Walking-related outcomes for individuals with traumatic and non-traumatic spinal cord injury inform physical therapy practice

Abstract

Objectives

To describe and compare patient demographics, inpatient lengths of stay (LOS), and walking-related functional outcomes of individuals with spinal cord injuries (SCIs) of traumatic (TSCI) and non-traumatic (NTSCI) etiologies. To contrast these features between individuals who walked from those who did not walk at discharge from inpatient rehabilitation.

Design

Prospective observational study; comparisons between TSCI and NTSCI, walkers and non-walkers. Information collected as a pilot project within a provincial SCI informatics strategy.

Setting

Rehabilitation hospital specialized for SCIs.

Participants

Adults with NTSCI (n = 31) or TSCI (n = 59) admitted to inpatient rehabilitation, 2007–2009.

Outcome measures

Lower-extremity motor scores (LEMS), spinal cord independence measure version III (SCIM-III) total and mobility subscores, functional independence measure (FIM), Length of Stay (LOS) at inpatient facilities.

Results

Groups (NTSCI vs. TSCI) did not differ in the proportion of individuals that achieved “walker” status (SCIM-III mobility indoors (MI) score ≥3 at rehab discharge) (P = 0.41, 48.9% overall). Inpatient LOS at both acute care and rehabilitation facilities did not differ between groups; however, TSCI non-walkers had longer inpatient rehabilitation LOS than TSCI walkers. Among walkers, improvement was shown on all three mobility subscores of the SCIM-III between admission and discharge from rehabilitation; highest significance was shown on the SCIM-III MI. Walking status at discharge (SCIM-III MI) was most strongly correlated with LEMS at rehab admission (r = 0.71, P < 0.001).

Conclusion

Walking outcomes are comparable among individuals with NTSCI vs. TSCI admitted for specialized SCI rehabilitation. Routine use of SCIM-III mobility items for assessment of walking outcome is recommended for inpatient rehabilitation.

Keywords:

• Myelopathy
• Spinal cord injuries
• Traumatic
• Non-traumatic
• Outcome measures
• Rehabilitation
• Walking
• Mobility
• Locomotor training
• Paraplegia
• Tetraplegia

Acknowledgments

This article is based on the presentation at the 5th National Spinal Cord Injury Conference held in Toronto, Ontario, Canada in October 2012. Funding was provided by the Ontario Ministry of Health and Long-Term Care (MOHLTC) and the Ontario Neurotrauma Foundation (Grant # SCI-2005-REG-02) for this research as part of the Ontario Spinal Cord Injury Informatics Strategy. The views expressed within this article are not necessarily those of the MOHLTC. The authors thank the participants for their cooperation and the physical therapists at Toronto Rehabilitation Institute – UHN Lyndhurst Centre for their commitment to collecting standardized walking data to assist both their clients and the growth of knowledge in SCI rehabilitation.