ORIGINAL RESEARCH| Volume 103, ISSUE 2, P215-223, February 2022

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Physical Function Recovery Trajectories After Spinal Cord Injury

Published:October 19, 2021DOI:



      To explore trajectories of functional recovery that occur during the first 2 years after spinal cord injury (SCI).


      Observational cohort study.


      Eight SCI Model System sites.


      A total of 479 adults with SCI completed 4 Spinal Cord Injury–Functional Index (SCI-FI) item banks within 4 months of injury and again at 2 weeks, 3, 6, 12, and 24 months after baseline assessment (N=479).



      Main Outcome Measures

      SCI-FI Basic Mobility/Capacity (C), Fine Motor Function/C, Self-care/C, and Wheelchair Mobility/Assistive Technology (AT) item banks.


      Growth mixture modeling was used to identify groups with similar trajectory patterns. For the Basic Mobility/C and Wheelchair Mobility/AT domains, models specifying 2 trajectory groups were selected. For both domains, a majority class exhibited average functional levels and gradual improvement, primarily in the first 6 months. A smaller group of individuals made gradual improvements but had greater initial functional limitations. The Self Care/C domain exhibited a similar pattern; however, a third, small class emerged that exhibited substantial improvement in the first 6 months. Finally, for individuals with tetraplegia, trajectories of Fine Motor Function/C scores followed 2 patterns, with individuals reporting generally low initial scores and then making either modest or large improvements. In individual growth curve models, injury/demographic factors predicted initial functional levels but less so regarding rates of recovery.


      Trajectories of functional recovery followed a small number of change patterns, although variation around these patterns emerged. During the first 2 years after initial hospitalization, SCI-FI scores showed modest improvements; however, substantial improvements were noted for a small number of individuals with severe limitations in fine motor and self-care function. Future studies should further explore the personal, medical, and environmental characteristics that influence functional trajectories during these first 2 years and beyond.


      List of abbreviations:

      AIC (Akaike's information criterion), AT (Assistive Technology (as descriptor for SCI-FI Wheelchair Mobility item bank)), C (Capacity (as descriptor for SCI-FI item banks)), GMM (growth mixture modeling), SABIC (sample-size adjusted Bayesian information criterion), SCI (spinal cord injury), SCI-FI (Spinal Cord Injury–Functional Index)
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