International Spinal Cord Injury Community Survey: Socioeconomic and Healthcare Satisfaction in Spain.

STUDY DESIGN: Survey study. OBJECTIVES: People living with spinal cord injury (SCI) are major healthcare and rehabilitation services consumers and have unmet healthcare needs. This study aimed to describe the socioeconomic characteristics of people living with SCI in Spain and to determine the level of use and satisfaction with the public healthcare system. METHODS: We conducted a survey (the Spanish version of the International Spinal Cord Injury Community Survey) consisting of 134 questions. We analyzed the age, sex, neurological classification of the injury on the American Spinal Injury Association Impairment Scale, time of injury, socio-occupational and socioeconomic status, and level of use and satisfaction with the public health system. RESULTS: 472 people responded to the survey [68.9% male; mean age 51.2 years (standard deviation: 13.9 years); 61.7% with paraplegia and 38.3% with tetraplegia]. 89.2% of those surveyed were unemployed and 77.1% received a disability pension. The number of medical visits was 2.3/year, and 19.8% of the patients required at least 1 hospital admission during the previous year. 94.7% of the people with SCI considered the health care received as good or very good. CONCLUSIONS: Respondents with SCI in Spain considered they had good access to primary and specialized care and were satisfied with the healthcare system. Notably, we observed a high average of annual visits to medical professionals but a low rate of hospitalizations. Technical aids and state services related to disability should be the most important elements to be improved.

Validación al español de la versión en inglés del Neurogenic Bowel Dysfunction score (NBD score) en pacientes con lesión neurológica de origen central / Spanish validation of the Neurogenic Bowel Dysfunction score -NBD score- in patients with central neurological injury

Objetivo: validar al español el Neurogenic Bowel Dysfunction score (NBD score) que cuantifica la severidad de la disfunción intestinal en pacientes con discapacidad por lesión neurológica central y la satisfacción con el manejo intestinal.Material59 pacientes, 30 pacientes afectados de discapacidad intestinal por lesión medular y 29 pacientes afectados de discapacidad intestinal por accidente vascular cerebral.ResultadosEl resultado de la fiabilidad del constructo de la traducción al español del NBD Score para todo el grupo de pacientes muestra una α de Cronbach para todas las variables de 0,970 y el resultado de la fiabilidad del NBD score para todo el grupo en el test-retest, mediante el coeficiente de correlación interclase fue 0,970 (95% IC 0,954-0,980).ConclusionesLa versión traducida al español del NBD score es una herramienta válida para ser utilizada en nuestro medio, permitirá un acercamiento más real a la situación de discapacidad de cada paciente en relación con la disfunción intestinal neurógena y conocer la intensidad de la afectación y la eficacia en su manejo mediante las diferentes propuestas terapéuticas. (AU)

Objective: to validate into Spanish the Neurogenic Bowel Dysfunction score (NBD score) that quantifies intestinal dysfunction severity in patients with disabilities due to central neurological injury and satisfaction with bowel management.Material59 patients, 30 patients affected by intestinal disability due to spinal cord injury and 29 patients with intestinal disability due to stroke.ResultsThe result of the reliability of the construction of the Spanish translation of the NBD score for the whole group of patients shows a Cronbach's α for all the variables of 0.970 and the result of the reliability of the NBD score for the whole group in test-retest, using the interclass correlation coefficient, was 0.970 (95% CI 0.954-0.980).ConclusionsThe Spanish version of the NBD score is a valid tool for use in our environment; it will allow a more real approach to the disability situation of each patient in relation to neurogenic intestinal dysfunction and knowledge of the degree and the involvement and effectiveness of management through different therapeutic proposals. (AU)

An open prospective study on the efficacy of Navina Smart, an electronic system for transanal irrigation, in neurogenic bowel dysfunction.

BACKGROUND: Transanal irrigation (TAI) has emerged as a key option when more conservative bowel management does not help spinal cord injured (SCI) individuals with neurogenic bowel dysfunction (NBD). AIM: To investigate the short-term efficacy and safety of an electronic TAI system (Navina Smart) in subjects with NBD. DESIGN: We present an open, prospective efficacy study on Navina Smart, in individuals with NBD secondary to SCI, studied at three months. POPULATION: Eighty-nine consecutive consenting established SCI individuals (61 male; mean age 48, range 18-77) naïve to TAI treatment were recruited from ten centres in seven countries. Subjects had confirmed NBD of at least moderate severity (NBD score ≥10). METHODS: Subjects were taught how to use the device at baseline assisted by the Navina Smart app, and treatment was tailored during phone calls until optimal TAI regime was achieved. The NBD score was measured at baseline and at three months follow up (mean 98 days). Safety analysis was performed on the complete population while per protocol (PP) analysis was performed on 52 subjects. RESULTS: PP analysis showed a significant decrease in mean NBD score (17.8 to 10, p<0.00001). In subjects with severe symptoms (defined as NBD score ≥14), mean NBD scores decreased (19.4 to 10.9, p<0.0001). The number of subjects with severe symptoms decreased from 41 (79%) subjects at baseline to 16 (31%) at three months follow-up. Device failure accounted for the commonest cause for loss of data. Side effects possibly related to the device developed in 11 subjects (12%). Discontinuation due to failure of therapy to relieve symptoms was reported by 5 subjects (6%). CONCLUSION: Navina Smart is effective for individuals with NBD, even those with severe symptoms; long-term data will follow. Whilst there were some device problems (addressed by the later stages of subject recruitment) the treatment was generally safe. CLINICAL TRIAL: (ClinicalTrials.gov number NCT02979808).

Spanish validation of the Neurogenic Bowel Dysfunction score -NBD score- in patients with central neurological injury. / Validación al español de la versión en inglés del Neurogenic Bowel Dysfunction score (NBD score) en pacientes con lesión neurológica de origen central.

OBJECTIVE: to validate into Spanish the Neurogenic Bowel Dysfunction score (NBD score) that quantifies intestinal dysfunction severity in patients with disabilities due to central neurological injury and satisfaction with bowel management. MATERIAL: 59 patients, 30 patients affected by intestinal disability due to spinal cord injury and 29 patients with intestinal disability due to stroke. RESULTS: The result of the reliability of the construction of the Spanish translation of the NBD score for the whole group of patients shows a Cronbach's α for all the variables of 0.970 and the result of the reliability of the NBD score for the whole group in test-retest, using the interclass correlation coefficient, was 0.970 (95% CI 0.954-0.980). CONCLUSIONS: The Spanish version of the NBD score is a valid tool for use in our environment; it will allow a more real approach to the disability situation of each patient in relation to neurogenic intestinal dysfunction and knowledge of the degree and the involvement and effectiveness of management through different therapeutic proposals.

Predictors of respiratory complications in patients with C5-T5 spinal cord injuries.

STUDY DESIGN: Retrospective chart audit. OBJECTIVES: Describing the respiratory complications and their predictive factors in patients with acute traumatic spinal cord injuries at C5-T5 level during the initial hospitalization. SETTING: Hospital Vall d'Hebron, Barcelona. METHODS: Data from patients admitted in a reference unit with acute traumatic injuries involving levels C5-T5. Respiratory complications were defined as: acute respiratory failure, respiratory infection, atelectasis, non-hemothorax pleural effusion, pulmonary embolism or haemoptysis. Candidate predictors of these complications were demographic data, comorbidity, smoking, history of respiratory disease, the spinal cord injury characteristics (level and ASIA Impairment Scale) and thoracic trauma. A logistic regression model was created to determine associations between potential predictors and respiratory complications. RESULTS: We studied 174 patients with an age of 47.9 (19.7) years, mostly men (87%), with low comorbidity. Coexistent thoracic trauma was found in 24 (19%) patients with cervical and 35 (75%) with thoracic injuries (p < 0.001). Respiratory complications were frequent (53%) and were associated to longer hospital stay: 83.1 (61.3) and 45.3 (28.1) days in patients with and without respiratory complications (p < 0.001). The strongest predictors of respiratory complications were: previous respiratory disease (OR 5.4, 95% CI: 1.5-19.2), complete motor function impairment (AIS A-B) (OR 4.7, 95% CI: 2.4-9.5) and concurrent chest trauma (OR 3.73, 95% CI: 1.8-7.9). CONCLUSIONS: Respiratory complications are common in traumatic spinal cord injuries between C5-T5. We identified previous respiratory disease, complete motor function impairment and the coexistence of thoracic trauma as predictors of respiratory complications. Identification of patients at risk might help clinicians to implement preventive strategies.

Respuesta: Evaluación respiratoria en personas con lesión medular / Reply: Respiratory assesment in people with spinal cord injury

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Validación española del cuestionario International Spinal Cord Injury Pulmonary Function Basic Data Set para valorar la repercusión de la lesión medular en el sistema respiratorio / Spanish validation of the International Spinal Cord Injury Pulmonary Function Basic Data Set questionnaire for the study of the repercussion of spinal cord injury in the respiratory system

Introducción y objetivo: La disfunción del sistema respiratorio y las complicaciones respiratorias en la lesión medular repercuten en la morbimortalidad. El objetivo de este trabajo fue: 1) traducir y validar al español el cuestionario de consenso internacional: International Spinal Cord Injury Pulmonary Function Basic Data Set, y 2) determinar la influencia de la lesión medular crónica en el sistema respiratorio, en términos de funcionalismo respiratorio. Material y método: Traducción y validación al español del cuestionario de consenso internacional de la función pulmonar para la lesión medular. Se realizó un estudio de fiabilidad del cuestionario y un estudio descriptivo transversal para determinar el estado del sistema respiratorio en los lesionados medulares. Resultados: El 91,9% no presentaban ninguna enfermedad respiratoria antes de la lesión medular. El 54,8% tenían historia tabáquica. El 27,4% presentaron complicaciones respiratorias. Los resultados de pruebas de función respiratoria fueron FVC 67%, FEV1 72% y PEF 70%. En cuanto a la fiabilidad y concordancia, fue del 98%. Conclusión: El cuestionario de consenso internacional sobre la función pulmonar en su versión española es una herramienta útil para el estudio de la afectación respiratoria en la lesión medular (AU)

Introduction and objective: The dysfunction of the respiratory system and the breathing complications in persons with injured spinal cord has an effect on the morbidity and the mortality of the disease. The objectives were: 1) to translate to Spanish and validate the questionnaire of international consensus: International Spinal Cord Injury Pulmonary Function Basic Data Set, and 2) to determine the influence of chronic spinal cord injury in the respiratory system in terms of respiratory functionalism. Materials and method: Translation to Spanish and validation of the questionnaire of international consensus intended for the study of the pulmonary function in spinal cord injury disease. We tested the reliability of that questionnaire. We conducted a descriptive transversal study to determine the degree of involvement of the respiratory system in spinal cord injury. Results: A percentage of 91.9 did not have any respiratory pathology before spinal cord injury and 54.8% of patients smoked. A percentage of 27.4 of patients presented breathing complications one year after the injury. Results of the respiratory function tests were: FVC 67%, FEV1 72% and PEF 70%. Concordance and reliability were 98%. Conclusion: The Spanish version of the questionnaire of international consensus about the pulmonary function is a useful tool for the study of the respiratory involvement in spinal cord injury (AU)

[Spanish validation of the International Spinal Cord Injury Pulmonary Function Basic Data Set questionnaire for the study of the repercussion of spinal cord injury in the respiratory system]. / Validación española del cuestionario International Spinal Cord Injury Pulmonary Function Basic Data Set para valorar la repercusión de la lesión medular en el sistema respiratorio.

INTRODUCTION AND OBJECTIVE: The dysfunction of the respiratory system and the breathing complications in persons with injured spinal cord has an effect on the morbidity and the mortality of the disease. The objectives were: 1) to translate to Spanish and validate the questionnaire of international consensus: International Spinal Cord Injury Pulmonary Function Basic Data Set, and 2) to determine the influence of chronic spinal cord injury in the respiratory system in terms of respiratory functionalism. MATERIALS AND METHOD: Translation to Spanish and validation of the questionnaire of international consensus intended for the study of the pulmonary function in spinal cord injury disease. We tested the reliability of that questionnaire. We conducted a descriptive transversal study to determine the degree of involvement of the respiratory system in spinal cord injury. RESULTS: A percentage of 91.9 did not have any respiratory pathology before spinal cord injury and 54.8% of patients smoked. A percentage of 27.4 of patients presented breathing complications one year after the injury. Results of the respiratory function tests were: FVC 67%, FEV1 72% and PEF 70%. Concordance and reliability were 98%. CONCLUSION: The Spanish version of the questionnaire of international consensus about the pulmonary function is a useful tool for the study of the respiratory involvement in spinal cord injury.

Validación de la versión española del cuestionario King's Health para la evaluación de la calidad de vida relacionada con la incontinencia urinaria en pacientes con lesión medular / Validation of the Spanish version of the King's Health questionnaire for evaluating quality of life related to urinary incontinence in patients with spinal cord injury

Background and objective: To determine the validity of the Spanish version of the King's Health Questionnaire (KHQ) in patients with spinal cord injury. Patients and methods: A cross-sectional study, including a total of 120 patients with spinal cord injury. The feasibility, cross-cultural validity, and internal consistency of the KHQ were evaluated. Results: The dimensions with the highest scores were: impact of urinary symptoms, personal relations, and physical limitations. The following groups presented a significantly poorer HRQoL: persons of advanced age in personal relations (P=0.042), women in limitations of daily life activities (P=0.009) and in the impact of urinary incontinence (P<0.01), paraplegic patients in personal relations, and patients with incomplete cord lesions in sleeping and energy (P<0.01). Patients with an external condom catheter presented a better HRQoL with significant differences in the dimension, limitations of daily life activities (P=0.04). The KHQ showed good internal consistency (Cronbach alpha 0.91). Conclusion:KHQ is a valid instrument for evaluating HRQoL related with urinary incontinence in patients with spinal cord injury (AU)

Fundamento y objetivo: Evaluar la validez de la versión española del King's Health Questionnaire (KHQ) en pacientes lesionados medulares (LM). Pacientes y método: Estudio transversal de 120 pacientes con lesión medular. Se evaluaron propiedades de factibilidad, validez transversal y consistencia interna del cuestionario KHQ. Resultados:Las dimensiones con mayor puntuación fueron: “impacto de síntomas urinarios”, “relaciones personales” y “limitaciones físicas”. Presentaron peor calidad de vida: pacientes de mayor edad, en las relaciones personales (p=0,042); las mujeres, en las limitaciones de las actividades de la vida diaria (p=0,009) y el impacto de la incontinencia urinaria (p<0,01); los parapléjicos, en las relaciones personales y las lesiones incompletas en el sueño y energía (p<0,01). Presentaron mejor calidad de vida: pacientes con colector permanente, siendo las diferencias significativas en la dimensión de “limitaciones en las actividades cotidianas” (p=0,04). La consistencia interna del cuestionario fue buena (alfa Cronbach 0,91). Conclusión: El KHQ es un instrumento válido para evaluar la calidad de vida relacionada con la incontinencia urinaria en pacientes con LM (AU)

Eficacia y seguridad de la toxina botulínica administrada en el esfínter uretral externo vía transperineal guiada mediante ecografía transrectal y electromiografía en la retención urinaria crónica secundaria a una lesión medular / Efficacy and safety of botulinum toxin in external urethral sphincter by transperineal way guided transrectal ultrasound and electromyography on chronic urinary retention due to spinal cord injury

Fundamento y objetivo: Evaluar la eficacia y seguridad de la toxina botulínica en la hipertonía esfinteriana en pacientes con lesión medular (LM). Pacientes y método: Ensayo clínico no controlado en varones con hipertonía esfinteriana secundaria a LM. Se aplicaron 100 U de Botox® vía transperineal en esfínter uretral externo guiado con electromiografía y ecografía transrectal. Se determinaron los siguientes parámetros: volumen urinario residual (VR), presión uretral máxima de cierre (PUMc), volumen de micción (M) y porcentaje de micción (MP). Se valoró la incidencia de disfunción eréctil mediante cuestionario International Index of Erectil Function (IIEF-5 items). Resultados: Se incluyeron 19 varones, con una media de edad de 40 años (extremos 22-56). El tiempo medio de seguimiento fue de 546 días (20 meses). Se realizó una infiltración cada 6 meses de promedio, con una media de 2,7 infiltraciones por paciente (extremos 1-7). El VR disminuyó 59,3ml (p=0,03), la micción aumentó 52ml (p=0,018) y el MP mejoró el 17,2% (p=0,011), mientras que los cambios en PUMc no fueron significativos. No empeoró la disfunción eréctil presentada ya previamente (IIEF-5: 11,4 a 13). Conclusión: La infiltración con toxina botulínica aplicada a esfínter uretral externo vía transperineal parece ser una eficaz y segura opción terapéutica (AU)

Background: To assess the efficacy and safety of botulinum toxin for sphincter hypertonia in patients with spinal cord injury (SCI). Patients and methods: Non-control clinical trial on men with neurogenic detrussor-sphincter dyssynergia (DSD) due to SCI. 100 IU of Botox® were injected through the transperineal way on external urethral sphincter under electromyography and transrectal ultrasound guidance. The following parameters were determined: post-void residual (PVR), maximum urethral pressure (MUP), miction volume (M) and miction percentage (MP). The incidence of erectile dysfunction was evaluated using the International Index of Erectile Function questionnaire (IIEF-5 items). Results: 19 men with an average age of 40years (ED 22-56) were included. The average time of monitoring was 546days (20 months). As an average, an infiltration was done every 6 months, with an average of 2.7 infiltrations per patient (1-7). PVR dropped by 59.3ml, p=0.03; miction raised to 52ml, p=0.018; MP was improved by 17.2%, p=0.011. Changes on MUP were not significant. Erectile dysfunction was not worse than the initial one (IIEF-5: 11.4 to 13). Conclusion: The infiltration of the toxin into the sphincter through the transperineal way seems to be an effective and safe therapeutic option (AU)

[Validation of the Spanish version of the King's Health questionnaire for evaluating quality of life related to urinary incontinence in patients with spinal cord injury]. / Validación de la versión española del cuestionario King's Health para la evaluación de la calidad de vida relacionada con la incontinencia urinaria en pacientes con lesión medular.

BACKGROUND AND OBJECTIVE: To determine the validity of the Spanish version of the King's Health Questionnaire (KHQ) in patients with spinal cord injury. PATIENTS AND METHODS: A cross-sectional study, including a total of 120 patients with spinal cord injury. The feasibility, cross-cultural validity, and internal consistency of the KHQ were evaluated. RESULTS: The dimensions with the highest scores were: impact of urinary symptoms, personal relations, and physical limitations. The following groups presented a significantly poorer HRQoL: persons of advanced age in personal relations (P=0.042), women in limitations of daily life activities (P=0.009) and in the impact of urinary incontinence (P<0.01), paraplegic patients in personal relations, and patients with incomplete cord lesions in sleeping and energy (P<0.01). Patients with an external condom catheter presented a better HRQoL with significant differences in the dimension, limitations of daily life activities (P=0.04). The KHQ showed good internal consistency (Cronbach alpha 0.91). CONCLUSION: KHQ is a valid instrument for evaluating HRQoL related with urinary incontinence in patients with spinal cord injury.

[Efficacy and safety of botulinum toxin in external urethral sphincter by transperineal way guided transrectal ultrasound and electromyography on chronic urinary retention due to spinal cord injury]. / Eficacia y seguridad de la toxina botulínica administrada en el esfínter uretral externo vía transperineal guiada mediante ecografía transrectal y electromiografía en la retención urinaria crónica secundaria a una lesión medular.

BACKGROUND: To assess the efficacy and safety of botulinum toxin for sphincter hypertonia in patients with spinal cord injury (SCI). PATIENTS AND METHODS: Non-control clinical trial on men with neurogenic detrussor-sphincter dyssynergia (DSD) due to SCI. 100 IU of Botox® were injected through the transperineal way on external urethral sphincter under electromyography and transrectal ultrasound guidance. The following parameters were determined: post-void residual (PVR), maximum urethral pressure (MUP), miction volume (M) and miction percentage (MP). The incidence of erectile dysfunction was evaluated using the International Index of Erectile Function questionnaire (IIEF-5 items). RESULTS: 19 men with an average age of 40 years (ED 22-56) were included. The average time of monitoring was 546 days (20 months). As an average, an infiltration was done every 6 months, with an average of 2.7 infiltrations per patient (1-7). PVR dropped by 59.3 ml, p=0.03; miction raised to 52 ml, p=0.018; MP was improved by 17.2%, p=0.011. Changes on MUP were not significant. Erectile dysfunction was not worse than the initial one (IIEF-5: 11.4 to 13). CONCLUSION: The infiltration of the toxin into the sphincter through the transperineal way seems to be an effective and safe therapeutic option.

Incapacidad por dolor lumbar en España / Disability from low back pain in Spain

Fundamento: La lumbalgia inespecífica es muy frecuente y no se ha cuantificado en España el impacto económico que supone la inactividad que provoca. Material y método: Se ha valorado la cifra total de lumbalgia y el impacto que tiene sobre las jornadas no trabajadas durante los ejercicios 1993-1997 en España. Resultados: La cifra total de lumbalgias alcanza una media de 55.338 por año (DE 9.230,1). La media del número de días de baja por lumbalgia o incapacidad transitoria en los cinco ejercicios analizados es de 21,9 días, con un intervalo entre 19,7 y 24,2 días. En el año 1998 representó un coste medio de 11.252.404.056 ptas. y el coste anual por absentismo fue de 209.666 ptas/trabajador. Conclusiones: El coste por incapacidad transitoria es mayor en España que en los de nuestro entorno de la Unión Europea. (AU)