Prognostic factors for functional disability in persons with spinal cord injury

This study investigated the combined impacts of socio-demographics, chronic health conditions (CHC), and injury-related factors on functional disability after spinal cord injury (SCI).

In this retrospective cross-sectional analysis of 264 SCI patients aged ≥20 years who were treated at the National Taiwan University Hospital between 2012 and 2019, functional disability was assessed using the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) score (range 0-100), and CHCs were quantified via the Charlson Comorbidity Index (CCI). Their SCI severity was categorized based on their injuries' neurological levels and their scores on the American Spinal Injury Association Impairment Scale (AIS). Linear regression was used to analyze the associations between clinical/sociodemographic variables and WHODAS 2.0 scores.

The participants (mean age: 59.8 years; 64.8 % male) had a mean WHODAS 2.0 score of 64.3. Cervical AIS A/B/C injuries were associated with the greatest disability (mean score: 69.9), followed by thoracic/lumbar AIS A/B/C (62.2) and all AIS D injuries (61.9). Longer durations since the injury occurred were associated with lesser disability (multiple linear regression estimate = -0.83, p = 0.0007). CCI scores, age, and gender exhibited no significant associations with disability. The thoracic/lumbar AIS A/B/C and AIS D groups respectively had 8.3- and 8.1-point lower WHODAS 2.0 scores than the cervical AIS A/B/C group (p < 0.01).

Neurological impairment and time elapsed post-injury are primary determinants of functional disability after SCI, whereas CHC, age, and gender appear to have limited impact.