Prevalence of secondary health conditions and mental status in persons with long-term spinal cord injury in South Africa: Comparison between public and private healthcare sectors
DOI:
https://doi.org/10.7196/SAMJ.2023.v113i5.16791Keywords:
secondary health conditions, mental healthAbstract
Background. Spinal cord injuries typically result in a range of negative health outcomes and health states, which impacts overall functioning, health and well-being. It remains important to establish the prevalence (burden) of health outcomes to help with the development of optimal treatment strategies.
Objectives. To determine the prevalence and treatment rates of secondary health conditions (SHCs) and mental health states in persons with long-term spinal cord injury (SCI) receiving public compared with private healthcare services in South Africa.
Methods. A cross-sectional survey included 200 community-dwelling persons with long-term SCI, 60% with paraplegia, 53% with complete injuries and 156 from the public and 44 from private healthcare sectors. The following modules of the International Spinal Cord Injury (InSCI) community survey were used: (i) demographic and injury characteristics; (ii) SHCs and treatment rates; and (iii) vitality and emotional well-being. All statistical analyses were stratified according to healthcare sector.
Results. Pain (47% v. 57), sexual dysfunction (59% v. 41%) and muscle spasms (54% v. 43%) were the most common SHCs in both cohorts, and the period prevalence was significantly higher for sleeping problems (41% v. 25%), sexual dysfunction (59% v. 41%) and contractures (42% v. 20%) in the public compared with the private cohort. Persons with SCI in the private cohort received treatment more often for sleeping problems (100% v. 45%), autonomic dysreflexia (75% v. 27%) and pain (56% v. 33%) than their counterparts with public insurance. Negative mental health states were prevalent in both groups.
Conclusion. SHCs and negative mental health were common in persons with SCI in South Africa, while those with public insurance reporter a higher occurrence of sleep problems and contractures, as well as lower treatment rates. Overall, a need exists to better support persons with SCI in the long-term context to facilitate improved functioning and wellbeing.
References
Nas K, Yazmalar L, Şah V, Aydın A, Öneş K. Rehabilitation of spinal cord injuries. World J Orthop 2015;6(1):8-16. doi: 10.5312/wjo.v6.i1.8.
Joseph C, Nilsson Wikmar L. Prevalence of secondary medical complications and risk factors for pressure ulcers after traumatic spinal cord injury during acute care in South Africa. Spinal Cord 2016;54(7):535-539. https://doi.org/10.1038/sc.2015.189.
Madasa V, Boggenpoel B, Phillips J, Joseph C. Mortality and secondary complications four years after traumatic spinal cord injury in Cape Town, South Africa. Spinal Cord Ser Cases 2020;6(1):84. https:// doi.org/10.1038/s41394-020-00334-w.
Cheng CL, Plashkes T, Shen T, et al. Does specialised inpatient rehabilitation affect whether or not people with traumatic spinal cord injury return home? J Neurotrauma 2017;34(20):2867-2876. https:// doi.org/10.1089/neu.2016.4930.
Wahman K, Wikmar LN, Chlaidze G, Joseph C. Secondary medical complications after traumatic spinal cord injury in Stockholm, Sweden: Towards developing prevention strategies. J Rehabil Med 2019;51(7):513-517. https://doi.org/10.2340/16501977-2568.
Sezer N, Akkuş S, Uğurlu FG. Chronic complications of spinal cord injury. World J Orthop 2015;6(1):24-33. doi.org/10.5312%2Fwjo.v6.i1.24
Adriaansen JJE, Post MWM, de Groot S, et al. Secondary health conditions in persons with spinal cord injury: A longitudinal study from one to five years post-discharge. J Rehabil Med 2013;45(10):1016- 1022. https://doi.org/10.2340/16501977-1207
Van Leeuwen C, Edelaar-Peeters Y, Peter C, Stiggelbout AM, Post MWM. Psychological factors and mental health in persons with spinal cord injury: An exploration of change or stability. J Rehabil Med 2015;47(6):531-537. https://doi.org/10.2340/16501977-1953
Post MWM, van Leeuwen CMC. Psychosocial issues in spinal cord injury: A review. Spinal Cord 2012;50(5):382-389. https://doi.org/10.1038/sc.2011.182
Zürcher C, Tough H, Fekete C, Group SS. Mental health in individuals with spinal cord injury: The role of socioeconomic conditions and social relationships. PloS One 2019;14(2). https://doi.org/10.1371/ journal.pone.0206069
Visser AM, Visagie S. Pressure ulcer knowledge, beliefs and practices in a group of South Africans with spinal cord injury. Spinal Cord Ser Cases 2019;5:83. https://doi.org/10.1038/s41394-019-0226-4
Wakefield D, Bayly J, Selman LE, Firth AM, Higginson IJ, Murtagh FEM. Patient empowerment, what does it mean for adults in the advanced stages of a life-limiting illness: A systematic review using critical interpretive synthesis. Palliat Med 2018;32(8):1288-1304. https://doi.org/10.1177/0269216318783919
Ahmat A, Okoroafor SC, Kazanga I, et al. The health workforce status in the WHO African Region: Findings of a cross-sectional study. BMJ Glob Health 2022;7:e008317. http://doi.org/10.1136/ bmjgh-2021-008317
Joseph C, Delcarme A, Vlok I, Wahman K, Phillips J, Wikmar LN. Incidence and aetiology of traumatic spinal cord injury in Cape Town, South Africa: A prospective, population-based study. Spinal Cord 2015;53(9):692-696. https://doi.org/10.1038/sc.2015.51
Mann TN, Schaaf HS, Dunn RN, et al. Child and adult spinal tuberculosis at tertiary hospitals in the Western Cape, South Africa: 4-year burden and trend. Epidemiol Infect 2018;146(16):2107-2115. https://doi.org/10.1017%2FS0950268818002649
Maart S, Jelsma J. Disability and access to health care – a community based descriptive study. Disabil Rehabil 2014;36(18):1489-1493. https://doi.org/10.3109/09638288.2013.807883
Mayosi BM, Benatar SR. Health and health care in south africa – 20 years after Mandela. N Engl J Med 2014;371(14):1344-1353. https://doi.org/10.1056/NEJMsr1405012
Phillips J, Braaf J, Joseph C. Another piece to the epidemiological puzzle of traumatic spinal cord injury in Cape Town, South Africa: A population-based study. S Afr Med J 2018;108(12):1051-1054. https:// doi.org/10.7196/SAMJ.2018.v108i12.13134
Stucki G, Bickenbach J. The implementation challenge and the learning health system for SCI initiative. Am J Phys Med Rehabil 2017;96(2):S55-S60. https://doi.org/10.1097/PHM.0000000000000672.
Ngobeni V, Breitenbach MC, Aye GC. Technical efficiency of provincial public healthcare in South Africa. Cost Eff Resour Alloc 2020;18(1):3. https://doi.org/10.1186/s12962-020-0199-y.
Gross-Hemmi MH, Post MWM, Ehrmann C, et al. Study protocol of the International Spinal Cord Injury (InSCI) community survey. Am J Phys Med Rehabil 2017;96(2):S23-S34.https://doi. org/10.1097/PHM.0000000000000647.
Fekete C, Post MWM, Bickenbach J, et al. A structured approach to capture the lived experience of spinal cord injury: Data model and questionnaire of the International Spinal Cord Injury community survey. Am J Phys Med Rehabil 2017;96(2):S5-S16.https://doi.org/10.1097/PHM.0000000000000622.
Kalpakjian CZ, Scelza WM, Forchheimer MB, Toussaint LL. Preliminary reliability and validity of a spinal cord injury secondary conditions scale. J Spinal Cord Med 2007;30(2):131-139. doi:10.1080/1 0790268.2007.11753924.
Sangha O, Stucki G, Liang MH, Fossel AH, Katz JN. The Self‐Administered Comorbidity Questionnaire: A new method to assess comorbidity for clinical and health services research. Arthritis Care Res Off J Am Coll Rheumatol 2003;49(2):156-163. https://doi.org/10.1002/art.10993.
Van Leeuwen C, Van Der Woude L, Post M. Validity of the mental health subscale of the SF-36 in persons with spinal cord injury. Spinal Cord 2012;50(9):707-710. https://doi.org/10.1038/sc.2012.33.
DeVivo MJ, Biering-Sørensen F, New P, Chen Y. Standardisation of data analysis and reporting of results from the International Spinal Cord Injury Core Data Set. Spinal Cord 2011;49(5):596-599. https://doi.org/10.1038/sc.2010.172.
Strøm V, Månum G, Arora M, et al. Physical health conditions in persons with spinal cord injury across 21 countries worldwide. J Rehabil Med 2022;54. doi.org/10.2340/jrm.v54.2040
Middleton JW, Arora M, Kifley A, et al. Australian arm of the International Spinal Cord Injury (Aus- InSCI) community survey: 1. Population-based design, methodology and cohort profile. Spinal Cord 2022 (epub ahead of print). doi.org/10.1038/s41393-022-00850-6
New PW. Secondary conditions in a community sample of people with spinal cord damage. J Spinal Cord Med 2016;39(6):665-670. doi.org/10.1080%2F10790268.2016.1138600
Park SE, Elliott S, Noonan VK, et al. Impact of bladder, bowel and sexual dysfunction on health status of people with thoracolumbar spinal cord injuries living in the community. J Spinal Cord Med 2017;40(5):548-559. https://doi.org/10.1080/10790268.2016.1213554.
Müller R, Landmann G, Béchir M, et al. Chronic pain, depression and quality of life in individuals with spinal cord injury: Mediating role of participation. J Rehabil Med 2017;49(6):489-496. https:// doi.org/10.2340/16501977-2241.
Richardson A, Samaranayaka A, Sullivan M, Derrett S. Secondary health conditions and disability among people with spinal cord injury: A prospective cohort study. J Spinal Cord Med 2021;44(1):19- 28. https://doi.org/10.1080/10790268.2019.1581392.
Gray A, Riddin J, Jugathpal J. Health Care and Pharmacy Practice in South Africa. Can J Hosp Pharm. 2016;69(1):36-41. https://doi.org/10.4212/cjhp.v69i1.1521
Kula N, Fryatt RJ. Public-private interactions on health in South Africa: Opportunities for scaling up. Health Policy Plan 2014;29(5):560-569. https://doi.org/10.1093/heapol/czt042
Maphumulo WT, Bhengu BR. Challenges of quality improvement in the healthcare of South Africa post-apartheid: A critical review. Curationis 2019;42(1):1-9. https://doi.org/10.4102%2Fcurationis. v42i1.1901
Piatt JA, Nagata S, Zahl M, Li J, Rosenbluth JP. Problematic secondary health conditions among adults with spinal cord injury and its impact on social participation and daily life. J Spinal Cord Med 2016;39(6):693-698. https://doi.org/10.1080/10790268.2015.1123845
Theron F, Wilson V, Scriba E, Campbell R, Van Zyl M. Best practice recommendations for bladder management in spinal cord-afflicted patients in South Africa. S Afr Med J 2019;2(2):195-202. https://doi. org/10.7196/SAMJ.2019.v109i3b.13690
Mashola MK, Mothabeng DJ. Associations between health behaviour, secondary health conditions and quality of life in people with spinal cord injury. Afr J Disabil 2019;8: 463. doi.org/10.4102%2Fajod. v8i0.463
Cao Y, DiPiro N, Krause JS. Health factors and spinal cord injury: A prospective study of risk of cause- specific mortality. Spinal Cord 2019;57(7):594-602. https://doi.org/10.1038/s41393-019-0264-6
Craig A, Tran Y, Wijesuriya N, Middleton J. Fatigue and tiredness in people with spinal cord injury. J Psychosom Res 2012;73(3):205-210. https://doi.org/10.1016/j.jpsychores.2012.07.005
SaundersLL,KrauseJS.Behavioralfactorsrelatedtofatigueamongpersonswithspinalcordinjury.Arch Phys Med Rehabil 2012;93(2):313-318. https://doi.org/10.1016%2Fj.apmr.2011.09.001
WilliamsR,MurrayA.Prevalenceofdepressionafterspinalcordinjury:Ameta-analysis.ArchPhysMed Rehabil 2015;96(1):133-140. https://doi.org/10.1016/j.apmr.2014.08.016
Craig A, Perry KN, Guest R, Tran Y, Dezarnaulds A, Hales A, et al. Prospective study of the occurrence of psychological disorders and comorbidities after spinal cord injury. Arch Phys Med Rehabil 2015;96(8):1426-1434. https://doi.org/10.1016/j.apmr.2015.02.027
FeketeC,ToughH,AroraM,etal.Aresocialrelationshipsanunderestimatedresourceformentalhealth in persons experiencing physical disability? Observational evidence from 22 countries. Int J Public Health 2021;66:619823. doi.org/10.3389%2Fijph.2021.619823
Van Diemen T, Crul T, van Nes I, Group SS, Geertzen JH, Post MW. Associations between self-efficacy and secondary health conditions in people living with spinal cord injury: A systematic review and meta- analysis. Arch Phys Med Rehabil 2017;98(12):2566-2577. https://doi.org/10.1016/j.apmr.2017.03.024
FinnerupNB,JensenMP,NorrbrinkC,etal.Aprospectivestudyofpainandpsychologicalfunctioning following traumatic spinal cord injury. Spinal Cord 2016;54(10):816-821. https://doi.org/10.1038/ sc.2015.236
HoulihanBV,Everhart-SkeelsS,GutnickD,etal.Empoweringadultswithchronicspinalcordinjuryto prevent secondary conditions. Arch Phys Med Rehabil 2016;97(10):1687-1695. https://doi.org/10.1016/j. apmr.2016.04.005
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Licensing Information
The SAMJ is published under an Attribution-Non Commercial International Creative Commons Attribution (CC-BY-NC 4.0) License. Under this license, authors agree to make articles available to users, without permission or fees, for any lawful, non-commercial purpose. Users may read, copy, or re-use published content as long as the author and original place of publication are properly cited.
Exceptions to this license model is allowed for UKRI and research funded by organisations requiring that research be published open-access without embargo, under a CC-BY licence. As per the journals archiving policy, authors are permitted to self-archive the author-accepted manuscript (AAM) in a repository.
Publishing Rights
Authors grant the Publisher the exclusive right to publish, display, reproduce and/or distribute the Work in print and electronic format and in any medium known or hereafter developed, including for commercial use. The Author also agrees that the Publisher may retain in print or electronic format more than one copy of the Work for the purpose of preservation, security and back-up.
