Analysis 1.1. Comparison 1 Electrical stimulation (plus standard care) versus sham/no electrical stimulation (plus standard care), Outcome
Objective: The objective of this study was to determine the inter-rater reliability and validity of using a telephone-based version of the spinal cord injury-secondary conditions scale (SCI-SCS). Trial design: A psychometric study was conducted. Setting: The study was conducted in Royal North Shore Hospital, Sydney, Australia. Participants: Forty people with a complete or an incomplete spinal cord injury. Methods: Inter-rater reliability was tested by comparing the telephone-based version of the SCI-SCS administered on two different days by two different telephone assessors. Validity was tested by comparing the telephone-based version of the SCI-SCS with the paper-based version of the SCI-SCS. Results: The median (interquartile range) age and time since injury were 54 (48-63) years and 28 (14-35) years, respectively. The intraclass correlation coefficient (95% confidence interval) reflecting the agreement between the telephone-based version of the SCI-SCS administered on two different days by two different assessors was 0.96 (0.93-0.98). The corresponding value reflecting agreement between the telephone-based assessment and the paper-based assessment was 0.90 (0.83-0.95). Conclusion:The telephone-based version of the SCI-SCS is a simple and a quick questionnaire to administer that has both inter-rater reliability and validity. It may be useful as a way to screen for secondary health conditions in low-and middle-income countries where it is not always feasible to provide routine face-to-face follow-ups and where literacy may be a problem. Spinal Cord (2016) 54, 402-405; doi:10.1038/sc.2015.119; published online 21 July 2015 INTRODUCTIONPeople with spinal cord injury (SCI) are susceptible to various secondary health conditions (that is, complications). These conditions have an impact on physical health, psychological well-being, quality of life and community participation. [1][2][3][4][5] The common secondary health conditions after SCI include pressure ulcers, urinary tract infections, deep vein thrombosis, spasticity, pain, respiratory problems and autonomic dysreflexia. 6 Some of these can be life threatening. In high-income countries, people with SCI are regularly followed up and assessed by clinicians for secondary health conditions. However, this level of service is often not feasible in low-and middle-income countries (LMIC). It is therefore important to find inexpensive ways to screen people for secondary health conditions that do not require costly and regular face-to-face assessments. If those at high risk of secondary health conditions could be identified, then they could be targeted for follow-up with clinicians and further investigation.There is currently only one assessment scale that is quick and easy to use and may provide a way for clinicians in LMIC to screen people with SCI for secondary health conditions. The assessment scale is called the Spinal Cord Injury-Secondary Conditions Scale (SCI-SCS). 7 It was first published in 2007 and is an adaptation of the generic Seekins Secondary Condition Que...
Analysis 1.1. Comparison 1 Electrical stimulation (plus standard care) versus sham/no electrical stimulation (plus standard care), Outcome
Study design: A within-participant, double-blind, cross-over, randomised control trial. Objectives: To determine the short-term effects of bronchodilator therapy on respiratory function in people with recently acquired motor complete tetraplegia. Setting: Hospital, Australia. Methods: A total of 12 people with recently acquired tetraplegia were randomised to receive either a one-off dose of a bronchodilator followed by an equivalent dose of a placebo propellant between 1 day and 1 week later or visa versa. The three outcomes were forced expiratory volume in 1 s (FEV1), peak expiratory flow rate (PEF) and forced vital capacity (FVC). These were measured while supine by a blinded assessor 10 and 30 min after treatment. Data were analysed on 11 participants and reported as percentage of predicted. Results: The FEV1, FVC and PEF mean between-group differences (95% confidence interval) at 10 min post treatment were 7.3% (2.7-11.9%; P ¼ 0.003), 5.5% (1.6-9.4%; P ¼ 0.008) and 20.1% (1.1-40.4%; P ¼ 0.039). Similar effects were observed at 30 min for FVC and FEV1 but not for PEF. Conclusion: Bronchodilator therapy has a beneficial effect on FEV1, FVC and PEF in participants with recently acquired tetraplegia.
Patients with tetraplegia are known to have higher rates of cardiovascular disease compared to ambulatory patients. Their cardiovascular risk profile may include atypical risk factors, for example, sleep disordered breathing, relative immobility and autonomic dysfunction. A high index of suspicion for cardiac pathology is warranted in those with cervical tetraplegia with persistent 'atypical' symptoms, including within the abdomen (especially when no specific abdominal organ dysfunction is evident). Sleep apnoea and significantly impaired mobility are potential cardiac risk factors in this patient group and should alert the emergency physician to cardiac disease (as in this case) irrespective of their complex past medical history and symptomatology.
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