Highlighting discrepancies in walking prediction accuracy for patients with traumatic spinal cord injury: an evaluation of validated prediction models using a Canadian Multicenter Spinal Cord Injury Registry

Phan, Philippe; Budhram, Brandon; Zhang, Qiong; Rivers, Carly S.; Noonan, Vanessa K.; Plashkes, Tova; Wai, Eugene K.; Paquet, Jérôme; Roffey, Darren M.; Tsai, Eve C.; Fallah, Nader

doi:10.1016/j.spinee.2018.08.016

Cited by 26 publications

(10 citation statements)

References 28 publications

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“…This model was simplified having only the three remaining variables: age (<65 years vs ≥65 years), L3 motor score, and S1 light touch score [ 13 ]. Critical analysis of both models with different patient cohorts revealed that these models achieved high prognostic accuracy for combined AIS categories, whereas applying these models to single AIS sub-groups led to considerably lower accuracy, thus limiting their applicability [ 14 •, 15 ]. Models that include additional parameters or use machine learning algorithms have been developed but showed comparable or inferior predictive accuracy of patient’s mobility [ 16 – 19 ].…”

Section: Clinical Outcome Measuresmentioning

confidence: 99%

Improving Diagnostic Workup Following Traumatic Spinal Cord Injury: Advances in Biomarkers

Schading

Emmenegger

Freund

2021

Curr Neurol Neurosci Rep

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Purpose of Review Traumatic spinal cord injury (SCI) is a life-changing event with drastic implications for patients due to sensorimotor impairment and autonomous dysfunction. Current clinical evaluations focus on the assessment of injury level and severity using standardized neurological examinations. However, they fail to predict individual trajectories of recovery, which highlights the need for the development of advanced diagnostics. This narrative review identifies recent advances in the search of clinically relevant biomarkers in the field of SCI. Recent Findings Advanced neuroimaging and molecular biomarkers sensitive to the disease processes initiated by the SCI have been identified. These biomarkers range from advanced neuroimaging techniques, neurophysiological readouts, and molecular biomarkers identifying the concentrations of several proteins in blood and CSF samples. Some of these biomarkers improve current prediction models based on clinical readouts. Validation with larger patient cohorts is warranted. Summary Several biomarkers have been identified—ranging from imaging to molecular markers—that could serve as advanced diagnostic and hence supplement current clinical assessments.

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Section: Clinical Outcome Measuresmentioning

confidence: 99%

Improving Diagnostic Workup Following Traumatic Spinal Cord Injury: Advances in Biomarkers

Schading

Emmenegger

Freund

2021

Curr Neurol Neurosci Rep

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“…The clinical prediction rules for predicting walking after SCI have limitations. These tools are not as accurate in predicting walking for those with more severe, but incomplete SCIs (AIS B and C) where prediction would be most clinically useful [6]. Early after SCI, sensorimotor testing for proper AIS classification may not be possible to perform-in instances of sedation, polytrauma, and/or concomitant brain injury-thus, the clinical prediction rules would not be available or applicable.…”

Section: Introductionmentioning

confidence: 99%

Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study

et al. 2020

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Study design Retrospective. Objectives Primary: to assess if axial damage ratios are predictors of future walking after spinal cord injury (SCI), and if they add any predictive value if initial neurological impairment grades are available. Secondary: to determine if lateral spinal cord regions are predictors of future lower extremity motor scores (LEMS). Setting University/hospital. Methods Axial T2-weighted MRIs were used. Axial damage ratios and non-damaged lateral cord volumes were calculated. Each participant answered at 1 year after SCI, “Are you able to walk for 150 feet? (45.72 meters)” For the secondary aim, right and left LEMS were used. Results In total, 145 participants were selected. Individuals that could walk had smaller ratios than those that were unable. Walking and axial damage ratios were negatively correlated. A 0.374 ratio cut-off showed optimal sensitivity/specificity. When initial neurological grades were used, axial damage ratios did not add predictive value. Forty-two participants had LEMS available and were included for the secondary aim. Right cord regions and right LEMS were positively correlated and left regions and left LEMS, but these variables were also correlated with each other. Conclusions Axial damage ratios were significant predictors of walking ability 1 year after SCI. However, this measure did not add predictive value over initial neurological grades. Lateral cord regions correlated with same-side LEMS, but the opposite was also found, calling this biomarker’s specificity into question. Axial damage ratios may be useful in predicting walking after SCI if initial neurological grades are unavailable. Sponsorship This research was funded by a National Institutes of Health award, National Institute of Child Health and Development—NIH R03HD094577.

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“…In rehabilitation research, the role of functioning as key health indicator complementing mortality and morbidity [12] poses the question of how prediction research, and specifically prediction models, can improve the use of functioning information for practice. In SCI literature, various efforts have been undertaken to develop and/or validate prediction models for outcomes related to specific aspects of functioning, such as ambulation, [13][14][15][16][17][18][19][20] or bladder and bowel outcomes [21][22][23] . Predictor finding studies for several functioning outcomes have already been reviewed and synthesized [24][25][26][27] .…”

Section: Introductionmentioning

confidence: 99%

The potential of prediction models of functioning remains to be fully exploited: A scoping review in the field of spinal cord injury rehabilitation

Hodel

Stucki

Prodinger

2021

Journal of Clinical Epidemiology

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Objective: The study aimed to explore existing prediction models of functioning in spinal cord injury (SCI). Study Design and Setting: The databases PubMed, EBSCOhost CINAHL Complete , and IEEE Xplore were searched for relevant literature. The search strategy included published search filters for prediction model and impact studies, index terms and keywords for SCI, and relevant outcome measures able to assess functioning as reflected in the International Classification of Functioning, Disability and Health (ICF). The search was completed in October 2020.Results: We identified seven prediction model studies reporting twelve prediction models of functioning. The identified prediction models were mainly envisioned to be used for rehabilitation planning, however, also other possible applications were stated. The method predominantly used was regression analysis and the investigated predictors covered mainly the ICF components of body functions and activities and participation , next to characteristics of the health condition and health interventions.Conclusion: Findings suggest that the development of prediction models of functioning for use in clinical practice remains to be fully exploited. By providing a comprehensive overview of what has been done, this review informs future research on prediction models of functioning in SCI and contributes to an efficient use of research evidence.

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Highlighting discrepancies in walking prediction accuracy for patients with traumatic spinal cord injury: an evaluation of validated prediction models using a Canadian Multicenter Spinal Cord Injury Registry

Cited by 26 publications

References 28 publications

Improving Diagnostic Workup Following Traumatic Spinal Cord Injury: Advances in Biomarkers

Improving Diagnostic Workup Following Traumatic Spinal Cord Injury: Advances in Biomarkers

Axial MRI biomarkers of spinal cord damage to predict future walking and motor function: a retrospective study

The potential of prediction models of functioning remains to be fully exploited: A scoping review in the field of spinal cord injury rehabilitation

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