UPMC Centers for Rehab Services, Pittsburgh, Pennsylvania, USA.
Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA.
J Spinal Cord Med. 2023 May;46(3):485-493. doi: 10.1080/10790268.2021.1888024. Epub 2021 Mar 11.
Mobility prognosis is a key focus during rehabilitation following spinal cord injury (SCI). The goal of this study was to prospectively evaluate the clinical utility of the van Middendorp clinical prediction rule (CPR). Observational study Inpatient rehabilitation unit Physical therapists and their patients with acute SCI and SCI disorders (SCI/D) for whom long-term ambulation prognosis was judged difficult to determine. N/A CPR-determined probability of ambulation, therapist reported clinical utility (yes/no), shared with the patient (yes/no), useful for motivation/setting realistic expectations, and Functional Independence Measure (FIM) Locomotion walk score. Five therapists and 52 patients (8 non-traumatic SCI/D) participated. 91% had lesions classified as AIS C or D. The median [IQR] for CPR probability of ambulation was 96.0 [86.5,99.0] for traumatic SCI and 80.0 [64.5, 94.5] for non-traumatic SCI/D. Clinical utility was reported for 45% of those with SCI and 88% with non-traumatic SCI/D. Therapists with less experience were more likely to report clinical utility and share with their patients. Ambulation probability was higher for patients who did not meet their FIM goal. CPR probability was correlated with discharge FIM only for non-traumatic SCI/D. The CPR was not predictive of inpatient rehabilitation outcomes, in fact outcomes varied widely for individuals with similar probabilities emphasizing the importance of clinical judgement and continued need to identify individual factors that affect ambulation. However, greater utility in establishing prognosis and goal setting was noted for clinicians with less experience and for individuals with non-traumatic SCI/D.
运动能力预后是脊髓损伤（SCI）康复中的一个关键关注点。本研究的目的是前瞻性评估范米登多普临床预测规则（CPR）的临床实用性。观察性研究 住院康复病房 物理治疗师及其急性 SCI 和 SCI 障碍（SCI/D）患者，这些患者的长期步行预后难以确定。 CPR 确定的步行能力概率、治疗师报告的临床实用性（是/否）、是否与患者共享（是/否）、对动机/设定现实期望有用，以及功能独立性测量（FIM）步行评分。5 名治疗师和 52 名患者（8 名非创伤性 SCI/D）参与了研究。91%的患者病变分类为 AIS C 或 D。创伤性 SCI 的 CPR 步行能力概率中位数[IQR]为 96.0[86.5,99.0]，非创伤性 SCI/D 为 80.0[64.5,94.5]。有 45%的 SCI 患者和 88%的非创伤性 SCI/D 患者报告了临床实用性。经验较少的治疗师更有可能报告临床实用性并与患者分享。未达到 FIM 目标的患者步行能力概率更高。CPR 概率与非创伤性 SCI/D 的出院 FIM 仅相关。CPR 不能预测住院康复结局，事实上，具有相似概率的个体的结局差异很大，这强调了临床判断的重要性，以及继续确定影响步行的个体因素的必要性。然而，对于经验较少的临床医生和非创伤性 SCI/D 患者，CPR 在建立预后和目标设定方面具有更大的实用性。
