Long-term assessment of the functional independence measure in sports-related spinal cord injury

Abstract

Context

Patients with spinal cord injury (SCI) secondary to traumatic sports-related etiology potentially face loss of independence. The Functional Independence Measure (FIM) assesses the amount of assistance patients require and has shown sensitivity to changes in patient functional status post injury.

Objectives

We aimed to (1) examine long-term outcomes following sports-related SCI (SRSCI) using FIM scoring at the time of injury, one year, and five years post-injury, and (2) determine predictors of independence at one and five-year follow-up considering surgical and non-surgical management. Few studies have investigated the cohort analyzed in this study.

Methods

The 1973–2016 National Spinal Cord Injury Model Systems (SCIMS) Database was used to develop a SRSCI cohort. The primary outcome of interest captured functional independence using a multivariate logistic regression, defined by FIM individual scores greater than or equal to six, evaluated at one and five years.

Results

A total of 491 patients were analyzed, 60 (12%) were female, 452 (92%) underwent surgery. The cohort demographics were stratified by patients with and without spine surgery and evaluated for functional independence in FIM subcategories. Increased time spent in inpatient rehabilitation and FIM score at post-operative discharge were associated with greater likelihood of functional ability at both one and five-year follow-up.

Conclusion

Our study demonstrated that SRSCI patients are a unique subset of SCI patients for whom factors repeatedly associated with independence at one year follow-up were dissimilar to those associated with independence at five-year follow-up. Larger prospective studies should be conducted to establish guidelines for this unique subcategory of SCI patients.

Keywords:

• Functional independence measure
• Long-term outcomes
• Spine surgery
• Spinal cord injury
• Sports-related spinal cord injury

Acknowledgements

The authors would like to thank professor Ruoqing Zhu, PhD from the University of Illinois Urbana-Champaign for his assistance in validating the statistical methods employed in this study and his support in computational methods in R.

Disclaimer statements

Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Declarations of interest Scott Zuckerman serves as an unaffiliated neurotrauma consultant for the NFL and is a member of the NFL Head, Neck, Spine Committee. All other authors declare no conflicts of interest.