Early predictors of developing problematic spasticity following traumatic spinal cord injury: A prospective cohort study

Abstract

Objective: To identify early predictors and develop reliable, validated prediction models for development of problematic spasticity after traumatic spinal cord injury (SCI).

Design: Prospective cohort study of the Rick Hansen Spinal Cord Injury Registry (RHSCIR), retrospective review of inpatient medical charts.

Setting: Quaternary trauma center, rehabilitation center, community settings.

Participants: Individuals with traumatic SCI between March 1, 2005, and March 31, 2014, prospectively enrolled in the Vancouver site RHSCIR.

Interventions: None.

Main Outcome Measure: Spasticity limiting function or requiring treatment (problematic spasticity) on the Spinal Cord Injury Health Questionnaire.

Results: In 350 patients, variables documented during hospitalization that predicted the development of problematic spasticity up to 5 years post-injury included: initial Glasgow Coma Scale; age at time of injury; admission to rehabilitation center; community discharge anti-spasticity medication prescription, neurological status, Penn Spasm Frequency Scale, and pain interference with quality of life, sleep, activities; greater change in AIS motor scores between admission and discharge. The predictive models had area under the receiver operating characteristic curve of 0.80 (95% CI 0.75, 0.85) in the development set (N = 244) and 0.84 (95% CI 0.74, 0.92) in the validation set (N = 106) for spasticity limiting function and 0.81 (95% CI 0.76, 0.85) in the development set and 0.85 (95% CI 0.77, 0.92) in the validation set for spasticity requiring treatment.

Conclusions: Our prediction models provide an early prognosis of risk of developing problematic spasticity after traumatic SCI, which can be used to improve clinical spasticity management and assist research (e.g. risk stratification in interventional trials).

Keywords:

• Spinal cord injury
• Spasticity
• Observational study

Acknowledgements

We are grateful to the following individuals for their contribution: Juliet Batke and Allan Aludino of the Vancouver Spine Research Program for database management and data abstraction; Glenys MacIsaac of the Rick Hansen Institute for technical support of data management; and Darby Thompson from Emmes Canada for statistical support and assistance with data analysis.

Disclaimer statements

Contributors None

Funding Dr Kwon is the Canada Research Chairs in Spinal Cord Injury

Declaration of interest Dr Holtz, Dr Kwon and Dr Mills declare no conflict of interest.

Conflicts of interest Ms Szefer is an employee of Emmes Canada. Dr Noonan is an employee of the Rick Hansen Institute.

ORCID

Kaila A. Holtz http://orcid.org/0000-0001-8919-8954

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.