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Poster 48: Gender Differences in Rehabilitation Outcomes Among Older Patients With a Traumatic Spinal Cord injury
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2009 ACRM–ASNR JOINT EDUCATIONAL CONFERENCE ABSTRACTS
stand retraining; 2) electrical stimulation alone; or 3) stand retraining alone. The electrical stimulation groups were given symmetrical biphasic pulses of 300 s at 35 Hz delivered across a 1000 ohm load bilaterally on the rectus femoris, bicep femoris, tibilias anterior, gastrocnemius muscles. Main Outcome Measures: Percent BMD change after intervention at the proximal femur, the distal femur, and the proximal tibia based on dual energy x-ray absorptiometry (DEXA; GE Lunar iDexa, Lunar Inc., Madison, WI). Results: For analyses the 2 groups receiving ES were combined. BMD increased significantly over time in the ES group compared to the stand retraining group (P⬍.05) at both the right distal femur (27% and⫺34%, respectively) and right proximal tibia (12% and⫺29%, respectively). No significant differences were found on the left side. This could have been due to the small n size. Conclusions: FES with and without loading has a positive effect on bone mineral density for the individuals with motor complete SCI. Key Words: Bone mineral density; Electrical stimulation; Rehabilitation; Spinal Cord Injury. Poster 48 Gender Differences in Rehabilitation Outcomes Among Older Patients With a Traumatic Spinal Cord injury. Holly DeMark (Rehabilitation Institute of Chicago, Chicago, IL), Anne Deutsch, Allen Heinemann, David Chen. Disclosure: None declared. Objective: To examine gender differences in rehabilitation outcomes among older adults with a traumatic spinal cord injury (TSCI). Design: Cohort study using secondary analysis of Medicare claims and assessment data. Setting: 1,063 inpatient rehabilitation hospitals and units. Participants: 6,657 aged Medicare fee-for-service beneficiaries with a TSCI discharged in 2002 to 2005. Interventions: None. Main Outcome Measures: Length of stay (LOS), discharge FIM self-care rating (range: 6 to 42), discharge FIM mobility rating (range: 5 to 35), discharge destination. Results: Approximately half (48.9%) of Medicare patients with a TSCI were women. Across all patients, women, when compared to men, had shorter rehabilitation stays (16.8 [11.5] vs 19.9 [14.5] days), achieved higher discharge FIM self-care skills (26.8 [9.0] vs 23.8 [10.2] FIM units) and higher discharge FIM mobility skills (18.2 [7.5] vs 17.1 [7.8] FIM units) and were more likely to be discharged to the community (65.2% vs 59.1%). Women had less severe injuries; men were more likely to have quadriplegia and more likely to have complete lesions than women. When outcomes were analyzed separately by the level and completeness of the SCI (e.g., paraplegia complete, paraplegia incomplete), no gender differences remained. Thus, outcome differences were related to injury severity. For each severity group, the percent of patients discharged to the community was similar for men and women, even though fewer women were married (35.2% vs.67.2% overall). Conclusions: Approximately half of aged Medicare fee-for-service patients with TSCI were women. Women had less severe injuries than men. Within severity groups men and women had similar outcomes. Key Words: Rehabilitation; Spinal cord injuries; Treatment outcomes. Poster 49 Medical and Psychosocial Predictors of Secondary Complications after SCI: A Longitudinal Study. Alexander Libin (National Rehabilitation Hospital, Washington, DC), Inger Ljungberg, Miriam Spungen, Thilo Kroll, Mark Beasley, Suzanne Groah. Disclosure: None declared. Objective: To explore predictors of secondary conditions in persons with SCI. Design: Prospective longitudinal study based on a withinsubject repeated measures design. Setting: Large metropolitan hospital. Participants: 62 individuals with AIS A/B/C/D SCI for more than 6 months. Interventions: Secondary conditions were self-reported via Arch Phys Med Rehabil Vol 90, October 2009
bi-weekly assessments of SCI individuals over 18 months. Regression modelling explored individual factors as predictors of secondary conditions. A backward elimination method was used to remove predictor variables with P values⬍.20 from this full model. In a final regression model reported predictors were significant at ␣⫽0.05. Main Outcome Measures: Secondary conditions in SCI. Results: GLM analysis showed that the rates of secondary conditions remained constant. Occupational and/or physical therapy visits predicted fewer pressure ulcers (PU), urinary tract infections (UTI), and breathing problems. Less exercise associated with UTI. Frequent hospitalization associated with tetraplegia, low exercise, and higher pain. Higher anxiety associated with longer duration of injury and PU. Being unemployed, of older age and with a higher pain associated with depression. Conclusions: Individual factors such as duration and level of injury, age and employment status are critical in identifying people at risk for secondary conditions. Modifiable factors such as exercise, pain management and anxietyrelated emotional regulation could be targeted for interventions. Key Words: Individual factors; Medical and psychosocial secondary conditions; Rehabilitation; Spinal cord injuies. Poster 50 Differences in Health-Related Quality of Life Between Individuals with Spinal Cord Injury and Controls in Neiva, Colombia. Juan Carlos Arango (Virginia Commonwealth University, Richmond, VA), Silvia Plaza, Jose Romero, Jose Pizarro, Kathryn Francis, Heather Rogers. Disclosure: None declared. Objective: To assess health-related quality of life (QOL) of individuals with spinal cord injury (SCI) in Neiva, Colombia. Design: Crosssectional. Setting: Community-based sample in Neiva, Colombia. Participants: 40 Colombians with SCI and 42 age- and gendermatched controls completed the Satisfaction with Life Scale (SWLS) and the SF-36, a self-report measure composed of eight component areas (physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/ fatigue, and general health perceptions). Interventions: Not applicable. Main Outcome Measures: Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) on health-related QOL, SWLS. Results: Compared with healthy controls, individuals with SCI had significantly lower means on five SF-36 sub-scales: physical functioning (22.5 vs 94.0; P⬍.001), role limitations due to physical problems (54.4 vs 77.4; P⬍.01), social functioning (66.6 vs 79.1; P⬍.05), pain (65.4 vs 79.5; P⬍.01), and general health (53.7 vs 68.7; P⬍.01). Although both groups scored similarly on the SF-36 emotional wellbeing subscale, individuals with SCI also had significantly lower SWLS scores compared to controls. Conclusions: Individuals with SCI living in rural Colombia report having poorer quality of life across various domains, including physical and social functioning and satisfaction with life. These findings suggest the need for rehabilitation health professionals to develop and implement interventions to improve quality of life and satisfaction with life in individuals with SCI. Key Words: Quality of life; Rehabilitation; Spinal Cord Injuries. Poster 51 Development of a Novel Automated Telehealth System for People with Spinal Cord Dysfunction. Bethlyn Houlihan (Boston Medical Center, Boston, MA), Alan Jette, Michael Paasche-Orlow, Jane Wierbicky, Judi Zazula, Kelsey Dicker, Pennie Cuevas, Stan Ducharme, Steve Williams. Disclosure: Poster Presentation, SCI Cotemporary Forums, March 2009. Objectives: While people with spinal cord dysfunction (SCD) have high rates of pressure ulcers and depression, few interventions have
2009 ACRM–ASNR JOINT EDUCATIONAL CONFERENCE ABSTRACTS
stand retraining; 2) electrical stimulation alone; or 3) stand retraining alone. The electrical stimulation groups were given symmetrical biphasic pulses of 300 s at 35 Hz delivered across a 1000 ohm load bilaterally on the rectus femoris, bicep femoris, tibilias anterior, gastrocnemius muscles. Main Outcome Measures: Percent BMD change after intervention at the proximal femur, the distal femur, and the proximal tibia based on dual energy x-ray absorptiometry (DEXA; GE Lunar iDexa, Lunar Inc., Madison, WI). Results: For analyses the 2 groups receiving ES were combined. BMD increased significantly over time in the ES group compared to the stand retraining group (P⬍.05) at both the right distal femur (27% and⫺34%, respectively) and right proximal tibia (12% and⫺29%, respectively). No significant differences were found on the left side. This could have been due to the small n size. Conclusions: FES with and without loading has a positive effect on bone mineral density for the individuals with motor complete SCI. Key Words: Bone mineral density; Electrical stimulation; Rehabilitation; Spinal Cord Injury. Poster 48 Gender Differences in Rehabilitation Outcomes Among Older Patients With a Traumatic Spinal Cord injury. Holly DeMark (Rehabilitation Institute of Chicago, Chicago, IL), Anne Deutsch, Allen Heinemann, David Chen. Disclosure: None declared. Objective: To examine gender differences in rehabilitation outcomes among older adults with a traumatic spinal cord injury (TSCI). Design: Cohort study using secondary analysis of Medicare claims and assessment data. Setting: 1,063 inpatient rehabilitation hospitals and units. Participants: 6,657 aged Medicare fee-for-service beneficiaries with a TSCI discharged in 2002 to 2005. Interventions: None. Main Outcome Measures: Length of stay (LOS), discharge FIM self-care rating (range: 6 to 42), discharge FIM mobility rating (range: 5 to 35), discharge destination. Results: Approximately half (48.9%) of Medicare patients with a TSCI were women. Across all patients, women, when compared to men, had shorter rehabilitation stays (16.8 [11.5] vs 19.9 [14.5] days), achieved higher discharge FIM self-care skills (26.8 [9.0] vs 23.8 [10.2] FIM units) and higher discharge FIM mobility skills (18.2 [7.5] vs 17.1 [7.8] FIM units) and were more likely to be discharged to the community (65.2% vs 59.1%). Women had less severe injuries; men were more likely to have quadriplegia and more likely to have complete lesions than women. When outcomes were analyzed separately by the level and completeness of the SCI (e.g., paraplegia complete, paraplegia incomplete), no gender differences remained. Thus, outcome differences were related to injury severity. For each severity group, the percent of patients discharged to the community was similar for men and women, even though fewer women were married (35.2% vs.67.2% overall). Conclusions: Approximately half of aged Medicare fee-for-service patients with TSCI were women. Women had less severe injuries than men. Within severity groups men and women had similar outcomes. Key Words: Rehabilitation; Spinal cord injuries; Treatment outcomes. Poster 49 Medical and Psychosocial Predictors of Secondary Complications after SCI: A Longitudinal Study. Alexander Libin (National Rehabilitation Hospital, Washington, DC), Inger Ljungberg, Miriam Spungen, Thilo Kroll, Mark Beasley, Suzanne Groah. Disclosure: None declared. Objective: To explore predictors of secondary conditions in persons with SCI. Design: Prospective longitudinal study based on a withinsubject repeated measures design. Setting: Large metropolitan hospital. Participants: 62 individuals with AIS A/B/C/D SCI for more than 6 months. Interventions: Secondary conditions were self-reported via Arch Phys Med Rehabil Vol 90, October 2009
bi-weekly assessments of SCI individuals over 18 months. Regression modelling explored individual factors as predictors of secondary conditions. A backward elimination method was used to remove predictor variables with P values⬍.20 from this full model. In a final regression model reported predictors were significant at ␣⫽0.05. Main Outcome Measures: Secondary conditions in SCI. Results: GLM analysis showed that the rates of secondary conditions remained constant. Occupational and/or physical therapy visits predicted fewer pressure ulcers (PU), urinary tract infections (UTI), and breathing problems. Less exercise associated with UTI. Frequent hospitalization associated with tetraplegia, low exercise, and higher pain. Higher anxiety associated with longer duration of injury and PU. Being unemployed, of older age and with a higher pain associated with depression. Conclusions: Individual factors such as duration and level of injury, age and employment status are critical in identifying people at risk for secondary conditions. Modifiable factors such as exercise, pain management and anxietyrelated emotional regulation could be targeted for interventions. Key Words: Individual factors; Medical and psychosocial secondary conditions; Rehabilitation; Spinal cord injuies. Poster 50 Differences in Health-Related Quality of Life Between Individuals with Spinal Cord Injury and Controls in Neiva, Colombia. Juan Carlos Arango (Virginia Commonwealth University, Richmond, VA), Silvia Plaza, Jose Romero, Jose Pizarro, Kathryn Francis, Heather Rogers. Disclosure: None declared. Objective: To assess health-related quality of life (QOL) of individuals with spinal cord injury (SCI) in Neiva, Colombia. Design: Crosssectional. Setting: Community-based sample in Neiva, Colombia. Participants: 40 Colombians with SCI and 42 age- and gendermatched controls completed the Satisfaction with Life Scale (SWLS) and the SF-36, a self-report measure composed of eight component areas (physical health problems, role limitations due to personal or emotional problems, emotional well-being, social functioning, energy/ fatigue, and general health perceptions). Interventions: Not applicable. Main Outcome Measures: Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) on health-related QOL, SWLS. Results: Compared with healthy controls, individuals with SCI had significantly lower means on five SF-36 sub-scales: physical functioning (22.5 vs 94.0; P⬍.001), role limitations due to physical problems (54.4 vs 77.4; P⬍.01), social functioning (66.6 vs 79.1; P⬍.05), pain (65.4 vs 79.5; P⬍.01), and general health (53.7 vs 68.7; P⬍.01). Although both groups scored similarly on the SF-36 emotional wellbeing subscale, individuals with SCI also had significantly lower SWLS scores compared to controls. Conclusions: Individuals with SCI living in rural Colombia report having poorer quality of life across various domains, including physical and social functioning and satisfaction with life. These findings suggest the need for rehabilitation health professionals to develop and implement interventions to improve quality of life and satisfaction with life in individuals with SCI. Key Words: Quality of life; Rehabilitation; Spinal Cord Injuries. Poster 51 Development of a Novel Automated Telehealth System for People with Spinal Cord Dysfunction. Bethlyn Houlihan (Boston Medical Center, Boston, MA), Alan Jette, Michael Paasche-Orlow, Jane Wierbicky, Judi Zazula, Kelsey Dicker, Pennie Cuevas, Stan Ducharme, Steve Williams. Disclosure: Poster Presentation, SCI Cotemporary Forums, March 2009. Objectives: While people with spinal cord dysfunction (SCD) have high rates of pressure ulcers and depression, few interventions have