Walking-related outcomes for individuals with traumatic and non-traumatic spinal cord injury inform physical therapy practice

• Published in: The journal of spinal cord medicine 2012-09, Vol.35 (5), p.371-381
• Main Authors: Marinho, Andresa R., Flett, Heather M., Craven, Catharine, Andrea Ottensmeyer, C., Parsons, Daria, Verrier, Molly C.
• Format: Article
• Language: English
• Subjects: Adult; Aged; Efferent Pathways - physiopathology; Female; Humans; Inpatients; Locomotor training; Male; Middle Aged; Mobility; Myelopathy; Non-traumatic; Outcome measures; Paraplegia; Physical Therapy Modalities; Predictive Value of Tests; Prospective Studies; Recovery of Function - physiology; Rehabilitation; Rehabilitation Centers; Spinal Cord Diseases - complications; Spinal Cord Diseases - physiopathology; Spinal Cord Diseases - rehabilitation; Spinal cord injuries; Spinal Cord Injuries - etiology; Spinal Cord Injuries - physiopathology; Spinal Cord Injuries - rehabilitation; Tetraplegia; Traumatic; Treatment Outcome; Walking; Walking - physiology
• ISSN: 1079-0268; 2045-7723
• DOI: 10.1179/2045772312Y.0000000038

Objectives To describe and compare patient demographics, inpatient lengths of stay (LOS), and walking-related functional outcomes of individuals with spinal cord injuries (SCIs) of traumatic (TSCI) and non-traumatic (NTSCI) etiologies. To contrast these features between individuals who walked from those who did not walk at discharge from inpatient rehabilitation. Design Prospective observational study; comparisons between TSCI and NTSCI, walkers and non-walkers. Information collected as a pilot project within a provincial SCI informatics strategy. Setting Rehabilitation hospital specialized for SCIs. Participants Adults with NTSCI (n = 31) or TSCI (n = 59) admitted to inpatient rehabilitation, 2007-2009. Outcome measures Lower-extremity motor scores (LEMS), spinal cord independence measure version III (SCIM-III) total and mobility subscores, functional independence measure (FIM), Length of Stay (LOS) at inpatient facilities. Results Groups (NTSCI vs. TSCI) did not differ in the proportion of individuals that achieved "walker" status (SCIM-III mobility indoors (MI) score ≥3 at rehab discharge) (P = 0.41, 48.9% overall). Inpatient LOS at both acute care and rehabilitation facilities did not differ between groups; however, TSCI non-walkers had longer inpatient rehabilitation LOS than TSCI walkers. Among walkers, improvement was shown on all three mobility subscores of the SCIM-III between admission and discharge from rehabilitation; highest significance was shown on the SCIM-III MI. Walking status at discharge (SCIM-III MI) was most strongly correlated with LEMS at rehab admission (r = 0.71, P < 0.001). Conclusion Walking outcomes are comparable among individuals with NTSCI vs. TSCI admitted for specialized SCI rehabilitation. Routine use of SCIM-III mobility items for assessment of walking outcome is recommended for inpatient rehabilitation.