Abstract
Purpose The objective of this study was to determine the independent association of ambulatory ability with complications and medical costs in patients with spinal cord injury (SCI).MethodsPatients with SCI between T1-T12 enrolled in the National Spinal Cord Injury Database (NSCID) provided a minimum one-year follow-up. Covariate-adjusted annual rates of important medical complications (pressure sore, urinary tract infection, hospitalization) and associated medical costs were determined over five years post-injury. ResultsA total of 1,753 patients provided data at one-year follow-up and 1,340 patients provided five-year data. At one-year post-injury, 82% of patients were non-ambulatory and 18% were ambulatory. After adjusting for important covariates, ambulatory status was associated with a lower annual probability of urinary tract infection (43% vs. 68%), pressure sore (12% vs. 35%), and hospitalization (23% vs. 34%). Covariate-adjusted base-case medical costs due to urinary tract infection, pressure sore, and hospitalization were 34% lower in ambulatory vs. non-ambulatory patients ($31,358 vs. $47,266) over five years. Probabilistic sensitivity analyses confirmed the base-case results.ConclusionIn spinal cord-injured individuals, the ability to ambulate is independently associated with lower complication risks and associated medical costs over the five-year period following injury. Long-term clinical benefit and cost savings may be realized with assisted or unassisted ambulation in spinal cord-injured patients.
Highlights
Recovery of ambulation is one of the main goals of patients following spinal cord injury (SCI) [1]
After adjusting for important covariates, ambulatory status was associated with a lower annual probability of urinary tract infection (43% vs. 68%), pressure sore (12% vs. 35%), and hospitalization (23% vs. 34%)
In spinal cord-injured individuals, the ability to ambulate is independently associated with lower complication risks and associated medical costs over the five-year period following injury
Summary
Recovery of ambulation is one of the main goals of patients following spinal cord injury (SCI) [1]. Intermittent standing and habitual ambulation improve upper body muscular fitness, slows the decline in bone mineral density by exposure to gravitational and muscular loading forces, improves circulatory responses, and reverses a number of the health risks associated with prolonged sitting [6,7,8,9]. Those who transition from wheelchair use at rehabilitation discharge to walking at one year report the highest quality of life among spinal cord-injured patients [10]. Many patients who may benefit from increased physical activity face barriers to participation such as lack of
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