Dataset Information

Non-adherence to follow-up care in persons with spinal cord injury within 10 years after initial rehabilitation.

ABSTRACT:

Objective

This study aimed to describe the temporal dynamics of and risk factors for non-adherence to outpatient follow-up care in the first 10 years after spinal cord injury.

Design

Retrospective single-centre cohort study using data from medical records and municipal resident registers.

Subjects/patients

Patients admitted to a specialized spinal cord injury centre in Switzerland discharged between 1 January 2010 and 31 December 2012 (n = 225). Time-to-event analysis was used to investigate the timing of the first non-adherence event, its association with spinal cord injury, and sociodemographic characteristics.

Results

36% of patients were adherent to annual follow-up appointments; 2% formally transferred to another SCI centre; 44% were non-adherent for general reasons (patient's will to discontinue care [12%] or unknown reasons [32%]); and 18% were non-adherent due to death. Risk factors for non-adherence included older age, lack of long-term partner, and more than 2 h of travel time to the clinic. In the youngest age group (18-30 years), 55% were non-adherent after 10 years.

Conclusion

A relevant proportion of individuals with spinal cord injury were lost to annual follow-up care. A holistic approach to patient engagement integrating solutions such as telemedicine and involvement of support networks could reduce the risk of non-adherence.

SUBMITTER: Eriks-Hoogland IE

PROVIDER: S-EPMC11367676 | biostudies-literature | 2024 Aug

REPOSITORIES: biostudies-literature

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Publications

Non-adherence to follow-up care in persons with spinal cord injury within 10 years after initial rehabilitation.

Eriks-Hoogland Inge E IE Müller Lorena L Hirsch Benjamin D N BDN Studer Lea L Gemperli Armin A Anderson Collene E CE

Journal of rehabilitation medicine 20240826

<h4>Objective</h4>This study aimed to describe the temporal dynamics of and risk factors for non-adherence to outpatient follow-up care in the first 10 years after spinal cord injury.<h4>Design</h4>Retrospective single-centre cohort study using data from medical records and municipal resident registers.<h4>Subjects/patients</h4>Patients admitted to a specialized spinal cord injury centre in Switzerland discharged between 1 January 2010 and 31 December 2012 (n = 225). Time-to-event analysis was u ...[more]

PMID: 39185548

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Project description:IntroductionWhile it is well-established that follow-up care programs play a crucial role in preventing and early detecting secondary health conditions (SHCs) in persons with spinal cord injury [SCI, including spina bifida (SB)], the availability of evidence-based follow-up care programs remains limited. Under the leadership of the German-speaking Medical Society for Paraplegiology (DMGP), we have developed an evidence based clinical practice guideline for follow-up care of SHCs in persons with SCI and identify research gaps.MethodsThis guideline was developed in accordance with the regulations of the Association of the Scientific Medical Societies in Germany (AWMF e.V.). To ensure an evidence-based guidance, we utilized the International Classification of Functioning, Disability and Health (ICF) generic core set and ICF Core Set for individuals with SCI in long-term context as our foundational framework. We conducted a comprehensive literature review to identify existing recommendations for follow-up care and graded the level of evidence according to relevant instruments. Subsequently, we formulated recommendations and achieved consensus through a structured nominal group process involving defined steps and neutral moderation, while adhering to the criteria outlined in the German guideline development instrument (DELBI).ResultsAlthough there is a fair number of literatures describing prevalence and severity of SHCs after SCI, the amount of literature including recommendations was low (19 for SCI and 6 for SB). Based on the current evidence on prevalence and severity of SHCs and available recommendations, a clinical practice guideline on follow-up care of most relevant SHCs was defined. The recommendations for follow-up care are described in the following chapters: (1) Nervous system; (2) (Neuropathic) pain; (3) Cardiovascular diseases; (4) Respiratory System; (5) Immunological system, vaccination and allergies; (6) Gastrointestinal tract and function; (7) Endocrinological system and nutrition; (8) Urogenital system; (9) Contraception, pregnancy, birth and postpartum care; (10) Musculoskeletal system; (11) Pressure injuries; (12) Psychological health; (13) Medication and polypharmacy.ConclusionWe could successfully establish an evidence based clinical practice guideline for follow-up care of SHCs in individuals with SCI. There is however a notable lack of high-quality recommendations for SCI follow-up care.

Project description:PurposeTo assess longer-term patterns of glaucoma medication adherence and identify whether patterns established during the first year of medication use persist during 3 subsequent years of follow-up.DesignRetrospective, longitudinal cohort analysis.ParticipantsBeneficiaries aged ≥40 years who were enrolled in a United States (US)-managed care plan for ≥7 years between 2001 and 2012 and newly diagnosed and treated for open-angle glaucoma.MethodsFor each enrollee, we quantified medication adherence using the medication possession ratio. Group-based trajectory modeling (GBTM) was applied to identify patterns of adherence for 1 and 4 years of follow-up. The percent of beneficiaries who remained in the same trajectory group in the 1- and 4-year models was tabulated to evaluate group stability. Factors impacting adherence at 1 and 4 years were identified using regression analyses.Main outcome measuresPatterns of glaucoma medication adherence.ResultsOf the 1234 eligible beneficiaries, GBTM identified 5 distinct glaucoma medication adherence patterns in both the 1-year and 4-year follow-up periods. These groups were as follows: (1) never adherent after their index prescription fill (7.5% and 15.6% of persons in the 1- and 4-year models, respectively); (2) persistently very poor adherence (14.9% and 23.4% of persons in the 1- and 4-year models, respectively); (3) declining adherence (9.5% and 9.1% of persons in the 1- and 4-year models, respectively); (4) persistently moderate adherence (48.1% and 37.0% of persons in the 1- and 4-year models, respectively); and (5) persistently good adherence (20.0% and 15.0% of persons in the 1- and 4-year models, respectively). More than 90% of beneficiaries in the 4 groups with the worst and best adherence patterns (groups 1, 2, 3, 5) maintained their patterns from their first year throughout their 4 years of follow-up. Those with persistently moderate adherence (group 4), the largest group, were most likely to change groups from 1 to 4 years of follow-up. Persons with the best adherence over 4 years were more likely to be white, to be older, to earn >$60 000/year, and to have more eye care visits (P < 0.05 for all comparisons). Those with a higher initial copayment cost had lower adherence rates (β = -0.06/dollar, P = 0.03).ConclusionsFor most patients who were newly prescribed glaucoma medications, adherence patterns observed in the first year of treatment reflect adherence patterns over the subsequent 3 years. Investing resources in both identifying and helping patients with suboptimal adherence patterns over the first year may have a large impact on longer-term adherence.

Project description:PurposeThe long-term situation of children with spinal cord injury (SCI) was investigated, and suggestions for helping them better return to the society were provided.MethodsSCI patients less than 18 years old hospitalized in Beijing Boai Hospital from January 2011 to December 2020 were retrospectively analyzed. Information including motor function, complications, characteristic changes, self-care abilities, school attendance and social participation were collected by telephone interview and electronic questionnaire. All the answers were statistically analyzed.ResultsA total of 86 cases were enrolled, 77 girls and 9 boys, with a median injury age of 6 years and 2 months. The follow-up time was 3-130 months. The main cause of trauma in these children was sport injury (66.3%), the thoracic spinal cord was involved the most (91.9%), and complete SCIs accounted for the majority (76.7%). In terms of complications, children with complete SCIs were more likely to have urinary incontinence, constipation and characteristic changes (p < 0.05); whereas the incomplete SCIs often have spasticity (p < 0.05). As to the daily living abilities, children with incomplete lumbar SCIs were more capable to accomplish personal hygiene, transfer, and bathing independently than those with complete injuries, or cervical/thoracic SCIs, respectively (p < 0.05). Moreover, children older than 9 years care more able to dress and transfer independently than the youngers (p < 0.05). Wheelchair users accounted for 84.9% and more than half of them were able to propel wheelchair independently, and those who move passively in wheelchairs were mostly introverted kids (p < 0.05). Almost all (93.8%) children with incomplete injuries were able to walk independently. Most (79.1%) children continued to attending school, and 41.9% participated in interest classes. Unfortunately, 67.4% of the children spent less time playing with their peers than before the injury.ConclusionSCIs impair physical structures and function of children, affect their independence in daily living, and restrict school attendance and social interaction. Comprehensive rehabilitation after injury is a systematic work. Medical staff and caregivers should not only pay attention to neurological function, but also help them improve self-care abilities. It is also important to balance rehabilitation training and school work and social participation.

Dataset Information

Non-adherence to follow-up care in persons with spinal cord injury within 10 years after initial rehabilitation.

Objective

Design

Subjects/patients

Results

Conclusion

Publications

Non-adherence to follow-up care in persons with spinal cord injury within 10 years after initial rehabilitation.

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