Clinical utility during inpatient rehabilitation of a clinical prediction rule for ambulation prognosis following spinal cord injury
OBJECTIVE: Mobility prognosis is a key focus during rehabilitation following spinal cord injury (SCI). The goal of this study was to prospectively evaluate the clinical utility of the van Middendorp clinical prediction rule (CPR). DESIGN: Observational study. SETTING: Inpatient rehabilitation unit. PARTICIPANTS: Physical therapists and their patients with acute SCI and SCI disorders (SCI/D) for whom long-term ambulation prognosis was judged difficult to determine. INTERVENTIONS: N/A. OUTCOME MEASURES: 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. RESULTS: Five therapists and 52 patients (8 non-traumatic SCI/D) participated. 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. CONCLUSION: The CPR was not predictive of inpatient rehabilitation outcomes, in fact outcomes varied widely for individuals with similar probabilities 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.