Timo Hinrichs

Health conditions in people with spinal cord injury: Contemporary evidence from a population-based community survey in Switzerland.

BACKGROUNDnHealth conditions in people with spinal cord injury are major determinants for disability, reduced well-being, and mortality. However, population-based evidence on the prevalence and treatment of health conditions in people with spinal cord injury is scarce.nnnOBJECTIVEnTo investigate health conditions in Swiss residents with spinal cord injury, specifically to analyse their prevalence, severity, co-occurrence, and treatment.nnnMETHODSnCross-sectional data (nu2009=u20091,549) from the community survey of the Swiss Spinal Cord Injury (SwiSCI) cohort study, including Swiss residents with spinal cord injury aged over 16 years, were analysed. Nineteen health conditions and their self-reported treatment were assessed with the spinal cord injury Secondary Conditions Scale and the Self-Administered Comorbidity Questionnaire. Prevalence and severity were compared across demographics and spinal cord injury characteristics. Co-occurrence of health conditions was examined using a binary non-metric dissimilarity measure and multi-dimensional scaling. Treatment rates were also examined.nnnRESULTSnNumber of concurrent health conditions was high (median 7; interquartile range 4-9; most frequent: spasticity, chronic pain, sexual dysfunction). Prevalence of health conditions increased with age and was higher in non-traumatic compared with traumatic spinal cord injury. Spinal cord injury specific conditions co-occurred. Relative frequencies of treatment were low (median 44%, interquartile range 25-64%), even for significant or chronic problems.nnnDISCUSSIONnA high prevalence of multimorbidity was found in community-dwelling persons with spinal cord injury. Treatment for some highly prevalent health conditions was infrequent.

Prevalence and associated factors of pain in the Swiss spinal cord injury population

Study design:Population-based, cross-sectional.Objectives:To determine pain prevalence and identify factors associated with chronic pain in individuals with spinal cord injury (SCI) living in Switzerland.Setting:Swiss SCI Cohort Study (SwiSCI).Methods:Pain characteristics were assessed using an adapted version of the International SCI Pain Basic Data Set, adding one item of the SCI Secondary Conditions Scale to address chronic pain. Pain prevalence was calculated using stratification over demographic, SCI-related and socioeconomic characteristics; odds ratios (adjusted for non-response) for determinants of severity of chronic pain were calculated using stereotype logistic regressions.Results:Pain (in the past week) was reported by 68.9% and chronic pain by 73.5% (significant 36.9%) of all participants (N=1549; 28% female). Most frequently reported pain type was musculoskeletal (71.1%). Back/spine was the most frequently reported pain location (54.6%). Contrasting the significant to the none/mild category of chronic pain, adjusted odds ratios were 1.54 (95% CI: 1.18–2.01; P<0.01) for women (vs men); 6.64 (95% CI: 3.37–11.67; P<0.001) for the oldest age group 61+ (vs youngest (16–30)); 3.41 (95% CI: 2.07–5.62; P<0.001) in individuals reporting severe financial hardship (vs no financial hardship). Individuals reporting specific SCI-related health conditions were 1.41–2.92 (P<0.05) times more likely to report chronic pain as significant rather than none/mild compared with those without the respective condition.Conclusions:Pain is highly prevalent in individuals with SCI living in Switzerland. Considered at risk for chronic pain are women, older individuals and individuals with financial hardship and specific secondary health conditions. Longitudinal studies are necessary to identify predictors for the development of pain and its chronification.

Subgroups in epidemiological studies on spinal cord injury: evaluation of international recommendations in the Swiss Spinal Cord Injury Cohort Study

OBJECTIVEnTo test subgroups of a community-based sample of individuals with spinal cord injury, categorized by the application of current recommendations by the International Spinal Cord Society.nnnDESIGNnCommunity survey.nnnPARTICIPANTSnIndividuals with traumatic and non-traumatic spinal cord injury residing in Switzerland.nnnMETHODSnRecommended subgroups of age, gender, years since injury, severity of injury and aetiology were tested against the following criteria: (i) distribution of participants across categories; (ii) within- and between-group variability with regard to selected outcomes of functioning and quality of life.nnnRESULTSnData-sets for 1,549 participants (28.5% women; mean age 52u2009±u200915 years) were available for analyses. There was a number of participants in every subgroup, yet numbers were relatively small in the group with the shortest time since injury (<u20091 year; nu2009=u200923) and in the oldest age group (≥u200976; nu2009=u200994). A high variability in some outcomes was detected between categories. All variables were predictive for most of the endpoints investigated.nnnCONCLUSIONnRecommended categorization could well fit the present sample. A minor concern was the low numbers of participants in some subgroups.

Do people with spinal cord injury meet the WHO recommendations on physical activity

ObjectivesTo describe physical activity (PA) levels in persons with spinal cord injury (SCI) and to investigate associated factors.MethodsPA behavior of people with SCI in Switzerland was assessed in a community survey with four items from the Physical Activity Scale for individuals with physical disabilities (PA of light, moderate, and strenuous intensity and muscle-strengthening exercises). In addition to descriptive analyses, the odds of performing PA according to the WHO recommendations (at least 2.5xa0h/week of at least moderate intensity) were analyzed by multivariable logistic regression.ResultsParticipants (nxa0=xa0485; aged 52.9xa0±xa014.8; 73.6xa0% male) carried out PA a total of 6.0xa0h/week (median). 18.6xa0% were physically inactive, 50.3xa0% carried out muscle-strengthening exercises, and 48.9xa0% fulfilled the WHO recommendations. Regression analyses showed that women, people aged 71+, and people with complete tetraplegia had significantly lower odds of fulfilling the WHO recommendations than participants in the respective reference category (men, ages 17–30, incomplete paraplegia).ConclusionsPA levels of people with SCI in Switzerland are rather high. However, some subgroups need special consideration when planning interventions to increase PA levels.

Determinants of handbike use in persons with spinal cord injury: results of a community survey in Switzerland

Abstract Purpose: To examine the prevalence and determinants of handbike use in persons living with spinal cord injury in Switzerland. Method: A population-based cross-sectional survey in Switzerland. Results: The crude prevalence of handbike use among the 1549 participants was 22.6%, varying between 25.3% in men and 17.7% in women. Prevalence was higher in complete than in incomplete spinal cord injury (SCI) (41.5% versus 11.9% in paraplegia, 25.6% versus 11.1% in tetraplegia). Multivariable analysis of handbike use confirmed differences with lesion characteristics and gender and showed a decline with age, lowest rates in the low-income group, variation with language, but no association with level of education or cause of spinal cord injury. In total, 45.8% of users reported to engage in handcycling at least once a week. Frequent contextual reasons for refraining from handcycling were: no interest (26%); inability due to disability (20%); unfamiliarity with the handbike (19%) and financial constraints (14%). Conclusions: Conditional on the major determinants that include demographic factors and lesion characteristics, main barriers involve contextual factors that can principally be overcome. Our findings thus suggest scope for promoting handcycling as a means towards a healthy and more physically active lifestyle in persons living with SCI. Implications for Rehabilitation Handcycling is an effective means of improving health and quality of life of persons with a spinal cord injury. Persons with the following traits are most likely to use the handbike: persons younger than 62 years, with a complete paraplegia, who are German-speaking (vs. French/Italian) and having a middle or high net income. Indicated reasons for not using a handbike varied by SCI characteristics and included disinterest, inability related to the level of impairment, unfamiliarity and financial costs. Barriers that involve the above mentioned contextual factors can principally be overcome by targeted policy or information campaigns.

Need and use of assistive devices for personal mobility by individuals with spinal cord injury

Objective: To investigate the provision, use, and unmet need of assistive devices for personal mobility in the Swiss population with spinal cord injury (SCI). Design: Community survey 2012 of the Swiss Spinal Cord Injury Cohort Study. Participants: Individuals aged 16 or older with traumatic or non-traumatic SCI residing in Switzerland. Interventions: Not applicable. Outcome Measures: Provision, frequency of use, and unmet need (i.e. perceiving the need of a device but it not being provided) of 11 mobility devices were assessed by self-report and analyzed descriptively. Provision of devices was further analyzed by sex, age, SCI etiology, SCI severity, and time since SCI. Results: Devices reported highest for provision (Nu2009=u2009492; mean age 55.3u2009±u200915.1 years; 28.9% female) were adapted cars (78.2%) and manual wheelchairs (69.9%). Provision of various devices markedly varied with age and SCI severity (e.g. 34.6% of those aged 76+ had a walking frame compared to 3.1% of those aged 31–45; 50.0% of participants with complete tetraplegia had a power wheelchair compared to 7.6% of those with complete paraplegia). Many devices were mostly used daily (e.g. manual wheelchair) while others were mostly used less frequently (e.g. handbikes). Unmet need was highest for arm braces (53.2% of those in need) and power assisted wheelchairs (47.3%), and lowest for crutches (11.4%) and manual wheelchairs (4.8%). Conclusion: The devices individuals have or use is largely dependent on their age and SCI severity. While most participants have access to basic mobility devices, there is still a considerable degree of unmet need for certain devices.

Age-related variation in mobility independence among wheelchair users with spinal cord injury: A cross-sectional study

Objective: To evaluate age-related variation in mobility independence among community-living wheelchair users with spinal cord injury (SCI). Design: Community Survey (2011–2013) as part of the Swiss Spinal Cord Injury Cohort Study. Setting: Community. Participants: Individuals aged 16 years or older with traumatic or non-traumatic SCI permanently residing in Switzerland and using a wheelchair for moving around moderate distances (10–100u2005m). Interventions: Not applicable. Outcome Measures: Mobility-related items of the Spinal Cord Independence Measure-Self Report were matched to the three principal domains “changing basic body position,” “transferring oneself” and “moving around.” Binary outcomes (“independence” vs. “no independence”) were created for every domain and analyzed using multivariable logistic regression (adjusted for sex, socioeconomic factors, SCI characteristics, and health conditions). Results: Regression analyses (Nu2009=u2009949; 27% women; median age 51, interquartile range 41–61) showed a decline in the odds of independence (odds ratio; 95% confidence interval) with increasing age for “changing basic body position” (age 16–30 (reference), 31–45 (0.99; 0.53–1.83), 46–60 (0.64; 0.33–1.21), 61–75 (0.45; 0.22–0.92), 76+ (0.18; 0.07–0.44); Pu2009<u20090.001), “transferring oneself” (age 16–30 (reference), 31–45 (0.77; 0.37–1.61), 46–60 (0.39; 0.18–0.84), 61+ (0.05; 0.02–0.14); Pu2009<u20090.001), and “moving around” (age 16–30 (reference), 31–45 (0.79; 0.42–1.48), 46–60 (0.49; 0.26–0.94), 61–75 (0.49; 0.24–1.01), 75+ (0.11; 0.04–0.30); Pu2009<u20090.001). Conclusions: Mobility independence was negatively associated with age in wheelchair users with SCI. Future longitudinal analyses are required to gain further insights into the causal factors for the age-related decline.

Diurnal profiles of pedometer-determined physical activity in chronically ill and mobility-limited older adults: a cross-sectional study

BackgroundThe aim of this study was to analyze diurnal profiles of physical activity for community-dwelling adults aged 70xa0years and over, and to explore the moderating effect of sex, age, morbidity, mobility limitation, and season on physical activity throughout the day.MethodsA sample of 149 primary health care patients (mean age 79.5u2009±u20095.2xa0years, 74.5% females) was included in the analyses. Participants’ physical activity was measured on up to six consecutive days via Omron Walking Style Pro HJ-720IT-E2 pedometer. Step count per day and per hour, and pedometer wear time were descriptively analyzed. A repeated measures ANOVA with physical activity per hour as dependent variable was performed to analyze the moderating effect of sex, age, morbidity, mobility limitation, and season on diurnal profiles of physical activity. The diurnal profile for the total sample and adjusted diurnal profiles for subgroups are presented.ResultsParticipants’ daily step count averaged 3280u2009±u20091873 steps/day. They wore the pedometer for 14.2u2009±u20091.7xa0hours per day and walked on average 234u2009±u2009139 steps per hour. With respect to diurnal profiles, there were two peaks at 10–11xa0AM (mean [95%-confidence interval]: 382 [329–435] steps) and at 3–4u2009pm (313 [261–365] steps) interrupted by a period of lower activity with a low point at 1–2u2009pm (229 [190–268] steps). A mobility limitation, defined by use of a cane or a rollator, had a significant moderating effect (pu2009=u20090.0237) on diurnal physical activity.ConclusionsThis is the first study to explore pedometer-determined diurnal profiles of physical activity in chronically ill and mobility-limited older adults. Prolonging periods of elevated physical activity in the afternoon while respecting individual daily routine and commitments could be one option for facilitating the integration of physical activity and for making it a habit in older adults’ daily lives. The use of a walking aid seems to be an indicator for a quite low activity plateau during the second half of the day. People who use walking aids should be motivated to increase their physical activity during afternoon; this might help to increase the overall low physical activity level of this vulnerable subgroup of older adults.

Associations with being physically active and the achievement of WHO recommendations on physical activity in people with spinal cord injury

Study Design:Secondary data analysis from the cross-sectional survey of the Swiss Spinal Cord Injury Cohort Study.Objectives:To explore associations with physical activity (PA) levels in people with spinal cord injury (SCI) with the specific aim to identify aspects that potentially explain being physically active (PHYS-ACT) and the achievement of the World Health Organization recommendations on PA.Setting:Community sample (n=485).Methods:Participants who completely answered four items of the Physical Activity Scale for Individuals with Physical Disabilities were included. Two outcome measures were defined: (1) being PHYS-ACT vs being completely inactive and (2) achieving WHO recommendations on PA (ACH-WHO-REC) (at least 2.5u2009h per week of at least moderate intensity) vs performing less. Independent variables were selected from the original questionnaire by applying the ICF framework. Multivariate logistic regression analyses were conducted.Results:In the participants (aged 52.8±14.8; 73.6% male) older age decreased, but being a manual wheelchair user increased the odds of achieving both outcomes. Social support and self-efficacy increased the odds of being PHYS-ACT. Use of an intermittent catheter increased, whereas dependency in self-care mobility and coping with emotions decreased the odds for ACH-WHO-REC. Experiencing hindrances due to accessibility is associated with increased odds for ACH-WHO-REC.Conclusion:Being PHYS-ACT at all and achieving the WHO recommendations on PA are associated with different aspects. Applying the ICF framework contributes to a comprehensive understanding of PA behavior in people with SCI, which can tailor the development of interventions. Longitudinal studies should be initiated to test these associations for causal relationships.

Work-related stress in midlife is associated with higher number of mobility limitation in older age-results from the FLAME study.

The aim of this study is to investigate whether work-related stress symptoms in midlife are associated with a number of mobility limitations during three decades from midlife to late life. Data for the study come from the Finnish Longitudinal Study of Municipal Employees (FLAME). The study includes a total of 5429 public sector employees aged 44–58xa0years at baseline who had information available on work-related stress symptoms in 1981 and 1985 and mobility limitation score during the subsequent 28-year follow-up. Four midlife work-related stress profiles were identified: negative reactions to work and depressiveness, perceived decrease in cognition, sleep disturbances, and somatic symptoms. People with a high number of stress symptoms in 1981 and 1985 were categorized as having constant stress. The number of self-reported mobility limitations was computed based on an eight-item list of mobility tasks presented to the participants in 1992, 1997, and 2009. Data were analyzed using joint Poisson regression models. The study showed that depending on the stress profile, persons suffering from constant stress in midlife had a higher risk of 30–70xa0% for having one more mobility limitation during the following 28xa0years compared to persons without stress after adjusting for mortality, several lifestyle factors, and chronic conditions. A less pronounced risk increase (20–40xa0%) was observed for persons with occasional symptoms. The study suggests that effective interventions aiming to reduce work-related stress should focus on both primary and secondary prevention.