Early predictors of developing problematic spasticity following traumatic spinal cord injury: A prospective cohort study

The Journal of Spinal Cord Medicine, 2020 · DOI: 10.1080/10790268.2018.1527082 · Published: May 1, 2020

Spinal Cord Injury Neurology Rehabilitation

Simple Explanation

This study aimed to find out what factors early after a traumatic spinal cord injury (SCI) can predict if someone will develop problematic spasticity, which is spasticity that limits function or requires treatment. The study looked at information collected during hospitalization, like age, injury severity, and medications, to see if these could predict spasticity up to 5 years after the injury. The researchers created prediction models that can help doctors identify patients at higher risk of developing problematic spasticity, so they can provide targeted treatment and support.

Study Duration

5 years

Participants

350 individuals with traumatic SCI

Evidence Level

Prospective cohort study

Key Findings

1
Variables during hospitalization that predicted problematic spasticity included initial Glasgow Coma Scale, age at injury, rehabilitation admission, and community discharge anti-spasticity medication prescription.
2
Neurological status, Penn Spasm Frequency Scale, and pain interference with quality of life, sleep, and activities also predicted problematic spasticity.
3
Greater change in AIS motor scores between admission and discharge was also a predictor.

Research Summary

This prospective cohort study identified early predictors of problematic spasticity following traumatic SCI by analyzing data from 350 patients enrolled in the Rick Hansen Spinal Cord Injury Registry. The study found that factors such as initial Glasgow Coma Scale, age at injury, admission to rehabilitation, and certain discharge characteristics (medication, neurological status, pain) were predictive of spasticity development up to 5 years post-injury. The researchers developed prediction models with good accuracy to identify individuals at risk, potentially improving clinical management and research efforts.

Practical Implications

Improved Clinical Spasticity Management

The prediction models can be used to identify patients at high risk of developing problematic spasticity, allowing for early intervention and targeted treatment strategies.

Risk Stratification in Interventional Trials

The models can assist in research by enabling risk stratification in interventional trials, ensuring that resources are allocated efficiently and that appropriate patients are included in studies.

Enhanced Patient Education

Early prognosis can inform patients about their risk of developing problematic spasticity, enabling them to take proactive measures and understand expected outcomes.

Study Limitations

1
Spasticity was assessed using self-report questionnaires; clinical data such as the Modified Ashworth Scale were not collected.
2
Results from this study are limited to the SCI population that received their post SCI acute treatment and rehabilitation at the RHSCIR centers involved in the study.
3
Differences in practice and the time between admission to community discharge between centers may affect outcomes.

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