Category: Spinal Cord Injury; Clinical Practice (assessment, diagnosis, treatment, knowledge translation/EBP, implementation science, program development)
Objective(s) : To map the scope of the literature on polypharmacy among individuals with spinal cord injury or dysfunction (SCI/D).
Data Sources : Five electronic databases were searched for articles published between January 1990 and July 2018. A search for grey literature was conducted on relevant websites. The following keywords were searched using Boolean operators, wild cards, proximity operators and truncations: spinal cord injuries, multiple medications, polypharmacy.
Study Selection : Included studies were required to meet the following criteria: (1) included individuals with SCI/D; (2) included individuals prescribed or taking multiple medications; and (3) published between January 1, 1990 and July 31, 2018. The initial search resulted in 1,459 articles and one article was identified from another source. The articles were screened for inclusion by two independent reviewers, all disagreements were discussed in-person.
Data Extraction : Two reviewers used a spreadsheet to independently extract data from the included articles. The reviewers met in person to discuss any questions regarding the extraction of data; these meetings took place before and during the extraction process.
Data Synthesis : Of the 18 studies included in the review, less than half defined polypharmacy. Definitions varied in the types and number of medications. Older age, higher level of injury and greater severity of injury were factors related to polypharmacy. Negative clinical outcomes, such as drug-related problems and bowel complications were identified.
Conclusions : This scoping review identified a paucity of research on polypharmacy post-SCI/D, highlighting a need for future research. To improve the state of knowledge, there is a need to better understand factors and clinical outcomes related to polypharmacy in persons with SCI/D and to explore experiences of persons with SCI/D, caregivers and clinicians with polypharmacy.
Lauren Cadel– Student, University of Toronto, Toronto, Ontario
Amanda Everall– Research Officer, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario
Sander Hitzig– Scientist, St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Ontario
Tanya Packer– Professor, Dalhousie University, Halifax, Nova Scotia
Tejal Patel– Clinical Assistant Professor, University of Waterloo, Kitchener, Ontario
Aisha Lofters– Clinician Scientist, St. Michael’s Hospital, Toronto, Ontario
Sara Guilcher– Assistant Professor, University of Toronto, Toronto, Ontario