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Buspirone for functional improvement after acute traumatic spinal cord injury: a propensity score-matched cohort study

Abstract

Study design

Retrospective analysis of treated inpatients compared to expected neurorecovery from a propensity score-matched national database cohort.

Objective

Evaluate the effectiveness of buspirone on clinical neurorecovery following traumatic SCI when started during acute inpatient rehabilitation.

Setting

University-based hospital in Boston, USA.

Methods

Chart review yielded thirty-one individuals with acute, traumatic SCI treated with buspirone during inpatient rehabilitation from 2011–2017. Propensity score matching to a cohort of individuals from the spinal cord injury model systems (SCIMS) national database was completed. Changes in upper extremity motor score (UEMS), lower extremity motor score (LEMS), American Spinal Injury Association Impairment Scale (AIS), neurological level of injury (NLI), and functional impairment measure (FIM) from admission to discharge and discharge to 1 year were computed and compared between matched pairs (buspirone and mean national SCIMs cohort). A local control cohort not treated with buspirone was similarly compared to a matched mean national SCIMs group to identify location-specific effects.

Results

From admission to discharge from inpatient rehabilitation, 95% confidence intervals of changes in UEMS (−2.43 to +2.78), LEMS (−1.02 to +6.02), AIS (−0.04 to +0.35), NLI (−0.42 to +1.08), and FIM (−4.42 to +6.40) were not significantly different between those individuals who received buspirone and their propensity-matched SCIMS cohort. Similarly, changes in these metrics were not significantly different at 1-year follow up. Buspirone group individuals with initial clinically complete SCI demonstrated a higher 1-year conversion rate to incomplete injury (6 out of 14; 42.9%) compared to the matched national SCIMS cohort (14 out of 70; 21.2%, p = 0.047) though this was not significantly different from non-buspirone local controls (p = 0.25).

Conclusions

Retrospective analysis shows no statistically significant difference in gross markers of neurorecovery following acute traumatic SCI when buspirone is initiated indiscriminately during acute inpatient rehabilitation. In individuals with clinically complete SCI, findings suggest possible increased rates of 1-year conversion to incomplete injury.

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Fig. 1: Study flowchart illustrating inclusion/exclusion and propensity score matching (PSM) process.
Fig. 2: Effect of buspirone compared to SCI model systems propensity-matched peers (1:5), 95% CI.

Data availability

The datasets generated during and/or analyzed during the current study are available in the National Spinal Cord Injury Model Systems (SCIMS) Database and can be requested per their internal policy upon approval [https://www.nscisc.uab.edu/Research/PublicDataRegister].

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Acknowledgements

The authors would like to specifically acknowledge the collective work of the National Spinal Cord Injury Statistical Center and Model Systems contributors, without whom this study would not have been possible.

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Contributions

JWM was responsible for conducting literature review, designing the study protocol, extracting and analyzing data, interpreting results, and writing the report. RS was responsible for designing the study protocol, extracting and analyzing data, creating tables and figures, interpreting results, and writing the report.

Corresponding author

Correspondence to James W. Morgan.

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The authors declare that they have no conflict of interest.

Ethical statement

This study has been reviewed and approved by the Partners Human Research Committee (Protocol #: 2018P000667/PHS). In addition, The IRB has reviewed and approved to use research data obtained from Protocol 2011P002173 and HIPAA de-identified data obtained from the National Spinal cord Injury Statistical Center controlled access research database. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research

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Morgan, J.W., Solinsky, R. Buspirone for functional improvement after acute traumatic spinal cord injury: a propensity score-matched cohort study. Spinal Cord 59, 563–570 (2021). https://doi.org/10.1038/s41393-020-00606-0

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