Clinical utility during inpatient rehabilitation of a clinical prediction rule for ambulation prognosis following spinal cord injury.
Clinical utility during inpatient rehabilitation of a clinical prediction rule for ambulation prognosis following spinal cord injury.
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脊髓损伤后步行预后的临床预测规则在住院康复期间的临床效用。
DOI：
10.1080/10790268.2021.1888024
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Worobey,LynnA
中科院分区：
文献类型：
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作者：
Everhart,Joseph;Somers,Martha;Hibbs,Rachel;Worobey,LynnA
目的：活动能力预后是脊髓损伤（SCI）术后康复的关键。本研究的目的是前瞻性评估van Middendorp临床预测规则（CPR）的临床应用。设计：观察性研究设置：住院康复病房参与者：物理治疗师及其患有急性脊髓损伤和脊髓损伤障碍（SCI/D）的患者，这些患者的长期活动预后难以确定。干预措施：无/无结果测量：cpr确定的行走概率，治疗师报告的临床效用（是/否），与患者共享（是/否），对激励/设定现实期望有用，功能独立测量（FIM）运动步行评分。结果：5名治疗师和52名患者（8名非创伤性SCI/D）参与。91%的患者有AIS C级或D级病变。创伤性脊髓损伤患者能够走动的CPR概率中位数[IQR]为96.0[86.5,99.0]，非创伤性脊髓损伤/D患者为80.0[64.5,94.5]。45%的脊髓损伤患者和88%的非创伤性脊髓损伤/损伤患者报告了临床效用。经验较少的治疗师更有可能报告临床效用并与患者分享。未达到FIM目标的患者的下床概率更高。心肺复苏术概率与出院FIM仅在非创伤性SCI/D患者中存在相关性。结论：心肺复苏术不能预测住院患者的康复结果，事实上，在概率相似的个体中，结果差异很大，这强调了临床判断的重要性，并继续需要识别影响活动的个体因素。然而，对于经验较少的临床医生和非创伤性SCI/D患者，在建立预后和目标设定方面的效用更大。
Objective:Mobility prognosis is a key focus during rehabilitation following spinal cord injury (SCI). The goal of this study was to prospectively evaluate the clinical utility of the van Middendorp clinical prediction rule (CPR).Design:Observational studySetting:Inpatient rehabilitation unitParticipants:Physical therapists and their patients with acute SCI and SCI disorders (SCI/D) for whom long-term ambulation prognosis was judged difficult to determine.Interventions:N/AOutcome Measures:CPR-determined probability of ambulation, therapist reported clinical utility (yes/no), shared with the patient (yes/no), useful for motivation/setting realistic expectations, and Functional Independence Measure (FIM) Locomotion walk score.Results:Five therapists and 52 patients (8 non-traumatic SCI/D) participated. 91% had lesions classified as AIS C or D. The median [IQR] for CPR probability of ambulation was 96.0 [86.5,99.0] for traumatic SCI and 80.0 [64.5, 94.5] for non-traumatic SCI/D. Clinical utility was reported for 45% of those with SCI and 88% with non-traumatic SCI/D. Therapists with less experience were more likely to report clinical utility and share with their patients. Ambulation probability was higher for patients who did not meet their FIM goal. CPR probability was correlated with discharge FIM only for non-traumatic SCI/D.Conclusion:The CPR was not predictive of inpatient rehabilitation outcomes, in fact outcomes varied widely for individuals with similar probabilities emphasizing the importance of clinical judgement and continued need to identify individual factors that affect ambulation. However, greater utility in establishing prognosis and goal setting was noted for clinicians with less experience and for individuals with non-traumatic SCI/D.