Umeå University's logo

Study design: Psychometric study.

Objectives: To evaluate the data completeness, data distribution and ceiling/floor effects, internal consistency and convergent validity of the Swedish versions of the Spinal Cord Independence Measure IV (s-SCIM IV) and the Spinal Cord Independence Measure Self-report (s-SCIM-SR).

Setting: Swedish inpatient and outpatient spinal cord injury (SCI) rehabilitation.

Methods: The translation process was based on established guidelines with researchers, clinicians and consumers. s-SCIM IV and FIMTM assessments were performed by observation and/or interview, s-SCIM-SR through self-report using paper forms.

Results: In total, 101 participants (82% men) were included. There were no missing data for s-SCIM IV and 92% had answered all items in s-SCIM-SR. No ceiling or floor effects were observed. Cronbach´s alpha for the total s-SCIM IV scale was 0.91 (subscales 0.68–0.93) and for the total s-SCIM-SR scale 0.91 (subscales 0.62–0.93), with the lowest alphas for Respiration and Sphincter Management in both outcome measures. s-SCIM IV and s-SCIM-SR correlated strongly with each other and with FIMTM.

Conclusions: Our results support the data completeness, lack of ceiling/floor effects, internal consistency (except the Respiration and Sphincter Management subscale) and convergent validity of the s-SCIM IV and s-SCIM-SR. Based on this initial psychometric testing, these outcome measures can be considered suitable to assess physical independence in inpatient and outpatient rehabilitation and long-term follow-up after SCI, for both clinical and research purposes. The now available Swedish versions of SCIM will enable a uniform national assessment of SCI-specific physical independence and facilitate research and international collaborations and comparisons.

Objective: To assess the prevalence of pain, anxiety and depression in a sample of chronic SCI patients in Northern Sweden.

Design: Descriptive, cross-sectional study.

Setting: Specialist Clinic at a University Hospital.

Participants: 78 patients with chronic spinal cord injury, at different injury and functional level.

Outcome measures: Patients registered presented pain above, at or below injury level on a Visual Analogue Scale (VAS). Patients currently on pain medication were also registered as having pain. Depression and anxiety were assessed by the Hospital Anxiety and Depression Rating Scale (HADS).

Results: Out of 78 patients, 58 (74%) indicated current presence of pain or were on continuous pain medication. Pain above injury level was present in 32% of the patients, with a mean VAS of 15.9±20.1, range 0-60mm. Pain at injury level were present in 24% of the patients, mean VAS 11.0±17.0, range 0-50mm and 58% had pain below injury level with a mean VAS 31.4±22.3, range 0-80mm.

Clinically significant psychological disorders were reported in 4 patients (5%) for both anxiety and depression.

Conclusions: Pain is very common in persons with chronic SCI, but, at least in a drug-treated population, the pain is at a mild or moderate level. Anxiety and depression were found much less common than reported in other studies. Medication effects have been considered. Even in a presumably well-medicated and well-rehabilitated population, there is still a need for further optimization of pain management, including both pharmacological and non-pharmacological methods.

Keywords: Tetraplegia; Paraplegia; Psychological Disorders; Visual Analogue Scale; Hospital Anxiety and Depression Scale

A spinal cord injury is a serious medical condition, often caused by a physical trauma. An injury to the spinal cord affects the neurotransmission between the brain and spinal cord segments below the level of injury. The SCI causes a loss of motor function, sensory function and autonomic regulation of the body, temporary or permanent. Significantly improved acute care, primary comprehensive rehabilitation and life-long structured follow-up has led to persons with spinal cord injury (SCI) living longer than ever before. However, increased long-time survival has allowed secondary conditions to emerge, like diabetes mellitus and where cardiovascular disease (CVD) now is the most common cause of death among SCI patients. Other possible CVD-related comorbidities in this patient group have been reported to be pain and mood disturbances. There is still lack of, and need for more knowledge in the field of CVD-related screening and prevention after SCI.

The overall aim of this thesis was to contribute to a scientific ground regarding the need for CVD-related screening and prevention after SCI.

In Paper I and Paper II, patients with wheelchair-dependent post-traumatic SCI (paraplegia) were assessed. The results in paper I showed that 80% of the examined patients had at least one cardiovascular disease risk marker irrespective of body mass index (BMI). Dyslipidemia was common for both men and women at all BMI categories. The study also showed a high prevalence of hypertension, especially in men. Paper II showed a low frequency of self-reported physical activity, where only one out of 5 persons reported undertaking physical activity >30 min/day. The physically active had lower diastolic blood pressure but no significant difference in blood lipids.

In paper III and IV, patients with SCI (tetraplegia and paraplegia) participated in the studies. Eighty-one percent of the patients had dyslipidemia, where also a majority of the patients with normal abdominal clinical measures had dyslipidemia. Self-reported physical activity >30min/day was reported by one third of the patients. No differences were found between physically active and not physically active patients when it came to blood glucose, serum lipid values and clinical measures (paper III). Pain was common in the patient group, however, most often on a mild to moderate level. Anxiety and depression was less common than reported in other studies (paper IV).

Objective: To survey the incidence of clinical risk markers and its correlation with established clinical measurements for cardiovascular disease (CVD) in a heterogeneous spinal cord injured (SCI) patient population.

Design: Descriptive, cross-sectional study.

Subjects: 78 patients with SCI, at different injury and functional level.

Methods: Anthropometric data, blood pressure, a blood lipid panel, blood glucose and a questionnaire were analyzed.

Results: Eighty-one percent of all patients had dyslipidemia (DL) and a majority of the patients with abdominal measures below the recommended cut-off levels had DL. Self-reported physical activity above the cut-off level was reported by 32.1%of the patients. There were no differences in clinical measures, serum lipid values and blood glucose between physically active and not active patients. No differences were seen between men/women, tetraplegia/paraplegia and wheelchair dependent/not wheelchair dependent patients.

Conclusion: DL is common and seems to be not treated or undertreated in the studied SCI patient group with different neurological lesion and functional levels. General anthropometric clinical measures do not seem to be valid for evaluating risk for CVD in this patient group.

Objective:

To examine whether self-reported physical activity of a moderate/vigorous intensity influences risk markers for cardiovascular disease in persons with paraplegia due to spinal cord injury.

Design:

Descriptive, cross-sectional study.

Subjects:

A total of 134 wheelchair-dependent individuals (103 men, 31 women) with chronic (>= 1 year) post-traumatic spinal cord injury with paraplegia.

Methods:

Cardiovascular disease markers (hypertension, blood glucose and a blood lipid panel) were analysed and related to physical activity.

Results:

One out of 5 persons reported undertaking physical activity >= 30 min/day. Persons who were physically active >= 30 min/day were significantly younger than inactive persons. Systolic and diastolic blood pressures were lower in the physically active group. When adjusting for age, the association between systolic blood pressure and physical activity disappeared. Physical activity >= 30 min/day had a tendency to positively influence body mass index and low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio. Men had significantly higher systolic and diastolic blood pressures than women, lower high-density lipoprotein cholesterol, higher low-density lipoprotein cholesterol/high-density lipoprotein cholesterol ratio and higher triglycerides. No other significant differences between men and women were found.

Conclusion:

Self-reported physical activity >= 30 min/day in persons with spinal cord injury positively influenced diastolic blood pressure. No other reductions in cardiovascular disease risk markers were seen after controlling for age. These results indicate a positive effect of physical activity, but it cannot be concluded that recommendations about physical activity in cardiovascular disease prevention for the general population apply to wheelchair-dependent persons with spinal cord injury.

Objective: To assess risk factors for cardiovascular disease at different body mass index values in persons with wheelchair-dependent paraplegia after spinal cord injuries. Design: Cross-sectional study. Subjects: A total of 135 individuals, age range 18-79 years, with chronic (>= 1 year) post-traumatic paraplegia. Methods: Body mass index was stratified into 6 categorical groups. Cardiovascular disease risk factors for hypertension, diabetes mellitus and a serum lipid profile were analysed and reported by body mass index category. Results: More than 80% of the examined participants had at least one cardiovascular disease risk factor irrespective of body mass index level. Hypertension was highly prevalent, especially in men. Dyslipidaemia was common at all body mass index categories in both men and women. Conclusion: Higher body mass index values tended to associate with more hypertension and diabetes mellitus, whereas dyslipidaemia was prevalent across all body mass index categories. Studies that intervene to reduce weight and or percentage body fat should be performed to determine the effect on reducing modifiable cardiovascular disease risk factors.