BACKGROUND:Gastrointestinal discomfort affects up to 70% of individuals with spinal cord injury (SCI), largely due to gut dysbiosis caused by altered transit time and reduced gastrointestinal motility from autonomic disruption. Emerging evidence links prebiotics and probiotics to improved microbiome balance and reduced inflammation, yet data in SCI remain limited. METHODS:Individuals aged ≥ 18 years, with a chronic SCI (≥1 year) experiencing significant gastrointestinal symptoms, will be invited to participate in this single-center randomized controlled crossover trial. Persons currently taking antibiotics, who have relevant eating or digestive disorders, or who have undergone a recent diet change will be excluded from the study. Participants will be randomized (1:1) into two groups. The first group will take a probiotic (Biotics-G, Burgerstein AG, Rapperswil-Jona, Switzerland) supplement for eight weeks, then after a four-week washout period, they will take a prebiotic (Oat Bran, Naturaplan, manufactured by Swissmill, Zurich, Switzerland) supplement for another eight weeks. The second group will receive the supplements in reverse order. The primary outcome is the Gastrointestinal Quality of Life Index, a questionnaire to assess quality of life related to gastrointestinal disorders. Secondary outcomes consist of gastrointestinal transit time, inflammatory blood markers, and gut microbiome composition. ETHICS:The study will be conducted in accordance with the Declaration of Helsinki. The study was approved by the Ethics Committee for Northwest/Central Switzerland (EKNZ, ID: 2025-00238, 24.02.2025, Version 2.0). The study is registered at ClinicalTrials.gov (ID: NCT06870331, 02.04.2025). Written informed consent will be obtained from all participants involved in the study.
IntroductionNeurogenic lower urinary tract dysfunction (NLUTD) is a frequent consequence of spinal cord injury or disease (SCI/D). It can lead to impaired bladder emptying, urinary incontinence, and recurrent urinary tract infections. For those unable to empty their bladder effectively, intermittent catheterization (IC) is the recommended first-line management. Clinical guidelines advise catheterization four to six times daily to prevent bladder overdistension (i.e., bladder volume > 500 ml), yet fixed schedules are often impractical due to fluctuating daily factors. Personalized scheduling is particularly challenging for individuals with SCI/D who lack bladder sensation. Consequently, a noninvasive and unobtrusive method for bladder volume monitoring is needed. Electrical bioimpedance (BI) is a promising solution, as it measures the impedimetric response of tissue to an applied electrical signal and should detect changes related to bladder filling. This may enable continuous, dynamic volume estimation and support individualized bladder management.Methods and analysisThis multi-center observational feasibility study evaluates a BI sensor for noninvasive bladder volume monitoring across three phases. Phase 1 assesses feasibility in individuals without SCI/D. Phase 2 includes individuals with chronic SCI/D and NLUTD to determine the difference between BI-derived bladder volume and the clinical gold standard (bladder volume determined by catheterization). Effects of abdominal adiposity and muscle activity on BI-signals will also be analyzed. Phase 3 examines the usability of a BI-based wearable during six hours of real-life use in wheelchair users reliant on intermittent catheterization. Sixty participants will be enrolled across all phases. The primary outcome is the difference in bladder volume (mL) between BI measurements and catheterized volumes in individuals with SCI/D. Secondary outcomes include physiological and motion parameters possibly affecting BI measurements. Analyses will be descriptive, focusing on signal quality, feasibility, and measurement agreement.DiscussionThis multi-phase feasibility study evaluates whether a BI sensor can measure bladder volume in individuals with SCI/D and NLUTD noninvasively and continuously. By validating BI in controlled and real-life settings, the study aims to determine its feasibility and potential as an alternative to current bladder volume assessment methods.
CONTEXT:Secondary health conditions are highly prevalent among persons with spinal cord injury (SCI) and affect functioning, well-being, and survival. The SCI-Secondary Conditions Scale (SCI-SCS) is widely used to assess problems with secondary health conditions, yet its psychometric properties have not been evaluated, and validity of self-ratings against clinical assessments remains limited. OBJECTIVE:To evaluate the psychometric properties of the SCI-SCS and validate patient self-reports against ratings of their treating medical doctor. DESIGN:A monocentric study conducted at an SCI center in Switzerland. SETTING:The SCI-SCS was completed by patients with SCI (N = 300) prior to routine annual follow-up consultations, while the medical doctor independently rated the same scale. OUTCOME MEASURES:Psychometric properties of the SCI-SCS, including fit, dimensionality, and local item dependence (LID), were assessed with the Partial Credit Model (PCM). Interrater agreement was evaluated using root mean squared error, Wilcoxon signed-rank tests, differential item functioning, and correlations of Rasch-transformed scores. RESULTS:After accounting for LID, the SCI-SCS demonstrated good fit and unidimensionality. Nine out of 15 items showed good interrater agreement with small effect sizes. However, notable discrepancies were observed for sexual dysfunction, sleep problems, contractures, bladder dysfunction, bowel dysfunction, and circulatory problems. Except for bladder dysfunction, patients tended to report higher problem severity than clinicians. CONCLUSION:The SCI-SCS is a psychometrically sound tool for assessing secondary conditions in people with SCI; however, self-reports may overestimate severity compared to physician ratings and should be interpreted with caution given differences between clinical judgement and patients' lived experience.
Background: As populations age, rehabilitation needs are increasing sharply. Older people experience declining intrinsic capacity, multimorbidity, and environmental barriers, which intensify their reliance on rehabilitation to optimize and maintain functional ability. Despite its critical role in healthy ageing, access to rehabilitation remains limited across the WHO European Region (WHO EURO).Aim: To examine the availability, implementation, and challenges of rehabilitation service delivery for older people in WHO EURO from the perspectives of rehabilitation stakeholders.Design and Methods: We conducted a secondary mixed-methods analysis of a 2023/2024 global online survey called "Rehabilitation Service Delivery to Foster Healthy Ageing," initially designed to identify and validate global rehabilitation delivery models, focusing on WHO EURO data. The survey, offered in 8 languages, targeted health and care workers providing rehabilitation for people aged 60 and above. Quantitative and qualitative data were analysed descriptively, thematically, and integrated using the Health System Dynamics Framework. Reporting followed CROSS and MMR-RHS guidelines.Results: 706 responses from 45 countries were analysed. Six validated rehabilitation delivery models were confirmed: outpatient, inpatient, home, telerehabilitation, community, and residential long-term care. Findings revealed disparities in the availability of these models and in the responsiveness - assessed through a self-designed responsiveness index - of rehabilitation services to ageing populations, varying by country and income level. Strengthening outpatient, home, and residential long-term rehabilitation was considered most urgently needed. Barriers and facilitators to strengthening rehabilitation were identified across all domains of the Health System Dynamics Framework and synthesized into 8 themes and 19 subthemes.Discussion: Rehabilitation models remain unevenly implemented across Europe, and inequities in provision persist. Systemic barriers span governance, financing, human resources, and service delivery, underlining the importance of integrated approaches that reflect older people's realities and priorities.Conclusion: Rehabilitation plays a key role not only after illness or injury but also in maintaining functional ability during age-related declines in intrinsic capacity. Strengthening rehabilitation for older people is essential for Healthy Ageing and requires investment, intersectoral collaboration, and implementation science to overcome systemic barriers.
PURPOSE:Sexual health education in rehabilitation remains inconsistent and often absent due to structural and practical barriers. Healthcare professionals play a crucial role in creating a safe environment that enables patients to address sexual health concerns. This study explores healthcare professionals' experiences and identifies barriers and enablers for integrating sexuality into SCI/D rehabilitation. MATERIALS AND METHODS:A sequential explanatory mixed-methods design was applied, prioritizing qualitative data. Healthcare professionals from three Swiss SCI/D rehabilitation centers completed a questionnaire assessing perceived importance of sexuality, experiences with education, and training needs. Focus groups with professionals from diverse backgrounds further examined barriers and enablers. Qualitative data were thematically analyzed and mapped to the Theoretical Domains Framework (TDF). RESULTS:Of 136 respondents, one-third had received training on sexuality after SCI/D, and almost half of them felt competent to provide related education. Although most considered sexuality important, fewer than 40% had initiated conversations. Three themes emerged (1): building confidence through knowledge (2), prioritizing sexuality as a shared responsibility, and (3) navigating social dynamics. Mapping to the TDF highlighted knowledge, skills, role clarity, context, and social influences as key factors. CONCLUSION:Addressing sexuality in SCI/D rehabilitation requires targeted training, clear responsibilities, and structured processes to foster holistic care.
