Ambulation and complications related to assistive devices after spinal cord injury

Abstract

Objective

To evaluate long-term health outcomes including pain intensity, pain interference, and fatigue among ambulatory persons with spinal cord injury (SCI).

Design

Prospective cohort study.

Setting

Data were analyzed at a major medical university in the southeast USA.

Participants

Participants included 783 ambulatory adults with SCI of traumatic origin, who were at least 1-year post-injury. Participants were identified through three sources of records at a large specialty hospital in the southeastern USA.

Interventions

Not applicable.

Outcome measures

Pain intensity and interference (Brief Pain Inventory) and fatigue (Modified Fatigue Impact Scale Abbreviated Version 5).

Results

Examining assistive devices used for ambulation, 66% of the population used at least one device. In the logistic model, wheelchair and cane usage were significantly related to the outcomes after controlling for age, gender, and race. Wheelchair usage 50% of the time or less was significantly related to pain intensity (odds ratio (OR) 2.05, 95% confidence interval (CI) = 1.39–3.03), pain interference (OR 2.11, 95% CI = 1.43–3.12), and fatigue (OR 1.99, 95% CI = 1.12–1.43). Additionally, unilateral cane use was significantly related to the outcomes; pain intensity (OR 1.86, 95% CI = 1.35–2.56), pain interference (OR 2.11, 95% CI = 1.52–2.93), and fatigue (OR 2.49, 95% CI = 1.52–4.08).

Conclusions

Among ambulatory persons with SCI, increased pain intensity, pain interference, and fatigue are associated with minimal wheelchair usage (50% or less) and less supportive assistive device (unilateral cane) usage.

Keywords:

• Spinal cord injuries
• Ambulation
• Assistive devices
• Pain
• Fatigue
• Outcomes
• Wheelchair
• Cane

Acknowledgements

The contents of this publication were developed under grants from the Department of Education, NIDRR grant numbers H133G090059, H133G050165, and the National Institutes of Health, grant number 1R01 NS 48117. However, those contents do not necessarily represent the policy of the Department of Education or NIH, and endorsement by the Federal Government should not be assumed.