| 1. |
- Aaby, Anders, et al.
(författare)
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Does the Danish version of the Spinal Cord Lesion-related Coping Strategies Questionnaire measure what we think it measures? : A triangulated mixed-methods validation approach
- 2022
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Ingår i: Spinal Cord. - : SPRINGERNATURE. - 1362-4393 .- 1476-5624.
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Tidskriftsartikel (refereegranskat)abstract
- Study design: Triangulated mixed-methods validation study.Objectives: To validate the Danish version of the Spinal Cord Lesion-related Coping Strategies Questionnaire (SCL-CSQ).Setting: Community in Denmark.Methods: Participants were invited via a patient organization and its specialized hospital. Eligibility criteria were having a spinal cord injury (SCI), being 18 years or older, and able to understand and respond in Danish. Quantitative data were collected to determine internal consistency and criterion validity of the three subscales of SCL-CSQ, i.e., acceptance, fighting spirit, and social reliance. The Three-Step Test-Interview approach was employed to determine whether items measured what they were intended to measure (i.e., construct validity based on response processes).Results: The quantitative sample consisted of 107 participants, and the interview sample comprised 11 participants. The acceptance and fighting spirit subscales showed adequate internal consistency (Cronbach's alpha of 0.72 and 0.76 respectively) and satisfactory criterion validity (expected correlations with quality of life and depression). The social reliance subscale showed inadequate internal consistency (Cronbach's alpha of 0.58) and criterion validity. All fighting spirit items and all but one acceptance items were interpreted congruently by most participants. Conversely, two social reliance items were only interpreted congruently by 9 and 27%.Conclusion: The acceptance and fighting spirit subscales of the Danish version of the SCL-CSQ showed good psychometric properties, while the social reliance subscale showed serious issues and should be revised. Researchers and clinicians are urged to reflect on these findings when revising the SCL-CSQ or adapting it to other languages, cultural contexts, and rehabilitation settings.
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| 2. |
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| 3. |
- Aito, S, et al.
(författare)
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Spinal cord injuries due to diving accidents
- 2005
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Ingår i: Spinal cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 43:2, s. 109-116
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Tidskriftsartikel (refereegranskat)
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| 4. |
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| 5. |
- Alexander, MS, et al.
(författare)
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International spinal cord injury female sexual and reproductive function basic data set
- 2011
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 49:7, s. 787-90
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To create the International Spinal Cord Injury (SCI) Female Sexual and Reproductive Function Basic Data Set within the International SCI Data Sets. Setting: An international working group. Methods: The draft of the data set was developed by an international working group consisting of members appointed by the International Spinal Cord Society (ISCoS), the American Spinal Injury Association (ASIA), and a representative from the Executive Committee of the International SCI Standards and Data Sets. The data set was developed in an iterative process with review and comments by members of the Executive Committee of the International SCI Standards and Data Sets, ISCoS Scientific Committee, ASIA Board and the ISCoS Council, as well as all interested organizations and individuals. In addition, the data set was posted for 2 months at the ISCoS and ASIA websites for comments. ISCoS and ASIA approved the final version of the data set. To make the data set uniform, each variable and each response category within each variable have been specifically designed to promote the collection and reporting of comparable minimal data. Results: Variables included in the International SCI Female Sexual and Reproductive Function Basic Data Set are as follows: date of data collection, interest in discussing sexual issues, sexual issues unrelated to spinal cord lesion, sexual dysfunction related to spinal cord lesion, psychogenic genital arousal, reflex genital arousal, orgasmic function and menstruation. Complete instruction for data collection, data sheet and training cases are available at the websites of ISCoS (http://www.iscos.org.uk) and ASIA (http://www.asia-spinalinjury.org).
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| 6. |
- Alexander, MS, et al.
(författare)
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International Spinal Cord Injury Male Sexual Function Basic Data Set
- 2011
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Ingår i: Spinal Cord. - 1362-4393. ; 49:7, s. 795-8
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To create the International Spinal Cord Injury (SCI) Male Sexual Function Basic Data Set within the International SCI Data Sets. Setting: An international working group. Methods: The draft of the data set was developed by an international working group consisting of members appointed by the International Spinal Cord Society (ISCoS), the American Spinal Injury Association (ASIA) and a representative from the executive committee of the International SCI Standards and Data Sets. The data set was developed in an iterative process with review and comments by the members of the executive committee of the International SCI Standards and Data Sets, ISCoS scientific committee, ASIA Board and the ISCoS Council, as well as all the interested organizations and individuals. Next, the data set was posted for 2 months at the ISCoS and ASIA's websites for comments. ISCoS and ASIA approved the final version of the data set. To make the data set uniform, each variable and each response category within each variable have been specifically defined in a way that is designed to promote the collection and reporting of comparable minimal data. Results: Variables included in the International SCI Male Sexual Function Basic Data Set are as follows: date of data collection, interest in discussing sexual issues, sexual issues unrelated to spinal cord lesion, sexual dysfunction related to spinal cord lesion, psychogenic erection, reflex erection, ejaculation and orgasmic function. Complete instructions for data collection, data sheet and training cases are available at the website of ISCoS (http://www.iscos.org.uk) and ASIA (http://www.asia-spinalinjury.org).
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| 7. |
- Alexander, M S, et al.
(författare)
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International standards to document remaining autonomic function after spinal cord injury.
- 2008
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 47:1, s. 36-43
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Experts opinions consensus. OBJECTIVE: To develop a common strategy to document remaining autonomic neurologic function following spinal cord injury (SCI). BACKGROUND AND RATIONALE: The impact of a specific SCI on a person's neurologic function is generally described through use of the International Standards for the Neurological Classification of SCI. These standards document the remaining motor and sensory function that a person may have; however, they do not provide information about the status of a person's autonomic function. METHODS: Based on this deficiency, the American Spinal Injury Association (ASIA) and the International Spinal Cord Society (ISCoS) commissioned a group of international experts to develop a common strategy to document the remaining autonomic neurologic function. RESULTS: Four subgroups were commissioned: bladder, bowel, sexual function and general autonomic function. On-line communication was followed by numerous face to face meetings. The information was then presented in a summary format at a course on Measurement in Spinal Cord Injury, held on June 24, 2006. Subsequent to this it was revised online by the committee members, posted on the websites of both ASIA and ISCoS for comment and re-revised through webcasts. Topics include an overview of autonomic anatomy, classification of cardiovascular, respiratory, sudomotor and thermoregulatory function, bladder, bowel and sexual function. CONCLUSION:This document describes a new system to document the impact of SCI on autonomic function. Based upon current knowledge of the neuroanatomy of autonomic function this paper provides a framework with which to communicate the effects of specific spinal cord injuries on cardiovascular, broncho-pulmonary, sudomotor, bladder, bowel and sexual function.
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| 8. |
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| 9. |
- Alm, M., et al.
(författare)
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Clinical evaluation of seating in persons with complete thoracic spinal cord injury
- 2003
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 41:10, s. 563-571
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Tidskriftsartikel (refereegranskat)abstract
- Study Design: Consecutive male patients studied with photographic measurement of a combination of clinical methods. Objectives: To describe seating in individuals with complete thoracic spinal cord injury (SCI) by using a combination of clinical methods. Setting: Spinalis SCI unit, Stockholm, Sweden. Methods: Wheelchair specifications were documented. Measurements of posture from photographs in 30 male subjects with complete thoracic SCI, sitting in a relaxed and an upright position on a standardized surface and in a wheelchair were calculated. A comparison was made between positions and seating surfaces. An examiner's classification of lower trunk position in wheelchair was compared to subjects' evaluations. SCI subjects reported sitting support, satisfaction, and wishes for improvement. Results: Most SCI subjects used similar wheelchair specifications. None of the backrests were custom designed. Relatively small differences were found between the relaxed and upright position in the wheelchair regarding measurements of posture and according to the examiner's classification of the lower trunk position. Only 13/30 SCI subjects were sitting with the lower trunk centered relative to the backrest in the upright position. The examiner's classification and the subjects' evaluation of asymmetric sitting were not always in agreement. Only 12/30 SCI subjects were satisfied with their way of sitting. Conclusion: Current wheelchair specifications and adjustments seem to inhibit a postural correction towards upright sitting and fail to provide sufficient lateral support. Findings indicate an inability for SCI subjects to vary their sitting position in a wheelchair to a large extent. Both an examiner's classification and subjects' evaluation of asymmetric sitting are necessary to obtain a sufficient knowledge base for subsequent adjustment. By using methods regarding different aspects of seating, a more comprehensive view of seating was achieved. The combination of clinical methods seems to be useful in order to describe seating in individuals with complete thoracic SCI.
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| 10. |
- Anderson, K. D., et al.
(författare)
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Acceptable benefits and risks associated with surgically improving arm function in individuals living with cervical spinal cord injury
- 2009
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Ingår i: Spinal Cord. - 1362-4393. ; 47:4, s. 334-8
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Secure, web-based survey. OBJECTIVES: To determine how quadriplegics in the US view tendon transfer surgeries (TTS) and what activities of daily living (ADL) involving arm/hand function are important in improving quality of life (QoL). SETTING: World wide web. METHODS: Individuals >or=18 years of age living with a cervical spinal cord injury (SCI). Participants obtained a pass code to enter a secure website and answered survey questions. A total of 137 participants completed the survey. RESULTS: Two-thirds of participants had injury levels between C4/5 and C5/6. Over 90% felt that improving their arm/hand function would improve their QoL. ADL that were ranked most important to regain were dressing, feeding, transferring in/out of bed, and handwriting. Less than half of the participants had never been told about TTS and only 9% had ever had TTS. Nearly 80% reported that they would be willing to spend 2-3 months being less independent, while recovering from surgery, to ultimately become more independent. Over 75% reported that the ideal time preferred to have TTS, if chosen, would be within 5 years post-injury. CONCLUSION: Regaining arm and hand function is of primary importance to individuals with cervical SCI, in particular, to increase independence in multiple ADL. There is a critical need in the US to improve awareness of TTS as a viable option for improving arm/hand function in some people. This information needs to be provided early after injury so that informed choices can be made within the first 5 years.
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| 11. |
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| 12. |
- Augutis, M, et al.
(författare)
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Pediatric spinal cord injury in a subset of European countries.
- 2006
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 44:2, s. 106-12
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Postal survey.SETTING: A total of 19 countries in Europe.OBJECTIVES: Firstly, to collect information about incidence and systems of care for pediatric spinal cord injury (pedSCI); including prevention, initial care and follow-up in a subset of European countries. Secondly, to initiate a network of involved professionals for exchange of information and development of research and care programs.METHODS: A short semi-structured questionnaire was sent to respondents working with spinal cord injury (SCI) in 19 countries in Europe.RESULTS: Only in Portugal and Sweden, is the incidence of pedSCI (fatal injuries included) established, that is 27 children/million children/year and 4.6 children/million children/year, respectively. For the other countries, the estimated incidence of pedSCI (nonfatal injuries) varied from 0.9 to 21.2 children/million children/year in the age group of 0-14 years. Although the incidence varies considerably, pedSCI is rare throughout Europe. The management differs between the countries depending on the age of the child and the local organization of health care.CONCLUSIONS: The survey confirms that pedSCI is rare. In order to establish high-quality standardized care, further integration of knowledge in this area is needed throughout Europe. The contacts initiated by this survey may be used to create an international network serving as a reference for health professionals, researchers and families, thereby possibly alleviating some of the unwanted variations of care identified in this study.
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| 13. |
- Augutis, M, et al.
(författare)
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Pediatric spinal cord injury in Sweden : incidence, etiology and outcome.
- 2003
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 41:6, s. 328-36
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Retrospective descriptive study.OBJECTIVES: To assess incidence, causes and early outcome of traumatic spinal cord injury (SCI) among children in Sweden, thereby identifying high-risk groups and situations as a basis for preventative measures and improved care.METHODS: Data from population registers, County Habilitation Centers as well as from informal sources were used to estimate the incidence of SCI in Sweden during the years 1985-1996 among children aged 0-15 years. Contacts with the treating hospitals, reviews of medical records and/or personal interviews were used to verify primary data. In total, 92 children were thus identified.RESULTS: The incidence was found to be 4.6/million children/year (95% CI 3.6-5.5). When excluding prehospital fatalities, the incidence was 2.4 (95% CI 1.8-3.1). The main cause of injury among fatalities was traffic accidents. Associated injuries occurred in 41% of the children. Among survivors (10-15 years), sports-related injuries (43%) were as common a cause as traffic accidents (39%). The survivors were treated in 18 different hospitals.CONCLUSION: Pediatric SCI in Sweden is rare, presumably because of effective primary prevention. Preventative measures should be further differentiated for each age group of children in accordance with their differing risk profiles. In contrast to the effective preventative measures that have been implemented in Sweden, care of these patients is still too fractionated and decentralized for sufficient specialization to emerge.
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| 14. |
- Augutis, M, et al.
(författare)
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Pediatric spinal cord injury in Sweden; how to identify a cohort of rare events.
- 2003
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 41:6, s. 337-46
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Register study enhanced and verified by medical records and personal interviews and examinations.SETTINGS: Sweden.OBJECTIVES: To define a method of identifying a study population of rare events. To point out the relative importance of every step, an example is given of identifying persons who sustained traumatic spinal cord injury (SCI) in childhood.METHODS: Cases were identified in seven steps that all needed to be fulfilled, from definition of selection criteria through combination of several data sources, to the use of several verification methods.RESULTS: Initial screening by registers identified 384 possible cases, which however were found by subsequent analysis to include a large number of incorrect cases. At completion of all analytic steps, 35 living cases could be fully verified and 14 deceased cases could be partially verified.CONCLUSIONS: Registers offer a practical initial source for study population identification. The screening of International Classification of Diseases codes defining SCI only included less than 30% of 'true' SCIs. Subsequently, further refinement and quality control is necessary in order to ensure validity. Such further verification is time-consuming, but nevertheless necessary in order to verify a true cohort.
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| 15. |
- Bach Baunsgaard, Carsten, et al.
(författare)
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Gait training after spinal cord injury: safety, feasibility and gait function following 8 weeks of training with the exoskeletons from Ekso Bionics.
- 2018
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Ingår i: Spinal cord. - : Springer Science and Business Media LLC. - 1476-5624 .- 1362-4393. ; 56, s. 106-116
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Tidskriftsartikel (refereegranskat)abstract
- Prospective quasi-experimental study, pre- and post-design.Assess safety, feasibility, training characteristics and changes in gait function for persons with spinal cord injury (SCI) using the robotic exoskeletons from Ekso Bionics.Nine European rehabilitation centres.Robotic exoskeleton gait training, three times weekly over 8 weeks. Time upright, time walking and steps in the device (training characteristics) were recorded longitudinally. Gait and neurological function were measured by 10 Metre Walk Test (10 MWT), Timed Up and Go (TUG), Berg Balance Scale (BBS), Walking Index for Spinal Cord Injury (WISCI) II and Lower Extremity Motor Score (LEMS).Fifty-two participants completed the training protocol. Median age: 35.8 years (IQR 27.5-52.5), men/women: N=36/16, neurological level of injury: C1-L2 and severity: AIS A-D (American Spinal Injury Association Impairment Scale). Time since injury (TSI)<1 year, N=25;>1 year, N=27. No serious adverse events occurred. Three participants dropped out following ankle swelling (overuse injury). Four participants sustained a Category II pressure ulcer at contact points with the device but completed the study and skin normalized. Training characteristics increased significantly for all subgroups. The number of participants with TSI<1 year and gait function increased from 20 to 56% (P=0.004) and 10MWT, TUG, BBS and LEMS results improved (P<0.05). The number of participants with TSI>1 year and gait function, increased from 41 to 44% and TUG and BBS results improved (P<0.05).Exoskeleton training was generally safe and feasible in a heterogeneous sample of persons with SCI. Results indicate potential benefits on gait function and balance.
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| 16. |
- Bendt, Martina, et al.
(författare)
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Adults with spina bifida : Ambulatory performance and cognitive capacity in relation to muscle function
- 2022
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 60:2, s. 122-128
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Cross-sectional study.OBJECTIVE: Describe and compare ambulatory performance and cognitive capacity in relation to muscle function in an adult cohort with spina bifida. Also, explore factors associated with ambulation in participants with muscle function level 3.SETTING: Specialist clinic for adults with spinal cord disorders in Stockholm, Sweden.METHODS: A total regional cohort of adults (n = 219) with spina bifida was invited, 196 (104 women, mean age 35 years, SD 13 years) participated. Mode of mobility, cognitive capacity and muscle function were investigated. For participants with muscle function level 3, factors associated with ambulation were investigated using multivariate logistic regression analysis.RESULTS: In all, 84 participants (42%) were community ambulators, 22 (12%) household ambulators and 90 (46%) wheelchair users. There was a linear association between the lower degree of muscle function and scoliosis (P < 0.001). Mode of mobility varied despite similar muscle prerequisites in participants with muscle function level 3 (n = 58). Factors associated with ambulation in participants with muscle function level 3 were the absence of scoliosis, lower BMI and higher cognitive capacity.CONCLUSIONS: Cognitive capacity and mode of mobility varied widely across the cohort. However, in participants with muscle function level 3, despite similar muscular prerequisites, a large variation in the mode of mobility was found, suggesting that other factors were involved. It is important to prevent scoliosis, support a healthy lifestyle, as well as offer cognitive screening and support to promote ambulatory function and optimise independence in the everyday lives of adults with spina bifida.
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| 17. |
- Bennegård, Gun-Marie, et al.
(författare)
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Higher glucose uptake in paralysed spastic leg.
- 2008
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 46:2, s. 103-6
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Insulin resistance and diabetes mellitus have been reported in the spinal cord injured (SCI). The group exhibits risk factors, as decreased physical activity, as well as episodes of stimulation of sympathetic nervous system below the level of lesion known to stimulate lipolysis, which in turn could induce insulin resistance. However, data are inconsistent, which might indicate the presence of protective mechanisms. OBJECTIVE: To investigate the glucose uptake in spastic paralysed SCI legs compared to able-bodied. To investigate regional differences between glucose handling in the arm and leg. STUDY DESIGN: Experimental controlled study. SETTINGS: Institution of Clinical Neuroscience and Physiology, Spinal Injures Unit, Sahlgrens University Hospital, Goteborg, Sweden. METHODS: Nine SCI subjects (2 C7, 7 T1-T4 ASIA A: 8, ASIA B: 1) were compared to 10 weight- and age-matched controls. Plasma flow in arm and leg was analysed by venous occlusion strain gauge plethysmography, and plasma derived from artery and veins in the arm and leg was analysed for glucose, insulin and lactate during fasting resting conditions. RESULTS: Glucose uptake was higher in SCI legs compared to controls. There was no difference in insulin uptake or lactate production. Plasma flow was higher in SCI legs compared to controls. Controls showed a higher glucose uptake and lactate production in arm than leg. CONCLUSIONS: Spasticity may counteract the risk of diabetes by inducing an insulin-independent glucose uptake. The regional difference in metabolism in able-bodied make it hazardous to do generalizations to whole body metabolism from arm or leg measurements.
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| 18. |
- Bersch, Ines, et al.
(författare)
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Electrical stimulation-a mapping system for hand dysfunction in tetraplegia
- 2018
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 56:5, s. 516-522
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Tidskriftsartikel (refereegranskat)abstract
- Study design Retrospective data analysis Objectives To define the distribution of the motor points and excitability of the key wrist and finger actuators in order to detect upper (UMN) and lower motor neuron (LMN) lesions potentially influencing the development of a tenodesis grasp. Setting A rehabilitation centre for spinal cord injuries, Nottwil, Switzerland. Methods Forearm muscles of 32 patients with tetraplegia (AIS A-D) were tested bilaterally with electrical stimulation (ES) to differentiate whether UMN or LMN was present. For testing, a standardised mapping was developed. All patients underwent the same positioning schedule. Results Sixteen hands developed a tenodesis grasps, 24 hands showed neither shortening nor tightening of the finger flexors. Two patients developed unilateral tenodesis grasp and showed no tightening of the finger flexors on the contralateral hand. Seven patients developed tenodesis grasps symmetrically and bilaterally, whereas one maintained an essentially open hand without tightening of the finger flexors. All hands that developed a tenodesis grasp showed a LMN lesion of the M. extensor digitorum communis (EDC). The frequency of the tenodesis grasp differed significantly between the groups with and without intact reflex arc (p < 0.0001). Conclusion Surface ES may serve as a diagnostic tool to detect an UMN or LMN lesion of the key actuator muscles affecting the tenodesis grasp. These findings provide information that is essential for the choice of treatment to optimise function of the tetraplegic hand.
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| 19. |
- Biering-Sørensen, F, et al.
(författare)
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International Spinal Cord Injury Upper Extremity Basic Data Set.
- 2014
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Ingår i: Spinal cord. - : Springer Science and Business Media LLC. - 1476-5624 .- 1362-4393. ; 52:9, s. 652-657
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Tidskriftsartikel (refereegranskat)abstract
- Objective:To develop an International Spinal Cord Injury (SCI) Upper Extremity Basic Data Set as part of the International SCI Data Sets, which facilitates consistent collection and reporting of basic upper extremity findings in the SCI population.Setting:International.Methods:A first draft of a SCI Upper Extremity Data Set was developed by an international working group. This was reviewed by many different organisations, societies and individuals over several months. A final version was created.Variables:The final version of the International SCI Upper Extremity Data Set contains variables related to basic hand-upper extremity function, use of assistive devices, SCI-related complications to upper extremity function and upper extremity/hand reconstructive surgery. Instructions for data collection and the data collection form are freely available on the ISCoS website (www.iscos.org.uk).Conclusion:The International SCI Upper Extremity Basic Data Set will facilitate consistent collection and reporting of basic upper extremity findings in the SCI population.
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| 20. |
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| 21. |
- Bjerkefors, Anna, et al.
(författare)
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Diagnostic accuracy of common clinical tests for assessing abdominal muscle function after motor-complete spinal cord injury above T6.
- 2015
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 53, s. 114-119
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Tidskriftsartikel (refereegranskat)abstract
- Study design:Diagnostic study.Objectives:The objective of this study was to compare patterns of electromyography (EMG) recordings of abdominal muscle function in persons with motor-complete spinal cord injury (SCI) above T6 and in able-bodied controls, and to determine whether manual examination or ultrasound measures of muscle activation can be accurate alternatives to EMG.Setting:Research center focused on SCI and University laboratory, Vancouver, Canada.Methods:Thirteen people with SCI (11 with American Spinal Injury Association Impairment Scale (AIS) A and 2 AIS B; C4-T5), and 13 matched able-bodied participants volunteered for the study. Participants completed trunk tasks during manual examination of the abdominal muscles and then performed maximal voluntary isometric contractions, while EMG activity and muscle thickness changes were recorded. The frequency of muscle responses detected by manual examination and ultrasound were compared with detection by EMG (sensitivity and specificity).Results:All individuals with SCI were able to elicit EMG activity above resting levels in at least one abdominal muscle during one task. In general, the activation pattern was task specific, confirming voluntary control of the muscles. Ultrasound, when compared with EMG, showed low sensitivity but was highly specific in its ability to detect preserved abdominal muscle function in persons with SCI. Conversely, manual examination was more sensitive than ultrasound but showed lower specificity.Conclusion:The results from this study confirm preserved voluntary abdominal muscle function in individuals classified with motor-complete SCI above T6 and highlight the need for further research in developing more accurate clinical measures to diagnose the level of trunk muscle preservation in individuals with SCI.Spinal Cord advance online publication, 25 November 2014; doi:10.1038/sc.2014.202.
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| 22. |
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| 23. |
- Bodin, Per, et al.
(författare)
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Effects of abdominal binding on breathing patterns during breathing exercises in persons with tetraplegia
- 2005
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 43, s. 117-122
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Tidskriftsartikel (refereegranskat)abstract
- Study design: Cross-sectional, experimental. Objectives: To investigate and compare static lung volumes and breathing patterns in persons with a cervical spinal cord lesion during breathing at rest, ordinary deep breathing, positive expiratory pressure (PEP) and inspiratory resistance-positive expiratory pressure (IR-PEP) with and without an abdominal binder (AB). Setting: The outpatient clinic at the Spinal Unit at Sahlgrenska University Hospital, Göteborg, Sweden. Method: The study group consisted of 20 persons with complete cervical cord lesion at C5–C8 level. Breathing patterns and static lung volumes with and without an AB were measured using a body plethysmograph. Results: With an AB, static lung volumes decreased, vital capacity increased, breathing patterns changed only marginally and functional residual capacity remained unchanged during PEP and IR-PEP. Conclusion: Evidence supporting the general use of an AB to prevent respiratory complications by means of respiratory training is questionable. However, the interindividual variation in our results indicates that we cannot rule out that some patients may benefit from the treatment. Sponsorship: This work was supported by grants from the Memorial Foundation of the Swedish Association of registered Physiotherapists and the Association of Cancer and Road Accident Victims, Sweden.
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| 24. |
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| 25. |
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| 26. |
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| 27. |
- Bunketorp Käll, Lina, 1975, et al.
(författare)
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Essential gains and health after upper-limb tetraplegia surgery identified by the International classification of functioning, disability and health (ICF)
- 2017
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 55:9, s. 857-863
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Tidskriftsartikel (refereegranskat)abstract
- Study Design: A questionnaire-based survey. Objectives: To describe functional gains and health following upper-limb tetraplegia surgery using the International Classification of Functioning, Disability and Health (ICF) as a reference and to explore interconnections across different dimensions of functioning and health. Setting: A specialized center for advanced reconstruction of extremities at Sahlgrenska University Hospital, Gothenburg, Sweden. Methods: Fifty-seven individuals who participated in a satisfaction survey were included in the present study. Besides questions concerned with the respondents' satisfaction with different aspects of surgery, the measures included perceived overall health status (EQ-VAS) and achieved grip strength. Univariate analyses were used to explore interconnections between measures. Results: The gains could be subcategorized and linked to the ICF domains 'mobility', 'self-care', 'communication', 'domestic life', and 'community, social and civic life', with 'handling objects' and 'maneuvering a wheelchair' as the most frequently reported gains. The mean EQ-VAS score was 67 +/- 22. No significant correlation was shown between grip strength and activity gains, nor between grip strength and perceived overall health. The degree of satisfaction was, however, associated with self-reported overall health among participants. Conclusion: The functional gains achieved after tetraplegia surgery could be applied to the ICF constructs' body functions/structures and activity with possible implications on participation. The overall health perception was relatively high and could be linked to the degree of satisfaction among participants. Muscle strength is not necessarily transferable to activity performance. This emphasizes the importance of addressing factors other than strength in the post-surgical rehabilitation and assessments.
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| 28. |
- Bunketorp Käll, Lina, 1975, et al.
(författare)
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Satisfaction with upper limb reconstructive surgery in individuals with tetraplegia: the development and reliability of a Swedish self-reported satisfaction questionnaire.
- 2017
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Ingår i: Spinal cord. - : Springer Science and Business Media LLC. - 1476-5624 .- 1362-4393. ; 55, s. 664-671
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Tidskriftsartikel (refereegranskat)abstract
- A questionnaire-based survey.To assess satisfaction after upper limb reconstructive surgery in individuals with tetraplegia and to determine the reliability of a Swedish satisfaction questionnaire.A center for advanced reconstruction of extremities, Gothenburg, Sweden.Seventy-eight individuals with tetraplegia were invited to participate in the survey assessing satisfaction with the result of surgery across various domains. Measures of reliability included stability and internal consistency of domains consisting questions regarding global satisfaction, activities and occupation/schooling.Fifty-eight individuals (76%) participated, among whom 47 (82%) completed the questionnaire twice for repeatability assessment. The responses in the domains relating to global satisfaction, activities and occupation/schooling were positive in 83%, 72% and 31% of participants, respectively. Ninety-five percent felt they had benefited from the surgery, and 86% felt that the surgery had made a positive impact on their life. The psychometric testing indicated that the questionnaire yields scores that are reliable by both test-retest and internal consistency, with the exception of the domain occupation/schooling that had a high prevalence of missing and neutral responses and seemingly represents separate and distinct entities.Surgical rehabilitation of the upper limb in tetraplegia is highly beneficial and rewarding from a patient perspective, leading to satisfactory gains in activities of daily living as well as enhanced quality of life. The questionnaire is a reliable instrument for measuring satisfaction after surgery. However, occupationally and educationally related aspects of the surgical outcome should constitute separate domains, and further modifications of the questionnaire are thus recommended.Spinal Cord advance online publication, 21 February 2017; doi:10.1038/sc.2017.12.
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| 29. |
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| 30. |
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| 31. |
- Dahlgren, A, et al.
(författare)
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Activity performance and upper extremity function in cervical spinal cord injury patients according to the Klein-Bell ADL Scale.
- 2007
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Ingår i: Spinal cord : the official journal of the International Medical Society of Paraplegia. - : Springer Science and Business Media LLC. - 1362-4393. ; 45:7, s. 475-84
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Cross-sectional study. OBJECTIVES: (1) To examine whether the Klein-Bell ADL Scale (K-B Scale) discriminates cervical spinal cord injury (SCI) patients in daily activities and to explore its applicability in this group of patients. (2) To examine the association between basic ADL and upper extremity function. (3) To investigate if grip ability can be discerned in the scale. SETTING: Spinal Cord Injury Unit, Sahlgrenska University Hospital, Göteborg, Sweden. METHODS: Fifty-five patients with cervical SCI with no prior reconstructive hand surgery were included in the study. Analyses of the patient's independence were made according to the K-B Scale. Three additional analyses were carried out, the first examined whether the use of assistive devices and house and car adaptations influenced independence. The last two used different approaches to investigate whether arm and grip function could be detected in the K-B scale. RESULTS: Raw score in the K-B Scale can discriminate for independence in daily activities but the scale's weight scheme does not function for cervical SCI patients. Assistive devices and car and house adaptations can compensate for dependence in daily activities. Lack of grip function decreases the patient's ability to become independent. Diagnosis-related activities cannot be assessed in all items. CONCLUSION: The K-B Scale's raw score was useful assessing daily activities in cervical SCI patients. Its reliability in conjunction with arm and grip function in patients with cervical SCI has yet to be proven.
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| 32. |
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| 33. |
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| 34. |
- Divanoglou, Anestis, et al.
(författare)
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Active Rehabilitation for persons with spinal cord injury in Botswana – effects of a community peer-based programme
- 2019
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624.
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Tidskriftsartikel (refereegranskat)abstract
- Study design:: Prospective cohort study with a repeated measures analysis. Objectives:: To measure the effects of the Active Rehabilitation (AR) training programme for community-dwelling individuals with spinal cord injury (SCI) in Botswana on physical independence, wheelchair mobility, self-efficacy, life satisfaction, level of physical activity and community participation. Setting:: The inaugural AR training programme in Botswana, a community peer-based programme for people with SCI. The 10-day residential programme in Botswana was led by an international team of peer mentors and health professionals. Methods:: Participants with SCI (on average 4 years after injury) completed a survey comprising a battery of standardised outcome measures at three timepoints: at the start, on completion and at 5 months after the programme (n = 14). Participants also completed a practical wheelchair skills test at start and completion of the programme (n = 17). Results:: Participants improved in the mobility subscale of the Spinal Cord Independence Measure Self Report on completion (p = 0.011, d = 0.85) and at 5-month follow-up (p = 0.005, d = 0.93) as compared to baseline. They also achieved moderate improvement in self-efficacy to manage their condition (physical function domain of Moorong Self-Efficacy Scale) and large improvements in wheelchair mobility as assessed through the Queensland Evaluation of Wheelchair Skills test and the Wheelchair Skills Test Questionnaire. All positive results were retained at 5-month follow-up. Conclusions:: Findings indicate that the peer-based programme AR can play an important role in promoting physical independence, wheelchair mobility and injury-management self-efficacy in community-dwelling individuals with SCI in Botswana.
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| 35. |
- Divanoglou, Anestis, et al.
(författare)
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Acute management of traumatic spinal cord injury in a Greek and a Swedish region : a prospective, population-based study.
- 2010
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 48:6, s. 477-482
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS). OBJECTIVES: To characterize patient populations and to compare acute management after traumatic spinal cord injury (TSCI). SETTINGS: The Greater Thessaloniki region in Greece and the Greater Stockholm region in Sweden. METHODS: Inception cohorts with acute TSCI that were hospitalized during the study period, that is September 2006 to October 2007, were identified. Overall, 81 out of 87 cases consented to inclusion in Thessaloniki and 47 out of 49 in Stockholm. Data from Thessaloniki were collected through physical examinations, medical record reviews and communication with TSCI cases and medical teams. Data from Stockholm were retrieved from the Nordic Spinal Cord Injury Registry. RESULTS: There were no significant differences between study groups with regard to core clinical characteristics. In contrast, there were significant differences in (1) transfer logistics from the scene of trauma to a tertiary-level hospital (number of intermediate admissions, modes of transportation and duration of transfer) and (2) acute key therapeutic interventions, that is, the use of mechanical ventilation (49% in Thessaloniki versus 20% in Stockholm), and performance of tracheostomy (36% in Thessaloniki versus 15% in Stockholm); spinal surgery was performed significantly more often and earlier in Stockholm than in Thessaloniki. CONCLUSIONS: Despite largely similar core clinical characteristics, Stockholm and Thessaloniki cases underwent significantly different acute management, most probably to be attributed to adaptations to the differing regional approaches of care one following a systematic approach of SCI care and the other not.
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| 36. |
- Divanoglou, A, et al.
(författare)
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Incidence of traumatic spinal cord injury in Thessaloniki, Greece and Stockholm, Sweden : a prospective population-based study.
- 2009
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 47:11, s. 796-801
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Prospective population-based open-ended study. This paper is part of the Stockholm-Thessaloniki Acute Traumatic Spinal Cord Injury Study.OBJECTIVES: To calculate incidence and evaluate the epidemiological profile of the incident population with traumatic spinal cord injury (TSCI).SETTINGS: The greater Thessaloniki region in Greece and the greater Stockholm region in Sweden.METHODS: TSCI individuals, older than 15 years of age, who had survived the first 7 days post-trauma, were identified through an active surveillance system. The forms of the Nordic Spinal Cord Injury Registry were used.RESULTS: 87 individuals were injured in the greater Thessaloniki and 49 in the greater Stockholm region. Annual crude incidence was 33.6 per million for Thessaloniki and 19.5 per million for the Stockholm region. The leading causes of injury for the Thessaloniki region were transportation accidents (51%) and falls (37%), and those for the Stockholm region were falls (47%) and transportation accidents (23%). A significantly larger number of individuals of the Thessaloniki group were injured in transportation accidents. There was no significant difference between regions with regard to the type of resulting impairment.CONCLUSIONS: Incidence of TSCI was considerably higher in the Thessaloniki region as compared with that in the Stockholm region, probably chiefly reflecting differences in preventative measures with regard to driving.
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| 37. |
- Divanoglou, A, et al.
(författare)
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Medical conditions and outcomes at 1 year after acute traumatic spinal cord injury in a Greek and a Swedish region : a prospective, population-based study
- 2010
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 48:6, s. 470-476
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: Prospective, population-based study. This paper is part of the Stockholm Thessaloniki Acute Traumatic Spinal Cord Injury Study (STATSCIS).OBJECTIVES: To evaluate and compare outcomes, length of stay (LOS), associated conditions and medical complications at 1-year post-trauma.SETTINGS: The Greater Thessaloniki region, Greece, and the Greater Stockholm region, Sweden. While Stockholm follows a SCI system of care, Thessaloniki follows a fragmented 'non-system' approach.SUBJECTS: Out of the 87 cases in Thessaloniki and the 49 cases in Stockholm who comprised the study population of STATSCIS, 75 and 42 cases respectively were successfully followed-up during the first year post-trauma.RESULTS: Significantly superior outcomes (that is, survival with neurological recovery, functional ability and discharge to home) and shorter LOS for initially motor complete cases occurred in Stockholm. Management routines known to increase long-term morbidity, for example, long-term tracheostomy and indwelling urethral catheters were significantly more common in Thessaloniki. Major medical complications, that is, multiple pressure ulcers, heterotopic ossification and bacteremia/sepsis were more frequent in Thessaloniki.CONCLUSIONS: Our findings show how two rather similar cohorts of TSCI manifest large discrepancies in terms of 1-year outcomes and complications, depending on the type of management they receive. As the major difference between regions was the presence or absence of a SCI system of care, rather than differences in availability of modern medicine, the mere presence of the latter does not seem to be sufficient to guarantee adequate outcomes. This study provides strong evidence as to the urgent need of implementing a SCI system of care in Greece.
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| 38. |
- Divanoglou, Anestis, et al.
(författare)
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Perceived effectiveness and mechanisms of community peer-based programmes for Spinal Cord Injuries- a systematic review of qualitative findings
- 2017
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 55:3, s. 225-234
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Forskningsöversikt (refereegranskat)abstract
- Study design: Systematic review and meta-synthesis of qualitative findings.Objectives: To establish the perceived effectiveness and mechanisms of community peer-based programmes based on narratives of consumers with spinal cord injury (SCI).Methods: Scopus, Academic Search Complete, CINAHL, Health Source, Medline, PsycARTICLES, PsychINFO, SPORTSDiscus and ProQuest were searched for articles published in English between January 1990 and December 2015. Qualitative studies referring to community peer-based interventions were included if most cases had a SCI. The results section of included studies was extracted and entered in NVivo. Data were inductively coded and analysed according to the three phases of Thematic Synthesis.Results: The search yielded 1402 unique records, out of which 126 were scrutinised in full. Four studies were appraised based on eight criteria and were finally included in the analysis. Three analytical themes emerged: (1) a unique learning environment created by the right mixture of learning resources, learning processes and a can-do attitude; (2) peer mentors—a unique learning resource with high level of relatedness that eases and empowers participants; and (3) an intervention that responds to important unmet needs and unrealised potential.Conclusions: Community peer-based programmes for people with SCI provide individualised training in important life areas, using a variety of learning resources and a plethora of learning processes. The high level of perceived effectiveness suggests that this type of intervention is an important tool of health systems post discharge from initial rehabilitation. Community organisations should be supported with evaluating their programmes through quality research.
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| 39. |
- Dunn, J. A., et al.
(författare)
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Grasp and Release Test for Tetraplegic Hand Assessment: an update of the Grasp and Release Test
- 2023
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Ingår i: Spinal Cord. - 1362-4393. ; 61:8, s. 466-468
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Tidskriftsartikel (refereegranskat)abstract
- The Grasp and Release Test (GRT) was originally developed to measure effectiveness of an implanted neuroprosthesis in people with tetraplegia. Its ease of use and lack of floor and ceiling effects culminated in recommendations for inclusion in a battery of tests to measure outcome following upper limb reconstructive surgery. However, the length of time taken to administer the GRT in a clinical setting, lack of instructions of accepted grasp patterns in the upper limb reconstructive surgery population and scoring procedures lead to differences in reporting outcomes using this measure. In order to ensure clinical utility for the upper limb reconstructive surgery population, revisions of the original test instructions have been made and are reported in this article. Further testing of the psychometric properties of the new measure are currently underway.
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| 40. |
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| 41. |
- Forslund, E B, et al.
(författare)
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Transfer from table to wheelchair in men and women with spinal cord injury : coordination of body movement and arm forces
- 2007
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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 45:1, s. 41-48
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Tidskriftsartikel (refereegranskat)abstract
- STUDY DESIGN: A complex set-up was used to investigate kinematics and ground reaction forces.SETTING: Motor Control and Physical Therapy Research Laboratory, Neurotec Department, Karolinska Institutet, Huddinge, Sweden.OBJECTIVE: To investigate how men and women with spinal cord injury (SCI) perform transfers from table to wheelchair with regard to timing and magnitude of force generation beneath the hands and associated body movements.METHODS: A total of 13 subjects (seven men, six women) with thoracic SCI. Kinematics of body movement were recorded (Elite 2000 system) simultaneously with the signals from three force plates (AMTI) placed beneath the buttocks and hands. Temporal and spatial parameters regarding head, trunk and trailing arm displacement, loading amplitudes and loading torque directions of both hands were analyzed for each trial and subject and compared between genders.RESULTS: Men and women used similar amplitudes of head bending and forward displacement of the trailing shoulder, while female subjects had significantly larger trunk rotation. Both genders applied significantly more weight on the trailing hand. Differences between genders were seen in direction and timing of peak torque beneath the hands.CONCLUSIONS: The forces beneath the trailing hand were larger than those in the leading, if there is weakness or pain in one arm, this arm should be selected as the leading. To avoid excessive load on the arms, technical aids and environmental factors should be very well adapted.SPONSORSHIP: This project was funded by the Swedish Research Council and the Health Care Science Committee of Karolinska Institutet.
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| 42. |
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| 43. |
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| 44. |
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| 45. |
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| 46. |
- Halvorsen, A., et al.
(författare)
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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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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 57:4, s. 331-338
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Tidskriftsartikel (refereegranskat)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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| 47. |
- Halvorsen, A., et al.
(författare)
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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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Ingår i: Spinal Cord. - : Springer Science and Business Media LLC. - 1362-4393 .- 1476-5624. ; 57:4, s. 324-330
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Tidskriftsartikel (refereegranskat)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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| 48. |
- Hanna-Mitchell, Ann T, et al.
(författare)
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The impact of neurotrophin-3 on the dorsal root transitional zone following injury
- 2008
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Ingår i: Spinal Cord. - 1362-4393 .- 1476-5624. ; 46:12, s. 804-810
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Tidskriftsartikel (refereegranskat)abstract
- Study design: Morphological and Stereological assessment of the dorsal root transitional zone (DRTZ) following complete crush injury, using light microscopy (LM) and transmission electron microscopy (TEM).Objectives: To assess the effect of exogenous neurotrophin-3 (NT-3) on the response of glial cells and axons to dorsal root damage.Setting: Department of Anatomy, University College Cork, Ireland and Department of Physiology, UMDS, University of London, UK.Methods: Cervical roots (C6-8) from rats which had undergone dorsal root crush axotomy 1 week earlier, in the presence (n = 3) and absence (n = 3) of NT-3, were processed for LM and TEM.Results: Unmyelinated axon number and size was greater in the DRTZ proximal ( Central Nervous System; CNS) and distal ( Peripheral Nervous System; PNS) compartments of NT-3-treated tissue. NT-3 was associated with a reduced astrocytic response, an increase in the proportion of oligodendrocytic tissue and a possible inhibition or delay of microglial activation. Disrupted-myelin volume in the DRTZ PNS and CNS compartments of treated tissue was lower, than in control tissue. In the PNS compartment, NT-3 treatment increased phagocyte and blood vessel numbers. It decreased myelinating activity, as sheath thickness was significantly lower and may also account for the noted lower Schwann cell and organelle volume in the test group.Conclusions: Our observations suggest that NT-3 interacts with non-neuronal tissue to facilitate the regenerative effort of damaged axons. This may be as a consequence of a direct action or indirectly mediated by modulation of non-neuronal responses to injury.
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| 49. |
- Hilton, G., et al.
(författare)
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Longitudinal employment outcomes of an early intervention vocational rehabilitation service for people admitted to rehabilitation with a traumatic spinal cord injury
- 2017
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Ingår i: Spinal Cord. - : Nature Publishing Group. - 1362-4393 .- 1476-5624. ; 55:8, s. 743-752
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Tidskriftsartikel (refereegranskat)abstract
- Study design: Longitudinal cohort design.Objectives: First, to explore the longitudinal outcomes for people who received early intervention vocational rehabilitation (EIVR); second, to examine the nature and extent of relationships between contextual factors and employment outcomes over time.Setting: Both inpatient and community-based clients of a Spinal Community Integration Service (SCIS).Methods: People of workforce age undergoing inpatient rehabilitation for traumatic spinal cord injury were invited to participate in EIVR as part of SCIS. Data were collected at the following three time points: Discharge and at 1 year and 2+ years post discharge. Measures included the spinal cord independence measure, hospital anxiety and depression scale, impact on participation and autonomy scale, numerical pain-rating scale and personal wellbeing index. A range of chi square, correlation and regression tests were undertaken to look for relationships between employment outcomes and demographic, emotional and physical characteristics.Results: Ninety-seven participants were recruited and 60 were available at the final time point where 33% (95% confidence interval (CI): 24-42%) had achieved an employment outcome. Greater social participation was strongly correlated with wellbeing (Ï =0.692), and reduced anxiety (Ï =â '0.522), depression (Ï =â '0.643) and pain (Ï =â '0.427) at the final time point. In a generalised linear mixed effect model, education status, relationship status and subjective wellbeing increased significantly the odds of being employed at the final time point. Tertiary education prior to injury was associated with eight times increased odds of being in employment at the final time point; being in a relationship at the time of injury was associated with increased odds of being in employment of more than 3.5; subjective wellbeing, while being the least powerful predictor was still associated with increased odds (1.8 times) of being employed at the final time point.Conclusions: EIVR shows promise in delivering similar return-to-work rates as those traditionally reported, but sooner. The dynamics around relationships, subjective wellbeing, social participation and employment outcomes require further exploration.
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