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P22 CHRONIC PAIN AFTER SPINAL CORD INJURY. PREVALENCE AND ASSOCIATED FACTORS. Author(s): Ferreiro-Velasco ME; Barca-Buyo A; Balsa-Mosquera B; Seoane-Rodriguez S; Montoto-Marqués A; Salvador-de la Barrera S; Rodriguez-Sotillo A. Name of ISCoS Member (Author): Antonio Montoto Marqués. Main institution where the work was done: Hospital Juan Canalejo. Spinal Cord Injuries Unit. A CORUÑA. SPAIN. Introduction: The aim of this study is to assess the prevalence of chronic pain in a sample of patients with spinal cord injuries, to investigate the relationship between physical factors associated with the injury and the presence and severity of pain and its interference in daily activities. Patients and methods: An observational study based in a personal interview was conducted. Demographic data, factors of the injury, anxiety and depression grade, presence, intensity and nature of chronic pain was collected. Results: One hundred and fourteen patients were included; 54.4% reported chronic pain with 26.2% describing it as severe. Below-level neuropathic pain was the most common type of pain. There was a relationship between the presence of pain and age at the time of interview (p=0.022) and at the onset of the injury (p=0.009); and also between the intensity of pain and its interference in daily activities (p=0.033). Anxiety and depression grades were higher in the patients with pain than in the control group (p=0.045). The results of logistic regression showed that the probability of suffering chronic pain was modified by the age at the time of injury, [OR: 1.03 CI 95% (1.00-1.06) P=0.042]. Conclusions: It was confirmed the high prevalence and intensity of chronic pain in spinal cord injured patients as well as its early onset after injury. Age, anxiety and depression grade were the only factors related with chronic pain. P23 A Study on the Unmet Needs of Persons with Spinal Cord Injury (SCI) Author(s): Nazirah Hasnan, Zaliha Omar Main institution where the work was done: University of Malaya, Kuala Lumpur, Malaysia Background: SCI is a devastating occurrence with multisystem consequences and many potential medical complications. Disabilities may occur in all domains of function and as a result, many SCI individuals despite being independent in most aspects remain dependent on various services for their life maintenance. It is crucial for rehabilitation professionals to identify these lifelong needs for the health and physical maintenance of these individuals. Aims: To examine the unmet needs of persons with SCI pertaining to their personal and social care, health care, accommodation, finance, education, employment, leisure, transport and access; as perceived by the SCI individuals, their carers and their nominated health care professionals. Methods: Interview study of thirty persons with SCI, eighteen carers and fifteen health care professionals. The outcome measure used was the Modified Southampton Needs Assessment Questionnaire. Results: Out of a list of ten, the SCI individuals reported an average 7.69 unmet needs, their carers 7.32 and the health care professionals 6.09. The most prevalent were self-actualization, equipment, mobility and financial needs. Conclusion: This study highlights many issues of unmet needs that impact greatly on the SCI individuals’ independence in health and physical maintenance and the achievement of a satisfactory quality of life. P24 Improving the Quality of Life for People with SCI through qualitative research Author(s): Dr. Chris Carpenter, Dr. Claire Weeks, Mr. Bert Forman Name of ISCoS Member (Author): Dr. Claire Weeks Main institution where the work was done: British Columbia Paraplegic Association This presentation will illustrate an example of health services and policy decisions based on rigorous research that involves the intended service recipients. It describes a qualitative focus group research study designed as the first phase of an evaluation of the role of the British Columbia Paraplegic Association (BCPA) in assisting individuals with spinal cord injury to achieve their quality of life goals in the community. The findings reinforce the importance of environmental factors, support from family and peers, adequate financial support and access to resources, living life with purpose and social involvement in contributing to community participation and reintegration. Recommendations are made for ongoing program and service planning. Practical examples will be given of changes implemented by the BCPA as a result of this evaluative study demonstrating the contribution that qualitative research ‘evidence’ can make in ascertaining and acting upon the primary stakeholder’s, that is, the client’s perspective. The findings should interest the full Spinal Cord Injury network including those in acute care, rehabilitation and community support systems. This qualitative research has formed a solid foundation for the second phase, which is a quantitative survey of the entire membership of BCPA, which is currently in progress. P25 Bone loss following spinal cord injury Author(s): Judith S Bubbear , Angela Gall , Fred RI Middleton, Vishna Shah and Richard W Keen. Name of ISCoS Member (Author): Angela Gall Main institution where the work was done: Royal National Orphopaedic Hospital, Stanmore, UK A retrospective analysis was made of the records of 64 chronic SCI patients (>1 year post-SCI). All patients had BMD measurements by dual energy xray absorbitometry (Hologic QDR-Delphi) at the lumbar spine and hip. None were weight-bearing, standing, or taking bisphosphonates. There were 48 men and 16 women. Mean age at scan was 40.8 years. Mean time post-SCI was 11 years. 23 were cervical, 38 thoracic and 3 lumbar lesions (42 complete, 22 incomplete). The mean (+ SD) Z-score at the spine was -0.01 (+1.87). This was not significantly different when compared to age-and-sex-matched controls. At the total hip and femoral neck the mean Z-scores were -2.00 (+1.91) and –2.43 (+ 1.43) respectively. These results were significantly reduced when compared to controls (p < 0.001). There was no correlation between time since injury, or level of injury, and BMD and no difference between the sexes. 3 fragility fractures had occurred (2 neck of femur, 1 tibia/fibula).These results confirm that hip BMD is significantly reduced post-SCI. Spinal BMD appears preserved. There is a risk of lower limb fragility fractures in our patients, as seen in epidemiological studies. Further studies are required into arresting bone loss post-SCI and reducing fracture risk. P26 Use of Alendronate in management of osteoporosis following spinal cord injury: A report of 4 cases Author(s): Judith S Bubbear , Angela Gall , Fred RI Middleton, Vishna Shah and Richard W Keen Name of ISCoS Member (Author): Angela Gall Main institution where the work was done: Royal National Orphopaedic Hospital, Stanmore, UK We report 4 spinal cord injury (SCI) patients treated with oral alendronate at standard doses, 2 male and 2 female (mean age 44) with cervical and thoracic injuries (3 complete, 1 incomplete). None were weight-bearing or standing. |Bone mineral density (BMD) was measured at spine (L1-4) and hip using dual energy x-ray absorptiometry (Hologic QDR-Delphi) pre-treatment and after 12-24 months. Alendronate was initiated an average of 12.75 years post-SCI (range 2-30). Treatment was well tolerated with no significant adverse effects. At baseline, the mean (SD) Z-score at the total hip was 3.7 (0.12); and femoral neck was 3.66 (0.51). These were significantly reduced compared to age-and-sex-matched controls (p <0.001). Although the mean (SD) lumbar spine BMD was reduced at -1.72 (1.85), this was not significant, p=0.103. BMD measurements at 12-24 months demonstrated that alendronate increased BMD at all skeletal sites. This was most marked at the lumbar spine (mean increase 6.59%) compared with the total hip (3.80%), and femoral neck (1.36%). These data confirm osteoporosis post-SCI is more marked at the hip than the spine. Alendronate effectively increases BMD with similar increases to those seen in idiopathic osteoporosis. However, absolute hip BMD remains low. Earlier bisphosphonate treatment may preserve BMD.
P28 A MULTICENTRE FOLLOW-UP ON TRAUMATIC SPINAL CORD INJURY PERSONS FOUR YEARS AFTER DISCHARGE (GISEM FU): CLINICAL ASPECTS Author(s): M.C. Pagliacci, M. Franceschini, B. Di Clemente, M. Agosti, L.Spizzichino, A. Citterio on behalf of GISEM (Gruppo Italiano Studio Epidemiologico Mielolesioni) Name of ISCoS Member (Author): M.C. Pagliacci Main institution where the work was done: Spinal Unit – Silvestrini Hospital, Perugia, Italy Study design: Prospective, multicentered follow-up study, with centralized data collection and analysis concerning the impact of disability deriving from spinal cord injury (SCI) on health needs and social life. Objectives: to evaluate survival, clinical complications, re-admissions and maintenance of clinical outcome (bladder management, bowel and bladder autonomy, continence, feeling of dependance) in traumatic SCI persons four years after comprehensive rehabilitation. Setting: Seven Spinal Units and 17 Rehabilitation Centres which had participated in the GISEM study four years mean before. Method: SCI patients, discharged after first hospitalization between 1997 and 1999, were enrolled. A standardized telephone questionnaire was centrally administered by a psychologist after obtaining informed consent. Results: over 511 contacted patients, 36 (7%) had died, 72 did not give their consent to the follow-up study, 403 (79%) completed the interview. The mean time from discharge was 3.8 years (median 3.8, range 2.7-5.2). Fifthy-three percent of subjects had SCI related clinical problem in the last six months; urological the most frequent (53.7%). One or more re-admissions were recorded in 56.8% of patients in the whole period. Seventhy-five of subjects reported bowel autonomy, 86% did not need help in bladder management. The multivariate analysis showed that complications are related to older age, longer LoS, lack of sphyncterial autonomy and completeness of lesion, while re-admissions are associated to male gender, longer LoS and lack of sphyncterial autonomy. Older age, no sphyncterial autonomy and shorter LoS in rehabilitation were associated to death during the FU period. The failure to obtain sphyncterial autonomy on discharge from rehabilitation is found as common predictive factor of poor outcome as judged from mortality, occurrence of complications and re-admissions during the FU period. Conclusion: These clinical data show important clinical needs of SCI people after discharge to be planned, especially re-admission and management of main complications, as well as the chance for regular clinical follow-up. P29 PAIN IN SPINAL CORD INJURY. A STUDY OF THE CHARACTERISTICS AND THE EXACERBATING FACTORS. Author(s): Tasiopoulos N, Zikopoulos K, Sivetidou S. Name of ISCoS Member (Author): Tasiopoulos N Main institution where the work was done: “ANAPLASI” REHABILITATION CENTER AIM. to investigate the incidence of pain in a group of patients with spinal cord injuries (SCI) within the Greek population, to ascertain its character and, to find the factors that may cause exacerbation. MATERIAL-METHOD. The material for this study was a group of 50 patients with SCI. All were asked to complete a questionnaire concerning the patients' pain, in which quality, intensity, timing, location and exacerbating factors were noted. All patients were classified according to ASIA Standards, and their functional ability was assessed according to the Modified Barthel Index (MBI). RESULTS. Most patients (n=35) sustained a complete injury, ASIA A. All 50 patients studied, regardless of the level of the SCI, reported pain or some other unpleasant or disturbing sensation (usually that of burning or of compression). In most cases more than one descriptive words were used to determine pain quality. Cold and damp weather, together with psychological stress and insomnia were the most frequently perceived exacerbating factors, followed by intense physical activity, spasticity, and constipation. CONCLUSION. All patients studied reported pain, even though not the typical pain, but rather an unpleasant sensation. Cold and damp weather were the most frequent exacerbating factors.
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