Incidence and predictors of contracture after spinal cord injurya prospective cohort study

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Journal Article
Spinal Cord, 2012, 50 (8), pp. 579 - 584
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Diong SC (2012) Incidence and prediction of contracture.pdfPublished Version490.67 kB
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Study design:Prospective cohort study.Objectives:To determine incidence of contracture and develop prediction models to identify patients susceptible to contracture after spinal cord injury.Setting:Two Sydney spinal cord injury units.Methods:A total of 92 consecutive patients with acute spinal cord injury were assessed within 35 days of injury and 1 year later. Incidence of contracture at 1 year was measured in all major appendicular joints by categorizing range of motion on a 4-point scale (0-no contracture to 3-severe contracture), and in the wrist, elbow, hip and ankle by measuring range of motion at standardized torque. Multivariate models were developed to predict contracture at ≥1 year using age, neurological status, spasticity, pain and limb fracture recorded at the time of injury.Results:At 1 year, 66% of participants developed at least one contracture (defined as 1 point deterioration on the 4-point scale). Incidence of contracture at each joint was: shoulder 43%, elbow and forearm 33%, wrist and hand 41%, hip 32%, knee 11% and ankle 40%. Incidence of contracture determined by standardized torque measures of range (defined as loss of ≥10 degrees) was: elbow 27%, wrist 26%, hip 23% and ankle 25%. Prediction models were statistically significant but lacked sufficient predictive accuracy to be clinically useful (R2 ≤ 31%).Conclusion:The incidence of contracture in major joints 1 year after spinal cord injury ranges from 11-43%. The ankle, wrist and shoulder are most commonly affected. It is difficult to accurately predict those susceptible to contracture soon after injury. © 2012 International Spinal Cord Society All rights reserved.
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