Upper extremity motor score required for clean intermittent catheterization in individuals with spinal cord injury.

Abstract

Retrospective cohort study. To identify sex- and age-stratified cutoff values of the upper extremity motor score (UEMS) that discriminate independent clean intermittent catheterization (CIC) acquisition and to examine whether UEMS assessed at 4 weeks post-injury predicts CIC acquisition in individuals with motor-complete spinal cord injury (SCI). A specialized spinal cord injury center in Japan. We included individuals with traumatic motor-complete SCI (American Spinal Injury Association Impairment Scale [AIS] A/B) hospitalized ≥4 weeks and classified as AIS A/B at discharge (n = 194). UEMS was assessed in 194 individuals at discharge and in 153 individuals at 4 weeks post-injury. The outcome was independent CIC at discharge. Participants were stratified by sex and age (<65 vs ≥65 years). UEMS cutoffs at discharge and 4 weeks were derived using receiver operating characteristic analyses, and area under the curve (AUC) was reported. Independent CIC was acquired by 91/194 (47%). Discharge UEMS cutoffs (AUC) were: males <65, 19 (0.97); males ≥65, 28 (0.97); females <65, 24 (0.95); females ≥65, 50 (0.96). At 4 weeks, corresponding cutoffs (AUC) were 13 (0.98), 23 (0.96), 19 (1.00), and 47 (0.90), in the same order. Study-specific equivalent motor levels corresponding to each UEMS cutoff were C6/C7/C6/T1 at discharge and C5/C6/C6/T1 at 4 weeks. UEMS yielded sex- and age-specific thresholds with good-to-excellent discrimination for CIC acquisition in traumatic motor-complete SCI. UEMS at 4 weeks may support early prediction of CIC acquisition by discharge; study-specific equivalent motor levels may aid interpretation.