Yun Kimin, Lim Jin-Cheol, Kim Onyoo
Department of Physical Medicine and Rehabilitation, National Rehabilitation Center, 58, Samgaksan-ro, Gangbuk-gu, Seoul, 01022, Republic of Korea.
Department of Education Measurement and Evaluation, Sungkyunkwan University, Seoul, Korea.
BMC Sports Sci Med Rehabil. 2024 Jul 3;16(1):148. doi: 10.1186/s13102-024-00928-z.
Tetraplegia is a debilitating sequela of spinal cord injury (SCI). However, comprehensive approaches for determining the influence of various factors on activities of daily living (ADL) in patients with tetraplegia are limited. Therefore, this study aimed to determine the influence of physical factors on ADL in patients with tetraplegia after adjusting for demographic, SCI-related, and cognitive factors.
This retrospective cross-sectional study enrolled 201 patients with tetraplegia who underwent inpatient rehabilitation at the National Rehabilitation Center in South Korea between 2019 and 2021. Patients' mean age was 50.5 years (standard deviation, 16.3), and 170 (84.6%) were men. The Korean Spinal Cord Independence Measure III (K-SCIM III) was used as the main outcome measure to assess patients' ADL ability. Hierarchical multiple regression modeling was conducted with K-SCIM as the dependent variable to examine the level of functioning and relative influencing factors.
Upper-extremity motor score (UEMS), upper-extremity spasticity and sitting balance scores were significant predictors of self-care; lower-extremity motor score (LEMS), musculoskeletal pain of shoulder, and sitting balance were significant predictors of respiratory and sphincter management; UEMS, LEMS, and sitting balance score were significant predictors of mobility; and UEMS, LEMS, musculoskeletal pain of shoulder, and sitting balance scores were significant predictors of the K-SCIM III total score after adjustment for demographic, SCI-related, and cognitive factors.
Physical factors had the greatest impact on all subscores and the K-SCIM III total score. Upper- and lower-extremity muscle strength and sitting balance significantly affected functional ability across all subscores.
四肢瘫痪是脊髓损伤（SCI）的一种致残后遗症。然而，确定各种因素对四肢瘫痪患者日常生活活动（ADL）影响的综合方法有限。因此，本研究旨在在调整人口统计学、SCI相关因素和认知因素后，确定身体因素对四肢瘫痪患者ADL的影响。
这项回顾性横断面研究纳入了2019年至2021年期间在韩国国家康复中心接受住院康复治疗的201例四肢瘫痪患者。患者的平均年龄为50.5岁（标准差为16.3），其中170例（84.6%）为男性。采用韩国脊髓独立测量量表III（K-SCIM III）作为主要结局指标来评估患者的ADL能力。以K-SCIM为因变量进行分层多元回归建模，以检验功能水平和相关影响因素。
上肢运动评分（UEMS）、上肢痉挛和坐位平衡评分是自我护理的显著预测因素；下肢运动评分（LEMS）、肩部肌肉骨骼疼痛和坐位平衡是呼吸和括约肌管理的显著预测因素；UEMS、LEMS和坐位平衡评分是移动性的显著预测因素；在调整人口统计学、SCI相关因素和认知因素后，UEMS、LEMS以及肩部肌肉骨骼疼痛和坐位平衡评分是K-SCIM III总分的显著预测因素。
身体因素对所有子评分和K-SCIM III总分影响最大。上肢和下肢肌肉力量以及坐位平衡对所有子评分的功能能力均有显著影响。
