Center for Post-acute Innovation andResearch, MedStar National Rehabilitation Hospital, Washington, DC 20010, USA.
Arch Phys Med Rehabil. 2013 Apr;94(4 Suppl):S125-36. doi: 10.1016/j.apmr.2012.10.039.
To examine the association between body weight, therapy participation, and functional outcomes among people with spinal cord injury (SCI).
Multisite prospective observational cohort study.
Six acute rehabilitation facilities.
Patients (N=1017) aged ≥ 12 years admitted for their initial rehabilitation after SCI.
Not applicable.
Motor FIM at inpatient rehabilitation discharge and 1 year postinjury.
Underweight and overweight/obese patients consisted of 2 different clusters of SCI patients. Underweight patients were more likely to be younger, black, less educated, single, have Medicaid as a primary payer, and more likely to have had a cervical level injury because of violence and vehicular-related events than their overweight and obese counterparts. We found few significant differences in hours of therapy during inpatient rehabilitation across weight groups. Among patients with C5-8 ASIA Impairment Scale (AIS) grades A, B, and C injuries, underweight patients received fewer hours of physical therapy per week than patients with a healthy weight (P=.028). Obese patients with paraplegia AIS grades A, B, and C received more hours of occupational therapy during their rehabilitation stay (P<.001) than other weight groups. A higher percentage of underweight patients had pressure ulcers during inpatient rehabilitation in C5-8 AIS grades A, B, and C and paraplegia AIS grades A, B, and C groups. Only in the paraplegia AIS grades A, B, and C group did we find a significant association between weight groups and discharge motor FIM score. Regression models showed that among C1-4 AIS grades A, B, and C patients, the overweight group had better 1-year follow-up motor FIM scores than other weight groups.
Patients who had an unhealthy body weight, that is, being underweight or obese, often have therapy participation and profiles different from those deemed healthy, or just overweight. For patients with paraplegia AIS grades A, B, and C, being overweight or obese was associated with diminished motor FIM outcomes at discharge from rehabilitation. The relation between body weight status, therapy participation, and outcomes are not consistent among study group participants.
研究体重、治疗参与度与脊髓损伤（SCI）患者功能结局之间的关联。
多地点前瞻性观察队列研究。
六家急性康复机构。
年龄≥ 12 岁、因初次 SCI 接受康复治疗而入院的患者（N=1017）。
无。
住院康复出院时和损伤后 1 年的运动功能独立性测量（Motor FIM）。
体重不足和超重/肥胖患者构成了 2 个不同的 SCI 患者亚群。与超重和肥胖患者相比，体重不足患者更年轻、更可能为黑人、受教育程度更低、单身、以医疗补助为主要支付方，且更有可能因暴力和车辆相关事件而颈段损伤。我们发现，各体重组患者在住院康复期间接受的治疗时间并无显著差异。在 C5-8 ASIA 损伤分级（AIS）为 A、B 和 C 的患者中，体重不足患者每周接受的物理治疗时间少于体重正常患者（P=.028）。截瘫 AIS 为 A、B 和 C 的肥胖患者在康复期间接受的职业治疗时间多于其他体重组（P<.001）。在 C5-8 AIS 为 A、B 和 C 以及截瘫 AIS 为 A、B 和 C 组中，更多体重不足患者在住院康复期间发生压疮。仅在截瘫 AIS 为 A、B 和 C 组中，我们发现体重组与出院时运动 FIM 评分之间存在显著关联。回归模型显示，在 C1-4 AIS 为 A、B 和 C 的患者中，超重组在 1 年随访时的运动 FIM 评分优于其他体重组。
体重不足或肥胖的患者往往具有不同的治疗参与度和特征，而不是被认为健康的体重，即超重。对于截瘫 AIS 为 A、B 和 C 的患者，超重或肥胖与康复出院时运动 FIM 结局下降相关。研究组参与者中，体重状况、治疗参与度和结局之间的关系并不一致。
