Obesity and inpatient rehabilitation outcomes for patients with a traumatic spinal cord injury

Objective To examine the effect of obesity on change in FIM self-care and mobility ratings and community discharge for patients with traumatic spinal cord injury (SCI). Design Retrospective cohort study analyzing National Model Systems SCI Database data. Setting Fourteen Model Systems SCI programs. Participants Patients (N=1524) with a new traumatic SCI discharged from Model Systems rehabilitation centers between October 2006 and October 2009. Interventions None. Main Outcome Measures Change in FIM self-care and mobility ratings, discharge destination. Separate analyses were conducted by neurologic category: paraplegia incomplete, paraplegia complete, tetraplegia incomplete, and tetraplegia complete. Results Of all patients with traumatic SCI, approximately 25% were obese at admission. Patients who were obese were more likely to be married and slightly older than nonobese patients. In patients with paraplegia incomplete, obese patients had lower FIM self-care (-1.9; 95% confidence interval [CI], -3.4 to -.4) and mobility score gains (-1.5; 95% CI, -2.9 to -.1) than normal-weight patients. For patients with paraplegia complete, obese patients had significantly lower self-care (-2.2; 95% CI, -3.5 to -.8) and mobility score gains (-2.7; 95% CI, -3.9 to -1.5). For patients with tetraplegia incomplete and tetraplegia complete, FIM self-care and mobility ratings for obese patients were not significantly different from ratings for normal-weight patients. Within each neurologic category, the percentage of patients discharged to the community was not significantly different for nonobese and obese patients. Conclusions Obesity appears to be a barrier to meeting self-care and mobility functional goals for patients with paraplegia in inpatient SCI rehabilitation.