# Clinical Determinants of Functional Independence at Discharge in Patients With Spinal Cord Dysfunction Due to Metastatic Spinal Tumors

## TL;DR

This study identifies factors like rapid cancer growth and severe paralysis that reduce the chances of patients with spinal tumors being independent at discharge.

## Contribution

The study introduces a new set of clinical predictors for functional independence in patients with spinal cord dysfunction due to metastatic tumors.

## Key findings

- Rapid-growing tumors and severe motor impairment significantly lower odds of independence in daily living activities.
- Elevated C-reactive protein/albumin ratio and persistent pain are also strong predictors of poor functional outcomes.
- Neurologic level and spinal instability alone cannot predict functional independence at discharge.

## Abstract

•Rapid cancer, severe paralysis, high C-reactive protein to albumin ratio, and persistent pain lower odds of independence in activities of daily living.•Neurologic level and spinal instability cannot alone predict functional outcomes.•Early recognition of these factors aids individualized rehabilitation and discharge planning.

Rapid cancer, severe paralysis, high C-reactive protein to albumin ratio, and persistent pain lower odds of independence in activities of daily living.

Neurologic level and spinal instability cannot alone predict functional outcomes.

Early recognition of these factors aids individualized rehabilitation and discharge planning.

To identify the clinical factors associated with independence in activities of daily living (ADL) at discharge in patients with spinal cord dysfunction resulting from metastatic spinal tumors.

Retrospective cohort study.

A single university hospital in Japan.

A total of 153 patients (N=153) (median age 69 [interquartile range: 58.5-75.5]; 67% men) with spinal cord dysfunction caused by metastatic spinal tumors received inpatient rehabilitation during hospitalization between 2012 and 2022. The inclusion criteria were age ≥18 years, a diagnosis of spinal cord dysfunction resulting from metastatic bone tumors, and participation in inpatient rehabilitation.

Participants underwent standard inpatient rehabilitation care. No study-specific intervention was provided.

Independence in ADL was defined as a Barthel index score of ≥85 at discharge. Data on demographics, clinical characteristics, and potential risk factors were extracted from medical records. Logistic regression analysis, adjusted for age, was conducted to identify predictors of independence in ADL at discharge.

Among the participants, 23 (15.0%) achieved independence in ADL at discharge. Logistic regression analysis identified the following 4 significant factors associated with reduced odds of independence in ADL: rapid-growing primary tumor type (odds ratio [OR]=5.93; 95% CI, 1.81-19.43), severe motor impairment at admission (OR=5.83; 95% CI, 1.89-18.00), elevated C-reactive protein/albumin ratio (OR=3.82; 95% CI, 1.53-17.80), and persistent movement-related pain (OR=1.34; 95% CI, 1.01-1.84).

Tumor aggressiveness, neurologic severity, systemic inflammation, and persistent pain significantly influenced independence in ADL at discharge. Early identification of these risk factors may guide individualized rehabilitation planning and optimize functional outcomes in this population.