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Journal articles on the topic 'Sci26000'

Author: Grafiati
Published: 28 July 2024
Last updated: 30 July 2024

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1

Michael, Erin, Terin Sytsma, and Rachel E. Cowan. "A Primary Care Provider’s Guide to Wheelchair Prescription for Persons With Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 2 (March 2020): 100–107. http://dx.doi.org/10.46292/sci2602-100.

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The wheelchair is an essential tool for individuals with spinal cord injury (SCI). When the capacity and fit of a wheelchair is matched to the needs and abilities of an individual with SCI, health, function, community participation, and quality of life are maximized. Throughout an individual’s life, function and health status can decline (or improve), necessitating a new wheelchair and/or seating components (eg, cushions and backrests). Additionally, a patient’s current wheelchair may be identified as a factor contributing to a health concern or functional deficit, again necessitating wheelchair adjustments. Primary care physicians often manage the complex and lifelong medical needs of individuals with SCI and play a key role in wheelchair evaluation and prescription. This article provides a broad overview of indicators that a new wheelchair is needed, describes the wheelchair prescription process, identifies important team members, reviews the major wheelchair components, and provides guidance to match components to patients’ needs and abilities.
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2

Milligan, James, Lance L. Goetz, and Michael J. Kennelly. "A Primary Care Provider’s Guide to Management of Neurogenic Lower Urinary Tract Dysfunction and Urinary Tract Infection After Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 2 (March 2020): 108–15. http://dx.doi.org/10.46292/sci2602-108.

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Neurogenic lower urinary tract dysfunction (NLUTD), previously termed neurogenic bladder dysfunction, is a common secondary complication of spinal cord injury (SCI). It is associated with significant morbidity, reduced quality of life, increased health care costs, and mortality. Primary care providers (PCPs) play an important role in optimizing urohealth over the life span. This article will review NLUTD in SCI, its complication, surveillance, and management. PCPs should be aware of SCI-related NLUTD, its complications, management, and surveillance recommendations, and when to refer to a specialist.
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Reyes, Maria Regina L., Mary Jo Elmo, Brandon Menachem, and Sara Mercedes Granda. "A Primary Care Provider’s Guide to Managing Respiratory Health in Subacute and Chronic Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 2 (March 2020): 116–22. http://dx.doi.org/10.46292/sci2602-116.

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Respiratory complications following spinal cord injury (SCI) have remained the leading cause of death across the lifespan and are one of the most common reasons for hospitalization. Complications from altered respiratory physiology after SCI include atelectasis, pneumonia, venous thromboembolic disease, and sleep-disordered breathing. The risk for complications is greater with higher SCI levels and severity, and mortality from pneumonia is heightened compared to the general population. Optimal primary care for individuals with SCI includes appropriate surveillance for SCI-specific respiratory disease, key preventive care including promotion of influenza immunization and respiratory muscle training, and early identification and treatment of pneumonia with institution of aggressive secretion management strategies. The respiratory physiology and specific management of respiratory complications after SCI is reviewed.
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Krassioukov, Andrei, Michael Stillman, and Lisa A. Beck. "A Primary Care Provider’s Guide to Autonomic Dysfunction Following Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 2 (March 2020): 123–27. http://dx.doi.org/10.46292/sci2602-123.

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Spinal cord injury (SCI) disrupts the crucial “crosstalk” between the spinal autonomic nervous system and supraspinal control centers. Therefore, SCI may result not only in motor paralysis but also in potentially life-threatening impairments of many autonomic functions including, but not limited to, blood pressure regulation. Despite the detrimental consequences of autonomic dysregulation, management and recovery of autonomic functions after SCI is greatly underexplored. Although impaired autonomic function may impact several organ systems, this overview will focus primarily on disruptions of cardiovascular and thermoregulation and will offer suggestions for management of these secondary effects of SCI.
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Sadowsky, Cristina L., Nina Mingioni, and Joseph Zinski. "A Primary Care Provider's Guide to Bone Health in Spinal Cord-Related Paralysis." Topics in Spinal Cord Injury Rehabilitation 26, no. 2 (March 2020): 128–33. http://dx.doi.org/10.46292/sci2602-128.

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Individuals with spinal cord injury/disorder (SCI/D) are at high risk for developing secondary osteoporosis. Bone loss after neurologic injury is multifactorial and is dependent on the time from and extent of neurologic injury. Most bone loss occurs in the first year after complete motor paralysis, and fractures occur most commonly in the distal femur and proximal tibia (paraplegic fracture). The 2019 International Society for Clinical Densitometry Position Statement in SCI establishes that dual-energy X-ray absorptiometry (DXA) can be used to both diagnose osteoporosis and predict lower extremity fracture risk in individuals with SCI/D. Pharmacologic treatments used in primary osteoporosis have mixed results when used for SCI/D-related osteoporosis. Ambulation, standing, and electrical stimulation may be helpful at increasing bone mineral density (BMD) in individuals with SCI/D but do not necessarily correlate with fracture risk reduction. Clinicians caring for individuals with spinal cord–related paralysis must maintain a high index of suspicion for fragility fractures and consider referral for surgical evaluation and management.
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Lee, Joseph, Jithin Varghese, Rose Brooks, and Benjamin J. Turpen. "A Primary Care Provider’s Guide to Accessibility After Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 2 (March 2020): 79–84. http://dx.doi.org/10.46292/sci2602-79.

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Individuals with spinal cord injury (SCI) continue to have shorter life expectancies, limited ability to receive basic health care, and unmet care needs when compared to the general population. Primary preventive health care services remain underutilized, contributing to an increased risk of secondary complications. Three broad themes have been identified that limit primary care providers (PCPs) in providing good quality care: physical barriers; attitudes, knowledge, and expertise; and systemic barriers. Making significant physical alterations in every primary care clinic is not realistic, but solutions such as seeking out community partnerships that offer accessibility or transportation and scheduling appointments around an individual’s needs can mitigate some access issues. Resources that improve provider and staff disability literacy and communication skills should be emphasized. PCPs should also seek out easily accessible practice tools (SCI-specific toolkit, manuals, modules, quick reference guides, and other educational materials) to address any knowledge gaps. From a systemic perspective, it is important to recognize community SCI resources and develop collaboration between primary, secondary, and tertiary care services that can benefit SCI patients. Providers can address some of these barriers that lead to inequitable health care practices and in turn provide good quality, patient-centered care for such vulnerable groups. This article serves to assist PCPs in identifying the challenges of providing equitable care to SCI individuals.
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Kuemmel, Angela, Josh Basile, Anne Bryden, Ngozi Ndukwe, and Kelley Brooks Simoneaux. "A Primary Care Provider’s Guide to Social Justice, the Right to Care, and the Barriers to Access After Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 2 (March 2020): 85–90. http://dx.doi.org/10.46292/sci2602-85.

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People living with spinal cord injury (SCI) face numerous barriers to primary care. This article identifies these barriers as social justice issues to emphasize their significance and the inequality of primary care received by people with SCI. Primary care providers have a responsibility to provide equal and accessible care to all patients and to remediate any obstacles to care. Understanding the well-documented barriers of competence, physical, policy and procedural, communication, and attitudes impacting primary care for people with SCI will bring much-needed awareness and opportunity for meaningful change. This article is a call to action for social justice within primary care and provides helpful recommendations for removing and addressing barriers. Better health care outcomes for people with SCI are possible if primary care physicians and providers become social justice advocates for their patients with SCI.
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8

Zebracki, Kathy, Michelle Melicosta, Cody Unser, and Lawrence C. Vogel. "A Primary Care Provider’s Guide to Pediatric Spinal Cord Injuries." Topics in Spinal Cord Injury Rehabilitation 26, no. 2 (March 2020): 91–99. http://dx.doi.org/10.46292/sci2602-91.

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Spinal cord injury (SCI) in youth presents with unique manifestations and complications as compared to adult-onset SCI. The primary care clinician must consider the physical, physiological, cognitive, and psychological changes transpiring during childhood and adolescence. Physical changes include increasing size, weight, and bladder volume. Physiologic considerations include decreasing heart rate and increasing blood pressure with age. Cognitive issues include communication, executive functioning, and self-management skills. Lastly, psychological processes involve emotional functioning and establishment of self-identify and autonomy in the context of life with SCI.
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9

Varghese, Jithin, Kim D. Anderson, Eva Widerström-Noga, and Upender Mehan. "A Primary Care Provider’s Guide to Pain After Spinal Cord Injury: Screening and Management." Topics in Spinal Cord Injury Rehabilitation 26, no. 3 (October 2020): 133–43. http://dx.doi.org/10.46292/sci2603-133.

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Individuals with spinal cord injury (SCI) often experience chronic pain as a secondary complication. It can significantly impair mental health, sleep, mood, and overall quality of life. It is important for providers within a primary care setting to recognize the different types of pain such as nociceptive and neuropathic. Various assessment tools are available to guide proper classification and subsequent management. Providers need to have a good knowledge base, structure, and patient focus when managing care. Nonpharmacological interventions are just as important and should be explored prior to or along with pharmacological interventions. Treatment modalities such as physical therapy, exercise, acupuncture, and cognitive behavioral therapy should be tailored to the individual to the greatest extent possible. Gabapentin, pregabalin, and amitriptyline have been studied extensively and are the first-line pharmacological agents for neuropathic pain. It is important to involve patients as equal stakeholders in any pain intervention with adequate lifelong follow-up. The aim of this article is to offer an overview of pain assessment, information, patient interaction, and treatment options available. Although chronic pain has remained difficult to treat successfully, primary care providers can play an integral role in delivering evidence-based and patient-centered care for managing chronic pain among individuals with SCI.
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Hough, Sigmund, Colleen Clemency Cordes, Lance L. Goetz, Angela Kuemmel, Jesse A. Lieberman, Linda R. Mona, Mitchell S. Tepper, and Jithin G. Varghese. "A Primary Care Provider’s Guide to Sexual Health for Individuals With Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 3 (October 2020): 144–51. http://dx.doi.org/10.46292/sci2603-144.

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The collaboration with individuals regarding their sexual health is an important component of patient-centered health care. However, talking about sexual health in primary care settings is an area not fully addressed as a result of time limitations, medical task prioritization, awareness or knowledge deficit, and discomfort with the topic of sexuality. A critical shift in professional focus from disease and medical illness to the promotion of health and wellness is a prerequisite to address sexual health in the primary care setting. This article provides guidance for practitioners in primary care settings who are caring for persons with spinal cord injury. Clinicians should seize the opportunity during the encounter to reframe the experience of disability as a social construct status, moving away from the narrow view of medical condition and “find it, fix it” to a broader understanding that provides increased access to care for sexual health and sexual pleasure.
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11

Bombardier, Charles H., Sean M. Hurt, and Natalie Peters. "A Primary Care Provider’s Guide to Depression After Spinal Cord Injury: Is It Normal? Do We Treat It?" Topics in Spinal Cord Injury Rehabilitation 26, no. 3 (October 2020): 152–56. http://dx.doi.org/10.46292/sci2603-152.

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Although most people with spinal cord injury (SCI) are emotionally resilient, as a group they are at increased risk of major depressive disorder. Depression tends to be undertreated in people with SCI, perhaps because depression is mistakenly viewed as an expected reaction to severe disability or is confused with grief. Depression and grief are distinguishable, and the Patient Health Questionnaire-9 is a reliable and valid screen for major depression in this population. Major depression can be treated with antidepressants, especially venlafaxine XR, and with psychotherapy, especially cognitive behavioral therapy, focused on helping the person resume activities that were previously enjoyable or meaningful. Structured exercise also may help relieve depressed mood.
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Cabahug, Philippines, Charles Pickard, Travis Edmiston, and Jesse A. Lieberman. "A Primary Care Provider’s Guide to Spasticity Management in Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 3 (October 2020): 157–65. http://dx.doi.org/10.46292/sci2603-157.

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Background: Muscle spasticity is a common sequela of spinal cord injury (SCI) that may impact daily function. Spasticity dynamically varies and is an important physiologic response to illness or other stressors. The challenge for the general practitioner is in recognizing, treating, and developing an effective plan focused on the patient’s individual goals. Objective: To provide the general practitioner with a basic contextual, diagnostic, and therapeutic approach to spasticity management for individuals with neurologic injury such as SCI. Discussion: Muscle spasticity can be disabling and can be managed effectively by using a comprehensive approach. We discuss a representative case and the assessment and planning for individuals with SCI and spasticity. Through an understanding of pathophysiology, careful history taking, and physical exam, a cause for increased spasticity can be identified, such as infection, constipation, or pregnancy. Symptomatology of these triggers is often quite different in the SCI population than in the general population. Management includes the treatment of this causative stressor as well as the thoughtful management of spasticity itself. Conclusion: Muscle spasticity is dynamic and requires a patient-centered approach. The general practitioner can play a key role in recognizing and treating spasticity in an individual with SCI. Comprehensive management to meet patient and caregiver goals involves primary care providers, specialists, and allied health practitioners.
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13

Slocum, Chloe, Molly Halloran, and Cody Unser. "A Primary Care Provider’s Guide to Clinical Needs of Women With Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 3 (October 2020): 166–71. http://dx.doi.org/10.46292/sci2603-166.

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Women are a growing proportion of individuals with SCI and have distinctive health needs spanning the life course that demand deliberate consideration and clinical expertise. Practitioners caring for women with SCI must incorporate broad medical knowledge of SCI physiology and health promotion for women, including differences in complication rates following SCI, and work collaboratively with rehabilitation, medical, and surgical specialists to optimize function and health for women with SCI. Clinical researchers must continue to perform population-based studies to best characterize the evolving needs of women with SCI and evaluate treatment efficacy and care delivery models to best serve this population.
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Durney, Philip, Michael Stillman, Wilda Montero, and Lance Goetz. "A Primary Care Provider’s Guide to Neurogenic Bowel Dysfunction in Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 3 (October 2020): 172–76. http://dx.doi.org/10.46292/sci2603-172.

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Spinal cord injury (SCI) affects the gastrointestinal (GI) tract in several ways, most notably by causing impairment of colonic motility and sphincter dysfunction. Altered GI function in the setting of neurological injury—also known as “neurogenic bowel dysfunction” (NBD) —strongly impacts the quality of life (QOL) of individuals living with SCI. Characterizing the severity of NBD, its impact on an individual’s QOL, and which interventions have been successful or ineffective is integral to the routine care of people living with SCI. Treatment of NBD is generally multimodal and includes attention to diet, pharmacologic and mechanical stimulation, and possibly surgery. This article discusses the pathophysiology of NBD and specific approaches to its management.
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Rosin, Nicole R., Robyn S. Tabibi, John D. Trimbath, and Mary Kristina Henzel. "A Primary Care Provider’s Guide to Prevention and Management of Pressure Injury and Skin Breakdown in People With Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 3 (October 2020): 177–85. http://dx.doi.org/10.46292/sci2603-177.

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Skin breakdown, including burns and pressure injuries (PrIs), is a devastating complication of spinal cord injury (SCI). Chronic wounds place the person with SCI at high risk of infections, sepsis, and death. Skin health and breakdown is individual and multifactorial, thus prevention requires individualized education focused on patient preferences and goals. Assessment requires an accurate description of wound type/PrI stage, location, size, wound bed, wound margin, epithelialization, exudate, and peri-wound condition. PrIs should be staged using the National Pressure Injury Advisory Panel (NPIAP) staging system. Successful treatment requires optimal wound bed preparation, pressure off-loading, and access to surgical specialists if needed. Mattress and seating systems, pressure relief, skin microclimate, nutrition, and home supports should be optimized. To promote wound healing and aid prevention, identifiable causes need to be removed, risk factors improved, and wound care provided. Infection should be treated with input from infectious disease specialists. Consideration for specialized surgical management including flaps and primary closures should be coordinated with the interdisciplinary team to optimize outcomes. If comorbid conditions promote wound chronicity, a palliative rather than curative treatment plan may be needed.
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Mulroy, Sara J., Luke Hafdahl, and Trevor Dyson-Hudson. "A Primary Care Provider’s Guide to Shoulder Pain After Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 3 (October 2020): 186–96. http://dx.doi.org/10.46292/sci2603-186.

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Shoulder pain is a common occurrence after spinal cord injury (SCI) and can have significant negative effects on health and function as many individuals with SCI are reliant on their upper extremities for mobility and self-care activities. Shoulder pain after SCI can be caused by acute injury or chronic pathology, but it is most often related to overuse injuries of the rotator cuff. Both acute strain and chronic overuse shoulder injuries in persons with SCI typically result from increased weight bearing on the upper extremities during transfers, weight-relief raises, and wheelchair propulsion, which are often performed in poor postural alignment owing to strength deficits. This article discusses management of patients with SCI who present with shoulder pain from the perspective of primary care physicians including evaluation and diagnostic procedures, interventions appropriate for both acute and chronic shoulder pain, and strategies for prevention.
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Gater, David R., Craig Bauman, and Rachel Cowan. "A Primary Care Provider’s Guide to Diet and Nutrition After Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 3 (October 2020): 197–202. http://dx.doi.org/10.46292/sci2603-197.

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Physiological changes that occur after spinal cord injury (SCI) are profound and affect almost every organ system in the human body. Energy balance is significantly altered due to motor paralysis, spasticity or flaccidity, neurogenic sarcopenia, neurogenic osteopenia, sympathetic nervous system disruption, and blunted anabolism. Energy expenditure is markedly reduced, whereas hypothalamic control of appetite and satiety is diminished, resulting in discordant energy intake. Ultimately, neurogenic obesity ensues as the result of a positive energy balance. Even though nutritional guidelines for persons with SCI have been available since 2009, the necessity for body composition assessment and total daily energy expenditure was insufficiently addressed such that most individuals with SCI continued in positive energy balance despite “adherence” to the guidelines. Macronutrients must be carefully assessed to optimize caloric intake, while micronutrient consumption may need to be supplemented in order to meet recommended daily allowances. Such a diet would emphasize foods with low caloric yet high nutrient density. This article reviews current literature regarding nutritional requirements for SCI and provides a straightforward plan for implementing more rigorous dietary interventions meant to address the obesity crisis in this especially vulnerable population.
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Stillman, Michael, Savalan Babapoor-Farrokhran, Ronald Goldberg, and David R. Gater. "A Provider’s Guide to Vascular Disease, Dyslipidemia, and Glycemic Dysregulation in Chronic Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 3 (October 2020): 203–8. http://dx.doi.org/10.46292/sci2603-203.

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Individuals with chronic spinal cord injury (SCI) are predisposed to accelerated atherogenesis, dyslipidemia, and glycemic dysregulation, although not enough is known about the etiologies or clinical consequences of these secondary effects of paralysis. While guidelines for the detection and treatment of cardiometabolic disease in SCI have recently been published, there has been a historical paucity of data-driven approaches to these conditions. This article will describe what is and not known about the cardiovascular disease and glycemic dysregulation that frequently attend SCI. It will conclude with a review of both guideline-driven and informal recommendations addressing the clinical care of people living with SCI.
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Milligan, James, Stephen Burns, Suzanne Groah, and Jeremy Howcroft. "A Primary Care Provider’s Guide to Preventive Health After Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 3 (October 2020): 209–19. http://dx.doi.org/10.46292/sci2603-209.

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Objective: Provide guidance for preventive health and health maintenance after spinal cord injury (SCI) for primary care providers (PCPs). Main message: Individuals with SCI may not receive the same preventive health care as the general population. Additionally, SCI-related secondary conditions may put their health at risk. SCI is considered a complex condition associated with many barriers to receiving quality primary care. Attention to routine preventive care and the unique health considerations of persons with SCI can improve health and quality of life and may prevent unnecessary health care utilization. Conclusion: PCPs are experts in preventive care and continuity of care, however individuals with SCI may not receive the same preventive care due to numerous barriers. This article serves as a quick reference for PCPs.
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Ferri-Caruana, Ana, Luís Millán-González, Xavier García-Massó, Soraya Pérez-Nombela, Maite Pellicer-Chenoll, and Pilar Serra-Añó. "Motivation to Physical Exercise in Manual Wheelchair Users With Paraplegia." Topics in Spinal Cord Injury Rehabilitation 26, no. 1 (December 2020): 1–10. http://dx.doi.org/10.1310/sci2601-01.

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Background: Motivation could be considered as a critical factor for being and staying physically active in the spinal cord–injured population. Objectives: Our goals were (1) to describe motivation to exercise in people with paraplegia, comparing those who engage in regular physical exercise with those who do not and (2) to establish whether such motivation is related to the type of physical exercise practiced. Methods: This study was quantitative, cross-sectional descriptive research. One-hundred and six participants with chronic paraplegia completed the Spanish version of the Exercise Motivations Inventory (EMI-2). Participants were divided into the non-exerciser group (NEG) and the exerciser group (EG). EG was subclassified into sports players (SPs) and physical exercisers (PEs). Results: Participants in both EG and NEG presented a similar motivation toward physical exercise. The most important motive to practice or to adhere to exercise in participants with SCI was ill-health avoidance (mean, 8.45; SD, 1.33). Fitness was the second most important motive (ie, nimbleness, flexibility, strength, and endurance). Motives that distinguished EG from NEG included enjoyment and revitalization [ t(41.9) = −2.54, p < .05, r = 0.36], competition [ t(56.8) = 2.24, p < .05, r = 0.28], and health pressure [ t(104) = 3.22, p < .01, r = 0.30]. Furthermore, we found that motivation was related to the type of physical exercise performed. SPs showed a statistically significantly higher score for competition and enjoyment and revitalization than PEs ( p < .05). Conclusion: Ill-health avoidance and fitness are the key motivational factors to practice and adhere to physical exercise. Motivation is related to the type of physical exercise performed. Health providers need to understand these factors to promote and sustain long-term adherence to exercise in the SCI population.
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VanDerwerker, Catherine Jefferson, Yue Cao, Chris M. Gregory, and James S. Krause. "Associations Between Doing Planned Exercise and Probable Major Depressive Disorder in Individuals Following Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 1 (December 2020): 11–20. http://dx.doi.org/10.1310/sci2601-11.

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Background: In neurologically healthy individuals, exercise positively impacts depressive symptoms, but there is limited knowledge regarding the association between exercise behaviors and depression after spinal cord injury (SCI). Objective: To examine associations between doing planned exercise and probable major depressive disorder (PMDD) after SCI. Methods: Community-dwelling adults, who were one or more years post traumatic SCI, completed self-report assessments at baseline (Time 1) and an average of 3.29 years later (Time 2). Patient Health Questionnaire-9 was used to assess depressive symptoms. Participants self-reported frequency of doing planned exercise. There were 1,790 participants who responded at both Time 1 and 2. Associations were analyzed using logistic regression. Results: Prevalence of PMDD was 10% at Time 1 and 12% at Time 2. Only 34% of participants at Time 1 and 29% at Time 2 reported doing planned exercise three or more times per week. The majority of participants (47%) reported no change in frequency of doing planned exercise between Times 1 and 2. Significant risk factors for PMDD at Time 2 included low household income ( p = .0085), poor to fair self-perceived health ( p < .0001), and doing less planned exercise at Time 2 ( p = .0005). Meanwhile, number of years post injury ( p = .04), doing planned exercise three or more times per week at Time 1 ( p = .0042), and doing more planned exercise at Time 2 ( p = .0005) were associated with decreased odds of PMDD at Time 2. Conclusion: These results demonstrate that a negative association exists between doing planned exercise and PMDD post SCI. Future longitudinal studies are needed to further explain these findings.
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Roels, Ellen H., Michiel F. Reneman, Peter W. New, Carlotte Kiekens, Lot Van Roey, Andrea Townson, Giorgio Scivoletto, et al. "International Comparison of Vocational Rehabilitation for Persons With Spinal Cord Injury: Systems, Practices, and Barriers." Topics in Spinal Cord Injury Rehabilitation 26, no. 1 (December 2020): 21–35. http://dx.doi.org/10.1310/sci2601-21.

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Background: Employment rates among people with spinal cord injury or spinal cord disease (SCI/D) show considerable variation across countries. One factor to explain this variation is differences in vocational rehabilitation (VR) systems. International comparative studies on VR however are nonexistent. Objectives: To describe and compare VR systems and practices and barriers for return to work in the rehabilitation of persons with SCI/D in multiple countries. Methods: A survey including clinical case examples was developed and completed by medical and VR experts from SCI/D rehabilitation centers in seven countries between April and August 2017. Results: Location (rehabilitation center vs community), timing (around admission, toward discharge, or after discharge from clinical rehabilitation), and funding (eg, insurance, rehabilitation center, employer, or community) of VR practices differ. Social security services vary greatly. The age and preinjury occupation of the patient influences the content of VR in some countries. Barriers encountered during VR were similar. No participant mentioned lack of interest in VR among team members as a barrier, but all mentioned lack of education of the team on VR as a barrier. Other frequently mentioned barriers were fatigue of the patient (86%), lack of confidence of the patient in his/her ability to work (86%), a gap in the team's knowledge of business/legal aspects (86%), and inadequate transportation/accessibility (86%). Conclusion: VR systems and practices, but not barriers, differ among centers. The variability in VR systems and social security services should be considered when comparing VR study results.
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McIntyre, Amanda, Stephanie L. Marrocco, Samantha A. McRae, Lindsay Sleeth, Sander Hitzig, Susan Jaglal, Gary Linassi, Sarah Munce, and Dalton L. Wolfe. "A Scoping Review of Self-Management Interventions Following Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 1 (December 2020): 36–63. http://dx.doi.org/10.1310/sci2601-36.

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Objective: To conduct a scoping review to identify what components of self-management are embedded in self-management interventions for spinal cord injury (SCI). Methods: In accordance with the approach and stages outlined by Arksey and O'Malley (2005), a comprehensive literature search was conducted using five databases. Study characteristics were extracted from included articles, and intervention descriptions were coded using Practical Reviews in Self-Management Support (PRISMS) (Pearce et al, 2016), Barlow et al (2002), and Lorig and Holman's (2003) taxonomy. Results: A total of 112 studies were included representing 102 unique self-management programs. The majority of the programs took an individual approach (52.0%) as opposed to a group (27.4%) or mixed approach (17.6%). While most of the programs covered general information, some provided specific symptom management. Peers were the most common tutor delivering the program material. The most common Barlow components included symptom management ( n = 44; 43.1%), information about condition/treatment ( n = 34; 33.3%), and coping ( n = 33; 32.4%). The most common PRISMS components were information about condition and management ( n = 85; 83.3%), training/rehearsal for psychological strategies ( n = 52; 51.0%), and lifestyle advice and support ( n = 52; 51.0%). The most common Lorig components were taking action ( n = 62; 60.8%), resource utilization ( n = 57; 55.9%), and self-tailoring ( n = 55; 53.9%). Conclusion: Applying self-management concepts to complex conditions such as SCI is only in the earliest stages of development. Despite having studied the topic from a broad perspective, this review reflects an ongoing program of research that links to an initiative to continue refining and testing self-management interventions in SCI.
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Beaudoin, Maude, Krista L. Best, François Routhier, Lynda Atack, Sander L. Hitzig, and Dahlia Kairy. "Usability of the Participation and Quality of Life (PAR-QoL) Outcomes Toolkit Website for Spinal Cord Injury." Topics in Spinal Cord Injury Rehabilitation 26, no. 1 (December 2020): 64–77. http://dx.doi.org/10.1310/sci2601-64.

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Background: Quality of life (QoL) is an important parameter to monitor during rehabilitation; however, accurate assessment is challenging. Among individuals with spinal cord injury (SCI), assessing QoL is further challenged due to complex sequelae, such as secondary health conditions and factors related to community integration. A Participation and Quality of Life (PAR-QoL) toolkit was created to aid clinicians and researchers in the selection of QoL outcomes tools specific to SCI. Objectives: The aim of this study was to evaluate the use and usability of the PAR-QoL toolkit. Methods: A cross-sectional study was conducted using an online survey from December 2013 to November 2016. Google Analytics were collected from April 2012 to April 2018. Survey sections addressed “use” (behavioral practices and actual use) and “usability” (perceived ease of use and perceived usefulness). Any person who visited the PAR-QoL website was invited to complete the survey. Summary statistics and percent concordances were calculated to describe results from the survey and Google Analytics. Results: The PAR-QoL website had 188,577 users. The five most visited webpages were outcome tools, with bounce rates ranging from 77% to 90%. Of the 46 survey respondents, 67% were not current users of the PAR-QoL website, and 87% intended to use the resources in the future. Conclusion: Uptake of the PAR-QoL website is currently limited. Usability of the PAR-QoL website may be improved by modifying navigation, removing the “less useful” components, ensuring regular updates of content and resources, and promoting the website.
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Aluce, Laurie M., Julie J. Cooper, Lillian L. Emlet, Simon J. Ostrowski, Elaine R. Cohen, Gordon J. Wood, and Julia H. Vermylen. "Virtual Simulation-Based Mastery Learning Ensures Competence in Breaking Bad News for Emergency Medicine Residents: A Multi-Institutional Study (Sci260)." Journal of Pain and Symptom Management 65, no. 5 (May 2023): e672-e673. http://dx.doi.org/10.1016/j.jpainsymman.2023.02.310.

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