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Summary

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There is level 1a evidence from systematic review that telecounselling is effective for managing common SCI comorbidities, including sleep difficulties and pain (Dorstyn et al. 2013).

There is level 1a evidence that telephone counselling led to improvements in anxiety, depression and coping following SCI but more powerful research is required to establish statistically significant differences (Dorstyn et al. 2012).

There is level 2 evidence that knowledge of two key health risks (skin and bladder management) is poor at the point of discharge from rehabilitation (Thietje et al. 2011)

There is level 3 evidence that depression rates are higher and onset is earlier among individuals with disabilities, especially traumatic-onset disabilities, such as SCI, compared to controls (McDermott et al. 2005). 

There is level 5 evidence that relatively few confirmed cases are receiving guideline-level treatment (Fann et al. 2011).

There is level 4 evidence that individuals with tSCI are using the ED for conditions that could be managed in primary care approximately half of the time (Guilcher et al. 2013)

There is level 4 evidence that individuals living in rural areas more likely to visit the Emergency Department than those living in cities (Munce et al. 2009; Guilcher et al. 2010).

There is level 4 evidence that adherence to clinical guidelines improves with targeted implementation plans (Goetz et al. 2005).

There is level 4 evidence that a weight management program can help individuals meet their goals for weight and body measurements (Radomski et al. 2011).

There is level 4 evidence that antiobiotic prescription does not significantly affect subsequent health service use among acute uncomplicated cases of respiratory infection (Evans et al. 2010).  There is Level 5 evidence that physicians are aware that antibiotic prescription must be carefully monitored to avoid antibiotic resistance (Evans et al. 2011).

There is level 4 evidence that GP utilization is related to older age, functional disability, and complications (Munce et al. 2009; Guilcher et al. 2010).

There is level 5 evidence that individuals with incomplete injuries are less satisfied with their GP than those with complete injuries (Hagen et al. 2012).

There is level 5 evidence that an intensive dietary and exercise program can improve markers of CVD risk (Myers et al. 2012).

There is level 5 evidence that factors predicting access to health services include health plan type, health condition, health status, severity of condition, income level and age (Beatty et al. 2003).

There is level 5 evidence that an annual Comprehensive Preventive Health Evaluation at the SCI centre is related to improved health care utilization and having health, psychosocial, and equipment needs met (Collins et al. 2005).

There is level 5 evidence that a minority ofphysiatrists are willing or capable of providing primary care to those with disabilities (Francisco et al. 1995).

There is level 5 evidence that there is considerable duplication between primary care and physiatry, despite high satisfaction with both (Donnelly et al. 2007).

There is level 5 evidence that there are significant differences in service utilization between Canadians, Americans, and Britons, but no difference in access to and satisfaction with the services (Donnelly et al. 2007).

There is level 5 evidence that limited knowledge of SCI, lack of funding, and service fragmentation are barriers to primary care (Cox et al. 2001; DiPonio et al. 2011).

There is level 5 evidence that 80% of issues raised by patients with SCI in primary care are disability-related (Warms 1987).  52% of contact with GP’s was regarding secondary complications; 34% of secondary complications are believed to be preventable.  72% of people with SCI report an unmet need for health care related to secondary health conditions (van Loo et al. 2009).

There is Level 5 evidence that veterans with mental illness and substance abuse issues are at increased risk of mortality (Findley et al. 2011).

There is level 5 evidence that physiatrists consider bone health after SCI is an important issue, and that they favour pharmacological treatment (Ashe et al. 2009).

There is level 5 evidence that the majority of medical residents are not comfortable treating a woman with tetraplegia who has recently become pregnant (Oshima et al. 1998).

There is level 5 evidence that individuals with chronic SCI would like more information regarding SCI and health risks.  Needs for lifestyle and emotional issues often go unmet (Donnelly et al. 2007).  Health promotion and counseling needs are typically unmet, including smoking cessation (Warms 1987; Weaver et al. 2011).  Information about chronic pain and pain management strategies is insufficient (Norman et al. 2010).  Ethnic minorities had the greatest unmet needs for information (Gontkovsky et al. 2007).  

There is level 5 evidence that 90% of individuals with SCI would like to receive written information about their condition following a medical checkup (Vaidyanathan et al. 2001).