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Describing Functioning in People Living With Spinal Cord Injury Across 22 Countries: A Graphical Modeling Approach

  • Cristina Ehrmann
    Affiliations
    Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland

    Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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  • Jan D. Reinhardt
    Correspondence
    Corresponding author Jan Dietrich Reinhardt, PhD, Institute for Disaster Management and Reconstruction, Sichuan University and Hong Kong Polytechnic University, 122 Huang He Rd, Chengdu 610207, China.
    Affiliations
    Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland

    Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland

    Institute for Disaster Management and Reconstruction, Sichuan University and Hong Kong Polytechnic University, Chengdu, China
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  • Conran Joseph
    Affiliations
    Division of Physiotherapy, Stellenbosch University, Stellenbosch, South Africa

    Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Solna, Sweden
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  • Nazirah Hasnan
    Affiliations
    University Hospital of Nantes, St Jacques Hospital, Nantes, France
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  • Brigitte Perrouin-Verbe
    Affiliations
    Department of Rehabilitation Medicine, University of Malaya, Kuala Lumpur, Malaysia
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  • Piotr Tederko
    Affiliations
    Department of Rehabilitation, 1st Faculty of Medicine, Medical University of Warsaw, Warsaw, Poland
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  • Mauro Zampolini
    Affiliations
    Department of Rehabilitation, San Giovanni Battista Hospital, Foligno, Perugia, Italy
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  • Author Footnotes
    ∗ The members of the InSCI group are: James Middleton, John Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical School, The University of Sydney, Sydney Australia; Linamara Battistella, School of Medicine, University of São Paulo, São Paulo, Brazil; Jianan Li, Department of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China; Christoph Gutenbrunner, Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany; Christina-Anastasia Rapidi, Department of Physical and Rehabilitation Medicine, General Hospital “G.Gennimatas,” Athens, Greece; Luh Karunia Wahyuni, Medicine and Rehabilitation Department, Dr Cipto Mangunkusumo National General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Eiichi Saitoh, Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan; Bum Suk Lee, Department of Rehabilitation Medicine, National Rehabilitation Center & Hospital, Seoul, Korea; Alvydas Juocevicius, Rehabilitation, Physical and Sport Medicine Center Department of Vilnius University Hospital Santariskiu Klinikos, Medical Faculty Vilnius University, Vilnius, Lithuania; Abderrazak Hajjioui, Department of Rehabilitation Medicine, Clinical Neuroscience Laboratory, Faculty of Medicine, Sidi Mohammed Ben Abdallah University, Fez, Morocco; Marcel W. Post, University of Groningen, University Medical Center Groningen, Center for Rehabilitation Medicine, Groningen, the Netherlands; Johan K. Stanghelle, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Oslo, Oslo, Norway; Daiana Popa, Clinical Rehabilitation Hospital Felix-Spa Bihor County, Oradea, Romania; Mercè Avellanet, Research group in Health Sciences and Health Services, Universitat d’Andorra, Spain; Michael Baumberger, Swiss Paraplegic Center, Nottwil, Switzerland; Apichana Kovindha, Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Reuben Escorpizo, The University of Vermont, Department of Rehabilitation and Movement Science, Burlington, VT, USA.
    InSCI
    Footnotes
    ∗ The members of the InSCI group are: James Middleton, John Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical School, The University of Sydney, Sydney Australia; Linamara Battistella, School of Medicine, University of São Paulo, São Paulo, Brazil; Jianan Li, Department of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China; Christoph Gutenbrunner, Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany; Christina-Anastasia Rapidi, Department of Physical and Rehabilitation Medicine, General Hospital “G.Gennimatas,” Athens, Greece; Luh Karunia Wahyuni, Medicine and Rehabilitation Department, Dr Cipto Mangunkusumo National General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Eiichi Saitoh, Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan; Bum Suk Lee, Department of Rehabilitation Medicine, National Rehabilitation Center & Hospital, Seoul, Korea; Alvydas Juocevicius, Rehabilitation, Physical and Sport Medicine Center Department of Vilnius University Hospital Santariskiu Klinikos, Medical Faculty Vilnius University, Vilnius, Lithuania; Abderrazak Hajjioui, Department of Rehabilitation Medicine, Clinical Neuroscience Laboratory, Faculty of Medicine, Sidi Mohammed Ben Abdallah University, Fez, Morocco; Marcel W. Post, University of Groningen, University Medical Center Groningen, Center for Rehabilitation Medicine, Groningen, the Netherlands; Johan K. Stanghelle, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Oslo, Oslo, Norway; Daiana Popa, Clinical Rehabilitation Hospital Felix-Spa Bihor County, Oradea, Romania; Mercè Avellanet, Research group in Health Sciences and Health Services, Universitat d’Andorra, Spain; Michael Baumberger, Swiss Paraplegic Center, Nottwil, Switzerland; Apichana Kovindha, Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Reuben Escorpizo, The University of Vermont, Department of Rehabilitation and Movement Science, Burlington, VT, USA.
    Authors List
  • Gerold Stucki
    Affiliations
    Swiss Paraplegic Research, Guido A. Zäch Institute, Nottwil, Switzerland

    Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland

    Center for Rehabilitation in Global Health Systems, WHO Collaborating Center, Department of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
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  • Author Footnotes
    ∗ The members of the InSCI group are: James Middleton, John Walsh Centre for Rehabilitation Research, Sydney Medical School, Northern Clinical School, The University of Sydney, Sydney Australia; Linamara Battistella, School of Medicine, University of São Paulo, São Paulo, Brazil; Jianan Li, Department of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China; Christoph Gutenbrunner, Department of Rehabilitation Medicine, Hannover Medical School, Hannover, Germany; Christina-Anastasia Rapidi, Department of Physical and Rehabilitation Medicine, General Hospital “G.Gennimatas,” Athens, Greece; Luh Karunia Wahyuni, Medicine and Rehabilitation Department, Dr Cipto Mangunkusumo National General Hospital - Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia; Eiichi Saitoh, Department of Rehabilitation Medicine I, School of Medicine, Fujita Health University, Toyoake, Japan; Bum Suk Lee, Department of Rehabilitation Medicine, National Rehabilitation Center & Hospital, Seoul, Korea; Alvydas Juocevicius, Rehabilitation, Physical and Sport Medicine Center Department of Vilnius University Hospital Santariskiu Klinikos, Medical Faculty Vilnius University, Vilnius, Lithuania; Abderrazak Hajjioui, Department of Rehabilitation Medicine, Clinical Neuroscience Laboratory, Faculty of Medicine, Sidi Mohammed Ben Abdallah University, Fez, Morocco; Marcel W. Post, University of Groningen, University Medical Center Groningen, Center for Rehabilitation Medicine, Groningen, the Netherlands; Johan K. Stanghelle, Department of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Oslo, Oslo, Norway; Daiana Popa, Clinical Rehabilitation Hospital Felix-Spa Bihor County, Oradea, Romania; Mercè Avellanet, Research group in Health Sciences and Health Services, Universitat d’Andorra, Spain; Michael Baumberger, Swiss Paraplegic Center, Nottwil, Switzerland; Apichana Kovindha, Department of Rehabilitation Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand; Reuben Escorpizo, The University of Vermont, Department of Rehabilitation and Movement Science, Burlington, VT, USA.
Published:September 24, 2020DOI:https://doi.org/10.1016/j.apmr.2020.09.374

      Abstract

      Objective

      To provide prevalence estimates for problems in functioning of community-dwelling persons with spinal cord injury (SCI) and to examine associations between various areas of functioning with the purpose of supporting countries in identifying targets for interventions.

      Design

      Cross-sectional survey.

      Setting

      Community, 22 countries including all World Health Organization regions.

      Participants

      Persons (N=12,591) with traumatic or nontraumatic SCI aged 18 years or older.

      Interventions

      Not applicable.

      Main Outcome Measures

      We estimated the prevalence of problems in 53 areas of functioning from the Brief International Classification of Functioning, Disability and Health (ICF) core set for SCI, long-term context, or ICF rehabilitation set covering 4 domains: impairments in body functions, impairments in mental functions, independence in performing activities, and restrictions in participation. Associations between areas of functioning were identified and visualized using conditional independence graphs.

      Results

      Participants had a median age of 52 years, 73% were male, and 63% had paraplegia. Feeling tired, bowel dysfunction, sexual functions, spasticity, pain, carrying out daily routine, doing housework, getting up off the floor from lying on the back, pushing open a heavy door, and standing unsupported had the highest prevalence of problems (>70%). Clustering of associations within the 4 functioning domains was found, with the highest numbers of associations within impairments in mental functions. For the whole International Spinal Cord Injury sample, areas with the highest numbers of associations were circulatory problems, transferring bed-wheelchair, and toileting, while for the World Health Organization European and Western Pacific regions, these were dressing upper body, transferring bed-wheelchair, handling stress, feeling downhearted and depressed, and feeling happy.

      Conclusions

      In each domain of functioning, high prevalence of problems and high connectivity of areas of functioning were identified. The understanding of problems and the identification of potential targets for intervention can inform decision makers at all levels of the health system aiming to improve the situation of people living with SCI.

      Keywords

      List of abbreviations:

      CIG (conditional independence graph), ICF (International Classification of Functioning, Disability and Health), InSCI (International Spinal Cord Injury), LASSO (least average shrinkage and selection operator), SCI (spinal cord injury), WHO (World Health Organization)
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      • Correction
        Archives of Physical Medicine and RehabilitationVol. 102Issue 4
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          In the article by Ehrmann et al, Describing Functioning in People Living With Spinal Cord Injury Across 22 Countries: A Graphical Modeling Approach, published in the Archives of Physical Medicine and Rehabilitation 2020;101:2112-2143 https://www.archives-pmr.org/article/S0003-9993(20)30958-8/fulltext , an author’s name was spelled incorrectly in the byline. It should be Brigitte Perrouin-Verbe.
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      • Correction
        Archives of Physical Medicine and RehabilitationVol. 102Issue 11
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          In the authorship listing for the InSCI group in “Describing functioning in people living with spinal cord injury across 22 countries: a graphic modeling approach” ( https://www.archives-pmr.org/article/S0003-9993 (20)30958-8/fulltext) Daniela Utiyama, PhD should be listed in that group in place of Prof. Liniamara Batistella.
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