Background
Methods
Study design
Measures
Outcome variables
Explanatory variables
Statistical methods
Results
Participants’ characteristics
Variable | Value (N = 1095) |
---|---|
Males, n (%) | 787 (72) |
Age groups, n (%) | |
16–29 years | 48 (4) |
30–44 years | 204 (19) |
45–59 years | 376 (34) |
60–74 years | 358 (33) |
≥75 years | 109 (10) |
Marrieda, n (%) | 590 (54) |
Informal caregiverb, n (%) | 498 (46) |
Born in Switzerland, n (%) | 909 (83) |
Years of education, n (%) | |
Less than 10 years | 65 (6) |
10–12 years | 206 (20) |
13–15 years | 438 (42) |
≥16 years | 342 (32) |
Employed, n (%) | 510 (47) |
Subjective social statusc, n (%) | |
Low (rungs 1–3) | 144 (14) |
Middle (rungs 4–7) | 738 (70) |
High (rungs 8–10) | 166 (16) |
Language, n (%) | |
German | 769 (70) |
French | 279 (26) |
Italian | 47 (4) |
Travel distance to health-care provider | |
≤25 min travel distance to personal GPd, n (%) | 913 (86) |
≤25 min travel distance to nearest SCI centred, n (%) | 334 (31) |
Time since SCI in years, median (Q1–Q3) | 15.7 (7.8–27.2) |
Tetraplegia, n (%) | 324 (30) |
Complete injury, n (%) | 361 (33) |
Missing | 120 (11) |
Traumatic SCI, n (%) | 872 (80) |
Morbidity profile
First contact of care | ||||
---|---|---|---|---|
GP (n = 483) | Specialist (n = 612) | |||
N = 1095 | Moderate/ Major problem1 | Moderate/ Major problem1 | Statistical significance2 | |
SCI-SCS score, (mean ± SD) | (14.0 ± 7.5) | (13.1 ± 7.7) | (14.6 ± 7.3) | †† |
Genitourinary and bowel | ||||
Bowel dysfunction, n (%) | 469 (43) | 187 (40) | 282 (60) | * |
Bladder dysfunction, n (%) | 488 (45) | 200 (41) | 288 (59) | |
Sexual dysfunction, n (%) | 608 (56) | 242 (40) | 366 (60) | ** |
Urinary tract infections, n (%) | 389 (36) | 155 (40) | 234 (60) | * |
Muscle structure and pain | ||||
Contractures, n (%) | 378 (35) | 162 (43) | 216 (57) | |
Pain, n (%) | 620 (57) | 274 (44) | 346 (56) | |
Muscle spasm (spasticity), n (%) | 518 (47) | 204 (39) | 314 (61) | ** |
Skin, breathing and metabolism | ||||
Pressure injuries, n (%) | 176 (16) | 73 (41) | 103 (59) | |
Diabetes mellitus, n (%) | 71 (6) | 45 (63) | 26 (37) | ** |
Respiratory problems, n (%) | 111 (10) | 49 (44) | 62 (56) | |
Injury due to loss of sensation, n (%) | 100 (9) | 39 (39) | 61 (61) | |
Circulatory and autonomic problems | ||||
Autonomic dysreflexia, n (%) | 145 (13) | 52 (36) | 93 (64) | * |
Postural hypotension, n (%) | 87 (8) | 32 (37) | 55 (63) | |
Circulatory problems, n (%) | 219 (20) | 92 (42) | 127 (58) | |
Heterotopic bone ossification, n (%) | 42 (4) | 22 (52) | 20 (48) | |
Other chronic conditions | ||||
Coronary heart disease, n (%) | 112 (10) | 62 (55) | 50 (45) | * |
Cancer, n (%) | 73 (7) | 37 (51) | 36 (49) | |
Depression, n (%) | 154 (14) | 72 (47) | 82 (53) | |
Sleep problems, n (%) | 384 (35) | 158 (41) | 226 (59) |
Use of health-care services
Utilization of health-care services in the previous year | First contact of care | |||||||
---|---|---|---|---|---|---|---|---|
GP | Specialist1 | |||||||
Visits2 | Number of visits | Number of days | Visits2 | Number of visits | Number of days | Statistical significance3 | ||
n (%) | n (%) | mean (SD) | mean (SD) | n (%) | mean (SD) 4 | Mean (SD) | ||
Total, n (%) | 1095 (100) | 483 (44) | 612 (56) | |||||
Health-care professionals | 1051 (96) | 456 (43) | 595 (57) | |||||
General practitioner | 909 (87) | 430 (47) | 5.1 (5.2) | 479 (53) | 3.9 (7.2) | †† *** | ||
Specialist for paraplegia | 463 (44) | 101 (22) | 1.7 (1.8) | 362 (78) | 2.6 (3.7) | † *** | ||
Other specialist | 561 (53) | 235 (42) | 5.3 (9.8) | 326 (58) | 4.5 (7.2) | |||
Nurse or midwife | 60 (6) | 30 (50) | 105.1 (156.0) | 30 (50) | 40.7 (86.7) | |||
Psychologist | 97 (9) | 44 (45) | 10.5 (12.2) | 53 (55) | 11.9 (14.3) | |||
Speech therapist | 15 (1) | 6 (40) | 19.8 (17.3) | 9 (60) | 31.3 (43.9) | |||
Occupational therapist | 176 (17) | 52 (30) | 18.6 (25.1) | 124 (70) | 21.3 (29.7) | *** | ||
Physiotherapist | 685 (65) | 273 (40) | 44.1 (36.6) | 412 (60) | 47.9 (36.0) | *** | ||
Ambulatory or polyclinic visits | 567 (53) | 205 (36) | 362 (64) | |||||
Planned | 446 (79) | 151 (34) | 3.7 (7.3) | 295 (66) | 3.6 (6.7) | *** | ||
Unplanned | 204 (36) | 83 (41) | 1.6 (1.1) | 121 (59) | 1.9 (3.7) | |||
SCI centres | 639 (59) | 169 (26) | 470 (74) | |||||
Control visit | 570 (89) | 141 (25) | 429 (75) | *** | ||||
Ambulatory treatment | 197 (31) | 40 (20) | 157 (80) | *** | ||||
Inpatient stay | 344 (31) | 133 (39) | 211 (61) | |||||
Hospital | 331 (96) | 129 (39) | 1.9 (1.7) | 22.8 (43.2) | 202 (61) | 1.5 (1.3) | 31.0 (42.8) | * |
SCI centre | 151 (44) | 35 (23) | 116 (77) | *** | ||||
No visits to any health service provider | 35 (3) | 21(60) | 14 (40) |
Factors associated with choice of GP as the first contact for SCI-specific care
Factors | Univariate OR (95% CI) | Multivariable OR (95% CI) |
---|---|---|
Sociodemographic factors | ||
Males, (ref: females) | 0.86 (0.66–1.12) | 0.97 (0.70–1.35) |
Age groups, (ref: 16–29 years) | ||
30–44 years | 0.99 (0.50–1.95) | 1.08 (0.52–2.23) |
45–59 years | 1.50 (0.79–2.85) | 1.41 (0.69–2.89) |
60–74 years | 2.14 (1.12–4.08) * | 1.62 (0.76–3.47) |
≥ 75 years | 5.11 (2.47–10.61) *** | 4.44 (1.85–10.69) ** |
Marrieda, (ref: single) | 1.29 (1.01–1.64) * | 1.07 (0.79–1.45) |
Informal caregiver, (ref: paid assistance or none)b | 0.84 (0.66–1.07) | 0.80 (0.59–1.09) |
Born in Switzerland, (ref: foreign born) | 1.02 (0.73–1.41) | 1.22 (0.83–1.80) |
Years of education, (ref: < 10 years) | ||
10–12 years | 0.80 (0.46–1.39) | 0.94 (0.50–1.76) |
13–15 years | 0.68 (0.40–1.16) | 0.85 (0.47–1.54) |
≥ 16 years | 0.44 (0.25–0.77) ** | 0.70 (0.38–1.31) |
Employed, (ref: unemployed) | 0.59 (0.46–0.75) *** | 0.90 (0.64–1.26) |
Subjective social status, (ref: low SSS [1–3])c | ||
Middle SSS (4–7) | 0.64 (0.44–0.91) * | 0.73 (0.47–1.13) |
High SSS (8–10) | 0.65 (0.41–1.02) | 0.81 (0.46–1.43) |
Income in Swiss Francsd, (ref: less than 2000) | ||
Between 2000 and 2999 | 1.20 (0.64–2.23) | 1.12 (0.55–2.27) |
Between 3000 and 3999 | 0.92 (0.50–1.69) | 0.93 (0.47–1.83) |
Between 4000 and 4999 | 0.73 (0.40–1.35) | 0.81 (0.40–1.63) |
Between 5000 and 6000 | 0.62 (0.33–1.14) | 0.62 (0.31–1.26) |
More than 6000 | 0.61 (0.34–1.11) | 0.70 (0.34–1.41) |
Geographical factors | ||
Language, (ref: German) | ||
French | 1.10 (0.83–1.45) | 0.99 (0.72–1.37) |
Italian | 2.44 (1.35–4.43) ** | 5.06 (2.44–10.47) *** |
Travel distancee to personal GP, (ref: > 25 min)g | ||
≤25 min to personal GP | 1.14 (0.81–1.61) | 1.22 (0.82–1.81) |
Travel distancee to SCI centre, (ref: > 25 min) | ||
≤ 25 min to nearest SCI centre | 0.88 (0.67–1.14) | 0.69 (0.51–0.93) * |
Injury-related factors | ||
Time since injury | 0.99 (0.99–1.00) | 1.01 (0.99–1.02) |
Lesion status, (ref: paraplegia) | ||
Tetraplegia | 0.95 (0.73–1.22) | 0.94 (0.68–1.29) |
Severity of injury, (ref: complete) | ||
Incomplete | 2.60 (1.99–3.37) *** | 2.39 (1.71–3.35) *** |
Cause of SCI, (ref: non-traumatic) | ||
Traumatic | 0.55 (0.41–0.73) *** | 0.75 (0.52–1.07) |
Secondary health conditions factors h | ||
SCI-SCS score | 0.97 (0.95-0.98) *** | 0.92 (0.86-0.99) * |
Genitourinary and bowel | ||
Bowel dysfunction | 0.73 (0.58–0.93) * | 0.86 (0.60–1.23) |
Bladder dysfunction | 0.80 (0.63–1.02) | 1.21 (0.84–1.76) |
Sexual dysfunction | 0.69 (0.55–0.88) ** | 1.09 (0.74–1.59) |
Urinary tract infections | 0.76 (0.59–0.98) * | 1.10 (0.77–1.56) |
Muscle structure and pain | ||
Contractures | 0.91 (0.71–1.16) | 1.05 (0.73–1.51) |
Pain | 1.00 (0.79–1.26) | 1.47 (1.04–2.09) * |
Muscle spasm (spasticity) | 0.71 (0.55–0.90) ** | 0.95 (0.68–1.34) |
Skin, breathing and metabolism | ||
Pressure injuries | 0.87 (0.63–1.20) | 1.10 (0.71–1.70) |
Diabetes mellitus | 2.22 (1.35–3.64) ** | 1.85 (1.05–3.27) * |
Respiratory problems | 0.97 (0.64–1.47) | 1.14 (0.68–1.90) |
Injury due to loss of sensation | 0.79 (0.52–1.20) | 1.23 (0.72–2.07) |
Circulatory/autonomic problems | ||
Autonomic dysreflexia | 0.68 (0.47–0.97) * | 1.08 (0.65–1.79) |
Postural hypotension | 0.71 (0.45–1.11) | 0.88 (0.48–1.60) |
Circulatory problems | 0.89 (0.65–1.22) | 1.11 (0.73–1.68) |
Heterotopic bone ossification | 1.33 (0.72–2.45) | 1.62 (0.77–3.42) |
Other chronic conditions | ||
Coronary heart disease | 1.59 (1.07–2.35) * | 1.22 (0.76–1.93) |
Cancer | 1.30 (0.80–2.11) | 0.95 (0.56–1.64) |
Depression | 1.11 (0.80–1.55) | 1.33 (0.89–1.98) |
Sleep problems | 0.83 (0.64–1.06) | 1.00 (0.70–1.41) |