Bowel Outcome Prediction After Traumatic Spinal Cord Injury: Longitudinal Cohort Study

Chiara Pavese, Lucas M. Bachmann, Martin Schubert, Armin Curt, Ulrich Mehnert, Marc P. Schneider, Giorgio Scivoletto, Enrico Finazzi Agrò, Doris Maier, Rainer Abel, Norbert Weidner, Rüdiger Rupp, Alfons G. Kessels, Thomas M. Kessler

Research output: Contribution to journalArticle

Abstract

Background. Predicting functional outcomes after traumatic spinal cord injury (SCI) is essential for counseling, rehabilitation planning, and discharge. Moreover, the outcome prognosis is crucial for patient stratification when designing clinical trials. However, no valid prediction rule is currently available for bowel outcomes after a SCI. Objective. To generate a model for predicting the achievement of independent, reliable bowel management at 1 year after traumatic SCI. Methods. We performed multivariable logistic regression analyses of data for 1250 patients with traumatic SCIs that were included in the European Multicenter Study about Spinal Cord Injury. The resulting model was prospectively validated on data for 186 patients. As potential predictors, we evaluated age, sex, and variables from the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the Spinal Cord Independence Measure (SCIM), measured within 40 days of the injury. A positive outcome at 1 year post-SCI was assessed with item 7 of the SCIM. Results. The model relied on a single predictor, the ISNCSCI total motor score—that is, the sum of muscle strengths in 5 key muscle groups in each limb. The area under the receiver operating characteristics curve (aROC) was 0.837 (95% CI: 0.815-0.859). The prospective validation confirmed high predictive power: aROC = 0.817 (95% CI: 0.754-0.881). Conclusions. We generated a valid model for predicting independent, reliable bowel management at 1 year after traumatic SCI. Its application could improve counseling, optimize patient-tailored rehabilitation planning, and become crucial for appropriate patient stratification in future clinical trials.

Original languageEnglish
JournalNeurorehabilitation and Neural Repair
DOIs
Publication statusAccepted/In press - Jan 1 2019

Fingerprint

Spinal Cord Injuries
Longitudinal Studies
Cohort Studies
ROC Curve
Counseling
Spinal Cord
Rehabilitation
Clinical Trials
Patient Discharge
Muscle Strength
Multicenter Studies
Extremities
Logistic Models
Regression Analysis
Muscles
Wounds and Injuries

Keywords

  • bowel function
  • cohort study
  • functional outcome
  • prediction
  • rehabilitation
  • spinal cord injury

ASJC Scopus subject areas

  • Rehabilitation
  • Neurology
  • Clinical Neurology

Cite this

Pavese, C., Bachmann, L. M., Schubert, M., Curt, A., Mehnert, U., Schneider, M. P., ... Kessler, T. M. (Accepted/In press). Bowel Outcome Prediction After Traumatic Spinal Cord Injury: Longitudinal Cohort Study. Neurorehabilitation and Neural Repair. https://doi.org/10.1177/1545968319868722

Bowel Outcome Prediction After Traumatic Spinal Cord Injury : Longitudinal Cohort Study. / Pavese, Chiara; Bachmann, Lucas M.; Schubert, Martin; Curt, Armin; Mehnert, Ulrich; Schneider, Marc P.; Scivoletto, Giorgio; Finazzi Agrò, Enrico; Maier, Doris; Abel, Rainer; Weidner, Norbert; Rupp, Rüdiger; Kessels, Alfons G.; Kessler, Thomas M.

In: Neurorehabilitation and Neural Repair, 01.01.2019.

Research output: Contribution to journalArticle

Pavese, C, Bachmann, LM, Schubert, M, Curt, A, Mehnert, U, Schneider, MP, Scivoletto, G, Finazzi Agrò, E, Maier, D, Abel, R, Weidner, N, Rupp, R, Kessels, AG & Kessler, TM 2019, 'Bowel Outcome Prediction After Traumatic Spinal Cord Injury: Longitudinal Cohort Study', Neurorehabilitation and Neural Repair. https://doi.org/10.1177/1545968319868722
Pavese, Chiara ; Bachmann, Lucas M. ; Schubert, Martin ; Curt, Armin ; Mehnert, Ulrich ; Schneider, Marc P. ; Scivoletto, Giorgio ; Finazzi Agrò, Enrico ; Maier, Doris ; Abel, Rainer ; Weidner, Norbert ; Rupp, Rüdiger ; Kessels, Alfons G. ; Kessler, Thomas M. / Bowel Outcome Prediction After Traumatic Spinal Cord Injury : Longitudinal Cohort Study. In: Neurorehabilitation and Neural Repair. 2019.
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abstract = "Background. Predicting functional outcomes after traumatic spinal cord injury (SCI) is essential for counseling, rehabilitation planning, and discharge. Moreover, the outcome prognosis is crucial for patient stratification when designing clinical trials. However, no valid prediction rule is currently available for bowel outcomes after a SCI. Objective. To generate a model for predicting the achievement of independent, reliable bowel management at 1 year after traumatic SCI. Methods. We performed multivariable logistic regression analyses of data for 1250 patients with traumatic SCIs that were included in the European Multicenter Study about Spinal Cord Injury. The resulting model was prospectively validated on data for 186 patients. As potential predictors, we evaluated age, sex, and variables from the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the Spinal Cord Independence Measure (SCIM), measured within 40 days of the injury. A positive outcome at 1 year post-SCI was assessed with item 7 of the SCIM. Results. The model relied on a single predictor, the ISNCSCI total motor score—that is, the sum of muscle strengths in 5 key muscle groups in each limb. The area under the receiver operating characteristics curve (aROC) was 0.837 (95{\%} CI: 0.815-0.859). The prospective validation confirmed high predictive power: aROC = 0.817 (95{\%} CI: 0.754-0.881). Conclusions. We generated a valid model for predicting independent, reliable bowel management at 1 year after traumatic SCI. Its application could improve counseling, optimize patient-tailored rehabilitation planning, and become crucial for appropriate patient stratification in future clinical trials.",
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AU - Pavese, Chiara

AU - Bachmann, Lucas M.

AU - Schubert, Martin

AU - Curt, Armin

AU - Mehnert, Ulrich

AU - Schneider, Marc P.

AU - Scivoletto, Giorgio

AU - Finazzi Agrò, Enrico

AU - Maier, Doris

AU - Abel, Rainer

AU - Weidner, Norbert

AU - Rupp, Rüdiger

AU - Kessels, Alfons G.

AU - Kessler, Thomas M.

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N2 - Background. Predicting functional outcomes after traumatic spinal cord injury (SCI) is essential for counseling, rehabilitation planning, and discharge. Moreover, the outcome prognosis is crucial for patient stratification when designing clinical trials. However, no valid prediction rule is currently available for bowel outcomes after a SCI. Objective. To generate a model for predicting the achievement of independent, reliable bowel management at 1 year after traumatic SCI. Methods. We performed multivariable logistic regression analyses of data for 1250 patients with traumatic SCIs that were included in the European Multicenter Study about Spinal Cord Injury. The resulting model was prospectively validated on data for 186 patients. As potential predictors, we evaluated age, sex, and variables from the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the Spinal Cord Independence Measure (SCIM), measured within 40 days of the injury. A positive outcome at 1 year post-SCI was assessed with item 7 of the SCIM. Results. The model relied on a single predictor, the ISNCSCI total motor score—that is, the sum of muscle strengths in 5 key muscle groups in each limb. The area under the receiver operating characteristics curve (aROC) was 0.837 (95% CI: 0.815-0.859). The prospective validation confirmed high predictive power: aROC = 0.817 (95% CI: 0.754-0.881). Conclusions. We generated a valid model for predicting independent, reliable bowel management at 1 year after traumatic SCI. Its application could improve counseling, optimize patient-tailored rehabilitation planning, and become crucial for appropriate patient stratification in future clinical trials.

AB - Background. Predicting functional outcomes after traumatic spinal cord injury (SCI) is essential for counseling, rehabilitation planning, and discharge. Moreover, the outcome prognosis is crucial for patient stratification when designing clinical trials. However, no valid prediction rule is currently available for bowel outcomes after a SCI. Objective. To generate a model for predicting the achievement of independent, reliable bowel management at 1 year after traumatic SCI. Methods. We performed multivariable logistic regression analyses of data for 1250 patients with traumatic SCIs that were included in the European Multicenter Study about Spinal Cord Injury. The resulting model was prospectively validated on data for 186 patients. As potential predictors, we evaluated age, sex, and variables from the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the Spinal Cord Independence Measure (SCIM), measured within 40 days of the injury. A positive outcome at 1 year post-SCI was assessed with item 7 of the SCIM. Results. The model relied on a single predictor, the ISNCSCI total motor score—that is, the sum of muscle strengths in 5 key muscle groups in each limb. The area under the receiver operating characteristics curve (aROC) was 0.837 (95% CI: 0.815-0.859). The prospective validation confirmed high predictive power: aROC = 0.817 (95% CI: 0.754-0.881). Conclusions. We generated a valid model for predicting independent, reliable bowel management at 1 year after traumatic SCI. Its application could improve counseling, optimize patient-tailored rehabilitation planning, and become crucial for appropriate patient stratification in future clinical trials.

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