Authors (including presenting author) :
Lau ACH, Wong EYW, So JKW, Pow LWS, Cheung EYY, Chau RMW
Affiliation :
Physiotherapy Department, Kowloon Hospital, Hong Kong
Introduction :
Outcome measure to reflect spinal cord injury (SCI) patients’ functional ability is essential to clinicians’ work in planning and implementing therapeutic program along the patient’s recovery pathway. Spinal Cord Independence Measure Version III(SCIM III) is designed for assessing SCI patients’ functional performance in daily routine and high validity and reliability of SCIM III was reported. Information of patients’ prognosis in early phase would be beneficial in discharge planning and resource utilization.
Objectives :
The current study was evaluating the predictive validity of SCIM III in SCI patients’ discharge functional mobility status and its cutoff score.
Methodology :
SCI patients in Kowloon Hospital in-patient rehabilitation were enrolled in this study. The SCIM data was collected by direct observation of patients upon admission and discharge by case physiotherapists. Discharge functional mobility status and length of stay(LOS) were collected. Receiver Operating Characteristics(ROC) curve was used to assess the predictive validity of SCIM III in differentiating patients as non-walker, indoor or outdoor walker upon discharge.
Result & Outcome :
251 patients(Male=64%(161), Female=36%(90)) aged 61.5±16.2 with LOS≤200 days were included in the study. Upon discharge, for the criteria as indoor walker, the Area Under Curve(AUC) was 0.835 (95%CI: 0.781-0.890,p< 0.001) and for the criteria as outdoor walker, AUC was 0.771 (95%CI: 0.712-0.830,p< 0.001). The optimal cutoff score of SCIM III of admission was 30 for indoor walker (sensitivity=0.688 and specificity=0.915) and 39 for outdoor walker (sensitivity=0.684 and specificity=0.735). Further analysis through linear regression model with age-controlled found that LOS is positively correlated with improvement of SCIM score(β=0.326,p< 0.001) for patients above cutoff of SCIM III for indoor walker upon admission. No correlation was revealed in patients below the cutoff (β=-0.071,p=0.482). SCIM score at admission demonstrated effective prediction for patients’ functional mobility status upon discharge. Positive association was also shown between LOS and improvement in SCIM score for potential SCI walkers, which may warrant for intense dose of training. Early prognostic prediction of patients’ ambulatory potential at admission facilitates stratified rehabilitation and clinicians’ discharge planning at initial stage of rehabilitation. Full utilization of rehabilitation pathway is suggested for potential SCI walkers to maximize their functional recovery during hospital stay.
