Spinal Cord Injury Model Systems Research Articles

Hospital-Acquired Pressure Ulcers and Long-Term Motor Score Recovery in Patients With Acute Cervical Spinal Cord Injury

Pressure ulcers (PUs) are (1) prevalent secondary complications after spinal cord injury (SCI), (2) present with elevated systemic inflammatory tone, and (3) may interfere with healing processes underlying neurological recovery (disrepair). To investigate whether PUs acquired during initial hospitalization are associated with neurological and functional long-term outcome and survival after SCI. Multicenter cohort study at 20 centers of the prospective SCI Model Systems (SCIMS) Database (Birmingham, AL). Patients with acute traumatic cervical SCI with relevant motor impairment (ie, American Spinal Injury Association [ASIA] impairment scale [AIS] A, B, and C) were enrolled from January 1996 to September 2006 and followed up until June 2016. Data were analyzed from April 2021 to September 2024. PUs acquired during surgical or first rehabilitative SCI care. The change in the ASIA motor score at 1 year after SCI was the primary end point. Secondary end points included the recovery of functional independence measure (FIM) motor score at 1 year after SCI and mortality up to 10 years. ASIA and FIM motor score were analyzed applying linear mixed models with random intercept adjusted for baseline neurological level, AIS, and sociodemographic factors. Mortality was analyzed using Cox regression. The study included 1282 patients with a mean (SD) age of 38.0 (15.7) years and consisted of 1028 (80.2%) male patients. Regarding race and ethnicity, 349 of 1249 (27.9%) were African American patients, 1139 of 1273 (89.5%) were non-Hispanic patients, and 834 of 1249 (66.8%) were White patients. During initial hospitalization, 594 patients (45.7%) acquired PUs. Exposure to PUs was associated with impaired motor recovery 1 year after SCI compared with unexposed patients (-9.1 ASIA motor score points; 95% CI, -12.3 to -6.0; P < .001). In addition, PUs were associated with lower recovery of physical independence 1 year after SCI (-8.3 FIM motor score points; 95% CI: -11.1 to -5.5; P < .001). Cox regression confirmed PUs as a risk marker for death up to 10 years after SCI (hazard ratio, 1.41; 95% CI, 1.09 to 1.82; P = .01). In this cohort study, PUs acquired during initial hospitalization after SCI were independently associated with poor long-term neurofunctional outcome. PUs constitute a modifiable factor associated with risk for worse long-term disability (recovery confounder) and elevated mortality.

Substance use during the COVID-19 pandemic among persons with traumatic spinal cord injury: A cross-sectional perspective

Study design: Analysis of data from two cohorts of Spinal Cord Injury Model Systems Database (SCIMS) participants, pre-pandemic (2017–2019, n = 6368) and during pandemic (2020, n = 1889). Objectives: To examine differences in substance use during the pandemic compared to the years prior to the pandemic. Setting: 19 SCIMS Centers. Methods: Participant characteristics, wellness (depression, life satisfaction, resilience), participation, and substance use between the two cohorts were compared. Multiple logistic regression examined the association of the pandemic with substance use after accounting for other factors. Results: Characteristics of the two cohorts were similar. Cannabis and sedative uses were not greatly different (28.8% vs 25.1%, and 8.3% vs 6.6%) but did reach statistical significance. Non-prescribed opioid use was double for the pandemic group (6.6% vs 3.3%). Alcohol use patterns were similar across the two cohorts. Measures of wellness were similar, while the pandemic group reported lower participation. The odds of use of cannabis, sedatives, and opioids were 1.3, 1.3, and 2.2 times greater, respectively, for the pandemic cohort after accounting for demographics, wellness, and participation. Greater use of non-prescribed opioids was reported during the pandemic in the South compared to prior to the pandemic (13.8% vs 6.1%). Conclusions: The pandemic may have been associated with increased use of non-prescribed substances in the traumatic spinal cord injury population. Efforts to pursue longitudinal investigations would be warranted for definitive analysis of trends. The provision of demonstrably effective substance use treatment resources delivered via accessible methods will likely be needed in this population, particularly opioid treatment.

Epidemiology of Spinal Cord Injury and Associated Mortality, Past and Present. Is There a Difference?

The demographics of spinal cord injury population has been dynamic over time especially with aging. This study investigated the patterns of SCI admissions by age in the United States over the past decade. Data was evaluated (2010-21), from the National Spinal Cord Injury Model Systems records. Patients were compared based on age (<70 and ≥70 years). Analysis of mortality, neurologic level of injury, neurologic improvement, and mortality by ASIA grade and neurologic level of injury. Patients greater than 70 were defined as elderly. 8,137 patients were reviewed with mean age 42.6 years (range 15-88). The mean admission rate per year was 678 (range 378 -758). For the elderly vs the younger cohort, incidence of fall decreased by 5% vs 3.3%, vehicle accidents increased by 3% vs 14%, high tetraplegia increased by 14.7% vs 22.5%, low tetraplegia decreased by 12% vs 5.7%. In the elderly, ASIA grades A, B and C decreased significantly while ASIA Grade D increased by 23.8%. In the younger cohort ASIA A and B injuries increased while C and D increased, all <5%. Overall, 32.1% of those with ASIA A and 68% with ASIA B injuries improved within one to two years after injury. In-hospital and 1-year mortalities decreased by 14.5% and 35.4% respectively in the elderly. The incidence of SCI increased. High cervical and incomplete injuries increased, while complete spinal cord injuries declined. In-hospital and 1-year mortality decreased. There was recovery in select cases of complete spinal cord injuries within 1 year.

Development and Validation of a Novel Nomogram for Predicting Mechanical Ventilation After Cervical Spinal Cord Injury

ObjectiveTo investigate the risk factors relating to the need for mechanical ventilation (MV) in isolated patients with cervical spinal cord injury (cSCI) and to construct a nomogram prediction model. DesignRetrospective analysis study. SettingNational Spinal Cord Injury Model System Database (NSCID) observation data were initially collected during rehabilitation hospitalization. ParticipantsA total of 5784 patients (N=5784) who had a cSCI were admitted to the NSCID between 2006 and 2021. InterventionsNot applicable. Main Outcome Measure(s)A univariate and multivariate logistic regression analysis was used to identify the independent factors affecting the use of MV in patients with cSCI, and these independent influencing factors were used to develop a nomogram prediction model. The area under the receiver operating characteristic curve (AUROC), calibration curve, and decision curve analysis (DCA) were used to evaluate the efficiency and the clinical application value of the model, respectively. ResultsIn a series of 5784 included patients, 926 cases (16.0%) were admitted to spinal cord model system inpatient rehabilitation with the need for MV. Logistic regression analysis demonstrated that associated injury, American Spinal Cord Injury Association Impairment Scale (AIS), the sum of unilateral optimal motor scores for each muscle segment of upper extremities (sUEM), and neurologic level of injury (NLI) were independent predictors for the use of MV (P<.05). The prediction nomogram of MV usage in patients with cSCI was established based on the above independent predictors. The AUROC of the training set, internal verification set, and external verification set were 0.871 (0.857-0.886), 0.867 (0.843-0.891), and 0.850 (0.824-0.875), respectively. The calibration curve and DCA results showed that the model had good calibration and clinical practicability. ConclusionsThe nomograph prediction model based on sUEM, NLI, associated injury, and AIS can accurately and effectively predict the risk of MV in patients with cSCI, to help clinicians screen high-risk patients and formulate targeted intervention measures.

Wheelchair Repairs: Delays, Causes, and Associated Outcomes

ObjectiveTo examine the length of time to complete wheelchair repairs and the relationship between negative outcomes and the factors that prevented or determined who performed the repairs. DesignSurvey, cross-sectional. SettingNine spinal cord injury (SCI) Model Systems Centers. ParticipantsWheelchair users with SCI reporting at least 1 repair (N=301). InterventionsNot applicable. Main Outcome MeasuresPrevalence of adverse consequences associated with wheelchair repairs, repairs completed of those needed, and time elapsed before wheelchair repair. ResultsOf the participants, 76% reported all necessary repairs were completed, 7% indicated that some repairs were addressed, and 14% reported none of the repairs were completed. The most common reason for incomplete repairs (30%) was the vendor's failure to complete the repair after being contacted. Among the repairs that were successfully completed, 56% were performed by vendors. The median time elapsed before repair was 14 days, with no significant difference observed in the time taken for repairs across different components. The most common consequences were being forced to use a backup wheelchair or being confined at home. A greater percentage of participants experienced each type of consequence, except injury, for repairs completed by vendors. ConclusionsThe high percentage of uncompleted wheelchair repairs poses a significant risk to users, and this risk is compounded by prolonged time taken by vendors to address breakdowns. Unsatisfactory vendor service was common, with a significantly larger proportion of participants experiencing consequences for repairs that required a vendor. This seems to indicate structural inadequacies within the repair process and the need for interventions to address these issues.

Development of Composite Measures of Neighborhood Economic Factors for Use in Spinal Cord Injury Outcomes Studies: A Spinal Cord Injury Model Systems Database Study

ObjectiveTo develop composite measures of neighborhood economic factors for use with the national Spinal Cord Injury Model Systems (SCIMSs) database in cross-sectional and longitudinal investigations of the social determinants of health. DesignSecondary data analysis of administrative data from the 2009, 2014, and 2019 American Community Survey (ACS) 5-year estimates and survey data collected for the SCIMS database. SettingCommunity. ParticipantsThe validity of the neighborhood economic measures developed from the ACS data was tested with a sample of SCIMS participants who completed a follow-up interview between 2017 and 2021 (N=8,130). The predictive validity of the neighborhood measures was assessed with a subsample of cases with complete data on the outcome and covariate measures (N=6,457). InterventionsNot applicable. Main Outcome MeasuresA binary measure of self-rated health status (1=poor/fair health; 0=good/very good/excellent). ResultsA combination of panel review and data reduction techniques yielded 2 distinct measuring neighborhood socioeconomic status (SES) and neighborhood socioeconomic disadvantage that were validated using 3 waves of ACS data and the SCIMS data. The odds of reporting poor health were lower among people living in moderate- and high-SES neighborhoods and highest among people living in moderately and highly disadvantaged neighborhoods. The negative association between neighborhood SES and poor health was fully attenuated by differences in participants’ individual demographic and economic characteristics whereas the positive association between neighborhood disadvantage and poor health persisted after adjusting for individual differences. ConclusionsThe two composite measures of neighborhood economic factors developed by this study are robust in samples from different periods of time and valid for use with the SCIMS database. Future investigations conducting surveillance of the needs of the SCI population using this resource may consider using these measures to assess the effect of the social determinants of health in outcomes after SCI.

Comparison of Demographics Across the Burn, Spinal Cord Injury, and Traumatic Brain Injury Model Systems

ObjectiveTo analyze the demographic profiles of participants in the traumatic brain injury, burn injury, and spinal cord injury model systems databases. DesignData from the Burn Model System (BMS), Traumatic Brain Injury Model System (TBIMS), and Spinal Cord Injury Model System (SCIMS) National Databases were analyzed from 1994-2020. SettingNot applicable. ParticipantsThe study included participants aged ≥16 years (N=42,407) with available data in selected variables, totaling 4807 burn injury, 19,127 TBI, and 18,473 SCI participants. InterventionsNot applicable. Main Outcome MeasuresVariables including age, race, ethnicity, sex, education level, primary payor source, family income level, employment status at 1 year postinjury, etiology, and mortality at 1 year postinjury were analyzed across the database. ResultsMedian ages at injury for BMS (40.4y), TBIMS (40y), and SCIMS (38y) National Database participants were comparable. Men constituted approximately 75% of participants in the BMS, TBIMS, and SCIMS datasets, with approximately 75% having a high-school education or less. The proportion of participants funded by Medicare during initial hospital care varied across the BMS (14%), TBIMS (15.6%), and SCIMS (10.2%). For family income (data available for BMS and SCIMS), approximately 30% of these participants reported a family income <$25,000. Etiology data indicated 49.0% of traumatic brain injury and 40.7% of spinal cord injury cases resulted from vehicular incidents. ConclusionsAn overlapping at-risk population for these injuries appears to be middle-aged men with lower education levels and family incomes who have access to vehicles. This underscores the need for preventive initiatives tailored to this identified population to mitigate the risk of these injuries.

Predictive modeling of ambulatory outcomes after spinal cord injury using machine learning.

Retrospective multi-site cohort study. To develop an accurate machine learning predictive model using predictor variables from the acute rehabilitation period to determine ambulatory status in spinal cord injury (SCI) one year post injury. Model SCI System (SCIMS) database between January 2000 and May 2019. Retrospective cohort study using data that were previously collected as part of the SCI Model System (SCIMS) database. A total of 4523 patients were analyzed comparing traditional models (van Middendorp and Hicks) compared to machine learning algorithms including Elastic Net Penalized Logistic Regression (ENPLR), Gradient Boosted Machine (GBM), and Artificial Neural Networks (ANN). Compared with GBM and ANN, ENPLR was determined to be the preferred model based on predictive accuracy metrics, calibration, and variable selection. The primary metric to judge discrimination was the area under the receiver operating characteristic curve (AUC). When compared to the van Middendorp all patients (0.916), ASIA A and D (0.951) and ASIA B and C (0.775) and Hicks all patients (0.89), ASIA A and D (0.934) and ASIA B and C (0.775), ENPLR demonstrated improved AUC for all patients (0.931), ASIA A and D (0.965) ASIA B and C (0.803). Utilizing artificial intelligence and machine learning methods are feasible for accurately classifying outcomes in SCI and may provide improved sensitivity in identifying which individuals are less likely to ambulate and may benefit from augmentative strategies, such as neuromodulation. Future directions should include the use of additional variables to further refine these models.

Clinical Subsets of Central Cord Syndrome: Is It a Distinct Entity from Other Forms of Incomplete Tetraplegia for Research?

Central cord syndrome (CCS) is the most prevalent and debated incomplete spinal cord injury (SCI) syndrome, with its hallmark feature being more pronounced weakness of the upper extremities than of the lower extremities. Varying definitions encapsulate multiple clinical features under the single umbrella term of CCS, complicating evaluation of its frequency, prognosis discussions, and outcomes research. Often, people with CCS are excluded from research protocols, as it is thought to have a favorable prognosis, but the vague nature of CCS raises doubts about the validity of this practice. The objective of this study was to categorize CCS into specific subsets with clear quantifiable differences, to assess whether this would enhance the ability to determine if individuals with CCS or its subsets exhibit distinct neurological and functional outcomes relative to others with incomplete tetraplegia. This study retrospectively reviewed individuals with new motor incomplete tetraplegia from traumatic SCI who enrolled in the Spinal Cord Injury Model Systems (SCIMS) database from 2010 to 2020. Through an assessment of the prevailing criteria for CCS, coupled with data analysis, we used two key criteria, including the severity of distal upper extremity weakness (i.e., hands and fingers) and extent of symmetry, to delineate three CCS subsets: full CCS, unilateral CCS, and borderline CCS. Of the 1490 participants in our sample, 17.5% had full, 25.6% had unilateral, and 9% had borderline CCS, together encompassing >50% of motor incomplete tetraplegia cases. Despite the increased sensitivity and specificity of these subsets compared with existing quantifiable criteria, substantial variability in clinical presentation was still observed. Overall, individuals meeting CCS subset criteria showed a higher likelihood of American Spinal Injury Association (ASIA) Impairment Scale (AIS) D grade than those with motor incomplete tetraplegia without CCS. Upper Extremity Motor Score (UEMS) for those with CCS was lower on admission, a difference that diminished by discharge, whereas their Lower Extremity Motor Score (LEMS) consistently remained higher than for those without CCS. However, these neurological distinctions did not result in significant functional differences, as lower and upper extremity functional outcomes at discharge were mostly similar, with some differences observed within those with AIS D grade. The AIS grade, rather than the diagnosis of CCS, remains the foremost determinant influencing neurological and functional outcomes. We recommend that future studies consider incorporating motor incomplete tetraplegia into their inclusion/exclusion criteria, instead of relying on criteria specific to CCS. Although there remains clinical value in characterizing an injury pattern as CCS and perhaps using the different subsets to better characterize the impairments, it does not appear to be a useful research criterion.

Impact of Upper Limb Motor Recovery on Functional Independence After Traumatic Low Cervical Spinal Cord Injury.

Cervical spinal cord injury (SCI) causes devastating loss of upper limb function and independence. Restoration of upper limb function can have a profound impact on independence and quality of life. In low-cervical SCI (level C5-C8), upper limb function can be restored via reinnervation strategies such as nerve transfer surgery. The translation of recovered upper limb motor function into functional independence in activities of daily living (ADLs), however, remains unknown in low cervical SCI (i.e., tetraplegia). The objective of this study was to evaluate the association of patterns in upper limb motor recovery with functional independence in ADLs. This will then inform prioritization of reinnervation strategies focused to maximize function in patients with tetraplegia. This retrospective study performed a secondary analysis of patients with low cervical (C5-C8) enrolled in the SCI Model Systems (SCIMS) database. Baseline neurological examinations and their association with functional independence in major ADLs-i.e., eating, bladder management, and transfers (bed/wheelchair/chair)-were evaluated. Motor functional recovery was defined as achieving motor strength, in modified research council (MRC) grade, of ≥ 3 /5 at one year from ≤ 2/5 at baseline. The association of motor function recovery with functional independence at one-year follow-up was compared in patients with recovered elbow flexion (C5), wrist extension (C6), elbow extension (C7), and finger flexion (C8). A multi-variable logistic regression analysis, adjusting for known factors influencing recovery after SCI, was performed to evaluate the impact of motor function at one year on a composite outcome of functional independence in major ADLs. Composite outcome was defined as functional independence measure score of 6 or higher (complete independence) in at least two domains among eating, bladder management, and transfers. Between 1992 and 2016, 1090 patients with low cervical SCI and complete neurological/functional measures were included. At baseline, 67% of patients had complete SCI and 33% had incomplete SCI. The majority of patients were dependent in eating, bladder management, and transfers. At one-year follow-up, the largest proportion of patients who recovered motor function in finger flexion (C8) and elbow extension (C7) gained independence in eating, bladder management, and transfers. In multi-variable analysis, patients who had recovered finger flexion (C8) or elbow extension (C7) had higher odds of gaining independence in a composite of major ADLs (odds ratio [OR] = 3.13 and OR = 2.87, respectively, p < 0.001). Age 60 years (OR = 0.44, p = 0.01), and complete SCI (OR = 0.43, p = 0.002) were associated with reduced odds of gaining independence in ADLs. After cervical SCI, finger flexion (C8) and elbow extension (C7) recovery translate into greater independence in eating, bladder management, and transfers. These results can be used to design individualized reinnervation plans to reanimate upper limb function and maximize independence in patients with low cervical SCI.

469 Recovery Rate of Motor Function During Rehabilitation After Traumatic Cervical Spinal Cord Injury Predicts Functional Status at Years 1 and 5 After Surgery: A Multicenter, Longitudinal Cohort Study

INTRODUCTION: Traumatic spinal cord injury (SCI) is a devastating condition. Early surgical decompression and rehabilitative efforts in cervical SCI patients has been shown to improve neurological outcomes. METHODS: A longitudinal, retrospective cohort study was conducted from the multicenter Spinal Cord Injury Model Systems (SCIMS) database on patients with motor Functional Independence Measure (FIM) scores at admission to and discharge from rehabilitation, year 1, and year 5. Patients who underwent surgical decompression with neurological levels of injury limited to the cervical region and those with American Spinal Injury Association (ASIA) Impairment Scale (AIS) grades of A and B were included. The FIM score was utilized to calculate changes in motor FIM scores over each respective time period. Multivariate logistical regression was performed to identify longitudinal predictors associated with functional independence. RESULTS: A total of 351 patients met the inclusion criteria. The change in motor FIM score during the inpatient rehab period was a significant predictor of achieving FI at 1 and 5 years (year 1: aOR = 15.6, 95% CI 3.94-77.6, p &lt; 0.0001; year 5: aOR = 28.0, 95% CI 6.13-173.6, p &lt; 0.0001). For patients not achieving FI at year 1, the change in motor FIM score during inpatient rehab was a greater predictor of FI at year 5 (aOR = 64.7, 95% CI 5.15-1717.3, p = 0.0004). CONCLUSIONS: Inpatient rehabilitation efforts may lead to greater long-term functional status and carry emphasized importance for patients who do not attain functional independence by year 1.

Residential Mobility and Reasons for Moving Among People Living With Spinal Cord Injury: Results of a Multisite Survey Study.

Residential mobility after spinal cord injury (SCI) has not been extensively examined despite a growing interest in investigating the relationship between neighborhood exposures and community living outcomes. This study explores residential mobility patterns, the annual move rate, and reasons for moving among a community-living sample of adults with SCI. A survey was conducted with 690 people at six SCI Model Systems centers in the United States between July 2017 and October 2020. The outcomes included move status in the past 12 months, move distance, and the primary reason for moving. A sample from the 2019 American Community Survey (ACS) 5-year pooled estimates was obtained for comparative analysis. Descriptive statistics were used to summarize the distributions of the outcomes and differences between the samples. The annual move rate for adults with SCI was 16.4%, and most moves were within the same county (56.6%). Recent movers were more likely to be young adults, be newly injured, and have low socioeconomic status. Housing quality, accessibility, and family were more frequently reported motivations for moving compared to employment. Young adults more commonly moved for family and accessibility, whereas middle-aged adults more commonly moved for housing quality. No notable difference was observed in the annual move rate between the SCI and the general population samples. These findings suggest an age-related pattern of residential relocation after SCI, which may be indicative an extended search for optimal living conditions that meet the housing and accessibility needs of this population.

Travel and Social Isolation of People With Spinal Cord Injury.

People with spinal cord injury (SCI) are at high risk for social isolation because they face barriers to social participation owing to limitations in physical functioning, secondary health conditions, and environmental barriers. Research has shown that social isolation, an objective lack of contact with others, can lead to loneliness, mental health issues, and low life satisfaction. Leisure travel, which involves interactions with others, may have the potential to reduce social isolation. To explore the association of travel participation with social isolation among people with SCI. A total of 11,091 cases from 2016-2021 in the SCI Model Systems database were included in the study. Participants were categorized into low and high social isolation groups. A hierarchical logistic regression was performed with social isolation as the dependent variable and travel groups as the independent variable, while controlling for age, family income, and health conditions. Travel participation is negatively associated with social isolation. People with SCI who traveled for one to two nights (odd ratio [OR] 0.52, 95% CI 0.40-0.67), three to four nights (OR 0.56, 95% CI 0.43-0.72), or more than five nights (OR 0.41, 95% CI 0.35-0.49) in the past 12 months are less likely to be socially isolated compared to those who have not traveled in the past 12 months. Travel participation may help reduce the social isolation of individuals with SCI. Therapists and rehabilitation professionals should design effective travel training programs that encourage patients with SCI to travel more often.

Prediction Model for Neurogenic Bladder Recovery One Year After Traumatic Spinal Cord Injury

Neurogenic bladder is a common complication after spinal cord injury (SCI) that carries substantial burdens on the inflicted individual. The objective of this study is to build a prediction model for neurogenic bladder recovery 1year after traumatic SCI. We queried the National Spinal Cord Injury Model Systems database for patients with traumatic SCI who had neurogenic bladder at the time of injury. The primary outcome of interest was the complete recovery of bladder function at 1year. Multiple imputations were performed to generate replacement values for missing data, and the final imputed data were used for our analysis. A multivariable odds logistic regression model was developed for complete bladder recovery at 1year. We identified a total of 2515 patients with abnormal bladder function at baseline who had an annual follow-up. A total of 417 patients (16.6%) recovered bladder function in 1year. Predictors of complete bladder recovery included the following baseline parameters: sacral sensation, American Spinal Injury Association (ASIA) impairment score, bowel function at baseline, voluntary sphincter contraction, anal sensation, S1 motor scores, and the number of days in the rehabilitation facility. The model performed with a discriminative capacity of 90.5%. We developed a prediction model for the probability of complete bladder recovery 1year after SCI. The model performed with a high discriminative capacity. This prediction model demonstrates potential utility in the counseling, research allocation, and management of individuals with SCI.

Risk Factors Associated With Suicidal Ideation in Individuals With Spinal Cord Injury

ObjectiveTo assess the frequency of suicidal ideation (SI) among individuals with chronic spinal cord injury (SCI) and to identify risk factors associated with SI. DesignCross-sectional. SettingCommunity setting. ParticipantsTwo hundred and forty-six individuals with chronic SCI participating in the Spinal Cord Injury Model Systems at a Level 1 Trauma center. InterventionsNot applicable. Main Outcome MeasureSI, as assessed by question 9 of the Patient Health Questionnaire-9. ResultsTwenty-seven (11.0%) participants endorsed SI; 6 (22.2%) of whom endorsed active SI with a plan of self-harm. Participants who endorsed SI had significantly higher depressive symptoms, lower resilience, and lower satisfaction with life (all Ps<.001). They also had lower perceived health (P<.001), Craig Handicap Assessment & Reporting Technique Short Form (CHART-SF) physical independence (P=.013), and Spinal Cord Injury – Functional Index with Assistive Technology domains of basic mobility (P=.003), self-care (P=.042), and fine motor skills (P=.035). However, participants who endorsed SI were not significantly different in re-hospitalization rates and in other domains of CHART-SF and SCI-AT. Logistic regression, with a forward selection procedure, was used to identify significant predictors of endorsing SI in the context of multiple associated variables. Depressive symptoms (odds ratio [OR]=1.18, P=.020), resilience (OR=0.85, P=.003), and physical independence (OR=0.98, P=.019) remained significant predictors of SI. ConclusionStudy findings suggest higher levels of SI among people with SCI, a substantial proportion of whom have active SI. Individuals with SCI who endorse SI have greater burden of poor physical and mental health, as well as poorer functional status and adaptation. Interventions targeting multiple dimensions of quality of life may help reduce risk of SI and suicide among individuals with SCI.

Assessing functional recovery for individuals with spinal cord injury post-discharge from inpatient rehabilitation

Objective: To determine the associations between trauma variables, acute phase-related variables, and patient-level characteristics with functional recovery during the first-year post-discharge from inpatient rehabilitation facilities (IRF) for individuals with spinal cord injury (SCI). Design: Retrospective cohort analysis. Setting: Two SCI Model Centers in Pennsylvania, United States. Methods: We were able to link 378 individuals with traumatic SCI between the Pennsylvania Trauma Systems Outcomes Study and the National SCI Model Systems databases. Nineteen individuals with SCI were excluded due to missing data. We estimated functional recovery based on changes in functional independence measure (FIM) total motor score during the first-year post-discharge from IRF in 359 individuals with SCI, who did not have any missing data, using ordinary least squares regression (OLS). Results: After discharge from IRF the majority of individuals with SCI improved over the first-year post-injury. Individuals with cervical A-C (injury severity group) who were older had a slight decrease in motor FIM at 1-year post-injury. Regression analysis indicated that lower functional recovery was associated with being of Black and Hispanic race and ethnicity, higher injury severity group, occurrence of non-pulmonary infection during acute care, and longer length of stay at IRF (R 2 = 0.36). Conclusions: Patient-level characteristics, trauma variables, and acute phase-related variables were associated with functional recovery post-discharge from IRF. Further research is necessary to collect and assess post-rehabilitation and socio-economic factors that play a critical role in continued functional recovery in the community.

Item Banks for Measuring the Effect of Blood Pressure Dysregulation on Health-Related Quality of Life in Persons With Spinal Cord Injury

ObjectiveTo report on the development and calibration of the new Blood Pressure Dysregulation Measurement System (BPD-MS) item banks that assess the effect of BPD on health-related quality of life (HRQOL) and the daily activities of Veterans and non-Veterans with spinal cord injury (SCI). DesignCross-sectional survey study. SettingTwo Veteran Affairs medical centers and a SCI model system site. Participants454 respondents with SCI (n=262 American Veterans and n=192 non-Veterans; N=454). InterventionsNot applicable Main Outcome MeasuresThe BPD-MS item banks. ResultsBPD item pools were developed and refined using literature reviews, qualitative data from focus groups, and cognitive debriefing of persons with SCI and professional caregivers. The item banks then underwent expert review, reading level assessment, and translatability review prior to field testing. The items pools consisted of 180 unique questions (items). Exploratory and confirmatory factor analyses, item response theory modeling, and differential item function investigations resulted in item banks that included a total of 150 items: 75 describing the effect of autonomic dysreflexia on HRQOL, 55 describing the effect of low blood pressure (LBP) on HRQOL, and 20 describing the effect of LBP on daily activities. In addition, 10-item short forms were constructed based on item response theory-derived item information values and the clinical relevance of item content. ConclusionsThe new BPD-MS item banks and corresponding 10-item short forms were developed using established rigorous measurement development standards, which represents the first BPD-specific patient-reported outcomes measurement system unique for use in the SCI population.

Association of upper-limb neurological recovery with functional outcomes in high cervical spinal cord injury.

High cervical spinal cord injury (SCI) results in complete loss of upper-limb function, resulting in debilitating tetraplegia and permanent disability. Spontaneous motor recovery occurs to varying degrees in some patients, particularly in the 1st year postinjury. However, the impact of this upper-limb motor recovery on long-term functional outcomes remains unknown. The objective of this study was to characterize the impact of upper-limb motor recovery on the degree of long-term functional outcomes in order to inform priorities for research interventions that restore upper-limb function in patients with high cervical SCI. A prospective cohort of high cervical SCI (C1-4) patients with American Spinal Injury Association Impairment Scale (AIS) grade A-D injury and enrolled in the Spinal Cord Injury Model Systems Database was included. Baseline neurological examinations and functional independence measures (FIMs) in feeding, bladder management, and transfers (bed/wheelchair/chair) were evaluated. Independence was defined as score ≥ 4 in each of the FIM domains at 1-year follow-up. At 1-year follow-up, functional independence was compared among patients who gained recovery (motor grade ≥ 3) in elbow flexors (C5), wrist extensors (C6), elbow extensors (C7), and finger flexors (C8). Multivariable logistic regression evaluated the impact of motor recovery on functional independence in feeding, bladder management, and transfers. Between 1992 and 2016, 405 high cervical SCI patients were included. At baseline, 97% of patients had impaired upper-limb function with total dependence in eating, bladder management, and transfers. At 1 year of follow-up, the largest proportion of patients who gained independence in eating, bladder management, and transfers had recovery in finger flexion (C8) and wrist extension (C6). Elbow flexion (C5) recovery had the lowest translation to functional independence. Patients who achieved elbow extension (C7) were able to transfer independently. On multivariable analysis, patients who gained elbow extension (C7) and finger flexion (C8) were 11 times more likely to gain functional independence (OR 11, 95% CI 2.8-47, p < 0.001) and patients who gained wrist extension (C6) were 7 times more likely to gain functional independence (OR 7.1, 95% CI 1.2-56, p = 0.04). Older age (≥ 60 years) and motor complete SCI (AIS grade A-B) reduced the likelihood of gaining independence. After high cervical SCI, patients who gained elbow extension (C7) and finger flexion (C8) had significantly greater independence in feeding, bladder management, and transfers than those with recovery in elbow flexion (C5) and wrist extension (C6). Recovery of elbow extension (C7) also increased the capability for independent transfers. This information can be used to set patient expectations and prioritize interventions that restore these upper-limb functions in patients with high cervical SCI.

MP52-06 CLINICAL AND SOCIODEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH SPINAL CORD INJURY ARE INDEPENDENTLY ASSOCIATED WITH CHOICE OF BLADDER MANAGEMENT METHOD

You have accessJournal of UrologyCME1 Apr 2023MP52-06 CLINICAL AND SOCIODEMOGRAPHIC CHARACTERISTICS OF PATIENTS WITH SPINAL CORD INJURY ARE INDEPENDENTLY ASSOCIATED WITH CHOICE OF BLADDER MANAGEMENT METHOD Megan Stout, Juan Peng, Yu-Ying Chen, Huacong Wen, Jan Schwab, and Nima Baradaran Megan StoutMegan Stout More articles by this author , Juan PengJuan Peng More articles by this author , Yu-Ying ChenYu-Ying Chen More articles by this author , Huacong WenHuacong Wen More articles by this author , Jan SchwabJan Schwab More articles by this author , and Nima BaradaranNima Baradaran More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003300.06AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Clinical factors are known to impact choice of bladder management method (BMM) in patients with spinal cord injury (SCI) such as injury level, impairment severity, manual dexterity, as well as patient preference. The primary objective of this study was to evaluate the effect of sociodemographic characteristics of patients in this context. METHODS: From the Spinal Cord Injury Model System adult patients (>18 at time of injury) were screened. Exclusion criteria included death within one year of injury and lack of BMM data. Outcomes of interest included age, gender, race, education, marital status, household income, employment status, health insurance type, injury level, injury etiology, ventilatory status, neurological impairment category (quadriplegic vs paraplegic), composite poverty scale, and American Spine Injury Association (ASIA) impairment scale. Logistic regression models and multivariate analysis was used to determine associations between sociodemographic factors and use of indwelling catheters as primary choice of BMM. RESULTS: A total of 12,708 patients were screened and 9,097 were included. Majority of patients were male (79.4%), white (71.2%), had an average annual income of <$25,000 (33.3%) and public insurance (68.5%). Most were tetraplegic (47.3%) with ASIA score of “A” (complete impairment, 57.5%).The BMM breakdown was those that used indwelling catheters (34.4%) versus those with “other” methods (intermittent catheterization, external catheters, or urinary diversion; 65.6%). On multivariate analysis, after adjusting for disease characteristics, men were significantly more likely to be impacted by sociodemographic factors. In men, white race, non-Hispanic ethnicity, having public insurance, lower income, higher impairment severity, older age at injury and longer injury duration was associated with higher use of indwelling catheters (Figure 1). In females, only age at injury and neurologic impairment were significant. CONCLUSIONS: Sociodemographic variables are significantly associated with the choice of BMM in men with SCI. The reason for the discrepancy between genders is unknown. Further analysis utilizing this database to discern BMM choice between groups could guide future patient counseling and optimization of care. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e704 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Megan Stout More articles by this author Juan Peng More articles by this author Yu-Ying Chen More articles by this author Huacong Wen More articles by this author Jan Schwab More articles by this author Nima Baradaran More articles by this author Expand All Advertisement PDF downloadLoading ...

146 Functional Priorities in High Cervical Spinal Cord Injury: Implications for Upper Limb Nerve Transfer Surgery

INTRODUCTION: High cervical spinal cord injury (SCI) results in complete impairment in upper limb function. Nerve transfer is an innovative reinnervation strategy for upper limb reanimation following SCI. However, the impact of upper limb motor recovery on the degree of long-term functional outcomes remains unknown. METHODS: A prospective cohort of high cervical SCI (C1-C4) patients enrolled in SCI model systems (SCIMS) was included. Baseline neurological examinations and functional independence measures (FIM) in eating, bladder-function, and transfers (bed/wheelchair/chair) were evaluated. At one-year follow-up, functional independence was compared in patients who gained recovery (motor grade &gt;=3) in C5-elbow flexion, C6-wrist extension, C7-elbow extension, and C8-finger flexion. A multivariable logistic regression evaluated the impact of motor recovery on functional independence on composite outcome of feeding, bladder-function, and transfers. RESULTS: Between 1992-2016, 405 high cervical SCI patients were included. At baseline, 97% patients had impaired upper limb function with inability in all functions. At one-year follow-up, the largest proportion of patients gaining independence in eating, bladder-function, and transfers had recovery in C8-finger-flexion and C6-wrist-extension. C5-elbow-flexion recovery had lowest translation into functional independence. Patients who achieved C7-elbow-extension were able to transfer independently. On multivariable analysis, C8-finger-flexion recovery had 12-times higher odds (p=0.004) and C6-wrist-extension recovery had 7-times higher odds (p=0.04) of gaining functional independence in composite outcome. Age &gt;=60 years and motor complete SCI (ASIA-A-B) were associated with reduced odds of gaining independence. 8% patients improved ASIA grades from baseline to 1-year. CONCLUSIONS: Following cervical SCI, C8-finger-flexion and C6-wrist-extension recovery can maximize functional independence. Recovery of C7-elbow-extension can increase transfer capability. This information may prioritize reinnervation strategies for individualized decision-making for nerve transfers in high cervical SCI.