516
K. Wahman et al.
Table IV. Association between injury characteristics and the 3 most
common complications during rehabilitation ( n = 31)
Variable, n
Tetraplegia
No
Number of complications
19 7
2 3
11 9
9 2
6 5
13 6
11 2
10 8
12 1
0.24
Zero or 1
Two or more
Spasticity
0.45
Yes
No
Urinary tract infections
0.13
Yes
No
Neuropathic pain
0.02
Yes
No
9
9
Complete Incomplete
11 15
1 4
5 15
2 9
4 7
3 16
6 7
6 12
Yes 5 8
No 7 11
0.62
Any complication
Yes
No
Number of complications
1.0
Zero or 1
Two or more
Spasticity
0.37
Yes
No
Urinary tract infections
0.71
Yes
p-value
0.30
Yes
Paraplegia
Any complication
No
Neuropathic pain
1.0
associations were found between completeness of
injury and the presence of any complication, number of
complications, and the 3 most common complications
during rehabilitation.
Association between secondary complications and
return-to-work one year after injury
Out of the initial 45 persons enrolled, 29 were eligible
for return-to-work, while the rest were retired prior
to injury (n = 12) or lost to follow-up (n = 3). The
remaining person died during acute care. No associa-
tion was found between return-to-work and having a
complication during acute care (p = 0.16), as well as
during rehabilitation (p = 1.0). Similarly, no associa-
tion was found between the number of complications,
i.e. zero-to-1 vs 2-or-more, and return-to-work during
both acute and inpatient rehabilitation. Level of injury,
as well as completeness of injury, had no association
with return-to-work.
DISCUSSION
The aim of this study was to determine the prevalence
of secondary medical complications during acute care
www.medicaljournals.se/jrm
and inpatient rehabilitation, and assess for associations
between level, as well as completeness, of injury and
the most common secondary complications during both
phases. Lastly, this study assessed whether the presence
and number of complications had an effect on return-
to-work one year after injury. Secondary complications
were present during both acute care and inpatient
rehabilitation. The most common complications, i.e.
UTIs and neuropathic pain, were the same for both
episodes of specialized care. In addition, neuropathic
pain was more common in those with tetraplegia than
paraplegia during both phases.
The prevalence of secondary medical conditions
during acute care appears high despite the use of
specialized services in the management of SCI in
Sweden. The findings of the current study on the
most common complications during acute care share
similarities with international literature. For example,
a study from the Netherlands found pressure injuries
(32%) and pulmonary complications (28%) to be
the leading secondary complications during acute
care (14), while another study, conducted in South
Africa, found pressure injuries (30%), pulmonary
complications (23%) and UTI (17%) to be the leading
complications during this care phase (4). The findings
of the current study thus imply better prevention of
pressure ulcers during acute care in Sweden. Howe-
ver, a better understanding of the influences leading
to the development of UTIs is required in order to
optimize patient-oriented, as well as healthcare ef-
ficiency, outcomes.
Concerning the prevalence of complications during
inpatient rehabilitation, the findings of the current
study corroborate with findings from the Netherlands
(15). In the latter study, the most common compli-
cations during this care episode were neurogenic
pain and spasticity (15). Again, the current findings
indicate a high prevalence of UTIs during the acute
phase. Furthermore, pressure injuries were not as rare
during rehabilitation as in acute care. Interestingly, we
found no or only a few cases of several complications,
such as deep vein thrombosis, autonomic dysreflexia,
and postural hypotension. On the contrary, the lack
of postural hypotension and autonomic dysreflexia in
acute care and rehabilitation, respectively, is peculiar.
There is therefore a need to investigate the evalua-
tion criteria of secondary medical complications in
the current healthcare context in order to assess its
alignment with international guidelines, which may
improve both diagnosis and treatment of preventable
complications.
Another aim of the current study was to assess for
associations between some injury characteristics and