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European Journal of Physical and Rehabilitation Medicine 2022 October;58(5):709-14

DOI: 10.23736/S1973-9087.22.07366-X

Copyright © 2022 THE AUTHORS

This is an open access article distributed under the terms of the CC BY-NC-ND 4.0 license which allows users to copy and distribute the manuscript, as long as this is not done for commercial purposes and further does not permit distribution of the manuscript if it is changed or edited in any way, and as long as the user gives appropriate credits to the original author(s) and the source (with a link to the formal publication through the relevant DOI) and provides a link to the license.

language: English

Prediction of bowel management independence after ischemic spinal cord injury

Chiara PAVESE 1, 2, 3, Giorgio SCIVOLETTO 4, Mariangela V. PUCI 5, Rainer ABEL 6, Armin CURT 1, Doris MAIER 7, Rüdiger RUPP 8, Martin SCHUBERT 1, Norbert WEIDNER 8, Cristina MONTOMOLI 5, Thomas M. KESSLER 9

1 Department of Neurology, Spinal Cord Injury Center, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; 2 Department of Clinical-Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; 3 Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation and Spinal Unit, Pavia Institute, Pavia, Italy; 4 Spinal Cord Unit and Spinal Rehabilitation (SpiRe) Lab, IRCCS Santa Lucia Foundation, Rome, Italy; 5 Unit of Biostatistics and Clinical Epidemiology, Department of Public Health, Experimental and Forensic Medicine, University of Pavia, Pavia, Italy; 6 Spinal Cord Injury Center, Hohe Warte, Bayreuth, Germany; 7 BG-Trauma Center, Murnau, Germany; 8 Spinal Cord Injury Center, Heidelberg University Hospital, Heidelberg, Germany; 9 Department of Neuro-Urology, Balgrist University Hospital, University of Zürich, Zürich, Switzerland



BACKGROUND: Ischemic spinal cord injury (SCI) belongs to the heterogeneous group of non-traumatic SCI, while the course of sensorimotor and functional recovery is comparable to traumatic SCI. Recently, we derived from data of patients with traumatic SCI a valid model to predict an independent and reliable bowel management one year after SCI.
AIM: To evaluate the performance of this model to predict an independent and reliable bowel management one year following ischemic SCI.
DESIGN: Prognostic study - observational study.
SETTING: European Multicenter Study about Spinal Cord Injury (EMSCI) ClinicalTrials.gov: NCT01571531.
POPULATION: One hundred and forty-two patients with ischemic SCI of various level and severity of injury.
METHODS: The prediction model relied on a single predictor collected within 40 days from injury, the International Standards for Neurological Classification of Spinal Cord Injury total motor score. Bowel outcome one year after SCI derived from the dichotomization of the Spinal Cord Independence Measure (SCIM) item 7 scores. We defined a positive outcome as independent bowel management with regular movements and appropriate timing with no or rare accidents (score of 10 in SCIM version II and score of 8 or 10 in version III).
RESULTS: The model showed a fair discrimination with an area under the receiver operating characteristic (ROC) curve of 0.780 (95% confidence interval=0.702-0.860). In addition, the model displayed an acceptable accuracy and calibration.
CONCLUSIONS: The study extends the validity of our rule to patients with ischemic SCI, thus providing the first model to predict an independent and reliable bowel management in this population.
CLINICAL REHABILITATION IMPACT: The model may be employed in clinical practice to counsel patients, to define the rehabilitation aims and to estimate the need of assistance after discharge, as well as in the research field for the optimization of patients’ allocation in the design of future clinical trials.


KEY WORDS: Spinal cord injuries; Spinal cord vascular diseases; Ischemia; Rehabilitation

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