Lower extremity fracture prevention and management in persons with spinal cord injuries and disorders: The patient perspective

Bella Etingen; Laura D Carbone; Marylou Guihan; Cara Ray; Hamad Aslam; Rachel Elam; Frances M Weaver

doi:10.1080/10790268.2021.1907675

Lower extremity fracture prevention and management in persons with spinal cord injuries and disorders: The patient perspective

J Spinal Cord Med. 2022 Nov;45(6):946-956. doi: 10.1080/10790268.2021.1907675. Epub 2021 Apr 8.

Authors

Bella Etingen¹, Laura D Carbone^{2

3}, Marylou Guihan^{1

4}, Cara Ray¹, Hamad Aslam⁵, Rachel Elam³, Frances M Weaver^{1

6}

Affiliations

¹ Center of Innovation for Complex Chronic Healthcare (CINCCH), Health Services Research and Development Service, Department of Veterans Affairs, Hines VA Hospital, Hines, Illinois, USA.
² Charlie Norwood Veterans Administration Medical Center, Augusta, Georgia, USA.
³ Department of Medicine, Division of Rheumatology, Medical College of Georgia at Augusta University, Augusta, Georgia, USA.
⁴ Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.
⁵ Shepherd Center for Spinal Cord Injury Rehabilitation, Atlanta, Georgia, USA.
⁶ Public Health Sciences, Parkinson School of Health Sciences and Public Health, Loyola University, Maywood, Illinois, USA.

Abstract

Context/objective: To describe patient experiences with fracture prevention and management among persons with spinal cord injuries/disorders (SCI/D).

Design: Qualitative data collected via semi-structured telephone interviews.

Setting: Veterans Health Administration (VA) SCI/D System of Care.

Participants: Veterans with SCI/D (n = 32) who had experienced at least one lower-extremity fracture in the prior 18 months.

Interventions: N/A.

Outcome measures: 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.

Results: 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.

Keywords: Bone health; Lower-extremity fractures; Osteoporosis; Spinal cord injury; Veterans.

Publication types

Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

Fractures, Bone* / etiology
Fractures, Bone* / prevention & control
Humans
Lower Extremity / injuries
Osteoporosis* / complications
Osteoporosis* / prevention & control
Spinal Cord Diseases*
Spinal Cord Injuries* / complications
Spinal Cord Injuries* / therapy

Grants and funding

This study was supported by the U.S. Department of Defense: [grant number SCI50092] and US Department of Veterans Affairs, Office of Research and Development, Health Services Research and Development Service: [grant number IIR 15-294].