A community-based intervention to prevent serious complications and death 2 years after discharge in people with spinal cord injury in Bangladesh (CIVIC): a randomised trial

Abstract

Study design Randomised controlled trial. Objectives To determine the effectiveness of a sustainable community-based intervention designed to prevent serious complications and death 2 years after discharge in people with spinal cord injury in Bangladesh. Setting Bangladesh. Methods A pragmatic randomised controlled trial was undertaken. People who had sustained a spinal cord injury in the preceding 2 years, were wheelchair-dependent, and were about to be discharged from hospital in Bangladesh were recruited and randomised to an Intervention or Control group using a concealed allocation procedure stratified by level of lesion (tetraplegia/paraplegia). Participants in the Intervention group received 36 phone calls and three home visits over the first 2 years following discharge. All participants received usual post-discharge care. Survival status and date of death were determined by blinded assessors 2 years after randomisation. Results Between July 2015 and March 2018, 410 participants were randomised (204 to Intervention, 206 to Control). There was no loss to follow up. At 2 years, 15 (7.4%) participants in the Intervention group and 16 (7.8%) participants in the Control group had died (hazard ratio from unadjusted Cox model = 0.93 [95% CI, 0.46 to 1.89]; p from log rank test 0.85). There were no clinically important or statistically significant average causal effects of intervention on the incidence or severity of complications. Conclusion A program of community-based care for people with recent spinal cord injury in Bangladesh involving frequent phone contact and occasional in-person contact with a health professional after discharge from hospital is no better at preventing death at 2 years than usual care.

Telemedicine for Preventing and Treating Pressure Injury After Spinal Cord Injury: Systematic Review and Meta-analysis

“…A total of 4 RCTs [ 7 , 19 , 27 , 36 ] reported on the severity of the pressure injury studied. The meta-analysis showed that patients in a telemedicine intervention group tended to have lower PUSH scores (n=162; WMD=–1.98, 95% CI –3.51 to –0.46; P =.01; I 2 =0%, fixed-effects model; Figure 3 ).…”

“…Overall, 27 studies [17][18][19][20][21][23][24][25][26][27][28][29][31][32][33][34][35][37][38][39][40][42][43][44][45]48,49] reported the incidence of pressure injury among their community-dwelling subjects. Among the studies, 18 were RCTs [17][18][19][20][21][24][25][26][27][28][29][31][32][33][34][35]37,38] analyzed by network meta-analysis, 5 were quasi-experimental studies [42][43][44]48,49] analyzed by meta-analysis, and 4…”

Self-Management Embedded in Daily Activities: A Photoelicitation Focus Group Study among Persons with Spinal Cord Injury and Their Primary Caregivers in Bangladesh

“…Moreover, the newly identified component, management of social complexities , will help healthcare professionals, especially occupational therapists, focus not only on the individual's health problems but also on additional social problems to facilitate social justice in daily life [ 10 ]. Recent local development of a community outreach program for persons with SCI failed to reduce comorbidity and mortality [ 47 ]. In the light of this study, we wonder whether the study failed because its main medical focus was limited to prevention of secondary complications and it did not address the social, economic, and cultural determinants of health and participation in daily activities.…”

Trans-Spinal Electrical Stimulation Therapy for Functional Rehabilitation after Spinal Cord Injury: Review

“…Spinal cord injury (SCI) is sudden, devastating, debilitating, and life-altering neurological damage that is correlated with severe physical, mental, social, and vocational impacts on the individual, family members, and healthcare systems [ 1 , 2 , 3 , 4 , 5 ]. Worldwide, the estimated incidence of SCI is between 250,000 and 500,000 per year [ 3 ].…”

“…Secondary complications, such as pressure ulcers, spasticity, pain, urinary tract infections, depression, bowel problems, cardiovascular complications, renal stones, autonomic dysreflexia, fracture [ 10 ], fatigue, respiratory complications, autonomic dysreflexia, and bladder dysfunction, hamper the healthy wellbeing, social participation, and productive activities as well as quality of life [ 11 ]. Among all the complications, paralysis or reduced mobility are the most visible complications after SCI [ 1 ]. Reversing the paralysis often reduces the secondary complications and, thus, improves the quality of life of these individuals with SCI [ 12 ].…”