Quality of life in patients after a traumatic cervical spinal cord injury based on the severity and recovery of the neurological impairment
1Houle-Clermont G, 2Richard-Denis A, 2Thompson C, 2Mac-Thiong J
1Université de Sherbrooke, Sherbrooke, Québec, Canada; 2Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
Objective: To determine whether the quality of life (QOL) one year post-injury assessed using the World Health Organization Quality of Life Assessment Instrument-Bref (WhoQOL-Bref) is primarily related to the acute neurological status, the chronic neurological status, or the improvement in neurological status.
Design/method: Through this prospective study, subjects with a traumatic cervical spinal cord injury (SCI) between May 2010 and October 2016 were recruited from a Level 1 Trauma Center specializing in SCI care. The final cohort comprised 167 patients (125 (75%) men and 42 (25%) women, with a mean age of 48,0 ± 18,2 years). Long-term QOL was assessed 6 or 12 months after the injury using the WhoQOL-Bref, which comprises four distinct domains (physical health, psychological, social relationships and environment).
Neurological impairment was measured from the American Spinal Injury Association impairment scale (AIS) grade at the time of presentation and at follow-up (6-12 months post trauma). Subjects were subdivided in two subgroups according to the motor completeness of the lesion at initial presentation, as motor-complete patients (AIS grades A and B) or motor-incomplete patients (AIS grades C and D). Four subgroups representing possible endpoints with regard to neurological recovery were analyzed: motor-complete patients remaining motor-complete (group 1), motor-complete becoming motor-incomplete (group 2), motor-incomplete remaining motor-incomplete (group 3), and motor-incomplete becoming AIS grade E (group 4). Comparisons of QOL scores were made between the different subgroups regarding the initial and final neurological status as well as improvement in neurological status. Student’s t-test analysis was used to examine whether significant differences occurred between the subgroups.
Results: The motor-completeness of the lesion at initial presentation was the only predictor of the QOL associated with all domains, confirming that more severe initial neurological impairment leads to poorer chronic QOL. As expected, QOL was also significantly improved for those reaching full neurological recovery (AIS grade E) in physical, social and psychological domains. In group 1, QOL was significantly poorer than in group 4 in physical, psychological and social domains. In group 2, QOL was significantly poorer than in groups 3 and 4 for physical and psychological domain. Also, QOL in group 3 was significantly poorer than in group 4 in psychological domain. There was no significant difference in QOL between the subgroups in the environmental domains for improvement in AIS grade.
Conclusion: Our study confirms that the initial AIS grade is the most important predictor of long-term QOL in patients with traumatic cervical SCI, when compared to the final AIS grade or the improvement in AIS grade. Improvement from a motor-incomplete lesion to AIS grade E also appears to be an indicator of a better outcome for QOL, especially in the physical and psychological domains.
Support: US Army Medical Research and Material Command (USAMRMC).
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