OBJECTIVE To identify the specific features that contribute to the variability in baseline wheelchair transfer and the changes in transfer ability (gain or loss) over time for a large cohort of patients with spina bifida (SB) in the National Spina Bifida Patient Registry (NSBPR). DESIGN Longitudinal cohort study. SETTING 35 United States outpatient SB clinic sites . PARTICIPANTS individuals (n=1,687) with SB ages 5-73 (median age =13.33) who were therapeutic ambulators or non-ambulators. INTERVENTION not applicable. MAIN OUTCOME MEASURE ability to transfer from a wheelchair to another level surface RESULTS: Bayesian Network Analysis (BNA) was used to reduce the initial variable set to the following predictors: SB sub phenotype, motor level, age, insurance, gender, race, ethnicity, surgical procedures, and number of visits. We used a multinomial logistic model with Wald Chi-square analysis of effects to examine the relationships between transfer ability and predictors. A total of 295 out of 1,687 eligible patients with myelomeningocele (17.56%) and 6 out of 58 eligible patients with non-myelomeningocele (10.32%) experienced changes in transfer ability during the period of the study. For those with MMC and non-MMC, the highest number of individuals exhibiting changes in motor level had changes from thoracic to high-lumbar, high-lumbar to thoracic, high-lumbar to mid-lumbar, and mid-lumbar to high-lumbar lesion levels. Results of the BNA revealed that motor level was the predominant factor associated with baseline transfer ability followed by age. The combination of SB sub phenotype, motor level, age, insurance status, number and type of surgical procedures, and time point, accurately classified the loss, gain, or no change in transfer ability 82.7% of the time. CONCLUSIONS Motor level was the predominant factor associated with baseline transfer ability, and the change in transfer ability was directly related to a corresponding change in motor level that might be explained by changes in muscle strength of the iliopsoas and quadriceps.

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脊柱裂患者运动水平与轮椅转移能力的关系：来自国家脊柱裂患者登记处的研究

目的 确定导致国家脊柱裂患者登记处 (NSBPR) 中的一大群脊柱裂 (SB) 患者的基线轮椅转移变异性和转移能力（增益或损失）随时间变化的特定特征. 设计 纵向队列研究。设置 35 个美国门诊 SB 诊所站点。参与者（n = 1,687）与 SB 年龄 5-73 （中位年龄 = 13.33）谁是治疗性步行者或非步行者。干预不适用。主要结果测量从轮椅转移到另一个水平表面的能力结果：贝叶斯网络分析 (BNA) 用于将初始变量集减少为以下预测变量：SB 亚表型、运动水平、年龄、保险、性别、种族、民族，手术程序和访问次数。我们使用具有 Wald 卡方效应分析的多项逻辑模型来检查转移能力和预测变量之间的关系。在研究期间，共有 1,687 名符合条件的脊髓脊膜膨出患者中的 295 名（17.56%）和 58 名符合条件的非脊髓脊膜膨出患者中的 6 名（10.32%）经历了转移能力的变化。对于患有 MMC 和非 MMC 的人，运动水平变化最多的个体从胸椎到高腰椎，从高腰椎到胸椎，从高腰椎到中腰椎，从中腰椎到高腰椎病变水平。BNA 的结果显示，运动水平是与基线转移能力相关的主要因素，其次是年龄。SB 亚表型、运动水平、年龄、保险状况、手术次数和类型的组合，和时间点，82.7% 的时间准确地分类了转移能力的损失、收益或没有变化。结论 运动水平是与基线转移能力相关的主要因素，转移能力的变化与运动水平的相应变化直接相关，这可能由髂腰肌和股四头肌肌肉力量的变化来解释。