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New Challenges in Health Care Services among Patients with Spinal...
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New Challenges in Health Care Services among Patients with Spinal Cord Injury

A special issue of Healthcare (ISSN 2227-9032). This special issue belongs to the section "Healthcare Quality and Patient Safety".

Deadline for manuscript submissions: closed (2 August 2024) | Viewed by 4647

Special Issue Editor

Dr. Chester H. Ho

E-Mail Website
Guest Editor
Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Alberta, Edmonton, AB T6G 2E8, Canada
Interests: spinal cord injury rehabilitation, including service delivery for rehabilitation, and also management of complications after spinal cord injury (e,g. pressure injury)

Special Issue Information

Dear Colleagues,

Persons with spinal cord injury experience significant changes in their physical, psychological and social status both from their initial injury and from many potential secondary complications that may become chronic conditions, requiring lifelong management. As a result, there are multiple health care needs that span across the continuum of care, necessitating the involvement by not only primary care and specialty clinicians, but also community support and services, vocational specialists, social and housing agencies, as well as policy makers with special expertise and knowledge on the care of persons with spinal cord injury. Appropriate coordination of these support and services with a person-centred approach is complex yet necessary, but it is not always possible or available among this diverse group of stakeholders. In fact, the gaps and challenges in lifelong support and service provision for persons with spinal cord injury differ greatly between jurisdictions and countries. Not only is the experience of persons with spinal cord injury affected, the issue with health equity has also been raised. This Special Issue aims to describe and address some of these challenges in support and service provision and coordination, to enhance the health care services of persons with spinal cord injury.

Dr. Chester H. Ho
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Healthcare is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2700 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • spinal cord injury
  • rehabilitation
  • healthcare delivery
  • patient experience
  • health inequities
  • patient navigation
  • transitions in care
  • model of care

Published Papers (4 papers)

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Research

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13 pages, 1754 KiB  
Article
The Changing Prevalence of Pressure Injury among Ontarians with SCI/D at Rehabilitation Admission: Opportunities for Improvement
by Beverley Catharine Craven, Emma A. Bateman, Heather Flett, Farnoosh Farahani, Dalton L. Wolfe, Sussan Askari, Maryam Omidvar and Mohammad Alavinia
Healthcare 2024, 12(11), 1084; https://doi.org/10.3390/healthcare12111084 - 25 May 2024
Viewed by 649
Abstract
Background: Despite preventability, 20–50% of patients with acute spinal cord injury/disease (SCI/D) develop hospital-acquired pressure injuries (PIs). The Spinal Cord Injury Implementation and Evaluation Quality Care Consortium (SCI IEQCC) aimed to mitigate PI risk through patient-reported daily skin checks alongside usual care. Methods: [...] Read more.
Background: Despite preventability, 20–50% of patients with acute spinal cord injury/disease (SCI/D) develop hospital-acquired pressure injuries (PIs). The Spinal Cord Injury Implementation and Evaluation Quality Care Consortium (SCI IEQCC) aimed to mitigate PI risk through patient-reported daily skin checks alongside usual care. Methods: This quality improvement initiative utilized an interrupted time series design, encompassing adults ≥ 18 years admitted for inpatient rehabilitation across five Ontario sites from 2020 to 2023. Patient demographics, etiology, and impairment data were obtained from a national registry, while participating sites gathered data on PI onset, location, and severity. Run charts depicted temporal trends, and statistical analyses, including chi-square and logistic regression, compared patients with and without PIs. Results: Data from 1767 discharged SCI/D patients revealed that 26% had ≥1 PI, with 59% being prevalent and 41% incident. Most severe PIs (stages III and IV and unstageable) were acquired prior to admission. Process indicator fidelity was reasonable at 68%. Patients with PIs experienced longer hospital stays, lower Functional Independence Measure (FIM) changes, and FIM efficiency during rehabilitation. Conclusions: PI prevalence is increasing, particularly sacral injuries at admission, while incident cases have decreased since 2021 due to regular skin checks. This trend calls for proactive health system interventions to reduce costs and improve patient outcomes. Full article
(This article belongs to the Special Issue New Challenges in Health Care Services among Patients with Spinal Cord Injury)
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14 pages, 730 KiB  
Article
Implementing Lived Experience Workshops in Regional Areas of British Columbia to Enhance Clinicians’ Confidence in Spinal Cord Injury Care: An Evaluation
by Hannah Prins, Scott Donia, Shannon Rockall, James Hektner, Spring Hawes, James J. Laskin, John Chernesky and Vanessa K. Noonan
Healthcare 2024, 12(7), 731; https://doi.org/10.3390/healthcare12070731 - 27 Mar 2024
Viewed by 972
Abstract
In British Columbia (BC), there are challenges accessing specialized spinal cord injury care and resources. This paper evaluated the impact of spinal cord injury health educational workshops delivered in regional communities that were informed by persons with lived experience. A community survey was [...] Read more.
In British Columbia (BC), there are challenges accessing specialized spinal cord injury care and resources. This paper evaluated the impact of spinal cord injury health educational workshops delivered in regional communities that were informed by persons with lived experience. A community survey was conducted with 44 persons with lived experience in a BC region to identify priority SCI health-related topics. Twenty-five topics were ranked from 1–14, with bowel and bladder management ranked 1 and 4, sexual health ranked 5, and pressure injuries ranked 7. Clinical perspectives on the priorities were collected from 102 clinicians in the BC region, who independently ranked 14 of these SCI topics and considered the former 4 topics to be lower clinical priority (ranked 11–14). These priorities informed a series of SCI clinical education workshops held at healthcare facilities in three regional cities. The goals were to improve clinicians’ knowledge and confidence levels when managing spinal cord injury health and to facilitate person-centred care. Positive feedback demonstrated that educational workshops supported by lived experience perspectives effectively enhanced the clinicians’ understanding of spinal cord injury and their priorities. Future plans include engaging more administrators as part of this initiative and conducting workshops in other regions of BC. Full article
(This article belongs to the Special Issue New Challenges in Health Care Services among Patients with Spinal Cord Injury)
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17 pages, 1342 KiB  
Article
Measures for Persons with Spinal Cord Injury to Monitor Their Transitions in Care, Health, Function, and Quality of Life Experiences and Needs: A Protocol for Co-Developing a Self-Evaluation Tool
by Katharina Kovacs Burns, Zahra Bhatia, Benveet Gill, Dalique van der Nest, Jason Knox, Magda Mouneimne, Taryn Buck, Rebecca Charbonneau, Kasey Aiello, Adalberto Loyola Sanchez, Rija Kamran, Olaleye Olayinka and Chester Ho
Healthcare 2024, 12(5), 527; https://doi.org/10.3390/healthcare12050527 - 23 Feb 2024
Viewed by 1060
Abstract
Evaluating the experiences of persons with spinal cord injury (PwSCI) regarding their transitions in care and changes in health, function, and quality of life is complex, fragmented, and involves multiple tools and measures. A staged protocol was implemented with PwSCI and relevant expert [...] Read more.
Evaluating the experiences of persons with spinal cord injury (PwSCI) regarding their transitions in care and changes in health, function, and quality of life is complex, fragmented, and involves multiple tools and measures. A staged protocol was implemented with PwSCI and relevant expert stakeholders initially exploring and selecting existing measures or tools through a modified Delphi process, followed by choosing one of two options. The options were to either support the use of the 10 selected tools from the Delphi method or to co-develop one unique condensed tool with relevant measures to evaluate all four domains. The stakeholders chose to co-develop one tool to be used by persons with SCI to monitor their transition experiences across settings and care providers. This includes any issues with care or support they needed to address at the time of discharge from acute care or rehabilitation and in the community at 3, 6, and 12 months or longer post-discharge. Once developed, the tool was made available online for the final stage of the protocol, which proposes that the tool be reliability tested prior to its launch, followed by validation testing by PwSCI. Full article
(This article belongs to the Special Issue New Challenges in Health Care Services among Patients with Spinal Cord Injury)
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Review

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27 pages, 699 KiB  
Review
Implementing Activity-Based Therapy for Spinal Cord Injury Rehabilitation in Canada: Challenges and Proposed Solutions
by Hope Jervis-Rademeyer, Lovisa Cheung, Nicole Cesca, Cindy Gauthier, Kristen Walden and Kristin E. Musselman
Healthcare 2024, 12(7), 703; https://doi.org/10.3390/healthcare12070703 - 22 Mar 2024
Viewed by 1253
Abstract
Activity-based therapy (ABT) is a therapeutic approach with multiple benefits including promoting neurorecovery and reducing the likelihood of secondary complications in people living with spinal cord injury (SCI). Barriers and facilitators to ABT implementation for SCI rehabilitation have been studied from various perspectives [...] Read more.
Activity-based therapy (ABT) is a therapeutic approach with multiple benefits including promoting neurorecovery and reducing the likelihood of secondary complications in people living with spinal cord injury (SCI). Barriers and facilitators to ABT implementation for SCI rehabilitation have been studied from various perspectives through qualitative research. However, these viewpoints have not been synthesized to identify challenges of and strategies for implementing ABT across the Canadian healthcare system. Thus, the purpose of our study was to examine the current state of ABT in Canadian healthcare settings according to users’ perspectives. Our main objectives were to compare barriers and facilitators to ABT implementation across Canadian healthcare settings according to users’ perspectives and to identify optimal intervention strategies for ABT delivery across the Canadian healthcare system from acute to community care. We searched Scopus, CINAHL, OvidMedline, and other sources. Eligible articles were qualitative or mixed methods studies exploring ABT for adults with SCI in a Canadian healthcare setting. We analyzed qualitative findings through a thematic synthesis followed by a deductive content analysis. The Mixed Methods Appraisal Tool was used for critical appraisal. Nine articles were included. The thematic synthesis revealed two main themes: (1) factors influencing acceptance and adaptation of ABT across healthcare settings in Canada and (2) proposed solutions. The deductive analysis applied the Behaviour Change Wheel (BCW) to identify limited components of behaviour and appropriate interventions. To address ABT implementation challenges across the Canadian healthcare system, evidence-based interventions should target BCW subcategories of reflective motivation, social opportunity, and physical opportunity. Full article
(This article belongs to the Special Issue New Challenges in Health Care Services among Patients with Spinal Cord Injury)
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