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      Home-Based Rehabilitation Programs: Promising Field to Maximize Function of Patients with Traumatic Spinal Cord Injury

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          Abstract

          Background:

          Traumatic spinal cord injury (TSCI) has profound effects on the patient's health condition and function. However current treatment strategies fail in terms of cure. Thus, rehabilitative management has become the main gadget to promote patients’ residual function. The most challenging aspect of rehabilitation is high costs of inpatient rehabilitation programs and poor continuity of care while patients are transferred to home. In this regard, numerous home based rehabilitation programs have been introduced.

          Objectives:

          This review is an attempt to better introduce and classify different aspects of home care programs for patients with TSCI all around the world.

          Methods:

          A literature search was conducted in the PubMed, Medline, and Google Scholar database. Studies that addressed rehabilitative programs for patients with TSCI in their home or home-like facilities were reviewed. Reference lists from retrieved articles were also reviewed.

          Results:

          Home based rehabilitation can be categorized in five different but naturally relevant fields: home aids/modification, home nursing and family help, social support, home based primary care (multidisciplinary physician groups), and novel models/methods (e.g. “transitional rehabilitation” or telemedicine).

          Conclusion:

          Since most investigators in TSCI home based rehabilitation have only introduced their findings, there are no comparative studies available. Thus future studies should be dedicated to clinical trials evaluating clinical efficacy of different strategies. A comprehensive integrated strategy with consideration to financial and other limitations should be applied to each specific area.

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          Most cited references48

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          Prevalence of depression after spinal cord injury: a meta-analysis.

          To use meta-analysis to synthesize point prevalence estimates of depressive disorder diagnoses for persons who have sustained a spinal cord injury (SCI).
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            Epidemiology of Traumatic Spinal Cord Injury in Developing Countries: A Systematic Review

            Background/Aims: To describe the epidemiology of spinal cord injury (SCI) in the developing world. Methods: Developing countries were selected based on the definition proposed by the International Monetary Fund. A literature search was performed in July 2012 in Medline and Embase. Further article procurement was obtained via the reference lists of the identified articles, websites, and direct contact with the authors of the identified studies. We designed search strategies using the key words: SCI, epidemiology, incidence, and prevalence. According to the inclusion criteria, 64 studies from 28 countries were included. Results: The incidence of SCI in developing countries is 25.5/million/year (95% CI: 21.7-29.4/million/year) and ranges from 2.1 to 130.7/million/year. Males comprised 82.8% (95% CI: 80.3-85.2) of all SCIs with a mean age of 32.4 years (95% CI: 29.7-35.2). The two leading causes of SCI were found to be motor vehicle crashes (41.4%; 95% CI: 35.4-47.4) and falls (34.9%; 95% CI: 26.7-43.1). Complete SCIs were found to be more common than incomplete injuries (complete SCI: 56.5%; 95% CI: 47.6-65.3; incomplete SCI: 43.0%; 95% CI: 34.1-52.0). Similarly, paraplegia was found to be more common than tetraplegia (paraplegia: 58.7%; 95% CI: 51.5-66.0; tetraplegia: 40.6%; 95% CI: 33.3-48.0). Conclusion: Through an understanding of the epidemiology of SCI in developing countries, appropriate preventative strategies and resource allocation may decrease the incidence and improve the care of these injuries.
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              Quality of life after spinal cord injury: a meta analysis of the effects of disablement components.

              While objective measures of impairment, disability and handicap can serve as outcome measures for the providers of medical and vocational rehabilitation services, for persons with spinal cord injury (SCI) themselves the only relevant measure of quality of life (QOL) is their own judgment as to their well-being. Subjective QOL in persons with SCI has been measured as happiness, psychological well-being morale and life satisfaction. Various studies have reported inconclusive or contradictory findings, likely due to small sample size, sample composition, measures used and other methodological issues. A meta analysis was performed to try to resolve these apparent discrepancies. A total of 22 studies with an average sample size of 102, was retrieved. Information on the relationship between QOL and impairment, disability, and handicap, if provided, was abstracted. Findings include the following: persons with SCI tend to report lower subjective well-being than non-disabled people; the relationship between impairment and QOL is weak (mean correlation: -0.05: 95% confidence interval: -0.12 to 0.02), and generally not found to be statistically significant; the association between disability and QOL is somewhat stronger (mean r: -0.21; confidence interval: -0.27 to -0.14), but not found consistently; the relationship between QOL and (aspects of) handicap is strongest (range for mean r: -0.17 to -0.48), and fairly consistently found. The number of studies available is too small to make analysis of factors that explain contradictory findings possible. Further use of subjective QOL measures in research on long-term outcomes of SCI is recommended, in order to properly reflect the perspective of the patients/clients themselves.
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                Author and article information

                Journal
                Asian J Neurosurg
                Asian J Neurosurg
                AJNS
                Asian Journal of Neurosurgery
                Wolters Kluwer - Medknow (India )
                1793-5482
                2248-9614
                Jul-Sep 2019
                : 14
                : 3
                : 634-640
                Affiliations
                [1 ] Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
                [2 ] Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
                [3 ] Department of Orthopedics and Neurosurgery, Thomas Jefferson University, The Rothman Institute, Philadelphia, PA, USA
                Author notes
                Address for correspondence: Dr. Vafa Rahimi-Movaghar, Sina Trauma and Surgery Research Center, Sina Hospital, Tehran University of Medical Sciences, Hassan-Abad Square, Imam Khomeini Ave, Tehran 11365-3876, Iran. E-mail: v_rahimi@ 123456sina.tums.ac.ir , v_rahimi@ 123456yahoo.com
                Article
                AJNS-14-634
                10.4103/ajns.AJNS_86_17
                6703054
                31497079
                a55b4fdf-3d66-4a9f-8e11-7e160f45a981
                Copyright: © 2019 Asian Journal of Neurosurgery

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Categories
                Review Article

                Surgery
                home care,rehabilitation,spinal cord injuries
                Surgery
                home care, rehabilitation, spinal cord injuries

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