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S
Xiaorong HU, Jian’an LI Department of Physical Medicine and Rehabilitation
Nanjing Medical University, China
Quality of life and social function of earthquake survivors with
spinal cord injury one year after returning to community
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30 months after Wenchuan Earthquake
Functional recovery after the early-stage of rehabilitation rescue in SCI survivors
? QOL & social function in the community
? What will be paid attention to in the long-term rehabilitation strategy for SCI?
Background
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Method
Quality of Life
Social Function
Gender/ Age/ Marriage/Education/ Employment/Annual income
AISA
Ability of Daily Living
Depression
Complication
Pain
On-site Survey
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Quality of Life
Social Function
Gender/ Age/ Marriage/Education/ Employment/Annual income
AISA
Depression
Complication
Pain
Ability of Daily Living
On-site SurveyWorld Health Organization Quality of Life Assessment Instrument-Bref (WHOQOL-BREF) The most appropriate scale for QOL of SCI patient• Individual’s overall perception of QOL & health • Domain: Physical Health/ Psychological/ Social Relationship/ Environment*Hill MR, Noonan VK, Sakakibara BM, Miller WC. Quality of life instruments and definitions in individuals with spinal cord injury: a systematic review. Spinal Cord. 2009
Method
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Method
Quality of Life
Social Function
Gender/ Age/ Marriage/Education/ Employment/Annual income
AISA
Ability of Daily Living
Depression
Complication
Pain
On-site Survey
Craig Handicap Assessment and Reporting Technique Short Form( CHART-SF)• Physical Independence
• Cognitive Independence
• Mobility
• Occupation
• Social Integration
• Economic Self-Sufficiency
• Gerhart KA, Weitzenkamp DA, Kennedy P, Glass CA, Charlifue SW. Correlates of stress in long-term spinal cord injury. Spinal Cord. 1999; 37(3):183-190
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Method
Quality of Life
Social Function
Gender/ Age/ Marriage/Education/ Employment/Annual income
AISA
Ability of Daily Living
Depression
Complication
Pain
On-site Survey
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Method
Quality of Life
Social Function
Gender/ Age/ Marriage/Education/ Employment/Annual income
AISA
Ability of Daily Living
Depression
Complication
Pain
On-site Survey ( 1) AIS A-C( 2) AIS D-E & SCI Syndrome
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Method
Quality of Life
Social Function
Gender/ Age/ Marriage/Education/ Employment/Annual income
AISA
Ability of Daily Living
Depression
Complication
Pain
On-site Survey
Pressure Sore/ UTI / Cystolith / Neurogenic Bladder/ RectumImpairment of Renal Function …
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Method
Quality of Life
Social Function
Gender/ Age/ Marriage/Education/ Employment/Annual income
AISA
Ability of Daily Living
Depression
Complication
Pain
On-site Survey
Visual Analogue Scale (VAS)
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Method
Quality of Life
Social Function
Gender/ Age/ Marriage/Education/ Employment/Annual income
AISA
Ability of Daily Living
Depression
Complication
Pain
Modified Barthel Index (MBI)
On-site Survey
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Method
Quality of Life
Social Function
Gender/ Age/ Marriage/Education/ Employment/Annual income
AISA
Ability of Daily Living
Depression
Complication
Pain
On-site Survey
Patient Health Questionnaire Depression Module (PHQ-9)
• Only 9 question• Suitable for community life• Accurate screening the symptom of depression• Good internal consistency and construct validity in SCI patient* Sakakibara BM, Miller WC, Orenczuk SG, Wolfe DL; SCIRE Research Team. A systematic review of depression and anxiety measures used with individuals with spinal cord injury. Spinal Cord. 2009; 47(12):841-851
• < 5 point: No need for treatment
• 5-14 point: Support, watchful waiting
• > 15 point: Antidepressant and/or psychotherapy
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Result
Age from 20 to 79 (52.6±15.8 years old)
19-40 41-60 > 600.00%
10.00%
20.00%
30.00%
40.00%
Age
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Result
41.2%58.8%
Gender
Male
Female
80.8%
3.85%
15.4%
Marriage
MarriedSingleWidowed
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Result
46.2%53.8%
Education
IlliteracyBe educated
15.4%
84.6%
Employment
EmployedAt home
The average family income in 2010:
RMB 5375±3186
Below the average annual income in rural China
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AISAbove
C7 C8-T6 T7-L2 L3-S2Below
S2 Total Percentage
A 1 5 6 23.1%
B 2 2 7.60%
C 7 7 26.9%
D 3 5 1 2 11 42.3%
Total 3 1 19 1 2 26
Result
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Above C7 C8-T6
T7-L2 L3-S2
BelowS2
Total Percentage
Wheelchair Independent 1 13 14 53.8%
Using orthotics
and/or aids 4 1 1 6 23.1%
Walk independentl
y 3 5 1 6 23.1%
Total 3 1 19 1 2 26
Result
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Above C7
C8-T6 T7-L2
L3-S2Belo
wS2
Total Percentage
Pain 3 1 19 1 2 26 100%New
pressure sore
1 10 1 12 46.2%
Neurogenic bladder 1 12 1 14 53.8%
Cystolith 2 2 7.69%Neurogenic
Rectum 1 8 2 11 42.3%
Heterotopic ossification 1 1 3.85%
Result
Above C7
C8-T6 T7-L2
L3-S2Belo
wS2
Total Percentage
Pain 3 1 19 1 2 26 100%New
pressure sore
1 10 1 12 46.2%
Neurogenic bladder 1 12 1 14 53.8%
Cystolith 2 2 7.69%Neurogenic
Rectum 1 8 2 11 42.3%
Heterotopic ossification 1 1 3.85%
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Result
Discharge VS Return to community for 1 year
Paired T test
Discharge In community T P
MBI 71.2±25.8 81.9±18.7 -3.37 0.002
VAS 5.38±2.38 5.12±1.70 0.548 0.589
PHQ-9 10.5±5.38 11.9±12.3 -0.652 0.520
Discharge In community T P
MBI 71.2±25.8 81.9±18.7 -3.37 0.002
VAS 5.38±2.38 5.12±1.70 0.548 0.589
PHQ-9 10.5±5.38 11.9±12.3 -0.652 0.520
QOL Discharge In community
T P
Total Score 68.3±12.6 71.4±10.2 -1.66 0.011overall perception
of QOL2.65±1.09 3.84±0.731 -6.48 0.000
overall perception of health
2.65±1.23 3.81±0.749 -5.62 0.000
Physical Health 19.0±4.98 20.6±2.58 -1.63 0.117Psychological 17.0±3.89 17.8±3.38 -1.31 0.202
Social Relationship 8.27±2.31 9.42±1.92 -2.55 0.017environment 24.1±5.65 23.6±6.14 0.449 0.657
QOL Discharge In community
T P
Total Score 68.3±12.6 71.4±10.2 -1.66 0.011
overall perception of QOL
2.65±1.09 3.84±0.731 -6.48 0.000
overall perception of health
2.65±1.23 3.81±0.749 -5.62 0.000
Physical Health 19.0±4.98 20.6±2.58 -1.63 0.117Psychological 17.0±3.89 17.8±3.38 -1.31 0.202
Social Relationship 8.27±2.31 9.42±1.92 -2.55 0.017
environment 24.1±5.65 23.6±6.14 0.449 0.657
CHART DischargeIn
community T P
Total score 322±87.0 344±80.8 -1.58 0.127Physical
Independence 89.4±11.2 96.4±4.70 -3.90 0.001
Cognitive Independence 78.5±24.5 56.9±19.8 4.01 0.000
Mobility 51.2±20.5 67.4±28.0 -2.84 0.009
Occupation 39.5±32.0 42.2±35.4 -2.90 0.108Social
Integration 63.0±25.5 66.6±27.7 -1.03 0.315
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Attention for the next step
Chronic neuropathic pain
Depression
Employment
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Rehabilitation Rescueafter the Disaster
Early and comprehensive intervention of rehab
Functional impact:Improve ADL, reduce complication and relieve symptom of depression
Long-term impact:Improve QOL and social participation, promote re-employment
[1]Rathore FA, Farooq F, Muzammil S, New PW, Ahmad N, Haig AJ. Spinal cord injury management and rehabilitation: highlights and shortcomings from the 2005 earthquake in Pakistan. Arch Phys Med Rehabil. 2008 Mar;89(3):579-85.[2]Li JJ, Gao F, Liu SJ, Treatment and rehabilitation of patients with spinal cord injury after earthquake. Chn J Rehabil Theory Pract. Jul. 2008. Vol. 14.No.7
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Conclusion
QOL and social function were significantly improved after Returning to the community.
Main factors: ADL, pain and depression.
Early rehabilitation can improve QOL and social function, even can be extended in the community.
Long-term rehabilitation strategy should pay attention to vocational training and social integration.
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Thank you!