Spinal cord injury and polypharmacy: a scoping review

Abstract

Purpose: The purpose of this scoping review was to map the scope of the literature on polypharmacy among individuals with spinal cord injury or dysfunction (SCI/D).

Material and methods: Five electronic databases were searched for literature published between January 1990 and July 2018. The following keywords were searched using Boolean operators, wild cards, proximity operators and truncations: spinal cord injuries, multiple medications, polypharmacy. The initial search identified 1,459 articles; 1,098 remained after deduplication. Following the title and abstract screen, 81 full-texts were reviewed, and 18 met all of the eligibility criteria for inclusion in the review.

Results: Of the 18 studies identified, 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 relating to polypharmacy.

Implications for rehabilitation

• Prescribers should be aware of the factors and negative clinical outcomes related to polypharmacy and spinal cord injuries/dysfunction, especially for patients with higher level and more severe injuries.

• Prescribers should work with their patients with spinal cord injuries/dysfunction to avoid inappropriate polypharmacy and to integrate appropriate alternatives to medications.

• Optimizing medication management should be a significant focus of spinal cord injury/dysfunction rehabilitation and research in order to develop targeted interventions that improve patient outcomes.

Keywords:

• Spinal cord injuries
• polypharmacy
• multiple medications
• scoping review
• medication-taking behavior

Acknowledgements

The authors would like to thank the University of Toronto librarians for their sharing their knowledge and expertise in literature syntheses, as well as Stephanie Cimino for her help with screening articles.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This project was funded by the Craig H. Neilsen Foundation (Psychosocial Research Pilot Grant #441259) and the Connaught New Investigator Award (University of Toronto). Lauren Cadel is supported by the Graduate Department of Pharmaceutical Sciences at the University of Toronto (Dean’s Fund; Clinical, Social & Administrative Pharmacy Professors’ Award for Thesis Research; and Pfizer Canada Fellowship in Health Outcomes Research) and by the Health System Performance Research Network, which receives funding from the Ontario Ministry of Health and Long Term Care Health Services Research Fund (#06034). Dr. Guilcher is supported by a Canadian Institutes for Health Research Embedded Clinician Scientist Salary Award on Transitions in Care (2016–2020).