Describing Functioning in People Living With Spinal Cord Injury Across 22 Countries: A Graphical Modeling Approach

Ehrmann C 1 , Reinhardt JD 2 , Joseph C 3 , Hasnan N 4 , Perrouin-Verbe B 5 , Tederko P 6 Show all authors , Zampolini M 7 , InSCI , Stucki G 8

Affiliations 

  • 1 Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
  • 2 Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Institute for Disaster Management and Reconstruction, Sichuan University and Hong Kong Polytechnic University, Chengdu, China. Electronic address: jan.reinhardt@paraplegie.ch
  • 3 Division of Physiotherapy, Stellenbosch University, Stellenbosch, South Africa; Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
  • 4 University Hospital of Nantes, St Jacques Hospital, Nantes, France
  • 5 Department of Rehabilitation Medicine, University of Malaya, Kuala Lumpur, Malaysia
  • 6 Department of Rehabilitation, 1st Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
  • 7 Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, Perugia, Italy
  • 8 Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland; Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland; Center for Rehabilitation in Global Health Systems, WHO Collaborating Center, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
Arch Phys Med Rehabil, 2020 12;101(12):2112-2143.
PMID: 32980339 DOI: 10.1016/j.apmr.2020.09.374

Abstract

OBJECTIVE: To provide prevalence estimates for problems in functioning of community-dwelling persons with spinal cord injury (SCI) and to examine associations between various areas of functioning with the purpose of supporting countries in identifying targets for interventions.

DESIGN: Cross-sectional survey.

SETTING: Community, 22 countries including all World Health Organization regions.

PARTICIPANTS: Persons (N=12,591) with traumatic or nontraumatic SCI aged 18 years or older.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: We estimated the prevalence of problems in 53 areas of functioning from the Brief International Classification of Functioning, Disability and Health (ICF) core set for SCI, long-term context, or ICF rehabilitation set covering 4 domains: impairments in body functions, impairments in mental functions, independence in performing activities, and restrictions in participation. Associations between areas of functioning were identified and visualized using conditional independence graphs.

RESULTS: Participants had a median age of 52 years, 73% were male, and 63% had paraplegia. Feeling tired, bowel dysfunction, sexual functions, spasticity, pain, carrying out daily routine, doing housework, getting up off the floor from lying on the back, pushing open a heavy door, and standing unsupported had the highest prevalence of problems (>70%). Clustering of associations within the 4 functioning domains was found, with the highest numbers of associations within impairments in mental functions. For the whole International Spinal Cord Injury sample, areas with the highest numbers of associations were circulatory problems, transferring bed-wheelchair, and toileting, while for the World Health Organization European and Western Pacific regions, these were dressing upper body, transferring bed-wheelchair, handling stress, feeling downhearted and depressed, and feeling happy.

CONCLUSIONS: In each domain of functioning, high prevalence of problems and high connectivity of areas of functioning were identified. The understanding of problems and the identification of potential targets for intervention can inform decision makers at all levels of the health system aiming to improve the situation of people living with SCI.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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