Functional skills after spinal cord injury rehabilitation: three-year longitudinal follow-up

Reports that spinal cord injury (SCI) patients maintain or improve functional abilities after initial rehabilitation have been limited by small sample size, inadequate functional measures, cross-sectional assessment at only one point in time, and lack of detailed statistical analysis. This study evaluated the follow-up functional status levels of 236 patients with traumatic SCI who completed comprehensive inpatient rehabilitation and were also followed for three years. The sample population was 83% men, with a mean age of 27.0 years. The 100-point Modified Barthel Index (MBI) was used to assess functional abilities. The 75 patients with complete quadriplegia had mean MBI scores of 30.3 at rehabilitation discharge and 37.8 at three-year follow-up. The 53 patients with incomplete quadriplegia were discharged with a mean MBI score of 53.8, and scored 68.3 at three-year follow up. The mean MBI scores for the 66 patients with complete paraplegia were 72.0 at discharge and 75.6 at three-year follow-up. The 42 patients with incomplete paraplegia had mean MBI scores of 77.0 at discharge and 86.1 at three-year follow-up. Each of the four groups demonstrated stability or increases in the proportions of patients who were independent in performance of each of the 14 MBI component tasks from discharge to follow-up. The finding that SCI patients, in this large series, maintained or improved functional levels for three years after discharge is consistent with previous studies and is reassuring to rehabilitation providers.