Patient-centered approach using COPM, GAS scores in medical rehabilitation of patients with tetraplegia after spinal cord injury

Abstract

To study the efficacy of the patient- and task-oriented approach and specific therapeutic exercises (TE) for the arms in patients after spinal cord injury at the cervical level. The study included 119 patients with a history of spinal injury of more than one year. They were divided into three demographically comparable groups. Group 1 patients (control) received standard of care: TE, physiotherapeutic treatment, social adaptation (SA), and massage; Group 2-standard of care and specific TE for the arms as part of the SA; Group 3-the same as Group 2 combined with the patient- and task-oriented approach (patient-selected activities were trained). Outcomes were assessed at the beginning (T1), end (T2), and at 1 year (T3) after a 30-day medical rehabilitation course. No statistically significant differences between the groups in demographic, neurological (ISCSCI score), motor (FIMm, VLT scores), psychological parameters (depression, anxiety), quality of life (WHOQOL-BREF score) before the medical rehabilitation (T1) were observed. At the end of the medical rehabilitation course (T2), the increase in functional scores was 6.0±5.4 points of FIMm score, 6.0±4.6 points of VLT score in group 1; 8.0±7.6 points of FIMm score, 7.0±7.1 points of VLT score in group 2; 9.0±6.9 points of FIMm score, 8.0±7.6 points of VLT in group 3. Significant differences were found between groups 1 and 2 and 3 on the domains of «finger I» (13.6±9.64 points vs. 15.2±9.40 and 15.3±9.21 points respectively), «fingers II-V» (9.4±6.76 points vs. 11.3±6.41 and 11.6±6.76 points respectively) of VLT score; between groups 3 and 1 on the domains «self-care» (25.9±9.67 points vs. 23.1±9.8 points), «transfer» (11.7±6.21 points vs. 10.6±6.1 points) of the FIMm score, and also the group 3 patients had a higher quality of life by 3.0±1.8 points. At delayed follow-up (T3-T2), no changes of the FIMm and VLT scores were detected within groups. In group 3, 69% of problems were identified in self-care (COPM); subjective assessment of functional improvement for COPM (T2-T1) was as follows: «performance» 4.7±1.27 points, «satisfaction» 3.8±1.63 points; for GAS the T-score at the end of rehabilitation was 1.3±0.55 points, and the greatest significance of change was noted for COPM under «performance» (ES=0.73), with the correlation coefficient between FIMm and COPM being 0.55 and 0.63 for «performance» and «satisfaction» domains, respectively. Patient- and task-oriented approach implemented by using COPM questionnaire and GAS score together with specific TE for arms is an effective method of motor medical rehabilitation of patients with posttraumatic cervical tetraplegia. This approach improves their quality of life, while parameters of subjective scores (COPM, GAS) have the same sensitivity in comparison with the conventional motor scores (FIMm, VLT).