The Stockholm spinal cord injury study : medical, economical and psycho-social outcomes in a prevalence population

Abstract

The first stage or the SSCIS, presented in this thesis is based on a near-total regional prevalence population of 353 individuals with traumatic SCI. Medical, economic, and psycho-social variables were assessed by semi-structured individual interview, physical examination, questionnaires and review of medical records. Comparisons were made with a normative population sample. A computerised medical record system was adapted and implemented as the instrument for structuring investigations, data storage and processing.

The main findings were: 1. Motor vehicle accidents accounted for almost 50% of cases, followed by falls (including diving), which accounted for more than 30% of cases. 2. Mean age at injury was 31 years. Over 50% of injuries occurred in the 16-30 year age group. 3. The male:female ratio was 4:1.4. The paraplegia:tetraplegia ratio was 3:2. 5. The incomlete:complete ratio was 3:2. 6. About 70% had experienced urinary tract infections. 7. About 40% had experienced decubitus ulcers. 8. About 20% had experienced urolithiasis, fractures, and spinal deformity, respectively. 9. Additionally, a wide range of less common complications from most organ systems were reported. 10. Problematic spasticity (among subjects with spastic paresis), and significant bladder and bowel dysfunction (most commonly due to incontinence and/or frequent infections, and constipation, respectively) all occurred in about 40%. 11. Significant chronic pain, most commonly of neurogenic type, was reported by about 70%. 12. Neurological deterioration was reported by about 30%. In 10% this included sensorimotor loss. 13. Significant sexual dysfunction was reported by 50% of males and 25% of females. Almost 30% had not had sexual intercourse after injury. 14. Over 70% relied partially or totally on sick-pension. 15. Differing vulnerability across SCI subgroups: a. More sexual problems and spasticity in males; b. More fractures, spinal deformity, shoulder/neck pain, anxiety and fatigue in females; e. More pain in those injured at older age; d. More spinal deformity in those injured at younger age; e. More medical problems and retirement in high and/or complete lesions. 16. Differences between the SCI versus normative group: a. Inferior health status, higher rate of health care consumption and sick-pension; b. More pain, bladder problems, fatigue, anxiety and insomnia; c. More use of antibiotics, laxatives, analgesics, sedatives, hypnotics; d. No increased prevalence of heart disease, hypertension, diabetes, tumors; e. Inferior "intrinsic" economy; f. More restricted social activities.

The main implications of the SSCIS: a. primary prevention programs should focus on the distinct high-risk groups and situations, and be designed to suit the target group; b. tertiary prevention programs are necessary and should include life-long, structured regular follow-up of all SCI patients by qualified and specialised staff, with a high degree of vigilance for prevention and early detection of complications and serious functional impairments, and a more aggressive approach towards treatment or such problems; c. the high prevalence or severe neurogenic pain and neurological deterioration should lead to increased awareness of these problems, and intensified research in rehabilitative neurosurgery and other treatment modalities; d. intensified vocational rehabilitation rather than sick-pension and further subsidies as primary means for enhancing economical and psycho-social outcomes; e. implementation of computer and information technology to facilitate functional centralisation of SCI care in "virtual" SCI units.