Abstract
Objective
To identify the specific features that contribute to the variability in baseline wheelchair
transfer and the changes in transfer ability (gain or loss) over time for a large
cohort of patients with spina bifida (SB) in the National Spina Bifida Patient Registry.
Design
Longitudinal cohort study.
Setting
A total of 35 United States outpatient SB clinic sites.
Participants
Individuals (N=1687) with SB ages 5-73 (median, 13.33) years who were therapeutic
ambulators or nonambulators.
Intervention
Not applicable.
Main Outcome Measure
Ability to transfer from a wheelchair to another level surface.
Results
Bayesian Network Analysis was used to reduce the initial variable set to the following
predictors: SB subphenotype, motor level, age, insurance, sex, race, ethnicity, surgical
procedures, and number of visits. We used a multinomial logistic model with Wald Chi-square
analysis of effects to examine the relationships between transfer ability and predictors.
A total of 295 of 1687 eligible patients (17.56%) with myelomeningocele (MMC) and
6 of 58 eligible patients (10.32%) with non-MMC experienced changes in transfer ability
during the period of the study. For those with MMC and non-MMC, the highest number
of individuals exhibiting changes in motor level had changes from thoracic to high-lumbar,
high-lumbar to thoracic, high-lumbar to midlumbar, and midlumbar to high-lumbar lesion
levels. Results of the Bayesian Network Analysis revealed that motor level was the
predominant factor associated with baseline transfer ability followed by age. The
combination of SB sub phenotype, motor level, age, insurance status, number and type
of surgical procedures, and time point accurately classified the loss, gain, or no
change in transfer ability 82.7% of the time.
Conclusions
Motor level was the predominant factor associated with baseline transfer ability,
and the change in transfer ability was directly related to a corresponding change
in motor level that might be explained by changes in muscle strength of the iliopsoas
and quadriceps.
Keywords
List of abbreviations:
MMC (myelomeningocele), NSBPR (National Spina Bifida Patient Registry), SB (spina bifida)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: July 16, 2020
Footnotes
Supported by the National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia (grant no. U01DD001078). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
