The Japanese Spinal Cord Injury Survey on the implementation status of International Standards for Neurological Classification of Spinal Cord Injury

Hiroki Okawara, Tomonori Sawada, Keiko Sugai, Masaya Nakamura
Purpose:

This study aimed to clarify the detailed implementation status of ISNCSCI for people with spinal cord injury in Japan.

Methods:

A web-based survey was conducted among people with chronic SCI in Japan, aged over 18 years, without cognitive decline, and who were out of hospital. In addition to the demographic and injury characteristics, each experienced item in the ISNCSCI was self-reported via a web-based questionnaire system in intensive care unit staying (acute phase), comprehensive rehabilitation unit staying (rehabilitative phase), and community living (chronic phase), respectively.

Results:

The responses were obtained from 177 people (36 female, 141 male) with chronic SCI in Japan, with the highest percentage of responses from people in their 50s, accounting for 31.6% of the total. Among the total, 84.7% belonged to the category more than 10 years since injury, and the injury types were cervical cord injury in 50.3%, thoracic cord injury in 39.0%, and lumbar cord injury in 13.0%. The experience rate per assessment item in the acute phase was 46.9% for light touch assessment, 42.4% for pin prick assessment, 50.8 % for motor function assessment, 13.0 % for sensory function assessment at S4/5, 10.2% for voluntary anal contraction (VAC) assessment, 5.1% for deep anal pressure (DAP) assessment, 13% of none of ISNCSCI. Even people with complete SCI (n = 110) had experience of 13.6 % for sensory function assessment at S4/5, 14.5% for VAC assessment, 6.0% for DAP assessment, and 13.6% for none of ISNCSCI. In addition, they had a lower experience rate for each item of the ISNCSCI in the rehabilitation phase and the chronic phase.

Conclusion(s):

In Japan, the nationwide implementation of ISNCSCI for people with SCI has not been fully achieved in medical practice. Notably, although the determination of sacral sparing is the crucial criterion for classifying the completeness of SCI, it has not been sufficiently performed even for people with complete SCI in practice. It is warranted to investigate the restriction factors and improve the usability of the ISNCSCI for the future establishment of the SCI registry in Japan.

Implications:

The current findings warn of the possibility that spinal cord injury rehabilitation care in Japan is not universally provided based on practically adequate evaluation.


Funding acknowledgements:
This work was supported by the Yuumi Memorial Foundation for Home Health Care for funding.
Keywords:
Spinal Cord Injury
Surveillance
Standardization
Primary topic:
Neurology: spinal cord injury
Second topic:
Globalisation: health systems, policies and strategies
Third topic:
Other
Did this work require ethics approval?:
Yes
Name the institution and ethics committee that approved your work:
This study was approved by the Ethics Committees of Keio University School of Medicine.
Provide the ethics approval number:
Approval No. 20231191
Has any of this material been/due to be published or presented at another national or international conference prior to the World Physiotherapy Congress 2025?:
No

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