BACKGROUND:Socioeconomic disparities are a persistent determinant of health outcomes, yet limited research has explored how income affects the overall functioning of individuals with spinal cord injury (SCI). OBJECTIVE:To examine the relationship between income and health in individuals with spinal cord injury (SCI), using functioning as a broader health measure. METHODS:This study analyzed income-related health disparities across income groups in individuals with traumatic SCI from ten countries, using cross-sectional data from the first Internal Spinal Cord Injury Survey (InSCI) and related studies (2017-2019). Functioning was assessed with the brief International Classification of Functioning, Disability and Health (ICF) core set for SCI. Income was categorized using general population income deciles for comparability. RESULTS:Lower-income individuals with SCI had poorer functioning than higher-income groups. The disparity in functioning scores between the highest and lowest income groups ranged from 3 to 14 points, with China showing the largest gap (11 points) and France and Switzerland the smallest (2 and 4 points, respectively). In South Korea, functioning scores were below 40 across all income groups. Age at injury onset significantly influenced disparities, with the greatest gaps among working-age individuals and, in some countries, older adults. CONCLUSION:Income-based income-related health disparities are evident in individuals with SCI, with lower income consistently linked to reduced functioning. The findings emphasize the need to address economic and age-related factors in SCI health interventions across diverse national contexts.

Objective: Greater mobility independence after spinal cord injury is thought to lead to better long-term outcomes. However, evidence is inconclusive for ambulation compared with wheelchair dependency. This study aimed to describe and compare long-term outcomes across mobility levels in individuals with spinal cord injury. Design: Cross-sectional survey. Subjects: Community-dwelling individuals with spinal cord injury in the Netherlands. Methods: Data were collected via the Dutch arm of the International Spinal Cord Injury (InSCI-NL) Survey (2018). Mobility level was assessed using the modified Spinal Cord Independence Measure-Self-Report. Long-term outcomes were compared across mobility levels, using generalised linear models. Results: 253 participants were included with a mean (standard deviation) age of 58.7 (13.6) years and median [interquartile range] time since injury of 10 [5.0–22.0] years. Electric wheelchair users reported lower functional independence, and more participation problems and secondary health conditions compared with manual wheelchair users (p < 0.001). Ambulatory individuals using walking aids reported no better outcomes than manual wheelchair users, except for functional independence (p < 0.001). Ambulatory individuals without walking aids reported more paid work than those with walking aids (62.7% vs 34.3%, p < 0.001). Conclusion: In general, electric wheelchair users reported the least favourable long-term outcomes. Remarkably, ambulatory individuals using walking aids generally did not report better outcomes than manual wheelchair users.

Objectives: To establish recommendations for designing, delivering, evaluating, and reporting exercise intervention research to improve fitness-related outcomes in people living with spinal cord injury (PwSCI). Design: International consensus process. Setting: (1) An expert panel was established consisting of 9 members of the governing panel of the International Spinal Cord Society Physical Activity Special Interest Group and 9 additional scientists who authored or co-authored >= 1 exercise randomized controlled trial paper involving PwSCI. (2) We invited the panelists to draft an outline of the recommendations for 1 intervention component. (3) The panel reviewed the draft outlines and determined whether they fit the scope and objectives of the project, whether they were evidence-based, and whether they were sufficiently detailed. (4) We interviewed 7 PwSCI who had participated in >= 1 exercise trial to gather insights on their experiences within the trials, what they liked, and what they would change. (5) A first draft of the recommendations was approved by the panel and circulated to the general members of the International Spinal Cord Society Physical Activity Special Interest Group to gather their suggestions and opinions via an online survey. (6) The member feedback was used to revise the recommendations and panel members approved a final version. Participants: N/A. Interventions: N/A. Main Outcome Measure(s): N/A. Results: We generated 33 recommendations regarding participant recruitment, study sample size determination, outcome measurement, potential confounders, exercise intervention prescription and delivery, supporting adherence to the intervention, monitoring and reporting adherence and retention, fidelity of the delivery of the intervention, monitoring and reporting adverse events, study design, and registration of study protocol and preparation of a protocol paper. Conclusions: International experts have come to consensus on recommendations for conducting exercise intervention research involving PwSCI. Adopting these recommendations will increase the quality of the research and the overall certainty of the evidence regarding the effects of exercise on health outcomes in PwSCI. Archives of Physical Medicine and Rehabilitation 2025;106:491-506 (c) 2024 by the American Congress of Rehabilitation Medicine. Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

OBJECTIVE:To estimate the causal effect of pneumonia on the length of stay (LOS) and associated costs during inpatient rehabilitation following an acute spinal cord injury (SCI). DESIGN:Prospective multicenter cohort study using a causal inference framework. SETTING:Ten centers specialized in SCI rehabilitation in high-income countries. PARTICIPANTS:Newly injured SCI patients with complete or incomplete lesions at cervical or thoracic levels (C1-T12) admitted for inpatient rehabilitation. The study included adults (N=486), predominantly men (76.1%), with a median age of 55 years, who were roughly evenly divided between paraplegia (46.5%) and tetraplegia (53.5%). INTERVENTIONS:Not applicable. MAIN OUTCOME MEASURES:Additional rehabilitation LOS and associated excess costs because of pneumonia. RESULTS:Experiencing at least 1 episode of pneumonia was associated with an 11% increase in rehabilitation LOS on average. The resulting excess LOS was 21.3 days (95% confidence interval (CI), 18.9-23.7). The additional LOS because of pneumonia costs, on average, $41,812.57 (standard deviation 20,909.73) per patient. Patients with motor complete tetraplegia had the longest rehabilitation LOS, both with and without pneumonia (256.0d; 95% CI, 226.7-285.2 vs 228.9d; 95% CI, 201.6-256.2) and subsequential higher costs. CONCLUSIONS:Our findings indicate that pneumonia increases the average rehabilitation length of stay by 21 days and incurs additional costs exceeding $41,000 per patient in individuals with acute SCI. Early screening and prevention are essential to manage these impacts, especially in patients with motor complete tetraplegia.

PURPOSE:To examine: (1) the proportion of individuals with spinal cord injury (SCI) meeting three exercise guidelines over one year following a five-month handcycle training period; (2) whether meeting these guidelines is associated with life satisfaction (LS) and mental health (MH); and (3) which components of exercise (moderate/vigorous aerobic or strength) are longitudinally associated with LS and MH. MATERIALS AND METHODS:Participants (N = 80) with SCI or spina bifida completed assessments at baseline (T1), post-training (T2), and four months (T3) and one year (T4) later. Measures included the Physical Activity Scale for Individuals with Physical Disabilities and LS and MH questionnaires. Exercise guidelines assessed were: 1) Martin Ginis et al. Fitness (2x/week 20 min moderate/vigorous aerobic + 2x/week strength), 2) Martin Ginis et al. Cardiometabolic (3x/week 30 min moderate/vigorous aerobic), and 3) WHO (150 min moderate or 75 min vigorous aerobic + 2x/week strength). Multilevel regression analyses evaluated associations. RESULTS:Adherence to the cardiometabolic guideline decreased post-training (p < 0.01). Meeting any guideline was associated with better MH (p < 0.01), but not LS (p = 0.23). Moderate exercise showed significant longitudinal positive associations with LS (p = 0.03) and MH (p = 0.02), unlike vigorous or strength training. CONCLUSIONS:Sustained moderate exercise promotes LS and MH in individuals with SCI.Implications for rehabilitationOnly one third of individuals with spinal cord injury (SCI) meet SCI-specific exercise guidelines, making them one of the least physicallyactive populations.Sustained interventions are necessary to maintain exercise adherence and achieve long-term benefits.Individuals who meet the cardiometabolic health guideline have a better mental health than those who do not meet the guideline.Encourage individuals with SCI to engage in regular, moderate-intensity exercise, as it benefits both mental health and subjective well-being.

Objective: To describe the occurrence of pneumonia in individuals with acute spinal cord injury (SCI) and identify its key predictors. Design: Multi-centric, longitudinal cohort study. Setting: 10 specialized SCI rehabilitation units in Europe and Australia. Participants: Eligible were 902 men and women with acute SCI, aged 18 years or older, with cervical or thoracic lesions and not dependent on 24hour mechanical ventilation; 503 participated in the study (N=503). Interventions: Not applicable. Main Outcome Measures: We assessed demographics and lesion related parameters at study entry, and any pneumonia events throughout inpatient rehabilitation. Respiratory function, decubitus, and urinary tract infections were assessed at 1, 3, and 6 months post injury as well as at discharge from inpatient rehabilitation. Time to event (pneumonia) analyses were done using the Kaplan -Meier method, and potential predictors for pneumonia were analyzed with multivariable survival models. Results: Five hundred three patients with SCI were included, with 70 experiencing at least 1 pneumonia event. 11 participants experienced 2 or more events during inpatient rehabilitation. Most events occurred very early after injury, with a median of 6 days. Pneumonia risk was associated with tetraplegia (hazard ratio [HR]=1.78; 95% confidence interval [CI] 1.00-3.17) and traumatic etiology (HR=3.75; 95% CI 1.30-10.8) American Spinal Injury Impairment Scale (AIS) A (HR=5.30; 95% CI 2.28-12.31), B (HR=4.38; 95% CI 1.77-10.83), or C (HR=4.09; 95% CI 1.71-9.81) lesions. For every 10 cmH 2 O increase in inspiratory muscle strength, pneumonia risk was reduced by 13% (HR=0.87; 95% CI 0.78-0.97). Conclusion: Pneumonia is a major complication after SCI with the highest incidence very early after injury. Individuals with traumatic or AIS A, B, or C tetraplegia are at highest risk for pneumonia. Archives of Physical Medicine and Rehabilitation 2024;105:884 -91 (c) 2023 by the American Congress of Rehabilitation Medicine.

Background: Due to the majority of males within the population of persons with spinal cord injuries (SCI), a male- oriented perception of persons with SCI might affect care provision in the way of prioritizing male needs. Objective: The objective of this cross-sectional study is to describe the patient experience of persons with SCI by gender. Methods: This study was based on the International Spinal Cord Injury Survey with 12,588 participants from 22 countries. An interval-based patient experience score was attained by partial credit model. Regression analysis was used in exploring the association between patient experience and gender. Results: Participants reported very good and good patient experience. Respectful treatment was reported by 78 % of participants; clear explanations by 75 %; involvement in decision-making by 71 %; satisfaction with services by 62 %. The average patient experience score was equal among males and females (average: 64, range: 0-100), with the highest score in participants from the USA (78) and the lowest - in Morocco (44). Patient experience score was not associated with gender. Females had lower odds of reporting better decision-making involvement, yet higher odds of better satisfaction. Older participants, with higher household income and better self-rated health, had lower odds of being satisfied. Conclusion: The majority of persons with SCI rated their experience as good or very good. Females were more likely to report higher satisfaction with services and lower involvement in decision-making. For other patient experience categories and the overall patient experience score, no association with gender was found.

Study design Longitudinal cohort study. Objectives Examine the longitudinal association between mobility and level of physical activity (PA) and explore which other factors are also associated with level of PA in ambulatory people with Spinal Cord Injury (SCI) during the first-year post-inpatient rehabilitation. Setting Three SCI-specialized rehabilitation centers and the Dutch community. Methods Forty-seven adults with recent SCI and ambulatory function were included. All had motor incomplete lesions, 49% had tetraplegia, and the mean age was 55 ± 13 years. Duration of accelerometry-based all-day PA and self-reported level of mobility, exertion of walking, pain, fatigue, depressive mood symptoms, fear of falling, exercise self-efficacy, and attitude toward PA were measured just before discharge from inpatient rehabilitation and 6 and 12 months after discharge. All data were longitudinally analyzed using generalized estimating equations analyses. Models were corrected for age, lesion level, and time since injury. Results Mobility was longitudinally associated with level of PA (beta: 4.5, P < 0.001, R 2 : 41%). In addition, lower levels of exertion of walking (beta: −5.6, P < 0.001), fear of falling (beta: −34.1, P < 0.001), and higher levels of exercise self-efficacy (beta: 2.3, P = 0.038) were associated with higher levels of PA. Exertion of walking and fear of falling were associated with level of PA independent of mobility. Conclusions Mobility, exertion of walking, fear of falling, and exercise self-efficacy seem to be correlates of level of PA in ambulatory people with SCI during the first year after inpatient rehabilitation. Targeting these factors using an interdisciplinary approach may enhance levels of PA in this population.

For most patients with an incomplete spinal cord injury, gait rehabilitation plays a key role in functional recovery. Gait is usually assessed by physiotherapists and rehabilitation physicians through observational analysis or by specialized personnel through laboratory gait analysis. However, observational analysis is prone to misjudgment, and laboratory analysis is complex and time-consuming. Inertial measurement units (IMUs) could be an interesting alternative to bring objective gait analysis closer to the actual healthcare providers. This article focuses on identifying the requirements of an IMU-based gait assessment interface for use in a clinical setting by rehabilitation physicians and physiotherapists. The design process consisted of four stages: (1) user research to identify physicians’ and physiotherapists’ needs and expectations, and the context wherein the system will be used; (2) analysing and interpreting user research results to collect insights and define the design vision; (3) conceptualization and evaluation of initial concepts for the layout of the gait assessment interface and visualization of the gait parameters; (4) developing and evaluating the initial design and prototype of the interface. Future research will need to be conducted to further develop the usability and functionality of the interface.

A spinal cord injury (SCI) causes a lesion-dependent loss of respiratory muscle innervation and function. This study aimed to evaluate the time course and key determinants of between-person variation in respiratory function after SCI. Multi-center, prospective cohort (10 SCI units). Adult inpatients with acute, complete or incomplete cervical or thoracic SCI were eligible. Descriptive analysis were used for demographics. Mixed effects multilevel regression models with random intercepts (for center and person) were generated to segregate between-person from within-person variation. Modelled outcome parameters were: maximal inspiratory pressure (MIP), maximal expiratory pressure (MEP), peak cough flow (PCF), forced vital capacity (FVC), forced expiratory volume in 1s (FEV1) and peak expiratory flow (PEF). Independent variables were sex, age, body height, time post injury/diagnosis, lesion etiology, lesion level and completeness as well as time-updated occurrence of pneumonia. 490 individuals, mean (SD) age of 51 (17) years, mean height 177 (9) cm. were enrolled between October 2016 & July 2021. 77% were male, 73% had a traumatic lesion and 54% had tetraplegia. MIP and MEP were 9 and 15cm H20 lower when preceded by any pneumonia event. Pneumonia was associated with a reduction in forced expiratory parameters thereafter, such as PCF (-45 l/min; 95% CI: -78 to -12 l/min) and PEF (-48 l/min; 95% CI: -77 to -20 l/min). Respiratory function measures showed a non-linear, decelerating increase with time post injury that leveled-off at maximum values towards the end of the first year. Respiratory muscle strength and lung function were consistently lower in the 60+ age group.

Purpose (1) To estimate the proportion of Dutch wheelchair users with spinal cord injury (SCI) who meet different SCI exercise guidelines; (2) to evaluate which demographic and lesion characteristics are associated with meeting these guidelines; (3) whether meeting these guidelines is associated with physical fitness and health. Materials and methods Based on the PASIPD questionnaire items, participants were allocated to meeting two SCI aerobic exercise guidelines, which differ in exercise load. Differences in personal, lesion, fitness, and health characteristics between groups were tested with a one-way ANOVA. Multiple regression analyses were performed to evaluate if meeting guidelines was associated with better fitness and health. Statistical significance was accepted at p < 0.05. Results Of the 358 included participants, 63.1% met at least one aerobic exercise guideline. Being female, older age, having tetraplegia, and lower educational level were associated with a lower likelihood to meet the aerobic exercise guidelines. Meeting aerobic exercise guidelines showed a positive association with all respiratory and exercise capacity parameters. Limited associations were found between meeting exercise guidelines and health. Conclusions Meeting exercise guidelines was associated with better respiratory functions and exercise capacity with additional fitness and some body composition benefits in higher exercise activity levels.

Objectives: Evidence on social inequalities in mental health of persons with physical impairments is limited. We therefore investigate associations of individual-level socioeconomic status (SES) and the country-level socioeconomic development (SED) with mental health in persons with spinal cord injury (SCI). Methods: We analyzed data from 12,588 participants of the International SCI Community Survey from 22 countries. To investigate individual-level inequalities, SES indicators (education, income, financial hardship, subjective status) were regressed on the SF-36 mental health index (MHI-5), stratified by countries. Country-level inequalities were analyzed with empirical Bayes estimates of random intercepts derived from linear mixed-models adjusting for individual-level SES. Results: Financial hardship and subjective status consistently predicted individual-level mental health inequalities. Country-level SED was inconsistently related to mental health when adjusting for individual-level SES. It however appeared that higher SED was associated with better mental health within higher-resourced countries. Conclusion: Reducing impoverishment and marginalization may present valuable strategies to reduce mental health inequalities in SCI populations. Investigations of country-level determinants of mental health in persons with SCI should consider influences beyond country-level SED, such as cultural factors.

For most patients with an incomplete spinal cord injury, gait rehabilitation plays a key role in functional recovery. However, few methods are available to reliably assess gait function during rehabilitation. Therefore, an easy-to-use gait assessment interface was designed that provides more accurate and objective information than can be obtained with observational gait analysis, in a way that is more intuitive and comprehensible than laboratory gait analysis. A user-centered design process was utilized to develop the interface. The paper focuses on the first phase of the design process, user research, and how co-design and user-centered design were used to identify the users' needs, expectations, and the context wherein the gait assessment interface would be used. This was done through conducting focus group sessions with physicians and physiotherapists and using interactive activity boards to obtain answers and facilitate discussion. In-depth and extensive information was obtained through focus group sessions and interactive activity boards. This information, as well as user-centered design practices, will be used throughout the further development of the gait assessment interface.

Objectives: To describe the 3-month prevalence and correlates of self-reported physical health conditions in persons with spinal cord injury (SCI) worldwide. Study design: Multinational cross-sectional survey. Subjects: Community-living persons with traumatic or non-traumatic SCI aged >18 years from 21 countries representing all the 6 World Health Organization regions. Methods: The study used data from 11,058 participants in the International SCI Community Survey (InSCI). The survey, based on the International Classification of Functioning, Disability and Health (ICF) Core Sets for SCI, was conducted in 2017–19 simultaneously in the participating countries. The health conditions were reported on a modified version of the SCI Secondary Conditions Scale. Results: Overall, 95.8% of the participants reported having experienced 1 or more health problems secondary to SCI. Having pain was the most prevalent problem (77.3%), followed by spasticity/muscle spasms (73.5%) and sexual dysfunction (71.3%), and the least prevalent was respiratory problems (28.8%). The participants reported a mean of 7.4 concurrent health conditions. Unmet healthcare needs, being a smoker, being a female, having a complete lesion, and a traumatic injury exhibited significant associations with comorbidity. Conclusion: Physical health problems secondary to SCI are extremely common worldwide and demand investment in appropriate management, medical care and preventative measures. LAY ABSTRACT More than 500,000 people experience a spinal cord injury (SCI) every year. Because of the impairments of having SCI, many experience co-occurrence of additional health conditions, called comorbidity. This study describes the 3-month prevalence, and associated factors of self-reported physical health conditions secondary to SCI across 21 countries worldwide. The study uses data from 11,058 adults with SCI participating in the International SCI Community Survey in 2017–19. The results showed that physical health problems secondary to SCI are extremely common worldwide. Having pain, muscle spasms/spasticity, sexual dysfunction and bowel dysfunction were the most common, all with rates above 70%. The participants experienced a mean of 7 concurrent health conditions in addition to their SCI. Those reporting unmet healthcare needs, being a smoker, female, and having a complete lesion were most at risk for having comorbidity. These findings demand investment in appropriate management, medical care and preventative measures.

INTRODUCTION:Pneumonia is one of the leading complications and causes of death after a spinal cord injury (SCI). After a cervical or thoracic lesion, impairment of the respiratory muscles decreases respiratory function, which increases the risk of respiratory complications. Pneumonia substantially reduces patient's quality of life, may prolong inpatient rehabilitation time, increase healthcare costs or at worse, lead to early death. Respiratory function and coughing can be improved through various interventions after SCI, but the available evidence as to which aspect of respiratory care should be optimised is inconclusive. Furthermore, ability of respiratory function parameters to predict pneumonia risk is insufficiently established. This paper details the protocol for a large-scale, multicentre research project that aims to evaluate the ability of parameters of respiratory function to predict and understand variation in inpatient risk of pneumonia in SCI.METHODS AND ANALYSIS:RESCOM, a prospective cohort study, began recruitment in October 2016 across 10 SCI rehabilitation centres from Australia, Austria, Germany, the Netherlands and Switzerland. Inpatients with acute SCI, with complete or incomplete cervical or thoracic lesions, 18 years or older and not/no more dependent on 24-hour mechanical ventilation within the first 3 months after injury are eligible for inclusion. The target sample size is 500 participants. The primary outcome is an occurrence of pneumonia; secondary outcomes include pneumonia-related mortality and quality of life. We will use the longitudinal data for prognostic models on inpatient pneumonia risk factors.ETHICS AND DISSEMINATION:The study has been reviewed and approved by all local ethics committees of all participating centres. Study results will be disseminated to the scientific community through peer-reviewed journals and conference presentations, to the SCI community, other stakeholders and via social media, newsletters and engagement activities.TRIAL REGISTRATION DETAILS:ClinicalTrials.gov NCT02891096.

Objective: To evaluate changes in duration of physical activity (PA) and sedentary behavior (SB) from discharge to 1 year after inpatient rehabilitation in ambulatory people with spinal cord injury (SCI). Design: Longitudinal cohort study with objective measurements of physical behavior at discharge and at 6 and 12 months post discharge. Setting: Three rehabilitation centers and the participant's home environment. Participants: Participants (N= 47) with ambulatory function were consecutively recruited from the self-management and self-efficacy in patients with SCI cohort (age 18 years or older, recent SCI, expected inpatient stay >4wk). Mean age was 54.5 +/- 12.9 years, all had incomplete lesions, 53% were men, 49% had tetraplegia, and 51% were community ambulators at discharge. Interventions: Not applicable. Main Outcome Measures: Duration (min) of PA (summed duration of walking, cycling, running, and wheeling) and SB (sitting/lying). Results: Mean duration of PA increased by 21 min/d (95% confidence interval, 7-35) and SB decreased by 64 min/d (95% confidence interval, -94 to -35) from discharge to 6 months after inpatient rehabilitation. No changes were found in the second half-year. One year after discharge mean PA was 116 +/- 59 min/d and mean SB was 665 +/- 121 min/d. The increase in PA was the result of an almost doubling of time spent walking. Variability in physical behavior and its change was large. Older age and lower ambulation level were associated with lower PA, lower ambulation level with higher SB, and tetraplegia was associated with a reduced increase in PA. Conclusions: At group level, duration of PA and SB improved following inpatient rehabilitation in ambulatory people with SCI. However, there were large differences between individuals. Levels 1 year after discharge were still unfavorable, particularly regarding SB. (C) 2020 by the American Congress of Rehabilitation Medicine

Purpose: To develop and validate predictive models for peak power output to provide guidelines for individualized handcycling graded exercise test protocols for people with spinal cord injury (SCI); and to define reference values. Materials and methods: Power output was measured in 128 handcyclists with SCI during a synchronous handcycling exercise test. Eighty percent of the data was used to develop four linear regression models: two theoretical and two statistical models with peak power output (in W and W/kg) as dependent variable. The other 20% of the data was used to determine agreement between predicted versus measured power output. Reference values were based on percentiles for the whole group. Results: Lesion level, handcycling training hours and sex or body mass index were significant determinants of peak power output. Theoretical models (R-2 = 42%) were superior to statistical models (R-2=39% for power output in W, R-2 = 30% for power output in W/kg). The intraclass correlation coefficients varied between 0.35 and 0.60, depending on the model. Absolute agreement was low. Conclusions: Both models and reference values provide insight in physical capacity of people with SCI in handcycling. However, due to the large part of unexplained variance and low absolute agreement, they should be used with caution.

Study design Multicenter cross-sectional study. Objectives To determine the prevalence of parenthood in long-term wheelchair-dependent persons who sustained a spinal cord injury (SCI) during their reproductive years. Secondary aims were to (1) explore patient-specific and disease-related factors associated with parenthood after SCI; and (2) quantify fertility aids used by men with SCI. Setting Eight specialized SCI rehabilitation centers in the Netherlands. Methods Questionnaires and physical examination were applied in 255 persons with SCI. Prevalence rates of parenthood among the general Dutch population were used for comparison. Logistic regression analyses were used to explore factors associated with parenthood after SCI. Results Prevalence of parenthood in SCI was 50% in men and 45% in women, which was significantly ( P < 0.05) lower than rates in the general population (74% in men and 81% in women). Among the parents with SCI, most (66% of males and 72% of females) of them had children after SCI. Parenting children after SCI was associated with partnership (OR = 14.5, P < .001 [men]; OR = 3.7, P = .05 [women]), normal micturition (OR = 4.9, P = .02 [men]), incomplete lesion (OR = 5.4, P = .03 [women]), and paraplegia (OR = 7.3, P = .02 [women]). The most frequently used methods for ejaculation and fertilization were electroejaculation (29%) and intracytoplasmatic sperm injection (23%). Conclusions Prevalence of parenthood in SCI persons is low. However, half of the persons with SCI do become parents, with most doing so following SCI. Demographic and disease-related factors may contribute to this.

Post, Marcel W.M. PhD; Nooijen, Carla F. PhD; Postma, Karin PT, PhD; Dekkers, Jos; Penninx, Frans; van den Berg-Emons, Rita J.G. PhD; Stam, Henk J. MD, PhD Author Information

Study design: Follow-up measurement in a multicenter prospective cohort study. Objectives: To examine the prevalence of impaired respiratory function (pulmonary function and perceived respiratory function), the incidence of respiratory infection and the associations among these parameters in people with spinal cord injury (SCI) 5 years after initial inpatient rehabilitation. Second, we assessed associations between respiratory function and health-related quality of life (HRQOL). Setting: Eight rehabilitation centers with specialized SCI units in the Netherlands. Methods: Measurements were performed 5 years after discharge of inpatient rehabilitation. Pulmonary function was determined by forced vital capacity (FVC) and perceived respiratory function by self-reported cough strength and dyspnea. HRQOL was measured using the Sickness Impact Profile 68 and the 36-item Short Form Health Survey. Results: One-hundred forty-seven people with SCI participated. Of this sample, 30.9% had impaired FVC, 35.9% poor or moderate cough strength, 18.4% dyspnea at rest and 29.0% dyspnea during activity. In the year before the measurements, 8.9% had had respiratory infection. FVC was associated with cough strength, but not with dyspnea. All respiratory function parameters were associated with social functioning, whereas other HRQOL domains were associated with dyspnea only. Conclusion: Five years after initial inpatient rehabilitation, impaired respiratory function and respiratory infection were common in people with SCI. More severely impaired respiratory function was associated with lower HRQOL. Sponsorship: The Netherlands Organisation for Health Research and Development.