Predicting Outdoor Walking 1 Year After Spinal Cord Injury: A Retrospective, Multisite External Validation Study.
Christina Draganich, Kenneth A Weber, Wesley A Thornton and 5 others
PMID 36630206WHAT IT FOUND
A three-item spinal cord injury rule predicted outdoor walking one year after injury in United States rehabilitation data.
A score of 33 or higher suggested likely outdoor walking; lower scores suggested worse prognosis.
Key findings
01In 3,721 participants from 12 spinal cord injury centers whose nerve scores were collected within 31 days of injury, a score of 33 or higher was the optimal threshold for predicting outdoor walking one year after spinal cord injury.
02In the separate testing site, the rule was correct for 88.0% of participants, identified 89.0% of outdoor walkers, and identified 87.3% of non-walkers.
03Across the full dataset, the rule was correct for 82.9% of participants, identified 88.1% of outdoor walkers, and identified 79.4% of non-walkers.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
The study was retrospective, and the researchers could not verify whether each ISNCSCI examination was performed accurately. All data came from spinal cord injury centers with formally trained ISNCSCI examiners, so the rule may not work as well in settings without that training. Outdoor walking was self-reported and used a different distance than the original rule. Nerve scores were collected within 31 days of injury, but not always in the acute phase recommended by current literature. The rule is based on care standards at the time of derivation and validation, so it may not reflect newer treatments. The paper does not test whether using the rule to guide therapy improves outcomes.
Declared interests
SCIMS centers are sponsored by the National Institute on Disability, Independent Living, and Rehabilitation Research, and the authors declared no conflicts of interest.
The easy way to misread this
Do not treat a score below 33 as proof that a patient cannot improve or will not benefit from therapy. The rule predicts self-reported outdoor walking at one year in a retrospective dataset. It does not test treatment effects or account for individual response.