Does the functional outcome 6 months after a traumatic spinal cord injury predicts the chronic functional outcome 12 months after the injury?
1Chatta R, 2Thompson C, 2Richard-Denis A, 2Mac-Thiong J
1Faculty of Medicine, University of Montreal, Montreal, Quebec, Canada; 2Hôpital du Sacré-Coeur, Montreal, Quebec, Canada
Objective: Assessment of chronic functional recovery in traumatic spinal cord injury (TSCI) patients is essential for prognosis, counseling, designing a personalized rehabilitation program and elaborating basic research in the long-term process. Currently the time by which patients reach their chronic functional outcome remains unknown. Some authors consider that a plateau is reached at 6 months, while other authors consider that it is reached at 12 months after the TSCI. The objective of the study is to determine 1) if there is significant functional recovery between 6 and 12 months after a TSCI, and 2) which socio-demographic and clinical characteristics are associated with a minimal clinical improvement difference (MCID) in functional recovery between 6 and 12 months.
Design/Methods: A total of 125 patients sustaining a TSCI were prospectively enrolled in a cohort study in a single Level I trauma center. Reaching a MCID of 4 points in the third version of the SCIM total score (SCIM-III) between 6- and 12-months post-SCI was the primary endpoint. Socio-demographic data, such as age and sex, clinical and trauma characteristics were collected prospectively and updated on a daily basis during the acute care hospitalization. The SCIM-III questionnaire was used to assess functional status 6- and 12- months post-SCI. Unpaired Student’s t-tests were used to compare socio-demographic and clinical characteristics between patients reaching the MCID or not. A multivariate logistic regression was used to identify predictors associated with reaching the MCID. Thirteen factors were included: 1) age; 2) gender; 3) motor completeness (complete vs incomplete); 4) neurological level of injury (tetraplegia vs paraplegia); 5) trauma velocity (high vs low); 6) Injury Severity Score (ISS); 7) occurrence of any complication; 8) surgical delay (<24h vs ≥24h after the TSCI); 9) presence of concomitant traumatic brain injury (TBI); 10) presence of spasticity signs; 11) length of stay (LOS) in days in acute care; 12) transfer to intensive functional rehabilitation (IFR) unit and 13) LOS in IFR.
Results: 38 patients reached the MCID between 6 and 12 months post-TSCI, while 87 patients did not. Patients reaching the MCID had lower baseline SCIM-III total scores at 6 months (67.6 ± 24.3 vs 85.3 ± 22.4; P= 10-5) and stayed longer (days) in IFR (79.2 ± 44.1 vs 39.1 ± 44.1; P= 10-5). Multivariate logistic regression analysis identified increased LOS in IFR as the single most important predictor for reaching a MCID between 6 and 12 months post-TSCI (b= 0.020; OR= 1.021 CI:95% (1.011 – 1.030); P= 10-5).
Conclusion: This study showed that functional capacity improved between 6 and 12 months post-TSCI for 30% patients. Improvement in functional capacity is more likely in patients having a lower SCIM-III score at 6 months and admitted for a longer duration in a IFR unit.
Support: USAMRMC (USA Medical Research and Material Command)
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