Abstract
Study design
Prospective cohort study.
Objectives
To validate a Clinical Prediction Rule (CPR) for ambulation in a non-traumatic spinal cord injury population (NTSCI).
Setting
Tertiary spinal rehabilitation inpatient service, Melbourne, Australia.
Methods
Adults with confirmed NTSCI were recruited between April 2013 and July 2017. Data based on the original van Middendorp CPR (age and four neurological variables) were collected from participant’s medical records and by interview. The Spinal Cord Independence Measure item 12 was used to quantify the ability to walk at 6 and 12 months. A receiver operator curve (ROC) was utilised to determine the performance of the CPR. Ambulatory outcomes were compared for AIS A, B, C and D and aetiology groups.
Results
The area under the ROC curve (AUC) was 0.94 with 95% confidence interval (CI) 0.86–1.0 (n = 52). Overall accuracy was 75% at 6 months and 82% at 12 months. For the whole cohort the sensitivity at 12 months was 95% and specificity 73%. However, specificity for AIS C and D was only 50%.
Conclusion
The CPR correctly predicted those who did not walk at 6 and 12 months following NTSCI, but was less accurate in predicting those who would walk particularly those with an AIS C or D classification. This CPR may be useful to inform planning for future care in individuals with NTSCI, particularly for those who are not expected to walk. Further research with larger sample sizes is required to determine if the trends identified in this study are generalisable.
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Change history
14 April 2020
A Correction to this paper has been published: https://doi.org/10.1038/s41393-020-0466-y
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Acknowledgements
We gratefully acknowledge Physiotherapists Genevieve Hendrey and Adele Winter from Caulfield Hospital for their contribution to participant recruitment.
Funding
This project was in part financially supported by an Alfred Health small research grant.
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RS and PN conceived the idea for the project; RS collected the data; BH analysed the data; BH, AH and CB interpreted the data; CB completed the literature review; CB wrote the first draft of the paper and all authors revised the paper.
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We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research. Approval was obtained from the Alfred Health Human Research Ethics Committee; ethics number = 114/13
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Sturt, R., Hill, B., Holland, A. et al. Validation of a clinical prediction rule for ambulation outcome after non-traumatic spinal cord injury. Spinal Cord 58, 609–615 (2020). https://doi.org/10.1038/s41393-019-0386-x
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DOI: https://doi.org/10.1038/s41393-019-0386-x
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