrogenic SCIs was most frequently located on the thoracic level. The patients suffered from clinical incomplete injuries (AIS score C and D) both at admittance and discharge from the SCU. Most patients improved, but no patient recovered completely after SCI. Conclusion: Although the annual incidence rate of iatrogenic SCI is low in Norway, individual consequences are serious. Increased awareness of the causes of SCI may decrease the risk of iatrogenic SCI.
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| 2. |
- Bakketun, T., et al.
(author)
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Myelomeningocele: Need for long-time complex follow-up - An observational study
- 2019
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In: Scoliosis and Spinal Disorders. - : Springer Science and Business Media LLC. - 2397-1789. ; 14:1
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Journal article (peer-reviewed)abstract
- Background: Myelomeningocele (MMC) is a congenital disorder that causes a variety of acute as well as late complications. Numerous health problems in adulthood have been described by the persons with MMC but not studied in clinical setting. This study gives implications for organization of the follow-up in adulthood. Objectives: To investigate the need for follow-up from different medical specialists as well as the need for organized focused rehabilitation among adults with MMC. Methods: Retrospective cohort study on adults with MMC including multiple departments in a university hospital in Norway. The number and cause of specialized hospital consultations were recorded for every patient. Correlation between childhood health condition related to MMC and the need for specialized consultations in adulthood as well as correlations between number of consultations and anatomical level of MMC, age, and observation time was performed for the whole group. Results: In total, 38 patients had 672 consultations related to MMC. The most frequent departments were neurology, neurosurgery, urology, gastroenterology, and orthopedics. Most consultations were planned. Complexity of MMC-related health condition correlated to number of specialist consultations (rho = 0.420, p = 0.009). Anatomical level of MMC, age, and length of observation time did not correlate with consultations. Pain and shunt failure were the most common reasons for consultations. Conclusions: Persons with MMC have a need for continuous, life-long multispecialized follow-up and rehabilitation. This is crucial for optimal function, satisfaction with life, and for long-term survival. Systematic follow-up together with rehabilitation will optimize health service. © 2019 The Author(s).
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| 3. |
- Gedde, M. H., et al.
(author)
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Traumatic vs non-traumatic spinal cord injury: A comparison of primary rehabilitation outcomes and complications during hospitalization
- 2019
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In: Journal of Spinal Cord Medicine. - : Informa UK Limited. - 1079-0268 .- 2045-7723. ; 42:6, s. 695-701
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Journal article (peer-reviewed)abstract
- Objective: To compare outcome for patients with traumatic (TSCI) and non-traumatic spinal cord injuries (NTSCI) after primary rehabilitation regarding neurological improvement measured by the American Spinal Injury Association Impairment Scale (AIS), length of stay and complications. Design: Retrospective comparative cohort study on patients with TSCI and NTSCI, hospitalized during a ten-year period at Haukeland University Hospital, Norway. Impairment, length of stay and complications during first in-patient rehabilitation period were analyzed. Uni- and multivariate analysis was performed. Setting: Spinal Cord Rehabilitation Unit, Haukeland University Hospital, Norway Participants: A total of 174 persons with a spinal cord injury (SCI) were included; 102 with TSCI and 72 with NTSCI. Outcome measures: Neurological improvement measured by AIS from admission to discharge, number of weeks in the hospital, frequency and significance of complications were compared. Results: Improvement in AIS after primary rehabilitation did not differ between TSCI and NTSCI. Length of stay was in average 3.4 weeks longer for TSCI. Urinary tract infections and pressure ulcers significantly influenced length of stay in both groups. Urinary tract infections were more frequent in TSCI (67%) vs NTSCI (42%). Pressure ulcers were more frequent among NTSCI (24%) vs TSCI (14%). Pneumonia and neuropathic pain did not depend on etiology and did not influence length of stay. Conclusions: Patients with SCI have a rehabilitation potential regardless of etiology. Complications are frequent in both groups and often prolong hospitalization. Complication patterns differ in the two groups, and specific prevention and optimal treatment will shorten and optimize the length of primary rehabilitation. © 2019, © The Academy of Spinal Cord Injury Professionals, Inc. 2019.
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| 4. |
- Halvorsen, A., et al.
(author)
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Epidemiology of traumatic spinal cord injury in Norway in 2012-2016: a registry-based cross-sectional study
- 2019
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In: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 57:4, s. 331-338
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Journal article (peer-reviewed)abstract
- Study design A registry-based cross-sectional study. Objectives To analyse the epidemiological and demographic characteristics of persons with traumatic spinal cord injury (TSCI) in Norway. Setting TSCI patients admitted for primary rehabilitation to one of the three specialised spinal cord injury (SCI) departments (located in Bergen, Trondheim, and Oslo) and consented to the Norwegian Spinal Cord Injury Registry (NorSCIR). Methods Analysis of data from NorSCIR during a 5-year period (2012-2016) was performed. Data were collected by using the International SCI Core Data Set as recommended by the International Spinal Cord Society (ISCoS). Results The lowest incidence of TSCI was 11.4/million (2012), and the highest incidence was 15.9/million (2014). In the study period, 349 individuals were registered with TSCI. In total, 76% were male, and the mean age was 47 (SD +/- 19) years. We observed dominance in the 60-74 years age group. The distribution between tetraplegia and paraplegia was 48%/42%. For those initially classified as American Spinal Cord Injury Association Impairment Scale (AIS) grade A (complete injury), 77% remained grade A at discharge. Considerable changes during primary rehabilitation after incomplete lesions were observed. Most patients (68%) were discharged home after primary rehabilitation. Falls were the main cause of TSCI (47%) and occurred more often during the weekend. Conclusion Through a National Medical Quality Registry based on internationally provided data sets, we are able to present systematic and updated data from Norway.
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| 5. |
- Halvorsen, A., et al.
(author)
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Non-traumatic spinal cord injury in Norway 2012-2016: analysis from a national registry and comparison with traumatic spinal cord injury
- 2019
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In: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 57:4, s. 324-330
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Journal article (peer-reviewed)abstract
- Study design Registry-based cross-sectional study. Objectives To describe and analyze epidemiological and demographic characteristics of non-traumatic spinal cord injury (NTSCI) and to compare persons with NTSCI and traumatic spinal cord injury (TSCI). Setting A total of 225 non-traumatic and 349 traumatic SCI patients were admitted for primary rehabilitation at one of the three specialized SCI departments in Norway (located in Bergen, Trondheim, and Oslo) from 2012 to 2016. Patients who consented to registration in the Norwegian Spinal Cord Injury Registry (NorSCIR) were included. Methods Data were collected using the International SCI Core Data Set, as recommended by the International Spinal Cord Society (ISCoS). Demographics and injury characteristics were analyzed descriptively. The NTSCI and TSCI groups were compared using a Mann-Whitney U test and chi-square test. Results The mean age of the NTSCI patients was 55 years, and 59% were male. The incidence of NTSCI was 7.7-10.4 per million person-years, which is lower than the incidence of TSCI. NTSCI individuals were older, less severely injured, and their length of stay at the hospital was shorter than the TSCI individuals. The results may be influenced by the inclusion criterion in the registry. This makes the analyzed sample for NTSCI less complete. However, the majority of patients with non-progressive NTSCI are included in the NorSCIR. Conclusion For the first time, we are able to provide the national epidemiological status on NTSCI based on available data from the national registry. Further studies are required to improve the capture of NTSCI for future incidence studies.
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| 6. |
- Halvorsen, Annette, et al.
(author)
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Realizing the potentials of a National Spinal Cord Injury Registry – 10 years of experiences
- 2023
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In: Norsk Epidemiologi. - 0803-2491. ; 31:1-2, s. 49-54
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Journal article (peer-reviewed)abstract
- The Norwegian Spinal Cord Injury Registry is a national quality registry that just celebrated its 10-year anniversary. The registry contributes to quality improvement in spinal cord injury care in Norway and other Nordic countries. The continuous improvement in clinical practice goes hand-in-hand with the further registry development. Data from the registry are furthermore used in different kinds of research projects. This article aims to provide an overview of how the Norwegian Spinal Cord Injury Registry was established, to share our experiences, insights, lessons learned during its development and ten years in operation, and to highlight its potential.
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| 7. |
- Irgens, Ingebjorg, et al.
(author)
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Cost-utility analysis and impact on the environment of videoconference in pressure injury. A randomized controlled trial in individuals with spinal cord injury
- 2024
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In: SPINAL CORD SERIES AND CASES. - 2058-6124. ; 10:1
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Journal article (peer-reviewed)abstract
- Study designA prospective randomized controlled trial (RCT) in persons with spinal cord injury (SCI) and ongoing pressure injury (PI).ObjectivesThe main aim was to perform a cost-utility analysis (CUA) alongside the RCT comparing regular care to regular care with additional videoconference consultations. Secondary aims were to assess costs and greenhouse gas emission related to transportation in the two study groups.SettingTwo spinal cord units in Norway.MethodsParticipants were allocated to a regular care group (RCG) and a regular care group with additional videoconference (VCG), in a 1-year follow-up between 2016 and 2018. Costs were prospectively collected, and health-related quality of life (HRQoL) data were collected at baseline and 12 months. The outcome was quality-adjusted life years (QALYs), derived from the EQ-5D-5L questionnaire. Results are reported as incremental cost-effectiveness ratio (ICER), expressed as the cost per additional QALY gained. Transportation related costs and environmental emissions were compared by t-tests.ResultsThere were 56 participants included, 28 in each group. Of these 27 in the VCG and 26 in the RCG completed. Three participants died. The mean cost per patient was euro 8819 in the VCG and euro 3607 in the RCG, with 0.1 QALYs gained in the VCG. No significant differences were identified regarding HRQoL or secondary outcomes.ConclusionThe VCG costs euro 5212 more for an additional 0.1 QALYs, giving an ICER of euro 52,120 per QALY. No significant differences were found regarding transportation-related costs, or emission of greenhouse gases.
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| 8. |
- Irgens, I., et al.
(author)
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Hospital based care at home: study protocol for a mixed epidemiological and randomized controlled trial
- 2019
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In: Trials. - : Springer Science and Business Media LLC. - 1745-6215. ; 20
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Journal article (peer-reviewed)abstract
- BackgroundIndividuals with spinal cord injuries (SCI) are prone to pressure ulcers (PUs) because of the loss of sensorimotor function involved as well as increased skin moisture. Treatment of PU after SCI is complicated, involving different specialties and with need for long-lasting follow-up. This study should identify risk factors for PU after SCI, and find an effective and less time-consuming treatment for the condition among different available methods for follow-up.Method/designThe first part of this research project aims to investigate the prevalence of PU among persons with SCI based on an epidemiological design. The study will identify possible risk factors for acquiring PU. A questionnaire focusing on previous and present PUs will be sent to persons who suffered SCIs between January 2004 and January 2014. In the second part we will compare two different treatment regimens of PU through a randomized controlled pilot trial (RCT) where we will compare outpatient SCI follow-up in a hospital versus outpatient follow-up from the patient's home, using telemedicine (teleSCI) interventions. We will compare the healing of the PU in the two groups (usual care versus teleSCI). The Tissue, Infection, Moisture Edge (TIME) registration form, the Photographic Wound Assessment Tool (PWAT) and the change in the ulcer size will be used to monitor the healing. Changes in health-related quality of life (HRQoL) and the need for assistance will be assessed using the Five Dimensions European Quality of Life scale (EQ-5D), the generic Medical Outcomes Study 12-item Short Form Health Survey (SF-12) modified version, the International Spinal Cord Injury Quality of Life Data set (ISCI-QoL Data set), and the Spinal Cord Independence Measure scale, version III (SCIM III). In addition to primary outcome measures, a cost-benefit evaluation and an assessment of patient satisfaction and participation will be performed, using customized questionnaires.DiscussionThe first part of the research project will reveal the epidemiology of PU after SCI, and explore the risk factors. This part enables further prevention of PU after SCI and this information will be used in the follow-up RCT. Videoconferencing in the outpatient follow-up of persons with SCI and PU will change clinical routines and facilitate interdisciplinary collaboration, communication and competence exchange among participants of the health care services. Our research protocol allows comparing methods for interaction between medical specialists at hospitals, local caregivers in the community, next of kin, and persons with SCI and PU. The RCT should identify advantages as well as challenges in the management of PU in different follow-up settings. This study aims to identify risk factors for PU after SCI, and find an effective and less time consuming treatment for the condition among different available methods for follow- up.Trial registration list list-type="order www.ClinicalTrials.gov, ID: NCT02800915, last update 9 October 2017.The National Regional Ethical Committee (REC) 2014/ 684/ REK-Nord. https://helseforskning.etikkom.no/prosjekterirek/prosjektregister/prosje kt?p_document_id=469163&p_parent_id=473640&_ikbLanguageCode=nhttps://app .cristin.no/projects/show.jsf?id=545284https://www.sunnaas.no/kliniske-s tudier/bruk-av-telemedisin-som-virkemiddel-til-samhandling-i-poliklinisk -oppfolging-av-pasienter-med-ryggmargsskade-og-trykksar
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| 9. |
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| 10. |
- Irgens, I., et al.
(author)
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Spinal cord injury and development of pressure injury during acute rehabilitation in Norway: a national retrospective cross-sectional study
- 2020
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In: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 58, s. 1069-1079
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Journal article (peer-reviewed)abstract
- Study design A national, retrospective, cross-sectional study. Objectives To analyze the prevalence of pressure injury (PI), and characteristics associated with PI development in the hospitalized population of persons with a newly acquired spinal cord injury (SCI) between 2004 and 2014. Setting All three specialized Spinal Cord Units in Norway. Methods Demographic data related to prevalence and potential risk factors were retrieved from the electronic medical record (EMR). Statistical analyses were performed, using IBM SPSS Statistics, version 23. Results We identified 1012 individuals with a new SCI. Mean age at injury was 48 years (SD 19). The period prevalence of PI was 16% (95% CI = 0.14-0.19), and identified PI associations were complete SCI (OR = 0.1), being injured abroad (OR = 2.4), bowel (OR = 13), and bladder (OR = 9.2) dysfunction; comorbidities like diabetes mellitus 1 (OR = 7.9), diagnosed depression (OR = 3.8), ventilator support (OR = 3.0), drug abuse (OR = 3.0), and concurrent traumatic brain injury (OR = 1.7). Individuals in the age group of 15-29 years had higher odds of PI compared with middle-aged individuals (45-59 years). Conclusion PI is a serious complication after SCI. The association between depression or comorbidity and PI occurrence should be investigated more thoroughly. We recommend implementation of a simple follow-up program regarding observation and prevention of PI. Increased awareness of factors that could contribute to PI will help to focus on better prevention and early recognition of PI. This will contribute to more optimal rehabilitation.
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| 11. |
- Irgens, I., et al.
(author)
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Telehealth for people with spinal cord injury: a narrative review
- 2018
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In: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 56:7, s. 643-655
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Journal article (peer-reviewed)abstract
- Study design Narrative review. Objectives To find and discuss what has been published about the use of telehealth, on people with spinal cord injury (teleSCI). Method Cochrane Library, Ovid Medline, EMBASE and CINAHL, from 1996 till June 2017 have been searched. Searches in PsycINFO, from 1996 till September 2017, were included afterwards. Extracted data include studies in English language, containing information about spinal cord injury and disorders, and telehealth. Literature reviews, systematic reviews, and studies containing other types of neurological disorders, were excluded. Studies were grouped based on how and to whom telehealth was offered. Results Twenty nine studies were included in the review. They were categorized according to the way teleSCI was provided, and to what modality was used. Some studies utilized more than one modality. TeleSCI seems to be favorable concerning treatment and follow-up, as well as favorable socioeconomically and environmentally. The studies spanned across several aims and outcomes. There was also heterogeneity in number of participants, the differences in modalities, and in the level of evidence. Thus it was challenging to compare studies and make future recommendations. Conclusions TeleSCI can be used for examination and guiding purposes. Further research is warranted to evaluate optimal utilization, methodology and efficacy.
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| 12. |
- Irgens, I., et al.
(author)
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Videoconferencing in Pressure Injury: Randomized Controlled Telemedicine Trial in Patients With Spinal Cord Injury
- 2022
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In: JMIR Formative Research. - : JMIR Publications Inc.. - 2561-326X. ; 6:4
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Journal article (peer-reviewed)abstract
- Background: Geographical, financial and travel-related barriers may impact access to necessary health care for people in need of long-term follow-up. Objective: The goal of the research was to perform a nonblinded, randomized, controlled trial on health-related quality of life (HRQoL), healing, interaction, and satisfaction of patients with spinal cord injury (SCI) and PI receiving multidisciplinary videoconference consultations from a wound clinic to the participant's home versus regular outpatient care. The multidisciplinary team consisted of a medical doctor, a wound nurse, and an occupational therapist. In both groups, district nurses attended the consultations at the participant's home. Methods: A total of 56 participants, 28 in each group, were randomized to a videoconference group (VCG) or a regular care group (RCG). Validated questionnaires were used to measure and compare the follow-up effect on HRQoL. Percentage reduction of wound volume was measured at end of the follow-up. A Likert scale was used to measure the satisfaction of the patients and district nurses regarding the interaction between different modalities of care in the 2 groups. Results: The HRQoL did not show significant differences between the 2 groups (P values ranging from.09 to.88) or the rate of PI healing, experienced interaction, and satisfaction in the groups. A total of 67% (37/55) of all PIs healed, 64% (18/28) in the VCG and 70% (19/27) in the RCG. Mean reduction in ulcer volume was 79% in the VCG and 85% in the RCG (P = .32). A Kaplan-Meier plot with a logrank test regarding time to healing did not show any significant difference between the 2 groups. Conclusions: Videoconference-based care seems to be a safe and efficient way to manage PIs in terms of HRQoL, healing, interaction, and satisfaction compared to conventional care for people with SCI. This should be considered when planning for future care. SCI has a huge impact on the individual, the family, and the health care system. There is an urgent need to improve systems of care so that individuals who live far from specialists and require long-term follow-up for conditions such as PI can get optimal treatment.
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| 13. |
- Josefsson, Charlotta, 1985, et al.
(author)
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Respiratory complications during initial rehabilitation and survival following spinal cord injury in Sweden: a retrospective study.
- 2021
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In: Spinal cord. - : Springer Science and Business Media LLC. - 1476-5624 .- 1362-4393. ; 59:6, s. 659-664
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Journal article (peer-reviewed)abstract
- Retrospective study.To determine prevalence of respiratory complications in individuals with spinal cord injury (SCI) during the initial rehabilitation at the spinal cord injury unit (SCU) and to describe the subsequent effect on mortality.The SCU at the university hospital in Gothenburg, Sweden.We reviewed the medical charts of newly injured persons with SCI who were admitted to the SCU between 1/1/2010 and 12/31/2014. Outcome measures were time to death, length of stay, occurrence of respiratory complications, and the use of breathing aids.A total of 136 consecutive individuals were included; 53% with cervical SCI and 20% with lower SCI suffered from one or several respiratory complications during their initial rehabilitation in the SCU. At follow-up, 10/1/2018, 20% of the individuals were deceased. The most common cause of death was related to respiratory insufficiency. The individuals with respiratory complications during the initial rehabilitation in the SCU had particularly shortened survival compared with those without. The relative risk (RR) of dying if the person suffered from any respiratory complications during their initial rehabilitation in the SCU was 2.1 times higher than for those with no respiratory complications (RR, 2.1; 95% CI, 1.1-3.9).Having respiratory complications at the SCU provides preliminary data to support the claim that respiratory complications predict premature mortality. Early diagnosis and prophylactic measures seem to be necessary to mitigate the adverse consequences of serious respiratory problems.
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| 14. |
- Kvistad, C. E., et al.
(author)
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Safety and Clinical Efficacy of Mesenchymal Stem Cell Treatment in Traumatic Spinal Cord Injury, Multiple Sclerosis and Ischemic Stroke - A Systematic Review and Meta-Analysis
- 2022
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In: Frontiers in Neurology. - : Frontiers Media SA. - 1664-2295. ; 13
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Journal article (peer-reviewed)abstract
- Background: Mesenchymal stem cells (MSCs) is an attractive candidate in regenerative research and clinical trials have assessed their therapeutic potential in different neurological conditions with disparate etiologies. In this systematic review, we aimed to assess safety and clinical effect of MSC treatment in traumatic spinal cord injury (TSCI), multiple sclerosis (MS) and ischemic stroke (IS). Methods: A systematic search was performed 2021-12-10 in MEDLINE, EMBASE, Web of Science and Cochrane where clinical studies assessing MSC treatment in TSCI, MS or IS were included. Studies without control group were excluded for efficacy analysis, but included in the safety analysis. For efficacy, AIS score, EDSS score and mRS were used as clinical endpoints and assessed in a meta-analysis using the random effects model. Findings: Of 5,548 identified records, 54 studies were included. Twenty-six studies assessed MSC treatment in TSCI, 14 in MS and nine in IS, of which seven, seven and five studies were controlled, respectively. There were seven serious adverse events (SAEs), of which four were related to the surgical procedure and included one death due to complications following the implantation of MSCs. Three SAEs were considered directly related to the MSC treatment and all these had a transient course. In TSCI, a meta-analysis showed no difference in conversion from AIS A to C and a trend toward more patients treated with MSCs improving from AIS A to B as compared to controls (p = 0.05). A subgroup analysis performed per protocol, showed more MSC treated patients improving from AIS A to C in studies including patients within 8 weeks after injury (p = 0.04). In MS and IS, there were no significant differences in clinical outcomes between MSC treated patients and controls as measured by EDSS and mRS, respectively. Interpretation: MSC-treatment is safe in patients with TSCI, MS and IS, although surgical implantation of MSC led to one fatal outcome in TSCI. There was no clear clinical benefit of MSC treatment, but this is not necessarily a proof of inefficacy due to the low number of controlled studies. Future studies assessing efficacy of MSC treatment should aim to do this in randomized, controlled studies.
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| 15. |
- Lili, Lamprini, et al.
(author)
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Associations between upper extremity functioning and kinematics in people with spinal cord injury
- 2021
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In: Journal of NeuroEngineering and Rehabilitation. - : Springer Science and Business Media LLC. - 1743-0003. ; 18:1
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Journal article (peer-reviewed)abstract
- Introduction More knowledge of the relationships between kinematic measures and clinical assessments is required to guide clinical decision making and future research. Objectives To determine which kinematic variables obtained during a drinking task were associated with clinical assessments of upper extremity functioning in people with spinal cord injury (SCI). Methods In total, 25 individuals with chronic cervical (n = 17) or thoracic (n = 8) complete (n = 14) or motor incomplete (n = 11) SCI (mean age 58.4, SD 13.8) were included. Kinematic data, including movement time, smoothness and joint angles was captured with a 5-camera optoelectronic system during a unimanual drinking task. Action Research Arm Test (ARAT), Sollerman Hand Function Test (SHFT) and basic hand classification of the Upper Extremity Data Set (ISCI-Hand) were used as clinical assessments. Multiple regression analysis was used to identify kinematic variables associated with clinical assessments after controlling for potential confounding factors, such as, age, severity of SCI, sensory function, and hand surgery. Results Movement time, smoothness and movement pattern kinematics including trunk displacement, elbow and wrist joint angles were correlated (p < 0.05) with all three clinical scales while the velocity-related kinematics and inter-joint coordination showed low correlations. Multiple regression analysis revealed that wrist angle combined with movement time or smoothness explained 82% and 77% of the total variance in ARAT and SHFT, respectively. Wrist angle alone explained 59% of the variance in ISCI-Hand. The proprioception of the hand increased the explanatory power in the models of ARAT and SHFT. Associations between kinematics and clinical assessments in the subgroup with cervical SCI were equivalent to the whole group analyses. The number of participants in the subgroup with thoracic SCI was small and only allowed limited analysis. Conclusions Wrist angle, movement time, movement smoothness are the most important kinematic variables associated with upper extremity clinical assessments in people with SCI. The results are most valid for individuals with cervical SCI. All three assessments are appropriate for SCI. Further research with larger representative sample of thoracic SCI needed.
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| 16. |
- Lili, Lamprini, et al.
(author)
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Independence and upper extremity functioning after spinal cord injury: a cross-sectional study.
- 2023
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In: Scientific reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 13:1
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Journal article (peer-reviewed)abstract
- Upper extremity functioning is important for achieving independence in activities of daily living (ADL). A better understanding of relationships between different aspects of independence in ADL after spinal cord injury (SCI) and upper extremity functioning is required to guide rehabilitation practices. To determine which aspects of independence in ADL are correlated with upper extremity functioning in individuals with cervical or thoracic SCI. A total of 25 adults (mean age 58.4years, 72% men) with established cervical or thoracic SCI were recruited. Independence in ADL was assessed by Spinal Cord Independence Measure (SCIM-III) and upper extremity functioning by kinematic measures (movement time, smoothness, and wrist angle during drinking task), grip strength, Upper Extremity Motor and Sensory Score, Box and Block Test (BBT), Action Research Arm Test (ARAT), and Upper Extremity Basic Data Set (ISCI-Hand and ISCI-Shoulder). Spearman correlation coefficients were used for data analyses. The SCIM-self-care subscale, particularly the feeding and dressing items, correlated moderately (r≥0.5) with movement time and smoothness, grip strength, ARAT, BBT, and ISCI-Hand. The SCIM-respiration/sphincter subscale and the SCIM-mobility showed very low and low correlations with upper extremity assessments. However, at item level, respiration and bed/wheelchair mobility showed moderate correlations. Independence in self-care as domain and feeding/dressing, respiration and bed/wheelchair mobility as separate items were dependent on upper extremity functioning in individuals with cervical or thoracic SCI. Movement time and smoothness along with BBT, grip strength, ARAT, and ISCI-Hand can be used as indicators of independence in ADL. These findings can provide guidance to clinical practice in selection of upper extremity assessments in the context for ADL in individuals with SCI.
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| 17. |
- Lili, Lamprini, et al.
(author)
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Participation and autonomy, independence in activities of daily living and upper extremity functioning in individuals with spinal cord injury.
- 2024
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In: Scientific reports. - 2045-2322. ; 14:1
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Journal article (peer-reviewed)abstract
- Improvements in care and rehabilitation have resulted in a higher proportion of people living with spinal cord injury (SCI), which calls for an increased focus on participation and autonomy. This observational cross-sectional study investigated the impact of SCI on autonomy and how it correlates to activity performance and upper extremity functioning. A total of 25 adults (mean age 58years) with chronic cervical or thoracic SCI were included. Self-perceived autonomy was measured with Impact on Participation and Autonomy questionnaire, independence in activities of daily living (ADL) with Spinal Cord Independence Measure, upper extremity functioning with Action Research Arm Test (ARAT) and kinematic measures of the drinking task. The results showed that most participants perceived injury-related restrictions in outdoor autonomy (80%), family role (76%), and in indoor autonomy (72%). Independence in self-care (r=0.72), mobility (r=0.59) and upper extremity kinematics of movement time (r=0.63) and smoothness (r=0.49) were correlated to indoors autonomy. Social life autonomy was correlated to self-care (r=0.50) and ARAT (r=0.41). In conclusion, autonomy was perceived restricted after SCI in several major life areas and correlated with independence in ADL and upper extremity functioning. The aspects of autonomy should be considered more in goal setting and clinical decision-making.
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| 18. |
- Mirzaeva, L., et al.
(author)
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Complications and mortality after acute traumatic spinal cord injury in Saint Petersburg, Russia
- 2020
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In: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 58, s. 970-979
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Journal article (peer-reviewed)abstract
- Study design: Retrospective cohort study. Objectives: We studied complications during early rehabilitation and their relation to length of stay (LOS) in the hospital as well as to survival in people with traumatic spinal cord injury (TSCI). Setting: All specialized hospitals of Saint Petersburg. Methods: We analysed all charts of patients admitted with acute TSCI to the city hospitals, 2012–2016. Patient characteristics, complications, time and cause of death, and LOS were recorded. Mean values with standard deviations and t-tests were used. We analysed mortality rate using the Kaplan–Meier method and calculated relative risks (RRs). Results: A total of 311 patients with TSCI were included. Complications occurred in 34% of patients; most were respiratory complications and pressure ulcers. Complications occurred more often in those with concomitant traumatic brain injury (TBI) (RR = 1.4, 95% CI: 1.2–1.8). All complications prolonged LOS (median, 11 days) and increased mortality in the acute phase (p < 0.001). In the early phase, 15% died, with a median time to death of 13 days. Respiratory complications markedly increased the death rate (RR = 18, 95% CI: 15–22). Mortality rate correlated also with age, TSCI severity and level, and concomitant TBI. Alcohol/drug consumption before TSCI increased the likelihood for complications (RR = 1.7, 95% CI: 1.3–2.1) and mortality (RR = 2.2, 95% CI: 1.6–3.1). Conclusion: Focus on prevention as well as early and optimal treatment of complications, together with no or low alcohol/drug consumption may reduce mortality in the early phase after TSCI and at the same time shorten LOS. © 2020, The Author(s), under exclusive licence to International Spinal Cord Society.
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| 19. |
- Mirzaeva, L., et al.
(author)
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Incidence of adult traumatic spinal cord injury in Saint Petersburg, Russia
- 2019
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In: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 57:8, s. 692-699
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Journal article (peer-reviewed)abstract
- Study design Retrospective population-based cohort study. Objectives To characterise the epidemiology of traumatic spinal cord injury (TSCI) among the inhabitants of Saint Petersburg, Russia. Methods Charts for all individuals admitted to city hospitals from 1st January 1 2012 to 31st December 2016 with acute TSCI were reviewed. Incidence rates were calculated for the whole period and for each year separately. Gender-specific and age-specific incidence rates were calculated, and epidemiological characteristics and possible risk factors were analysed. Results A total of 361 people were identified. The average annual incidence rate was 17.6 per million, varying from 21.2 (2013) to 13.6 (2016), and 70.9% were men. Mean age at injury was 42.1 years. Injuries from falls represented 49.8% of cases, and motor vehicle accidents 18.9%. The male:female ratio in the low-falls group was 1.2:1, and among the elderly patients, it was 0.5:1. Lesions at the cervical level were involved in 49.3%, thoracic in 24.7%, and lumbar/sacral in 23.5%. TSCI was complete in 16.9%. Concomitant injuries occurred in 47.2% of cases, and traumatic brain injuries in 37.7%. Conclusion TSCI incidence decreased during the observation period and was 2.4 times more common among men than women. In half of the cases, injuries involved the cervical level, and a fall was the most frequent injury cause. Elderly women more often had falls from a low height than men. Multiple injuries-most frequently traumatic brain injuries-were common.
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| 20. |
- Mirzaeva, L., et al.
(author)
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Influence of age on acute traumatic spinal cord injury in Saint Petersburg, Russia
- 2022
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In: Spinal cord series and cases. - : Springer Science and Business Media LLC. - 2058-6124. ; 8:1
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Journal article (peer-reviewed)abstract
- STUDY DESIGN: Retrospective cohort study. OBJECTIVES: To evaluate influence of age after traumatic spinal cord injury (TSCI). SETTING: 13 specialized hospitals with neurosurgical departments of Saint Petersburg, Russia. METHODS: Charts of all patients admitted with TSCI to the city hospitals 2012-2016. Demographic and clinical characteristics, surgical interventions, complications, mortality rate, and hospital stays were recorded. RESULTS: 311 patients with TSCI were included. TSCI was more common in younger age. Mean age (SD) was 42.4 (16.8) years. Patients were divided into four age groups: 18-29, 30-44, 45-59 and ≥60 years. The group ≥60 years had the lowest percentage of concomitant traumatic brain injury (TBI), 25%, versus 43% in TSCI<60 years, p<0.05. Low falls were the most frequent cause in patients aged 60 years and older, and led to less severe neurological deficits (p<0.05). Complications were most frequent in motor complete TSCI (AIS A and AIS B) and in persons with combined TSCI and TBI at older age. Total complication rate was 67% at the age of ≥60 years versus 38% <60 years in TSCI with TBI (p<0.05). Respiratory complications occurred in 67% ≥45 years versus 45% <45 years, p<0.05. In-hospital mortality rate after TSCI was higher in the oldest age group. CONCLUSIONS: Respiratory complications are common and the in-hospital mortality is higher among elderly people. Older patients with TSCI and TBI are at high risk for complications. © 2022. The Author(s), under exclusive licence to International Spinal Cord Society.
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| 21. |
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| 22. |
- Taule, T., et al.
(author)
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Edinburgh Cognitive and Behavioral Amyotrophic Lateral Sclerosis Screen (ECAS) in Norway: Protocol for validation and a prospective cohort study
- 2019
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In: Contemporary Clinical Trials Communications. - : Elsevier BV. - 2451-8654. ; 14
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Journal article (peer-reviewed)abstract
- In amyotrophic lateral sclerosis (ALS) cognitive impairment may occur. This could detrimentally influence communication between patient and health-care professionals and make clinical assessment difficult. Given the short life expectancy after diagnosis, it is crucial to accurately identify ALS patients early. Although suitable cognitive screening tools for patients with ALS are available, they have not been evaluated in a Norwegian population. Interpretation of scores for available tests and practical application of scoring is also not well established. The protocol described here involves two related studies that aim to improve the quality of ALS clinical testing instruments used in the Norwegian population. The first is a validation study that evaluates the psychometric properties of the ECAS-Norwegian. The second is a prospective cohort study that evaluates the ECAS-Norwegian as a tool to predict early changes in ability to work, drive a car and the need for advanced therapy. Study 1 is a multicenter study using international quality criteria. Patients with ALS, healthy control subjects, and control subjects with dementia will be included. Primary outcome is ECAS-Norwegian scores. In study 2, patients with ALS will be included. ECAS-Norwegian compared to Clinical Dementia Rating score and Montreal Cognitive Assessment scores will be used as a prognostic tool for working, driving, and initiating advanced life-prolonging therapy. Before clinical implementation, the ECAS-Norwegian needs to be evaluated and validated. Successful validation and implementation of the ECAS-Norwegian may provide early identification of cognitive impairment in ALS, leading to more proactive, individualized treatment.
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| 23. |
- Taule, T., et al.
(author)
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Norwegian version of the Edinburgh cognitive and behavioural ALS screen: Construct validity, internal consistency, inter-rater, and test-retest reliability
- 2023
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In: Plos One. - 1932-6203. ; 18:5
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Journal article (peer-reviewed)abstract
- BackgroundResearch collaboration highlight a need for validated tests in other languages than English. Translation and culture adjustments may threaten essential features of the original instrument. ObjectiveTo assess the internal consistency, inter-rater and test-retest reliability, and construct validity of the Norwegian version of the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis (ALS) Screen (ECAS-N). MethodsPerformance of 71 subjects with ALS, 85 healthy controls (HC) and 6 controls with Alzheimer's disease (AD) were assessed with the ECAS-N. Test-retest interval was four months. Internal consistency was evaluated using Cronbach's alpha; reliability was assessed using intraclass correlation coefficient (ICC), Cohen's kappa, and Bland Altman plot. Five hypothesis, including the Montreal Cognitive Assessment (MoCA) screen, was evaluated for construct validity. ResultsECAS-N total score produced a Cronbach's alpha of 0.65, had excellent inter-rater reliability (ICC = 0.99) and acceptable test-retest reliability (ICC = 0.73). Construct validity analysis suggested valid use of the ECAS-N to distinguish people with ALS-specific cognitive impairment from HC (p = 0.001) and those with AD (p = 0.002). The MoCA and ECAS-N were moderately correlated (r = 0.53). ConclusionThe ECAS-N has potential to be used by different testers in clinical practice and research to screen patients with ALS who speak Norwegian and for documenting cognitive impairment over time.
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| 24. |
- Taule, T., et al.
(author)
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Psychometric Properties of Cognitive Assessment in Amyotrophic Lateral Sclerosis: A Systematic Review
- 2020
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In: Patient-Related Outcome Measures. - 1179-271X. ; 11, s. 181-194
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Journal article (peer-reviewed)abstract
- Purpose: We aimed to list all tests used to assess cognitive change in patients with amyotrophic lateral sclerosis (ALS) and to provide a descriptive synthesis of the psychometric properties of tests that were evaluated in a population of ALS patients. Materials and Methods: The protocol is registered in PROSPERO (ID: CRD42017055603). We systematically search for literature in 11 databases. Full-text articles, in any language, with original research were included. All included articles were scrutinised by two independent authors. Disagreement was resolved by consensus. The framework of Lezak informed conceptualises of the tests identified. To evaluate methodological quality, we used the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN). Data were synthesised using criteria proposed by the Cochrane Back Review Group. Results: Of 319 included articles, 46 articles reported information on the psychometric properties of cognitive tests used in patients with ALS. We found that the highest level of evidence was supported for the Reading the Mind in the Eye Test (RME), Addenbrooke's Cognitive Evaluation (ACE) and Frontal Assessment Battery (FAB). Moderate level of evidence was found for the screening tests; Edinburgh Cognitive and Behavioural ALS Screen (ECAS) and the Montreal Cognitive Assessment (MoCA). Conclusion: The screening test, ECAS and the social cognition test, RME, may have some advantages over other tests that have been used for assessing cognitive change in ALS patients. Recommendations of ALS-specific tests with sound psychometric properties are urgently needed.
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| 25. |
- Taule, T., et al.
(author)
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Translation, cultural adaptation, and validation of a screening test for cognitive and behavioural changes in amyotrophic lateral sclerosis
- 2022
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In: Disability and Rehabilitation. - : Informa UK Limited. - 0963-8288 .- 1464-5165. ; 44:23, s. 7069-7077
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Journal article (peer-reviewed)abstract
- Purpose To describe challenges of translating and culturally adapting the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis (ALS) Screen into Norwegian (ECAS-N), evaluate its content validity; provide age- and education-balanced norms for verbal fluency and cut-off values for abnormal performance. Materials and methods Translation to Norwegian and back-translation to English complied with standard methods. Patients and ALS experts evaluated the relevance, comprehensiveness and comprehensibility of the translated ECAS (ECAS-N). Content validity indexes at the item level (I-CVI), scale level (S-CVI) and inter-rater agreement were calculated. Performance of controls determined norms for written and spoken verbal fluency (n = 559) and cut-off scores for abnormal performance (n = 85). Results High levels of content validity was achieved for all items of the ECAS-N, I-CVI, S-CVI and inter-rater agreement was 87.5%. Age- and education-balanced norms for written and spoken verbal fluency were produced. Cut-off scores of abnormal performance were slightly lower than the original ECAS. Conclusions The ECAS-N holds promise for detecting cognitive and behavioural impairment in Norwegian patients with ALS. Cut-off scores are situational and could slightly vary between different cultures. The ECAS-N can be used in international research, but researchers should be aware of the differences between the tests applied in the studies.
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