Nontraumatic spinal cord lesions: a prospective study of medical complications during in-patient rehabilitation

Abstract

Prospective study between 1st Jan 1995 and 31st Dec 1999. To document medical complications among subjects with Nontraumatic Spinal Cord Lesions (NTSCL) during in-patient rehabilitation. Bangalore, India. Persons with NTSCL admitted for in-patient rehabilitation were included in the study. Clinical evaluation was carried out according to The International Standards for Neurological and Functional classification of Spinal Cord Injury. Disability was quantified using Barthel index. All medical complications were documented. A total of 297 subjects (154 men and 143 women) with NTSCL were included. The number of medical complications in each patient varied from 0 to 17 (mean=6.1+/-3.7). Common complications seen were urinary tract infections (184), spasticity (169), pain (149), urinary incontinence (147), depression (114), respiratory tract infections (101), constipation (92), pressure ulcers (89), contractures (52) and sleep disturbance (43). The number of medical complications correlated positively with duration of stay (Pearson's correlation coefficient r=0.5, P<0.01) and negatively with Barthel Index at admission (r=-0.2, P<0.05) and at discharge (r=-0.2, P<0.05). Complications were more frequent among people with tetraplegia than those with paraplegia (P<0.001). Medical complications are frequent among subjects undergoing rehabilitation for NTSCL. Patients with severe disability at admission have more complications during rehabilitation. Conversely, individuals with more complications have greater disability at discharge.