Healthcare Library Current Awareness Bulletin – Spinal Cord Injuries

Spinal cord injury (SCI) is a devastating type of neurological trauma with limited therapeutic opportunities. The pathophysiology of SCI involves primary and secondary mechanisms of injury. Among all the secondary injury mechanisms, the inflammatory response is the major contributor and results in expansion of the lesion and further loss of neurologic function. Meanwhile, the inflammation directly and indirectly dominates the outcomes of SCI, including not only pain and motor dysfunction, but also preventingneuronal regeneration. Microglia and macrophages play very important roles in secondary injury. Microglia reside in spinal parenchyma and survey the microenvironment through the signals of injury or infection. Macrophages are derived from monocytes recruited to injured sites from the peripheral circulation. Activated resident microglia and monocyte-derived macrophages induce and magnify immune and inflammatory responses not only by means of their secretory moleculesand phagocytosis, but also through their influence on astrocytes, oligodendrocytes and demyelination. In this review, we focus on the roles of microglia and macrophages in secondary injury and how they contribute to the sequelae of SCI. Publication type: Journal: Review Source: EMBASE 17.Title: Gabapentinoids are effective in decreasing neuropathic pain and other secondary outcomes after spinal cord injury: A meta-analysis Citation: Archives of Physical Medicine and Rehabilitation, November 2014, vol./is. 95/11(2180-2186), 0003-9993;1532821X (01 Nov 2014) Author(s): Mehta S., McIntyre A., Dijkers M., Loh E., Teasell R.W. Language: English Abstract: Objective To examine the effectiveness of gabapentin and pregabalin in diminishing neuropathic pain and other secondary conditions in individuals with spinal cord injury (SCI). Data Sources A systematic search was conducted using multiple databases for relevant articles published from 1980 to June 2013. Study Selection Controlled and uncontrolled trials involving gabapentin and pregabalin for treatment of neuropathic pain, with >3 subjects and >50% of study population with SCI, were included. Data Extraction Two independent reviewers selected studies based on inclusion criteria and then extracted data. Pooled analysis using Cohen's d to calculate standardized mean difference (SMD), SE, and 95% confidence interval (CI) for primary (pain) and secondary outcomes (anxiety, depression, sleep interference) was conducted. Data Synthesis Eight studies met inclusion criteria. There was a significant reduction in the intensity of neuropathic pain at <3 months (SMD=.96+.11; 95% CI,.74-1.19; P<.001) and between 3 and 6 months (SMD=2.80+.18; 95% CI, 2.44-3.16; P<.001). A subanalysis found a significant decrease in pain with gabapentin (SMD=1.20+.16; 95% CI,.88-1.52; P<.001) and with pregabalin (SMD=1.71+.13; 95% CI, 1.458-1.965; P<.001). A significant reduction in other SCI secondary conditions, including sleep interference (SMD=1.46+.12; 95% CI, 1.22-1.71; P<.001), anxiety (SMD=1.05+.12; 95% CI,.811.29; P<.001), and depression (SMD=1.22+.13; 95% CI,.967-1.481; P<.001) symptoms, was shown. A significantly higher risk of dizziness (risk ratio [RR]=2.02, P=.02), edema (RR=6.140, P=.04), and somnolence (RR=1.75, P=.01) was observed.Conclusions Gabapentin and pregabalin appear useful for treating pain and other secondary conditions after SCI. Effectiveness comparative to other analgesics has not been studied. Patients need to be monitored closely for side effects. Publication type: Journal: Review Source: EMBASE Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Archives of Physical Medicine and Rehabilitation Full text: Available ARCHIVES OF PHYSICAL MEDICINE AND REHABILITATION at Salisbury District Hospital Healthcare Library 18.Title: Health Care Provider Practices, Barriers, and Facilitators for Weight Management for Individuals with Spinal Cord Injuries and Disorders. Citation: Topics in Spinal Cord Injury Rehabilitation, 01 October 2014, vol./is. 20/4(329-337), 10820744 Author(s): Locatelli, Sara M., Gerber, Ben S., Goldstein, Barry, Weaver, Frances M., LaVela, Sherri L. Language: English Abstract: Background: Even though weight management is essential for the health of individuals with spinal cord injuries and disorders (SCI/D), little is known about current practices, barriers, and facilitators. Objective: To describe weight management delivery in the Veterans Affairs (VA) SCI/D System of Care, including barriers and facilitators experienced by health care providers. Methods: Qualitative focus groups were conducted in person at 4 geographically dispersed VA medical facilities delivering care to Veterans with SCI/D. Thirty-two employees involved in weight management efforts participated. Audio-recordings were transcribed and analyzed using qualitative content analysis techniques. Results: Participants at SCI centers reported that weight management treatment was delivered through the center by a multidisciplinary team using education (eg, written materials) and counseling/consults. Participants at SCI spoke facilities generally depended on facility-level programs (eg, MOVE!) to deliver treatment. Spoke facilities discussed barriers to delivering treatment through their SCI team, including staff shortages and resource and structural issues. MOVE! staff discussed barriers, including limited wheelchair space in classrooms. Staff participants across facilities noted that Veterans with SCI/D were hesitant to use facility-level programs, because of nonspecific SCI-relevant information and discomfort attending sessions with general Veterans. Other barriers, for both centers and spoke facilities, included necessary medications that increase weight, lack of evidence-based guidelines for weight management, safety concerns, and facility layout/accessibility. Facilitators included facility leadership support, provider involvement/prioritization, and community resources. Conclusions: Weight management programs delivered through the SCI team, with peers and SCI-relevant content, are likely more acceptable and beneficial to individuals with SCI/D. Program classrooms should provide ample space for individuals with SCI/D. Publication type: journal article Source: CINAHL Full text: Available Topics in Spinal Cord Injury Rehabilitation at Topics in Spinal Cord Injury Rehabilitation 19.Title: Health Care Utilization in Persons with Traumatic Spinal Cord Injury: The Importance of Multimorbidity and the Impact on Patient Outcomes. Citation: Topics in Spinal Cord Injury Rehabilitation, 01 October 2014, vol./is. 20/4(289-301), 10820744 Author(s): Noonan, Vanessa K., Fallah, Nader, Park, So Eyun, Dumont, Frédéric S., Leblond, Jean, Cobb, John, Noreau, Luc Language: English Abstract: Background: Persons with spinal cord injury (SCI) living in the community have high health care utilization (HCU). To date, the interrelationships among multiple secondary health conditions (multimorbidity due to comorbidities and complications) that drive HCU and their impact on patient outcomes are unknown. Objective: To determine the association among multimorbidity, HCU, health status, and quality of life. Methods: Community-dwelling persons with traumatic SCI participated in an online/phone SCI Community Survey. Participants were grouped using the 7-item HCU questionnaire (group 1 did not receive needed care and/or rehospitalized; group 2 received needed care but rehospitalized; group 3 received needed care and not rehospitalized). Personal, injury, and environmental factors; multimorbidity (presence/absence of 30 comorbidities/ complications); health status (Short Form-12); and quality of life measures (Life Satisfaction-11 first question and single-item quality of life measure) were collected. Associations among these variables were assessed using multivariate analysis. Results: The 1,137 survey participants were divided into 3 groups: group 1 (n = 292), group 2 (n = 194), and group 3 (n = 650). Group 1 had the greatest number of secondary health conditions (15.14 ± 3.86) followed by group 2 (13.60 ± 4.00) and group 3 (12.00 ± 4.16) (P < .05). Multimorbidity and HCU were significant risk factors for having a lower SF-12 Mental (P < .001) and Physical Component Score (P < .001). They in turn were associated with participants reporting a lower quality of life (P < .001, for both questions). Conclusions: Multimorbidity and HCU are interrelated and associated with lower health status, which in turn is associated with lower quality of life. Future work will include the development of a screening tool to identify persons with SCI at risk of inappropriate HCU (eg, rehospitalization, not able to access care), which should lead to better patient outcomes and cost savings. Publication type: journal article Source: CINAHL Full text: Available Topics in Spinal Cord Injury Rehabilitation at Topics in Spinal Cord Injury Rehabilitation 20.Title: How well do randomised controlled trials of physical interventions for people with spinal cord injury adhere to the CONSORT guidelines? An analysis of trials published over a 10-year period. Citation: Spinal Cord, November 2014, vol./is. 52/11(795-802), 1362-4393;1476-5624 (2014 Nov) Author(s): Harvey LA, Glinsky JV, Bowden JL, Arora M Language: English Abstract: STUDY DESIGN: Cross-sectional descriptive study of randomised controlled trials involving physical interventions for people with spinal cord injury (SCI) published between 2003 and 2013.OBJECTIVES: To determine how well randomised controlled trials of physical interventions for people with SCI adhere to the CONSORT (Consolidated Standards of Reporting Trials) guidelines.SETTING: University of Sydney, Sydney, NSW, Australia.METHODS: A search was conducted for randomised controlled trials designed to determine the effectiveness of physical interventions for people with SCI published between 2003 and 2013. The CONSORT checklist for the reporting o