Brodie M. Sakakibara

Global incidence and prevalence of traumatic spinal cord injury

This systematic review examines the incidence and prevalence of traumatic spinal cord injury (SCI) in different countries worldwide and their trends over time. The literature search of the studies published between 1950 and 2012 captured 1,871 articles of which 64 articles on incidence and 13 articles on prevalence fulfilled the inclusion and exclusion criteria. The global incidence of SCI varied from 8.0 to 246.0 cases per million inhabitants per year. The global prevalence varied from 236.0 to 1,298.0 per million inhabitants. In addition to regional differences regarding the prevalence rates of SCI across the globe, there has been a trend towards increasing prevalence rates over the last decades. Our results suggest a relatively broad variation of incidence and prevalence rates of SCI among distinctive geographic regions. These results emphasize the need for further studies on incidence and prevalence of SCI, and for international standards and guidelines for reporting on SCI.

Quality of life instruments and definitions in individuals with spinal cord injury: a systematic review.

Study design:A systematic review.Objective:To critically review quality of life (QOL) instruments used with spinal cord injury (SCI) populations.Setting:Vancouver, Canada.Methods:A systematic literature review was conducted for publications assessing the measurement properties of QOL outcome measures. Pre-established criteria were used to evaluate the measurement properties.Results:Fourteen articles reporting on 13 QOL instruments met the inclusion criteria, including the Patient Reported Impact of Spasticity Measure (PRISM), Quality of Well-being Scale, Qualiveen, Sickness Impact Profile (SIP68), Short Form (SF)-36, SF-36V, SF-12, SF-6D, Quality of Life Index, Quality of Life Profile for Adults with Physical Disabilities (QOLP-PD), Satisfaction with Life Scale, Sense of Well-being Index (SWBI), and the World Health Organization Quality of Life–BREF scale (WHOQOL-BREF). The SF-36 and WHOQOL-BREF have been widely used and validated. The SIP68, QOLP-PD, SF-36V, and SWBI are promising with limited investigation. The Qualiveen and PRISM performed well and are specific to SCI complications.Conclusion:The WHOQOL-BREF is presently the most acceptable and established instrument to assess QOL after SCI. The SIP68, QOLP-PD, SF-36V, and SWBI are promising; however, require further evaluation of their measurement properties.

An evidence-based review of aging of the body systems following spinal cord injury

Study design:Systematic review.Objective:To systematically review evidence on aging of the body systems after spinal cord injury (SCI).Setting:Toronto, Ontario and Vancouver, British Columbia, Canada.Methods:Electronic databases (MEDLINE/PubMed, CINAHL, EMBASE and PsycINFO), were searched for studies published between 1980 and 2009. The search was augmented by reviewing the reference lists of relevant papers. Non-intervention studies that were longitudinal or cross-sectional with able-bodied controls that were at minimum matched on chronological age were included for review. Levels of evidence were assigned to the study design using a modified Sackett scale.Results:Of the 74 studies selected for inclusion, 16 were longitudinal in design. The hypothesis that SCI represents a model for premature aging is supported by a large proportion of level 5 evidence for the cardiovascular and endocrine systems, level 2, 4 and 5 evidence for the musculoskeletal system, and limited level 5 evidence for the immune system. Only a few level 4 and 5 studies for the respiratory system were found. The evidence on the genitourinary system, gastrointestinal system, and for skin and subcutaneous tissues provide level 4 and 5 evidence that premature aging may not be occurring. The evidence on the nervous system does not provide evidence of premature aging as a result of SCI.Conclusions:Premature aging appears to occur in some systems after SCI. Additional longitudinal studies are required to confirm these findings.Sponsorship:Rick Hansen Institute; Ontario Neurotrauma Foundation.

Wheelchair skills training to improve confidence with using a manual wheelchair among older adults: A pilot study

OBJECTIVE To examine the effects of wheelchair skills training on confidence in older adults who are inexperienced wheelchair users. DESIGN Parallel group, single-blind randomized controlled trial. SETTING Research laboratory in a rehabilitation hospital. PARTICIPANTS Participants (N=20) who were community-living older adults at least 65 years old (mean age, 70y), 50% women, and who had no experience of using a wheelchair were randomly allocated to an intervention (n=10) or control (n=10) group. INTERVENTIONS The intervention group received two 1-hour training sessions that followed the Wheelchair Skills Training Program (WSTP) protocol. The control group received a single socialization contact. MAIN OUTCOME MEASURE The Wheelchair Use Confidence Scale-Manual (WheelCon-M) was used to evaluate confidence with using a manual wheelchair. The WheelCon-M is a self-report questionnaire that comprises 65 items in 6 conceptual areas. RESULTS A 1-way between-groups analysis of covariance revealed a significant difference in postintervention WheelCon-M scores between the intervention and control groups (F1,17=10.9, P=.004) after controlling for baseline WheelCon-M scores. A large effect size was also observed (partial η(2)=.39). Secondary analyses revealed that the WSTP had greater effects on confidence in areas related to maneuvering around the physical environment, knowledge and problem solving, advocacy, and managing emotions than in areas related to performing activities and behaving in social situations. CONCLUSION Two 1-hour WSTP sessions improve confidence with using a manual wheelchair among older adults who are inexperienced wheelchair users.

Capturing step counts at slow walking speeds in older adults: comparison of ankle and waist placement of measuring device.

OBJECTIVE It is important for older adults to be physically active, but many older adults walk slowly. This study examined the accuracy of a commercially available step-count device (Fitbit One) at slow speeds and compared the accuracy of the device when worn at the ankle and waist in older adults. METHODS The Fitbit One was placed at the ankle and waist of participants (n=42; mean age 73 years) while they performed walking trials at 7 different speeds (0.3-0.9 m/s). Step counts obtained from video recordings were used as the gold standard comparison to determine the accuracy of the device. RESULTS The ankle-worn device had significantly less error than the waist-worn device at all speeds. The percentage error of the ankle-worn device was less than 10% at speeds of 0.4-0.9 m/s and did not record zero steps at any speed. The percentage error of the waist-worn device was below 10% at only the 2 fastest speeds (0.8 and 0.9 m/s) and recorded zero steps for numerous participants at speeds of 0.3-0.5 m/s. CONCLUSION The Fitbit One can accurately capture steps at slow speeds when placed at the ankle and thus may be appropriate for capturing physical activity in slow-walking older adults.

Association Between Self-efficacy and Participation in Community-Dwelling Manual Wheelchair Users Aged 50 Years or Older

Background Self-efficacy with using a wheelchair is an emerging construct in the wheelchair-use literature that may have implications for the participation frequency in social and personal roles of wheelchair users. Objectives The aim of this study was to investigate the direct and mediated effects of self-efficacy on participation frequency in community-dwelling manual wheelchair users aged 50 years or older. Design A cross-sectional study was conducted. Methods Participants were community-dwelling wheelchair users (N=124), 50 years of age or older (mean=59.7 years), with at least 6 months of experience with wheelchair use. The Late-Life Disability Instrument, the Wheelchair Use Confidence Scale, the Life-Space Assessment, and the Wheelchair Skills Test–Questionnaire Version measured participation frequency, self-efficacy, life-space mobility, and wheelchair skills, respectively. Multiple regression analyses with bootstrapping were used to investigate the direct and mediated effects. The International Classification of Functioning, Disability and Health was used to guide the analyses. Results Self-efficacy was a statistically significant determinant of participation frequency and accounted for 17.2% of the participation variance after controlling for age, number of comorbidities, and social support. The total mediating effect by life-space mobility, wheelchair skills, and perceived participation limitations was statistically significant (point estimate=0.14; bootstrapped 95% confidence interval=0.04, 0.24); however, the specific indirect effect by the wheelchair skills variable did not contribute to the total effect above and beyond the other 2 mediators. The mediated model accounted for 55.0% of the participation variance. Limitations Causality cannot be established due to the cross-sectional nature of the data, and the self-report nature of our data from a volunteer sample may be influenced by measurement bias or social desirability, or both. Conclusion Self-efficacy directly and indirectly influences the participation frequency in community-dwelling manual wheelchair users aged 50 years or older. Development of interventions to address low self-efficacy is warranted.

Preliminary examination of the relation between participation and confidence in older manual wheelchair users.

OBJECTIVE To examine the relation between frequency of participation and confidence with using a manual wheelchair among community-living, older wheelchair users, and the moderating effect of sex. DESIGN Cross-sectional. SETTING Community. PARTICIPANTS Participants (N=54) who were community-living manual wheelchair users (65% men), were ≥50 years of age (mean, 59y), used their wheelchair daily, and had ≥6 months experience using a wheelchair. INTERVENTIONS None. MAIN OUTCOME MEASURES The 16-item Late Life Disability Instrument and the 65-item Wheelchair Use Confidence Scale measured participation and confidence, respectively. Age, sex, and wheelchair skill measured using the performance-based Wheelchair Skills Test were included as covariates in the multiple regression models. RESULTS Significant and positive relations exist between participation and (1) confidence (β=.83, P=.002) and (2) interaction term (β=.33, P=.05). The R(2) change associated with confidence was 10% (P=.02), and 6% (P=.05) for the interaction term. Subsequent regression analyses revealed that the magnitude of the relation between higher confidence and greater participation is stronger for men (β=1.05, P=.002) than for women (β=.44, P=.05). CONCLUSIONS Confidence with using a manual wheelchair is a positive and significant determinant of frequency of participation of older wheelchair users, after controlling for important covariates. Because the relation is moderated by sex, treatments addressing low confidence may lead to increased frequency of participation, especially for wheelchair users who are men.

Rasch analyses of the Activities-specific Balance Confidence Scale with individuals 50 years and older with lower-limb amputations.

OBJECTIVES To explore shortened response formats for use with the Activities-specific Balance Confidence (ABC) Scale and then evaluate the unidimensionality of the scale, the item difficulty, the scale for redundancy and content gaps, and the item standard error of measurement (SEM) and internal consistency reliability among aging individuals with a lower-limb amputation living in the community. DESIGN Secondary analysis of cross-sectional survey and chart review data. SETTING Outpatient amputee clinics, Ontario, Canada. PARTICIPANTS Community living adults (N=448; ≥50y; mean, 68y) who have used a prosthesis for at least 6 months for a major unilateral lower-limb amputation. Of the participants, 325 (72.5%) were men. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE ABC Scale. RESULTS A 5-option response format outperformed 4- and 6-option formats. Factor analyses confirmed a unidimensional scale. The distance between response options is not the same for all items on the scale, evident by the Rasch Partial Credit Model (PCM) having a better fit to the data than the Rasch Rating Scale Model. Two items, however, did not fit the PCM within statistical reason. Revising the wording of the 2 items may resolve the misfit and improve the construct validity and lower the standard error of measurement. Overall, the difficulty of the scales items is appropriate for use with aging individuals with lower-limb amputation, and is most reliable (Cronbach α=0.94) for use with individuals with moderately low balance confidence levels. CONCLUSIONS The ABC Scale with a simplified 5-option response format is a valid and reliable measure of balance confidence for use with individuals aging with a lower-limb amputation.

Influences of Wheelchair-Related Efficacy on Life-Space Mobility in Adults Who Use a Wheelchair and Live in the Community

Background Self-efficacy has important implications for health and functioning in people with limited mobility. However, the influence of self-efficacy on mobility in adults who use wheelchairs has yet to be investigated. Objective The study objective was to: (1) estimate the direct association between wheelchair use self-efficacy and life-space mobility and (2) investigate an indirect effect through wheelchair skills. Design This was a cross-sectional study. Methods Participants (N=124) were adults who use a wheelchair, live in the community, and were 50 years of age and older (X̅=59.67, range=50–84), with at least 6 months of experience with manual wheelchair use; 60% were men. The 20-item Life-Space Assessment, the 65-item Wheelchair Use Confidence Scale, and the 32-item Wheelchair Skills Test-Questionnaire were used to measure life-space mobility, self-efficacy, and wheelchair skills, respectively. Results Self-efficacy had a statistically significant association with life-space mobility (nonstandardized regression coefficient=0.23, 95% confidence interval=0.07, 0.39) after controlling for sex, number of comorbidities, geographic location, and assistance with using a wheelchair. This model accounted for 37.1% of the life-space mobility variance, and the unique contribution of self-efficacy was 3.5%. The indirect effect through wheelchair skills was also statistically significant (point estimate=0.21, 95% bootstrapped confidence interval=0.05, 0.43) and accounted for 91.3% of the direct effect of self-efficacy on life-space mobility. This model accounted for 39.2% of the life-space mobility variance. Limitations Causality could not be established because of the study design. The self-report nature of data from volunteers may be influenced by recall bias, social desirability, or both. Conclusions Wheelchair use self-efficacy had both direct and indirect associations with life-space mobility after controlling for confounding variables. Interventions targeted toward improving self-efficacy may lead to improvements in life-space mobility.

An evidence-based review on the influence of aging with a spinal cord injury on subjective quality of life

Study design:Systematic review.Objectives:To identify changes in subjective quality of life (QoL) as one ages with a spinal cord injury (SCI).Setting:Vancouver, Canada.Methods:Electronic databases were searched for studies reporting on age-related QoL changes over time. Data from relevant studies were transcribed into data extraction forms and analyzed by years post injury (YPI) and chronologic age. Each study was assigned a level of evidence based on a modified Sackett scale.Results:In all, 21 studies, each with a low level of evidence, were included for review. The results indicated that regardless of chronologic age, individuals with relatively new SCI have the potential to improve their QoL. Among individuals with advanced YPI, overall QoL is consistently reported as good or excellent over time, however, with variations in different QoL domains.Conclusion:The QoL of individuals aging with a SCI has the potential to improve, and remain high and stable over time. As the identified studies provide low levels of evidence, more longitudinal research with greater methodological and measurement rigor is needed to corroborate the findings and conclusions of this review.