Longitudinal prospective cohort study.

To assess the coefficient of efficacy and the influence of various demographic and neurological factors on changes in Spinal Cord Independence Measure Ⅲ (SCIM-Ⅲ) scores over time in traumatic spinal cord injury (TSCI) patients.

Patient recruitment and evaluations were conducted at the Brain and Spinal Injury Research Center in Imam Khomeini Hospital Complex, Tehran, Iran.

The study was performed over an 8-year period in our outpatient rehabilitation setting. Changes in SCIM-Ⅲ scores were assessed in 559 TSCI patients (of 1460 enrolled patients) who fit the inclusion criteria. All included patients participated in our outpatient rehabilitation program, which consisted of a multidisciplinary education program combined with occupational therapy, physical therapy, and home nursing as a rehabilitation package for a 6-month period. Patients then received follow-up assessments every 6 months.

Predictors of the SCIM-Ⅲ score as a rehabilitation outcome tool, and of its change over time, included age (younger patients had better outcomes, p = 0.067), marital status (married patients had better outcomes, p = 0.031), education level (patients with university education had better outcomes, p = 0.003), occupation status (employed patients had better outcomes, p = 0.009), and neurological level of injury (patients with injuries at lower levels had better outcomes, p < 0.001). However, sex and injury severity as per the American Spinal Injury Association Impairment Scale (AIS) had no significant effects on functional outcomes (i.e., SCIM-Ⅲ score changes over time).

Age, marital status, education level, employment, and neurological level all affected the final SCIM-Ⅲ scores of SCI patients. By contrast, sex and AIS grade were not significant predictors of SCIM-Ⅲ outcomes. Further studies that include additional factors may be useful for future SCIM-Ⅲ models.