Follow-up study of spinal cord injured patients after discharge from inpatient rehabilitation in Nepal in 2007

Abstract

Study design: Observational cohort study. Objectives: To evaluate ongoing health and community reintegration of patients with spinal cord injury (SCI) after discharge from inpatient rehabilitation in Nepal. Setting: Nepal. Methods: This study follows a cohort of 37 patients with SCI in Nepal, 1-2 years after discharge from inpatient rehabilitation in 2007. Participants were visited at home and data were obtained through semi-structured interviews that evaluated health, independence in daily living (Modified Barthel Index), community participation (Participation Scale) and barriers due to socioeconomic issues, housing, accessibility, and availability and use of mobility aids. Results: One-quarter of the cohort had died (35% of wheelchair users). Secondary health concerns, such as pressure ulcers and urinary tract infections, were common in the 24 patients interviewed, and eight had been rehospitalized to treat them. Inappropriate wheelchairs, inadequate housing and rugged terrain restricted accessibility. 80% of wheelchair users could not enter their homes independently and 74% of those who were using mobility aids could not access the community independently because of the physical terrain. Of all those who were interviewed, half had no accessible toilet, access to a water source or road access to their home. Community participation was a challenge for most using mobility devices, and less than half earned any income. Conclusion: This study identifies important areas of focus for rehabilitation centres in less-resourced contexts like Nepal to help with reintegration after discharge: vocational training during or after rehabilitation; accessible housing; wheelchairs appropriate to the terrain and the need for strong community-based rehabilitation.

Pressure ulcers in people with spinal cord injury in developing nations

“…34 In addition, the hospitals and clinics that performed the cited studies may not have the financial resources or infrastructure to document and report all PUs reliably. 28 Furthermore, individuals with more severe mobility impairments and those who live remotely are unlikely to be captured by such studies because of limited transportation options in many low resource communities.…”

“…Ten articles were identified that reported the prevalence or incidence of PUs in community dwellers from 6 months to 20 years after injury. [24][25][26][27][28][29][30][31][32][33] Of note, very few of these study subjects were reported to have undergone SCI rehabilitation. These 10 papers reported a PU prevalence of 26.7-46.2%, mean of 35.2%.…”

“…Two had no mattresses on wooden bed frames; the rest had mattresses made of locally available foam or cotton materials.' 28 As these authors illustrate, mobility may be limited by more than neurologic deficits. Shore and Juillerat 44 have shown that by increasing mobility through donated wheelchairs, neurologically impaired patients in Vietnam, Chile and India had a significant decrease in PUs.…”

“…By breaching the protective skin barrier, PUs lead to local, systemic, chronic or even life-threatening infections. 53 PUs and their associated infections are associated with increased re-hospitalization rates, 28,54 increased duration of hospitalization, 21 decreased life expectancy and death. 26,34,[54][55][56][57] The costs of PUs extend well beyond the expense of infectious complications.…”

Psychological and socioeconomic status, complications and quality of life in people with spinal cord injuries after discharge from hospital in Bangladesh: a cohort study

“…[1][2][3] Some studies have also examined these issues in LMICs. [4][5][6][7] However, few studies sample in a representative way-most, instead, rely on samples of convenience. Therefore, we sought to determine the psychological and socioeconomic status, complications, and QOL in people living with SCI in Bangladesh after discharge from hospital.…”