Using the Standing and Walking Assessment Tool at Discharge Predicts Community Outdoor Walking Capacity in Persons With Traumatic Spinal Cord Injury.
Heather A Hong, Kristen Walden, James J Laskin and 11 others
PMID 37561412WHAT IT FOUND
Discharge SWAT stage 3B or higher predicted outdoor walking one year later.
Stage 4 predicted independent walking without aids. Lower stages predicted non-walking. Use these cutoffs to guide equipment prescription and discharge planning for spinal cord injury patients.
Key findings
01SWAT stage 3B or higher at discharge was associated with community walking, while stage 4 was associated with independent community walking.
02Discharge scores for the Berg Balance Scale, modified Timed Up and Go, Activities-Specific Balance Confidence Scale, and 10-Meter Walk Test were significantly associated with independent community walking.
03The Activities-Specific Balance Confidence Scale had the highest discriminative ability (area under the curve 0.91) to distinguish walkers with aids from independent walkers.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
The study relied on registry data where many participants had missing or incomplete SWAT stage data (n = 707 excluded or incomplete). Follow-up was at 12 months (±4), which may be too early for motor recovery to plateau in all participants. The definition of community walking used the Spinal Cord Independence Measure III outdoor mobility score, which reflects the person's chosen method of moving outdoors rather than pure physical capacity. Some participants with the ability to walk may have chosen a wheelchair due to fear of falling or environmental barriers. The study did not account for secondary health conditions like pain or spasticity, or environmental factors like rural vs. urban living, which may influence walking choices.
Declared interests
The funders (Praxis Spinal Cord Institute, Health Canada, Pacific Economic Development Canada, and provincial governments) played no role in the design, conduct, or reporting of this study.
The easy way to misread this
Do not interpret the prediction of 'community walking' as a guarantee of physical ability. The outcome measure reflects the patient's chosen method of outdoor mobility. Some patients with the physical capacity to walk may choose a wheelchair due to fear of falling, pain, or environmental barriers, so a low SWAT stage does not necessarily mean the patient cannot walk physically.