Do individuals from an SCI-specialized rehabilitation facility have fewer secondary health conditions than those from a non-SCI-specialized rehabilitation facility? Analysis of the InSCI database from a middle-income country.

OBJECTIVES: To determine whether attending an SCI-specialized rehabilitation facility (SSRF) is independently associated with having fewer secondary health conditions (SHCs) in middle-income country contexts. STUDY DESIGN: Cross-sectional observational study. SETTING: Four rehabilitation facilities in Thailand (one SSRF and three non-SSRF). METHODS: Data from a Thai arm of the International Spinal Cord Injury Community Survey (InSCI) were analyzed. SHCs occurring within the last three months were evaluated using the Spinal Cord Injury Secondary Condition Scale. A causal diagram was applied to create a multivariable regression model to determine the independent effect of attending in the SSRF on having SHC as a single condition and as a sum score. RESULTS: Three hundred and thirteen individuals with chronic SCI were included in this study. Two hundred and nineteen participants (70%) were recruited from the SSRF. Being recruited from the SSRF was an independent negative correlating factor of the SHC sum score with an unstandardized coefficient of -1.12 (95% CI: -2.00-0.24). Being recruited from the SSRF was also an independent negative correlating factor of having bladder dysfunction, sexual dysfunction, and pressure ulcer SHC with an odds ratio of 0.32 (95% CI: 0.16-0.59), 0.43 (95% CI: 0.22-0.84), and 0.46 (95% CI: 0.24-0.89), respectively. CONCLUSION: Attending an SSRF was significantly associated with having fewer SHCs, specifically, bladder dysfunctions, sexual dysfunctions, and pressure ulcers. These results suggest the importance of having SSRF in middle-income countries for delivering effective care to people with SCI and standardized education to health care providers.

COVID-19 vaccination status in people with spinal cord injury: Results from a cross-sectional study in Thailand.

OBJECTIVE: To assess COVID-19 vaccination status among individuals with spinal cord injury (SCI). DESIGN: A cross-sectional study. SETTING: Twelve hospitals from all regions of Thailand. PARTICIPANTS: One hundred and eighty people with SCI were randomly selected from the Thai SCI registry database. INTERVENTION: Not applicable. OUTCOME MEASURES: The primary outcome, which was the COVID-19 vaccination status, and the secondary outcomes, which were the number of vaccination doses, satisfaction and dissatisfaction aspects, and barriers to vaccination, were recorded using a specifically developed questionnaire over the telephone during February to March 2022. Data were analyzed using descriptive analyses, bivariate, and multivariable analyses. RESULTS: Of the 96 people with SCI who were able to respond, the prevalence of receiving at least one dose was 77% but the prevalence of receiving a booster dose was 20%. Being non-traumatic SCI correlated negatively with having received any vaccination doses when compared to traumatic SCI. Most of the participants were satisfied with the government provision of COVID-19 vaccines. The major barriers to vaccination were problems related to a negative attitude toward the vaccination, followed by transportation difficulties and wheelchair-inaccessible vaccination sites. CONCLUSIONS: Seventy-seven percent of people with SCI participating in this study received at least one dose of the COVID-19 vaccine, whereas only 20% of them received a booster dose of the COVID-19 vaccination. To increase the prevalence of vaccination, healthcare providers should deliver the fact regarding COVID-19 vaccination to reduce negative attitudes, as well as remove physical barriers to vaccination places for people with SCI.

Health care and rehabilitation services utilization, benefits and satisfaction: a community survey of individuals with spinal cord injury in Thailand.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: This study aimed to explore and report on health care and rehabilitation service utilization, rehabilitation service benefits, and levels of satisfaction of individuals with spinal cord injury (SCI) living in communities in Thailand. SETTING: Four rehabilitation facilities in Thailand, two university hospitals (Maharaj Nakorn Chiang Mai Hospital in Chiang Mai Province and Siriraj Hospital in Bangkok), one large provincial hospital (Ratchaburi Hospital in Ratchaburi Province), and one national rehabilitation institute (Sirindhorn National Medical Rehabilitation Institute in Nonthaburi Province). METHODS: This study was part of the International Spinal Cord Injury Community Survey (InSCI). Individuals with SCI completed a set of questionnaires, then data related to their health care and rehabilitation services were extracted and analyzed. RESULTS: Of the 320 participants, most were male (71%), and the majority were living with paraplegia (73%). In cases of mild illnesses where hospitalization was not required, 46% went to a nearby health service hospital. In cases of serious illnesses where hospitalization was required, 39% went to a higher-level hospital. The majority (80%) were satisfied with their experience with health care services. The three top preferred products and services in descending order were wheelchairs and cushions, increased disability pension, medication and medical equipment including bladder relaxants, urinary catheters and urine bags. CONCLUSIONS: Individuals with SCI living in communities in Thailand preferred treatment at a nearby district hospital for mild illnesses with one-third transferring to a higher-level hospital for serious illnesses. The majority were satisfied with the health care services and rehabilitation services.

Is admission to an SCI specialized rehabilitation facility associated with better functional outcomes? Analysis of data from the Thai Spinal Cord Injury Registry.

STUDY DESIGN: Prospective cohort study of the Thai Spinal Cord Injury Registry. OBJECTIVE: To determine whether being admitted to a spinal cord injury (SCI) specialized rehabilitation facility (SSRF) is associated with better functional outcomes. SETTING: Four rehabilitation facilities in Thailand; one a SSRF and the others non-SSRFs. METHODS: Data from the one SSRF and three non-SSRFs were extracted from the Thai Spinal Cord Injury Registry. Multivariate regression analysis was used to exclude the effect of confounding factors and prove the independent association of SSRF admission with respect to Spinal Cord Independence Measurement (SCIM) at discharge. RESULTS: Among the 234 new SCI inpatients enrolled, 167 persons (71%) had been admitted to the SSRF. The SSRF had a greater proportion of persons with AIS A, B, C tetraplegia and people with AIS D, whereas the non-SSRFs had a higher proportion of patients with AIS A, B or C paraplegia. Patients discharged from the SSRF demonstrated a greater SCIM score improvement than those from the non-SSRFs (24.1 vs 17.0; p = 0.003). By using multivariate regression analysis controlling for age, time from injury to rehabilitation, severity of injury and SCIM score on admission, SSRF admission was found to be an independent predictive factor of SCIM score improvement at discharge (p = 0.008). CONCLUSION: Admission to an SSRF is associated with better rehabilitation outcomes. This finding supports the importance of SSRF access to improve the functional outcome of patients with SCI.