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Interaction between injury severity and rehabilitation intervention on independence in activities of daily living in persons with spinal cord injury

Abstract

Study design

Longitudinal secondary analysis of observational data.

Objectives

To examine the effectiveness of physical (PT) and occupational therapy (OT) interventions in improving Spinal Cord Independence Measure III (SCIM III) scores among individuals with spinal cord injury (SCI).

Setting

Two SCI centers in Japan.

Methods

The content and time of rehabilitation interventions, and International Standards for Neurological Classification of SCI and SCIM III scores, were recorded at nine time points (72 h; 2, 4, and 6 weeks; and 2, 3, 4, 5, and 6 months after injury) for hospitalized individuals with SCI. Overall, 204 participants were included and categorized into four groups based on admission severity. Using a linear mixed-effects model, the effectiveness of PT and OT interventions — defined by the International Spinal Cord Injury Physical Therapy-Occupational Therapy Basic Data Set — was assessed using the SCIM III score as the dependent variable.

Results

The following items showed interaction effects between severity and treatment time for the SCIM III score: [Strength training] for PT and OT, and [Standing control activities] and [Gross motor upper extremity] for OT. Intervention effects were observed for [Bed/seated control activities], [Walking and stairs], and [Gross motor upper extremity] for PT, and [Fine motor upper extremity] for OT, regardless of severity.

Conclusions

The results suggest that considering the interaction between injury severity and rehabilitation interventions is essential for optimizing treatment plans and determining appropriate intervention timing. These findings may support clinical decision-making and contribute to improving functional outcomes in individuals with SCI.

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Fig. 1: Flowchart of participant selection.
Fig. 2: Heat map of intervention time by severity group.
Fig. 3: Predicted SCIM III total score for interventions with significant interactions between severity and treatment time.

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Data availability

The data analyzed in this study were obtained from clinical data within the survey of “Research on Establishment of Rehabilitation Treatment Accompanying Spinal Cord Regeneration Therapy”. The dataset generated during this study is available from the corresponding author upon reasonable request.

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Acknowledgements

This research was supported by the Japan Agency for Medical Research and Development (AMED) under Grant Number JP20bk0104017 and a research grant from The General Insurance Association of Japan. We are grateful to Editage (www.editage.com) for their English language editing. We would also like to express our gratitude to the staff at the Hokkaido Spinal Cord Injury Center and the Spinal Cord Injury Center, who helped us with data collection and other tasks.

Funding

This research was supported by the Japan Agency for Medical Research and Development (AMED) (Grant Number: JP20bk0104017) and a research grant from The General Insurance Association of Japan.

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Contributions

All authors were involved in the research design and preparation of this manuscript. RK, HS, TH, KK, S Matsumoto, R Ideta, RW, YE, MY, MK, YA, S Murai, R Ifuku, TO, KS, and TN were strongly involved in data collection and in creating the data collection manual. RK, TK, YE, and MK were strongly involved in the postcollection data analysis.

Corresponding author

Correspondence to Ryuichiro Koga.

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Competing interests

The authors declare no competing interests.

Ethical approval

This study was approved by the Spinal Injuries Center Ethics Committee [19–4] based on the Declaration of Helsinki. Written and verbal explanations of the contents of this study were provided to the participants, and informed consent was obtained. We declare that all applicable institutional and governmental regulations regarding the ethical use of human volunteers were followed during the course of this research.

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Koga, R., Kakuma, T., Sakai, H. et al. Interaction between injury severity and rehabilitation intervention on independence in activities of daily living in persons with spinal cord injury. Spinal Cord 63, 377–384 (2025). https://doi.org/10.1038/s41393-025-01092-y

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