Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Badalona, Barcelona, Spain.
Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.
J Spinal Cord Med. 2024 Sep;47(5):649-660. doi: 10.1080/10790268.2023.2183326. Epub 2023 Mar 13.
Being able to survive in the long-term independently is of concern to patients with spinal cord injury (SCI), their relatives, and to those providing or planning health care, especially at rehabilitation discharge. Most previous studies have attempted to predict functional dependency in activities of daily living within one year after injury
(1) build 18 different predictive models, each model using one FIM (Functional Independence Measure) item, assessed at discharge, as independent predictor of total FIM score at chronic phase (3-6 years post-injury) (2) build three different predictive models, using in each model an item from a different FIM domain with the highest predictive power obtained in objective (1) to predict "good" functional independence at chronic phase and (3) adjust the 3 models from objective (2) with known confounding factors.
This observational study included 461 patients admitted to rehabilitation between 2009 and 2019. We applied regression models to predict total FIM score and "good" functional independence (FIM motor score ≥ 65) reporting adjusted , odds ratios, ROC-AUC (95% CI) tested using 10-fold cross-validation.
The top three predictors, each from a different FIM domain, were Toilet (adjusted = 0.53, Transfers domain), Toileting (adjusted = 0.46, Self-care domain), and Bowel (adjusted = 0.35, Sphincter control domain). These three items were also predictors of "good" functional independence (AUC: 0.84-0.87) and their predictive power increased (AUC: 0.88-0.93) when adjusted by age, paraplegia, time since injury, and length of stay.
Discharge FIM items accurately predict long-term functional independence.
能够独立长期生存是脊髓损伤（SCI）患者、其亲属以及提供或计划医疗保健的人员关注的问题，尤其是在康复出院时。大多数先前的研究都试图预测损伤后一年内日常生活活动中的功能依赖。
（1）构建 18 个不同的预测模型，每个模型均使用出院时评估的一项 FIM（功能独立性测量）项目作为慢性期（损伤后 3-6 年）总 FIM 评分的独立预测因子；（2）构建三个不同的预测模型，每个模型均使用在目标 1 中获得的预测能力最高的来自不同 FIM 领域的一个项目来预测慢性期的“良好”功能独立性；（3）使用已知混杂因素调整目标 2 中的 3 个模型。
这项观察性研究纳入了 2009 年至 2019 年期间入组康复的 461 名患者。我们应用回归模型来预测总 FIM 评分和“良好”的功能独立性（FIM 运动评分≥65），报告调整后的比值比和 ROC-AUC（95%CI），并使用 10 折交叉验证进行检验。
三个预测因子均来自不同的 FIM 领域，分别是如厕（调整后 = 0.53，转移领域）、如厕（调整后 = 0.46，自我护理领域）和排便（调整后 = 0.35，括约控制领域）。这三个项目也是“良好”功能独立性的预测因子（AUC：0.84-0.87），当通过年龄、截瘫、损伤后时间和住院时间进行调整时，其预测能力增加（AUC：0.88-0.93）。
出院时的 FIM 项目能准确预测长期功能独立性。
