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Study design:This is a retrospective analysis.Objectives:The objective of this study was to describe and quantify the discrepancy in the classification of the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) by clinicians versus a validated computational algorithm.Settings:European Multicenter Study on Human Spinal Cord Injury (EMSCI).Methods:Fully documented ISNCSCI data sets from EMSCI's first years (2003-2005) classified by clinicians (mostly spinal cord medicine residents, who received in-house ISNCSCI training by senior SCI physicians) were computationally reclassified. Any differences in the scoring of sensory and motor levels, American Spinal Injury Association Impairment Scale (AIS) or the zone of partial preservation (ZPP) were quantified.Results:Four hundred and twenty ISNCSCI data sets were evaluated. The lowest agreement was found in motor levels (right: 62.1%, P=0.002; left: 61.8%, P=0.003), followed by motor ZPP (right: 81.6%, P=0.74; left 80.0%, P=0.27) and then AIS (83.4%, P=0.001). Sensory levels and sensory ZPP showed the best concordance (right sensory level: 90.8%, P=0.66; left sensory level: 90.0%, P=0.30; right sensory ZPP: 91.0%, P=0.18; left sensory ZPP: 92.2%, P=0.03). AIS B was most often misinterpreted as AIS C and vice versa (AIS B as C: 29.4% and AIS C as B: 38.6%).Conclusion:Most difficult classification tasks were the correct determination of motor levels and the differentiation between AIS B and AIS C/D. These issues should be addressed in upcoming ISNCSCI revisions. Training is strongly recommended to improve classification skills for clinical practice, as well as for clinical investigators conducting spinal cord studies.Sponsorship:This study is partially funded by the International Foundation for Research in Paraplegia, Zurich, Switzerland. [ABSTRACT FROM AUTHOR]

Study design:Mixed methods study design.Objectives:The Work Rehabilitation Questionnaire-Self-Report Version (WORQ-SELF) is an assessment tool based on the International Classification of Functioning, Disability and Health (ICF) developed to evaluate functioning in different patient populations in vocational rehabilitation (VR) settings. The objective of this study is to establish the content validity of WORQ-SELF in a subgroup of spinal cord injury (SCI) patients in the early post-acute context.Setting:Swiss Paraplegic Research and Swiss Paraplegic Centre, Nottwil, Switzerland.Methods:Contents of WORQ-SELF were compared with semi-guided interviews with SCI patients in Switzerland, the Comprehensive ICF Core Set for SCI early post-acute, and outcome instruments used in VR and SCI. A frequency analysis was performed.Results:WORQ-SELF represented 46 different ICF categories and of these 37 categories were confirmed by the patient interviews. The Comprehensive ICF Core Set for SCI confirmed 25 categories. Four instruments used in VR and SCI setting were identified. Contents of those instruments confirmed 14 categories of WORQ-SELF. Overall, 26 categories of the WORQ-SELF were confirmed by at least 2 of the 3 sources, 13 categories by 1 source and 7 were not confirmed by any of the sources.Conclusion:The WORQ-SELF proved to have content validity for utility in patients with SCI within the context of VR. WORQ-SELF can be used to assess the functioning and disability of patients in the return to work process. [ABSTRACT FROM AUTHOR]

Study design:Randomized, within-in participant cross-over study.Objective:The purpose of this study was to determine the effect on comfort and pressure of lying with the shoulders and bed in different positions for people with tetraplegia.Setting:Rehabilitation hospital.Methods:Twenty people with tetraplegia were tested lying supine with the shoulders and bed in seven different positions. The positions used a combination of three arm and two bed positions. Six of the positions reflected what is commonly recommended in acute spinal cord injury units including a crucifix-type position. The seventh position was selected by participants and reflected their preferred sleeping position. There were five outcomes: general comfort, shoulder comfort, participant choice of preferred position, peak pressure under the shoulders and areal pressure under the shoulders. Pressure was measured using a pressure mapping system and comfort using a visual analogue scale (VAS).Results:The participants reported significantly higher (P<0.01) general comfort and shoulder comfort in their self-selected position compared with all other positions. There was no statistical difference in peak pressure (P=0.15) or areal pressure (P=0.08) under the shoulders between the seven positions. Most participants indicated that they preferred to lie with their shoulders adducted and internally rotated and the hands either by their sides or on their stomachs.Conclusion:The position of the shoulders has little effect on pressure but a notable effect on comfort. Participants preferred to sleep with their arms beside their bodies, not with their arms in a crucifix position as commonly advocated. [ABSTRACT FROM AUTHOR]

Study design:A multi-centre cross-sectional study.Objective:To examine the relationship of self-efficacy and self-esteem with participation of persons with spinal cord injury (SCI) from a comprehensive bio-psycho-social perspective, based on the conceptual framework of the International Classification of Functioning, Disability and Health (ICF).Setting:Community-dwelling participants, <5 years post discharge, recruited through three SCI rehabilitation centers in Switzerland.Methods:Data were collected by means of standardized self-report questionnaires sent to the eligible participants by postal mail. The questionnaires covered the different components of the ICF's bio-psycho-social model, namely health conditions, body functions, participation, environmental and personal factors. Bivariate correlations and multivariate linear regression analyses with participation as the dependent variable have been conducted.Results:In all, 102 persons with SCI answered the survey, response rate 25.9%. Self-esteem (r=0.61) and self-efficacy (r=0.54) correlated highly with participation and were the strongest correlates of participation. They were stronger correlates of participation than symptoms of anxiety, depressive symptoms, pain, health conditions, social support, coping styles or sense of coherence. Participation seemed to be independent of gender, age, level or completeness of injury. Self-efficacy and self-esteem explained together with time since discharge and years of education 48% of the variance in participation adjusting for health condition, depressive symptoms, pain interference and social support.Conclusion:Considering self-efficacy and self-esteem within the comprehensive framework of the ICF can contribute to a better understanding of functioning, disability and health in SCI, which in turn may facilitate the development of interventions to support the persons' adjustment and reintegration. [ABSTRACT FROM AUTHOR]

Study design:Multicentre controlled study.Objectives:To investigate if individuals with and without spinal cord injury (SCI) differ in biopsychosocial variables according to the International Classification of Functioning, Disability and Health (ICF).Setting:Participants were recruited through three major SCI rehabilitation centres in Switzerland.Methods:A convenience sample of people with SCI (N=102) and a matched non-SCI sample (N=73) were compared according to secondary conditions, pain, depressive symptoms, participation, social support, self-efficacy, self-esteem, coping and sense of coherence. Difference tests and multivariate logistic regression analyses to predict the likelihood of group membership were calculated.Results:People with SCI reported more health conditions, higher levels of anxiety and depressive symptoms, worse pain and pain interference, lower level of participation and social support, lower self-efficacy, self-esteem and task- and emotion-oriented coping. The two samples did not differ in satisfaction with social support, in use of avoidance-oriented coping and in sense of coherence. Health conditions, pain interference, participation and age were found to be significant predictors of the likelihood of group membership. In the logistic regression models, the number of health conditions, limitations due to health conditions, pain interference, participation, task-oriented coping and age are significant predictors of group membership, accounting for 55% of variation.Conclusion:Health conditions, pain interference and participation seemed to be the areas of biopsychosocial functioning that are substantially influenced by SCI. Potential buffering resources seem to be diminished in individuals with SCI. In rehabilitation practice, prevention of secondary conditions, treatment of pain, enhancement of participation and strengthening resources should be addressed. [ABSTRACT FROM AUTHOR]

Study design:Qualitative, multi-center study.Objectives:The objective of this study is to explore the aspects of functioning and disability that are relevant to individuals with spinal cord injury (SCI), using a comprehensive approach based on the International Classification of Functioning, Disability and Health (ICF).Methods:Forty-nine people with SCI from early post-acute and long-term rehabilitation settings participated in nine focus groups. Five open-ended questions based on the ICF were used to initiate discussion about relevant Body Functions and Structures, Activities and Participation, Environmental and Personal Factors. The focus groups were audiotaped and the recording was transcribed verbatim. Qualitative analyses included the identification, extraction and coding of meaningful concepts from the transcribed dialogue. Concepts were coded according to established rules using ICF categories and were summarized semi-quantitatively.Results:In the analysis, 1582 different concepts were identified. For coding one concept, an average of 1.4 ICF categories was used. This resulted in 2235 concept-ICF category links, 1068 in the early post-acute and 1167 in the long-term context, respectively. For the coding, 274 out of the 1454 categories contained in the ICF were used.Conclusion:The ICF coding showed the broad range of relevant aspects in the functioning experience of persons with SCI. Besides body limitations (especially paralysis and pain), the most relevant concepts covered mainly barriers in physical environment, assistive devices and social support, as well as the impact on everyday life regarding leisure and work. The resulting list of ICF categories can be helpful in facilitating person-centered clinical care and research. [ABSTRACT FROM AUTHOR]

Study design:The study is conducted on the basis of comparative-repeated measures.Objectives:The objective of this study is to assess the reliability of non-invasive cardiac output (CO) measurements in individuals with tetraplegia (TP) at rest and during exercise using Innocor, and to test the hypothesis that CO measurements are less reliable in TP than in able-bodied (AB) individuals.Setting:Ambulatory volunteers, Switzerland.Methods:Nine male motor-complete TP (C5-C7) and nine pair-matched AB performed repeated CO measurements at rest and during submaximal arm-crank and wheelchair exercises in four different test sessions. Within- and between-day reliabilities were compared between TP and AB.Results:Mean differences between measurements at rest (TP vs AB, within-day: 0.1±0.5 vs 0.2±0.6 l min−1, between-day: −0.7±0.6 vs −0.1±0.8 l min−1), during arm-crank (TP vs AB, within-day: 0.1±0.9 vs 0.5±0.7 l min−1, between-day: −0.3±1.1 vs 0.0±1.1 l min−1) and wheelchair exercises (TP vs AB, within-day: 0.3±1.2 vs -0.1±0.8 l min−1, between-day: 0.1±1.1 vs 0.5±0.9 l min−1) were not significantly different between TP and AB (all P>0.05). Coefficients of variation in TP (within-day, rest: 6.8%, arm-crank: 9.6% and wheelchair: 10.8%; between-day, rest: 11.9%, arm-crank: 11.2% and wheelchair: 10.3%) and in AB (within-day, rest: 7.7%, arm crank: 6.8% and wheelchair: 6.0%; between-day, rest: 9.2%, arm crank: 8.5% and wheelchair: 8.0%) indicated acceptable reliability.Conclusion:In contrast to our hypothesis, we found non-invasive CO measurements using Innocor to be as reliable in TP as they are in AB. Consequently, Innocor can be recommended for repeated assessments of CO in TP within routine diagnostics or for evaluation of training progress.Sponsorship:The study was supported by the Swiss National Science Foundation (Grant no. 32-116777). [ABSTRACT FROM AUTHOR]

Objectives:To evaluate whether the ice water test (IWT) should be performed before or after the standard urodynamic investigation (UDI).Patients and methods:Two cohorts of patients suffering from neurogenic lower urinary tract dysfunction (NLUTD) due to spinal cord injury (SCI) were matched by lesion level and age. The patients of cohort A (n=55, retrospective cohort) underwent the IWT before and the patients of cohort B (n=110, prospective cohort) after standard UDI. The IWT effect on urodynamic parameters has been compared between the two groups using the Mann-Whitney U-test for independent samples. UDI was performed according to good urodynamic practices recommended by the International Continence Society.Results:The mean age of both cohorts was 49 years. Performing the IWT before versus after standard UDI resulted in a significantly lower maximum cystometric bladder capacity (P=0.01), lower incidence of detrusor overactivity (P=0.017) and lower maximum detrusor pressure during IWT (P=0.04). All other urodynamic parameters assessed demonstrated no significant difference (P>0.05).Conclusions:Our results are in line with findings from animal studies demonstrating a bladder cooling-induced gating effect on the micturition reflex volume threshold on the level of sacral interneurons. Since the IWT is an unphysiological investigation that might significantly bias subsequent urodynamics, we suggest that the IWT should not precede more physiological standard UDI. [ABSTRACT FROM AUTHOR]