Physiatrists' opinions and practice patterns for bone health after SCI

Abstract

Study design: Self-report survey Objective: To ascertain physiatrists' opinions and current practice patterns for bone health management after spinal cord injury (SCI). Participants: Physiatrists who work in teaching rehabilitation centers in Canada. Methods: A 4-page 17-question survey (available in French and English) was sent to working physiatrists in all major Canadian SCI rehabilitation centers. Results: We had an 85% response rate (22 responses). Physiatrists reported that they should be managing bone health issues after SCI in conjunction with family physicians, and most respondents assess and treat for bone health after SCI. However, just over one-third of the physiatrists reported that the current treatment options are not effective for low bone mass; there was more support for pharmacological treatments than there was for rehabilitation modalities. Conclusion: Bone health after SCI is an important health concern that is being managed by physiatrists; however, more discussion and research is needed to ascertain the effectiveness of assessment and treatment options for low bone mass. Spinal Cord IntroductionBone health after a spinal cord injury (SCI) is an important issue that needs to be addressed because of an increased risk for fragility fractures 1-5 and the majority of these fractures occur during transfers or other activities that involve minimal or no trauma. 1 Contributing to the increased risk for fragility fracture is the loss of bone mineral density (BMD) in the lower extremity that was initially thought to stabilize around 1 year after injury 6 but below that of ablebodied peers. More recent literature supports a continual loss of bone mass with time since injury suggesting that bone mineral loss continues 7 and contributes to the increased risk of fractures. In the general population, people who sustain a low-impact trauma fracture (falling from a standing height or less) have an increased risk for subsequent fracture, thus practice guidelines emphasize that these fragility fractures should prompt a workup to determine possible causes and appropriate management. 8 For people with SCI, previous literature suggests that the mean incidence of lower limb fracture is approximately 2% per year. 9 Yet despite these data there has been little published studies to highlight physiatrist practice patterns for bone health specifically for people with SCI.Prevention and treatment of osteoporosis following SCI has been investigated as early as a few days after the initial injury. 10 However, in practice, bone health interventions are generally initiated in the in-patient rehabilitation setting where physiatrists, specialists in rehabilitation medicine, are most often involved. In Canada, as advocated from best practice guidelines, people with SCI are treated in specialized rehabilitation centers that are teaching hospitals. After being discharged from rehabilitation and living in the community, bone health evaluation may involve the ongoing care by physiatrists and/or family physicians. Family physici...

Self-Report of One-Year Fracture Incidence and Osteoporosis Prevalence in a Community Cohort of Canadians with Spinal Cord Injury

“…Despite self-reported bone health screening practices between 54% and 82% 22,23 among health care providers, a recent retrospective review of postfracture care across 4 Veterans Affairs Medical Centers in the United States revealed that less than 5% of individuals with SCI had a DXA scan in the year before or after fracture. 6 The lack of proper screening practices and awareness among health care providers suggests that current practices are likely failing to identify persons at high risk of fracture, thereby limiting the ability to prevent fracture occurrence.…”

Predicting patient-specific rates of bone loss at fracture-prone sites after spinal cord injury

“…At present, there is no consensus on a systematic approach to the management of sublesional bone loss and fracture after SCI. Spinal injuries physicians typically have a reactive response to fracture, rather than implementing proactive management [10]. Early identification of individuals at highest risk of fracture may allow targeted preventative treatment, which would ideally begin during their inpatient stay in their primary care or rehabilitation unit.…”

<p>Impact Of Spinal Cord Injury On Sleep: Current Perspectives</p>

“…Subsequently, individuals living with SCI report daytime symptoms such as fatigue, excessive day time sleepiness,11,12 difficulties with concentration, and impaired quality of life. Furthermore, fatigue and excessive daytime sleepiness, have been associated with pain,13 depression,14 side effects of medications, spasticity,15 discomforts related to posture16 and autonomic dysfunction17 in people living with SCI. Intrestingly, recent studies suggested that SCI does not in itself result in significantly impact of fatigue on health-related quality of life 18.…”