A comprehensive rehabilitation service
improves functioning and quality of life
in spinal cord研究生：朱杰
injured earthquake victims
导师 ：励建安 教授
Xia Zhang, MD, PhD
First affiliated hospital
Nanjing Medical University
China
1
Mianzhu county
•11,000 people died
• 60 KM to the epicenter
• Mountainous area
11th CSPMR Congress
2
NHV Model
NGOs, Health departments and rehabilitation Volunteers
Disabled
Person’s
Federation
Earthquake
Survivors
Handicap
International
Rehab
PT/Nurse
equipment
CBR
Health
Bureau
IBR
Local
Hospital
NGO(CFCF)
3
Discharge from
hospital (2009)
1 year after (2010) 3 years after (2012)
Aims
Functioning status
Risk
 Quality of life
factors
 Social participation

+
5
Subjects
29 SCIs from Mianzhu County Hospital
Exclusion criteria:
Eligibility criteria:
(i) SCI with TBI and/or
(i) SCI deduced by EQ
2 Non earthquake
SCIs of the extremities;
fractures
(ii) 18 years and older
(ii) inability to complete the
1 survivors ≤18 YO
(iii) got rehabilitation
questionnaires, medical
therapy in Mianzhu
examinations and clinical
People’s Hospital
assessment instruments.
6
Data Collection
Physical
examination
Questionnaires
General
information
Injury level
and severity
Physical
Function
Mental
Function
Social
Function
7
Data Collection
Physical
examination
Questionnaires
General
information
Gender/
Age/ Marriage/
Injury
level
Education/
Employment
and severity
Physical
Function
Mental
Function
Social
Function
8
Data Collection
Physical
examination
Questionnaires
General
information
Injury level
and severity
American Spinal
Physical
Injury Association
Function
Impairment
Scale, AIS
Mental
Function
Social
Function
•美国脊柱损伤协会,ASIA国际脊髓学会,ISCoS,等.脊髓损伤神经学分类国际标准(第6版).中国康复理论与实
践,2007;13(1):963-972
9
Data Collection
Physical
examination
Questionnaires
General
information
Injury level
and severity
Physical
Function
Modified Barthel Index, MBI
Mental
Visual Analogue Scale,VAS
Function
Social
Function
•Shah S, Muncer S. Sensitivity of Shah, Vanclay and Cooper's modified Barthel Index. Clin Rehabil.
2000; 14(5):551-552.
•Taylor J, Huelbes S, Albu S, et al. Neuropathic pain intensity, unpleasantness, coping strategies,
and psychosocial factors after spinal cord injury: an exploratory longitudinal study during the first
10
year. Pain Med. 2012;13(11):1457-68.
Data Collection
Physical
examination
Questionnaires
General
information
Injury level
and severity
Physical
Patient
Health
Function
Questionnaire,PHQ-9
Mental
Function
Social
Function
•akakibara BM, Miller WC, Orenczuk SG, et al. A systematic review of depression and anxiety measures
11
used with individuals with spinal cord injury. Spinal Cord, 2009;47(12):841-51.
Data Collection
General
information
Craig Hospital Handicap Assessment and
Injury
level
Reporting Technique,CHART
and severity
Physical
Physical independence
examination
Cognitive independence
Physical
Mobility
Function
Occupation
Mental
Social integration
Questionnaires
Function
Economy
Social
Function
12
• Noonan VK, Miller WC, Noreau L. A review of instruments assessing participation in persons with
spinal cord injury. Spinal Cord. 2009;47(6):435-446.
Data Analysis
 Dependent variables
MBI
VAS
Mixed effects model
PHQ-9
Longitudinal Tobit regression
Quality of life
Social
linear Integration
mixed model
 Independent variables
Gender
Age
Injury level
AIS
Injury time
13
SCI data
AIS
C1-C8
T1-T12
L1-L5
Below
S1
Total Percentage
A
6
6
23.1
B
C
2
3
4
2
7
7.7
26.9
D
3
2
5
19.2
3
11.5
1
3.8
2
2
7.7
2
26
100
E
2
CCS
1
1
CMS
Total
3
15
6
Abbr: CCS is central cord syndrome,
CMS is conus medullaris syndrome
14
SCI data
AIS
C1-C8
A
B
C
D
T1-T12
L1-L5
6
Total Percentage
6
23.1
7.7
Male 212, Female 14 2
3
4
7
26.9
Age 52.6±15.8
3
2
5
19.2
Married 21, single1, widow4
E
2
CCS
1
1
CMS
Total
Below
S1
3
15
6
3
11.5
1
3.8
2
2
7.7
2
26
100
Abbr: CCS is central cord syndrome,
CMS is conus medullaris syndrome
15
Physical functioning-MBI
#Analyse
with 2009 data, P<0.05
*Analyse with 2010 data,P<0.05
16
dependent
variable
Independent variables
Gender
（reference: female）
Age
Injury level
(ref:cervical)
thoracic
lumbar
-14.7
-0.5
-64.7
-65.5
sacral
AIS B
MBI
correlation
coefficient
-13.7
AIS C
AIS
（ref:AIS A）
Time
（ref：2009）
AIS D
AIS E
central cord
syndrome
2010
2012
55.5
65.0
13.7
15.0
regression: Log likelihood = -217.29
17
Physical functioning-VAS
18
dependent
variable
Independent variables
correlation
coefficient
Gender
（reference: female）
-2.1
Age
Injury level
(ref:cervical)
thoracic
lumbar
sacral
VAS
AIS
（ref:AIS A）
AIS B
AIS C
Time
（ref：2009）
AIS D
AIS E
central cord
syndrome
2010
2012
regression: Log likelihood = -160.08 19
Physical function

Pain
No significant
change
 Aggravating
factors
 •8
yearsBody
afterposture
Tangshan Earthquake,
Cold,
26.4% of SCIs
suffered from pain
 Alleviating
factors
• Distracting activities, rest, medication

* 李建军, 周红俊, 刘根林, 刘松怀, 赵超男, 宓忠祥等. 唐山地震26年后幸存脊髓损伤患者的社会调查. 中国康复理论与实践, 2005;11:110–112.
* 李红, 沈彤. 脊髓损伤患者住院康复后社区生存质量的调查. 按摩与康复医学, 2010;23:114-116.
WenD,
HC,
Reinhardt
JD,MM.
Gosney
J, Baumberger
M, Zhang
X, over
& Li Ja 10-year period in persons with
•Rintala
Hart
KA, Priebe
Predicting
consistency
of pain
(2013).
cord
injuryrelated
chronic
in victims of the 2008 Sichuan earthquake: a
spinal
cord Spinal
injury. [J]
Rehabil
Res Dev,
2004; pain
41:75–88.
prospective cohort study. Spinal Cord. Jul 2. doi: 10.1038/sc.2013.59. [Epubahead of print]
•Widerstrom-Noga E,Cruz-Almeida Y,Felix ER,et al.Relationship between pain characteristics and pain
20
adaptation type in persons with SCI. [J] Rehabil Res Dev, 2009;46:43–56.
Psychological function
#Analyse
with 2009 data, P<0.05;
21
dependent
variable
Independent variables
correlation
coefficient
Gender
（reference: female）
Age
Injury level
(ref:cervical)
thoracic
lumbar
sacral
AIS B
PHQ-9
AIS C
AIS
（ref:AIS A）
Time
（ref：2009）
AIS D
AIS E
central cord
syndrome
2010
2012
-3.3
regression: Log likelihood = -211.7422
Psychological function

Depression was prevalent.

The incidence of depression after Taiwan
earthquake is also prevalent.

Our work

SCI self help group
•Hung-Chi Wu, Pesus Chou, Frank Huang-Chih Chou, et al. Survey of quality of life and related risk
factors for
a Taiwanese village population 3 years post-earthquake. Aust N Z J Psychiatry,2006;40(4):355-61.
•Sakakibara BM, Miller WC, Orenczuk SG, et al. A systematic review of depression and anxiety measures
used
23
with individuals with spinal cord injury. Spinal Cord,2009;47(12):841-851.
Quality of life
Physical health
Mental health
Social
relationships
Environment
#Analyse
with 2009 data, P<0.05;
*Analyse with 2010 data, P<0.05.
24
dependent
variable
Independent variables
correlation
coefficient
Gender
（reference: female）
8.9
Age
Injury level
(ref:cervical)
Quality
of life
thoracic
lumbar
sacral
AIS B
AIS
（ref:AIS A）
Time
（ref：2009）
AIS C
9.4
AIS D
AIS E
central cord
syndrome
2010
2012
8.4
25
regression: Log likelihood =-260.77
Quality of life

Quality of life improved
 Relationship between injury level, AIS and quality
of life
 Aim to increase environment area score.
Motor ability effects quality of life
 Home adaption

•Gosney J, Reinhardt JD, Haig AJ, et al. Developing Post-disaster physical rehabilitation:role of the
World Health Organization Liaison Sub-Committee on Rehabilitation Disaster Relief of the International
Society of Physical and Rehabilitation Medicine. J Rehabil Med.2011;43:965–968.
•Post
MW,
Witte LP,
van
Asbeck
et al.
Predictors
health
status
and lifecord
satisfaction
in spinal
•Anson
C, de
Stanwyck
DJ,
Krause
JS.FW,
Social
support
and of
health
status
in spinal
injury. Paraplegia,
26
cord
Arch Phys Med Rehabil,1998;79(4):395–401.
1993;injury.
31: 632–638.
Social integration
Physical
independence
Cognitive
independence
Mobility
Occupation
Social
integration
#Analyse
with 2009 data, P<0.05;
*Analyse with 2010 data, P<0.05.
27
dependent
variable
Independent variables
correlation
coefficient
Gender
（reference: female）
Age
Injury level
(ref:cervical)
Social
Integrati
on
thoracic
lumbar
-2.4
155.8
162.5
sacral
195.4
AIS B
AIS
（ref:AIS A）
Time
（ref：2009）
AIS C
AIS D
AIS E
central cord
syndrome
2010
2012
50.8
142.8
207.8
33.1
47.0
regression: Log likelihood =-396.27
28
Social integration

Determinants of social integration
Gender, age, AIS, anxiety,depression, pain,
health condition, social support and coping ability



Social integration
Cognitive independence improved
•Geyh S, Nick E, Stirnimann D, et al. Self-efficacy and self-esteem as predictors of participation in
spinal cord injury-an ICF-based study. Spinal Cord, 2012;50(9):699-706.
•Samuelkamaleshkumar S, Radhika S, Cherian B, et al. Community reintegration in rehabilitated South
Indian persons with spinal cord injury. Archives of Physical Medicine and
29
Rehabilitation,2010;91(7):1117-1121.
Conclusions
 NHV improved ADL, psychological condition,
QoL and social integration in SCI patients 3
years after the earthquake.
 Important preditors of QoL and social integration:
Injury level and severity.
30
NHV model - Scientific research in rehab disaster relief
1.
Analysis of functional status, quality of life and community integration in earthquake
survivors
with spinal cord injury at hospital discharge and one year in中国康复医
the community.
张霞，卞荣，励建安等。四川江油地震伤员康复状况分析;
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Journal
of Rehabilitation
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张霞，励建安，陈思婧等。医疗康复对四肢骨不连地震伤员生活质量的
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绵竹地震胫腓骨骨折伤员功能恢复的影响因素分析;
中国康复医学杂志,
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Xia Zhang, Xiaorong Hu, Jianan Li, et al. 中华物理医学与康复杂志,
Functional outcomes and 2010,
9. 3. cord
四川地震51例脊髓损伤康复医疗状况分析;
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地震骨折伤员慢性疼痛的相关因素及与生存质量的关系;
4. 四川省北川中学地震伤员康复状况调查分析;
中国康复医学杂志,中华物理医学与康
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复杂志, 2011, 9: 673-677.
5. 4. Wen
HC,
Reinhardt
JD,
Gosney J, Baumberger
M,al.
Zhang
X, & Li J of the NHV
Xia
Zhang,
Jan D.
Reinhardt,
Jianan Li, et
Effectiveness
11. (2013).
绵竹脊髓损伤地震伤员生存质量和抑郁状态分析;
中华物理医学与康复杂志,
Spinal
cord
injuryrelated
chronic
pain
in
victims
of
the 2008
Sichuan earthqua
rehabilitation services programme on long-term physical
functioning
in
2012,
已接收.
ke:survivors
a prospective
cohort
Spinal
Cord. Jul 2.adoi:
10.1038/sc.2013.59.
of the
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earthquake:
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6.
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31
One
Foundation—Best
CivilInfluential
Disaster
China
Charity Award- Best
Relief
Project（2012）
(2012)
32
33