Ambulatory individuals have a high risk of falling and of fall-related injuries. Fall history, fear of falling and walking speed could predict recurrent falls and injurious falls. Further studies with larger samples are needed to validate these findings. [Jørgensen V, Butler Forslund E, Opheim A, Franzén E, Wahman K, Hultling C, Seiger Å, Ståhle A, Stanghelle JK, Roaldsen KS (2017) Falls and fear of falling predict future falls and related injuries in ambulatory individuals with spinal cord injury: a longitudinal observational study. Journal of Physiotherapy 63: 108-113].

Previous recurrent falls was a strong predictor of future falls. The incidence of falls, recurrent falls and fall-related injuries was high. Hence, prevention of falls and fall-related injuries is important.

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Objective: To investigate how men and women with spinal cord injury (SCI) perform transfers from table to wheelchair with regard to timing and magnitude of force generation beneath the hands and associated body movements. Methods: A total of 13 subjects (seven men, six women) with thoracic SCI. Kinematics of body movement were recorded (Elite 2000 system) simultaneously with the signals from three force plates (AMTI) placed beneath the buttocks and hands. Temporal and spatial parameters regarding head, trunk and trailing arm displacement, loading amplitudes and loading torque directions of both hands were analyzed for each trial and subject and compared between genders. Results: Men and women used similar amplitudes of head bending and forward displacement of the trailing shoulder, while female subjects had significantly larger trunk rotation. Both genders applied significantly more weight on the trailing hand. Differences between genders were seen in direction and timing of peak torque beneath the hands. Conclusions: The forces beneath the trailing hand were larger than those in the leading, if there is weakness or pain in one arm, this arm should be selected as the leading. To avoid excessive load on the arms, technical aids and environmental factors should be very well adapted.

Objective To describe data completeness, targeting and reliability of the Swedish version of the Spinal Cord Independence Measure Self-Report (s-SCIM-SR). Design Translation and reliability study. Subjects Programme participants ( n = 48) and peer mentors ( n = 42) with spinal cord injury enrolled in the INTERnational Project for the Evaluation of “activE Rehabilitation” (inter-PEER). Methods The translation process was based on guidelines/recommendations, and involved expert competence, including consumers. The s-SCIM-SR was distributed online, once for programme participants and twice for peer mentors. Results Sixty-nine individuals (77%) obtained a total score. Most missing data were found in the items Respiration and Using the toilet. Cronbach’s alpha for the full scale was 0.89, for Self-care 0.92, for Respiration and sphincter management 0.37 and for Mobility 0.86. The intraclass correlation coefficient was excellent for all subscales and the full scale. Measures of variability showed high sensitivity to changes and Bland Altman analyses revealed no systematic changes between evaluation points. Conclusion These results support the data completeness, targeting and reliability of the Swedish version of the SCIM-SR. However, some problems were found in the subscale Respiration and sphincter management. The s-SCIM-SR can be considered psychometrically sound and suitable to assess physical independence among persons with spinal cord injury in Swedish community settings. LAY ABSTRACT After spinal cord injury, an important goal in rehabilitation is to attain a high level of physical independence. In Sweden, no spinal cord injury-specific assessment tool to evaluate physical independence has previously been nationally available. This study presents the translation process and evaluation of the measurement properties of the Swedish version of the Spinal Cord Independence Measure Self-Report (s-SCIM-SR) in a community rehabilitation setting. The translation process involved expert competence, including consumers, and resulted in minor cultural adaptations. The s-SCIM-SR was distributed online to 90 persons with chronic spinal cord injury. Overall, the s-SCIM-SR performed equally as well as the original version in terms of missing data, general agreement between items, and agreement between 2 evaluation points. However, some problems were found in the subscale Respiration and sphincter management. In conclusion, the s-SCIM-SR can be considered psychometrically sound and suitable to assess physical independence among persons with spinal cord injury in Swedish community settings.

Background: As technology is advancing, so are the possibilities for new data collection methods in research, potentially improving data quality and validity of the results. In Sweden, a system using frequent repeated data collection using text messages, SMS Track, has been used in clinical research for more than a decade. In this paper, compliance with repeated text message questions was examined across five different studies, i.e. if compliance was 1: associated with study-specific factors (age or gender of the subjects, the condition, its' severity or course, i.e. improvement, relapse or steady state) and/or. 2: associated with the methodology itself (the question being asked, the frequency and number of questions, duration of data collection, initial compliance or the management of the system). Methods: Descriptive comparisons were done across five studies. Three studies were collecting weekly responses over at least 52 weeks ("Weekly studies") and were used to investigate the effect of age, sex and pain severity on compliance, the effect of early compliance for late compliance, and finally the early occurrence of two successive weeks with non-compliance. Result: Compliance was excellent across all five studies, and only influenced somewhat by age, sex and pain-level. The factor "study" remained significant in the final model thus the observed differences may be a result of the conditions studied but does not seem to be attributable to severity or development of these conditions. Number and frequency of questions did not influence compliance, nor did study duration. Conclusions: Compliance was excellent in the included studies and was not affected by population factors. However, differences in compliance were observed that cannot be easily explained and warrant further investigation. In particular, the nature of the variables or the management of the study are potential areas for further investigations.

Objective: Translation of the Spinal Cord Injury Falls Concern Scale (SCI-FCS); validation and investigation of psychometric properties. Design: Translation, adaptation and validation study. Subjects/patients: Eighty-seven wheelchair users with chronic SCI attending follow-up at Rehab Station Stockholm/Spinalis, Sweden. Methods: The SCI-FCS was translated to Swedish and culturally adapted according to guidelines. Construct validity was examined with the Mann-Whitney U-test, and psychometric properties with factor and Rasch analysis. Results: Participants generally reported low levels of concerns about falling. Participants with higher SCI-FCS scores also reported fear of falling, had been injured for a shorter time, reported symptoms of depression, anxiety and fatigue, and were unable to get up from the ground independently. Falls with or without injury the previous year, age, level of injury, sex and sitting balance did not differentiate the level of SCI-FCS score. The median SCI-FCS score was 21 (range 16-64). Cronbachs alpha (0.95), factor and Rasch analysis showed similar results of the Swedish as of the original version. Conclusion: The Swedish SCI-FCS showed high internal consistency and similar measurement properties and structure as the original version. It showed discriminant ability for fear of falling, time since injury, symptoms of depression or anxiety, fatigue and ability to get up from the ground but not for age, gender or falls. Persons with shorter time since injury, psychological concerns, fatigue and decreased mobility were more concerned about falling. In a clinical setting, the SCI-FCS might help identifying issues to address to reduce the concerns about falling.

Falls in the previous year showed a better predictive accuracy than DFRI due to the low sensitivity of DFRI. As previous falls had low specificity, it still remains difficult to predict falls in those who have not fallen yet.