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

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

Method

Quality of Life

Social Function

Gender/ Age/ Marriage/Education/ Employment/Annual income

AISA

Ability of Daily Living

Depression

Complication

Pain

On-site Survey

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

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

Method

Quality of Life

Social Function

Gender/ Age/ Marriage/Education/ Employment/Annual income

AISA

Ability of Daily Living

Depression

Complication

Pain

On-site Survey

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

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 …

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)

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

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

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

Result

41.2%58.8%

Gender

Male

Female

80.8%

3.85%

15.4%

Marriage

MarriedSingleWidowed

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

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

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

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%

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

Attention for the next step

Chronic neuropathic pain

Depression

Employment

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

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.

Thank you!