P153. Long term assessment of the functional independence measure on sports spinal cord injury patients

Abstract

<h3>BACKGROUND CONTEXT</h3> Patients with spinal cord injury (SCI) secondary to traumatic sports-related etiology potentially face loss of independence. The Functional Independence Measure (FIM) assesses the degree to which patients require assistance. Overall FIM score and subcomponents have shown sensitivity to changes in patient's functional status during the period after injury. <h3>PURPOSE</h3> Long-term functional outcomes are poorly explored among patients that had a sports-related SCI based on surgical (SS) or non-surgical (NSS) status. We investigated subscales of the FIM at 1-year and 5-years post rehabilitation to identify factors associated with long-term independence. <h3>STUDY DESIGN/SETTING</h3> The 1973-2016 National Spinal Cord Injury Model Systems (SCIMS) Database was used to develop our cohort of sports SCI patients. Patients who had an etiology of sports-related trauma and a completed FIM at 1-year and 5-years followup were included in the final analysis. <h3>PATIENT SAMPLE</h3> Analysis was performed on 491 patients, 60 (12.2%) were female and 452 (92%) underwent surgery. <h3>OUTCOME MEASURES</h3> Primary outcomes of interest were functional independence, defined by FIM individual scores of 6 or 7, for each subcomponent of FIM evaluated at 1-year and 5-years. <h3>METHODS</h3> Multiple multivariable logistic regressions were performed to identify significant factors. <h3>RESULTS</h3> Initial multivariable analysis showed that patients that are younger in age (P=0.012), white race (P=0.033), not married (P=0.021), and with more severe injury (P=0.011) were more likely to undergo surgery. The cohort was stratified by patients with and without spine surgery and evaluated by multivariate logistic regression for independence in FIM subcategories including self-care, sphincter control, mobility, and locomotion. Spine surgery was associated with poorer outcomes in all FIM subcategories at 1-year followup, but was insignificant at 5-year followup. Rehabilitation length of stay was significantly associated with improved independence at 1-year followup. Lesser severity of injury indicated by ASIA scale was associated with better independence outcomes at 5-year followup while mechanical ventilation at med/surg admission was associated with poorer 5-year independence outcomes. <h3>CONCLUSIONS</h3> Our study demonstrated that patients undergoing spine surgery had lower odds of achieving independent status across all FIM subcategories at 1-year followup, yet when evaluated at 5-year, spine surgery patients had no statistically significant differences in outcomes when compared to medically managed patients. Additionally, we identified that factors repeatedly associated with improved independence at 1-year followup are strictly dissimilar to those associated with improved independence at 5-year followup. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.