急性 AIS D 级脊髓损伤后完全与不完全长期功能独立的预测:一项前瞻性队列研究

IF 2.4 Q1 REHABILITATION Topics in Spinal Cord Injury Rehabilitation Pub Date : 2024-01-01 Epub Date: 2024-08-08 DOI:10.46292/sci23-00090
Antoine Dionne, Andréane Richard-Denis, Jean-Marc Mac-Thiong
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引用次数: 0

摘要

背景:美国脊髓损伤协会损伤量表(AIS)D级创伤性脊髓损伤(tSCI)患者的比例正在增加。虽然最初的运动障碍可能相对较轻,但有些患者无法恢复功能独立性:本研究旨在确定 AIS D 级创伤性脊髓损伤后未能达到完全功能独立的相关因素:在一家专门从事 SCI 护理的一级创伤中心开展了一项前瞻性队列观察研究。研究考虑了121名AIS-D级tSCI患者的前瞻性队列。研究人员对患者的基线特征、急性期住院时间、住院康复需求以及12个月的功能状态进行了评估。通过单变量和分类及回归树(CART)分析,确定达到完全或不完全功能独立(定义为随访12个月时SCIM III总分满分)的相关因素:在生活自理、呼吸/括约肌管理和行动能力方面,分别有69.3%、83.3%和61.4%的患者达到完全独立。共有 64 人(52%)在所有三个领域都达到了完全功能独立。在CART分析中,我们发现,如果患者的基线运动评分≥83分(65%的患者),且合并症较少(如果Charlson合并症指数[CCI]≤4,70%的患者),则更有可能实现完全功能独立:结论:约半数患有 AIS D 级 tSCI 的患者有望实现完全的长期功能独立。重要的是,在急性期护理过程中应及早识别基线运动评分为 D 级的患者。
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Predicting Complete versus Incomplete Long-Term Functional Independence after Acute AIS Grade D Spinal Cord Injury: A Prospective Cohort Study.

Background: The proportion of patients with American Spinal Injury Association Impairment Scale (AIS) grade D traumatic spinal cord injuries (tSCI) is increasing. Although initial motor deficits can be relatively mild, some individuals fail to recover functional independence.

Objectives: This study aims to identify factors associated with failure to reach complete functional independence after AIS grade D tSCI.

Methods: An observational prospective cohort study was conducted at a level 1 trauma center specialized in SCI care. A prospective cohort of 121 individuals with an AIS-D tSCI was considered. The baseline characteristics, length of acute stay, need for inpatient rehabilitation, and 12-month functional status were assessed. Univariate and classification and regression tree (CART) analyses were performed to identify factors associated with reaching complete versus incomplete functional independence (defined as perfect total SCIM III score at 12-month follow-up).

Results: There were 69.3%, 83.3%, and 61.4% individuals reaching complete independence in self-care, respiration/sphincter management, and mobility, respectively. A total of 64 individuals (52%) reached complete functional independence in all three domains. In the CART analysis, we found that patients are more likely to achieve complete functional independence when they have a baseline motor score ≥83 (65% individuals) and if they present fewer medical comorbidities (70% individuals if Charlson Comorbidity Index [CCI] ≤4).

Conclusion: About half of individuals with AIS grade D tSCI can expect complete long-term functional independence. It is important to recognize early during acute care individuals with baseline motor score <83 or a high burden of comorbidities (CCI ≥5) to optimize their rehabilitation plan.

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来源期刊
CiteScore
3.20
自引率
3.40%
发文量
33
期刊介绍: Now in our 22nd year as the leading interdisciplinary journal of SCI rehabilitation techniques and care. TSCIR is peer-reviewed, practical, and features one key topic per issue. Published topics include: mobility, sexuality, genitourinary, functional assessment, skin care, psychosocial, high tetraplegia, physical activity, pediatric, FES, sci/tbi, electronic medicine, orthotics, secondary conditions, research, aging, legal issues, women & sci, pain, environmental effects, life care planning
期刊最新文献
Cerebrovascular Reactivity Following Spinal Cord Injury. Functional Sitting Balance and Anthropometric Measures Are Related to Inspiratory Muscle Performance in People with Spinal Cord Injury. Predicting Complete versus Incomplete Long-Term Functional Independence after Acute AIS Grade D Spinal Cord Injury: A Prospective Cohort Study. Management of Sleep-Disordered Breathing in a Spinal Cord Injury Rehabilitation Center: Model of Care Adaptation and Implementation Comparison of One-Year Postinjury Mobility Outcomes Between Locomotor Training and Usual Care After Motor Incomplete Spinal Cord Injury
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