DISCUSSION
The results of this study show that physical therapists can
predict future mobility of patients with SCI with a high level
of accuracy at the time of admission to rehabilitation. This
finding has important implications for the goal-setting process
as well as for ensuring appropriate prescription of equipment
and discharge planning.6,22
Therapists were most accurate at predicting patients’
ability to negotiate curbs in a wheelchair as measured with the
5AML. The scoring of the 5AML takes into account patients’
ability to negotiate small and large curbs with and without
assistance or aids. Therapists may have been best at predicting
future ability to negotiate curbs because ability to perform
this skill is largely determined by neurological status and
only slightly influenced by other factors. Physical therapists
were not as accurate at predicting patients’ ability to push
a wheelchair on a ramp using the 5AML. The scoring of the
5AML takes into account patients’ ability to push up and down
steep and gentle ramps with and without assistance after taking
into account time. The most likely explanation for this finding
is that this skill is not strongly correlated with neurological
status and instead is largely determined by fitness, which is
difficult to predict.
It is possible that patients’ future mobility was limited
or enhanced by therapists’ predictions so that the predictions
the therapists made became self-fulfilling. However, for the
predictions to be self-fulfilling, it would require the therapists
to remember what they had predicted initially, and then deliberately
either advance or hinder a patient’s progress over
a 3-month period. It is unlikely this happened. In addition,
at least 40% of the predictions were made at the acute SCI
unit just prior to patients’ transfer to the rehabilitation facility.
Therapists in the rehabilitation facility were not aware of what
the therapists from the acute facility had predicted. Similarly,
in the second SCI unit, therapists predicting patients’ future
mobility were often not the patients’ sole therapists for the
entire 3-month rehabilitation period.
The secondary post hoc analyses were included to explore
the possibility that therapists are more accurate at predicting
mobility in patients with AIS A/B lesions than AIS C/D
lesions; this was not the case. There was little difference between
therapists’ accuracy at predicting patients with AIS A/B
lesions and patients with AIS C/D lesions (as reflected by the
overlap in all confidence intervals for the correlation values for
the 2 subgroups). However, these results need to be interpreted
with caution because of the small sample size and the associated
imprecision of estimates. Not surprisingly, the greatest
difference between therapists’ ability to predict mobility in the
2 subgroups was for the WISCI item. Therapists had difficulty
accurately predicting future WISCI scores for those with AIS
C/D lesions. For example, only 67% of predictions were within