Topics in spinal cord injury rehabilitation · 2026
A Bedside Score Predicts One-Year Walking Recovery in AIS C Spinal Cord Injury: A Multisite Cohort Study.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Smith Andrew C, Kepple Jeffrey, Weber Kenneth A, Thornton Wesley A, Connor Jordan R, Villines Jesse, Tefertiller Candace, Park Andrew, Berliner Jeffrey, Draganich Christina
Аннотация
BACKGROUND: Walking recovery after American Spinal Injury Association Impairment Scale (AIS) C spinal cord injury (SCI) remains difficult to predict.
OBJECTIVES: This study aimed to validate the prognostic value of quadriceps strength for future walking and to develop and test a simplified bedside clinical prediction rule (CPR) for walking recovery in AIS C SCI.
METHODS: We conducted a retrospective cohort study using Spinal Cord Injury Model Systems data. Neurological examinations were performed at rehabilitation admission. Predictors included binary indicators of ≥3/5 muscle strength for key myotomes (L2, L3, L4, S1) and age cutoffs (≥50, ≥65 years). Logistic regression coefficients were scaled into an integer-based bedside score with 3 categories: likely walk, likely no walk, and uncertain. Model performance was evaluated using a random 20% holdout test set. A total of 1414 adults initially classified as AIS C were included; 40% achieved walking recovery at 1 year.
RESULTS: Quadriceps strength ≥3/5 was significantly associated with walking recovery (P < .0001) but demonstrated modest diagnostic accuracy when considered alone. In the CPR training set, 9% were categorized as likely walk and 7% as likely no walk, with accuracy 81%, sensitivity 92%, specificity 72%, positive predictive value 72%, and negative predictive value 92%, with similar performance in the test set. A large proportion of patients remained uncertain.
CONCLUSION: A simple bedside score combining lower extremity strength and age offers clinically useful early risk stratification for individuals with AIS C SCI. Prospective validation and refinement are needed to improve classification of indeterminate cases. The CPR is available at: aiscwalkingcpr.org.
OBJECTIVES: This study aimed to validate the prognostic value of quadriceps strength for future walking and to develop and test a simplified bedside clinical prediction rule (CPR) for walking recovery in AIS C SCI.
METHODS: We conducted a retrospective cohort study using Spinal Cord Injury Model Systems data. Neurological examinations were performed at rehabilitation admission. Predictors included binary indicators of ≥3/5 muscle strength for key myotomes (L2, L3, L4, S1) and age cutoffs (≥50, ≥65 years). Logistic regression coefficients were scaled into an integer-based bedside score with 3 categories: likely walk, likely no walk, and uncertain. Model performance was evaluated using a random 20% holdout test set. A total of 1414 adults initially classified as AIS C were included; 40% achieved walking recovery at 1 year.
RESULTS: Quadriceps strength ≥3/5 was significantly associated with walking recovery (P < .0001) but demonstrated modest diagnostic accuracy when considered alone. In the CPR training set, 9% were categorized as likely walk and 7% as likely no walk, with accuracy 81%, sensitivity 92%, specificity 72%, positive predictive value 72%, and negative predictive value 92%, with similar performance in the test set. A large proportion of patients remained uncertain.
CONCLUSION: A simple bedside score combining lower extremity strength and age offers clinically useful early risk stratification for individuals with AIS C SCI. Prospective validation and refinement are needed to improve classification of indeterminate cases. The CPR is available at: aiscwalkingcpr.org.