Psychological and socioeconomic status, complications and quality of life in people with spinal cord injuries after discharge from hospital in Bangladesh: a cohort study
Abstract:Study design: Mixed retrospective-prospective cohort study. Objectives: To determine psychological and socioeconomic status, complications and quality of life in people with spinal cord injuries (SCI) after discharge from a hospital in Bangladesh. Setting: Bangladesh. Methods: All patients admitted in 2011 with a recent SCI to a hospital in Bangladesh were identified. Patients were interviewed by telephone in 2014 using translated versions of the SF12, the SCI Secondary Conditions Scale, the Centre for Epidemi… Show more
“…It is natural that, when those with a complete motor lesion were compared with those with an incomplete lesion, a complete lesion was associated with more difficulties in getting around and self-care. In our study, inability to walk was correlated with other impairments (getting around, self-care, participation and cognition) as in previous studies, which found wheelchair-dependency (36,37) and mobility restrictions (17) to increase difficulties in other domains of participation (17,37) and to decrease quality of life (36). Also, current employment was found to be associated with other domains (mobility, self-care, and life activities) in our study population.…”
Two easy-to-use validated International Classification of Functioning, Disability and Health (ICF)-based tools, the 12-item patient and proxy World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the 7-item World Health Organization minimal generic set used by a physician, were found to be reliable and useful in assessing functioning in patients with spinal cord injury. These tools can, with little effort, be used to detect activity limitations and participation restrictions, and differentiate various severities and levels of spinal cord injury. As the minimal generic set is brief and limited, we recommend using the 12-item WHODAS 2.0 when planning individualized services for patients with spinal cord injury. Objective: To compare easy-to-use International Classification of Functioning, Disability and Health (ICF)-based measures of functioning with the level and severity of spinal cord injury. Methods: Cross-sectional study. Patients (n = 142) and their significant others completed the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire. A physician at the university hospital outpatient clinic assessed functioning with the 7-item World Health Organization (WHO) minimal generic set. Results: The patient and proxy WHODAS sum score was rated severe with decreasing severity in groups with complete and partial tetraplegia and paraplegia, respectively. Working ability was rated most severely impaired in the tetraplegic groups. Between-group differences were also found in mobility, household tasks, and self-care. Mobility was found to be associated with lesion severity; life activities, participation and friendships with lesion level; and self-care and WHODAS sum score with both lesion severity and level. Depending on the level and severity of spinal cord injury, a moderate to strong correlation was found between the sum scores of the 2 tools, and mostly very strong correlations between patient and proxy assessments of functioning. Conclusion: Both generic ICF-based tools, despite their briefness, seemed to be useful as they were able to differentiate various levels and severities of spinal cord injury. We recommend using the 12-item WHODAS 2.0 when planning individualized services for patients with spinal cord injury.
“…It is natural that, when those with a complete motor lesion were compared with those with an incomplete lesion, a complete lesion was associated with more difficulties in getting around and self-care. In our study, inability to walk was correlated with other impairments (getting around, self-care, participation and cognition) as in previous studies, which found wheelchair-dependency (36,37) and mobility restrictions (17) to increase difficulties in other domains of participation (17,37) and to decrease quality of life (36). Also, current employment was found to be associated with other domains (mobility, self-care, and life activities) in our study population.…”
Two easy-to-use validated International Classification of Functioning, Disability and Health (ICF)-based tools, the 12-item patient and proxy World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the 7-item World Health Organization minimal generic set used by a physician, were found to be reliable and useful in assessing functioning in patients with spinal cord injury. These tools can, with little effort, be used to detect activity limitations and participation restrictions, and differentiate various severities and levels of spinal cord injury. As the minimal generic set is brief and limited, we recommend using the 12-item WHODAS 2.0 when planning individualized services for patients with spinal cord injury. Objective: To compare easy-to-use International Classification of Functioning, Disability and Health (ICF)-based measures of functioning with the level and severity of spinal cord injury. Methods: Cross-sectional study. Patients (n = 142) and their significant others completed the 12-item World Health Organization Disability Assessment Schedule (WHODAS 2.0) questionnaire. A physician at the university hospital outpatient clinic assessed functioning with the 7-item World Health Organization (WHO) minimal generic set. Results: The patient and proxy WHODAS sum score was rated severe with decreasing severity in groups with complete and partial tetraplegia and paraplegia, respectively. Working ability was rated most severely impaired in the tetraplegic groups. Between-group differences were also found in mobility, household tasks, and self-care. Mobility was found to be associated with lesion severity; life activities, participation and friendships with lesion level; and self-care and WHODAS sum score with both lesion severity and level. Depending on the level and severity of spinal cord injury, a moderate to strong correlation was found between the sum scores of the 2 tools, and mostly very strong correlations between patient and proxy assessments of functioning. Conclusion: Both generic ICF-based tools, despite their briefness, seemed to be useful as they were able to differentiate various levels and severities of spinal cord injury. We recommend using the 12-item WHODAS 2.0 when planning individualized services for patients with spinal cord injury.
“…This lack of protection against climate change is especially true for those persons with SCI living in underdeveloped countries. Thus, increases in global temperature may further challenge decentralized thermoregulatory mechanisms and expose the vulnerability of persons with SCI to hyperthermia and challenge survival when attempting to cope with prolonged heat exposure [42][43][44][45][46].…”
The three cases demonstrate the signs and symptoms that may accompany hyperthermia in persons with SCI. The onset may be quite rapid and the condition persistent, despite ambient temperatures being much less intense than expected to be necessary to induce similar conditions in able-bodied (AB) persons. The responses of the persons in the case studies to the temperature regulation and autonomic control of sweating sections of the Autonomic Standards would identify them as being vulnerable and warrant providing appropriate exposure guidelines and precautions to them and their caregivers.
“…In spite of a promising political environment for people with disabilities, research still indicates that many people with spinal cord injury (often wheelchair users) in Bangladesh rarely leave their homes, have reduced opportunities for employment, experience poverty, and have secondary conditions such as pressure ulcers (Hossain et al, 2016). Additionally, evidence demonstrates that people with spinal cord injury in Bangladesh report low total community integration and life satisfaction (Ahmed et al, 2017).…”
Section: Introductionmentioning
confidence: 99%
“…Additionally, evidence demonstrates that people with spinal cord injury in Bangladesh report low total community integration and life satisfaction (Ahmed et al, 2017). Researchers have also indicated that people with spinal cord injury, many of whom use wheelchairs, have moderate rates of depression and report limited quality of life (Hossain et al, 2016) as well as lower self-efficacy (which has been linked to depression) (Villanueva et al, 2017). In the light of this situation, there is a necessity for better identification of barriers in the hope that policy-makers and service providers may then direct their attention to facilitate effective interventions and improve the quality of life for this population (Hossain et al, 2016;Ahmed et al, 2017).…”
Purpose: People who use wheelchairs face a range of physical, social, and economic barriers to regular participation in their communities. These barriers may be more acute in countries such as Bangladesh which are affected by poverty and often lack the physical infrastructure or resources necessary to create inclusive or accessible environments. This research aimed to identify: (a) the barriers and facilitators to accessibility faced by wheelchair users in Bangladesh; (b) how these barriers affect the inclusion of wheelchair users in Bangladeshi society; and (c) what could be done to improve accessibility and inclusion for wheelchair users in Bangladesh.Methods: This participatory action research (PAR) project used Photovoice and semi-structured interviews to identify barriers and facilitators to accessibility for people who use wheelchairs in Bangladesh.Results: Participants mentioned a number of barriers in public spaces, such as roads, missing or inadequate ramps, inaccessible restrooms, and negative attitudes. There were also participants who had made their home environments more accessible with accommodations such as ramps, arrangement of space, and low countertops/work spaces. Women wheelchair users seemed to face greater barriers to access, as compared to men, in a range of community spaces and activities. Participants’ recommendations for improvement targeted government stakeholders and included greater focus on road infrastructure, particularly during flooding in the rainy season, and modifications to the public transportation system.Conclusion: A key goal of the study was to identify barriers and facilitators, and use the information gathered to promote social change on the ground. Future research and action should encourage more people to get involved in removing barriers for people with disabilities, in Bangladesh as well as globally.
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