Prediction of bladder outcomes after ischemic spinal cord injury: A longitudinal cohort study from the European multicenter study about spinal cord injury

Scivoletto, Giorgio; Pavese, Chiara; Bachmann, Lucas M.; Schubert, Martin; Curt, Armin; Agrò, Enrico Finazzi; Kessels, Alfons G.H.; Kessler, Thomas M.

doi:10.1002/nau.23521

Cited by 12 publications

(15 citation statements)

References 24 publications

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“…16 That model was subsequently validated in a large, independent cohort, based on data from the National Spinal Cord Injury Database, 18 on US patients with traumatic SCIs and, additionally, on patients with ischemic SCIs. 17 Finally, the outcome measure used in the present study (ie, the SCIM) was reliable and valid; it might be the best primary outcome measure for functional capacity in future phase 3 clinical trials. 43 It should be noted that the SCIM is an objective outcome measure; it does not consider any subjective evaluation of outcome or the level of patient satisfaction.…”

Section: Strengths and Limitationsmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

“…13 This identification would promote the optimization of future clinical trial designs for evaluating the efficacy of new bowel management interventions because it could facilitate the stratification of intervention groups for the likelihood of spontaneous recovery. 13 Although there are valid prediction models for locomotion, 14 upper-limb function, 15 and bladder function, [16][17][18] no similar tool is available for bowel function. Thus, we aimed to derive and validate a model for predicting the achievement of independent bowel management, with reliable bowel movements and continence, at 1 year after traumatic SCI.…”

Section: Introductionmentioning

confidence: 99%

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

Pavese

Bachmann

Schubert

et al. 2019

Neurorehabil Neural Repair

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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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Section: Strengths and Limitationsmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

Pavese

Bachmann

Schubert

et al. 2019

Neurorehabil Neural Repair

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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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“…1 Over the last years, several models have been introduced for the prediction of the main functional outcomes after SCI, such as upper limb function, ambulation, and bladder control. [2][3][4][5] Our group has recently derived and validated in patients with traumatic SCI included in the European Multicenter Study about Spinal Cord Injury (EMSCI; http://www.emsci.org; ClinicalTrials.gov Identifier: NCT01571531) 2 models to predict independent and reliable bowel management 1 year after traumatic SCI. 6 However, in order to use and implement the predictive models, their generalizability in new populations external to EMSCI should be evaluated.…”

Section: Introductionmentioning

confidence: 99%

External Validation Confirms Validity of a Simple Model to Predict Bowel Outcome After Traumatic Spinal Cord Injury

Pavese

Scivoletto

Puci

et al. 2021

Neurorehabil Neural Repair

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Background. The prediction of functional outcomes after spinal cord injury (SCI) is essential to plan the rehabilitation phase and the social reintegration. Recently, 2 models to predict independent and reliable bowel management 1 year after traumatic SCI have been derived and validated in 2 cohorts of patients included in the European Multicenter Study about Spinal Cord Injury (EMSCI). Objective. We aimed to validate 2 prediction models for bowel outcome after traumatic SCI in a patient sample external to EMSCI. Methods. The simplified model (based on a single predictor, the International Standards for Neurological Classification of Spinal Cord Injury [ISNCSCI] total motor score) and the full model (based on 2 predictors, the ISNCSCI total motor score and item 3a of the Spinal Cord Independence Measure) were applied to the retrospectively collected data of 111 patients with traumatic SCI. Results. The simplified and the full models showed excellent discrimination with an area under the receiver operating characteristic curve of .939 (95% confidence interval (CI) .87-1.00) and .922 (95% CI 0.85-.99), respectively. Both models displayed similar results for sensitivity and negative predictive values; however, the simplified model showed higher values for specificity, positive predictive values, and accuracy. The calibration analysis showed a partial overlap between predicted probabilities and observed proportion, with better and acceptable calibration for the simplified model. Conclusions. Using an independent sample, our study demonstrates the validity of a simple model to predict independent and reliable bowel management 1 year after traumatic SCI.

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Prediction of bladder outcomes after ischemic spinal cord injury: A longitudinal cohort study from the European multicenter study about spinal cord injury

Abstract: Comparable to acute traumatic SCI, also in ischemic SCI the outcome of full bladder function recovery can be predicted by clinical scores, and prediction models of bladder outcomes may be applicable in clinical trials.

Cited by 12 publications

References 24 publications

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

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

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

External Validation Confirms Validity of a Simple Model to Predict Bowel Outcome After Traumatic Spinal Cord Injury

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