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ISSN: 2376-0281
International Journal of Neurorehabilitation
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Demography, Diagnosis and Complications of Spinal Cord Injury Patients in a Rehabilitation Center of Bangladesh

Mohammad Morshedul Quadir1, Krishno Sen1, Mst. Rebeka Sultana2, Md. Shahoriar Ahmed1, Farjana Taoheed1, Amin Andalib3*, Russell Kabir4, AM Fariduzzaman5 and SM Yasir Arafat6

1Centre for the Rehabilitation of the Paralysed (CRP), Dhaka, Bangladesh

2New Deep Clinic and Diagnostic Centre, Dhaka, Bangladesh

3Department of Surgery, Dhaka Medical College, Dhaka, Bangladesh

4Anglia Ruskin University, Chelmsford, UK

5Department of Psychiatry, Bangabandhu Sheikh Mujib Medical University, Bangladesh

6Department of Public Health, ASA University Bangladesh

*Corresponding Author:
Amin Andalib
Department of Surgery, Dhaka Medical College
Dhaka, Bangladesh
Tel: +8801713068868
E-mail: [email protected]

Received date: January 31, 2017; Accepted date: February 07, 2017; Published date: February 14, 2017

Citation: Quadir MM, Sen K, Sultana MR, Ahmed MS, Taoheed F, et al. (2017) Demography, Diagnosis and Complications of Spinal Cord Injury Patients in a Rehabilitation Center of Bangladesh. Int J eurorehabilitation 4:244. doi:10.4172/2376-0281.1000244

Copyright: © 2017 Quadir MM, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited

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Abstract

Background: Spinal cord injury and its health related complications pose a major impact on the overall morbidity and mortality as well as cause economic constrains. It was aimed at looking into the demographic distribution, diagnosis, as well as complications in patients with spinal cord injury.

Methods: The study was conducted at Centre for the Rehabilitation of the Paralysed (CRP) between 2012 and 2013 from 201 respondents with the help of a structured preformed pretested questionnaire by face to face interview.

Results: Out of 201 respondents 176 (87.6%) were male and 25 (12.4%) were female; majority of the patients were in their 3rd decade which consisted 28.6%, followed by 27.4% in between 21-30 years and 26.8% in between 41-50. Most of the respondents of this study had traumatic paraplegia (56.5%) and Buttock was found to be the predominant site for developing site pressure sore as evident form 67.5%.

Conclusion: Productive males are more prone to spinal cord injury and the most common diagnosis is paraplegia with the most risky area is buttock for developing pressure sore. The findings may add in the way of developing awareness among stakeholders regarding demography, diagnosis and the pattern of the complications in a country like Bangladesh.

Keywords

Bed sore; Spinal cord injury; Rehabilitation center; Complications; Bangladesh.

Introduction

Spinal cord injury, is certainly a debilitating and devastating condition in terms of its effect on a person`s physical, mental, familial as well as social life [1]. Due to its profound impact on a person`s overall quality of life and increasingly high incidence, injury to spinal cord due to any pathology is now considered as a morbid condition as well as a threat to both personal and national economy [2,3]. Spinal cord injury itself is a crippling condition, at the same time may lead to a variety of complications which can affect the life of the patient as it increases the treatment cost significantly and accelerate the disease process which link to early mortality [1,3,4]. The incidence of Spinal cord injury is increasing throughout the world with an annual incidence rate of 15 to 40 per million with a male predominance, more prevalence in low socio-economic society and the causes ranges from traumatic in most of the case like motor vehicle accident to gunshot injury and physical violence, however non traumatic causes like Tuberculosis (TB) of the spine is also responsible for this [3-6]. A great variety of complications usually follow injury to spinal cord such as pressure sore, urinary complications, most of which are preventable nonetheless these associated complications are the most common cause of re-hospitalization following spinal cord injury and eventually lead to a great deal of disability, morbidity, degree of dependence and mortality [1-4].

Spinal cord injury is a severe condition of the musculoskeletal system, more often leading to permanent disability and on the top of that brings about drastic changes the functioning ability of the patient and eventually encompassing each and every aspect of life [5-8]. Complications may associate virtually all systems of the body namely cardio-respiratory system, genitourinary system, local disorders like pressure sore or full blown biochemical disorders. Such domino effect following the injury to spinal cord significantly decreases the quality of life of the individual and happens on the early or acute stage when initial rehabilitation process are being initiated [6]. Spinal cord injury whether traumatic or form other cause and its associated chronic disabilities and deterioration of the quality of life may be generalized by more substantial data on the demographic distribution of the condition, association of complications with sex, employment, social status and overall condition of the individual [4-6,9-11].

Bangladesh a poor developing country with a literacy rate of about 61.0% among the age of 15 years and above [12,13] spinal cord injury and its health related complications are a major issue as it causes a great deal of morbidity and mortality as well as economic problems [14]. The researcher aimed to looking into the trend in demographic distribution of spinal cord injury, diagnosis, as well as complications in patients with spinal cord injury which will help to identify the specific population group at risk and take preventive measure to prevent the associated complications [15-17].

Methods

Study place

Centre for the Rehabilitation of the Paralysed (CRP) one of the largest rehabilitation centre for different injury in Bangladesh. It receives referrals from other hospitals and all over the Bangladesh. Here patients admitted with or without pressure ulcer. Some pressure ulcers are cure by conservative treatment and some are needs surgery when it became uncontrolled. In CRP given extensive education and counseling about pressure ulcer care not only pressure care but also all aspects about how they can pass their life with Spinal Cord Injury (SCI). The rehabilitation procedure going through 3 months long or sometimes more according to patient’s physical condition and recovery time. After patients discharge from CRP, health care professionals will follow-up the patients in Community by doing patients home visit.

Data collection, management and analysis

Data were collected between 2012 and 2013 from the community during the home visit of previously admitted patients at CRP with spinal cord injury. A structured preformed pretested questionnaire was used to collect the data from 201 patients by face to face interview. After collection data were managed properly and was analyzed in SPSS 16 version and Microsoft Excel Software 2007 version.

Ethical consideration

The researchers were properly concerned about the ethical issues relate to the study. Formal ethical clearance was taken from the ethical review committee of the CRP for conducting this study. As the patients were discharge from CRP they all are willing to give all information to the CRP health care professionals. Confidentiality of the persons and the information was maintained and observed and unauthorized persons did not have any access to the collected data.

Demographic Variables
Gender Gender Frequency Percent
Male 176 87.6
Female 25 12.4
Age Age Frequency Percent
11 to 20 8 4.8
21 to 30 46 27.4
31 to 40 48 28.6
41 to 50 45 26.8
51 to 60 12 7.1
61 to 70 7 4.2
71 to 80 2 1.2
Income Income (BDT) Frequency Percent
0 to 5000 101 70.1
5000 to 10000 30 20.8
10000 to 15000 6 4.2
15000 to 20000 6 4.2
20000 to 25000 0 0
25000 to 30000 0 0
30000 to 35000 0 0
35000 to 40000 1 0.7
Employment Status Employment Status Frequency Percent
Yes 93 47
No 103 53

Table 1: Distribution of demographic variables among the respondents (n=201).

Results

Among 201 respondents 176 were male (87.6%) and 25 were female (12.4%). Most of the patients were in their 3rd decade which consisted 28.6%, followed by 27.4% in between 21-30 years and 26.8% in between 41-50. 93 of the respondent (47%) were employed and 103 were unemployed (57%) and 70.1% population had income below 5000 BDT and 20.8% had between 5000 to 10000 BDT (Table 1).

Out of 201 respondents, 168 diagnoses was available and among them 56.5% (95) had the diagnosis of traumatic paraplegia and 29.2% had traumatic tetraplegia whereas Non-traumatic paraplegia, Guillain- Barre Syndrome and TB spine were the other diagnosis having the distribution of 9.5%, 4.2% and 0.6%, respectively (Figure 1).

22.7% (45) of the respondents had pressure sore present and most of these sore were located over buttock which had 67.5% followed by Ischial Tuberosity having 7.5% of the sore (Table 2). 16.9% respondents had complained of having burning sensation during urination and 10.8% was found to have urinary incontinence. 17.8% population received medical and same amount had the hospital management however 22.8% did not receive any treatment (Table 3).

Presence of Pressure sore, their location and type of treatment
Presence of Pressure sore Pressure sore Present Frequency Percent
Yes 45 22.7
No 153 77.3
Location of Sore Location of sore Frequency Percent
Buttock 27 67.5
Ischial Tuberosity 3 7.5
Others 10 25
Type of Treatment Treatment Type Frequency Percent
Medicine 9 4.5
Hospital 2 1
Kobiraz 1 0.5
Village Doctor 4 2
No Treatment 4 2
Self-Management 3 1.5
Dressing 12 1.5
CRP`s Advice 3 1.5

Table 2: Distribution and location pressure sore among the respondents (n=201).

international-journal-of-neurorehabilitation-diagnosis-respondents

Figure 1: Distribution of diagnosis of the respondents (n=168).

Urinary Complications and Received Managements
Urinary Complications Types of Complication Frequency Percent
No problem 108 55.4
Fistula 1 0.5
Burning Sensation 33 16.9
Pain 7 3.6
Stone in Kidney 1 0.5
Incontinence 21 10.8
UTI 12 6.2
Problem in catheterization 10 5.1
Others 2 1
Types of Treatment for Urine Problem Treatment Frequency Percent
Medicine 18 17.8
Hospital 18 17.8
Kobiraz 4 4
Village doctor 7 6.9
Private clinic 3 3
No treatment 23 22.8
Self-Management 28 27.7
Types of Management Management Frequency Percent
Taping 1 0.7
Permanent Catheter 15 9.9
Plain Catheter 67 44.1
Condom Catheter 3 2
Norma Method 57 37.5
Others 7 4.6

Table 3: Distribution of urinary complications and received managements.

Discussion

The study population was a selected group of people suffering from spinal cord injury that made it necessary to get admission in hospital. The Demographic variables author took into consideration were sex, age, employment status and income of the patient. Out of 201 study population 176 were male and 25 were female and this male predominance was also reported in the previous studies carried out both locally [14,18-20] and globally [4-11,21] (Table 1). In this study most of the patients were in their 3rd decade which consisted 28.6% , followed by 27.4% in between 21-30 years and 26.8% in between 41-50, which was also a common finding as reported by Hossain et al. [22] where mean age was 47.44 ± 13.30 [17]; Ulrich et al found it 36.1 and according to Lali et al. [21] mean age was 35.3, but in some studies the age of the study population was little bit different [4,14,16,18] (Table 1). It was found that 93 of the respondent (47%) were employed and 103 were unemployed (57%) which somewhat correlate with Zahangir et al, who reported 36% of the patient to be day laborer [18] and also Ulrich et al., according to whom only 22% of the patients were full time employed but does not go in line with Lali et al. and other articles [4,14,17,22] (Table 1). A general trend of development of pressure sore among people with low income was found in this study which was also common in the other reports [4,11,18,19]. Most of the respondents of this study had paraplegia (56.5%) and the principle cause was trauma which was similar to the report Rahman et al. but Guihan et al. reported most of their patients (73.3%) had complete spinal cord injury [10,14,20] but in all the reports the major cause of injury was reported to be trauma whether road traffic accident or fall from height or any other mechanism of traumatic injury [4,10,11,14,20,21] (Figure 1). Regarding the location, the authors found Buttock to be the predominant site for developing site pressure sore as evident form 67.5% patient had sore over their buttock followed by Ischial tuberosity (7.5%) and this finding was similar to Hossain et al. and Ulrich et al. reported the lower back to the commonest site for pressure sore [17,22] (Table 3). In this article 44.6% of the respondents had urinary complication and 16.9% had dysuria and 10.8% had urinary incontinence which is almost similar to the report of Thiyagarajan et al. and Guihan et al. [16,20] (Table 3). 30 patients with pressure sore had other skin disease which may be supported by the report of Guihan and Bombardier, where 96.2% patient had associated skin disease, but Endocrine conditions like Diabetes had a significant association whit development of pressure sore along with vascular conditions which were not evident in the current study [20]. Moreover, other risk factors for developing pressure sore in patients with spinal cord injury like inability to turn the body independently or systemic conditions like anemia, jaundice, malnutrition as reported by many authors [4,9,10,16,22] where not evident in this particular study.

Conclusion

Spinal cord, injury regardless of the cause has grave consequences as it creates a great deal of physical, psychological as well as economic restraints. Adult male seems to be at more risk of spinal cord injury and paraplegia is the commonest diagnosis, usually associated with multidimensional complications such as pressure sore. Further large scale study would help to generalize the findings and to encourage the further involvement of the stake holders to prevent the onset of the devastating course.

Acknowledgement

Author acknowledges the Kauvery Research Group for necessary support.

References

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