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Biomedical subjects

G G Whiteneck

Publications and source records attributed to G G Whiteneck.

At least 19 recordsLinked to original sources
PubMed2002

A tale of two countries: environmental impacts on social participation after spinal cord injury.

STUDY DESIGN: Comparative analysis of survey data produced in two countries. OBJECTIVES: To assess the degree to which environmental barriers impact social participation, and to identify the aspects of participation most affected. SETTING: Community-dwelling individuals with spinal cord injury in the USA and Turkey. METHODS: Subjects completed the Functional Independence Measure (FIM) motor score, the Craig Hospital Inventory of Environmental Factors (CHIEF), and the Craig Handicap Assessment and Reporting Technique (CHART). Analysis of co-variance was used to analyze CHIEF and CHART differences within and between country. RESULTS: US subjects reported higher participation scores (CHART) and lower barriers (CHIEF), however, when controls for age, gender, time since injury and motor ability (FIM) were applied, country differences in reports of barriers were limited. Motor ability was the major predictor of participation, which was minimally affected by barriers. CONCLUSION: Conceptualization and measurement issues may have been the reason for the minimal support for the hypothesis that environment affects participation. Suggestions for future research are made. SPONSORSHIP: National Institute on Disability and Rehabilitation Research, Centers for Disease Control and Prevention.

Activities of Daily Living↗
PubMed2001

Ageing with spinal cord injury: cross-sectional and longitudinal effects.

STUDY DESIGN: Longitudinal and cross-sectional. OBJECTIVE: To determine whether, for studies of ageing with a spinal cord injury, the cross-sectional differences in outcomes across both age and years post injury (YPI) differ from the longitudinal change. SETTING: Two SCI centres in England: the National Spinal Injuries Centre in Aylesbury, and the Regional Spinal Injuries Centre in Southport. METHODS: A total of 315 people who sustained spinal cord injuries prior to 1971 underwent comprehensive health and psychosocial status interviews at one or more of the study assessments (1990, 1993, 1996, and 1999). A range of continuous and dichotomous outcomes was analyzed to detect both cross-sectional differences by age and average individual changes over multiple measurements. RESULTS: Frequently, outcomes changed longitudinally without showing any cross-sectional differences. Cross-sectional age was more commonly associated with the worsening of a condition while cross-sectional YPI was commonly associated with improvement. After controlling for cross-sectional effects, psychological measures generally showed minor deterioration, measures of community integration both improved and deteriorated, upper extremity pain increased, lower enxtremity pain decreased, and participants tended to quit smoking. CONCLUSION: Using longitudinal findings that control for cross-sectional differences produces a more complete description of ageing with a spinal cord injury.

Activities of Daily Living↗
PubMed2001

The use of proxies in community integration research.

OBJECTIVE: To assess the level of agreement between persons with various disabilities and their proxies in reporting community integration outcomes using the Craig Handicap Assessment and Reporting Technique (CHART). DESIGN: Reliability study. SETTING: Participants living in the community for a minimum of 6 months after onset of disability or completion of inpatient rehabilitation. PARTICIPANTS: Persons (n = 983) with disability resulting from amputation, burn, multiple sclerosis, spinal cord injury (SCI), stroke, or traumatic brain injury and their self-selected proxies. INTERVENTIONS: Telephone interview of subjects (FIM instrument, CHART); proxies (CHART). FIM instrument assesses the degree of assistance with physical and cognitive subscales; CHART measures community integration in 6 subscales: physical, cognitive, and economic independence, and mobility, social integration, and occupation. MAIN OUTCOME MEASURES: Intraclass correlation coefficients (ICCs) were used to assess participant-proxy agreement, and stepwise multiple regressions were used to identify patterns of difference in agreement based on disability type and demographic variables. RESULTS: Thirty-seven of the 38 items examined for the entire sample yielded moderate to strong ICCs. Multiple regression analyses indicated that proxies overrated participants with severe functional cognitive disabilities on the mobility subscale (p < .001), overrated participants with less than a high school education on the total CHART score (p < .01), and underrated participants with SCIs on the occupation subscale (p < .01). Differences in all cases, however, were less than 6 points out of a possible score of 100 per subscale. CONCLUSIONS: Participant-proxy agreement across the 6 disability groups provided evidence in support of the inclusion of proxy data for persons with various types of disabilities in community integration research.

Adult↗
PubMed2001

Role of survey research in assessing rehabilitation outcomes.

Survey research, although often misperceived as superficial and less scientific than other research methodologies, is nonetheless a valid and reliable technique that physiatrists and researchers use to study a range of important rehabilitation outcomes. Surveys are particularly valuable for describing characteristics in large groups--such as the nature and extent of disability within a population--or for learning about outcomes in a given sample. They are the preferred approach for tracking the perceptions of rehabilitation consumers and for obtaining the data that drive service provision, programmatic development, and policy change. On the national, state, and local levels, the authors describe examples of successful survey research efforts, illustrating the types of data obtained, and the usefulness of those data.

Disability Evaluation↗
PubMed2000

Health outcomes among American Indians with spinal cord injury.

OBJECTIVE: To identify factors related to risk for poor health outcomes and secondary conditions in a sample of American Indians with spinal cord injury (SCI). DESIGN: Interviews were conducted by telephone with most participants; those who did not have telephones returned materials by mail. SETTING: A large rehabilitation hospital in the Western/ Mountain region of the United States. PARTICIPANTS: Ninety-seven American Indians with SCI completed a comprehensive health interview. All participants were adults with traumatic SCI and were at least 1 year postinjury. MAIN OUTCOME MEASURES: Selected items from the Behavioral Risk Factor Surveillance System were used to assess health behaviors and general health outcomes. Two secondary conditions were also investigated as outcome measures: pressure sores and post-SCI injuries. RESULTS: Multiple linear regression was used to predict seven health-related outcomes. Depressive symptomatology and post-SCI injuries were the primary predictors of the majority of health outcomes. Alcohol consumption was associated with a greater risk for post-SCI injuries, and being older at injury was associated with poorer health outcomes. CONCLUSIONS: Interventions to reduce depression, injuries, and alcohol misuse have potential for improving health among American Indians with SCI.

Adult↗
PubMed1999

Longitudinal outcomes in spinal cord injury: aging, secondary conditions, and well-being.

OBJECTIVE: To specify the degree to which current age, duration of injury, and neurologic status affect the frequency of secondary health and psychosocial conditions in persons with long-term spinal cord injury (SCI), using both longitudinal and cross-sectional analysis techniques. DESIGN: Prospective longitudinal examination and data collection involving individuals with SCI studied initially at their 5th, 10th, and 15th anniversaries postinjury, and subsequently 5 years later at their 10th, 15th, and 20th anniversaries postinjury. SETTING: Five Regional Model Spinal Cord Injury Systems. PARTICIPANTS: The 439 individuals who meet the inclusion criteria for the National SCI Database and who are enrolled in a longitudinal study of secondary conditions and SCI. MAIN OUTCOME MEASURES: Physical and psychosocial status at various times postinjury. RESULTS: There are different reports of various conditions when analyzing by neurologic groups, duration of injury, and age. Cross-sectional and longitudinal analyses also demonstrate different patterns of complications. CONCLUSIONS: The longitudinal method, like cross-sectional research, allows for identification of physical and psychosocial changes soon after they occur. Longitudinal research, however, also makes possible the development of predictive models for various long-term outcomes.

Activities of Daily Living↗
PubMed1999

Health behaviors among American Indians with spinal cord injury: comparison with data from the 1996 Behavioral Risk Factor Surveillance System.

OBJECTIVE: To identify patterns of health behaviors and health outcomes among a sample of American Indian men with spinal cord injury. DESIGN: Telephone interviews with all participants, except those who did not have telephones (they returned materials by mail). SETTING: Large rehabilitation hospital in the Western mountain region of the United States. PARTICIPANTS: Seventy-six American Indian men with traumatic SCI of at least 1 year in duration. MAIN OUTCOME MEASURE: Selected health-related behaviors from the Behavioral Risk Factor Surveillance System (BRFSS) were used to assess health behaviors and general health outcomes among the American Indian SCI sample and to compare findings with those from American Indian men without SCI based on nationwide BRFSS data. RESULTS: The study participants reported lower overall health and satisfaction with health care than the non-SCI BRFSS group. They also reported a different pattern of health behaviors, including a greater frequency of inoculations for flu and pneumonia but a lower rate of HIV testing and cholesterol screening. A smaller percentage of American Indians used alcohol, but those who did reported more heavy drinking. CONCLUSIONS: American Indians with SCI are more likely to receive health care consistent with the prevention of secondary conditions of SCI (eg, pneumonia), but less likely to receive basic health screens intended to prevent chronic health diseases.

Adult↗
PubMed1999

The effect of tidal volumes on the time to wean persons with high tetraplegia from ventilators.

STUDY DESIGN: Retrospective review of patient medical records comparing the outcomes of two groups of individuals with high-level (C3-4) tetraplegia- those with high-volume and those with low-volume mechanical ventilation. OBJECTIVES: To determine if higher volume mechanical ventilation contributes to faster weaning from the ventilator with fewer complications in individuals with ventilator dependent high-level tetraplegia. SETTING: A Model Spinal Injury Center, located in Colorado, USA, which treats patients referred from throughout the Rocky Mountain region as well as other states. METHODS: The medical records of 42 individuals with ventilator dependent C3-4 tetraplegia, admitted consecutively to the Rocky Mountain Regional Spinal Injury System between 1983 and 1993, were reviewed. All had required full-time mechanical ventilation upon admission, but had successfully weaned by discharge. They were divided into two groups that differed with respect to the ventilator tidal volumes used during their treatment and weaning: a large volume group (> 20 mls/kg of body weight) and a smaller volume group (< 20 mls/kg of body weight). RESULTS: Though the two groups were equivalent in neurological level and completeness, muscular function, initial spontaneous vital capacity, the weaning method used (T-piece), and final spontaneous vital capacity, those in the large tidal volume group successfully weaned an average of 21 days faster than the lower tidal volume group (37.6 days vs 58.7 days, P=0.02). They also had significantly less atelectasis (P=0.01) than the lower tidal volume group. CONCLUSION: This research suggests that the use of higher ventilator tidal volumes may speed up the weaning process and lessen respiratory complications. Because of the potential for this to decrease the length and cost of the rehabilitation programs for persons with high-level tetraplegia, further large-scale research is needed to verify these single-center findings.

Adolescent↗
PubMed1998

Secondary conditions following spinal cord injury in a population-based sample.

This prospective study investigates the frequency of both medical and non-medical complications reported by the population based cohort of SCI survivors reported to the Colorado Spinal Cord Injury Early Notification System (ENS). Persons reported to the ENS between January 1 1986 and December 31 1993, representing the broad spectrum of all severities of spinal cord injury and potential complications, were solicited to participate in comprehensive follow-up interviews at their first, third and fifth year post injury. Hospitalizations of a week or longer were experienced by more than 10% of the participants at each of the three interview years. Similarly, the medical complications of spasticity or pain were reported by more than 25% of the participants, and pressure sores were reported by more than 10% at all three time periods. The chief non-medical complications (conditions) were financial concerns and transportation problems. Although these reported medical and non-medical complications present significant obstacles to be overcome, less than three percent of those surveyed at any of the time periods reported experiencing depression; and only 14% rated their quality of life as being poor.

Adolescent↗
PubMed1998

Evaluating neurological group homogeneity in assessing the mortality risk for people with spinal cord injuries.

A study of 3178 individuals injured in Britain between 1943 and 1990 and surviving the first year post-injury was conducted to evaluate the homogeneity of mortality risk ratios within groups based on varying degrees of neurological injury level and completeness of the injury. The study shows that it is less than optimal to combine individuals into neurological groupings of C1-C4 ABC, C5-C8 ABC and T1-S5 ABC since the risk ratios are not homogeneous within these groups. Similarly, combining individuals into neurological groupings of tetraplegia complete, tetraplegia incomplete, paraplegia complete and paraplegia incomplete may not be appropriate for the same reasons. The consequence of performing a survival analysis using either of the traditional sets of groups is to dilute the risk ratios for a subset of individuals within a particular group, thereby providing less discrimination between neurological groups. Cox proportional hazards regression was employed to determine a set of neurological groupings with homogeneous risk ratios within a group while providing better differentiation between groups.

Adolescent↗
PubMed1998

Long-term survival in spinal cord injury: a fifty year investigation.

The aims of this study were to examine long-term survival in a population-based sample of spinal cord injury (SCI) survivors in Great Britain, identify risk factors contributing to deaths and explore trends in cause of death over the decades following SCI. Current survival status was successfully identified in 92.3% of the study sample. Standardised mortality ratios (SMRs) were calculated and compared with a similar USA study. Relative risk ratio analysis showed that higher mortality risk was associated with higher neurologic level and completeness of spinal cord injury, older age at injury and earlier year of injury. For the entire fifty year time period, the leading cause of death was related to the respiratory system; urinary deaths ranked second followed by heart disease related deaths, but patterns in causes of death changed over time. In the early decades of injury, urinary deaths ranked first, heart disease deaths second and respiratory deaths third. In the last two decades of injury, respiratory deaths ranked first, heart related deaths were second, injury related deaths ranked third and urinary deaths fourth. This study also raises the question of examining alternative neurological groupings for future mortality risk analysis.

Adolescent↗
PubMed1997

Evaluating sources of traumatic spinal cord injury surveillance data in Colorado.

The purpose of this study is to evaluate the sources reporting hospitalized spinal cord injury cases to the statewide, population-based surveillance system in Colorado for the year 1994. Three reporting sources were evaluated: clinical contact persons, medical records departments, and a centralized statewide hospital discharge database. Two evaluation strategies were utilized; these include both measures of accuracy and estimates of missed cases. For the latter, capture-recapture techniques were used to estimate the number of hospitalized spinal cord injury cases missed by all three reporting sources. The clinical contact persons reported 84 confirmed cases, missed 80 confirmed cases, and reported 10 cases that were later determined not to have spinal cord injuries, resulting in a sensitivity of 0.51. Medical records departments and the discharge database reported 143 and 147 cases, respectively, missed 21 and 17 confirmed cases, and reported 118 and 69 cases that were later determined not to be cases of hospitalized injuries of the spinal cord, resulting in sensitivities of 0.87 and 0.90. Capture-recapture results indicate all three sources combined missed an estimated 1-5 cases, yielding a total annual incidence rate for hospitalized spinal cord injury ranging from 45.1 to 46.3 per million population.

Colorado↗
PubMed1997

Spouses of spinal cord injury survivors: the added impact of caregiving.

OBJECTIVE: To better understand the needs of spouses who provide care to spinal cord injury (SCI) survivors, by comparing their self-perceptions and complaints with those of their partners with disabilities and with those of spouses who do not provide care. DESIGN: Survey, including demographics, health concerns questionnaire, and administration of the Center for Epidemiologic Studies Depression Scale (CES-D), the Perceived Stress Scale (PSS), the Life Satisfaction Index (LSI-Z), and the Quality of Life and Individual Needs Questionnaire. SETTING: Two British SCI treatment centers, serving a defined population-based catchment area. PARTICIPANTS: One hundred twenty-four spouses of a longitudinally followed sample of SCI survivors, all of whom had been injured 23 or more years when the study was conducted in 1993. OUTCOME MEASURES: Scores on the above standardized tests, and responses to survey questions. RESULTS: Spouses had more depressive affect (p < .001) than their partners with disabilities, as measured by the CES-D. On the PSS, they exhibited no significant differences. Compared with spouses who were not caregivers, the caregiving spouses reported more physical stress (p = .005), emotional stress (p = .011), burnout (p = .007), fatigue (p = .002), and anger and resentment (p = .029). On the CES-D, they had more symptoms of depressive affect (p = .004) and somatic depression (p = .005). CONCLUSIONS: Spouses of long-term SCI survivors who fulfill a caregiving role report more symptoms of stress and depression than their partners with disabilities and other spouses who are not caregivers.

Adult↗
PubMed1996

Cost of traumatic spinal cord injury in a population-based registry.

This prospective study examines a population based cohort of 115 Coloradans identified as having an acute traumatic spinal cord injury by the Spinal Cord Injury Early Notification System in 1989. Comprehensive medical cost and complication data were collected for the first 2 years of survival. Unlike previous cost studies, this group represents the broad spectrum of spinal cord injured persons, reflected in a truly population based sample. Nearly 22 million dollars were spent during the first 2 years post injury on behalf of these Coloradans. Care provided to the 27 persons with Frankel A, B or C tetraplegia accounted for $10.9 million (50%); $7.6 million (35%) was spent providing care for the 36 people with Frankel A, B or C paraplegia; and the remaining $3.3 million (15%) was required for services provided to the 52 persons who had resolved to either Frankel D or E at acute care discharge. Of the $6.3 million that was spent post hospital discharge, $2.5 million (39%) is directly attributable to in-home care, and another $2.0 million (32%) is directly attributable to secondary medical complications. The most expensive complications occurred in the neurological, skin, respiratory and orthopedic body systems.

Colorado↗
PubMed1995

Self-managed versus agency-provided personal assistance care for individuals with high level tetraplegia.

OBJECTIVE: To determine whether a finite population, with severe physical disability, had better perceived quality of life, health status, and lower cost depending on whether they used agencies for their caregivers or hired, trained, and reimbursed their caregivers, independently. DESIGN AND SETTING: A survey, including demographics and portions of the Rand-36, LSI-A, PASI, PIP and CHART. The interviews were completed by telephone, by the leading author. PARTICIPANTS: Seventy-one persons who had sustained spinal cord lesions between C1 and C4. All were at least 1 year postinjury and had received rehabilitation at a local hospital in Englewood, Colorado. Ten additional persons came from the leading author's case management caseload or from a Boston rehabilitation center. They were interviewed in person for pretesting. MAIN OUTCOME MEASURES: Chi square, t tests, and multiple regression analysis, which controlled for potentially confounding group differences. Individuals were placed in two cohorts. Twenty-nine persons received primarily agency provided care and 42 individuals used personal care attendants. RESULTS: The self-managed group showed significantly better health outcomes, with fewer rehospitalizations and diminished preventable complications. They also experienced greater life satisfaction and significantly lower costs. Those in the self-managed care group had significantly higher composite scores on Rand-36, indicating higher perception of recent health status. Significant differences in mean PIP scores indicated that members of the self-managed care cohort perceived greater control over day-to-day lives. PASI scores showed that persons in this cohort had greater satisfaction with their caregivers and costs. Cost benefit analysis showed appreciable lowering of costs in the self-managed care group. CONCLUSIONS: The self-managed care group had many more hours of paid attendant care, whereas the agency provider group had almost equal amounts of care from paid and unpaid providers. Persons using self-managed care reported having fewer medical problems, fewer hospitalizations and better perception of health. Participants declared greater satisfaction in having a choice of caregivers. Persons who were self-managing their care spent less money and used more hours of paid care. The financial burden borne both by the individual and society and the emotional burden borne by families and friends were diminished by the persons managing their care individually.

Adult↗