Laura A. May

Utilization of health services following spinal cord injury: a 6-year follow-up study

Study design: Cohort study with 6-years follow-up.Objective: To describe the utilization of health services by persons with spinal cord injury (SCI) and compare it with that of the general population.Setting: Alberta, Canada.Methods: All persons who sustained an SCI in Alberta between April 1992 and March 1994 were followed from date of injury to 6 years postinjury. Cases were matched (1:5) with controls randomly selected from the general population and matched for age, gender, and region of residence. Administrative data from centralized health care databases were compiled to provide a complete picture of health care use, including hospitalizations, physician contacts, long-term care admissions, home care services, and the occurrence of secondary complications.Results: In all, 233 individuals with SCI and 1165 matched controls were followed for 6 years. Compared with the control group, persons with SCI were rehospitalized 2.6 times more often, spent 3.3 more days in hospital, were 2.7 times more likely to have a physician contact, and required 30 times more hours of home care services. Of those with SCI, 47.6% were treated for a urinary tract infection, 33.8% for pneumonia, 27.5% for depression, and 19.7% for decubitus ulcer.Conclusion: SCI places a heavy burden on the health care system. Persons with SCI have greater rates of contact with the health system compared with the general population. Secondary complications continue to affect persons with SCI long after the acute trauma.

The epidemiology of traumatic spinal cord injury in Alberta, Canada

OBJECTIVES To describe the incidence and pattern of traumatic spinal cord injury and cauda equina injury (SCI) in a geographically defined region of Canada. METHODS The study period was April 1, 1997 to March 31, 2000. Data were gathered from three provincial sources: administrative data from the Alberta Ministry of Health and Wellness, records from the Alberta Trauma Registry, and death certificates from the Office of the Medical Examiner. RESULTS From all three data sources, 450 cases of SCI were identified. Of these, 71 (15.8%) died prior to hospitalization. The annual incidence rate was 52.5/million population (95% CI: 47.7, 57.4). For those who survived to hospital admission, the incidence rate was 44.3/million/year (95% CI: 39.8, 48.7). The incidence rates for males were consistently higher than for females for all age groups. Motor vehicle collisions accounted for 56.4% of injuries, followed by falls (19.1%). The highest incidence of motor vehicle-related SCI occurred to those between 15 and 29 years (60/million/year). Fall-related injuries primarily occurred to those older than 60 years (45/million/year). Rural residents were 2.5 times as likely to be injured as urban residents. CONCLUSION Prevention strategies for SCI should target males of all ages, adolescents and young adults of both sexes, rural residents, motor vehicle collisions, and fall prevention for those older than 60 years.

Assessment of isokinetic and hand-held dynamometer measures of shoulder rotator strength among individuals with spinal cord injury

OBJECTIVE To determine the intrarater reliability of the hand-held dynamometer (HHD) for the measurement of shoulder rotation and to examine the relationship between the peak force values of the HHD and the isokinetic dynamometer. PARTICIPANTS Twenty-five spinal cord injured individuals, 12 persons with paraplegia and 13 persons with tetraplegia between the ages of 18 and 42 years, were recruited from the community. SETTING Private practice clinic. PROCEDURES All participants were tested with the HHD by one examiner to determine reliability. On the same day, these participants underwent isokinetic testing to determine the relationship of the HHD and Cybex dynamometer measurements. RESULTS The intraclass correlation coefficients for the intrarater reliability ranged from .89 to .96. The Pearson product moment correlation was used to analyze the relationship between the two devices. All coefficients (.52 to .88) were statistically significant (p < .01); however, separate analyses for the persons with paraplegia and tetraplegia differed considerably. There was substantial variability of the isokinetic strength values at the lower levels of isometric strength. CONCLUSIONS The HHD can be used reliably to measure shoulder rotation in paraplegic and tetraplegic spinal cord injured individuals. Although it appears that the relationship between HHD and isokinetic measurement is poor for the participants with tetraplegia, the variability of the isokinetic scores indicates that this observation may be a function of the method of isokinetic measurements. Further study with a modified isokinetic testing protocol is needed to clarify the results of the participants with tetraplegia.

Role of conceptual models in a physical therapy curriculum: application of an integrated model of theory, research, and clinical practice.

The Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada, recently implemented a Master of Physical Therapy (MPT) entry-level degree program. As part of the curriculum design, two models were developed, a Model of Best Practice and the Clinical Decision-Making Model. Both models incorporate four key concepts of the new curriculum: 1) the concept that theory, research, and clinical practice are interdependent and inform each other; 2) the importance of client-centered practice; 3) the terminology and philosophical framework of the World Health Organizations International Classification of Functioning, Disability, and Health; and 4) the importance of evidence-based practice. In this article the general purposes of models for learning are described; the two models developed for the MPT program are described; and examples of their use with curriculum design and teaching are provided. Our experiences with both the development and use of models of practice have been positive. The models have provided both faculty and students with a simple, systematic structured framework to organize teaching and learning in the MPT program.

Measuring quality of life of persons with spinal cord injury: Substantive and structural validation

The purpose of this study was to evaluate the substantive and structural validity of an existing measure of quality of life (QOL), the spinal cord injury (SCI) version of the Ferrans and Powers quality of life index (QLI). To evaluate substantive validity, 11 individuals with a SCI participated in ‘think aloud’ interviews to determine meaningfulness of the QLI items and to identify areas requiring modification. Free sort and ranking exercises of the items were used to evaluate the structural validity of the domains and scoring rubric. Content analysis of the interview comments resulted in the addition of two items and wording revision to three items. The free sort exercise revealed that the domains as perceived by the participants differed somewhat from those of the test developer. The contribution of the satisfaction and importance sections proposed by the scoring model was not completely supported by the data from the ranking exercise. It is concluded that the modified version of the QLI reflects the perspectives of persons with SCI spinal cord injury as represented by the participants of this study. The structural validity evaluation has implications for the use of domain subscores and weighted vs. section scores. Further evaluation of the modified version is necessary before widespread use with this patient population.

Evaluation of powered mobility use in home and community environments.

The purpose of this study was to evaluate the use of powered mobility by young individuals with physical disabilities. The four study objectives were to: (a) describe the characteristics of children and adolescents who received powered wheelchairs at eighteen years of age or younger, (b) evaluate the longitudinal use or disuse of powered mobility by these participants, (c) describe the extent and locations of powered mobility use, and (d) explore environmental (i.e., physical, social and attitudinal) barriers and facilitators to successful powered mobility use with the participants and their families. Sixty-six families shared information during a structured telephone interview. The results of this study confirm that younger children are now receiving powered wheelchairs. The results also suggest that powered mobility is reserved for children with the most severe disabilities. Physical and occupational therapists can work collaboratively with more families to explore powered mobility as one of an array of early movement options.