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Factors Associated With Ambulation in Myelomeningocele: A Longitudinal Study From the National Spina Bifida Patient Registry.

Publication ,  Journal Article
Davis, WA; Zigler, CK; Crytzer, TM; Izzo, S; Houtrow, AJ; Dicianno, BE
Published in: Am J Phys Med Rehabil
July 2020

OBJECTIVE: Evidence is limited regarding clinical factors associated with ambulation status over the lifespan of individuals with myelomeningocele. We used longitudinal data from the National Spina Bifida Patient Registry to model population-level variation in ambulation over time and hypothesized that effects of clinical factors associated with ambulation would vary by age and motor level. DESIGN: A population-averaged generalized estimating equation was used to estimate the probability of independent ambulation. Model predictors included time (age), race, ethnicity, sex, insurance, and interactions between time, motor level, and the number of orthopedic, noncerebral shunt neurosurgeries, and cerebral shunt neurosurgeries. RESULTS: The study cohort included 5371 participants with myelomeningocele. A change from sacral to low-lumbar motor level initially reduced the odds of independent ambulation (OR = 0.24, 95% CI = 0.15-0.38) but became insignificant with increasing age. Surgery count was associated with decreased odds of independent ambulation (orthopedic: OR = 0.65, 95% CI = 0.50-0.85; noncerebral shunt neurosurgery: OR = 0.65, 95% CI = 0.51-0.84; cerebral shunt: OR = 0.90, 95% CI = 0.83-0.98), with increasing effects seen at lower motor levels. CONCLUSIONS: Our findings suggest that effects of several commonly accepted predictors of ambulation status vary with time. As the myelomeningocele population ages, it becomes increasingly important that study design account for this time-varying nature of clinical reality. TO CLAIM CME CREDITS: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME CME OBJECTIVES: Upon completion of this article, the reader should be able to: (1) Describe general trends in ambulation status by age in the myelomeningocele population; (2) Recognize the nuances of cause and effect underlying the relationship between surgical intervention and ambulation status; (3) Explain why variation of clinical effect over time within myelomeningocele population matters. LEVEL: Advanced ACCREDITATION: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

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Published In

Am J Phys Med Rehabil

DOI

EISSN

1537-7385

Publication Date

July 2020

Volume

99

Issue

7

Start / End Page

586 / 594

Location

United States

Related Subject Headings

  • Young Adult
  • Walking
  • United States
  • Retrospective Studies
  • Rehabilitation
  • Registries
  • Paraplegia
  • Orthopedic Procedures
  • Neurosurgical Procedures
  • Mobility Limitation
 

Citation

APA
Chicago
ICMJE
MLA
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Davis, W. A., Zigler, C. K., Crytzer, T. M., Izzo, S., Houtrow, A. J., & Dicianno, B. E. (2020). Factors Associated With Ambulation in Myelomeningocele: A Longitudinal Study From the National Spina Bifida Patient Registry. Am J Phys Med Rehabil, 99(7), 586–594. https://doi.org/10.1097/PHM.0000000000001406
Davis, W Austin, Christina K. Zigler, Theresa M. Crytzer, Sara Izzo, Amy J. Houtrow, and Brad E. Dicianno. “Factors Associated With Ambulation in Myelomeningocele: A Longitudinal Study From the National Spina Bifida Patient Registry.Am J Phys Med Rehabil 99, no. 7 (July 2020): 586–94. https://doi.org/10.1097/PHM.0000000000001406.
Davis WA, Zigler CK, Crytzer TM, Izzo S, Houtrow AJ, Dicianno BE. Factors Associated With Ambulation in Myelomeningocele: A Longitudinal Study From the National Spina Bifida Patient Registry. Am J Phys Med Rehabil. 2020 Jul;99(7):586–94.
Davis, W. Austin, et al. “Factors Associated With Ambulation in Myelomeningocele: A Longitudinal Study From the National Spina Bifida Patient Registry.Am J Phys Med Rehabil, vol. 99, no. 7, July 2020, pp. 586–94. Pubmed, doi:10.1097/PHM.0000000000001406.
Davis WA, Zigler CK, Crytzer TM, Izzo S, Houtrow AJ, Dicianno BE. Factors Associated With Ambulation in Myelomeningocele: A Longitudinal Study From the National Spina Bifida Patient Registry. Am J Phys Med Rehabil. 2020 Jul;99(7):586–594.

Published In

Am J Phys Med Rehabil

DOI

EISSN

1537-7385

Publication Date

July 2020

Volume

99

Issue

7

Start / End Page

586 / 594

Location

United States

Related Subject Headings

  • Young Adult
  • Walking
  • United States
  • Retrospective Studies
  • Rehabilitation
  • Registries
  • Paraplegia
  • Orthopedic Procedures
  • Neurosurgical Procedures
  • Mobility Limitation