Effects on age on spinal cord lesion patients' rehabilitation
Effects on age on spinal cord lesion patients' rehabilitation
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DOI：
10.1038/sj.sc.3101489
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发表时间：
2003-08-01
期刊：
影响因子：
2.2
通讯作者：
Molinari, M
中科院分区：
文献类型：
--
作者：
Scivoletto, G;Morganti, B;Molinari, M
研究设计：本研究的目的是关注创伤性和非创伤性脊髓损伤患者人群的年龄相关特征。目的：研究创伤性和非创伤性脊髓损伤老年人的人口统计学、损伤和结局特征，并将这些特征与匹配队列中的年轻患者进行比较。脊髓单位，基金会圣露西亚IRCCS，一个大型康复医院的中南部的意大利。方法：在总数，284个连续的新受伤的创伤性和非创伤性脊髓病变的患者进行了回顾性分析，并根据年龄分为两组：50岁以下（第1组）和50岁以上（第2组）。收集以下信息：损伤开始至入院;损伤变量：病因、节段、相关损伤、医疗并发症和手术干预;住院时间;美国脊髓损伤协会（ASIA）损伤和运动评分;评估日常生活独立性的Barthel指数（BI）和Rivermead活动指数（RMI）;评估脊髓损伤步行指数;患者出院时的目的地。在一个子集的130名受试者，一个块设计，匹配程序被用来控制的协变效应的损伤特征，从病变和病因学的年龄effects.Results：在整个组的284例患者，老年受试者有较高的概率有不完全性四肢瘫痪的非创伤性起源，他们也表现出较短的住院时间和较高的并发症发生率。在匹配的队列中，年轻患者表现出更好的神经功能恢复（意为ASIA损伤等级改善和运动评分增加）、出院时显著更高的Barthel指数和RMI、自主膀胱和肠道管理的更高独立性水平以及更高的独立行走频率。患有脊髓损伤和疾病的老年人表现良好，但在行走、膀胱和肠独立性方面的结果不如年轻受试者有利，并且有更多相关的医疗问题。因此，不同的康复策略，需要为老年人，最大限度地缩短住院时间，并提供必要的医疗护理和增加物理辅助资源出院后。
Study design: The present study was undertaken to focus the age-related characteristics of a population of traumatic and nontraumatic spinal cord patients.Objectives: to examine demographic, injury and outcome characteristics of older adults with spinal cord lesions as a result of trauma and nontrauma, and to compare these characteristics with those of younger patients in matched cohorts.Setting: Spinal Cord Unit, Fondazione Santa Lucia IRCCS, a large rehabilitation hospital of the centre-south of Italy.Methods: In total, 284 consecutive newly injured patients with traumatic and nontraumatic spinal cord lesions were retrospectively reviewed and divided according to age into two groups: under 50 years (group 1) and over 50 years (group 2). The following information was collected: onset of lesion to admission; injury variables: aetiology, level, associated injuries, medical complications and surgical intervention; length of stay; American Spinal Injury Association (ASIA) impairment and motor scores; Barthel Index (BI) and Rivermead Mobility Index (RMI) to assess independence in daily living; Walking Index for Spinal Cord Injury to assess ambulation; patients destination at discharge. In a subset of 130 subjects, a block design, matching procedure was used to control for the covariant effects of injury characteristics, time from lesion and aetiology on age effects.Results: In the entire group of 284 patients, older subjects had a higher probability of having incomplete tetraplegia of nontraumatic origin; they also showed a shorter length of stay and a higher rate of complications. In the matched cohorts, younger patients showed better neurologic recovery( intended as ASIA impairment grade improvement and motor scores increase), significantly higher Barthel Index and RMI at discharge, a higher level of independence in spontaneous bladder and bowel management and a higher frequency of independent walking.Conclusion: Older individuals with spinal cord injury and disease do well, but have a less favourable outcome in regard to walking, bladder and bowel independence than younger subjects and have more associated medical problems. Different rehabilitative strategies, therefore, are required for older subjects, which maximises the shorter length of stay and provides the necessary medical care and increased physical assistant resources following discharge.