Prognostic Models for Physical Capacity at Discharge and 1 Year Postdischarge From Rehabilitation in Persons With Spinal Cord Injury

Abstract

Haisma JA, van der Woude LH, Stam HJ, Bergen MP, Sluis TA, de Groot S, Dallmeijer AJ, Bussmann JB. Prognostic models for physical capacity at discharge and 1 year postdischarge from rehabilitation in persons with spinal cord injury. Objective To develop prognostic models for physical capacity at discharge and 1 year after discharge from inpatient rehabilitation in persons with spinal cord injury (SCI). Design Inception cohort; data collected at start of rehabilitation (n=104), at discharge (n=81), and 1 year later (n=74). Setting Eight Dutch rehabilitation centers. Participants Patients with SCI at initial rehabilitation. Interventions Not applicable. Main Outcome Measures Physical capacity determined by endurance capacity (peak oxygen uptake [V o 2peak, in L/min] and power output [POpeak, in watts]) during a maximal exercise test, arm muscle strength, and respiratory function. Multiple regression models, either with or without prior outcome, evaluated subject, lifestyle, and lesion-related predictors. Results Only start V o 2peak contributed to the prediction of discharge V o 2peak ( R 2=.51). Discharge V o 2peak contributed to its prediction 1 year later ( R 2=.75). Start POpeak, sex, age, and level of lesion contributed to discharge POpeak ( R 2=.73). Discharge POpeak, hours of employment before injury, and level of lesion contributed to POpeak 1 year later ( R 2=.81). Models without prior outcome explained less variance. Education, employment, body mass index, not smoking, and conservative stabilization of the spine positively contributed to endurance capacity. Muscle strength was well predicted ( R 2 range, .68−.84). Without prior outcome, respiratory function was poorly predicted. Conclusions Because prior outcome contributed to an accurate prediction, the early assessment of physical capacity is important in establishing prognoses. Although their accuracy warrants caution in their application, models could complement clinical expertise when informing patients about expected physical outcome and identifying those at risk of low physical capacity.