使用出院时的站立和行走评估工具预测外伤性脊髓损伤患者的社区户外行走能力。
Using the Standing and Walking Assessment Tool at Discharge Predicts Community Outdoor Walking Capacity in Persons With Traumatic Spinal Cord Injury.
机构信息
Praxis Spinal Cord Institute, Vancouver, British Columbia, Canada.
Parkwood Institute, London, Ontario, Canada.
出版信息
Phys Ther. 2023 Nov 4;103(11). doi: 10.1093/ptj/pzad106.
OBJECTIVE
The Standing and Walking Assessment Tool (SWAT) standardizes the timing and content of walking assessments during inpatient rehabilitation by combining 12 stages ranging from lowest to highest function (0, 0.5, 1A, 1B, 1C, 2A, 2B, 2C, 3A, 3B, 3C, and 4) with 5 standard measures: the Berg Balance Scale, the modified Timed "Up & Go" test, the Activities-specific Balance Confidence Scale, the modified 6-Minute Walk Test, and the 10-Meter Walk Test (10MWT). This study aimed to determine if the SWAT at rehabilitation discharge could predict outdoor walking capacity 1-year after discharge in people with traumatic spinal cord injury.
METHODS
This retrospective study used data obtained from the Rick Hansen Spinal Cord Injury Registry from 2014 to 2020. Community outdoor walking capacity was measured using the Spinal Cord Independence Measure III (SCIM III) outdoor mobility score obtained 12 (±4) months after discharge. Of 206 study participants, 90 were community nonwalkers (ie, SCIM III score 0-3), 41 were community walkers with aids (ie, SCIM III score 4-6), and 75 were independent community walkers (ie, SCIM III score 7-8). Bivariate, multivariable regression, and an area under the receiver operating characteristic curve analyses were performed.
RESULTS
At rehabilitation discharge, 3 significant SWAT associations were confirmed: 0-3A with community nonwalkers, 3B/higher with community walkers with and without an aid, and 4 with independent community walkers. Moreover, at discharge, a higher (Berg Balance Scale, Activities-specific Balance Confidence Scale), faster (modified Timed "Up & Go," 10MWT), or further (10MWT) SWAT measure was significantly associated with independent community walking. Multivariable analysis indicated that all SWAT measures, except the 10MWT were significant predictors of independent community walking. Furthermore, the Activities-Specific Balance Confidence Scale had the highest area under the receiver operating characteristic score (0.91), demonstrating an excellent ability to distinguish community walkers with aids from independent community walkers.
CONCLUSION
The SWAT stage and measures at discharge can predict community outdoor walking capacity in persons with traumatic spinal cord injury. Notably, a patient's confidence in performing activities plays an important part in achieving walking ability in the community.
IMPACT
The discharge SWAT is useful to optimize discharge planning.
目的
通过将最低到最高功能的 12 个阶段（0、0.5、1A、1B、1C、2A、2B、2C、3A、3B、3C 和 4）与 5 个标准测量指标（伯格平衡量表、改良计时“站起和行走”测试、活动特异性平衡信心量表、改良 6 分钟步行测试和 10 米步行测试）相结合，行走评估工具（SWAT）使住院康复期间的行走评估标准化。本研究旨在确定在创伤性脊髓损伤患者出院时的 SWAT 是否可以预测出院后 1 年的户外行走能力。
方法
本回顾性研究使用了 2014 年至 2020 年里克·汉森脊髓损伤登记处的数据。社区户外行走能力使用出院后 12（±4）个月获得的脊髓独立性测量量表第三版（SCIM III）户外移动评分进行测量。在 206 名研究参与者中，90 名是社区非步行者（即，SCIM III 评分为 0-3），41 名是社区步行者（即，SCIM III 评分为 4-6），75 名是独立社区步行者（即，SCIM III 评分为 7-8）。进行了双变量、多变量回归和受试者工作特征曲线下面积分析。
结果
在康复出院时，确定了 3 个与 SWAT 相关的显著关联：0-3A 与社区非步行者相关，3B/更高与有或没有辅助工具的社区步行者相关，4 与独立社区步行者相关。此外，在出院时，更高（伯格平衡量表、活动特异性平衡信心量表）、更快（改良计时“站起和行走”测试、10 米步行测试）或更远（10 米步行测试）的 SWAT 测量值与独立社区行走显著相关。多变量分析表明，除 10 米步行测试外，所有 SWAT 测量值均为独立社区行走的显著预测指标。此外，活动特异性平衡信心量表的受试者工作特征曲线下面积最高（0.91），表明其在区分有辅助工具的社区步行者和独立社区步行者方面具有出色的能力。
结论
SWAT 出院时的阶段和措施可以预测创伤性脊髓损伤患者的社区户外行走能力。值得注意的是，患者进行活动的信心在实现社区行走能力方面起着重要作用。
影响
出院时的 SWAT 有助于优化出院计划。
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