Spinal cord injury rehabilitation should not focus on mobility alone
MedWire News: Individuals with spinal cord injury (SCI) who are able to walk at discharge but find themselves in a wheelchair within a year have a significantly worse quality of life (QoL) than their peers who switch from walking to wheelchair or maintain walking or wheelchair use, study results show.
The walking-to-wheelchair group also had higher levels of pain and depression suggesting that early attempts to walk were ineffective and kept individuals from participating in community activities - or that unfamiliarity with wheelchair use after transition prevented social involvement.
"The drive to become fully ambulatory again, whether prompted by the individuals, families, or even rehabilitation teams, may not be the best goal for certain individuals," Michael Boninger (University of Pittsburgh, Pennsylvania, USA) and colleagues comment in the Archives of Physical Medicine and Rehabilitation.
Of the approximately 12,000 new SCI cases in the USA each year, 25 to 33% of individuals regain some degree of ambulation by the time of discharge.
Promise of an eventual cure may further focus patients on ambulation-related goals because they may see their new disability as temporary.
However, as Boninger et al observe: "Individuals who have not regained sufficient motor function, yet strive for primary ambulation, may find that being ambulatory results in more inconveniences than benefits."
They therefore performed a study to examine the relationship between subjective QoL factors and change in mobility among 1826 individuals who presented with traumatic SCI between June 2004 and July 2009 and returned for 1-year follow-up.
Assessments performed at follow-up included impairment based on lower-extremity motor score, QoL based on Craig handicap assessment and reporting technique, patient health questionnaire, satisfaction with life scale, self-perceived health status, and pain severity scores.
During the study period, 306 patients were ambulatory at discharge and remained so at follow-up; 1152 were in a wheelchair at discharge and remained so; 313 were in wheelchair at discharge but regained ambulation at follow-up; while 55 were ambulatory at discharge then switched to wheelchair.
Notably the latter group had the highest number of individuals from minority groups (52.8%) and the lowest employment rate (7.3%).
Compared with individuals who transitioned from wheelchair use to walking or maintained wheelchair use or ambulation, the walking-to-wheelchair transition group had significantly lower QoL scores, including higher depression and higher pain severity.
"Rehabilitation professionals should consider encouraging marginal ambulators to work toward functional independence from a wheelchair rather than primary ambulation during acute inpatient rehabilitation after SCI," Boninger et al comment.
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Andrew Czyzewski