Incidence and predictors of contracture after spinal cord injury-a prospective cohort study

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 (R-2 <= 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. Spinal Cord (2012) 50, 579-584; doi:10.1038/sc.2012.25; published online 27 March 2012