1148 - Predictors of Ambulation Outcomes in Adults with Spinal Cord Injury: A Systematic Review

To systematically review clinical, electrophysiological, and imaging predictors of ambulation outcomes in adults with spinal cord injury (SCI), and to identify consistent prognostic factors that can inform rehabilitation planning and future prediction models.

Design:

A systematic review protocol was developed using the PICO framework and registered in PROSPERO. PubMed, Scopus, and Google Scholar were searched without date or language restrictions. Eligible studies included adult SCI populations that reported predictors of ambulation outcomes such as the Walking Index for Spinal Cord Injury (WISCI), Functional Ambulation Category (FAC), Functional Independence Measure–locomotion (FIM-locomotion), and 10-Meter Walk Test (10MWT). Three reviewers independently screened studies, extracted data on design, population, predictors, and outcomes, and synthesized findings in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist.

 

Results:

The review identified multiple predictors across clinical cohorts. The American Spinal Injury Association Impairment Scale (AIS) grade at baseline or within 2 weeks, lower extremity motor score (LEMS ≥30 at 2 months), and younger age were the most consistent predictors of ambulation, particularly among AIS C patients. Early motor recovery and incomplete injury were strongly associated with favorable prognosis. Electrophysiological measures, including somatosensory evoked potentials (SSEPs) and motor evoked potentials (MEPs), as well as imaging markers such as MRI damage ratio, provided incremental prognostic value in select studies. Common limitations included small sample sizes, single-center designs, heterogeneous outcome measures, and limited follow-up durations.

Conclusions:

AIS grade, LEMS, and age are the most reliable predictors of ambulation outcomes in adults with SCI. Electrophysiological and imaging measures may provide additional prognostic information but remain under-validated. Future research should emphasize multi-center prospective cohorts with standardized predictor batteries to refine prognostic accuracy and strengthen clinical translation.