Predictive Factors of Resumption of Functional Mobility after Spinal Cord Injury Rehabilitation – a Prospective Cohort Study in Kowloon Hospital

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Authors (including presenting author) :
Chan WK(1), Ng HP(1), Chan HL(1), To TS(1), Lee YT(1), Cheung PC(2), Cheng KH(2), Li W(2)
Affiliation :
(1)Occupational Therapy Department, Kowloon Hospital, (2)Department of Orthopaedics & Traumatology, Queen Elizabeth Hospital
Introduction :
Patients with spinal cord injury (SCI) rated walking recovery as one of the main goals for spinal cord rehabilitation (van Silfhout et al., 2015). Understanding the prognostic factors influencing the recovery of ambulation is important in setting realistic goals and formulating treatment plans in our spinal cord rehabilitation in-patient setting. The prediction rule for ambulation outcome developed by Middendorp et al (2011) demonstrated validity in their European population, in patient cohorts in the United States (Malla, 2013), Australia (van Silfhout et al., 2015) and Canada (Hicksa et al., 2017). However, there is no prediction rule available for our local population.
Objectives :
To identify predictive factors for the ambulation recovery after SCI in a local hospital setting
Methodology :
A prospective cohort study was conducted with SCI patients whom were admitted to the spinal centre of Kowloon Hospital between 2002 and 2016. Demographic data and results of physical and functional assessments at admission were collected. Outcome measure was whether patient could walk at 6-month follow-up. Logistic regression analysis was used to investigate the association of ambulation recovery with age, gender, severity of injury, etiology, the level of injury, clinical syndrome, total motor score of bilateral quadriceps femoris muscles (L3), total motor score of bilateral gastrosoleus muscles (S1) and ADL performance on admission.
Result & Outcome :
Of the 478 patients with SCI, 64.2% were male. The mean age of the subjects was 60. 89.7% had incomplete SCI. 63% of the subject had SCI at cervical level. On admission, 77.6% of them required heavy assistance in ADL (Functional Independence Measure, FIM, motor score below 52). At 6-month follow-up, 27.9% of them were walker. Factors predicting ambulation recovery were age (below 65) (P=.003, adjusted OR=2.610), incomplete SCI (P=.033, adjusted OR=2.969), total motor score of bilateral quadriceps femoris muscles 6-10/10 (P=.039, adjusted OR=3.603), total motor score of bilateral gastrosoleus muscles 1-5/10 (P=.037, adjusted OR=3.377), total motor score of bilateral gastrosoleus muscles 6-10/10 (P=.002, adjusted OR=6.633), FIM motor score 14-51/91 (P=.000, adjusted OR=4.792) and FIM motor score above 52/91 (P=.000 adjusted OR=19.909). Conclusion: The result showed that age < 65, incomplete SCI, higher motor score of quadriceps femoris and gastrosoleus muscles and better self-care ability on admission predicts higher chance of walking recovery. However, gender, etiology, the level of injury and clinical syndrome were not significant predictors for walking recovery in patients with SCI.

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