Understanding the rehabilitation needs and expected rehabilitation
outcomes in different spinal cord injury (SCI) patients is essential in
prognostic planning and guidance of the patient and care-giver from the outset.
According to a World Health Organization (WHO) report, in the year 2021, there
were around 15.4 million people living with SCI globally. Various
differences exist in characteristics of patients who have sustained a SCI.
Although SCI can be seen in both males and females, there is a clear difference,
with the proportion of males among this patient population being as high as 81%.
The extent of impairment due to the SCI depends on the severity and
location of injury. The causes of SCI can be broadly classified into traumatic
and non-traumatic. The most common causes of traumatic SCI vary in different
countries. Road traffic accidents (RTAs) account for the most cases of
traumatic SCI in the developed nations. A study conducted to understand the
demographic pattern of SCI patients in India reported RTAs as the most common
cause (45.00%) followed by fall from height as the second leading cause
(39.60%). However, other studies in developing nations in south-east Asia
have reported falls from height as the leading cause. The reported
incidence rate for traumatic SCI is 26.48 (95% CI, 24.15–28.93) per million
people and that for non-traumatic SCI is 17.93 (95% CI, 13.30-23.26) per
million people. The mean age for patients with an SCI due to traumatic
causes was 41 years (95% CI: 28-57) whereas for non-traumatic SCIs it was
reported to be 60 years (48-70). The older age of patients with
non-traumatic SCIs makes their rehabilitation challenging due to the added
age-related comorbidities.
Over the years, SCI due to non-traumatic causes has been on an
incline. A study conducted among SCI patients (n=1080) in Italy reported 45% of
the total cases having a non-traumatic origin of injury. Most common causes
of non-traumatic SCI include spinal tumors, Pott’s spine, and transverse
myelitis. The etiologies can be broadly classified as degenerative,
inflammatory, neoplastic, and vascular. When comparing traumatic and
non-traumatic SCI patients, a meta-analysis reported that most patients with
traumatic SCI belonged to American Spinal Injury Impairment Scale (AIS) Grade
A, where as those with non-traumatic SCI belonged to AIS grade D. The
duration of stay in hospitals and the associated treatment cost also differ
between the two groups, with traumatic SCIs incurring heavier expenditures on
the patient. Thus, outcomes which can be expected between these two
patient groups are different. Additionally, various medical complications could
occur in SCI patients which affect their recovery, such as urinary tract
infections (UTIs), pulmonary infections, pressure injuries, and neuropathic
pain. They not only delay the recovery and increase the hospital stay, but
they also worsen the outcomes of rehabilitation.
Very few studies exist in the Indian context which have reported on
the demographics and outcomes of in-patient rehabilitation in SCI patients,
with an emphasis on comparing the outcomes between traumatic and non-traumatic
causes of SCI. Additionally, no studies have reported on the long-term
implications of in-patient rehabilitation followed by community-based
rehabilitation. Medical complications due to SCI and other pre-existing medical
comorbidities influence the outcomes of rehabilitation. This study aims to
better understand the demographics of SCI due to traumatic and non-traumatic
causes, and compare the short and long-term outcomes of in-patient
rehabilitation between the two groups. Objectives - To assess the demographics of
spinal cord injury patients admitted for rehabilitation in a tertiary health
care institute - To assess and compare the
immediate and long-term neurological and functional outcomes in traumatic and
non-traumatic SCI patients - To assess and compare the
rehabilitation needs of traumatic and non-traumatic SCI patients
Type of study: Our research approach involves a retrospective observational study,
where we will gather and analyze quantitative and qualitative data to address
our research objectives. Data of all the SCI patients
admitted in the PMR ward at the All-India Institute of Medical Sciences (AIIMS)
Raebareli will be collected. Data will be extracted in a retrospective manner
from the medical records of all these patients admitted in the previous two and
a half years from March 2022 to August 2024. Patients who fulfill the inclusion
and exclusion criteria will be included in the study for further data analysis.
All SCI patients admitted in PMR
ward undergo a thorough clinical assessment and
functional evaluation on admission, which is then repeated at discharge. A
record of any medical complications and their management, at or during their
admission period is maintained as a part of routine practice.
Patients are prescribed an
individualized neurorehabilitation protocol which includes educating the patient and caregivers about the disease/ condition,
prognosis and short- and long-term complications and their prevention (Postural
care, Activity modification, and Dietary advice), the role of rehabilitation in
PMR setting, identification of architectural barriers at home and appropriate
management as indicated advised to the patient, prescription of various
investigations, therapeutic exercises as indicated, prescription of orthotic
devices as deemed necessary, and medications as needed. The following data will be
collected from the medical records of all SCI patients:
A)
Demographic and
Socioeconomic Information 1)
Age 2)
Sex 3)
Education level 4)
Occupation 5)
Economic status. B)
Information related to SCI: 1)
Time between injury and first
admission for acute care 2)
Mode of transport from site of
injury to place of primary care 3)
Time since injury 4)
Cause/ mechanism of injury 5)
Neurological level of injury 6)
Operative vs. conservative management 7)
American Spinal Injury
Association (ASIA) Impairment Scale (AIS) grade 8)
Length of hospital stay at
first admission for rehabilitation 9)
Low extremity motor score
(LEMS) 10)
Total motor score 11)
Total sensory score 12)
Means of bladder voiding and
bowel management 13)
Pressure injuries 14)
Other medical complications of
SCI 15)
Pre-existing comorbidities. C)
Functional Outcome Measure: 1)
Functional Independence Measure
(FIM) score during admission, discharge, and follow up 2)
Walking Index for Spinal Cord
Injury (WISCI) [13] during admission, discharge, and follow up
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