The impact of metabolic risk factors on FIM efficiency during acute rehabilitation: a retrospective study of traumatic spinal cord injury
Kleven A, Hoppe K, Reeves R, Hollman J, Scarisbrick I
Mayo Clinic Department of Physical Medicine and Rehabilitation, Rochester, MN, MN, USA
Objective: The presence of metabolic dysfunction impacts outcomes of individuals with a wide range of medical conditions. It is known that metabolic risk factors increase after spinal cord injury (SCI) and can negatively affect function, however any impact on acute outcomes is not well understood. We hypothesized that the presence of risk factors for metabolic dysfunction in individuals with traumatic thoracic SCI would reduce efficiency of improvement in the Functional Independence Measure (FIM) during their initial inpatient rehabilitation stay.
Design/Method: A retrospective chart review was conducted of 1793 patients with an inpatient rehabilitation stay from a SCI database at a tertiary care center between 2000 and 2016. Of this cohort, 84 patients were identified who had an acute inpatient rehabilitation stay after traumatic thoracic SCI. Patients with ASIA Impairment Scale (AIS) classification A (n=64), B (n=6), C (n=11), and D (n=3) were included. The average age was 36 years (Range, 7 to 92 years). There were 63 males and 21 females with a mean number of days from injury to rehab admission of 28 days and mean stay of 33 days. Patients were assessed for factors associated with the Metabolic Syndrome, namely obesity, insulin resistance, hypertension, and hyperlipidemia. If a patient had two or more risk factors, they were characterized as having metabolic dysfunction (n=24). FIM efficiency was calculated by measuring the change in FIM over the length of rehabilitation stay.
Results: A mixed model ANOVA was used for analysis. The change in FIM score from admit to discharge did not differ between patients with or without at least two risk factors for metabolic dysfunction. The time by metabolic dysfunction interaction (F = 3.1, p = 0.08), time by AIS level interaction (F = 1.2, p = 0.3) and time by metabolic dysfunction by AIS level interaction (F = 0.7, p = 0.5) were not statistically significant. The presence of two risk factors for metabolic dysfunction did not affect the change in FIM score from admission to discharge and there was not a metabolic dysfunction by AIS classification interaction. However, FIM score did improve significantly from admit to discharge with the time variable being significant (F = 65, p < 0.001). The time by age interaction (F = 13.4, p < 0.001) was also significant. Regardless of the presence of metabolic dysfunction or AIS level, younger individuals had a greater change in FIM score compared to older subjects.
Conclusion: The presence of two risk factors of the Metabolic Syndrome do not affect FIM efficiency over the acute rehabilitation stay in individuals with AIS A thoracic SCI. However, follow up studies are needed to determine if the presence of risk factors for metabolic dysfunction at the time of SCI affect FIM efficiency during the subacute or more chronic periods of recovery. Efforts to identify a larger sample across multiple AIS levels will also be needed to make conclusions about the impact of risk factors for metabolic dysfunction on other levels of injury.
Support: The Mayo Clinic Rehabilitation Medicine Research Center, the Craig H. Neilsen Foundation, the Center for Biomedical Discovery and the Minnesota Spinal Cord Injury and Traumatic Brain Injury Research Grant Program.
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