Early opportunities to improve chronic functional outcome following traumatic spinal cord injury
Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
Accurately predicting functional recovery in an asset for all clinicians and decision makers involved in the care of patients with acute traumatic spinal cord injury (TSCI). Unfortunately, there is a lack of information on the relative importance of significant predictors of global functional outcome. There is also a need for identifying functional predictors that can be timely optimized by the medical and rehabilitation teams throughout the hospitalizations phases. The main objective of this work is to review and rate factors that are consistently and independently associated with global functional outcome in individuals with TSCI. This work also proposes a new conceptual framework that illustrates the impact of specific categories of factors and their interaction with each other. The grade of severity of the SCI is the main predictor of global functional outcome following TSCI. Other factors may modulate this interaction according to their respective strength of impact. Younger age, lower neurologic level of injury and higher initial motor score were the main socio-demographic and trauma-related factors. Surgical management, higher functional status at discharge from acute care, shorter acute care length of stay, and access to specialized multidisciplinary functional rehabilitation were main modifiable factors. Prevention of medical complications, higher intensity and patient participation level in functional rehabilitation therapies were also contributing factors associated with improved global functional outcome.
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