Impact of Frailty on Functional Improvement Following Traumatic Spinal Cord Injury: A Japanese Single-Center Experience
Abstract
1. Introduction
2. Material and Methods
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Makizako, H.; Nishita, Y.; Jeong, S.; Otsuka, R.; Shimada, H.; Iijima, K.; Obuchi, S.; Kim, H.; Kitamura, A.; Ohara, Y.; et al. Trends in the Prevalence of Frailty in Japan: A Meta-Analysis from the Ilsa-J. J. Frailty Aging 2021, 10, 211–218. [Google Scholar] [CrossRef] [PubMed]
- Vale, H. Impact of Japan’s Aging Population on Healthcare Costs and the Long-Term Care Insurance System. Stud. Soc. Sci. Humanit. 2024, 3, 39–44. [Google Scholar]
- Clegg, A.; Young, J.; Iliffe, S.; Rikkert, M.O.; Rockwood, K. Frailty in elderly people. Lancet 2013, 381, 752–762. [Google Scholar] [CrossRef] [PubMed]
- Cesari, M.; Prince, M.; Thiyagarajan, J.A.; De Carvalho, I.A.; Bernabei, R.; Chan, P.; Gutierrez-Robledo, L.M.; Michel, J.P.; Morley, J.E.; Ong, P.; et al. Frailty: An Emerging Public Health Priority. J. Am. Med. Dir. Assoc. 2016, 17, 188–192. [Google Scholar] [CrossRef] [PubMed]
- Iqbal, J.; Denvir, M.; Gunn, J. Frailty assessment in elderly people. Lancet 2013, 381, 1985–1986. [Google Scholar] [CrossRef] [PubMed]
- Kulminski, A.M.; Ukraintseva, S.V.; Kulminskaya, I.V.; Arbeev, K.G.; Land, K.; Yashin, A.I. Cumulative deficits better characterize susceptibility to death in elderly people than phenotypic frailty: Lessons from the Cardiovascular Health Study. J. Am. Geriatr. Soc. 2008, 56, 898–903. [Google Scholar] [CrossRef] [PubMed]
- Yoshikawa, M.; Konomi, T.; Maeda, S.; Tabuki, H.; Uemura, O.; Yato, Y. Problems in adjusting discharge during the recovery period of patients with spinal cord injury: Using spinal cord independence measure (SCIM). J. Jpn. Med. Soc. Spinal Cord. Lesion 2020, 33, 140–142. [Google Scholar]
- Katoh, S.; Enishi, T.; Sato, N.; Sairyo, K. High incidence of acute traumatic spinal cord injury in a rural population in Japan in 2011 and 2012: An epidemiological study. Spinal Cord 2014, 52, 264–267. [Google Scholar] [CrossRef] [PubMed]
- Miyakoshi, N.; Suda, K.; Kudo, D.; Sakai, H.; Nakagawa, Y.; Mikami, Y.; Suzuki, S.; Tokioka, T.; Tokuhiro, A.; Takei, H.; et al. A nationwide survey on the incidence and characteristics of traumatic spinal cord injury in Japan in 2018. Spinal Cord 2021, 59, 626–634. [Google Scholar] [CrossRef]
- Fawcett, J.W.; Curt, A.; Steeves, J.D.; Coleman, W.P.; Tuszynski, M.H.; Lammertse, D.; Bartlett, P.F.; Blight, A.R.; Dietz, V.; Ditunno, J.; et al. Guidelines for the conduct of clinical trials for spinal cord injury as developed by the ICCP panel: Spontaneous recovery after spinal cord injury and statistical power needed for therapeutic clinical trials. Spinal Cord. 2007, 45, 190–205. [Google Scholar] [CrossRef]
- Burns, A.S.; Marino, R.J.; Flanders, A.E.; Flett, H. Clinical diagnosis and prognosis following spinal cord injury. Handb. Clin. Neurol. 2012, 109, 47–62. [Google Scholar] [CrossRef]
- Kawano, O.; Maeda, T.; Mori, E.; Takao, T.; Sakai, H.; Masuda, M.; Morishita, Y.; Hayashi, T.; Kubota, K.; Kobayakawa, K.; et al. How much time is necessary to confirm the diagnosis of permanent complete cervical spinal cord injury? Spinal Cord. 2020, 58, 284–289. [Google Scholar] [CrossRef]
- Cowley, A.; Goldberg, S.E.; Gordon, A.L.; Logan, P.A. Rehabilitation potential in older people living with frailty: A systematic mapping review. BMC Geriatr. 2021, 21, 533. [Google Scholar] [CrossRef] [PubMed]
- Myers, J.; Lee, M.; Kiratli, J. Cardiovascular disease in spinal cord injury: An overview of prevalence, risk, evaluation, and management. Am. J. Phys. Med. Rehabil. 2007, 86, 142–152. [Google Scholar] [CrossRef] [PubMed]
- Berlowitz, D.J.; Wadsworth, B.; Ross, J. Respiratory problems and management in people with spinal cord injury. Breathe 2016, 12, 328–340. [Google Scholar] [CrossRef]
- Van Leeuwen, C.M.; Kraaijeveld, S.; Lindeman, E.; Post, M.W. Associations between psychological factors and quality of life ratings in persons with spinal cord injury: A systematic review. Spinal Cord. 2012, 50, 174–187. [Google Scholar] [CrossRef] [PubMed]
- Catz, A.; Itzkovich, M.; Tamir, A.; Philo, O.; Steinberg, F.; Ring, H.; Ronen, J.; Spasser, R.; Gepstein, R. SCIM--spinal cord independence measure (version II): Sensitivity to functional changes. Harefuah 2002, 141, 1025–1031, 1091. [Google Scholar]
- Itzkovich, M.; Gelernter, I.; Biering-Sorensen, F.; Weeks, C.; Laramee, M.T.; Craven, B.C.; Tonack, M.; Hitzig, S.L.; Glaser, E.; Zeilig, G.; et al. The Spinal Cord Independence Measure (SCIM) version III: Reliability and validity in a multi-center international study. Disabil. Rehabil. 2007, 29, 1926–1933. [Google Scholar] [CrossRef]
- Tsiouris, A.; Hammoud, Z.T.; Velanovich, V.; Hodari, A.; Borgi, J.; Rubinfeld, I. A modified frailty index to assess morbidity and mortality after lobectomy. J. Surg. Res. 2013, 183, 40–46. [Google Scholar] [CrossRef]
- Leven, D.M.; Lee, N.J.; Kothari, P.; Steinberger, J.; Guzman, J.; Skovrlj, B.; Shin, J.I.; Caridi, J.M.; Cho, S.K. Frailty Index Is a Significant Predictor of Complications and Mortality After Surgery for Adult Spinal Deformity. Spine 2016, 41, E1394–E1401. [Google Scholar] [CrossRef]
- Ali, R.; Schwalb, J.M.; Nerenz, D.R.; Antoine, H.J.; Rubinfeld, I. Use of the modified frailty index to predict 30-day morbidity and mortality from spine surgery. J. Neurosurg. Spine 2016, 25, 537–541. [Google Scholar] [CrossRef] [PubMed]
- Dicpinigaitis, A.J.; Al-Mufti, F.; Bempong, P.O.; Kazim, S.F.; Cooper, J.B.; Dominguez, J.F.; Stein, A.; Kalakoti, P.; Hanft, S.; Pisapia, J.; et al. Prognostic Significance of Baseline Frailty Status in Traumatic Spinal Cord Injury. Neurosurgery 2022, 91, 575–582. [Google Scholar] [CrossRef] [PubMed]
- Lucas, J.T.; Ducker, T.B. Motor classification of spinal cord injuries with mobility, morbidity and recovery indices. Am. Surg. 1979, 45, 151–158. [Google Scholar] [PubMed]
- Kanda, Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transpl. 2013, 48, 452–458. [Google Scholar] [CrossRef] [PubMed]
- Morley, J.E.; Vellas, B.; van Kan, G.A.; Anker, S.D.; Bauer, J.M.; Bernabei, R.; Cesari, M.; Chumlea, W.C.; Doehner, W.; Evans, J.; et al. Frailty consensus: A call to action. J. Am. Med. Dir. Assoc. 2013, 14, 392–397. [Google Scholar] [CrossRef] [PubMed]
- Lang, P.O.; Michel, J.P.; Zekry, D. Frailty syndrome: A transitional state in a dynamic process. Gerontology 2009, 55, 539–549. [Google Scholar] [CrossRef] [PubMed]
- Cesari, M.; Gambassi, G.; van Kan, G.A.; Vellas, B. The frailty phenotype and the frailty index: Different instruments for different purposes. Age Ageing 2014, 43, 10–12. [Google Scholar] [CrossRef] [PubMed]
- Mouchtouris, N.; Luck, T.; Locke, K.; Hines, K.; Franco, D.; Yudkoff, C.; Sivaganesan, A.; Heller, J.; Prasad, S.; Harrop, J.; et al. Comparison of 5-Item and 11-Item Modified Frailty Index as Predictors of Functional Independence in Patients With Spinal Cord Injury. Glob. Spine J. 2023. [Google Scholar] [CrossRef] [PubMed]
- Banaszek, D.; Inglis, T.; Marion, T.E.; Charest-Morin, R.; Moskven, E.; Rivers, C.S.; Kurban, D.; Flexman, A.M.; Ailon, T.; Dea, N.; et al. Effect of Frailty on Outcome after Traumatic Spinal Cord Injury. J. Neurotrauma 2020, 37, 839–845. [Google Scholar] [CrossRef]
- Chu, H.; Chen, L.; Li, J.; Li, J.; Yang, D.; Yang, M.; Du, L.; Wang, M.; Gao, F. Impact of Frailty on Inpatient Outcomes of Acute Traumatic Spinal Cord Injury: Evidence From US National Inpatient Sample. Neurologist 2024, 29, 82–90. [Google Scholar] [CrossRef]
- Rockwood, K.; Song, X.; Mitnitski, A. Changes in relative fitness and frailty across the adult lifespan: Evidence from the Canadian National Population Health Survey. CMAJ 2011, 183, E487–E494. [Google Scholar] [CrossRef] [PubMed]
- Unai, K.; Uemura, O.; Takemura, R.; Kawakami, M.; Liu, M. Association Between SCIM III Total Scores and Individual Item Scores to Predict Independence With ADLs in Persons With Spinal Cord Injury. Arch. Rehabil. Res. Clin. Transl. 2019, 1, 100029. [Google Scholar] [CrossRef] [PubMed]
Robust (n = 97) | Frail (n = 24) | p | |
---|---|---|---|
Age at Injury (Year; Mean [SD]) | 56.6 ± 19.8 | 71.8 ± 9.7 | <0.01 |
Age Demographic (n [%]) | |||
<60 | 44 (45.4) | 4 (16.7) | <0.05 |
60–74 | 34 (35.1) | 11 (45.8) | - |
≥75 | 19 (19.6) | 9 (37.5) | - |
Sex (Male/Female) | 81:16 | 21:3 | 0.76 |
Injury Pattern (n [%]) | |||
Paraplegia | 13 (13.4) | 2 (8.3) | 0.73 |
Tetraplegia | 84 (86.6) | 22 (91.7) | - |
Initial Neurological AIS Status (n [%]) | |||
A | 25 (28.7) | 4 (19.0) | 0.40 |
B | 18 (20.7) | 8 (38.1) | - |
C | 21 (24.1) | 5 (23.8) | - |
D | 23 (26.4) | 4 (19.0) | - |
Robust (n = 97) | Frail (n = 24) | p | |
---|---|---|---|
SCIM Score (Out of 100) | |||
Initial Score (Mean [SD]) | 27.6 ± 23.5 | 18.5 ± 16.7 | 0.09 |
Discharge Score (Mean [SD]) | 47.4 ± 29.9 | 30.7 ± 26.5 | <0.05 |
Percent Recovery (%; Mean [SD]) | 33.5 ± 29.0 | 16.7 ± 26.7 | <0.05 |
Hospital Stay (Day; Mean [SD]) | 254.1 ± 136.7 | 224.7 ± 129.8 | 0.34 |
Home Discharge (n [%]) | 66 (68.0) | 11 (45.8) | <0.05 |
Requiring Total Assistance at Admission (n [%]) | 43 (45.3) | 9 (37.5) | 0.65 |
Requiring Total Assistance at Discharge (n [%]) | 20 (20.8) | 7 (29.2) | 0.42 |
Complication | |||
Tracheostomy (n [%]) | 16 (16.5) | 4 (16.7) | 1 |
Pressure Ulcer (n [%]) | 18 (18.6) | 8 (33.3) | 0.16 |
In-Hospital Death (n [%]) | 3 (3.1) | 0 (0.0) | 1 |
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Konomi, T.; Yoshikawa, M.; Kajikawa, K.; Kitagawa, T.; Kobayashi, Y.; Furukawa, M.; Fujiyoshi, K.; Yato, Y. Impact of Frailty on Functional Improvement Following Traumatic Spinal Cord Injury: A Japanese Single-Center Experience. J. Clin. Med. 2024, 13, 4154. https://doi.org/10.3390/jcm13144154
Konomi T, Yoshikawa M, Kajikawa K, Kitagawa T, Kobayashi Y, Furukawa M, Fujiyoshi K, Yato Y. Impact of Frailty on Functional Improvement Following Traumatic Spinal Cord Injury: A Japanese Single-Center Experience. Journal of Clinical Medicine. 2024; 13(14):4154. https://doi.org/10.3390/jcm13144154
Chicago/Turabian StyleKonomi, Tsunehiko, Minako Yoshikawa, Keita Kajikawa, Takahiro Kitagawa, Yoshiomi Kobayashi, Mitsuru Furukawa, Kanehiro Fujiyoshi, and Yoshiyuki Yato. 2024. "Impact of Frailty on Functional Improvement Following Traumatic Spinal Cord Injury: A Japanese Single-Center Experience" Journal of Clinical Medicine 13, no. 14: 4154. https://doi.org/10.3390/jcm13144154
APA StyleKonomi, T., Yoshikawa, M., Kajikawa, K., Kitagawa, T., Kobayashi, Y., Furukawa, M., Fujiyoshi, K., & Yato, Y. (2024). Impact of Frailty on Functional Improvement Following Traumatic Spinal Cord Injury: A Japanese Single-Center Experience. Journal of Clinical Medicine, 13(14), 4154. https://doi.org/10.3390/jcm13144154