Article | Published:

Replication and novel analysis of age and sex effects on the neurologic and functional value of each spinal segment in the US healthcare setting

Spinal Cord (2018) | Download Citation

Abstract

Study design

Replication of previously developed prognostic model.

Objectives

In motor complete injuries at admission to rehabilitation, perform; (1) replication analyses of the relationships between ISNCSCI motor level and motor scores and SCIM and (2) novel analyses to determine if age and/or sex moderate relationship between neurological impairment and function.

Setting

Admission to initial inpatient rehabilitation in the United States.

Methods

Post-Hoc analyses of data collected as part of a separate study. Replication analyses: (1) Pearson’s correlation assessed relationship strength between neurologic impairment and function. (2) Multiple linear regression assessed if center or age influenced functional outcome. Novel analyses: (1) Moderated multiple regression assessed if age and/or sex moderated the lesion level-function relationship.

Results

Of the 406 datasets, 161 were motor complete injuries, and included in the analyses. Median time post injury at admission to rehabilitation was 19 days. Our replication analyses confirmed the neurologic and functional value of each spinal segment reported by the EM-SCI group (all p ≤ 0.018). We failed to confirm their reported age effect (p = 0.05) and non-effect of center (p = 0.037). Our novel analyses indicated that age coded as above/below 50 moderated the relationship between neurologic impairment and function (p = 0.038) in cervical injuries only, but that age coded as above/below 35 (all p ≥ 0.510) and sex (all p ≥ 0.465) did not.

Conclusions

The neurological and functional value of each segment is consistent across very different healthcare settings in early and late sub-acute stages and minimally impacted by age and sex. Differences related to centers and age may confound efficacy trials.

Sponsorship

The Miami Project to Cure Paralysis; The Craig H. Neilsen Foundation (83492)

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Acknowledgements

We acknowledge Carla Strohhofer’s substantial effort on cleaning and error checking the database and financial support from The Miami Project to Cure Paralysis and The Craig H. Neilsen Foundation (83492).

Funding

The Miami Project to Cure Paralysis and The Craig H. Neilsen Foundation (83492).

Authors’ contributions

REC conceptualized the manuscript; contributed to the selection of aims, selected and executed all statistical analyses, developed the tables and figures, and contributed to multiple drafts of the manuscript. KDA designed and executed the original study that resulted in the database; contributed to the selection of aims, and contributed to multiple drafts of the manuscript.

Author information

Affiliations

  1. Department of Neurosurgery and Miami Project to Cure Paralysis, Miller School of Medicine, University of Miami, Miami, Fl, USA

    • Rachel E. Cowan
  2. Department of Physical Medicine and Rehabilitation, MetroHealth Medical Center, Institute for Functional Restoration, Case Western Reserve University, Cleveland, OH, USA

    • Kim D. Anderson

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Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Kim D. Anderson.

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DOI

https://doi.org/10.1038/s41393-018-0206-8