Reliability of the International Spinal Cord Injury Upper Extremity Basic Data Set.

STUDY DESIGN: It is a psychometrics study. OBJECTIVE: To assess the inter-rater reliability of the International Spinal Cord Injury Upper Extremity Basic Data Set (ISCI-UE). SETTING: Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand. METHODS: Individuals with subacute and chronic cervical spinal cord injury (SCI) were recruited. One examiner rated five parts of the ISCI-UE, including the ability to reach and grasp, the shoulder function classification, utilization of adaptive devices used to enhance upper-extremity function, complications affecting upper-extremity function, and upper extremity/hand reconstructive surgery. A second blinded examiner repeated the procedures within 1 day. Quadratic weighted kappa was calculated to determine the inter-rater reliability. RESULTS: Sixty participants were included in the study. Fifty-two patients were men, and the mean (SD) age of participants was 42.9 (14.3) years. The median (interquartile range) time since injury was 9.5 (1-53) months. A total of 117 upper limbs were assessed. The inter-rater reliability was substantial, with almost perfect agreement in all items (ability to reach and grasp = 0.98; shoulder function classification = 0.97; use of assistive devices = 0.89; complications = 0.74; and surgery = 1). CONCLUSION: The International Spinal Cord Injury Upper Extremity Basic Data Set (ISCI-UE) has very good inter-rater reliability for evaluating individuals with cervical SCI.

International Spinal Cord Society (ISCoS) database: Asian Spinal Cord Network (ASCoN) Pilot Project [IDAPP].

STUDY DESIGN: Global mapping project of ISCoS for traumatic spinal cord injury (T-SCI) highlighted paucity of data from low and middle income countries (LMICs). Recognizing this gap, IDAPP study of one year duration was proposed as the first step to develop an International SCI database. OBJECTIVES: Primary objective was to assess database variables, processes involved and web platform for their suitability with a view to provide guidance for a large scale global project. Secondary objective was to capture demographic and selected injury/safety data on patients with T-SCI with a view to formulate prevention strategies. SETTING: Nine centers from Asia. METHODS: All patients with T-SCI admitted for first time were included. International SCI Core Data Set and especially compiled Minimal Safety Data Set were used as data elements. Questionnaire was used for feedback from centers. RESULTS: Results showed relevance and appropriateness of processes, data variables and web platform of the study. Ease of entering and retrieval of data from web platform was confirmed. Cost of one year IDAPP study was USD 7780. 975 patients were enrolled. 790 (81%) were males. High falls (n = 513, 52%) as a cause and complete injuries (n = 547, 56%) were more common. There was a higher percentage of thoracic and lumbar injuries (n = 516, 53%). CONCLUSIONS: The study confirms that establishing the SCI database is possible using the variables, processes and web platform of the pilot study. It also provides a low cost solution. Expansion to other centers/regions and including non-traumatic SCI would be the next step forward.

Prevalence of pressure ulcers in Thai wheelchair users with chronic spinal cord injuries.

STUDY DESIGN: A cross-sectional study. OBJECTIVES: To study prevalence of pressure ulcers (PrUs), quality of life (QoL) and effect of wheelchair cushions used by Thai wheelchair users with chronic spinal cord injury (SCI). SETTING: Maharaj Hospital, Chiang Mai, Thailand. METHODS: Thai chronic SCI wheelchair users, aged over 18 years and non-ambulatory with ASIA impairment scale A, B or C were recruited. They completed the PrUs questionnaire and rated the EuroQoL-5D and their health status with a visual analog scale (VAS). Demographic data of each participant were extracted from medical records. The EQ-5D health states were transformed to utility scores by using the Thai algorithm and the prevalence of PrUs was reported. The EQ-5D, the utility scores and the health status VAS were compared between those with and without current PrUs and between those participants using foam and air-filled cushions. RESULTS: Of 129 participants, 26.4% had current PrUs at the time of the study, 27.9% had healed PrUs and 45.7% never had PrUs. The median VAS score for health status was 70 (Q1=50, Q3=80). Based on the EQ-5D, only one dimension (anxiety/depression) was significantly different between those with and those without current PrUs (P=0.015). Those using an air-filled cushions had a mean utility score four times higher than of those using a foam cushion (0.131 vs. 0.032, P=0.089) but not statistically significant. CONCLUSIONS: PrUs are still prevalent among Thai wheelchair users with chronic SCI. Anxiety/depression is associated with current ulcers.

Pulmonary embolism after manual muscle testing in an incomplete paraplegic patient: a case report.

OBJECTIVE: To report and discuss the case of an incomplete paraplegic patient who died of pulmonary embolism (PE) aggravated by manual muscle testing. SETTING: Acute spinal ward, Maharaj Hospital, Chiang Mai, Thailand. CASE REPORT: A 79-year-old man suffering from chest trauma, fractured ribs and a fracture of T11 with incomplete paraplegia, American Spinal Injury Association impairment scale D. Intercostal tubes were inserted at both sides due to haemothorax. Ten days after onset, T9 to L2 posterior instrumentation was successfully completed. A week after the operation, he was allowed to stand on a tilt-table and a rehabilitation specialist was consulted to assess and plan to encourage ambulation. After manual muscle testing of the right hip flexors and knee extensors, the patient suffered from a short period of unconsciousness and breathlessness. Electrocardiography showed right bundle branch block and a drop in oxygen saturation from 98 to 70%. After oxygenation with mask and bag, oxygen saturation increased to 90%. PE or acute myocardial infarction was suspected. After insertion of an endotracheal tube, the patient went into cardiac arrest. Cardiopulmonary resuscitation failed. The autopsy revealed large and small thromboemboli in both lungs, particularly in the pulmonary artery. CONCLUSION: Strong hip and knee muscle contractions during manual muscle testing were suspected of triggering massive pulmonary emboli from the proximal vein of the right leg of a paraplegic patient who had functional motor movements and did not receive any thromboembolic prophylaxis which caused unexpected fatal pulmonary emboli. Screening of venous thromboembolism risks and its symptoms/signs before mobilisation is mandatory.