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Published on: June 16, 2016
Predicting Functional Walking at Discharge from Inpatient Rehabilitation After Traumatic Spinal Cord Injury: A
Jonathan E Ripic1, Emily C Workman1, Elizabeth Gray2,3,4
1Shirley Ryan AbilityLab, Chicago, Illinois.
Background:
Predicting walking ability after spinal cord injury (SCI) is important to patients. Clinical prediction rules (CPR) have been developed to aid in predicting walking ability by 1 year but not by inpatient rehabilitation facility (IRF) discharge.
Objectives:
The purpose of this study was to identify a new threshold from the Canadian Outdoor Walking CPR (Jean-CPR) to determine accuracy in predicting household walking ability by discharge from IRF.
Methods:
This was a single-site retrospective analysis conducted at an IRF in the United States. The main predictor variables for walking ability were lumbar spinal level 3 and 5 motor and sacral level 1 light touch (LT) scores. We used train-test split modeling for the Jean-CPR to determine an optimal predictive threshold for household walking at discharge. The optimal threshold was applied to an independent testing group.
Results:
From a total of 573 patient records, a Jean-CPR score ≥50 predicted household walking by discharge from IRF with an area under the curve of 0.945 (95% CI 0.91-0.98, P < .0001). For those with American Spinal Injury Association Impairment Scale (AIS) B/C injuries, a Jean-CPR score ≥50 demonstrated an AUC of 0.847 and a sensitivity of 86.36%.
Conclusion:
This study is the first to validate a walking CPR in the early phases of SCI recovery. Future research may benefit from assessing the external validity of our results and assessing against clinician decision-making. Our results support the use of the Jean-CPR for predicting walking ability by discharge from an IRF.