Browsing by Author "Dhakal, Raju"

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    Functional outcome following inpatient rehabilitation among individuals with complete spinal cord injury in Nepal
    (Springer Nature, 2021-10-07) Khatri, Prakriti; Jalayondeja, Chutima; Dhakal, Raju; Groves, Christine C.; Physical Medicine and Rehabilitation, School of Medicine
    Objectives: To describe functional outcomes using Spinal Cord Independence Measure III (SCIM III) following inpatient rehabilitation among individuals with complete spinal cord injury (SCI) in the low-income setting of Nepal; to evaluate functional changes from rehabilitation admission to discharge and to compare functional outcomes between neurological levels of injury (NLI) at discharge. Setting: Spinal Injury Rehabilitation Centre (SIRC), Kavrepalanchowk, Nepal. Methods: We present data of all individuals with complete SCI who completed rehabilitation at SIRC in 2017. Data collected included: demographics, aetiology, neurological assessment, admission/discharge SCIM III scores, and length of stay. Data were analyzed using descriptive statistics. Pre/post-SCIM III scores were analyzed using Related-Samples Wilcoxon signed-rank test. Comparative analysis between NLIs was done using the Kruskal Wallis ANOVA test followed by pairwise Mann-Whitney U tests. Results: Ninety-six individuals were included. Mean (SD) age was 33.5 (14.2) years, with a male/female ratio of 3.4:1. Median admission and discharge total SCIM III scores for cervical, thoracic and lumbosacral levels were 10 and 21, 16 and 61, and 41 and 79.5, respectively. Median total SCIM III score change between admission and discharge were 11 (p = 0.003), 43 (p < 0.001) and 40 (p = 0.068) for cervical, thoracic and lumbar groups, respectively. Conclusions: This study is the first of its kind to describe functional outcomes among individuals with complete SCI in the low-income setting of Nepal. All SCI groups showed a positive trend in SCIM III from admission to discharge, with improvements reaching statistical significance among groups with cervical and thoracic NLIs.
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    Post-traumatic stress disorder among individuals with traumatic spinal cord injury in Nepal: a cross-sectional study
    (Springer Nature, 2023-04-06) Parajuli, Bikash; Acharya, Khagendra; Grooves, Christine C.; Dhakal, Raju; Shrestha, Jemina; Shrestha, Rahul; Manandhar, Mishu; Physical Medicine and Rehabilitation, School of Medicine
    Study design: Cross-sectional study OBJECTIVES: To identify the prevalence of posttraumatic stress disorder (PTSD) among the individuals with traumatic spinal cord injury (TSCI) and to examine the relationships between demographic and clinical characteristics, and PTSD. Setting: Spinal Injury Rehabilitation Center (SIRC) and Dhulikhel Hospital, Kathmandu University Hospital (DH, KUH), Kavrepalanchowk, Nepal. Methods: Individuals above 18 years of age with TSCI of at least one month from trauma and admitted to SIRC and DH, KUH from June 2019 to May 2021 were included. The specific stress version of the PostTraumatic Stress Disorder Checklist (PCL), was utilized. To classify the neurological status of TSCI individuals, International Standard for Neurological Classification of Spinal Cord Injury (ISNCSCI) was used. Hierarchical multiple regression analysis between independent variables and normalized PCL score was done to evaluate the predictors of PTSD. Results: Among 163 patients, the overall prevalence of PTSD was 27%, and the mean PCL score was 36 ± 13.9. Factors predictive of PTSD included gender, family type, ethnicity, and literacy rate. No significant association was found between the clinical characteristics and PTSD. Conclusions: PTSD appears to be considerably prevalent among individuals with TSCI in Nepal. Females, individuals from nuclear families, individuals with lower literacy, and individuals from lower caste are significantly vulnerable to developing PTSD. However, clinical characteristics do not appear to be influential in the development of PTSD.
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    Rehabilitation in Nepal
    (Elsevier, 2019-11) Dhakal, Raju; Groves, Christine C.; Physical Medicine and Rehabilitation, School of Medicine
    As a low-income country with a significant burden of disease and frequent natural disasters, the need for rehabilitation in Nepal is significant. Rehabilitation services currently available in Nepal are limited, but the government has recently adopted a 10-year action plan to address rehabilitation needs nationwide. Rehabilitation education and training is necessary to provide and retain adequate multidisciplinary rehabilitation providers for current and future needs in Nepal. The implementation of evidence-based recommendations to improve the quality of rehabilitation services and access to rehabilitation is critical to maximize individual and community well-being.
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    Risk Factors, Clinical Features, and Outcomes among Stroke Patients Presenting to Spinal Injury Rehabilitation Centre
    (Nepal Health Research Council, 2021) Dhakal, Raju; Khadka, Anjita; Groves, Christine; Physical Medicine and Rehabilitation, School of Medicine
    Background: Worldwide, stroke is the second leading cause of death and disability. The burden of stroke in countries like Nepal is increasing. The purpose of this study is to describe the epidemiology, clinical features, and functional outcomes of individuals with stroke in a rehabilitation hospital in Nepal. Methods: A prospective descriptive study was conducted among individuals with stroke presenting for inpatient rehabilitation to the Nepal’s first interdisciplinary inpatient stroke rehabilitation unit over a one-year period; from 1 April 2018 – 30 March 2019. Results: Twenty-four individuals were enrolled, with average age of 56.8 years (SD 11.9, range 38-79). Seventeen patients (71%) presented with ischemic stroke. Hypertension was the most common modifiable stroke risk factor observed, present in 21 (88%) of individuals. Median rehabilitation length of stay was 32.5 days (IQR 15.3 – 68.8). Median Modified Barthel Index at admission was 25.0 (IQR 8.5-57.0) and at discharge was 67.0 (IQR 46.0-88.0), a statistically significant improvement (Z = -3.408, p = 0.001). Median Modified Rankin Scale on admission was 5.0 (IQR 4.0-5.0) and at discharge was 4.0 (IQR 3.6-4.8; Z = -3.276, p = 0.001). Conclusions: Most individuals with stroke admitted for interdisciplinary stroke rehabilitation demonstrated “severe” levels of disability and dependency on admission, and “moderate” levels of disability and dependency at the time of discharge. Hypertension represents a strategic target for primary and secondary prevention of stroke. With the burden of stroke increasing in Nepal, it is imperative to improve long-term availability and access to comprehensive stroke care for all affected individuals.
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    Student Competition (Knowledge Generation) ID 1986472: Experience of patients with spinal cord injury regarding the quality of care during acute hospital stay in Nepal
    (Allen Press, 2023) Gautam, Srijana; Mushahwar, Vivian; Baniya, Mandira; Manhas, Kiran Pohar; Dhakal, Raju; Groves, Christine Cain; Ho, Chester; Physical Medicine and Rehabilitation, School of Medicine
    Background: Spinal cord injury (SCI) results in physical impairments and psychosocial issues that generate challenges to individuals, families, and society. Understanding the acute care hospital experience after SCI is important as it may have an impact on persons with spinal cord injuries’ (PWSCI) subsequent journey to the rehabilitation center and community. This experience has not been studied in Nepal, especially from the perspective of PWSCI. Objectives: To understand how PWSCI (1) are involved in decision-making for their care; (2) are educated about secondary complications and, (3) perceive overall positive and negative experiences regarding their care during their acute care hospital stay in Nepal. Methods: Qualitative study based on Van Manen’s phenomenology using purposive sampling at the Spinal Injury Rehabilitation Center, the only dedicated SCI center in Nepal. We interviewed participants (n=24) who were referred from nine different acute hospitals using a semi-structured interview guide co-developed with SCI experts and PWSCI. Using thematic analysis, we extracted the findings with Manen’s approach. Results: We identified three preliminary themes: (1) Families, but not PWSCI, are often included in the decision-making process; (2) For education on secondary complications, only pressure injury prevention was recalled; (3) Timeliness of spinal surgery was a concern. Conclusion: There are opportunities to improve the acute care experience for PWSCI in Nepal. PWSCI desired to be more engaged in the decision-making process and more involved in their own care. Concerns regarding the timeliness of surgery correlated with the findings of previous Nepali studies.
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    A team effort in Nepal: experiences from managing a large COVID-19 rehabilitation hospital outbreak
    (Nature, 2021) Dhakal, Raju; O'Connell, Colleen; Gurung, Jas Bahadur; Shah, Ram Prakash; Adhikari, Hari Prasad; Chandi, Nita; Groves, Christine C.; Physical Medicine and Rehabilitation, School of Medicine
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    The demographics and traumatic causes of spinal cord injury in Nepal: An observational study
    (Sage, 2021) Willott, Arran; Dhakal, Raju; Groves, Christine; Mytton, Julie; Ellis, Matthew; Physical Medicine and Rehabilitation, School of Medicine
    Introduction: There has been little systematic study of the epidemiology of traumatic spinal cord injury (TSCI) in Nepal, South-East Asia, and low- and middle-income countries (LMICs) in general. One third of the global morbidity and mortality due to injuries is concentrated in South-East Asia. We need to better understand the circumstances leading to TSCI if we are to make progress with prevention. Method: The Spinal Injury Rehabilitation Centre (SIRC) in Nepal systemically collected prospective data describing people with TSCI admitted between September 2015 and August 2016. Descriptive analyses of variables yielded demographic, aetiological and clinical descriptors of this cohort. Cross-tabulations were used to explore the associations between variables. Results: Of 184 admissions over one year, males were admitted to SIRC almost 2.3 times more often than females. Young adults (21–30 years) were the largest age group (34%). The majority of TSCI resulted in paraplegia (67%) and was complete in nearly half (49%). Falls caused the majority of TSCI (69%), and falls from trees were the most common. Road traffic injuries (RTIs) were the second leading cause (29%); the majority involved two- or three-wheeled motorised vehicles and patients were most commonly driving. Conclusion: Falls were the leading cause of TSCI across both genders and all age groups, followed by RTIs, which occurred most often in young adults and men. Injury surveillance and further research would provide a greater understanding of the pattern of TSCI and enable progress in TSCI prevention and rehabilitation.