Spinal Cord https://doi.org/10.1038/s41393-019-0386-x ARTICLE Validation of a clinical prediction rule for ambulation outcome after non-traumatic spinal cord injury Rodney Sturt 1 ● Chloe Bevans 1 ● Bridget Hill 1,2 ● Anne Holland 1,3 ● Peter W. New 2,4,5 Received: 16 July 2019 / Revised: 20 October 2019 / Accepted: 3 November 2019 © The Author(s), under exclusive licence to International Spinal Cord Society 2019 Abstract Study design Prospective cohort study. Objectives To validate a Clinical Prediction Rule (CPR) for ambulation in a non-traumatic spinal cord injury population (NTSCI). Setting Tertiary spinal rehabilitation inpatient service, Melbourne, Australia. Methods Adults with confirmed NTSCI were recruited between April 2013 and July 2017. Data based on the original van Middendorp CPR (age and four neurological variables) were collected from participant’s medical records and by interview. The Spinal Cord Independence Measure item 12 was used to quantify the ability to walk at 6 and 12 months. A receiver operator curve (ROC) was utilised to determine the performance of the CPR. Ambulatory outcomes were compared for AIS A, B, C and D and aetiology groups. Results The area under the ROC curve (AUC) was 0.94 with 95% confidence interval (CI) 0.86–1.0 (n = 52). Overall accuracy was 75% at 6 months and 82% at 12 months. For the whole cohort the sensitivity at 12 months was 95% and specificity 73%. However, specificity for AIS C and D was only 50%. Conclusion The CPR correctly predicted those who did not walk at 6 and 12 months following NTSCI, but was less accurate in predicting those who would walk particularly those with an AIS C or D classification. This CPR may be useful to inform planning for future care in individuals with NTSCI, particularly for those who are not expected to walk. Further research with larger sample sizes is required to determine if the trends identified in this study are generalisable. Introduction Non-traumatic spinal cord injury (NTSCI) is damage to the spinal cord due to causes other than trauma, most com- monly resulting from degeneration of the vertebral column, metastatic disease, inflammation, infection or vascular aetiologies [1, 2]. NTSCI incidence has been reported to vary globally between 6 and 76 per million of population. While this is a relatively low incidence, it is believed to be greater than traumatic spinal cord injury (TSCI) in many developed countries [3]. The functional, social and financial impact from NTSCI is comparable to that of TSCI and places a significant burden on the healthcare system [4]. Symptoms of NTSCI can be slow to develop and diagnosis can be significantly delayed, which may impact access to specialist spinal rehabilitation and classification of injury level and severity. NTSCI generally affects older people, and as a result its incidence is only expected to increase with an ageing population [5]. People who have sustained a spinal cord injury from any cause prioritise return to walking as a key rehabilitation * Rodney Sturt r.sturt@alfred.org.au 1 Department of Physiotherapy, Alfred Health, Melbourne, VIC, Australia 2 Epworth–Monash Rehabilitation Medicine Unit, Monash University, Melbourne, VIC, Australia 3 Department of Physiotherapy, La Trobe University, Melbourne, VIC, Australia 4 Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Melbourne, VIC, Australia 5 Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, VIC, Australia Supplementary information The online version of this article (https:// doi.org/10.1038/s41393-019-0386-x) contains supplementary material, which is available to authorised users. 1234567890();,: 1234567890();,: