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Multicenter Study
. 2024 Jan;105(1):10-19.
doi: 10.1016/j.apmr.2023.06.015. Epub 2023 Jul 5.

A Single Dermatome Clinical Prediction Rule for Independent Walking 1 Year After Spinal Cord Injury

Andrew C Smith  1 , Christina Draganich  2 , Wesley A Thornton  3 , Jeffrey C Berliner  3 , Peter J Lennarson  4 , Enrico Rejc  5 , Mitch Sevigny  6 , Susan Charlifue  6 , Candace Tefertiller  6 , Kenneth A Weber 2nd  7
Affiliations
Multicenter Study

A Single Dermatome Clinical Prediction Rule for Independent Walking 1 Year After Spinal Cord Injury

Andrew C Smith et al. Arch Phys Med Rehabil. 2024 Jan.

Abstract

Objective: To derive and validate a simple, accurate CPR to predict future independent walking ability after SCI at the bedside that does not rely on motor scores and is predictive for those initially classified in the middle of the SCI severity spectrum.

Design: Retrospective cohort study. Binary variables were derived, indicating degrees of sensation to evaluate predictive value of pinprick and light touch variables across dermatomes. The optimal single sensory modality and dermatome was used to derive our CPR, which was validated on an independent dataset.

Setting: Analysis of SCI Model Systems dataset.

Participants: Individuals with traumatic SCI. The data of 3679 participants (N=3679) were included with 623 participants comprising the derivation dataset and 3056 comprising the validation dataset.

Interventions: Not applicable.

Main outcome measures: Self-reported ability to walk both indoors and outdoors.

Results: Pinprick testing at S1 over lateral heels, within 31 days of SCI, accurately identified future independent walkers 1 year after SCI. Normal pinprick in both lateral heels provided good prognosis, any pinprick sensation in either lateral heel provided fair prognosis, and no sensation provided poor prognosis. This CPR performed satisfactorily in the middle SCI severity subgroup.

Conclusions: In this large multi-site study, we derived and validated a simple, accurate CPR using only pinprick sensory testing at lateral heels that predicts future independent walking after SCI.

Keywords: Clinical prediction rule; Pinprick; Rehabilitation; Spinal cord injury; Walking.

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Figures

Fig 1
Fig 1
Positive and negative predictive values of the candidate CPR variables derived from the pinprick (A) and light touch sensory scores (B) in the derivation dataset (n=623). For each dermatome and the pinprick and light touch sensory scores, we derived binary variables that indicated normal sensation bilaterally (both left and right), normal sensation unilaterally (left or right), any sensation (normal or altered) bilaterally (left and right), and any sensation (normal or altered) unilaterally (left or right). Mean PPVs and NPVs are shown for each candidate variable (●). Error bars=bootstrapped 95% CIs. ★=Used in CPR.
Fig 2
Fig 2
Positive and negative predictive values of the candidate CPR variables derived from the pinprick sensory scores at the L4 and S1 dermatomes in the AIS B and C derivation dataset subset (n=179). In the whole derivation dataset, pinprick at the L4 and S1 dermatomes had similar predictive value (fig 1). When considering the AIS B and C subset of the derivation dataset, pinprick at the S1 dermatome yielded the optimal PPV (primary measure) and NPV (secondary measure) for predicting independent walking, so pinprick sensation at S1 was used to derive the CPR. Mean PPVs and NPVs are shown for each candidate variable (●). Error bars=bootstrapped 95% CIs. ★=Used in CPR.
Fig 3
Fig 3
The S1 lateral heel pinprick clinical prediction rule.
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References

    1. Ditunno PL, Patrick M, Stineman M, Ditunno JF. Who wants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study. Spinal Cord 2008;46:500–6. - PubMed
    1. Pelletier-Roy R, Richard-Denis A, Jean S, et al. Clinical judgment is a cornerstone for validating and using clinical prediction rules: a head-to-head study on ambulation outcomes for spinal cord injured patients. Spinal Cord 2021;59:1104–10. - PubMed
    1. van Middendorp JJ, Hosman AJ, Donders ART, et al. A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study. Lancet 2011;377:1004–10. - PubMed
    1. Hicks KE, Zhao Y, Fallah N, et al. A simplified clinical prediction rule for prognosticating independent walking after spinal cord injury: a prospective study from a Canadian multicenter spinal cord injury registry. Spine J 2017;17:1383–92. - PubMed
    1. Jean S, Mac-Thiong JM, Jean MC, Dionne A, Bégin J, Richard-Denis A. Early clinical prediction of independent outdoor functional walking capacity in a prospective cohort of traumatic spinal cord injury patients. Am J Phys Med Rehabil 2021;100:1034–41. - PubMed

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