Index > Vol. 39/2007 > Iss. 5/May > pp. 393-398 > Abstract
| Spinal cord injuries

Complications following spinal cord injury: Occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation

doi: 10.2340/16501977-0067

Abstract:

Objective: To assess the occurrence and risk factors for complications following spinal cord injury during and after inpatient rehabilitation.
Design: Multicentre longitudinal study.
Subjects: A total of 212 persons with a spinal cord injury admitted to specialized rehabilitation centres.
Methods: Assessments at the start of active rehabilitation (n = 212), 3 months later (n = 143), at discharge (n = 191) and 1 year after discharge (n = 143).
Results: Multi-level random coefficient analyses revealed that complications were common following spinal cord injury. Most subjects reported neurogenic and musculoskeletal pain, or had spasticity at each assessment. During the year after discharge, complications remained common: urinary tract infections and pressure sores affected 49% and 36% of the population, respectively. The degree of pain decreased, whereas the degree of spasticity increased significantly during inpatient rehabilitation. Overall, increased age, increased body mass index, traumatic lesion, tetraplegia, and complete lesion all increased the risk of complications.
Conclusion: Complications are common following spinal cord injury. They need specific attention after discharge from inpatient rehabilitation and within subpopulations.

Authors:

Janneke A. Haisma, Lucas H. van der Woude, Henk J. Stam, Michael P. Bergen, Tebbe A. Sluis, Marcel W. Post and Johannes B. Bussmann

Key words:

spinal cord injury, complications, risk factors, rehabilitation.

References

  1. Noreau L, Proulx P, Gagnon L, Drolet M, Laramee MT. Secondary impairments after spinal cord injury: a population-based study. Am J Phys Med Rehabil 2000; 79: 526–535.
  2. Westgren N, Levi R. Quality of life and traumatic spinal cord injury. Arch Phys Med Rehabil 1998; 79: 1433–1439. Link to article
  3. Bloemen-Vrencken JH, Post MW, Hendriks JM, De Reus EC, De Witte LP. Health problems of persons with spinal cord injury living in the Netherlands. Disabil Rehabil 2005; 27: 1381–1389.
  4. Valtonen K, Karlsson AK, Alaranta H, Viikari-Juntura E. Work participation among persons with traumatic spinal cord injury and meningomyelocele1. J Rehabil Med 2006; 38: 192–200.
  5. Meyers AR, Andresen EM, Hagglund KJ. A model of outcomes research: spinal cord injury. Arch Phys Med Rehabil 2000; 81: S81–S90.
  6. Kirschblum S, Campagnolo DI, DeLisa JA, editors. Spinal cord medicine. Philadelphia: Lippincott Williams & Wilkins; 2002.
  7. Burchiel KJ, Hsu FP. Pain and spasticity after spinal cord injury: mechanisms and treatment. Spine 2001; 26: S146–S160.
  8. Werhagen L, Budh CN, Hultling C, Molander C. Neuropathic pain after traumatic spinal cord injury – relations to gender, spinal level, completeness, and age at the time of injury. Spinal Cord 2004; 42: 665–673.
  9. McKinley WO, Jackson AB, Cardenas DD, DeVivo MJ. Long-term medical complications after traumatic spinal cord injury: a regional model systems analysis. Arch Phys Med Rehabil 1999; 80: 1402–1410.
  10. Chen Y, Devivo MJ, Jackson AB. Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects. Arch Phys Med Rehabil 2005; 86: 1208–1213.
  11. Post MW, Dallmeijer AJ, Angenot EL, van Asbeck FW, van der Woude LH. Duration and functional outcome of spinal cord injury rehabilitation in the Netherlands. J Rehabil Res Dev 2005; 42: 75–85.
  12. Cardenas DD, Hoffman JM, Kirshblum S, McKinley W. Etiology and incidence of rehospitalization after traumatic spinal cord injury: a multicenter analysis. Arch Phys Med Rehabil 2004; 85: 1757–1763.
  13. Vanden Bossche L, Vanderstraeten G. Heterotopic ossification: a review. J Rehabil Med 2005; 37: 129–136.
  14. DeVivo MJ, Krause JS, Lammertse DP. Recent trends in mortality and causes of death among persons with spinal cord injury. Arch Phys Med Rehabil 1999; 80: 1411–1419.
  15. Aito S. Complications during the acute phase of traumatic spinal cord lesions. Spinal Cord 2003; 41: 629–635.
  16. New P, Rawicki HB, Bailey MJ. Nontraumatic spinal cord injury rehabilitation: pressure ulcer pattern, prediction and impact. Arch Phys Med Rehabil 2004; 85: 87–93.
  17. Chen D, Apple DF Jr. , Hudson LM, Bode R. Medical complications during acute rehabilitation following spinal cord injury – current experience of the model systems. Arch Phys Med Rehabil 1999; 80: 1397–1401.
  18. Maynard FM Jr. , Bracken MB, Creasey G, Ditunno JF Jr. , Donovan WH, Ducker TB, et al. International standards for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Spinal Cord 1997; 35: 266–274. Link to article
  19. Twisk JW. Applied longitudinal data analysis for epidemiology; a practical guide. Cambridge: Cambridge University Press; 2003.
  20. Rasbash J, Browne W, Goldstein H, Yang M, Plewis I, Healy M, et al. A user’s guide to MLwiN. London: University of London: 2002. 
.
  21. Siddall PJ, Loeser JD. Pain following spinal cord injury. Spinal Cord 2001; 39: 63–73.
  22. van Drongelen S, de Groot S, Veeger HE, Angenot EL, Dallmeijer AJ, Post MW, et al. Upper extremity musculoskeletal pain during and after rehabilitation in wheelchair-using persons with a spinal cord injury. Spinal Cord 2006; 44: 152–159.
  23. Bloemen-Vrencken JH, de Witte LP. Post-discharge nursing problems of spinal cord injured patients: on which fields can nurses contribute to rehabilitation? Clin Rehabil 2003; 17: 890–898.
  24. Winslow C, Rozovsky J. Effect of spinal cord injury on the respiratory system. Am J Phys Med Rehabil 2003; 82: 803–814.
  25. Haisma JA, Bussmann JB, Stam HJ, Sluis TA, Bergen MP, 
Dallmeijer AJ, et al. Changes in physical capacity during and after inpatient rehabilitation in subjects with a spinal cord injury. Arch Phys Med Rehabil 2006; 87: 741–748.
  26. DeVivo MJ, Kartus PL, Rutt RD, Stover SL, Fine PR. The influence of age at time of spinal cord injury on rehabilitation outcome. Arch Neurol 1990; 47: 687–691.
  27. van Asbeck FW, Post MW, Pangalila RF. An epidemiological description of spinal cord injuries in The Netherlands in 1994. Spinal Cord 2000; 38: 420–424.
  28. Buchholz AC, Bugaresti JM. A review of body mass index and waist circumference as markers of obesity and coronary heart disease risk in persons with chronic spinal cord injury. Spinal Cord 2005; 43: 513–518.
  29. Janssen TW, van Oers CA, van Kamp GJ, TenVoorde BJ, van der Woude LH, Hollander AP. Coronary heart disease risk indicators, aerobic power, and physical activity in men with spinal cord injuries. Arch Phys Med Rehabil 1997; 78: 697–705. Link to article
  30. Tate DG, Forchheimer MB, Krause JS, Meade MA, Bombardier CH. Patterns of alcohol and substance use and abuse in persons with spinal cord injury: risk factors and correlates. Arch Phys Med Rehabil 2004; 85: 1837–1847.