Pub Date : 2024-07-03DOI: 10.1038/s41393-024-00998-3
Jia Li, Matthew Farrow, Kerollos Ibrahim, Dana M. McTigue, John Kramer, Bobo Tong, Catherine Jutzeler, Linda Jones, Ceren Yarar-Fisher
Secondary analysis of a randomized, multi-center, placebo-controlled study(Sygen®). To evaluate racial differences in serological markers in individuals with spinal cord injury(SCI) across the first year of injury. Hospitals in North America. Serological markers (e.g.,cell count, liver, kidney, and pancreatic function, metabolism, and muscle damage) were assessed among 316 participants (247 White, 69 Black) at admission, weeks 1, 2, 4, 8, and 52 post-injury. Linear mixed models were employed to explore the main effects of time, race (Black vs. White), and their interaction, with adjustment of covariates such as study center, polytrauma, injury (level, completeness), treatment group, and sex. A main effect of race was observed where White individuals had higher alanine transaminase, blood urea nitrogen(BUN), BUN/Creatinine ratio, sodium, and chloride, while Black individuals had higher calcium, total serum protein, and platelets. For markers with interaction effects, post-hoc comparisons showed that at week 52, White individuals had higher mature neutrophils, hematocrit, hemoglobin, mean corpuscular hemoglobin, albumin, and triglycerides, and Black individuals had higher amylase. Eosinophils, monocytes, red blood cells, aspartate aminotransferase, bilirubin, cholesterol, partial thromboplastin time, urine specific gravity, urine pH, CO2, and inorganic phosphorus did not differ between races. Our results revealed racial differences in serological markers and underscores the importance of considering race as a determinant of physiological responses. Future studies are warranted to explore the causes and implications of these racial disparities to facilitate tailored clinical management and social policy changes that can improve health equity.
{"title":"Racial differences in serological markers across the first year of injury in spinal cord injury: a retrospective analysis of a multi-center interventional study","authors":"Jia Li, Matthew Farrow, Kerollos Ibrahim, Dana M. McTigue, John Kramer, Bobo Tong, Catherine Jutzeler, Linda Jones, Ceren Yarar-Fisher","doi":"10.1038/s41393-024-00998-3","DOIUrl":"10.1038/s41393-024-00998-3","url":null,"abstract":"Secondary analysis of a randomized, multi-center, placebo-controlled study(Sygen®). To evaluate racial differences in serological markers in individuals with spinal cord injury(SCI) across the first year of injury. Hospitals in North America. Serological markers (e.g.,cell count, liver, kidney, and pancreatic function, metabolism, and muscle damage) were assessed among 316 participants (247 White, 69 Black) at admission, weeks 1, 2, 4, 8, and 52 post-injury. Linear mixed models were employed to explore the main effects of time, race (Black vs. White), and their interaction, with adjustment of covariates such as study center, polytrauma, injury (level, completeness), treatment group, and sex. A main effect of race was observed where White individuals had higher alanine transaminase, blood urea nitrogen(BUN), BUN/Creatinine ratio, sodium, and chloride, while Black individuals had higher calcium, total serum protein, and platelets. For markers with interaction effects, post-hoc comparisons showed that at week 52, White individuals had higher mature neutrophils, hematocrit, hemoglobin, mean corpuscular hemoglobin, albumin, and triglycerides, and Black individuals had higher amylase. Eosinophils, monocytes, red blood cells, aspartate aminotransferase, bilirubin, cholesterol, partial thromboplastin time, urine specific gravity, urine pH, CO2, and inorganic phosphorus did not differ between races. Our results revealed racial differences in serological markers and underscores the importance of considering race as a determinant of physiological responses. Future studies are warranted to explore the causes and implications of these racial disparities to facilitate tailored clinical management and social policy changes that can improve health equity.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 8","pages":"486-494"},"PeriodicalIF":2.1,"publicationDate":"2024-07-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300300/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141498983","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-27DOI: 10.1038/s41393-024-01009-1
Paul Lin, Neil Kamdar, Gianna M. Rodriguez, Christine Cigolle, Denise Tate, Elham Mahmoudi
Retrospective case/control longitudinal cohort study Prevalent traumatic spinal cord injury (TSCI) is associated with Alzheimer’s disease and related dementia (ADRD). We examined the hazard ratio for ADRD after incident TSCI and hypothesized that ADRD hazard is greater among adults with incident TSCI compared with their matched control of adults without TSCI. Using 2010–2020 U.S. national private administrative claims data, we identified adults aged 45 years and older with probable (likely and highly likely) incident TSCI (n = 657). Our controls included one-to-ten matched cohort of people without TSCI (n = 6553). We applied Cox survival models and adjusted them for age, sex, years of living with certain chronic conditions, exposure to six classes of prescribed medications, and neighborhood characteristics of place of residence. Hazard ratios were used to compare the results within a 4-year follow-up. Our fully adjusted model without any interaction showed that incident TSCI increased the risk for ADRD (HR = 1.30; 95% CI, 1.01–1.67). People aged 45–64 with incident TSCI were at high risk for ADRD (HR = 5.14; 95% CI, 2.27–11.67) and no significant risk after age 65 (HR = 1.20; 95% CI, .92–1.55). Our sensitivity analyses confirmed a higher hazard ratio for ADRD after incident TSCI at 45–64 years of age compared with the matched controls. TSCI is associated with a higher hazard of ADRD. This study informs the need to update clinical guidelines for cognitive screening after TSCI to address the heightened risk of cognitive decline and to shed light on the causality between TSCI and ADRD.
{"title":"Incident traumatic spinal cord injury and risk of Alzheimer’s disease and related dementia: longitudinal case and control cohort study","authors":"Paul Lin, Neil Kamdar, Gianna M. Rodriguez, Christine Cigolle, Denise Tate, Elham Mahmoudi","doi":"10.1038/s41393-024-01009-1","DOIUrl":"10.1038/s41393-024-01009-1","url":null,"abstract":"Retrospective case/control longitudinal cohort study Prevalent traumatic spinal cord injury (TSCI) is associated with Alzheimer’s disease and related dementia (ADRD). We examined the hazard ratio for ADRD after incident TSCI and hypothesized that ADRD hazard is greater among adults with incident TSCI compared with their matched control of adults without TSCI. Using 2010–2020 U.S. national private administrative claims data, we identified adults aged 45 years and older with probable (likely and highly likely) incident TSCI (n = 657). Our controls included one-to-ten matched cohort of people without TSCI (n = 6553). We applied Cox survival models and adjusted them for age, sex, years of living with certain chronic conditions, exposure to six classes of prescribed medications, and neighborhood characteristics of place of residence. Hazard ratios were used to compare the results within a 4-year follow-up. Our fully adjusted model without any interaction showed that incident TSCI increased the risk for ADRD (HR = 1.30; 95% CI, 1.01–1.67). People aged 45–64 with incident TSCI were at high risk for ADRD (HR = 5.14; 95% CI, 2.27–11.67) and no significant risk after age 65 (HR = 1.20; 95% CI, .92–1.55). Our sensitivity analyses confirmed a higher hazard ratio for ADRD after incident TSCI at 45–64 years of age compared with the matched controls. TSCI is associated with a higher hazard of ADRD. This study informs the need to update clinical guidelines for cognitive screening after TSCI to address the heightened risk of cognitive decline and to shed light on the causality between TSCI and ADRD.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 8","pages":"479-485"},"PeriodicalIF":2.1,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141470733","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-24DOI: 10.1038/s41393-024-01003-7
Benjamin D. Holmes, Ruta Brazauskas, Harvinder S. Chhabra
Cross-sectional study. To evaluate etiologic factors associated with spinal cord injury (SCI) severity and to identify predictive factors of reduction in SCI severity in six countries. SCI centers in Bangladesh, India, Malaysia, Nepal, Sri Lanka, and Thailand. Data from centers collected between October 2015 and February 2021 were analyzed using descriptive statistics and logistic regression. Among 2634 individuals, the leading cause of SCIs was falls (n = 1410, 54%); most occurred from ≥1 meter (n = 1078). Most single-level neurological injuries occurred in the thoracic region (n = 977, 39%). Greater than half of SCIs (n = 1423, 54%) were graded American Spinal Injury Association Impairment Scale (AIS) A. Thoracic SCIs accounted for 53% (n = 757) of all one-level AIS A SCIs. The percentage of thoracic SCIs graded AIS A (78%) was significantly higher than high cervical (52%), low cervical (48%), lumbar (24%), and sacral (31%) SCIs (p < 0.001). Regression analyses isolated predictive factors both of SCI severity and inpatient improvement. Four factors predicted severity: age, neurological level, etiology, and country of residence. Four factors predicted improvement: age, neurological level, AIS grade on intake, and country of residence. Findings can be used by healthcare providers and public health agencies in these countries to inform the public of the risk of SCI due to falls. Future studies should examine the social and occupational milieux of falls. Country-to-country comparisons of prehospital and inpatient care are also justified. Fall prevention policies can encourage the use of safety equipment when performing tasks at heights ≥1 meter.
{"title":"Spinal cord injury etiology, severity, and care in East Asia: a cross-sectional analysis of the International Spinal Cord Society Database Project","authors":"Benjamin D. Holmes, Ruta Brazauskas, Harvinder S. Chhabra","doi":"10.1038/s41393-024-01003-7","DOIUrl":"10.1038/s41393-024-01003-7","url":null,"abstract":"Cross-sectional study. To evaluate etiologic factors associated with spinal cord injury (SCI) severity and to identify predictive factors of reduction in SCI severity in six countries. SCI centers in Bangladesh, India, Malaysia, Nepal, Sri Lanka, and Thailand. Data from centers collected between October 2015 and February 2021 were analyzed using descriptive statistics and logistic regression. Among 2634 individuals, the leading cause of SCIs was falls (n = 1410, 54%); most occurred from ≥1 meter (n = 1078). Most single-level neurological injuries occurred in the thoracic region (n = 977, 39%). Greater than half of SCIs (n = 1423, 54%) were graded American Spinal Injury Association Impairment Scale (AIS) A. Thoracic SCIs accounted for 53% (n = 757) of all one-level AIS A SCIs. The percentage of thoracic SCIs graded AIS A (78%) was significantly higher than high cervical (52%), low cervical (48%), lumbar (24%), and sacral (31%) SCIs (p < 0.001). Regression analyses isolated predictive factors both of SCI severity and inpatient improvement. Four factors predicted severity: age, neurological level, etiology, and country of residence. Four factors predicted improvement: age, neurological level, AIS grade on intake, and country of residence. Findings can be used by healthcare providers and public health agencies in these countries to inform the public of the risk of SCI due to falls. Future studies should examine the social and occupational milieux of falls. Country-to-country comparisons of prehospital and inpatient care are also justified. Fall prevention policies can encourage the use of safety equipment when performing tasks at heights ≥1 meter.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 7","pages":"421-427"},"PeriodicalIF":2.1,"publicationDate":"2024-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141447135","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-21DOI: 10.1038/s41393-024-01011-7
Giovana S. Sprizon, Natália D. Pereira, Lorena O. Almeida, Sarah M. Dos Anjos, David M. Morris, Jocemar Ilha
Mixed-method approach. To develop and assess the content validity of a semi-structured interview that captures the lived experience of using a manual wheelchair among individuals with SCI in the real world, the Wheelchair Mobility Activity Log (WC-MAL). SCIR-Group (UDESC)/Brazil. Developing the WC-MAL comprised five steps: (1) defining the construct—based on the International Classification of Functioning, Disability and Health (ICF); (2) identifying relevant activities from other assessment instruments and interviews with the end-users (14 Individuals with SCI and 13 rehabilitation professionals); (3) Selecting the items – activities were linked to ICF codes and grouped into sets; (4) developing the scoring scales based on interviews with the end-users; and, (5) evaluating content validity in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The content validity ratio (CVR) for each item and scale and the overall instrument content validity index (CVI) were calculated. From an initial draft of 295 activities identified, a set of 222 activities was linked to the ICF domain of “Mobility (d4)” and further refined to generate the 23 items in the WC-MAL. Three scales were developed to assess Frequency (how often), Performance (how well), and Assistance (assistance needed) levels. The items and scales showed a CVR superior to the critical value established (≥0.64). The general CVI value was 0.96. The WC-MAL is a promising clinical instrument with adequate content validity to assess the spontaneous use of the manual wheelchair in the real world among individuals with SCI.
{"title":"A semi-structured interview to capture manual wheelchair use for mobility activities among individuals with spinal cord injury in real-life situations: development and content validity of the Wheelchair Mobility Activity Log (WC-MAL)","authors":"Giovana S. Sprizon, Natália D. Pereira, Lorena O. Almeida, Sarah M. Dos Anjos, David M. Morris, Jocemar Ilha","doi":"10.1038/s41393-024-01011-7","DOIUrl":"10.1038/s41393-024-01011-7","url":null,"abstract":"Mixed-method approach. To develop and assess the content validity of a semi-structured interview that captures the lived experience of using a manual wheelchair among individuals with SCI in the real world, the Wheelchair Mobility Activity Log (WC-MAL). SCIR-Group (UDESC)/Brazil. Developing the WC-MAL comprised five steps: (1) defining the construct—based on the International Classification of Functioning, Disability and Health (ICF); (2) identifying relevant activities from other assessment instruments and interviews with the end-users (14 Individuals with SCI and 13 rehabilitation professionals); (3) Selecting the items – activities were linked to ICF codes and grouped into sets; (4) developing the scoring scales based on interviews with the end-users; and, (5) evaluating content validity in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN). The content validity ratio (CVR) for each item and scale and the overall instrument content validity index (CVI) were calculated. From an initial draft of 295 activities identified, a set of 222 activities was linked to the ICF domain of “Mobility (d4)” and further refined to generate the 23 items in the WC-MAL. Three scales were developed to assess Frequency (how often), Performance (how well), and Assistance (assistance needed) levels. The items and scales showed a CVR superior to the critical value established (≥0.64). The general CVI value was 0.96. The WC-MAL is a promising clinical instrument with adequate content validity to assess the spontaneous use of the manual wheelchair in the real world among individuals with SCI.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 8","pages":"468-478"},"PeriodicalIF":2.1,"publicationDate":"2024-06-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141437567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-20DOI: 10.1038/s41393-024-01010-8
Reed Handlery, Kaci Handlery, Dana Kahl, Lyndsie Koon, Elizabeth W. Regan
{"title":"Correction: High intensity functional training for people with spinal cord injury & their care partners","authors":"Reed Handlery, Kaci Handlery, Dana Kahl, Lyndsie Koon, Elizabeth W. Regan","doi":"10.1038/s41393-024-01010-8","DOIUrl":"10.1038/s41393-024-01010-8","url":null,"abstract":"","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 7","pages":"428-428"},"PeriodicalIF":2.1,"publicationDate":"2024-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-01010-8.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141432854","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-19DOI: 10.1038/s41393-024-01006-4
Pablo V. Escribá, Ángel M. Gil-Agudo, Joan Vidal Samsó, Judith Sánchez-Raya, Sebastián Salvador-de la Barrera, Vanesa Soto-León, Natacha León-Álvarez, Bosco Méndez Ferrer, Miguel David Membrilla-Mesa, Carolina Redondo Galán, Jesús Benito-Penalva, Antonio Montoto-Marqués, Javier Medel Rebollo, Ramiro Palazón García, Francisco Gutiérrez Henares, Marc Miralles, Manuel Torres, Ana B. Nieto-Librero, David García Marco, Carmela Gómez, David Jimeno, Antonio Oliviero
Double-blind, randomized, placebo-controlled, parallel-group multicentric phase IIA clinical trial. To assess the safety and tolerability of oral administration of NFX-88 in subjects with chronic spinal cord injury (SCI) and explore its efficacy in pain control. A total of 7 spinal cord injury rehabilitation units in Spain. A total of 61 adult with traumatic complete or incomplete spinal cord injury (C4-T12 level), were randomised 1:1:1:1 to a placebo, NFX88 1.05 g, 2.1 g, 4.2 g/day for up to 12 weeks. The placebo or NFX-88 was administered as add-on therapy to pre-existing pregabalin (150–300 mg per day). Safety and tolerability were evaluated, and the Visual Analogue Scale (VAS) was the primary measure to explore the efficacy of NFX-88 in pain control. No severe treatment-related adverse effects were reported for any of the four study groups. 44 SCI individuals completed the study and were analysed. The data obtained from the VAS analysis and the PainDETECT Questionnaire (PD-Q) suggested that the combination of NFX88 with pregabalin is more effective than pregabalin with placebo at reducing neuropathic pain (NP) in individuals with SCI and that the dose 2.10 g/day causes the most dramatic pain relief. NFX88 treatment was found to be highly safe and well tolerated, with the dose of 2.10 g/day being the most effective at causing pain relief. Thus, the promising efficacy of this first-in-class lipid mediator deserves further consideration in future clinical trials.
{"title":"Randomised, double-blind, placebo-controlled, parallel-group, multicentric, phase IIA clinical trial for evaluating the safety, tolerability, and therapeutic efficacy of daily oral administration of NFX88 to treat neuropathic pain in individuals with spinal cord injury","authors":"Pablo V. Escribá, Ángel M. Gil-Agudo, Joan Vidal Samsó, Judith Sánchez-Raya, Sebastián Salvador-de la Barrera, Vanesa Soto-León, Natacha León-Álvarez, Bosco Méndez Ferrer, Miguel David Membrilla-Mesa, Carolina Redondo Galán, Jesús Benito-Penalva, Antonio Montoto-Marqués, Javier Medel Rebollo, Ramiro Palazón García, Francisco Gutiérrez Henares, Marc Miralles, Manuel Torres, Ana B. Nieto-Librero, David García Marco, Carmela Gómez, David Jimeno, Antonio Oliviero","doi":"10.1038/s41393-024-01006-4","DOIUrl":"10.1038/s41393-024-01006-4","url":null,"abstract":"Double-blind, randomized, placebo-controlled, parallel-group multicentric phase IIA clinical trial. To assess the safety and tolerability of oral administration of NFX-88 in subjects with chronic spinal cord injury (SCI) and explore its efficacy in pain control. A total of 7 spinal cord injury rehabilitation units in Spain. A total of 61 adult with traumatic complete or incomplete spinal cord injury (C4-T12 level), were randomised 1:1:1:1 to a placebo, NFX88 1.05 g, 2.1 g, 4.2 g/day for up to 12 weeks. The placebo or NFX-88 was administered as add-on therapy to pre-existing pregabalin (150–300 mg per day). Safety and tolerability were evaluated, and the Visual Analogue Scale (VAS) was the primary measure to explore the efficacy of NFX-88 in pain control. No severe treatment-related adverse effects were reported for any of the four study groups. 44 SCI individuals completed the study and were analysed. The data obtained from the VAS analysis and the PainDETECT Questionnaire (PD-Q) suggested that the combination of NFX88 with pregabalin is more effective than pregabalin with placebo at reducing neuropathic pain (NP) in individuals with SCI and that the dose 2.10 g/day causes the most dramatic pain relief. NFX88 treatment was found to be highly safe and well tolerated, with the dose of 2.10 g/day being the most effective at causing pain relief. Thus, the promising efficacy of this first-in-class lipid mediator deserves further consideration in future clinical trials.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 8","pages":"454-467"},"PeriodicalIF":2.1,"publicationDate":"2024-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11300303/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141427668","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-18DOI: 10.1038/s41393-024-01008-2
Christina Draganich, Dustin Anderson, Grant J. Dornan, Mitch Sevigny, Jeffrey Berliner, Susan Charlifue, Abigail Welch, Andrew Smith
Retrospective multi-site cohort study. To develop an accurate machine learning predictive model using predictor variables from the acute rehabilitation period to determine ambulatory status in spinal cord injury (SCI) one year post injury. Model SCI System (SCIMS) database between January 2000 and May 2019. Retrospective cohort study using data that were previously collected as part of the SCI Model System (SCIMS) database. A total of 4523 patients were analyzed comparing traditional models (van Middendorp and Hicks) compared to machine learning algorithms including Elastic Net Penalized Logistic Regression (ENPLR), Gradient Boosted Machine (GBM), and Artificial Neural Networks (ANN). Compared with GBM and ANN, ENPLR was determined to be the preferred model based on predictive accuracy metrics, calibration, and variable selection. The primary metric to judge discrimination was the area under the receiver operating characteristic curve (AUC). When compared to the van Middendorp all patients (0.916), ASIA A and D (0.951) and ASIA B and C (0.775) and Hicks all patients (0.89), ASIA A and D (0.934) and ASIA B and C (0.775), ENPLR demonstrated improved AUC for all patients (0.931), ASIA A and D (0.965) ASIA B and C (0.803). Utilizing artificial intelligence and machine learning methods are feasible for accurately classifying outcomes in SCI and may provide improved sensitivity in identifying which individuals are less likely to ambulate and may benefit from augmentative strategies, such as neuromodulation. Future directions should include the use of additional variables to further refine these models.
研究设计目标：利用急性康复期的预测变量，开发一个准确的机器学习预测模型，以确定脊髓损伤（SCI）患者伤后一年的活动状态：利用急性康复期的预测变量开发精确的机器学习预测模型，以确定脊髓损伤（SCI）伤后一年的活动状态：2000年1月至2019年5月期间的SCI模型系统（SCIMS）数据库：回顾性队列研究，使用之前作为 SCI 模型系统（SCIMS）数据库一部分收集的数据。共对 4523 名患者进行了分析，将传统模型（van Middendorp 和 Hicks）与机器学习算法（包括弹性净惩罚逻辑回归（ENPLR）、梯度提升机（GBM）和人工神经网络（ANN））进行了比较：结果：与 GBM 和 ANN 相比，根据预测准确度指标、校准和变量选择，ENPLR 被确定为首选模型。判别的主要指标是接收者工作特征曲线下的面积（AUC）。与 van Middendorp 所有患者（0.916）、ASIA A 和 D（0.951）以及 ASIA B 和 C（0.775）和 Hicks 所有患者（0.89）、ASIA A 和 D（0.934）以及 ASIA B 和 C（0.775）相比，ENPLR 对所有患者（0.931）、ASIA A 和 D（0.965）以及 ASIA B 和 C（0.803）的 AUC 有所提高：利用人工智能和机器学习方法对 SCI 的结果进行准确分类是可行的，而且可以提高灵敏度，识别出哪些患者不太可能行走，并可能从神经调控等增强策略中获益。未来的发展方向应包括使用其他变量来进一步完善这些模型。
{"title":"Predictive modeling of ambulatory outcomes after spinal cord injury using machine learning","authors":"Christina Draganich, Dustin Anderson, Grant J. Dornan, Mitch Sevigny, Jeffrey Berliner, Susan Charlifue, Abigail Welch, Andrew Smith","doi":"10.1038/s41393-024-01008-2","DOIUrl":"10.1038/s41393-024-01008-2","url":null,"abstract":"Retrospective multi-site cohort study. To develop an accurate machine learning predictive model using predictor variables from the acute rehabilitation period to determine ambulatory status in spinal cord injury (SCI) one year post injury. Model SCI System (SCIMS) database between January 2000 and May 2019. Retrospective cohort study using data that were previously collected as part of the SCI Model System (SCIMS) database. A total of 4523 patients were analyzed comparing traditional models (van Middendorp and Hicks) compared to machine learning algorithms including Elastic Net Penalized Logistic Regression (ENPLR), Gradient Boosted Machine (GBM), and Artificial Neural Networks (ANN). Compared with GBM and ANN, ENPLR was determined to be the preferred model based on predictive accuracy metrics, calibration, and variable selection. The primary metric to judge discrimination was the area under the receiver operating characteristic curve (AUC). When compared to the van Middendorp all patients (0.916), ASIA A and D (0.951) and ASIA B and C (0.775) and Hicks all patients (0.89), ASIA A and D (0.934) and ASIA B and C (0.775), ENPLR demonstrated improved AUC for all patients (0.931), ASIA A and D (0.965) ASIA B and C (0.803). Utilizing artificial intelligence and machine learning methods are feasible for accurately classifying outcomes in SCI and may provide improved sensitivity in identifying which individuals are less likely to ambulate and may benefit from augmentative strategies, such as neuromodulation. Future directions should include the use of additional variables to further refine these models.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 8","pages":"446-453"},"PeriodicalIF":2.1,"publicationDate":"2024-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Prospective observational study. Classification of spinal-cord injury and prediction of independence in activities of daily living (ADL) based on performance evaluations such as upper-limb function have not been reported. Therefore, this study aimed to establish a severity classification and calculate cutoff values for independence in ADL using the Capabilities of Upper Extremity Test (CUE-T) for individuals with cervical spinal-cord injury (CSCI). A spinal-cord injury rehabilitation center in Japan. This study included individuals with subacute CSCI. Collected data included the CUE-T and Spinal Cord Independence Measure III (SCIM III) scores. The severity classification was used for the hierarchical cluster analysis using the CUE-T. The cutoff values of CUE-T scores for independence in ADL were calculated using an adjustment model with logistic regression analysis. The dependent variable was binary (independent/non-independent) for each SCIM III Self-care item, and the independent variable was CUE-T. A total of 71 participants were included in the analysis. The severity of upper-limb dysfunction was classified into four categories using CUE-T. Significant differences in upper-limb function and ADL were observed between clusters. The cutoff values for CUE-T score for independence in ADL ranged from 37 to 91 points. All cutoff values showed good results in the internal validation, sensitivity analysis. This study determined the severity of upper limb function in CSCI and the cutoff values of CUE-T scores for independence in ADL. These results may help set criteria and goals for interventions in the clinical and research fields. None.
{"title":"Classification of upper-limb dysfunction severity and prediction of independence in activities of daily living after cervical spinal-cord injury","authors":"Kazumasa Jimbo, Kazuhiro Miyata, Hiroshi Yuine, Kousuke Takahama, Tomohiro Yoshimura, Honoka Shiba, Taichi Yasumori, Naohisa Kikuchi, Hideki Shiraishi","doi":"10.1038/s41393-024-01005-5","DOIUrl":"10.1038/s41393-024-01005-5","url":null,"abstract":"Prospective observational study. Classification of spinal-cord injury and prediction of independence in activities of daily living (ADL) based on performance evaluations such as upper-limb function have not been reported. Therefore, this study aimed to establish a severity classification and calculate cutoff values for independence in ADL using the Capabilities of Upper Extremity Test (CUE-T) for individuals with cervical spinal-cord injury (CSCI). A spinal-cord injury rehabilitation center in Japan. This study included individuals with subacute CSCI. Collected data included the CUE-T and Spinal Cord Independence Measure III (SCIM III) scores. The severity classification was used for the hierarchical cluster analysis using the CUE-T. The cutoff values of CUE-T scores for independence in ADL were calculated using an adjustment model with logistic regression analysis. The dependent variable was binary (independent/non-independent) for each SCIM III Self-care item, and the independent variable was CUE-T. A total of 71 participants were included in the analysis. The severity of upper-limb dysfunction was classified into four categories using CUE-T. Significant differences in upper-limb function and ADL were observed between clusters. The cutoff values for CUE-T score for independence in ADL ranged from 37 to 91 points. All cutoff values showed good results in the internal validation, sensitivity analysis. This study determined the severity of upper limb function in CSCI and the cutoff values of CUE-T scores for independence in ADL. These results may help set criteria and goals for interventions in the clinical and research fields. None.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 9","pages":"507-513"},"PeriodicalIF":2.1,"publicationDate":"2024-06-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-01005-5.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141421030","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-13DOI: 10.1038/s41393-024-01007-3
Joshua W. Peiffer, Angela Philippus, Karen Kanaster, Kimberley R. Monden
This is a secondary analysis of data from a cross-sectional, observational study. The study aimed to determine whether stigma mediates the relationship between preceived injustice and depression symptoms among individuals with spinal cord injuries. Secondary analysis of participants enrolled in the Spinal Cord Injury Model System at a specialty rehabilitation hospital in the Western United States. A sample of 225 participants completed the questionnaires; eight participants were removed due to incomplete data, resulting in a final sample size of 217 participants (79% male; 21% female). Participants were, on average, 53 years old and were predominantly male, white, and 20 years post-injury. A bootstrapping mediation analysis was conducted to evaluate the stigma-mediated relationship between injustice appraisals and depression symptoms. Injustice appraisals were assessed using the Injustice Experience Questionnaire, stigma with the Spinal Cord Injury Quality of Life Stigma–Short Form, and depression symptoms with the Patient Health Questionnaire–9. Stigma was found to mediate the relationship between injustice appraisals and depression, with an estimated proportion mediated of 80.9% (p ≤ 0.0001). This study provides a novel finding that the relationship between injustice appraisals and depression symptoms is mediated by stigma. Consistent with previous research, injustice appraisals were associated with greater severity of depression symptoms. Results provide further evidence for the role of injustice appraisals after spinal cord injury and a potential mechanism (i.e., stigma) by which it may exert its effect on depression symptoms.
{"title":"Understanding the association between perceived injustice, depression symptoms, and stigma in individuals with traumatic spinal cord injury","authors":"Joshua W. Peiffer, Angela Philippus, Karen Kanaster, Kimberley R. Monden","doi":"10.1038/s41393-024-01007-3","DOIUrl":"10.1038/s41393-024-01007-3","url":null,"abstract":"This is a secondary analysis of data from a cross-sectional, observational study. The study aimed to determine whether stigma mediates the relationship between preceived injustice and depression symptoms among individuals with spinal cord injuries. Secondary analysis of participants enrolled in the Spinal Cord Injury Model System at a specialty rehabilitation hospital in the Western United States. A sample of 225 participants completed the questionnaires; eight participants were removed due to incomplete data, resulting in a final sample size of 217 participants (79% male; 21% female). Participants were, on average, 53 years old and were predominantly male, white, and 20 years post-injury. A bootstrapping mediation analysis was conducted to evaluate the stigma-mediated relationship between injustice appraisals and depression symptoms. Injustice appraisals were assessed using the Injustice Experience Questionnaire, stigma with the Spinal Cord Injury Quality of Life Stigma–Short Form, and depression symptoms with the Patient Health Questionnaire–9. Stigma was found to mediate the relationship between injustice appraisals and depression, with an estimated proportion mediated of 80.9% (p ≤ 0.0001). This study provides a novel finding that the relationship between injustice appraisals and depression symptoms is mediated by stigma. Consistent with previous research, injustice appraisals were associated with greater severity of depression symptoms. Results provide further evidence for the role of injustice appraisals after spinal cord injury and a potential mechanism (i.e., stigma) by which it may exert its effect on depression symptoms.","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 8","pages":"440-445"},"PeriodicalIF":2.1,"publicationDate":"2024-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141318308","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-10DOI: 10.1038/s41393-024-01001-9
Michael G. Fehlings
{"title":"From the desk of Spinal Cord’s New Editor","authors":"Michael G. Fehlings","doi":"10.1038/s41393-024-01001-9","DOIUrl":"10.1038/s41393-024-01001-9","url":null,"abstract":"","PeriodicalId":21976,"journal":{"name":"Spinal cord","volume":"62 5","pages":"199-199"},"PeriodicalIF":2.2,"publicationDate":"2024-06-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.nature.com/articles/s41393-024-01001-9.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141301680","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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