The prevalence and profile of spinal cord injury in public rehabilitation hospitals in Gauteng, South Africa: a retrospective, population-based study

Abstract

Introduction: Spinal cord injury (SCI) is devastating, with morbidity affecting physical, emotional, social and vocational life areas. The effects of SCI are multifactorial and have been shown to negatively impact well-being and health-related quality of life. Rehabilitation plays an important role in the prevention of secondary health complications and attainment of functional independence. The Rehabilitation 2030 Call for Action by the World Health Organization has highlighted the need for ongoing surveillance and collection of rehabilitation data to inform planning and optimize service delivery for persons with spinal cord injury (PWSCI).

Aim: The aim of this study was to determine the prevalence and profile of SCI in public healthcare rehabilitation units in Gauteng.

Methodology: A retrospective, medical record review was performed at each of the five public healthcare rehabilitation units in Gauteng. Participants included PWSCI aged 18 yearsand above who were admitted for rehabilitation between 01 January 2018 and 31 December 2019 with a confirmed, first-time SCI irrespective of cause. A specifically designed data collection form was generated and used, and included all components of the International Spinal Cord Injury Core Data Set.

Results: Overall, 998 patients were admitted for rehabilitation in Gauteng’s public healthcare rehabilitation units during the study period. Of these, 386 were PWSCI that fitted the inclusion criteria and their medical records were thus included in the study. This gave the province a SCI prevalence of 38.67% in public healthcare rehabilitation units. Items that were not documented in the medical records are specified as missing in this dissertation. An overall mean age of 36.90 years (SD = 12.12) was noted in the study with those sustaining a traumatic spinal cord injury (TSCI) significantly younger than those sustaining a nontraumatic spinal cord injury (NTSCI) (p ≤ 0.001). The mean age of participants who sustained a TSCI was 33.56 years (SD = 10.08) whereas the mean age of those sustaining a NTSCI was 43.20 years (SD = 13.14). With regards to sex, males accounted for 69.95% (n = 270) of study participants and females 30.05% (n = 116). Sex was also found to be significantly associated with aetiology, with males more likely to sustain a TSCI (n = 212, 84.46%) and females more vulnerable to NTSCI (n = 76, 58.02%) (p ≤ 0.001). A positive HIV status (n = 65, 16.84%) and presence of comorbidities (n = 89, 23.06%) were found to be significant risk factors for developing a NTSCI (p ≤ 0.001). Traumatic SCI (n = 251, 65.70%) was found to be more common than NTSCI (n = 131, 34.29%) with the leading cause of injury assault (n = 136, 35.6%) followed by transportation-related injuries (n = 87, 22.77%) and infectious causes (n = 66, 17.28%). Classification of injury according to the American Spinal Injury Association (ASIA) Impairment Scale (AIS) found complete AIS A injuries to be most common (n = 170, 44.04%) with this finding significantly associated with TSCI (p ≤ 0.001). Most participants in this study were classified as paraplegic (n = 210, 54.40%) with the lower thoracic spine the area most commonly injured (n = 105, 27.20%). The majority of participants were admitted from tertiary-level healthcare institutions (n = 224, 58.03%) with a mean time between injury and rehabilitation admission of 64.48 days (SD = 59.78). The mean length of stay in rehabilitation was 85.59 days (SD = 63.2) with 342 PWSCI (88.60%) completing rehabilitation and being discharged, most commonly to a private residence (n = 330, 96.49%). The majority of these participants made use of a manually-operated wheelchair at discharge (n = 185, 54.09%). Of those that did not complete rehabilitation (n = 44, 11.40%), 6.48% demised (n = 25), 2.07% refused continuation of rehabilitative treatment (n = 8), 1.81% absconded (n = 7) and 1.04% became medically unstable and were deemed unfit to continue rehabilitation (n = 4).

Conclusion: The findings of this study vary greatly between each of the five public healthcare rehabilitation units but were overall found to be similar to those previously published in Gauteng. A finding unique to South Africa that was confirmed by this study is that more females were affected by NTSCI. This study serves as a strong foundation from which to conduct further epidemiological research into PWSCI not only in Gauteng, but in all other provinces of South Africa too. Furthermore, it is recommended that the epidemiological profile be extended to include privately-funded rehabilitation units in Gauteng and/or South Africa such that there is a comprehensive understanding of SCI on a national scale.