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)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Understanding spinal cord injury.in: International perspectives on spinal cord injury. WHO, Geneva2013: 3-10
- International Classification of Functioning, Disability and Health: ICF.WHO, Geneva2001
- Graphical modelling: a tool for describing and understanding the functioning of people living with a health condition.Eur J Phys Rehabil Med. 2019; 55: 131-135
- Study protocol of the International Spinal Cord Injury (InSCI) community survey.Am J Phys Med Rehabil. 2017; 96: S23-34
- The International Spinal Cord Injury survey and the learning health system for spinal cord injury.Am J Phys Med Rehabil. 2017; 96: S2-4
- Causal inference using graphical models with the R package pcalg.J Stat Softw. 2012; 47: 1-22
- Describing functioning in people living with spinal cord injury in Switzerland: a graphical modeling approach.Arch Phys Med Rehabil. 2018; 99: 1965-1981
- Functioning and disability in people living with spinal cord injury in high- and low-resourced countries: a comparative analysis of 14 countries.Int J Public Health. 2011; 56: 341-352
- A structured approach to capture the lived experience of spinal cord injury: data model and questionnaire of the International Spinal Cord Injury community survey.Am J Phys Med Rehabil. 2017; 96: S5-16
- ICF core sets for individuals with spinal cord injury in the long-term context.Spinal Cord. 2010; 48: 305-312
- Toward the International Classification of Functioning, Disability and Health (ICF) rehabilitation set: a minimal generic set of domains for rehabilitation as a health strategy.Arch Phys Med Rehabil. 2016; 97: 875-884
- Preliminary reliability and validity of a spinal cord injury secondary conditions scale.J Spinal Cord Med. 2007; 30: 131-139
- Measuring disability: comparing the impact of two data collection approaches on disability rates.Int J Environ Res Public Health. 2015; 12: 10329-10351
- The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection.Med Care. 1992; 30: 473-483
- Development and validation of a self-report version of the Spinal Cord Independence Measure (SCIM III).Spinal Cord. 2013; 51: 40-47
- Development and initial evaluation of the SCI-FI/AT.J Spinal Cord Med. 2015; 38: 409-418
- Gross domestic product based on purchasing power parity (GDP PPP) by 354 countries.(Available at:) (Accessed September 10, 2019)
- Subgroups in epidemiological studies on spinal cord injury: evaluation of international recommendations in the Swiss Spinal Cord Injury Cohort Study.J Rehabil Med. 2016; 48: 141-148
- Cohort profile of the International Spinal Cord Injury (InSCI) community survey implemented in 22 countries.Arch Phys Med Rehabil. 2020 Jun 10; ([Epub ahead of print])
- Graphical models illustrated complex associations between variables describing human functioning.J Clin Epidemiol. 2009; 62: 922-933
- Graphical modeling of binary data using the LASSO: a simulation study.BMC Med Res Methodol. 2012; 12: 16
- Regression shrinkage and selection via the LASSO.J R Stat Soc Series B Stat Methodol. 1996; 7: 267-288
- Bagging predictors.Mach Learn. 1996; 24: 123-140
- A significance test for the LASSO.Ann Stat. 2014; 42: 413-468
- Complex networks: structure and dynamics.Phys Rep. 2006; 424: 175-308
- Random forest missing data algorithms.Stat Anal Data Min. 2017; 10: 363-377
- Adjustment after spinal cord injury: a 9-year longitudinal study.Arch Phys Med Rehabil. 1997; 78: 651-657
- Chronic pain after SCI. A patient survey.Spinal Cord. 2000; 38: 611-614
- Symptom burden in persons with spinal cord injury.Arch Phys Med Rehabil. 2007; 88: 638-645
- Long-term consequences of spinal cord injury on social participation: the occurrence of handicap situations.Disabil Rehabil. 2000; 22: 170-180
- A systematic review of the effectiveness of task-specific rehabilitation interventions for improving independent sitting and standing function in spinal cord injury.J Spinal Cord Med. 2018; 41: 254-266
- Medical co-morbidities, secondary complications, and mortality in elderly with acute spinal cord injury.J Neurotrauma. 2003; 20: 391-399
- Differences in functioning of individuals with tetraplegia and paraplegia according to the International Classification of Functioning, Disability and Health (ICF).Spinal Cord. 2011; 49: 534-543
- Sleep problems in individuals with spinal cord injury: frequency and age effects.Rehabil Psychol. 2009; 54: 323-331
- Spinal cord injury and partner relationships.Spinal Cord. 2000; 38: 2-6
- Bowel management in spinal cord injury patients.Clin Colon Rectal Surg. 2014; 27: 113-115
- Bladder management in persons with spinal cord lesion.Spinal Cord. 2004; 42: 694-698
- Cultural influences on pain.Rev Pain. 2008; 1: 6-9
- The environment and disease: association and causation.Proc R Soc Med. 1965; 58: 295-300
Article info
Publication history
Published online: September 24, 2020
Footnotes
Disclosures: none.
Identification
Copyright
© 2020 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
ScienceDirect
Access this article on ScienceDirectLinked Article
- CorrectionArchives of Physical Medicine and RehabilitationVol. 102Issue 4
- PreviewIn 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.
- Full-Text
- Preview
- CorrectionArchives of Physical Medicine and RehabilitationVol. 102Issue 11
- PreviewIn 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.
- Full-Text
- Preview
