Spinal Cord Injury-Functional Index/Capacity: Responsiveness to Change Over Time

Factors influencing on functional independence outcomes after hospitalization and rehabilitation in children with spinal cord injury

OBJECTIVE

This study is to investigate the factors that influence functional autonomy outcomes in children who have undergone rehabilitation for spinal cord injury. The aim is to enhance the clinical guidance provided to inpatients at the China Rehabilitation Research Center, Beijing Bo-ai Hospital. Furthermore, the objective is to optimize rehabilitation interventions and establish a scientific basis.

METHODS

This study employed a retrospective survey method for data collection and analysis. Descriptive analysis, one-way ANOVA analysis, and Multiple logistic regression analysis were utilized to examine the influencing factors associated with the prognosis of functional independence outcomes in children with SCI. The degree of influence of each independent variable on functional independence outcomes was ultimately determined.

RESULTS

The total score of SCIM-III at admission was 41.48 ± 4.089, and the total score of SCIM-III at discharge was 50.05 ± 25.028, resulting in a significant difference in the total score of SCIM-III was (8.57 ± 7.000, p < 0.001).In one-way ANOVA analysis, Self-care: injury segments, damage plane, ASIA, assistive devices, complications, rehabilitation duration treatment, WISCI-II, UEMS and LEMS, BI, and 6WMD groups were statistically significant (p < 0.001). Respiratory and sphincter management: injury segments, ASIA, complications, injury to recovery time interval, rehabilitation duration treatment, WISCI-II, UEMS and LEMS, BI, and 6WMD groups were statistically significant (p < 0.05). Move: age, injury segments, damage plane, rehabilitation duration treatment, WISCI-II, UEMS and LEMS groups were statistically significant (p < 0.05). SCIM-III total score: age, AISA, assistive devices, injury to recovery time interval, rehabilitation duration treatment were statistically significant (p < 0.05). Multiple logistic regression analysis, revealed that the injury to recovery time interval had a negative correlation with the total difference in SCIM-III scale (t = -9.893, p < 0.001; 95%CI-12.006~-7.780), while the duration of rehabilitation treatment (t = 4.245, p < 0.001, 95%CI 2.636 ~ 5.854) had a positive correlation with different age groups (t = 4.002, p < 0.001, 95%CI 2.421 ~ 5.583).

CONCLUSION

The shorter the interval between the time of spinal cord injury and the time of intervention for rehabilitation, the more favorable the functional recovery of the children. Children with SCI who were hospitalized for rehabilitation and achieved 3-month daily functional independence scores were more successful. It is recommended that rehabilitation interventions for children with SCI in this institution should be initiated as early as possible and maintained over time. Among the subjects, the prognosis of functional independence was more favorable in the school-age group (6-18y) than in the preschool group (3-6 y).

The Role of Upper Extremity Motor Function in the Choice of Bladder Management in Those Unable to Volitionally Void due to Neurologic Dysfunction

It is estimated that 425,000 individuals with neurologic bladder dysfunction (spinal cordinjury, spina bifida and multiple sclerosis) are unable to volitionally void and must rely oncatheter drainage. Upper extremity (UE) motor function is one of the most important factors indetermining the type of bladder management chosen in individuals who cannot volitionally void. Novel bladder management solutions for those with impaired UE motor function and concurrent impairments involitional voiding continue to be an area of need. Those with poor UE motor function more often choose an indwelling catheter, whereas those with normal UE motor function more often choose clean intermittent catheterization.

Outcomes of Patients with Cervical Spinal Cord Injury Treated by Surgery and Their Prognostic Factors

Objective

To investigate the outcomes of patients with cervical spinal cord injury treated by surgery and their prognostic factors.

Methods

We retrospectively analyzed 139 patients with cervical spinal cord injury treated by surgery at our hospital, who were admitted between January 2017 and December 2018. Depending on the Barthel index at last follow-up, the patients were divided into the recovery group (n = 60, Barthel index > 45) and the nonrecovery group (n = 79, Barthel index ≤ 45). General information of patients in the two groups was compared. The significant factors were further introduced into the logistic regression model. The poor prognostic factors of cervical spinal cord injury treated by surgery were analyzed, and specific nursing measures were taken.

Results

There were significant differences in the duration of injury before admission, duration of injury before surgery, transportation and protection before admission, spinal canal invasion rate, and hormonal therapy within 8 h after injury between the patients achieving good postoperative recovery and those not (P < 0.05). Logistic regression analysis showed that all the factors above were prognostic factors for cervical spinal cord injury treated surgically.

Conclusion

The duration of injury before admission, duration of injury before surgery, transportation and protection before admission, spinal canal invasion rate, and hormonal therapy within 8 h after injury were prognostic factors of patients with cervical spinal cord injury treated by surgery. The following factors should be considered for favorable outcomes: spinal protection during transportation to hospital, timely hormonal shock therapy to delay injury progression, and timely surgery to relieve pain. The spine is composed of cervical, thoracic, lumbar, sacral, and caudal vertebrae.

Overview of the Spinal Cord Injury-Functional Index (SCI-FI): Structure and Recent Advances

The Spinal Cord Injury - Functional Index is a system of patient reported outcomes (PRO) measures of functional activities developed specifically with and for individuals with spinal cord injury (SCI). The SCI-FI was designed to overcome limitations in measurement of the full range of activities and breadth of content of physical functioning commonly used in SCI research. Generic measurement tools of physical function (i.e., those focused on the general population) tend to overemphasize mobility and do not contain enough items at the lower end of the functional range (e.g., appropriate for individuals with tetraplegia). The SCI-FI consists of nine item response theory (IRT)-calibrated item banks that represent relevant and meaningful item content for individuals with SCI, span a wide range of functional abilities, and subdivide physical functioning into important subdomains, including basic mobility, self-care, and fine motor function. Since the original publication of the SCI-FI in 2012, there have been significant advances in and publications on the reliability and psychometric properties of the measures. The manuscripts presented in this special section clarify the SCI-FI structure and present new research on the SCI-FI measurement system.

Validation of the Spinal Cord Injury Functional Index for Use in Community-Dwelling Individuals With SCI

OBJECTIVE

To evaluate the psychometric properties of the Spinal Cord Injury Functional Index (SCI-FI) instruments in a community-dwelling sample.

DESIGN

Cross-sectional study.

SETTING

Community setting.

PARTICIPANTS

Individuals (N=269) recruited from 6 SCI Model Systems sites.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Participants completed computer adaptive test and short form versions of 4 SCI-FI/Capacity (C) banks (ie, Ambulation, Basic Mobility, Fine Motor, Self-Care) and 1 SCI-FI/Assistive Technology (AT) bank (Wheelchair Mobility) at baseline and after 2 weeks. The Self-Report Functional Measure (SRFM) and the clinician-rated motor FIM were used to evaluate evidence of convergent validity.

RESULTS

Pearson correlations, intraclass correlation coefficients, minimal detectable change, and Bland-Altman plots supported the test-retest reliability of the SCI-FI instruments. Correlations were large with the SRFM (.69-.89) and moderate-to-large for the FIM instrument (.44-.64), supporting convergent validity. Known-groups validity was demonstrated by a significant main effect of injury level on all instruments and a main effect of injury completeness on the SCI-FI/C instruments. A ceiling effect was detected for individuals with incomplete paraplegia on the Fine Motor/C and Self-Care/C Short Forms.

CONCLUSION

Findings support the test-retest reliability, convergent validity, and known-groups validity of the SCI-FI/C instruments and the SCI-FI/AT Wheelchair Mobility instruments for use by community-dwelling individuals.