Factors that influence functional ability in individuals with spinal cord injury.
Hastings, Bronwyn Meloney
There is a dearth of published literature that documents the levels of functional ability post spinal cord injury (SCI) resulting in paraplegia, at discharge from in-patient rehabilitation facilities within Gauteng. In addition, the factors that influence functional ability are poorly defined in individuals with paraplegia, at their discharge from in-patient rehabilitation facilities in Gauteng. This necessitated further investigation since it is vital for the rehabilitation of individuals with SCI resulting in paraplegia. The aim of the study was to determine the functional ability and the factors that affect the functional ability in individuals with a SCI resulting in paraplegia, at discharge from rehabilitation facilities in Gauteng. The first objective of the study was to establish the level of functional ability in patients with SCI at discharge from in-patient rehabilitation. The second objective of the study was to describe the physical and demographic factors of the study population. The third objective of the study was to establish the demographic and physical factors that influence the level of functional ability in patients with SCI at discharge from in-patient rehabilitation. This was a cross-sectional, observational study design. Three instruments were used in this study: a self-designed questionnaire to establish the factors that influence the level of functional ability in patients with SCI at discharge from an in-patient rehabilitation unit; the American Spinal Injury Association (ASIA) classification scale of neurological impairment to describe the level and completeness of the lesion and the Spinal Cord Independence Measure III (SCIM III) to determine the level of functional ability. The main results of the study were as follows: The average SCIM score in this population was 64.6 (±27.6) with the lowest score being 20 and the highest score being 84. Participants with non traumatic SCI had 16.87% lower SCIM scores than those with traumatic SCI. After multivariate analysis the following factors were found to influence function: For every one year increase in the age of the participant, there was 0.18% decrease in the SCIM score. For every day increase in LOS, there was a corresponding increase of 0.06% in the SCIM score. With respect to the presence of a pressure sore from the acute hospital, those who had pressure sores had 9% lower SCIM scores than those who did not have pressure sores. Participants with spasticity had 8.3% lower SCIM scores relative to those that did not have spasticity. Relative to participants in government funding classification, workman’s compensation participants had 4.82% lower SCIM score followed by the medical aid participants with 8.07% lower SCIM and the private participants with 10.84% lower SCIM scores. For every unit increase in the ASIA motor score, there was an increase of 1.29% in the SCIM score. Conclusion: Majority of the participants in this study were discharged from rehabilitation without reaching functional independence. The following categories of patients with SCI may need to be monitored more for functional outcomes during rehabilitation and assisted in order to attain good functional ability: older age, a short rehabilitation length of stay, funded privately, a low ASIA motor score, having a pressure sore or spasticity, and higher level of SCI. Key words: Functional outcomes, paraplegia, rehabilitation, neurological level, spinal cord injury.