The Journal of Spinal Cord Medicine最新文献

{"title":"Effect of the Affordable Care Act on healthcare utilization for Veterans with spinal cord injuries and disorders.","authors":"Rachael N Martinez,&nbsp;Bridget M Smith,&nbsp;Dustin D French,&nbsp;Timothy P Hogan,&nbsp;Beverly Gonzalez,&nbsp;Chad M Osteen,&nbsp;Maya Hatch,&nbsp;Vicki Anderson,&nbsp;Elizabeth Tarlov,&nbsp;Abigail Silva,&nbsp;Barry Goldstein,&nbsp;Kevin T Stroupe","doi":"10.1080/10790268.2020.1829419","DOIUrl":"https://doi.org/10.1080/10790268.2020.1829419","url":null,"abstract":"<p><p><b>Context/Objective:</b> Provisions of the Affordable Care Act (ACA) potentially increase insurance options for Veterans with disabilities. We examined Veterans with spinal cord injuries and disorders (SCI/D) to assess whether the ACA was associated with changes in healthcare utilization from Department of Veterans Affairs (VA) healthcare facilities.<b>Design:</b> Using national VA data, we investigated impacts on VA healthcare utilization pre- (2012/13) and post-ACA (2014/15) implementation with negative binomial regression models.<b>Setting:</b> VA healthcare facilities.<b>Participants:</b> 8,591 VA users with SCI/D. Veterans with acute myelitis, Guillain-Barré syndrome, multiple sclerosis, or amyotrophic lateral sclerosis were excluded as were patients who died during the study period.<b>Interventions:</b> We assessed VA healthcare utilization before and after ACA implementation.<b>Outcome Measures:</b> Total numbers of VA visits for SCI/D care, diagnostic care, primary care, specialty care, and mental health care, and VA admissions.<b>Results:</b> The number of VA admissions was 7% higher in the post than pre-ACA implementation period (P < 0.01). The number of VA visits post-implementation increased for SCI/D care (8%; P < 0.01) and specialty care (12%; P < 0.001). Conversely, the number of mental health visits was 17% lower in the post-ACA period (P < 0.001). Veterans with SCI/D who live <5 miles from their nearest VA facility received VA care more frequently than those ≥40 miles from VA (P < 0.001).<b>Conclusion:</b> Counter to expectations, results suggest that Veterans with SCI/D sought more frequent VA care after ACA implementation, indicating Veterans with SCI/D continue to utilize the lifelong, comprehensive care provided at VA.</p>","PeriodicalId":501560,"journal":{"name":"The Journal of Spinal Cord Medicine","volume":" ","pages":"575-584"},"PeriodicalIF":1.7,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/10790268.2020.1829419","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38519008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Nutrition counseling and monitoring via tele-nutrition for healthy diet for people with spinal cord injury: A case series analyses.","authors":"Shelley Wood,&nbsp;Cria-May Khong,&nbsp;Benjamin Dirlikov,&nbsp;Kazuko Shem","doi":"10.1080/10790268.2021.1871824","DOIUrl":"https://doi.org/10.1080/10790268.2021.1871824","url":null,"abstract":"<p><strong>Objective: </strong>To evaluate the effect of a tele-nutrition counseling program on diet quality, weight, waist circumference, and quality of life in people with spinal cord injury (SCI).</p><p><strong>Design: </strong>Prospective observational study.</p><p><strong>Participants: </strong>Fifteen participants with SCI were enrolled from an acute inpatient rehabilitation unit and outpatient SCI clinic; ten participants completed the intervention.</p><p><strong>Interventions: </strong>Six tele-nutrition counseling sessions over 3 months, utilizing videoconferencing and a photographic food diary.</p><p><strong>Outcome measures: </strong>Weight, waist circumference, Life Satisfaction Index A (LSIA), Knowledge and Nutrition Evaluation with Supplement on Eating Behavior, and Program Satisfaction Survey (PSS).</p><p><strong>Results: </strong>Ten participants completed both baseline and 3-month follow-up evaluations and were used in this analysis. There were no statistically significant changes from baseline to 3-month follow up in weight, waist circumference, Knowledge and Nutrition Evaluation, and LSIA (P > .48). Using the Supplement on Eating Behavior total score to measure overall changes in healthy food choices, 9 out of 10 participants rated their healthy food choices as improving (P = .008). A post-hoc exploratory itemized analysis on the Supplement on Eating Behavior revealed significant improvements from baseline to 3-month follow-up in participant's self-reported choice of balanced meals (P = .008), reading food labels (P = .031), logging meals (P = .007), and monitoring portions of eating favorite foods (P = .031). Participants endorsed a 97-100% satisfaction rating in relation to perceived health benefits, equipment, and program satisfaction.</p><p><strong>Conclusion: </strong>This study provides preliminary data suggesting that tele-nutrition is an efficacious intervention that may improve diet quality for individuals with SCI.</p>","PeriodicalId":501560,"journal":{"name":"The Journal of Spinal Cord Medicine","volume":" ","pages":"547-555"},"PeriodicalIF":1.7,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/10790268.2021.1871824","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25385413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"User-centered design and development of a trunk control device for persons with spinal cord injury: A pilot study.","authors":"John M Looft,&nbsp;Robert Sjoholm,&nbsp;Andrew H Hansen,&nbsp;Stuart Fairhurst,&nbsp;Greg Voss,&nbsp;Clifford A Dellamano,&nbsp;Jason Egginton,&nbsp;Christine Olney,&nbsp;Gary Goldish","doi":"10.1080/10790268.2020.1863897","DOIUrl":"https://doi.org/10.1080/10790268.2020.1863897","url":null,"abstract":"<p><strong>Context/objective: </strong>There are no wheelchair products designed to allow users to dynamically control trunk posture to both significantly improve functional reach and provide pressure relief during forward lean. This pilot study sought to (1) gather stakeholder desires regarding necessary features for a trunk control system and (2) subsequently develop and pilot test a first-generation trunk control prototype.</p><p><strong>Design: </strong>Multi-staged mixed methods study design.</p><p><strong>Setting: </strong>Minneapolis VA Health Care System, Minneapolis, MN.</p><p><strong>Participants: </strong>Eight people with spinal cord injuries were recruited to participate in a focus group<b>.</b> Five participants returned to discuss, rate, and select a design concepts for prototype development. Two participants returned to test the first-generation trunk control prototype.</p><p><strong>Interventions: </strong>The focus group members selected a trunk control device design that uses backpack straps with a single cable as the most desired option. Our design team then manufactured the first-generation prototype at the Minneapolis VA.</p><p><strong>Outcome measures: </strong>Bimanual workspace capabilities (<i>n </i>= 1) and pressure map relief changes (<i>n </i>= 2) during supported forward lean were measured. Both participants also provided feedback on the trunk control devices usability.</p><p><strong>Results: </strong>Bimanual workspace (for Participant 1) was increased by 311% in the sagittal plane with use of the trunk control device as compared to without. Pressure relief during a forward lean was increased with an overall dispersion index reduction of 87.6% and 27.7% for Participant 1 and Participant 2 respectfully.</p><p><strong>Conclusion: </strong>This pilot study successfully elicited desired features for a trunk control device from stakeholders and successfully developed and tested a first-generation trunk control prototype.</p>","PeriodicalId":501560,"journal":{"name":"The Journal of Spinal Cord Medicine","volume":" ","pages":"585-594"},"PeriodicalIF":1.7,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/10790268.2020.1863897","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25464231","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Effects of trunk muscle activation on trunk stability, arm power, blood pressure and performance in wheelchair rugby players with a spinal cord injury.","authors":"Ingrid Kouwijzer,&nbsp;Mathijs van der Meer,&nbsp;Thomas W J Janssen","doi":"10.1080/10790268.2020.1830249","DOIUrl":"https://doi.org/10.1080/10790268.2020.1830249","url":null,"abstract":"<p><p><b>Objective:</b> In wheelchair rugby (WR) athletes with tetraplegia, wheelchair performance may be impaired due to (partial) loss of innervation of upper extremity and trunk muscles, and low blood pressure (BP). The objective was to assess the effects of electrical stimulation (ES)-induced co-contraction of trunk muscles on trunk stability, arm force/power, BP, and WR performance.<b>Design:</b> Cross-sectional study.<b>Setting:</b> Rehabilitation research laboratory and WR court.<b>Participants:</b> Eleven WR athletes with tetraplegia.<b>Interventions:</b> ES was applied to the rectus abdominis, obliquus externus abdominis and erector spinae muscles. For every test, the ES condition was compared to the non-ES condition.<b>Outcome measures:</b> Stability was assessed with reaching tasks, arm force/power with an isokinetic test on a dynamometer, BP during an ES protocol and WR skill performance with the USA Wheelchair Rugby Skill Assessment.<b>Results:</b> Overall reaching distance (ES 14.6 ± 7.5 cm, non-ES 13.4 ± 8.2 cm), and BP showed a significant increase with ES. Arm force (ES 154 ± 106 N, non-ES 148 ± 102 N) and power (ES 37 ± 26 W, non-ES 36 ± 25 W), and WR skills were not significantly improved.<b>Conclusion:</b> ES-induced trunk muscle activation positively affects trunk stability and BP, but not arm force/power. No effects were found in WR skill performance, probably due to abdominal strapping. More research is needed to assess different ES (training) protocols and longitudinal effects.</p>","PeriodicalId":501560,"journal":{"name":"The Journal of Spinal Cord Medicine","volume":" ","pages":"605-613"},"PeriodicalIF":1.7,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/10790268.2020.1830249","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38580407","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outcomes of the five times sit<b>-</b>to<b>-</b>stand test could determine lower limb functions of ambulatory people with spinal cord injury only when assessed without hands.","authors":"Lalita Khuna,&nbsp;Supaporn Phadungkit,&nbsp;Thiwabhorn Thaweewannakij,&nbsp;Pipatana Amatachaya,&nbsp;Sugalya Amatachaya","doi":"10.1080/10790268.2020.1803658","DOIUrl":"https://doi.org/10.1080/10790268.2020.1803658","url":null,"abstract":"<p><p><b>Context/Objectives:</b> Various clinical application of the five times sit-to-stand test (FTSST), with or without hands, may confound the outcomes to determine the lower limb functions and mobility of individuals with spinal cord injury (SCI). This study assessed the concurrent validity of the FTSST in ambulatory individuals with SCI who completed the test with or without hands as verified using standard measures for lower extremity motor scores (LEMS) and functional mobility necessary for independence and safety of these individuals.<b>Design:</b> Cross-sectional study.<b>Setting:</b> Tertiary rehabilitation centers and community hospitals.<b>Participants:</b> Fifty-six ambulatory individuals with motor incomplete SCI who were able to walk independently with or without a walking device over at least 10 m.<b>Outcome Measures:</b> Time to complete the FTSST with or without hands according to individuals' abilities, LEMS, and functional mobility.<b>Results:</b> Time to complete the FTSST showed moderate-to-strong correlation with the LEMS scores and all functional mobility tests (<i>ρ</i> = -0.38 to -0.71, P < 0.05), but only in those who performed the test without hands. By contrast, data of those who completed the FTSST with hands were significantly correlated only with the ankle muscle strength and the functional mobility measures that allow upper limb contribution in the tests (<i>ρ</i> = -0.40 to 0.52, P < 0.05).<b>Conclusion:</b> Upper limb involvement could confound the outcomes of the FTSST. The present findings suggest the use of FTSST without hands to determine the lower limb functions of ambulatory individuals with SCI.</p>","PeriodicalId":501560,"journal":{"name":"The Journal of Spinal Cord Medicine","volume":" ","pages":"402-409"},"PeriodicalIF":1.7,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/10790268.2020.1803658","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38276040","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Community organization factors affecting veteran participation in adaptive sports.","authors":"Zachariah G Whiting,&nbsp;David Falk,&nbsp;Jonathan Lee,&nbsp;Beth Weinman,&nbsp;Jesse M Pines,&nbsp;Kenneth Lee","doi":"10.1080/10790268.2020.1803657","DOIUrl":"https://doi.org/10.1080/10790268.2020.1803657","url":null,"abstract":"<p><p><b>Objective:</b> This study aims to describe United States military veteran participation in adaptive sports and to assess the demographic make-up and organizational characteristics of existing adaptive sports programs.<b>Design:</b> Prospective, cross-sectional survey.<b>Setting:</b> Community organizations with adaptive sports programs.<b>Participants:</b> 85 adaptive sports programs.<b>Interventions:</b> Nine question survey.<b>Outcome Measures:</b> Demographic data and sports offered by adaptive sports programs in the United States.<b>Results:</b> The survey response rate was 70%. The median number of total participants in an organization was 75 and the median number of veterans was 50. 76% of organizations had some degree of affiliation with a VAMC. Organizations affiliated with a VAMC are more likely to be rehabilitation centers, whereas community organizations with no VAMC affiliation are most commonly independent organizations with no rehabilitation component. Individuals of all ages participate in adaptive sports, with increasing participation associated with increasing age. Golf was the sport offered most commonly by adaptive sports programs in this survey. Low-contact sports were offered more often than high-contact sports, and the majority of programs offered adaptive sports year-round.<b>Conclusions:</b> Our results suggest that U.S. Military veterans represent a large proportion of the individuals participating in adaptive sports. Further research specifically focusing on factors veterans find desirable when considering participating in adaptive sports is indicated to identify programs that should be promoted, developed, and funded to increase veteran participation in adaptive sports.</p>","PeriodicalId":501560,"journal":{"name":"The Journal of Spinal Cord Medicine","volume":" ","pages":"395-401"},"PeriodicalIF":1.7,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/10790268.2020.1803657","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38284877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Frequency of turning in bed at home in persons with chronic spinal cord injury.","authors":"Fatma Eren, Robert DeLuca, Steven Kirshblum","doi":"10.1080/10790268.2020.1800965","DOIUrl":"10.1080/10790268.2020.1800965","url":null,"abstract":"<p><p><b>Objective:</b> To determine the routine turning frequency of persons with chronic spinal cord injury (SCI) in bed at night in their home environment.<b>Design:</b> An online questionnaire consisting of 22 questions.<b>Setting:</b> Free standing SCI rehabilitation facility.<b>Participants:</b> Persons between ages 18-75 with a traumatic SCI for ≥3 months, and living at home.<b>Interventions:</b> None.<b>Outcome measures:</b> Questionnaire-based evaluation of turning frequency of persons with SCI.<b>Results:</b> 86 subjects (70 men) with traumatic SCI completed the survey; 66.3% with tetraplegia and 41.9% with a neurological complete SCI. Almost every participant (96%) recalled being counseled on the importance of turning in bed at night upon discharge from their rehabilitation facility with 48.4% recalling the frequency recommended as every 2 h. At present, 25.6% of subjects reported turning every 2 h, 15.1% every 3 h, 15.1% every 4 h, 3.5% every 6 h, and 40.7% of respondents stated that they do not turn regularly at night.<b>Conclusion:</b> Although frequently recommended for repositioning at night in bed every two hours for persons with chronic SCI, especially for those at risk for pressure injuries, only 25.6% of individuals report turning at this frequency and 40.7% report not turning at night time regularly. The reasons for limited turning may be multi-factorial, however, this finding may serve as a call to practitioners to best determine the most appropriate turning frequency that can meet compliance of the individual with SCI, as well as maintain skin protection in the chronic period after injury.</p>","PeriodicalId":501560,"journal":{"name":"The Journal of Spinal Cord Medicine","volume":" ","pages":"390-394"},"PeriodicalIF":0.0,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9135412/pdf/YSCM_45_1800965.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38284324","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Benefits and interval training in individuals with spinal cord injury: A thematic review.","authors":"David R Dolbow,&nbsp;Glen M Davis,&nbsp;Michael Welsch,&nbsp;Ashraf S Gorgey","doi":"10.1080/10790268.2021.2002020","DOIUrl":"https://doi.org/10.1080/10790268.2021.2002020","url":null,"abstract":"<p><strong>Background: </strong>Arm crank ergometry (ACE), functional electrical stimulation leg cycling exercise (FES-LCE), and the combination of the two (FES hybrid exercise) have all been used as activities to help improve the fitness-related health of individuals with spinal cord injury (SCI). More recently, high-intensity interval training (HIIT) has become popular in the non-disabled community due to its ability to produce greater aerobic fitness benefits or equivalent benefits with reduced time commitment.</p><p><strong>Objective: </strong>This thematic review of the literature sought to determine the potential benefits and practicality of using ACE, FES-LCE, and FES hybrid exercise in an interval training format for individuals with SCI.</p><p><strong>Methods: </strong>Systematic literature searches were conducted in May 2020 and March 2021 focusing on interval training in individuals with SCI. Pre-defined nested search terms were used to narrow the available literature from 4273 citations to 1362 articles. The titles and abstracts were then reviewed to determine the appropriateness of the articles ending with fifteen articles.</p><p><strong>Results: </strong>The literature was limited to fifteen articles with low participant numbers (n = 1-20). However, in each article, HIIT protocols either demonstrated a greater improvement in cardiovascular, metabolic, or practicality scores compared to moderate intensity continuous training (MICT) protocols, or improvement during relatively brief time commitments.</p><p><strong>Conclusion: </strong>The available literature lacked sufficient numbers of randomized control trials. However, the available evidence is encouraging concerning the potential benefits and practicality of using HIIT (ACE, FES-LCE, or FES hybrid exercise) to improve aerobic and anaerobic capacity and decrease cardiometabolic risk after SCI.</p>","PeriodicalId":501560,"journal":{"name":"The Journal of Spinal Cord Medicine","volume":" ","pages":"327-338"},"PeriodicalIF":1.7,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9135438/pdf/YSCM_45_2002020.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39685008","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal arachnoiditis leading to recurrent reversible myelopathy: A case report.","authors":"Erol Jahja,&nbsp;Charles Sansur,&nbsp;Peter Howard Gorman","doi":"10.1080/10790268.2020.1830250","DOIUrl":"https://doi.org/10.1080/10790268.2020.1830250","url":null,"abstract":"<p><p><b>Context</b>: A patient followed in the outpatient spinal cord injury support clinic at a VA Medical Center with a prior remote history of a gunshot wound to the back and multiple prior myelograms presented with a recurrent waxing and waning weakness of the left lower extremity and intermittent incontinence of bowel and bladder.<b>Findings</b>: During the evaluation, the patient experienced an immediate albeit temporary improvement in symptoms after a diagnostic lumbar puncture performed for CT myelogram. The symptoms of myelopathy reoccurred several weeks, but then the patient had a similar experience with rapid improvement in symptoms after an accidental fall down a flight of steps. Subsequently, the foot weakness and incontinence returned one week later. The patient ultimately developed permanent improvement in signs and symptoms after surgical intervention which included intradural lysis of adhesions, incision of the arachnoid membrane and resection of a cystic lesion.<b>Clinical relevance</b>: Patients who experience unexpected, albeit transient improvement in myelopathic symptoms who are known or suspected to have arachnoiditis should be evaluated for surgically remediable lesions. Remediation of these lesions can potentially improve long term outcome.</p>","PeriodicalId":501560,"journal":{"name":"The Journal of Spinal Cord Medicine","volume":" ","pages":"472-475"},"PeriodicalIF":1.7,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/10790268.2020.1830250","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38677137","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Limb loss in individuals with chronic spinal cord injury.","authors":"Jelena Svircev,&nbsp;Debbie Tan,&nbsp;Ashley Garrison,&nbsp;Brent Pennelly,&nbsp;Stephen P Burns","doi":"10.1080/10790268.2020.1800964","DOIUrl":"https://doi.org/10.1080/10790268.2020.1800964","url":null,"abstract":"<p><p><b>Objective</b>: The purpose of this study is to describe a population of individuals with chronic spinal cord injury (SCI), who underwent lower limb amputations, identify indications for amputations, medical co-morbidities and summarize resulting complications and functional changes.<b>Design</b>: Retrospective observational cohort study.<b>Setting:</b> SCI Service, Department of Veterans Affairs (VA) Health Care System.<b>Participants</b>: Veterans with SCI of greater than one-year duration who underwent amputation at a VA Medical Center over a 15-year period, using patient registry and electronic health records. Diagnosis and procedure codes were utilized to identify amputations.<b>Interventions</b>: Not applicable.<b>Outcome measures</b>: Amputation level, complications, functional status, change in prescribed mobility equipment and mortality.<b>Results</b>: 52 individuals with SCI received amputation surgery with a mean age of 62.9 years at time of amputation. Thirty-seven (71.2%) had paraplegia, and 34 (65.3%) had motor-complete SCI. Pressure injuries and osteomyelitis were most common indications for amputation. Amputations were primarily (83%) at the transtibial level or more proximal, with the most common amputation level at transfemoral/through-knee (29;55.8%). Postoperative complications occurred in five individuals. Seven of nine individuals who were ambulatory pre-surgery remained ambulatory. Equipment modifications were required in 37 (71%) of individuals. Five-year survival following amputations was 52%, and presence of peripheral vascular disease was significantly associated with mortality (P = 0.006).<b>Conclusions</b>: Pressure injuries and osteomyelitis were most common etiologies for limb loss. Less than half experienced functional change after amputation; more than half required new or modified mobility equipment. An increase in mortality may reflect overall health deterioration over time.</p>","PeriodicalId":501560,"journal":{"name":"The Journal of Spinal Cord Medicine","volume":" ","pages":"420-425"},"PeriodicalIF":1.7,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1080/10790268.2020.1800964","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38273658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}