New research from the SCI Model Systems
The Northwest Regional Spinal Cord Injury (SCI) System (NWRSCIS) at the University of Washington is one of 14 federally funded SCI Model System centers around the country. These centers provide the highest standard of SCI care, conduct research, and gather ongoing information from SCI patients for the National SCI Model System database. If you have completed questionnaires for the NWRSCIS or another Model System since your injury, then you have participated in research that contributes to improvements in SCI care. Thank you for being part of these efforts.
The March 2011 issue of Archives of Physical Medicine and Rehabilitation focuses exclusively on SCI Model Systems research outcomes. Six of the 23 studies published in this issue are summarized here. Names of NWRSCIS authors are in bold face type.
Depression common but under-treated after SCI
Depression is a harmful and sometimes deadly condition that affects about one in five people with SCI. In a study of 1,035 individuals with SCI, 21% had major depression one year after injury, and 18% had either continuing or new depression after 5 years. A significant minority of participants (8.7%) had chronic or recurring depression, much higher than the 2.7% rate of chronic depression in the general population. Pain and health problems increased a person’s chances of being depressed. Depression is common in people with SCI and health providers need to be alert for possible signs and risks. (Hoffman JM, Bombardier CH, Graves DE, et al. A longitudinal study of depression from 1 to 5 years after spinal cord injury. Arch Phys Med Rehabil. 2011 Mar;92(3):411-8.)In a separate study involving 947 individuals with SCI, 23% were depressed. Of these, only 29% were taking antidepressants and 11% had received counseling within the past three months. Far fewer had received enough antidepressants or counseling. Why are people with SCI receiving too little treatment for depression? People with SCI have more barriers to getting medical care, such as limited transportation or inadequate insurance coverage. They may be too embarrassed to discuss or admit to being depressed. And health providers may not be screening their SCI patients for depression, possibly because other medical problems are more pressing or obvious. The researchers urge health providers to do a better job of screening patients with SCI for depression and, once treated, following up to see if the treatment is working. (Fann JR, Bombardier CH, Richards JS, Tate DG, et al. Depression after spinal cord injury: comorbidities, mental health service use, and adequacy of treatment. Arch Phys Med Rehabil. 2011 Mar;92(3):352-60)
Setting the stage for experimental treatments
How do we know if a new treatment really improves recovery? In the world of SCI recovery research, one of the challenges of conducting clinical trials is being able to tell whether any improvement in function was caused by the experimental treatment, or if the patient would have improved anyway, since most people with SCI have some natural recovery in the first year after injury.
The researchers looked at the changes in motor function that naturally occurred during the first year after injury in 1,436 individuals with tetraplegia (quadriplegia). They found that people with initially complete injuries converted to incomplete injuries at a somewhat higher rate (30%) than was previously thought, including 7.1% converting to ASIA Impairment Scale grade D. They identified neurological measures that would be appropriate outcome measures for future clinical trials. (Marino RJ, Burns S, Graves DE, et al. Upper- and lower-extremity motor recovery after traumatic cervical spinal cord injury: an update from the national spinal cord injury database. Arch Phys Med Rehabil. 2011 Mar;92(3):369-75.)
Mechanical ventilation and quality of life
The goal of this study was to learn more about how people on ventilators feel about their health and quality of life. Earlier research found that people on ventilators reported quality of life that was as good or even better than similar patients with SCI who did not require ventilators. In this study of 1,635 people with tetraplegia, participants completed questionnaires one year after injury. Their responses showed that although the ventilator users reported lower quality of life and health than non-ventilator users, they generally said their quality of life was good. It is possible that reported quality of life improves over time, as the earlier studies included patients with longer duration of ventilator dependence than in this study. These findings are important because many health care providers incorrectly expect that ventilator-dependent patients will have a poor quality of life. (Charlifue S, Apple D, Burns SP, et al. Mechanical ventilation, health, and quality of life following spinal cord injury. Arch Phys Med Rehabil. 2011 Mar;92(3):457-63)
In a group of almost 8,000 people with SCI, 27% did not own a cell telephone (in contrast to only 13% in the general population). Those who owned cell phones were more socially connected and involved in activities outside the home and more likely to have jobs than those who did not own cell phones.
Owning a cell phone has many benefits, and better access to cell phone technology is needed for this population. (Roach MJ, Harrington A, Powell H, Nemunaitis G. Cell telephone ownership and social integration in persons with spinal cord injury. Arch Phys Med Rehabil. 2011 Mar;92(3):472-6.)
In a study of 3,726 individuals with SCI, 36.5% reported they drove their own (modified) vehicle. This group had greater participation in the community, were more likely to be employed, and had greater independence than those who did not drive. They also had better mental and physical health, life satisfaction and higher incomes than non-drivers.
Since anyone with SCI below C4 has good potential for driving a modified vehicle, better driving rehabilitation and assistive technology services are needed for people with SCI so they can reap the many benefits of driving. (Norweg A, Jette AM, Houlihan B, et al. Patterns, predictors, and associated benefits of driving a modified vehicle after spinal cord injury: findings from the National Spinal Cord Injury Model Systems. Arch Phys Med Rehabil. 2011 Mar;92(3):477-83.)
In a group of 1,381 people with chronic SCI, 7.5% were underweight, 31.4% were overweight, and 22.1% were obese. Pain and unplanned hospitalizations were more common among those who were either obese or underweight. Participation in the community was also lower in these two groups. Living alone, a cervical injury and less education increased the risk for weight-related problems. Greater efforts are needed to prevent and manage underweight and overweight in persons with SCI in order to reduce the risk of secondary complications. (Chen Y, Cao Y, Allen V, Richards JS. Weight matters: physical and psychosocial well being of persons with spinal cord injury in relation to body mass index. Arch Phys Med Rehabil. 2011 Mar;92(3):391-8.)