Is comorbidity related to the independence of patients with spinal cord injury?

Öz

Aim: Apart from the complications of spinal cord injury, some comorbidities in patients with this injury should be considered in the long term. In this study, we aimed to identify the comorbidities in patients with chronic spinal cord injury and the relationship of these comorbidities with the patients’ level of independence.
Methods: This retrospective cohort study involved 40 patients who had spinal cord injury and were admitted to an inpatient rehabilitation program at our hospital between March 2014 and January 2016. The participants were evaluated in terms of age, height, weight, body mass index, place of residence, and marital status. Their type, level, and duration of injury were also assessed. ASIA Impairment Scale (AIS), Functional Independence Scale (FIM), Functional Ambulation Scale (FAS), Spinal Cord Independence Scale (SCIM), and Cumulative Illness Rating Scale (CIRS) were used to evaluate the patients.
Results: The mean age of the 40 patients with chronic spinal cord injury was 41.83 (16.87) years. Their most common comorbidities were genitourinary (62.5%), lower gastrointestinal (50%), and ophthalmological–otolaryngologic problems (42.5%). No correlation was found between the CIRS scores and the SCIM Personal Care, Respiratory and Sphincter Management, Mobility, and the total SCIM scores of the participants. (P=0.949, P=0.469, P=0.452, P=0.521, respectively). By contrast, the FIM scores were correlated with the SCIM scores of the cases (P=0.014).
Conclusion: The most common long-term comorbidities in patients with spinal cord injury were genitourinary, lower gastrointestinal, and ophthalmological–otolaryngologic problems. However, these comorbidities were not directly related to the patients’ ambulation and independence levels.

Anahtar Kelimeler

• Spinal cord injury,Comorbidity,Independence,Ambulation

Omurilik yaralanmalı hastalarda komorbidite bağımsızlık ile ilişkili midir?

Öz

Amaç: Omurilik yaralanması ile yaşayan bireyler de gelişebilecek komplikasyonlar dışında birtakım komorbiditelerde uzun vade de göz önünde bulundurulmalıdır. Bu çalışmada kronik omurilik yaralanmalı hastalarda görülebilecek komorbiditelerin tanımlanması ve bunların bağımlılık düzeyi ile ilişkisini incelemeyi amaçladık.
Yöntemler: Mart 2014-Ocak 2016 tarihleri arasında hastanemizde omurilik yaralanması nedeni ile yatarak rehabilitasyon programına alınan 40 olgu ile retrospektif kohort çalışma yapıldı. Katılımcılar; yaş, boy, kilo, vücut kitle indeksi, yaşadığı yer, medeni hal vb. demografik yönden değerlendirildi. Yaralanma şekli, yaralanma seviyesi, yaralanma süresi ile ASIA Bozukluk Skalası (AIS), Fonksiyonel Bağımsızlık Ölçeği (FBÖ), Fonksiyonel Ambulasyon Skalası (FAS), Spinal Kord Bağımsızlık Ölçeği (SBÖ) ve Kümülatif Hastalık Değerlendirme Ölçeği (CIRS) ölçekleri ile de değerlendirildi.
Bulgular: Yaş ortalamaları 41,83 (16,87) olan toplam 40 kronik omurilik yaralanmalı hasta çalışmaya dahil edildi. En sık görülen komorbiditeler; genitoürüner sistem problemleri (%62,5), alt gastrointestinal sistem problemleri (%50), oftalmolojik-otolaringolojik problemler (%42,5) olarak görüldü. Çalışmaya katılan olguların CIRS skorları ile FBÖ skorları ve SCIM skorları ile arasında istatistiksel olarak anlamlı ilişki saptanmamıştır (sırasıyla P=0,949, P=0,469, P=0,452, P=0,521). Olguların FBÖ skorları ile SCIM skorları arasında pozitif yönlü ilişki istatistiksel olarak anlamlı bulunmuştur (P=0,014).
Sonuç: Omurilik yaralanmalı hastalarda uzun dönemde en sık görülen komorbiditeler; genitoürüner sistem problemleri, alt gastrointestinal sistem problemleri, oftalmolojik-otolaringolojik problemlerdir. Komorbiditelerin, ambulasyon düzeyi ve bağımsızlık düzeyi ile doğrudan ilişkisi bulunmamıştır. 

Anahtar Kelimeler

• Omurilik yaralanması,Komorbidite,Bağımsızlık,Ambulasyon

Kaynakça

1. 1. Karacan I, Koyuncu H, Pekel Ö, Sümbüloğlu G, Kırnap M, Dursun H, et al. Traumatic spinal cord injuries in Turkey: a nation-wide epidemiological study. Spinal Cord. 2000;38(11):697–701.
2. 2. Peterson MD, Kamdar N, Whitney DG, Ng S, Chiodo A, Tate DG. Psychological morbidity and chronic disease among adults with nontraumatic spinal cord injuries: a cohort study of privately insured beneficiaries. Spine J. 2019;19(10):1680-6. doi: 10.1016/j.spinee.2019.05.591.
3. 3. Högel F, Mach O, Maier D. Functional outcome of patients 12 and 48 weeks after acute traumatic tetraplegia and paraplegia: data analysis from 2004–2009. Spinal Cord. 2012;50(7):517-20. doi: 10.1038/sc.2011.171.
4. 4. Young M, McKay C, Williams S, Rouse P, Bilzon JL. Time-related changes in quality of life in persons with lower limb amputation or spinal cord injury: protocol for a systematic review. SystRev.2019:8(1);1-6. doi: 10.1186/s13643-019-1108-3
5. 5. Gündüz B. ASIA Update-ASIA Impairment Scale: level determination, classification, and case examples. Turk J Phys Med Rehab. 2015;61(suppl 1):525-31.
6. 6. Holden MK, Gill KM, Magliozzi MR, Nathan J, Piehl-Baker L. Clinical gait assessment in the neurologically impaired: reliability and meaningfulness. Phys Ther.1984;64(1):35-40.
7. 7. Linacre JM, Heinemann JW, Wright BD, Granger CV, Hamilton BB. The structure and stability of the functional independence measure. Arch Phys Med Rehabil. 1994;75(2):127-32.
8. 8. Catz A, Itzkovich M. Spinal cord independence measure: comprehensive ability to rating scale for the spinal cord lesion. J Rehabil Res. 2007;44(1):65-8. doi:10.1682/jrrd.2005.07.0123

9. 9. Hudon C, Fortin M, Soubhi H. Abbreviated guidelines for scoring the Cumulative Illness Rating Scale (CIRS) in family practice. J Clin Epidemiol. 2007;60(2):212. doi:10.1016/j.jclinepi.2005.12.021
10. 10. Bryce T. Spinal Cord Injury. In: Cifu DX, editor. Braddom’s Physical Medicine and Rehabilitation, 5th ed. Philadelphia: Saunders; 2016. pp.1095–136.
11. 11. Jensen MP, Kuehn CM, Amtmann D, Cardenas DD. Symptom burden in persons with spinal cord injury. Arch Phys Med Rehabil.2007; 88(5);638-45. doi:10.1016/j.apmr.2007.02.002
12. 12. Davidoff G, Morris J, Roth E, Bleiberg J. Closed head injury in spinal cord injured patients: retrospective study of loss of consciousness and post-traumatic amnesia. Arch Phys Med Rehabil. 1985;66:41-3.
13. 13. Sherman AL, Cardenas DD, Swedberg S. Management of traumatic optic neuropathy with coexistent spinal cord injury: a case report. Arch Phys Med Rehabil. 1997;78:1012-4. doi:10.1016/s0003-9993(97)90068-x
14. 14. Rothe NK, Sjoloe AK, Jensen H, Borch-Johnsen K, Rosenberg T. The prevalence and incidence of visual impairment in people of age 20 –59 years in industrialized countries: a review. Ophthalmic Epidemiol. 2003;10:279-91. doi:10.1076/opep.10.4.279.15909
15. 15. Yojana S, Mehta K, Girish M. Epidemiological profile of otorhinolaryngological emergencies at a medical college, in rural area of Gujarat. Indian J Otolaryngol Head & Neck Surg.2012;64.3:218-24. doi:10.1007/s12070-011-0293-8.
16. 16. Budh CN, Osteråker AL. Life satisfaction in individuals with a spinal cord injury and pain. Clin Rehabil. 2007;21(1):89-96. doi:10.1177/0269215506070313
17. 17. Ravenscroft A, Ahmed YS, Burnside IG. Chronic pain after SCI. A patient survey. Spinal Cord. 2000;38(10):611-4. doi:10.1038/sj.sc.3101073
18. 18. Turesson C. Comorbidity in rheumatoid arthritis. Swiss Med Wkly. 2016 Apr 5;146:w14290. doi: 10.4414/smw.2016.14290.
19. 19. Keskin D, Borman P, Yağcı İ, Bodur H. Comorbidity In Patients With Rheumatoid Artrhritis. J PMR Sci. 2007;3:76-9.
20. 20. Gomez AT, Kiberd BA, Royston JP, Alfaadhel T, Soroka SD, Hemmelgarn BR, et al. Comorbidity burden at dialysis initiation and mortality: a cohort study. Can J Kidney Health Dis.2015;8(2):34. doi: 10.1186/s40697-015-0068-3.
21. 21. Kreuter M, Siösteen A, Erkholm B, Byström U, Brown DJ.Health and quality of life of persons with spinal cord lesion in Australia and Sweden. Spinal Cord. 2005;43(2):123-9. doi:10.1038/sj.sc.3101692
22. 22. Schellevis FG, van der Velden, van de Lisdonk E, van Eijk JT, van Weel C. Comorbidity of chronic diseases in general practice. J Clin Epidemiol. 1993;46:469-73. doi:10.1016/0895-4356(93)90024-u