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Revisiting functioning recovery in persons with spinal cord injury undergoing first rehabilitation: Trajectory and network analysis of a Swiss cohort study

PLoS ONE, 2024 · DOI: https://doi.org/10.1371/journal.pone.0297682 · Published: February 9, 2024

Spinal Cord InjuryParticipationRehabilitation

Simple Explanation

This study investigates how people with spinal cord injuries (SCI) recover their ability to function during their initial rehabilitation in Switzerland. The researchers used data from a large group of SCI patients to identify common patterns, or trajectories, in their recovery of functioning. The study also looked at how different aspects of functioning are related to each other, to identify key areas that could be targeted to improve overall recovery.

Study Duration
May 2013 and March 2022
Participants
N = 1099 individuals with SCI undergoing initial rehabilitation in Switzerland
Evidence Level
Not specified

Key Findings

  • 1
    The study confirmed four previously identified functioning trajectory classes: stable high functioning, early, moderate, and slow functioning improvement.
  • 2
    Network analysis of the moderate improvement class revealed highly connected functioning problems at admission, including feeding, dressing, mobility in bed, and toilet use.
  • 3
    These highly connected functioning domains may indicate potential trajectory-specific targets for clinical interventions.

Research Summary

This study re-estimated previously published functioning trajectory models based on an updated dataset, and confirmed the corresponding four trajectory classes of stable high functioning, early, moderate, and slow functioning improvement, respectively. Corresponding association structures between relevant functioning problems in the moderate improvement class were explored and centrality indices at T1 revealed 'Feeding', 'Dressing upper body', and 'Dressing lower body' in the self-care subscale, 'Mobility in bed' in the mobility subscale, and 'Use of toilet' in the respiration and sphincter management subscale as highly connected nodes in the network for both indices. These functioning domains might indicate potential trajectory-specific targets for clinical interventions.

Practical Implications

Targeted Interventions

Identifies specific functioning domains (e.g., feeding, dressing) as potential targets for interventions tailored to individuals following a moderate improvement trajectory.

Clinical Practice

Findings may inform discussions about the application and use of functioning trajectories in clinical practice, assisting health professionals in understanding the longitudinal course of functioning.

Rehabilitation Goals

Highlights the importance of addressing interconnected functioning problems to improve overall abilities in various domains during initial rehabilitation.

Study Limitations

  • 1
    Potential non-response and item non-response bias in the SwiSCI Inception Cohort Study.
  • 2
    Interpretation of identified functioning trajectory classes may be limited due to heterogeneity within classes.
  • 3
    Sample size limited network analysis to the stable high and the moderate functioning improvement classes.

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