Praxis leads the analysis of national and provincial SCI data to describe epidemiology.
This includes updating the incidence and prevalence of traumatic and non-traumatic SCI, and conducting health economic assessments (costs, return on investment) to inform planning, funding, delivery and evaluation of injury prevention and health care programs.
Epidemiology of Traumatic SCI
Since our initial report on TSCI incidence in Canada (Noonan 2012), we recently published an updated incidence and prevalence of TSCI, and trends over time using national-level health administrative data (Thorogood 2023). For 2019, there were an estimated 1,199 cases (32.0 per million) of TSCI admitted to hospitals. The estimated number of people living with TSCI was 30,239 (804/million) (52% with paraplegia and 48% with tetraplegia). During the 15-year time frame, trends included an increase in incident cases each year, an older average age at injury (47 to 54 years old) and a larger proportion over the age of 65.
Epidemiology of Non-traumatic SCI
We are taking a similar approach with the national administrative data to investigate the incidence and prevalence of NTSCI in Canada. Work is underway with Drs. Chester Ho, Jeffery Bakal, and Tara Whitten at Provincial Research Data Services, Alberta Health Services. A NTSCI National Advisory Working Group consisting of experts including persons with lived experience in SCI (PLEX) and researchers in NTSCI will be convened to provide input on the analysis and next steps towards building a national NTSCI strategy. Experts such as Drs. Ho, Susan Jaglal, and Colleen O’Connell, with Praxis’ support, have previously developed and validated an algorithm to identify persons with NTSCI using health administrative data from various provinces. This work is critical in getting a better estimate of the entire population at risk and at multiple clinical points of care.
Traumatic SCI in BC
Linking the BC health administrative data from Population Data BC with our RHSCIR data, the Praxis Research Team, together with spine surgeons Drs Marcel Dvorak and Brian Kwon, are working to identify the incidence and prevalence of TSCI in BC, and also to examine whether patients admitted to specialized centres that provide acute and rehabilitation SCI care with SCI specialized personnel and technologies would have better outcomes than patients who were admitted to a non-specialized centre. The first publication focused on survival outcomes following TSCI is published in the Journal of Neurotrauma. Preliminary results related to health care utilization rates following the injury have been presented at the Canadian Spine Society 2024 Conference and are to be submitted for publication.
Praxis has been collaborating with other research groups and clinical teams on using this rich BC dataset to investigate other SCI-related topics. One such project is with Drs. Jason Sutherland and Michael Bond, UBC Centre for Health Services and Policy Research (CHSPR), and involves estimating the epidemiology, life expectancy, health care utilization and medication use in the BC TSCI population.
Pediatric TSCI
The incidence of pediatric SCI is relatively low; however, the consequences are devastating with substantial impact on young people living with the condition, their families, the health care system and society. To date, most of the research and evidence available has focused on SCI in adults. Through the support of a philanthropic donor, Praxis conducted the first Canadian environmental scan of pediatric SCI research and care. The goal was to improve the understanding of pediatric SCI and identify priority knowledge gaps.
To continue advance work in pediatric SCI, ongoing collaboration with Drs. James Crispo and Jacquelyn Cragg, UBC International Collaboration on Repair Discoveries (ICORD), using US national database to estimate the number of children admitted to a hospital due to TSCI (Crispo 2022) and the trends in emergency department visits for TSCI in children in the US (Crispo 2023).
Economic research in spinal cord injury (SCI) informs decisions in care and supports Canadian network initiatives.
Contributing to Future Healthcare Decisions
There are several important pieces to the Canadian healthcare puzzle. Economic analysis is an accepted and effective method for generating information to inform decisions. Economic research methodologies and techniques can serve to illustrate the burden of SCI, on the value of interventions on the direct and indirect cost of secondary health conditions for example, and establish evidence.
The Vision of a Health Economics Agenda
Praxis is supporting the development and implementation of a health economics agenda for spinal cord injury research in Canada. The agenda recognizes Praxis’ core programs, concurrent Canadian SCI Network member-led initiatives, and the gap in empirical health economic evidence in the field of SCI. Its intent is to lead collaboration between individuals and organizations with relevant experience, expertise and influence in order to establish evidence of the burden of SCI and the costs and consequences of initiatives aimed at mitigating the burden.
The health economics agenda for SCI research in Canada directs economic research in SCI to:
- Increase the breadth, quality, and applicability of health economic analyses in the field of SCI;
- Inform and encourage decisions concerning the care of individuals with SCI in Canada; and
- Support Canadian SCI Network initiatives, including initiatives to demonstrate the value and expand the implementation of evidence-informed practices and support health technology and service innovation to prevent excess healthcare costs and protect and promote the well-being of individuals with SCI, their families, and supporters.
Health Economics Reports + Publications
Praxis publishes reports on health economics aims and results. We also collaborate on publications which contribute to establishing evidence in this area.
Requests for Services
Praxis provides ongoing data support for RHSCIR – our national Canadian SCI registry – by supporting site data collection from the onset of a person’s injury, through their hospital stay and once they have returned to the community.
Health Economics Reports + Publications
Health Economics Agenda
The “Health Economics: Agenda for SCI Research in Canada” report presents a detailed agenda for establishing evidence of the burden of spinal cord injury (SCI). It also explores the costs and consequences of initiatives aimed at mitigating the burden.
Results
Health Economics: 2021 Results Report
This five-year Results Report (2016-2021) on the Health Economics Agenda includes a summary of the work Praxis has done in collaboration since the agenda was published.
Publications
A list of the publications in the report with links to where they can be found online.
2020
White, Barry A. B., Rivers, Carly S., Chisholm, Jo-Anne, Willms, Rhonda, Papp, Anthony, Sproule, Shannon and McMurtry, Heather. Community Acquired Pressure Injuries in a Work-Related Spinal Cord Injury Population: Problem Characterization and Assessment of a Working Solution. Journal of Tissue Viability. Available online 27 July 2020.
Whitehurst DGT et al. Empirical validity of a generic, preference-based capability wellbeing instrument (ICECAP-A) in the context of spinal cord injury – in 2020 accepted for publication in The Patient – Patient-Centered Outcomes Research.
2018
Iorio-Morin, C, Noonan, V. K., White, A.B., Noreau, L., Leblond, J., Dumont, F. S., Kwon, B. K., Dvorak, M., Dea, N. Quality of Life and Health Utility Scores Among Canadians Living With Traumatic Spinal Cord Injury – A National Cross-Sectional Study. Spine: July 15, 2018 – Volume 43 – Issue 14 – p 999-1006.
Engel L, Bryan S, Noonan VK, Whitehurst DGT. Using path analysis to investigate the relationships between standardized instruments that measure health-related quality of life, capability wellbeing and subjective wellbeing: An application in the context of spinal cord injury. Soc Sci Med. 2018 Sep;213:154-164. doi: 10.1016/j.socscimed.2018.07.041. Epub 2018 Jul 29. PubMed PMID: 30081357.
2017
White, Barry A.B., Dea, Nicolas, Street, John T., Cheng, Christiana L., Rivers, Carly S., Attabib, Najmedden, Kwon, Brian K., Fisher, Charles G., and Dvorak, Marcel F. The Economic Burden of Urinary Tract Infection and Pressure Ulceration in Acute Traumatic Spinal Cord Injury Admissions: Evidence for Comparative Economics and Decision. Analytics from a Matched Case-Control Study. Journal of Neurotrauma. Oct 2017.
2016
Squair, Jordan W., White, Barry A. B., Bravo, Grace I., Martin Ginis, Kathleen A., and Krassioukov, Andrei V. The Economic Burden of Autonomic Dysreflexia during Hospitalization for Individuals with Spinal Cord Injury. Journal of Neurotrauma X:1–6 (2016) DOI: 10.1089/neu.2015.4370
Whitehurst DGT, Mittmann N, Noonan VK, Dvorak MF, Bryan S. Health state descriptions, valuations and individuals’ capacity to walk: a comparative evaluation of preference-based instruments in the context of spinal cord injury. Qual Life Res. 2016 Oct;25(10):2481-2496. doi: 10.1007/s11136-016-1297-3. Epub 2016 Apr 20. PubMed PMID: 27098235.
Other/Related
Chan B, Benton B, McIntyre A, Mittmann N, Teasell RW, Wolfe DL. Economic evaluation of spinal cord injury. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Noonan VK, Loh E, McIntyre A, editors. Spinal Cord Injury Rehabilitation Evidence. Version 7.0: p 1-34. 2019.
Rivers CS, Fallah N, Noonan VK, Whitehurst DG, Schwartz CE, Finkelstein JA, Craven BC, Ethans K, O’Connell C, Truchon BC, Ho C, Linassi AG, Short C, Tsai E, Drew B, Ahn H, Dvorak MF, Paquet J, Fehlings MG, Noreau L. Health Conditions: Effect on Function, Health-Related Quality of Life, and Life Satisfaction After Traumatic Spinal Cord Injury. A Prospective Observational Registry Cohort Study. Arch Phys Med Rehabil. 2018 Mar;99(3):443-451. doi: 10.1016/j.apmr.2017.06.012. Epub 2017 Jul 19. PubMed PMID: 28732686.