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对急性创伤性脊髓损伤的功能恢复的临床表型进行分类. 一个观察性队列研究

Pascal Mputu Mputu^1,2, Marie Beauséjour^3,4, Andréane Richard-Denis^1,5

¹Hôpital du Sacré-Cœur de Montréal/CIUSSS NÎM, Montreal, Canada.

Disability and rehabilitation

|February 23, 2024

概括

这项研究根据最初的神经评估确定了四个患者子组,在脊髓损伤 (SCI) 后具有不同的功能结果. 这些子组的早期识别可以指导个性化康复和为改善康复设定目标.

科学领域:

神经学神经学
康复医学康复医学康复医学
临床结果研究研究

背景情况:

脊髓损伤 (SCI) 会导致各种功能障碍.
预测SCI后的功能恢复对于有效的康复计划至关重要.
目前的方法可能无法完全捕捉SCI后患者结局的异质性.

研究的目的:

在SCI之后识别不同的患者子组,具有不同的功能结果.
研究初始神经状态与长期功能恢复之间的关系.
开发SCI患者功能结果的预测模型.

主要方法:

一项观察性队列研究利用了Rick-Hansen注册表 (RHSCIR) (2014-2019) 中675名患者的数据.
用分类和回归树 (CART) 分析来确定患者子组.
预测因素包括国际脊髓损伤神经分类标准 (ISNCSCI) 的组成部分:AIS,NLI,UEMS,LEMS,针刺 (PPSS) 和轻触 (LTSS).
使用脊髓独立测量 (SCIM) 测量了功能性结果.
在2020-2021年期间治疗的62名患者进行了时间验证.

主要成果:

出现了四个不同的子组,显示与PPSS,LEMS和UEMS相关的SCIM总分数不断增加.
1小组 (PPSS <27) 的平均totSCIM值为28.4 ± 16.3.3.
第二小组 (PPSS ≥27,LEMS <1.5,UEMS <45) 的平均totSCIM值为39.5±19.0.
第三次子组 (PPSS ≥27,LEMS <1.5,UEMS ≥45) 的平均totSCIM值为57.4±13.8.8,而第三次子组的平均totSCIM值为57.4±13.8.
第4个子组 (PPSS ≥27,LEMS ≥1.5) 的平均totSCIM值为66.3±21.7.
该CART模型表现出良好的预测准确性 (R平方0.556在开发中,0.520在验证中).

结论:

该研究成功地确定了四个具有特征的患者子组,在创伤性SCI (tSCI) 后具有不同的功能恢复表型.
这些由PPSS,LEMS和UEMS定义的子组可以帮助临床医生在早期康复规划和现实的目标设定中.
改善的感官功能 (PPSS ≥27) 似乎对增强运动效果和预测更好的功能结果至关重要.

关键词:

这就是ISNCSCI.脊髓损伤导致的脊髓损伤临床表现型的临床表现型功能恢复恢复的功能恢复.回归树是一个回归树.

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