Change in mobility independence over 5 years for persons with chronic spinal cord injury

Abstract

Objectives

To evaluate change in mobility independence (MI) in community dwelling persons with spinal cord injury (SCI).

Participants

Community Survey.

Design

Cohort study. Rasch analysis was applied to the mobility subscale of the Spinal Cord Independence Measure – Self-Report data from years 2012 to 2017, resulting in a Rasch Mobility Independence Score (RMIS). We employed multilevel modeling to examine RMIS and its change over 5 years, adjusting for demographics and SCI severity; random forest regression was applied to determine the impact of modifiable factors (e.g. environmental factors, home-support) on its change.

Results

The analysis included 728 participants. The majority (≈85%) of participants demonstrated little or no change in RMIS from 2012 to 2017; however, a smaller proportion (15%) showed considerably large change of more than 10 on the 100-point scale. A mixed-effects model with random slopes and intercepts described the dataset very well (conditional R² of 0.95) in terms of demographics and SCI severity. Age was the main predictor of change in RMIS. Considering SCI severity, change in RMIS was related to age for the subgroup with paraplegia, and to time since injury for the subgroup with tetraplegia. No impact of modifiable factors was found.

Conclusion

RMIS in persons with SCI changes over a period of 5 years, especially in elder patients with paraplegia and persons with incomplete tetraplegia with more than 15 years of time since injury. During routine follow-up change in mobility independence should be assessed in order to timely intervene and prevent mobility loss and participation limitations.

Keywords:

• Mobility independence
• Spinal cord injury
• Age
• Time since injury
• Change

Acknowledgements

We thank the SwiSCI Steering Committee with its members Xavier Jordan, Fabienne Reynard (Clinique Romande de Réadaptation, Sion); Michael Baumberger, Hans Peter Gmünder (Swiss Paraplegic Center, Nottwil); Armin Curt, Martin Schubert (University Clinic Balgrist, Zürich); Margret Hund-Georgiadis, Kerstin Hug (REHAB Basel, Basel); Laurent Prince (Swiss Paraplegic Association, Nottwil); Heidi Hanselmann (Swiss Paraplegic Foundation, Nottwil); Daniel Joggi (Representative of persons with SCI); Nadja Münzel (Parahelp, Nottwil); Mirjam Brach, Gerold Stucki (Swiss Paraplegic Research, Nottwil); Armin Gemperli (SwiSCI Coordination Group at Swiss Paraplegic Research, Nottwil).

Statement of ethics

Ethical approval for Survey 2012 was approved by the principal ethics committee on research involving humans of the Canton of Lucerne (KEK Luzern, internal application 11042, approved 28.06.2011) and subsequently endorsed by the additional involved cantonal ethics committees of Cantons Basel-Stadt (EK Basel, internal application 306/11, approved 06.09.2011) and Valais (CCVEM Sion, internal application CCVEM042/11, approved 06.12.2011). Ethical approval for Survey 2017 was granted by the leading ethical institution Ethikkommision Nordwest-und Zentralschweiz (EKNZ, Project-ID: 11042 PB_2016-02608, approved Dec 2016). We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

Data availability statement

Owing to our commitment to SwiSCI study participants and their privacy, datasets generated during the current study are not made publicly available but can be provided by the SwiSCI Study Center based on reasonable request ([email protected]).

Disclaimer statements

Contributors All authors have contributed to the conception, data analysis and/or interpretation, writing and reviewing of the manuscript.

Funding This study has been financed in the framework of SwiSCI, supported by the Swiss Paraplegic Foundation.

Conflicts of interest Authors have no conflict of interests to declare.