Causes and length of stay of readmission among individuals with traumatic spinal cord injury: a prospective observational cohort study

Background: Secondary conditions may reduce function and participation in individuals with chronic Spinal Cord Injury (SCI). The knowledge of reasons for readmission to the hospital may be enlightening to prevent them and remodel the health services. Study design: Multicenter prospective observational study of all consecutive readmissions of persons with SCI after rehabilitation completion. Objectives: To explore the characteristics of individuals with SCI readmitted to the hospital, the reasons for readmissions and the burden on hospitalization in terms of length of stay (LoS) for different conditions. Setting: 31 Italian specialized SCI centers. Methods: Data on people with traumatic SCI readmitted to SCI centers were recorded about: age, sex, SCI level and severity group, geographical origin, readmission causes, clinical interventions during hospitalization, LoS and discharge destination. Linear and multiple logistic regression analyses were performed considering LoS (days) as dependent variable for correlations with independent variables. All tests were two-sided. Results: Among 1039 persons with traumatic SCI enrolled (mean age 46, males 85%, tetraplegia 43%), 59.09% of the readmissions were caused by urological problems, 39.74% by pressure injury and 35.41% by spasticity (68% readmitted for ≥2 causes, associated with longer LoS). The mean LoS was 48 days: pressure injury, rehabilitative needs, sexual, bowel, and pain problems were associated with longer and urological problems with shorter LoS. People from the South of the country were frequently (68%) readmitted to the northern centers. Conclusions: Urological problems, pressure injury and spasticity were the most frequent causes of re-hospitalization in individuals with traumatic SCI. The migration trend seeking SCI-specific treatments suggests geographic areas to which health care organizations need to pay more attention

Development and validation of the Italian version of the Spinal CordIndependence Measure III

Purpose. To provide a translation and cultural adaptation of the Spinal Cord Independence Measure version III scale for Italy (i-SCIM3) and to validate this version of the scale. Method. i-SCIM3 was developed involving a forward–backward translation and administered to patients with spinal cord lesions (SCL) admitted to two centers. Two raters for each center evaluated patients at admission and discharge. Psychometric testing included reliability by internal consistency (Cronbach’s a) and test–retest reliability. The validity of i-SCIM3 was assessed by comparing it with the Italian version of Functional Independence MeasureTM (FIMTM). Results. One hundred three adult patients with SCL (84 males) with a mean age of 50.33 + 15.35 years were recruited. Seventy-four patients were paraplegic and 29 patients were tetraplegic. The median time elapsed between the two evaluations was 77.5 days (interquartile range, 53–144 days). Internal consistency, inter-rater reliability, and test–retest reliability were satisfactory overall, showing values higher than 0.90. The validity of i-SCIM3 was confirmed by the close correlation with FIM results both at admission and discharge (r ¼0.91, p 5 0.01). The sensitivity to change of i-SCIM3 was similar to that of FIM. Conclusion. i-SCIM3 was found to be a consistent, reliable, and valid scale for use in the clinical setting. It is the first validated scale in Italian for patients with SCL

Concorso ProgettABILE

Nel novembre 2009 sono stata chiamata a far parte di una Commissione per un Concorso di idee bandito dalla Società Italiana di Medicina Fisica e Riabilitativa (SIMFER) per individuare una struttura aperta al pubblico con soluzioni innovative relativamente alla partecipazione ad attività svolte da persone con disabilità. La Commissione, era composta dal Presidente e vice Presidente della SIMFER, due medici, “digiuni” di teorie architettoniche, ma esperti di patologie che rendono disabili e, quindi, di problemi connessi alla disabilità, da me e dall’arch. Carlo Pisanò, per la SIMFER, e da tecnici referenti di associazioni di utenti. 13 i progetti presentati. I 3 gruppi di progettisti vincitori e un quarto gruppo che ha ricevuto la menzione speciale sono stati premiati il 25 maggio 2010 a Venezia in occasione del 38° Congresso Nazionale SIMFER e del 17° Congresso Europeo dell’ESPRM, in cui sono stata chiamata ad allestire la mostra dei 13 progetti, a presentare il Concorso ProgettABILE in una sessione dedicata alla premiazione dei progetti. I progetti premiati sono stati segnalati ai Sindaci dei Comuni interessati, alcuni presenti a Venezia, con l’intento di spingere alla realizzazione di questi interventi che si sono incentrati su aree di proprietà pubblica, particolarmente significative e strategiche ai fini del completamento e della riqualificazione e valorizzazione di uno spazio urbano accessibile a tutti

Incidence of traumatic spinal cord injury in Italy during 2013-2014: A population-based study

Study design: Observational prospective population-based incidence study. Objectives: The main objective of this study was to assess the incidence of traumatic spinal cord injuries (TSCIs) and incidence rates, in order to provide estimates by age, gender, characteristics and cause. Setting: This study was conducted at acute-care spinal cord injury (SCI) hospitals and SCI centers from 11 Italian regions, between 1 October 2013 and 30 September 2014. Methods: Data of all consecutive patients with acute TSCI who met the inclusion criteria were obtained through case reporting by clinicians. The data were collected into a web database. Incidence rates and incidence rate ratios were calculated and stratified by age, gender, cause, level and completeness. Results: From 50% of the entire population of Italy, 445 new cases of TSCI were included. The crude incidence rate of TSCI was 14.7 cases per million per year (95% CI: 13.4-16.4); the overall male to female ratio was 4:1 and the mean age was 54. Complete information was available in 85% of the sample and revealed tetraplegia in 58% and incomplete lesion in 67% of cases. The leading cause of TSCI was falls (40.9%) followed by road traffic accidents (33.5%). The leading cause was falls for patients over 55 and road traffic accidents for patients under 55. Conclusion: The changing trend of TSCI epidemiology concerns the increase in the average age of TSCI people and the increase of both cervical and incomplete lesions. The etiology shows the primacy of falls over road traffic accidents and suggests the need for a change in prevention policies