[Nerve transfer in patients with tetraplegia: improvement in hand function]. / Zenuwtransfer bij patiënten met een tetraplegie.

Reconstruction of arm and hand function in patients with a cervical spinal cord injury can improve their quality of life. Elbow extension, wrist extension, grip function and opening of the hand can be reconstructed. Traditionally, this has been done through tendon transpositions. Nerve transfer is a new technique. A functioning motor nerve branch is moved and connected to a muscle or muscle group damaged by the spinal cord injury. This technique has several advantages. Multiple functions can be restored by one nerve transfer, no long-term hand-rehabilitation is required and there is no risk of adhesions of the transposition. The most important disadvantage is the recovery time, as a results of the slow ingrowth of the nerve transfer, which takes at least 12 to 18 months. For each spinal cord injury patient, an individual action plan must be made, because not every patient has the same options and these are sometimes very limited.

The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15): Validation of the Dutch version in patients with multiple sclerosis and spinal cord injury.

AIMS: The Multiple Sclerosis Intimacy and Sexuality Questionnaire (MSISQ-15) evaluates symptoms of sexual dysfunction in patients with multiple sclerosis (MS). The objective of this study was to provide and validate a Dutch version of the MSISQ-15 in patients with neurological disease such as MS and spinal cord injury (SCI). METHODS: The linguistic validation process of the original English MSISQ-15 into Dutch was performed according to standardized guidelines. Sexually active patients with MS or spinal cord disorders, including SCI and cauda equine syndrome, who visited a tertiary urology center or a rehabilitation center completed the MSISQ-15, Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) in women, or International Index of Erection Function (IIEF-15) in men at baseline (test) and 2 weeks later (retest). A reference group recruited from a general medical practice completed the questionnaires once. Data were analyzed for measurement properties. RESULTS: Fifty-three patients with MS, 49 patients with spinal cord disorder, and 50 references were included. Content validity was adequate. Internal consistency (Cronbach's alpha >0.8) and reproducibility (intraclass correlation coefficient >0.8) of the MSISQ-15 were excellent. Patients' MSISQ-15 scores were correlated with severity of symptoms of sexual dysfunction measured by PISQ-12 or IIEF-15 and confirmed positive rating for criterion validity. MSISQ-15 scores in patients were higher than in references (on a scale of 15-75: 38.9 ± 11.4 vs 21.1 ± 5.4; P < 0.001), indicating good construct validity. CONCLUSIONS: The Dutch MSISQ-15 is a reliable and valid measure to evaluate symptoms of sexual dysfunction in patients with MS or with SCI.

The validation of the Dutch SF-Qualiveen, a questionnaire on urinary-specific quality of life, in spinal cord injury patients.

BACKGROUND: Optimizing the patients' quality of life is one of the main goals in the urological management of spinal cord injury (SCI) patients. In this study we validated the Dutch SF-Qualiveen, a short questionnaire that measures the urinary-specific quality of life, in SCI patients. No such measure is yet available for this patient group. METHODS: In 2015-2016 SCI patients with urinary symptomatology who visited the outpatient clinics of Urology at the Erasmus Medical Centre and Rehabilitation at Rijndam Revalidation completed the SF-Qualiveen and UDI-6 during the visit and 1-2 weeks later. The UDI-6, a urinary tract symptom inventory, served as gold standard. Controls, recruited from the Otolaryngology outpatient clinic, completed the questionnaires once. Content-, construct-, and criterion validity and reliability (internal consistency and reproducibility) of the SF-Qualiveen were determined. RESULTS: Fifty seven SCI patients and 50 controls were included. 12 SCI patients asserted that the SF-Qualiveen covered their bladder problems (good content validity). Patients' SF-Qualiveen scores being positively associated with severity of urinary symptoms and patients' scores being higher than those of controls indicated good construct validity. The positive association that was found between SF-Qualiveen and UDI-6 in patients (r = 0.66-0.67, P < 0.001) and controls (r = 0.63, P < 0.001) confirmed good criterion validity. Internal consistency (Cronbach's alpha 0.89-0.92) and reproducibility (intraclass correlation coefficient 0.94) of the SF-Qualiveen were good. CONCLUSIONS: The Dutch SF-Qualiveen is a valid and reliable tool to measure the urinary-specific quality of life in SCI patients.

Working mechanisms of a behavioural intervention promoting physical activity in persons with subacute spinal cord injury.

OBJECTIVE: In order to unravel the working mechanisms that underlie the effectiveness of a behavioural intervention promoting physical activity in persons with subacute spinal cord injury, the aim of this study was to assess the mediating effects of physical and psychosocial factors on the intervention effect on physical activity. DESIGN: Randomized controlled trial. SETTING: Four rehabilitation centres in the Netherlands. SUBJECTS: Thirty-nine persons with subacute spinal cord injury. INTERVENTION: Behavioural intervention promoting an active lifestyle, based on motivational interviewing. The intervention involved a total of 13 individual sessions beginning 2 months before and ending 6 months after discharge from initial inpatient rehabilitation. MAIN MEASURES: The potential mediating effects of fatigue, pain, depression, illness cognition, exercise self-efficacy, coping and social support on the effect of the behavioural intervention on objectively measured physical activity (B = 0.35 h, p < 0.01) were studied. Measurements were performed at baseline, discharge, 6 months and 1 year after discharge. RESULTS: No single factor was found that strongly mediated the effect of the behavioural intervention on physical activity; however, multiple factors could partly explain the effect. Mediating effects greater than 10% were found for proactive coping (17.6%), exercise self-efficacy (15.9%), pain disability (15.3%) and helplessness (12.5%). DISCUSSION: Proactive coping (the ability to anticipate and deal with potential threats before they occur), exercise self-efficacy (self-confidence with respect to performing exercise and daily physical activities), pain disability (interference by pain of daily activities) and helplessness (emphasizing the aversive meaning of the disease) are important concepts in interventions promoting physical activity in persons with subacute spinal cord injury.

Longitudinal association between respiratory muscle strength and cough capacity in persons with spinal cord injury: An explorative analysis of data from a randomized controlled trial.

OBJECTIVE: To assess the longitudinal association between respiratory muscle strength and cough capacity in persons with recent spinal cord injury. DESIGN: Longitudinal analyses. SUBJECTS: Forty persons with recent spinal cord injury and impaired pulmonary function. METHODS: Measurements were performed 4 weeks after the start of rehabilitation, 9 and 17 weeks after the first measurement, and one year after discharge from inpatient rehabilitation. Peak cough flow was measured with a spirometer. Maximum inspiratory and expiratory pressures (MIP and MEP), expressed in cmH2O, were measured at the mouth. RESULTS: Both MIP and MEP were significantly positively associated with peak cough flow. After correction for confounders and time 10 cmH2O higher MIP was associated with a 0.32 l/s higher peak cough flow, and a 10 cmH2O higher MEP was associated with a 0.15 l/s higher peak cough flow. The association between MIP and peak cough flow was mainly based on within-subject variance. The association between MIP and peak cough flow was stronger than between MEP and peak cough flow. CONCLUSION: Improvement in respiratory muscle strength is associated with improvement in cough capacity in persons with recent spinal cord injury who have impaired pulmonary function.

The influence of time and adaptation on health state valuations in patients with spinal cord injury.

OBJECTIVES: One of the explanations for the difference between health state utilities elicited from patients and the public--often provided but seldom studied--is adaptation. The influence of adaptation on utilities was investigated in patients with spinal cord injury. METHODS: Interviews were held at 3 time points (T1, after admission to the rehabilitation center; T2, during active rehabilitation; T3, at least half a year after discharge). At T1, 60 patients were interviewed; 10 patients withdrew at T2 and T3. At all time points, patients were asked to value their own health and a health state description of rheumatoid arthritis on a time trade-off and a visual analogue scale. The Barthel Index, a measure of independence from help in activities of daily living, and the adjustment ladder were filled out. Main analyses were performed using mixed linear models taking the time-dependent covariates (Barthel Index and adjustment ladder) into account. RESULTS: Time trade-off valuations for patients' own health changed over time, even after correction for gain in independence from help in activities of daily living, F(2, 59) = 8.86, P < 0.001. This change was related to overall adaptation. Both a main effect for adaptation, F(87, 1) = 10.05; P = 0.002, and an interaction effect between adaptation and time, F(41, 1)= 4.10, P = 0.024, were seen for time trade-off valuations. Valuations given for one's own health on the visual analogue scale did not significantly change over time, nor did the valuations for the hypothetical health state. CONCLUSION: Patients' health state valuations change over time, over and above the change expected by the rehabilitation process, and this change is partly explained by adaptation. Experience with a chronic illness did not lead to change in valuations of hypothetical health states.

[Decubitus ulcers in spinal cord lesion: proactive inspection]. / Decubitus bij dwarslaesiepatiënten: proactief inspecteren.

Two patients, a 23-year-old and a 70-year-old man, were admitted to a hospital with a spinal cord lesion. During their stay they developed severe decubitus ulcers which was not noticed until after they were moved to our rehabilitation centre. Despite conventional wound therapy one of the two patients developed an infection deriving from the necrotic decubitus wound which resulted in severe sepsis. A necrotomy had been delayed because of the medical history of this patient and because of the waiting list. These cases show that all parties involved with patients with spinal cord lesions should be aware of the high risk of decubitus ulcers. Frequent skin checks of the sites at risk by both carer and patient are necessary, and early necrotomy is important for the adequate treatment of decubitus.