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Journal of Advanced Nursing Jan 2018To synthesize the qualitative research evidence that explored how survivors of adult spinal cord injury experience and make sense of resilience. (Review)
Review
AIM
To synthesize the qualitative research evidence that explored how survivors of adult spinal cord injury experience and make sense of resilience.
BACKGROUND
Spinal cord injury is often a sudden and unexpected life-changing event requiring complex and long-term rehabilitation. The development of resilience is essential in determining how spinal cord injury survivors negotiate this injury and rehabilitation.
DESIGN
A qualitative systematic review and thematic synthesis of the research evidence.
DATA SOURCES
CINAHL, PubMed, Embase, Scopus and PsycINFO were searched, no restriction dates were used.
REVIEW METHODS
Methodological quality was assessed using the Critical Appraisal Skills Programme checklist. Thematic synthesis focused on how survivors of adult spinal cord injury experience and make sense of resilience.
RESULTS
Six qualitative research articles reported the experiences of 84 spinal cord injury survivors. Themes identified were: uncertainty and regaining independence; prior experiences of resilience; adopting resilient thinking; and strengthening resilience through supports.
CONCLUSION
Recovery and rehabilitation following spinal cord survivors is influenced by the individual's capacity for resilience. Resilience may be influenced by previous life experiences and enhanced by supportive nursing staff encouraging self-efficacy. Survivors identified the need for active involvement in decision-making about their care to enable a sense of regaining control of their lives. This has the potential to have a significant impact on their self-efficacy and in turn health outcomes.
Topics: Adult; Humans; Nurse's Role; Psychosocial Support Systems; Qualitative Research; Resilience, Psychological; Self Efficacy; Spinal Cord Injuries; Survivors
PubMed: 28726274
DOI: 10.1111/jan.13396 -
The Journal of Spinal Cord Medicine May 2016Despite the recognition of sports as a significant contributor in the etiology of spinal cord injury (SCI), no studies have systematically explored the epidemiology of... (Review)
Review
CONTEXT
Despite the recognition of sports as a significant contributor in the etiology of spinal cord injury (SCI), no studies have systematically explored the epidemiology of SCI caused by sports.
OBJECTIVE
This paper aims to give a systematic overview of the epidemiology of sport-related spinal cord injury around the world.
METHODS
A systematic review was conducted to identify published literature reporting the epidemiology of SCI caused by sports. The literature search was conducted in MEDLINE/PubMed, CINAHL, EMBASE, PsycINFO and Sportdiscus with date limits 1980 through to July 2015. Data from 54 studies covering 25 countries was extracted and collated.
RESULTS
Important findings include identification of 6 countries in which sports accounts for over 13% of SCI (highest to lowest: Russia, Fiji, New Zealand, Iceland, France and Canada); individual sports with high risk for SCI (diving, skiing, rugby, and horseback riding); and the most common level of injury for various sports (almost entirely cervical for hockey, skiing, diving and American football, while over half of horseback riding and snowboarding injuries are thoracic or lumbosacral).
CONCLUSION
This paper identifies countries and sports with higher rates of sport-related SCIs where implementation of prevention programs and reporting systems to track SCI epidemiology may be helpful, and highlights gaps in our current knowledge for further investigation. The comparison of SCI occurrence for each sport across countries, as well as examination of the specific characteristics of SCI incurred for individual sports will assist in directing efforts for prevention.
Topics: Athletic Injuries; Female; Humans; Male; Spinal Cord Injuries; Sports
PubMed: 26864974
DOI: 10.1080/10790268.2016.1138601 -
European Spine Journal : Official... Nov 2022This study aimed to investigate the neurological outcome, trends and sequelae following surgical or conservative treatment of intramedullary spinal cord cavernous... (Review)
Review
PURPOSE
This study aimed to investigate the neurological outcome, trends and sequelae following surgical or conservative treatment of intramedullary spinal cord cavernous malformations (ISCCMs).
METHODS
A systematic review was performed according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. The primary outcome measure was the change in the neurological status after surgery or conservative management. A logistic regression analysis investigating prognostic factors related to outcome was also performed.
RESULTS
Twenty-one studies with 1091 patients in total were included, of which 1005 (92.1%) underwent surgical resection and 86 (7.9%) were treated conservatively. Gross total resection was achieved in 95.7% of the patients and partial resection in 4.3%. Most lesions (60.2%) were located in the thoracic spine and presented with motor (60.4%) and sensory deficits (59.7%). In the long term, surgical treatment resulted in an improved neurological status in 36.9% of the patients, in 55.8% it remained stable, and in 7.3% it deteriorated compared to the preoperative state. In the conservative cohort, 21.7% improved, 69.6% remained stable, and 8.7% deteriorated. Solitary lesions, duration of preoperative symptoms less than 3 months as well as an improved post-operative neurological status were predictors of a favourable long-term outcome.
CONCLUSIONS
Whenever feasible, symptomatic patients with ISCCM are recommended to undergo surgery within 3 months from symptom onset. Absence of multiple lesions and, most importantly, post-operative symptom improvement foresee a favourable long-term outcome. Further research is warranted to discern the role of conservative treatment in symptomatic patients.
Topics: Humans; Spinal Cord Neoplasms; Treatment Outcome; Follow-Up Studies; Retrospective Studies; Nervous System Malformations; Spinal Cord; Neurosurgical Procedures
PubMed: 35931791
DOI: 10.1007/s00586-022-07332-6 -
Spinal Cord Jan 2017This is a systematic literature review. (Review)
Review
STUDY DESIGN
This is a systematic literature review.
OBJECTIVES
The objectives of this study were to investigate, first, the proportion of spinal cord injury (SCI) caused by suicidal behaviour; second, the proportion of deaths in the SCI population caused by suicide; and third, the risk factors associated with suicidal behaviour.
SETTING
This study was conducted in the UK.
METHODS
AMED, EMBASE, HMIC, BNI, Medline, PsycInfo, CINAHL and HEALTH BUSINESS ELITE were searched between January and February 2016, identifying a total of 404 articles published between 1990 and 2016. Full articles, written in English, looking at suicide before and after SCI were selected. On the basis of the inclusion criteria, 22 relevant articles were included in this literature review.
RESULTS
Studies reported that between 0 and 6.8% of individuals with SCI had acquired their injury as a result of attempted suicide. The predominant method used in these attempts was deliberate falling/jumping from buildings and bridges. Suicidal behaviour post SCI was frequently reported as a cause of death; studies reported that between 5.8 and 11% of deaths were a result of suicide. The predominant methods used were gunshot and overdose. Psychiatric diagnoses were identified to be a major risk factor for suicidal behaviour.
CONCLUSION
Individuals with SCI are at risk of attempting suicide; this risk is increased by the presence of a psychiatric diagnosis. There is a crucial need for risk assessment and psychological intervention for individuals with mental health issues following SCI.
Topics: Humans; Risk Factors; Spinal Cord Injuries; Suicide
PubMed: 27670807
DOI: 10.1038/sc.2016.135 -
World Neurosurgery Mar 2024Spasticity is a form of muscle hypertonia secondary to various diseases, including traumatic brain injury, spinal cord injury, cerebral palsy, and multiple sclerosis.... (Review)
Review
OBJECTIVE
Spasticity is a form of muscle hypertonia secondary to various diseases, including traumatic brain injury, spinal cord injury, cerebral palsy, and multiple sclerosis. Medical treatments are available; however, these often result in insufficient clinical response. This review evaluates the role of epidural spinal cord stimulation (SCS) in the treatment of spasticity and associated functional outcomes.
METHODS
A systematic review of the literature was performed using the Embase, CENTRAL, and MEDLINE databases. We included studies that used epidural SCS to treat spasticity. Studies investigating functional electric stimulation, transcutaneous SCS, and animal models of spasticity were excluded. We also excluded studies that used SCS to treat other symptoms such as pain.
RESULTS
Thirty-four studies were included in the final analysis. The pooled rate of subjective improvement in spasticity was 78% (95% confidence interval, 64%-91%; I = 77%), 40% (95% confidence interval, 7%-73%; I = 88%) for increased H-reflex threshold or decreased Hoffman reflex/muscle response wave ratio, and 73% (65%-80%; I = 50%) for improved ambulation. Patients with spinal causes had better outcomes compared with patients with cerebral causes. Up to 10% of patients experienced complications including infections and hardware malfunction.
CONCLUSIONS
Our review of the literature suggests that SCS may be a safe and useful tool for the management of spasticity; however, there is significant heterogeneity among studies. The quality of studies is also low. Further studies are needed to fully evaluate the usefulness of this technology, including various stimulation paradigms across different causes of spasticity.
Topics: Animals; Humans; Spinal Cord Stimulation; Spinal Cord Injuries; Pain; Muscle Spasticity; Walking; Reflex, Abnormal; Spinal Cord
PubMed: 38181878
DOI: 10.1016/j.wneu.2023.12.158 -
Acta Neurochirurgica Sep 2023To determine existing trends concerning in-hospital mortality in patients with traumatic subaxial cervical spinal cord injury (SCI) over the last four decades. (Meta-Analysis)
Meta-Analysis Review
PURPOSE
To determine existing trends concerning in-hospital mortality in patients with traumatic subaxial cervical spinal cord injury (SCI) over the last four decades.
METHODS
We searched MEDLINE and EMBASE to assess the role of the following factors on in-hospital mortality over the last four decades: neurological deficit, age, surgical decompression, use of computed tomography (CT) and magnetic resonance imaging (MRI), use of methylprednisolone in the acute post-injury period, and study location (developing versus developed countries).
RESULTS
Among 3333 papers after deduplication, 21 studies met the eligibility criteria. The mortality rate was 17.88% [95% confidence interval (CI): 12.9-22.87%]. No significant trend in mortality rate was observed over the 42-year period (meta-regression coefficient = 0.317; p = 0.372). Subgroup analysis revealed no significant association between acute subaxial cervical SCI-related mortality when stratified by use of surgery, administration of methylprednisolone, use of MRI and CT imaging, study design (prospective versus retrospective study), and study location. The mortality rate was significantly higher in complete SCI (20.66%, p = 0.002) and American Spinal Injury Association impairment scale (AIS) A (20.57%) and B (9.28%) (p = 0.028).
CONCLUSION
A very low level of evidence showed that in-hospital mortality in patients with traumatic subaxial cervical SCI did not decrease over the last four decades despite diagnostic and therapeutic advancements. The overall acute mortality rate following subaxial cervical SCI is 17.88%. We recommend reporting a stratified mortality rate according to key factors such as treatment paradigms, age, and severity of injury in future studies.
Topics: Humans; Hospital Mortality; Cervical Cord; Prospective Studies; Retrospective Studies; Neck Injuries; Spinal Cord Injuries; Methylprednisolone
PubMed: 37480505
DOI: 10.1007/s00701-023-05720-5 -
The Journal of Spinal Cord Medicine Jul 2016Spinal cord injury commonly results in neuromuscular weakness that impacts respiratory function. This would be expected to be associated with an increased likelihood of... (Review)
Review
CONTEXT
Spinal cord injury commonly results in neuromuscular weakness that impacts respiratory function. This would be expected to be associated with an increased likelihood of sleep-disordered breathing.
OBJECTIVE
(1) Understand the incidence and prevalence of sleep disordered breathing in spinal cord injury. (2) Understand the relationship between injury and patient characteristics and the incidence of sleep disordered breathing in spinal cord injury. (3) Distinguish between obstructive sleep apnea and central sleep apnea incidence in spinal cord injury. (4) Clarify the relationship between sleep disordered breathing and stroke, myocardial infarction, metabolic dysfunction, injuries, autonomic dysreflexia and spasticity incidence in persons with spinal cord injury. (5) Understand treatment tolerance and outcome in persons with spinal cord injury and sleep disordered breathing.
METHODS
Extensive database search including PubMed, Cochrane Library, CINAHL and Web of Science.
RESULTS
Given the current literature limitations, sleep disordered breathing as currently defined is high in patients with spinal cord injury, approaching 60% in motor complete persons with tetraplegia. Central apnea is more common in patients with tetraplegia than in patients with paraplegia.
CONCLUSION
Early formal sleep study in patients with acute complete tetraplegia is recommended. In patients with incomplete tetraplegia and with paraplegia, the incidence of sleep-disordered breathing is significantly higher than the general population. With the lack of correlation between symptoms and SDB, formal study would be reasonable. There is insufficient evidence in the literature on the impact of treatment on morbidity, mortality and quality of life outcomes.
Topics: Humans; Sleep Apnea Syndromes; Spinal Cord Injuries
PubMed: 27077573
DOI: 10.1080/10790268.2015.1126449 -
NeuroRehabilitation 2021Epidural spinal cord stimulation (ESCS) emerged as a technology for eliciting motor function in the 1990's and was subsequently employed therapeutically in the... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Epidural spinal cord stimulation (ESCS) emerged as a technology for eliciting motor function in the 1990's and was subsequently employed therapeutically in the population with spinal cord injury (SCI). Despite a considerable number of ESCS studies, a comprehensive systematic review of ESCS remains unpublished.
OBJECTIVE
The current review of the existing literature evaluated the efficacy of ESCS for improving motor function in individuals with SCI.
METHODS
A search for ESCS studies was performed using the following databases: Medline (Ovid), Web of Science and Embase. Furthermore, to maximize results, an inverse manual search of references cited by identified articles was also performed. Studies published between January 1995 and June 2020 were included. The search was constructed around the following key terms: Spinal cord stimulation, SCI and motor response generation.
RESULTS
A total of 3435 articles were initially screened, of which 18 met the inclusion criteria. The total sample comprised of 24 participants with SCI. All studies reported some measure of improvement in motor activity with ESCS, with 17 reporting altered EMG responses. Functional improvements were reported in stepping (n = 11) or muscle force (n = 4). Only 5 studies assessed ASIA scale pre- and post-intervention, documenting improved classification in 4 of 11 participants. Appraisal using the modified Downs and Black quality checklist determined that reviewed studies were of poor quality. Due to heterogeneity of outcome measures utilized in studies reviewed, a meta-analysis of data was not possible.
CONCLUSION
While the basic science is encouraging, the therapeutic efficacy of ESCS remains inconclusive.
Topics: Humans; Outcome Assessment, Health Care; Spinal Cord Injuries; Spinal Cord Stimulation
PubMed: 33967072
DOI: 10.3233/NRE-210093 -
Neuromodulation : Journal of the... Jan 2023Spinal cord stimulation (SCS) is a last-resort treatment for patients with chronic neuropathic pain. The mechanism underlying SCS and pain relief is not yet fully... (Review)
Review
OBJECTIVES
Spinal cord stimulation (SCS) is a last-resort treatment for patients with chronic neuropathic pain. The mechanism underlying SCS and pain relief is not yet fully understood. Because the inflammatory balance between pro- and anti-inflammatory molecules in the spinal nociceptive network is pivotal in the development and maintenance of neuropathic pain, the working mechanism of SCS is suggested to be related to the modulation of this balance. The aim of this systematic review is to summarize and understand the effects of different SCS paradigms on the central inflammatory balance in the spinal cord.
MATERIALS AND METHODS
A systematic literature search was conducted using MEDLINE, Embase, and PubMed. All articles studying the effects of SCS on inflammatory or glial markers in neuropathic pain models were included. A quality assessment was performed on predetermined entities of bias.
RESULTS
A total of 11 articles were eligible for this systematic review. In general, induction of neuropathic pain in rats results in a proinflammatory state and at the same time an increased activity/expression of microglial and astroglial cells in the spinal cord dorsal horn. Conventional SCS seems to further enhance this proinflammatory state and increase the messenger RNA expression of microglial markers, but it also results in a decrease in microglial protein marker levels. High-frequency and especially differential targeted multiplexed SCS can not only restore the balance between pro- and anti-inflammatory molecules but also minimize the overexpression/activation of glial cells. Quality assessment and risk of bias analysis of the studies included make it clear that the results of these preclinical studies must be interpreted with caution.
CONCLUSIONS
In summary, the preclinical findings tend to indicate that there is a distinct SCS paradigm-related effect in the modulation of the central inflammatory balance of the spinal dorsal horn.
Topics: Rats; Animals; Spinal Cord Stimulation; Neuralgia; Pain Management; Spinal Cord; Spinal Cord Dorsal Horn
PubMed: 35931643
DOI: 10.1016/j.neurom.2022.04.049 -
Neurosurgical Review Apr 2022Aneurysms arising in the spinal circulation are rare and underreported. The objective of this study was to systematically review the English literature on different... (Review)
Review
Aneurysms arising in the spinal circulation are rare and underreported. The objective of this study was to systematically review the English literature on different aspects of isolated spinal aneurysms using the PubMed, Ovid MEDLINE, and Google Scholar databases. Eighty-two papers reporting 107 individual patient cases were included. Most isolated spinal aneurysms have a fusiform morphology, and are most commonly found in the anterior spinal artery at the thoracic or cervical levels. Subarachnoid hemorrhage is the most common form of presentation, and sudden onset back pain is the most common initial symptom. The diagnosis of spinal aneurysms requires a high degree of clinical suspicion. Because of their small size, they can be missed on CT/MR angiography and spinal angiogram may be employed. Treatment of spinal aneurysms should be individualized on a case-by-case basis. Conservative management can be a valid option in spinal aneurysms where the risk of treatment is high. Surgical or endovascular intervention may be indicated in cases of significant or progressive neurologic decline due aneurysmal mass effect, or progressive growth of the aneurysm despite conservative treatment.
Topics: Aneurysm, Ruptured; Humans; Intracranial Aneurysm; Spinal Cord; Spine; Subarachnoid Hemorrhage; Treatment Outcome; Vertebral Artery
PubMed: 34541624
DOI: 10.1007/s10143-021-01645-8