Karen A. Hart

Chronic pain in a community-based sample of men with spinal cord injury: Prevalence, severity, and relationship with impairment, disability, handicap, and subjective well-being

OBJECTIVE To assess the prevalence, severity, and correlates of chronic pain in a community-based sample of men with spinal cord injury (SCI). DESIGN Survey. SETTING Community. PARTICIPANTS Seventy-seven men with SCI randomly selected from a sampling frame solicited from the community. METHOD Participants completed standardized questionnaires assessing many areas of life, were interviewed in their homes, and underwent a physical examination at a hospital. There they were interviewed by an anesthesiologist regarding chronic pain, and a nurse administered objective pain measures. RESULTS Seventy-five percent of the men reported chronic pain. Chronic pain was associated with more depressive symptoms, more perceived stress, and poorer self-assessed health. Greater intensity of pain was related to less paralytic impairment, violent etiology, and more perceived stress. Area of the body affected by pain was related to independence and mobility. CONCLUSIONS Because of the high prevalence of chronic pain in the population with SCI and its relation to disability, handicap, and quality of life, health care providers need to give this issue the same priority given to other SCI health issues. Analysis of individual pain components provides better information than assessing overall pain. It is futile to treat SCI pain without giving full attention to subjective factors.

Alcohol and marijuana use in a community-based sample of persons with spinal cord injury.

The prevalence of self-reported alcohol and marijuana use, along with alcohol abuse as measured by the Short Michigan Alcoholism Screening Test, was assessed for a community-based sample (n = 123) of persons with spinal cord injury (SCI). Correlates of alcohol and marijuana use and alcohol abuse also were examined, including demographic variables, measures of impairment, disability, and handicap, SCI medical complications, and measures of subjective assessment such as health rating, health maintenance behaviors, depression, life satisfaction, perceived stress, pain, and social support. Prevalence of alcohol use (59%) and marijuana use (16%) in persons with SCI was less than that of comparison groups in the general population. However, prevalence of alcohol abuse (21%) exceeded that of general population studies. Participants who abused alcohol shared the following criteria: (1) perceived their overall health as worse than those who did not abuse alcohol; (2) were more depressed; and (3) experienced more stress in their lives than those who did not abuse alcohol. Participants who used marijuana were younger at the time of the study and were younger at injury. They were also more depressed and more stressed. The indications of alcohol abuse in one in five persons with SCI living in the community mandates that screening, treatment, and referrals be part of any rehabilitation treatment program.

Sexual activities, concerns and interests of men with spinal cord injury.

White MJ, Rintala DH, Hart KA, Young ME, Fuhrer MJ: Sexual activities, concerns and interests of men with spinal cord injury. Am J Phys Med Rehabil 1992;71:225-231. A representative sample of 79 men with spinal cord injury, drawn from a sampling frame of 661 women and men who reside in the community, was studied in terms of sexual activity, concerns and interests. Participants responded to a questionnaire and rating scales and were physically examined to establish their neurologic status. With respect to eleven other areas of life, sex life ranked the lowest in terms of satisfaction and fifth in terms of importance. Of the sample, 67% reported having had a physical relationship (not necessarily including intercourse) in the past 12 months. Areas of sexual activity about which respondents were most concerned were not satisfying a partner, getting or giving a sexual disease, urinary accidents, and not getting enough personal satisfaction. From among seven topics related to sexuality, the three in which there was greatest interest were methods and techniques to achieve sexual satisfaction, helping a partner cope emotionally with limitations on sexual activity and ability to have children.

Sexual activities, concerns and interests of women with spinal cord injury living in the community.

White MJ, Rintala DH, Hart KA, Fuhrer MJ: Sexual activities, concerns and interests of women with spinal cord injury living in the community. Am J Phys Med Rehabil 1993;72:372–378A representative sample of 40 women selected from a community-based sampling frame of 661 men and women with spinal cord injury was studied for sexual activities, concerns and interests. Participants responded to a questionnaire and rating scales and were physically examined to establish their neurologic status. With respect to 11 other areas of life, sex life ranked tenth in importance and tenth in satisfaction. In the sample, 65% reported having had a physical relationship (not necessarily including intercourse) in the past 12 months. Areas of greatest concern were problems associated with urinary and bowel accidents and not satisfying a partner. Regarding topics of interest related to sexual activity, highest priorities were assigned to coping emotionally with changes in sexual functioning and helping a partner cope emotionally with limitations on sexual activity. Compared with a previously studied group of men with spinal cord injury, the women in the sample exhibited distinctive needs that were not being addressed sufficiently by rehabilitation professionals.

Predicting consistency of pain over a 10-year period in persons with spinal cord injury

This longitudinal study was designed to test the hypothesis that persons who consistently report pain at three (women) or four (men) measurement points across 10 years (1988 to 1998) are different both physically and psychologically from those who inconsistently or never report pain. Participants were 96 persons with spinal cord injury (SCI) living in the community who participated at every measurement point. Measures included consistency of reports of pain (i.e., reported having had problems with pain in the 12 months prior to all, some, or no measurement points); demographic and injury-related data; and measures of physical and psychological health, function, and social support. Of the 96 participants, approximately half of the men and three-fourths of the women consistently reported pain at each point. Phase 1 predictors of the consistency of pain reports for men were being less impaired, being more independent, experiencing more stress, and receiving less social support. Women consistently reporting pain had more stress at Phase 1 than women inconsistently reporting pain. Persons with SCI at risk for chronic pain should be identified and referred to a multidisciplinary pain management program.

Evaluation and promotion of the clinician-educator: the faculty viewpoint.

Kevorkian CG, Rintala DH, Hart KA: Evaluation and promotion of the clinician-educator: the faculty viewpoint. Am J Phys Med Rehabil 2001;80:47–55. Changes in healthcare management and reimbursement have contributed to alterations in the traditional culture of academic medical centers and the roles and responsibilities of their physician faculty, including clinician-educators. Questions concerning the appropriate evaluation methodology and criteria for promotion of such clinical faculty have been raised. In our survey of a large university-based physical medicine and rehabilitation department, only minimal differences were related to age, gender, and academic rank, and these are discussed.

Racial and Ethnic Differences in Community Reintegration in a Community-Based Sample of Adults with Spinal Cord Injury

The relationship of race/ethnicity to community integration and other variables was assessed in a sample of 164 adults who had lived with spinal cord injury for 2 to 47 years. Compared with blacks and Hispanics, whites were older, better educated, better off financially, less likely to have a violent etiology, less severely impaired, more physically independent, better able to access their community, and involved in more productive activities. Hierarchical regression analyses revealed that after controlling for other demographic and injury-related variables, the amount of variance in mobility and productivity accounted for by race/ethnicity was substantially reduced.

Long-term outcomes following spinal cord injury

Long-term outcome assessment of people with spinal cord injury (SCI) beyond acute rehabilitation is becoming an increasingly important issue as life expectancies for people with SCI approach those of the general population. This article provides information about research on the long-term physical and psychological well-being and the community integration of individuals with SCI. Persons with SCI have been found to have more physical and psychological problems and they are less well integrated into the community than the general population. Long-term measurement issues, criteria for selection of instruments, and recommended instruments are discussed.

The Use of Personal Assistance Services by Persons With Spinal Cord Injury Policy Issues Surrounding Reliance on Family and Paid Providers

Previous discussions of personal assistance have focused on census data and descriptions of service programs. The current study examines patterns of usage of personal assistance among a community-based sample of 284 persons with spinal cord injury and how these patterns relate to other aspects of their lives. Expected significant relationships were found among variables of who provides assistance, whether they are paid, and with whom participants live, and between the amount of assistance received and severity of disability. Unexpectedly high rates of use of unpaid nonrelatives and paid relatives were found, as was the use of a combination of relatives and nonrelatives as assistants. Use of nonrelatives increased with education level. The effect of usage pattern on productivity could not be examined due to a staggeringly high unemployment rate (89%). Implications of these results for development of a national policy on providing personal assistance services, the expansion of formal service delivery systems, and the further investigation of the use of personal assistance are discussed.

Rehabilitation research: The new focus of the American congress of rehabilitation medicine☆

A S PRESIDENT OF the American Congress of Rehabilitation Medicine, and on behalf of the 11 other Board members, I welcome you to the 74th annual meeting of the ACRM. This has been a year of huge steps for ACRM, and it has been a privilege to serve as your President. In this Presidential address I will do two things: 1. Bring you up to date on what has been happening with our organization since we were last together at the annual meeting in Chicago, and 2. Challenge you with some possible actions to begin to take during this meeting. On the update, I ask the indulgence of those of you who have read the Open Line to the President column in the last three Rehabilitation Outlook newsletters and the letter that was mailed to each member last month. As I begin, I want you to know that throughout every action and decision made this year, it was clear that there was a background commitment shared by each individual member of the ACRM Board-that our purpose was and is to improve the lives of people with chronic disabling conditions. Now, for a review of some of the issues of the past 3 years.