Quality of Life of Patients with Spinal Cord Injury in Italy: - - PDF document

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Quality of Life of Patients with Spinal Cord Injury in Italy: - - PDF document

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Quality of Life of Patients with Spinal Cord Injury in Italy: Preliminary Evaluation Carla ROGNONI * Gabriella FIZZOTTI # , Caterina PISTARINI # , Silvana QUAGLINI * * Department of Electrical, Computer # Spinal Unit and Biomedical Engineering

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UNIVERSITÀ DI PAVIA

Quality of Life of Patients with Spinal Cord Injury in Italy: Preliminary Evaluation

Carla ROGNONI* Gabriella FIZZOTTI#, Caterina PISTARINI#, Silvana QUAGLINI*

* Department of Electrical, Computer

and Biomedical Engineering University of Pavia, Italy

# Spinal Unit

Maugeri IRCCS Foundation Pavia, Italy

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Introduction (1)

  • Actually,

the World Health Organization’s International Classification

  • f

Functioning, Disability and Health encourages the integration

  • f

a comprehensive definition of health when examining patient-related outcomes after injury

  • r disease
  • One of the most relevant disabilities

is caused by Spinal Cord Injury (SCI)

  • Typical causes of spinal cord damage are trauma (such as a

traffic collision, a dive into shallow water, a fall, a sport injury), disease (such as transverse myelitis, multiple sclerosis or polio), or congenital disorders (such as spina bifida)

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Introduction (2)

  • In most cases a SCI

leads to paraplegia

  • r quadriplegia
  • The loss is usually

sensory and motor, which means that both sensation and control are lost

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Introduction (3)

  • The rehabilitation process following a SCI typically begins in

the acute care setting

  • Physical therapists, occupational therapists, social workers,

psychologists and other healthcare professionals typically work as a team under the coordination of a physiatrist to decide on goals with the patient and develop a plan of discharge that is appropriate for the patient’s condition

  • A primary goal of rehabilitation is to restore, to the

greatest possible extent, the physical functioning of an individual after illness or injury

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Aim

The aim of this study is twofold: 1) to evaluate the quality of life of patients with SCI, focusing on the associations among functional status and health dimensions 2) to provide a synthetic quality of life index (utility coefficient) to be used in cost-utility analyses involving SCI patients

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

SF-36 questionnaire (1)

  • To date, a specific validated tool for

assessing the quality of life in patients with SCI is not available to our knowledge

  • A recent meta-analysis identified the SF-36

questionnaire as the most commonly used QoL instrument in the SCI literature

  • The SF-36 is a 36-item self-administered

survey

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

SF-36 questionnaire (2)

  • The SF-36 measures 8 health domains, in a 0-

100 scale (100=perfect health):

  • Physical Functioning - PF
  • Social Functioning - SF
  • Role limitations due to Physical health - RP
  • role limitations due to Mental Health - MH
  • General Health - GH
  • Emotional Role functioning - RE
  • ViTality - VT
  • Bodily Pain – BP
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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

SF-36 questionnaire (3)

  • From these scores,

two further synthetic indexes may be calculated:

  • Physical Synthetic

Index – PSI

  • Mental Synthetic

Index - MSI

Physical Functioning (PF) Role Physical (RP) Bodily Pain (BP) General Health (GH) Vitality (VT) Social Functioning (SF) Role-Emotional (RE) Mental Health (MH) Physical Health Mental Health

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Utility coefficient

  • The utility coefficient, ranging from 0 to 1,

corresponds to the quality of life of the patient during a time period, where a value of 1 corresponds to perfect health and a value of 0 corresponds to the worst possible health state that in general is “death”

1

Perfect health Death

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Methods (1)

  • The SF-36 questionnaire has been administered to

130 SCI patients treated at the Spinal Unit of Maugeri IRCCS Foundation (Pavia-Italy) from January 2013 to January 2014

  • The algorithm developed by Brazier and colleagues

was applied to convert the SF-36 scores into utility coefficients (U)

Microsoft Access

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Methods (2)

  • Respondents’ quality of life was evaluated comparing

the distributions of all the scales in different groups

  • f patients (Mann-Whitney test) related to:
  • gender (M/F)
  • disease phase (acute/chronic)
  • paralysis type (quadriplegia/paraplegia)
  • patient status (inpatient/outpatient)
  • cause of the lesion (traumatic/non traumatic)
  • ASIA grade (A-B/C-D)*

* American Spinal Injury Association (ASIA) classification grades patients based on their functional impairment from A (greatest impairment) to E (normal condition)

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Results

  • At the time of the questionnaire

administration, 82 patients were hospitalised while the remaining 48 were outpatients, 66 presented a traumatic SCI and 64 non traumatic injuries/illnesses.

  • Median age was 54 years in men and 60 years

in women. Patients in acute phase of disease were 36. Patients distribution among ASIA categories was well balanced (75 patients were ASIA A or B).

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Comparison with Italian population

  • The SF-36 subscale scores that revealed a

stronger impact of SCI were those related to the physical domains

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Comparison between groups (1)

* * * * * * * * * * * * *

disease phase (acute vs. chronic) patient status (inpatient vs. outpatient) ASIA grade (A-B vs. C-D) cause of the lesion (traumatic

  • vs. non-traumatic)
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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Comparison between groups (2)

  • No difference was found between males and females,

and between quadriplegic and paraplegic patients

  • ASIA C-D subgroup showed a significant inverse

correlation between GH score and the elapsed time from the spinal cord lesion (p=0.034)

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Utility coefficients distribution

  • Estimated utility coefficients ranged from

0.32 to 0.96 (mean=0.62, SD=0.14)

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Univariate analyses

  • No significant correlations were found for MSI

Parameter Correlated parameter R P Description U Patient’s age

  • 0.18 0.037

Lower values for older patients U Cause of the lesion 0.23 0.008 Lower values for non traumatic patients PSI Cause of the lesion 0.2 0.023 Lower values for non traumatic patients PSI Patient’s status 0.18 0.04 Lower values for inpatients

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Conclusions

  • The concept of quality of life is certainly

linked to the patient's residual motor abilities and alongside to his/her degree of autonomy

  • The questionnaire administration becomes

important during the rehabilitation period, firstly in the short term and consequently in the long term, to monitor the patient’s progress

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Open issues

  • One concern that has been raised in the

rehabilitation community about the SF-36 regards its inclusion of three questions referring to walking and two others that concern climbing stairs

  • Some critics have questioned the sensitivity of

these questions, noting that most people lacking preserved motor function are fully limited in regard to all of these items

  • It is unclear how to manage these questions, if

and how to modify them and what the new questions would assess

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Future developments

  • The study suggests that an extensive analysis could be

performed considering other variables that can be correlated to the different SF-36 scales such as, for example, social and/or working integration, family support and the motherland for a comprehensive assessment of the patient without forgetting his/her cultural origins

  • A modified version of the SF-36 questionnaire can be

implemented as proposed by Unalan et al. (2007) where concepts like “climbing stairs” and “walking” are replaced with the word “going”

  • Further researches are needed in this direction to

develop valid and reliable instruments to assess the health status in people with SCI

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Angelo Nuzzo IIT@SEMM, Milan, 2011

MIE 2014, Istanbul, 2014

Carla Rognoni

Thanks for your attention

carla.rognoni@unipv.it