Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development Service, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA.
Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA.
J Spinal Cord Med. 2022 Nov;45(6):946-956. doi: 10.1080/10790268.2021.1907675. Epub 2021 Apr 8.
CONTEXT/OBJECTIVE: To describe patient experiences with fracture prevention and management among persons with spinal cord injuries/disorders (SCI/D).
Qualitative data collected via semi-structured telephone interviews.
Veterans Health Administration (VA) SCI/D System of Care.
Veterans with SCI/D (= 32) who had experienced at least one lower-extremity fracture in the prior 18 months.
N/A.
Interview questions addressed patients': pre-fracture knowledge of osteoporosis and bone health, diagnosis and management of osteoporosis, history and experiences with fracture treatment, and post-fracture care and experiences.
Participants expressed concerns about bone health and fractures in particular, which for some, limited activities and participation. Participants recalled receiving little information from providers about bone health or osteoporosis and described little knowledge about osteoporosis prevention prior to their fracture. Few participants reported medication management for osteoporosis, however many reported receiving radiographs/scans to confirm a fracture and most reported being managed non-operatively. Some reported preference for surgical treatment and believed their outcomes would have been better had their fracture been managed differently. Many reported not feeling fully included in treatment decision-making. Some described decreased function, independence and/or participation post-fracture.
CONCLUSION(S): Our results indicate that persons with SCI/D report lacking substantive knowledge about bone health and/or fracture prevention, and following fracture, feel unable and/or hesitant to resume pre-fracture participation. In addition, our findings indicate that individuals with SCI/D may not feel as engaged as they would like to be in establishing fracture treatment plans. As such, persons with SCI/D may benefit from ongoing discussions with providers about risks and benefits of fracture treatment options and consideration of subsequent function and participation, to ensure patients preferences are considered.
背景/目的：描述脊髓损伤/疾病（SCI/D）患者在预防和管理骨折方面的体验。
通过半结构化电话访谈收集定性数据。
退伍军人事务部（VA）SCI/D 护理系统。
在过去 18 个月内经历过至少一次下肢骨折的 SCI/D 退伍军人（n=32）。
无。
访谈问题涉及患者：骨折前对骨质疏松症和骨骼健康的了解，骨质疏松症的诊断和管理，骨折治疗的历史和经验，以及骨折后的护理和体验。
参与者对骨骼健康和骨折特别关注，这使他们中的一些人限制了活动和参与。参与者回忆说，他们从提供者那里获得的关于骨骼健康或骨质疏松症的信息很少，并描述了在骨折前对骨质疏松症预防的了解甚少。很少有参与者报告接受骨质疏松症药物治疗，但许多人报告接受 X 光/扫描以确认骨折，大多数人报告接受非手术治疗。一些人报告对手术治疗有偏好，并认为如果他们的骨折处理方式不同，他们的结果会更好。许多人报告说他们在治疗决策中没有完全被包括在内。一些人描述了骨折后功能、独立性和/或参与度下降。
我们的研究结果表明，SCI/D 患者报告缺乏关于骨骼健康和/或骨折预防的实质性知识，并且在骨折后，他们感到无法或犹豫恢复骨折前的参与度。此外，我们的研究结果表明，SCI/D 患者可能不像他们希望的那样积极参与建立骨折治疗计划。因此，SCI/D 患者可能受益于与提供者就骨折治疗方案的风险和益处进行持续讨论，并考虑随后的功能和参与度，以确保考虑到患者的偏好。
