Health problems and quality of life in women with spinal cord injury – a comparison between Norway and Cambodia T. Glott. Sunnaas Rehabilitation Hospital R. Nilsen, G. Aasen. Sophies Minde Ortopediteknikk AS

NOSCOS Göteborg 2011 Cambodia Battambang Inhabitants approx 15 million Monarchy Elections (prime minister Hun Sen) Capital Phnom Penh GDP pr capita 2006 USD 513 Corruption is common – 3rd most corrupt in Asia

NOSCOS Göteborg 2011 Spinal center in Battambang Sathia Kim, Cambodian Trust – Dr Sokhom Chan Built 1991 Supported by European Union Responsible Handicap International France Funding gradually decreased from 2006 Responsible authority: Ministry of Veterans Affairs

NOSCOS Göteborg 2011 Epidemiology Incidence of injuries unknown A low estimate: Mortality - unknown Survival/ complication rates – unknown beds for rehabilitation

NOSCOS Göteborg 2011 WHOQOL-BREF The WHOQOL-BREF contains a total of 26 questions in four domains: 1. Physical health 1.Activities of daily living Dependence on medicinal substances and medical aids Energy and fatigue Mobility Pain and discomfort Sleep and rest Work Capacity 2. Psychological Bodily image and appearance Negative feelings Positive feelings Self-esteem Spirituality / Religion / Personal beliefs Thinking, learning, memory and concentration 3. Social relationships Personal relationships Social support Sexual activity 4. Environment Financial resources Freedom, physical safety and security Health and social care: accessibility and quality Home environment Opportunities for acquiring new information and skills Participation in and opportunities for recreation / leisure activities Physical environment (pollution / noise / traffic / climate) Transport

NOSCOS Göteborg 2011 Methods and participants 27 women with spinal cord injury were interviewed by female Khmer and compared to able bodied women In subjects with spinal cord injury mean age was 35 age (range 13 to 53 years), and all were paraplegic 60 % was married Mean time since injury was 10 years (0-25 years) Injury 78 % AIS A 15 % AIS B 7 % AIS C Thoracic level 80 % Lumbar level 20 % Norwegian women with spinal cord injury (n=25) part of other study

NOSCOS Göteborg 2011 ISCOS data set and WHOQOL-BREF translation into khmer

NOSCOS Göteborg 2011 WHOQOL-BREF: Comparison across groups and domains Difference between all domains paraplegics vs control group in Cambodia (p<0,002)

NOSCOS Göteborg 2011 Bladder problems 48 % experienced severe incontinence more than once a day Single use catheters and other equipment were not available Urinary tract infections were prevalent Antibiotics were not readily available for patients If treated quinolones were a common choice Dip stick slides often showed difficult restitance pattern

NOSCOS Göteborg 2011 Pain 78 % reported pain once or more during the day Medication for pain not readily available Often located at site of injury Most patients had never done any radiological examination Scoliosis was a common finding.

NOSCOS Göteborg 2011 Pressure sores 30 % had ulcers grade 3 or 4 Basic equpiment for pressure sore prevention was lacking (mattresses etc)

NOSCOS Göteborg 2011 Quality of life There was no correlation in any of the domain between quality of life and marital status, pain or incontinence Limitied number of patients The validity of WHOQOL-BREF in Cambodia? Are the general living conditions more important for quality of life than social status or medical complications?

NOSCOS Göteborg 2011 Conclusion Comparative studies between countries and cultures can be an approach to assess impacts of different factors for quality of life after spinal cord injury The results may be important for developing services for persons with spinal cord injury for health personell and authorities Low-cost and feasible project that promotes cooperation Provides knowledge about outcome