Physical Therapists Study Clinical Utility During Inpatient Rehabilitation of a CPR for Ambulation Prognosis Following SCI
June 28, 2023
A team of physical therapists from the UPMC Rehabilitation Institute, the University of Pittsburgh Department of Physical Medicine and Rehabilitation, and Duquesne University published a study to prospectively evaluate the clinical utility of the van Middendorp clinical prediction rule (CPR). Mobility prognosis is a key focus during rehabilitation following spinal cord injury (SCI).
The research team conducted this observational study in an inpatient rehabilitation unit with five physical therapists and their 52 patients with acute SCI and SCI disorders (8 non-traumatic SCI/D) for whom long-term ambulation prognosis was judged difficult to determine. Results were measured via CPR-determined probability of ambulation, therapist reported clinical utility (yes/no), shared with the patient (yes/no), useful for motivation/setting realistic expectations, and Functional Independence Measure (FIM) Locomotion walk score.
Of the participants, 91% had lesions classified as AIS C or D. The median [IQR] for CPR probability of ambulation was 96.0 [86.5,99.0] for traumatic SCI and 80.0 [64.5, 94.5] for non-traumatic SCI/D. Clinical utility was reported for 45% of those with SCI and 88% with non-traumatic SCI/D. Therapists with less experience were more likely to report clinical utility and share with their patients. Ambulation probability was higher for patients who did not meet their FIM goal. CPR probability was correlated with discharge FIM only for non-traumatic SCI/D.
The team concluded that the CPR was not predictive of inpatient rehabilitation outcomes. In fact, outcomes varied widely for individuals with similar probabilities, therefore emphasizing the importance of clinical judgement and continued need to identify individual factors that affect ambulation. However, greater utility in establishing prognosis and goal setting was noted for clinicians with less experience and for individuals with non-traumatic SCI/D.
Read the full study.
Research team
Joseph Everhart, DPT, NCS
Martha Somers, DPT
Rachel Hibbs, DPT, NCS, ATP/SMS
Lynn Worobey, PhD, DPT, ATP
