Early Outcomes Can Predict Functional Recovery After Traumatic Spinal Cord Injury
Spinal cord injury (SCI) is a debilitating, irreversible condition that may affect a survivor’s health and wellbeing for the rest of their life. While some individuals with SCI may go on to regain some degree of motor function and independence through rehabilitation during the recovery period, clinicians are limited in their ability to predict those patients who will recover and those who will not. This uncertainty places further emotional strain on affected individuals and their caregivers, which can exacerbate mood and psychological problems that are common after SCI, such as depression and anxiety.
Accordingly, clinicians are motivated to identify predictors of functional recovery among patients with SCI, not only to provide relief to patients and their families but to inform decision-making during the rehabilitation process. A group of researchers addressed this knowledge gap with a study of post-SCI functional outcomes among 143 SCI patients. They collected data from patients whose medical records contained relevant information about their injury and data from functional outcome measures, including the American Spinal Injury Association (ASIA) score and the Spinal Cord Independent Measure III (SCIM-III).
The researchers’ analysis revealed that poor functional independence at six months and one year post-SCI was predicted by higher body mass index (BMI), the presence of pre-existing health conditions, poor motor performance upon hospital admission, and surgical treatment more than 24 hours after injury. Age and gender were not predictors of functional recovery, although some studies have suggested that adolescents regain a higher degree of function than elderly patients.
These findings offer a useful patient profile for poor long-term functional outcomes. As expected, patients with more severe injuries and more immediate loss of function are at higher risk for limited functional recovery following SCI. Additionally, overweight patients and those who were diagnosed with other health conditions prior to injury were less likely to recover motor function and independence because in-hospital medical complications delayed the rehabilitation process. Clinicians should consider that these individuals may require more supports and services in the post-injury period.
Most importantly, this work supports early surgical treatment following SCI. Treatment timing remains a controversial topic in SCI care, although most evidence (including the present study) has found that surgical intervention within the first 24 hours of injury improves outcomes across several domains, including functional recovery. Further research is necessary to determine optimal timing for early surgical intervention following SCI.
Overgaard Wichmann T, Haldrup Jensen M, Kasch H, & Rasmussen MM. Early clinical predictors of functional recovery following traumatic spinal cord injury: A population-based study of 143 patients. Acta Neurochirurgica. (August 2021).