Archives of Physical Medicine and Rehabilitation journal homepage: www.archives-pmr.org Archives of Physical Medicine and Rehabilitation 2016;97:726-32
ORIGINAL RESEARCH
Independent Association of Vitamin D With Physical Function in People With Chronic Spinal Cord Injury Arcangelo Barbonetti, MD,a,b Alessandra Sperandio, MD,a Alessandro Micillo, MD,a Settimio D’Andrea, MD,a Federica Pacca, ScD,b Giorgio Felzani, MD,b Sandro Francavilla, MD,a Felice Francavilla, MDa From the aAndrology Unit, Department of Life, Health and Environment Sciences, University of L’Aquila, L’Aquila; and bSpinal Unit, San Raffaele Sulmona Institute, Sulmona, Italy.
Abstract Objective: To explore the relation between vitamin D and physical function outcomes in people with spinal cord injury (SCI). Design: Cross-sectional study. Setting: Rehabilitation institute. Participants: Consecutive patients (NZ100; 72 men and 28 women) with chronic SCI admitted to a rehabilitation program. Interventions: Not applicable. Main Outcome Measures: Functional independence in activities of daily living (ADL) and leisure time physical activity (LTPA) were assessed as measures of physical function. Results: Vitamin D deficiency (.99
NOTE. Data were expressed as mean SD when normally distributed, as median (minimumemaximum) for parameters with nonnormal distribution, and as n (%) when categorical. Coexisting illnesses included heart diseases, hypertension, diabetes, dyslipidemia, nonalcoholic fatty liver disease, chronic kidney failure, and depression. Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase.
www.archives-pmr.org
Vitamin D and physical function in spine injury
729
2-sided Student t test were used, as appropriate, for data analysis. Proportional differences were assessed by the chi-square test or the Fisher exact test, as appropriate. Multivariate regression analyses of square rootetransformed values were used to assess the independent association of the physical function outcomes (SCIM and LTPA) with significant predictors selected by univariate analyses. Normality of the residual errors in the regression models was verified by residual diagnosis (theoretical values vs residuals and normal Q-Q plot and Shapiro-Wilk normality test on model residuals).
Results A deficiency of 25(OH)D (30ng/mL. Table 1 shows the characteristics of patients with and without 25(OH)D deficiency. The group with 25(OH)D deficiency exhibited a significantly higher BMI, had a lower functional independence degree in ADL assessed by the SCIM, and was engaged in a significantly poorer weekly LTPA. As shown in table 2, at the univariate analyses including putative determinants of poorer physical function, lower 25(OH)D levels were significantly associated both with lower SCIM scores and poorer engagement in LTPA. Other significant predictors of lower SCIM scores were tetraplegic status, motor complete lesion, no walking ability, and coexisting depression. Other significant predictors of poorer LTPA were more advanced age, higher BMI, and coexisting depression. Significant predictors of physical function outcomes selected by the univariate analyses were included in multivariate regression analyses. Lower 25(OH)D levels were independently associated with poorer SCIM scores (fig 1A) and poorer LTPA (fig 1B), explaining 14.8% (bZ.59; P
ORIGINAL RESEARCH
Independent Association of Vitamin D With Physical Function in People With Chronic Spinal Cord Injury Arcangelo Barbonetti, MD,a,b Alessandra Sperandio, MD,a Alessandro Micillo, MD,a Settimio D’Andrea, MD,a Federica Pacca, ScD,b Giorgio Felzani, MD,b Sandro Francavilla, MD,a Felice Francavilla, MDa From the aAndrology Unit, Department of Life, Health and Environment Sciences, University of L’Aquila, L’Aquila; and bSpinal Unit, San Raffaele Sulmona Institute, Sulmona, Italy.
Abstract Objective: To explore the relation between vitamin D and physical function outcomes in people with spinal cord injury (SCI). Design: Cross-sectional study. Setting: Rehabilitation institute. Participants: Consecutive patients (NZ100; 72 men and 28 women) with chronic SCI admitted to a rehabilitation program. Interventions: Not applicable. Main Outcome Measures: Functional independence in activities of daily living (ADL) and leisure time physical activity (LTPA) were assessed as measures of physical function. Results: Vitamin D deficiency (.99
NOTE. Data were expressed as mean SD when normally distributed, as median (minimumemaximum) for parameters with nonnormal distribution, and as n (%) when categorical. Coexisting illnesses included heart diseases, hypertension, diabetes, dyslipidemia, nonalcoholic fatty liver disease, chronic kidney failure, and depression. Abbreviations: ALT, alanine aminotransferase; AST, aspartate aminotransferase.
www.archives-pmr.org
Vitamin D and physical function in spine injury
729
2-sided Student t test were used, as appropriate, for data analysis. Proportional differences were assessed by the chi-square test or the Fisher exact test, as appropriate. Multivariate regression analyses of square rootetransformed values were used to assess the independent association of the physical function outcomes (SCIM and LTPA) with significant predictors selected by univariate analyses. Normality of the residual errors in the regression models was verified by residual diagnosis (theoretical values vs residuals and normal Q-Q plot and Shapiro-Wilk normality test on model residuals).
Results A deficiency of 25(OH)D (30ng/mL. Table 1 shows the characteristics of patients with and without 25(OH)D deficiency. The group with 25(OH)D deficiency exhibited a significantly higher BMI, had a lower functional independence degree in ADL assessed by the SCIM, and was engaged in a significantly poorer weekly LTPA. As shown in table 2, at the univariate analyses including putative determinants of poorer physical function, lower 25(OH)D levels were significantly associated both with lower SCIM scores and poorer engagement in LTPA. Other significant predictors of lower SCIM scores were tetraplegic status, motor complete lesion, no walking ability, and coexisting depression. Other significant predictors of poorer LTPA were more advanced age, higher BMI, and coexisting depression. Significant predictors of physical function outcomes selected by the univariate analyses were included in multivariate regression analyses. Lower 25(OH)D levels were independently associated with poorer SCIM scores (fig 1A) and poorer LTPA (fig 1B), explaining 14.8% (bZ.59; P
