title: Outcomes 2 years after traumatic spinal cord injury in Botswana: a follow-up study.
abstract: METHODS
  Prospective follow-up study.
  
  
  OBJECTIVE
  To identify indicators leading to compliance with yearly controls (YCs) and to describe the clinical and functional outcomes 2 years after traumatic spinal cord injury (SCI).
  
  
  METHODS
  The national SCI rehabilitation centre in Botswana.
  
  
  METHODS
  Included in the study were all people who were admitted with a traumatic SCI during a 2-year period and survived to be discharged (n=38). Data were collected at the YCs and included demographic characteristics and clinical and functional outcomes. Comparisons were made between those who did or did not attend YCs and between those who did or did not develop pressure ulcers (PUs).
  
  
  RESULTS
  The follow-up rate was 71% (27/38) with higher attendance among those with complete injuries and those with secondary complications, especially pain. Age, gender, distance to the centre and education did not affect the follow-up rate. Self-catheterisation and suprapubic catheter were the preferred methods to manage neurogenic bladder dysfunction. Despite high rates of PUs (48%) and urinary tract infections (UTIs; 41%), no death had occurred during the follow-up period. Furthermore, one-third had resumed work.
  
  
  CONCLUSIONS
  Despite high rates of UTIs and PUs developed in the home environment, this study showed a high survival rate 2 years after traumatic SCI, which might be explained by the establishment of a specialised SCI unit and the high follow-up rate. In addition, the continuing contact with the SCI staff might have facilitated the relatively high return-to-work rate. Long-term follow-up seems possible even in resource-constrained settings with clearly stated objectives, transport, dedicated staff and well-educated patients and families.
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.|Spinalis/Rehab Station Stockholm, Stockholm, Sweden.
authors.forename: I
authors.initials: I
authors.lastname: Löfvenmark
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
authors.forename: L Nilsson
authors.initials: LN
authors.lastname: Wikmar
authors.affiliation: Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Hasselberg
authors.affiliation: Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Norrbrink
authors.affiliation: Division of Neurodegeneration, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Hultling
mesh_terms: D000293:Adolescent; D000328:Adult; D001902:Botswana / Q000453:epidemiology; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D003668:Pressure Ulcer / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D011446:Prospective Studies; D062707:Return to Work; D012648:Self Care; D019529:Sexuality; D012959:Socioeconomic Factors; D013119:Spinal Cord Injuries / Q000150:complications / Q000453:epidemiology* / Q000628:therapy*; D016896:Treatment Outcome; D001750:Urinary Bladder, Neurogenic / Q000453:epidemiology / Q000209:etiology / Q000534:rehabilitation; D014552:Urinary Tract Infections / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D055815:Young Adult