Impact of vitamin D on mobilization, pulmonary function tests, grip strength and functionality in patients with spinal cord injury: A cross-sectional study

Abstract

Aim: Since vitamin D deficiency is a growing problem worldwide, insufficient levels of vitamin D were reported in patients with spinal cord injury (SCI). It was stated that levels of vitamin D may be an indirect indicator of functional status in patients with SCI. The aim of this study was to investigate the relationship between vitamin D levels and mobilization, functionality, grip strength, and pulmonary function test parameters in patients with subacute SCI.
Methods: Fifty-eight patients with subacute motor complete thoracic (T) and lumbar SCI injuries [46 males, 12 females; mean age 32.0 (11.2) years] were included. The time to complete the verticalization program on the tilt table without any orthostatic symptoms was considered as the ‘time of mobilization.’ Grip strength (GS) was measured using a dynamometer, pulmonary function test (PFT) parameters were measured using a spirometer, and functional status was measured using the Functional Independence Measure (FIM). For determining the levels of vitamin D, 25-hydroxy-vitamin D [25(OH)D] was measured and levels below 20 ng/mL were considered as deficiency. The patients were divided into two groups according to 25(OH)D levels, <20 ng/mL and ≥20 ng/mL. The demographic features, mobilization, PFT, GS, and FIM scores were compared according to the levels of 25(OH)D. The patients were divided into two other groups according to neurologic levels: levels between T6-10 and levels T11 and below, and then intragroup comparisons according to the levels of 25(OH)D were performed.
Results: The mean 25(OH)D level of the patients was found as 19.8 (8.3) ng/mL. When all patients were evaluated, time of mobilization was longer and FIM scores were lower in the 25(OH)D deficient group than in the other group (P<0.001 and P=0.038, respectively). When patients were evaluated separately according to their neurologic levels, time of mobilization was longer in the 25(OH)D deficient group, both in patients with a lesion level between T6-10 and the lesion levels T11 and below (P<0.001 and P=0.009, respectively). There was no statistically significant difference between the groups in terms of other clinical evaluations according to the neurologic levels of the patients.
Conclusion: Among the patients with SCI, time of mobilization of patients with vitamin D deficiency was longer than those of patients with non-deficient vitamin D levels, regardless of the neurologic level. Although the results of this study showed no statistically significant difference there may also be a relationship between vitamin D levels and pulmonary functions, GS, and FIM scores.

Keywords

• Paraplegia
• 25-hydroxy-vitamin D
• Orthostatic hypotension
• Lung function
• Functional independence measure

D vitamininin omurilik yaralanmalı hastalarda mobilizasyon, solunum fonksiyon testleri, kavrama gücü ve fonksiyonellik üzerine etkisi: Kesitsel bir çalışma

Öz

Amaç: D vitamini eksikliği dünya çapında büyüyen bir problem olduğundan, omurilik yaralanmalı (OY) hastalarda da yetersiz D vitamini seviyeleri bildirilmiştir. D vitamini düzeylerinin, OY hastalarda fonksiyonel durumun dolaylı bir göstergesi olabileceği belirtilmiştir. Bu çalışmanın amacı, subakut dönemdeki OY hastalarda D vitamini düzeyleri ile mobilizasyon, fonksiyonel durum, el kavrama gücü ve solunum fonksiyon testi (SFT) parametreleri arasındaki ilişkiyi araştırmaktır.
Yöntemler: Subakut motor komplet torakal (T) ve lomber OY 58 hasta [46 erkek, 12 kadın; yaş ortalaması 32.0 (11.2) yıl] çalışmaya dahil edildi. Herhangi bir ortostatik semptom olmadan tilt masası ile vertikalizasyon programını tamamlama süresi “mobilizasyon zamanı” olarak değerlendirildi. El kavrama gücü dinamometre ile, SFT spirometre ile, fonksiyonel durum ise Fonksiyonel Bağımsızlık Ölçeği (FBÖ) ile değerlendirildi. D vitamini düzeylerini belirlemek için 25-hidroksi-vitamin D [25(OH)D] ölçümü yapıldı ve 20ng/mL’nin altındaki değerler eksiklik olarak değerlendirildi. Hastalar 25(OH)D seviyeleri <20 ng/mL olan ve 25(OH)D seviyeleri ≥20 ng/mL olan olmak üzere iki gruba ayrıldırlar. Demografik özellikler, mobilizasyon, SFT, el kavrama gücü ve FBÖ skorlarları 25(OH)D düzeylerine göre karşılaştırıldı. Hastalar nörolojik seviyelerine göre de farklı iki gruba ayrıldılar: Seviye T6-T10 arası ve seviye T11 ve altı. Sonrasında 25(OH)D düzeylerine göre grup içi karşılaştırmalar yapıldı.
Bulgular: Hastaların ortalama 25(OH)D düzeyleri 19.8 (8.3) ng/mL olarak bulundu. Tüm hastalar değerlendirildiğinde, 25(OH)D eksikliği olan grupta diğer gruba göre “mobilizasyon zamanı” daha uzundu ve FBÖ skorları daha düşüktü (sırasıyla P<0,001 and P=0,038). Hastalar nörolojik düzeylerine göre ayrı ayrı değerlendirildiğinde; hem lezyon seviyesi T6-T10 arası olan grupta hem de lezyon seviyesi T11 ve altı olan grupta; 25(OH)D eksikliği olan hastalarda “mobilizasyon zamanı” daha uzundu (sırasıyla P<0,001 and P=0,009). Hastalar nörolojik düzeylerine göre ayrıldıklarında diğer klinik değerlendirmeleri açısından; gruplar arasında istatistiksel olarak anlamlı fark yoktu.
Sonuç: OY hastalarda; nörolojik seviyeden bağımsız olarak D vitamini eksikliği olan hastaların mobilizasyon süresi olmayan hastalara göre daha uzundur. Bu çalışmanın sonuçları istatistiksel olarak anlamlı bir fark göstermese de, D vitamini düzeyleri ile solunum fonksiyonları, el kavrama gücü ve FBÖ skorları arasında da bir ilişki olabilir. 

Anahtar Kelimeler

• Parapleji
• 25-hidroksi-vitamin D
• Ortostatik hipotansiyon
• Akciğer fonksiyonu
• Fonksiyonel bağımsızlık ölçeği

Kaynakça

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