Impact of vitamin D on mobilization, pulmonary function tests, grip strength and functionality in patients with spinal cord injury: A cross-sectional study
Keywords:Paraplegia, 25-hydroxy-vitamin D, Orthostatic hypotension, Lung function, Functional independence measure
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.
Amrein K, Scherkl M, Hoffmann M, Neuwersch-Sommeregger S, Kostenberger M, Tmava Berisha A, et al. Vitamin D deficiency 2.0: an update on the current status worldwide. Eur J Clin Nutr. 2020. Epub 2020/01/22. doi: 10.1038/s41430-020-0558-y.
Aoun A, Maalouf J, Fahed M, El Jabbour F. When and How to Diagnose and Treat Vitamin D Deficiency in Adults: A Practical and Clinical Update. J Diet Suppl. 2019:1-19. doi:10.1080/19390211.2019.1577935.
Charoenngam N, Shirvani A, Holick MF. Vitamin D for skeletal and non-skeletal health: What we should know? J Clin Orthop Trauma. 2019;10(6):1082-93. doi:10.1016/j.jcot.2019.07.004.
Celep G, Durmaz ZH, Dörtok Demir H, Erdoğan Y. Vitamin D status in infancy: What is the solution? J Surg Med. 2019;3(8):579-82. doi: 10.28982/josam.555486.
Holick MF. The vitamin D deficiency pandemic: Approaches for diagnosis, treatment and prevention. Rev Endocr Metab Disord. 2017;18(2):153-65. doi: 10.1007/s11154-017-9424-1.
Nemunaitis GA, Mejia M, Nagy JA, Johnson T, Chae J, Roach MJ. A descriptive study on vitamin D levels in individuals with spinal cord injury in an acute inpatient rehabilitation setting. PM R. 2010;2(3):202-8 doi: 10.1016/j.pmrj.2010.01.010.
Lamarche J, Mailhot G. Vitamin D and spinal cord injury: should we care? Spinal Cord. 2016;54(12):1060-75. doi: 10.1038/sc.2016.131.
Özgirgin N, Koyuncu E, Nakipoğlu Yüzer GF, Taşoğlu Ö, Yenigün D. Is spinal cord injury a risk factor for vitamin D deficiency? Turk J Phys Med Rehab. 2016;62(1):57-63. doi:10.5606/tftrd.2016.39260.
Barbonetti A, D'Andrea S, Martorella A, Felzani G, Francavilla S, Francavilla F. Low vitamin D levels are independent predictors of 1-year worsening in physical function in people with chronic spinal cord injury: a longitudinal study. Spinal Cord. 2018;56(5):494-501. doi: 10.1038/s41393-017-0058-7.
Barbonetti A, Sperandio A, Micillo A, D'Andrea S, Pacca F, Felzani G, et al. Independent Association of Vitamin D With Physical Function in People With Chronic Spinal Cord Injury. Arch Phys Med Rehabil. 2016;97(5):726-32. doi: 10.1016/j.apmr.2016.01.002.
Hagen EM. Acute complications of spinal cord injuries. World J Orthop. 2015;6(1):17-23. doi: 10.5312/wjo.v6.i1.17.
Tesini S, Frotzler A, Bersch I, Tobon A. Prevention of Orthostatic Hypotension with Electric Stimulation in Persons with Acute Spinal Cord Injury. Biomed Tech (Berl). 2013;58 Suppl 1. doi:10.1515/bmt-2013-4029.
Annweiler C, Schott AM, Rolland Y, Beauchet O. Vitamin D deficiency is associated with orthostatic hypotension in oldest-old women. J Intern Med. 2014;276(3):285-95. doi:10.1111/joim.12201.
Jang W, Park J, Kim JS, Youn J, Oh E, Kwon KY, et al. Vitamin D deficiency in Parkinson's disease patients with orthostatic hypotension. Acta Neurol Scand. 2015;132(4):242-50. doi:10.1111/ane.12390.
McCarroll KG, Robinson DJ, Coughlan A, Healy M, Kenny RA, Cunningham C. Vitamin D and orthostatic hypotension. Age Ageing. 2012;41(6):810-3. doi: 10.1093/ageing/afs088.
Ometto F, Stubbs B, Annweiler C, Duval GT, Jang W, Kim HT, et al. Hypovitaminosis D and orthostatic hypotension: a systematic review and meta-analysis. J Hypertens. 2016;34(6):1036-43. doi: 10.1097/HJH.0000000000000907.
Soysal P, Yay A, Isik AT. Does vitamin D deficiency increase orthostatic hypotension risk in the elderly patients? Arch Gerontol Geriatr. 2014;59(1):74-7. doi:10.1016/j.archger.2014.03.008.
Veronese N, Trevisan C, Bolzetta F, De Rui M, Zambon S, Musacchio E, et al. Hypovitaminosis D predicts the onset of orthostatic hypotension in older adults. J Am Soc Hypertens. 2016;10(9):724-32. doi: 10.1016/j.jash.2016.06.038.
Nas K, Yazmalar L, Sah V, Aydin A, Ones K. Rehabilitation of spinal cord injuries. World J Orthop. 2015;6(1):8-16. doi: 10.5312/wjo.v6.i1.8.
Brumpton BM, Langhammer A, Henriksen AH, Camargo CA, Jr., Chen Y, Romundstad PR, et al. Vitamin D and Lung Function Decline in Adults With Asthma: The HUNT Study. Am J Epidemiol. 2016;183(8):739-46. doi: 10.1093/aje/kwv243.
Ford ES. Lung function, 25-hydroxyvitamin D concentrations and mortality in US adults. Eur J Clin Nutr. 2015;69(5):572-8. doi: 10.1038/ejcn.2014.162.
Solidoro P, Bellocchia M, Facchini F. The immunobiological and clinical role of vitamin D in obstructive lung diseases. Minerva Medica. 2016;107:12-9.
Garshick E, Walia P, Goldstein RL, Teylan MA, Lazzari AA, Tun CG, et al. Associations between vitamin D and pulmonary function in chronic spinal cord injury. J Spinal Cord Med. 2019;42(2):171-7. doi: 10.1080/10790268.2018.1432305.
Walia P, Goldstein RL, Teylan M, Lazzari AA, Hart JE, Tun CG, et al. Associations between vitamin D, adiposity, and respiratory symptoms in chronic spinal cord injury. J Spinal Cord Med. 2018;41(6):667-75. doi: 10.1080/10790268.2017.1374020.
Gunduz B, Erhan B. Update for Examination Sheet of International Standards for Neurological Classification of Spinal Cord Injury. Turk J Phys Med Rehab. 2015;61(1):91-4. doi: 10.5152/tftrd.2015.34682.
Gündüz B, Turna I. Rehabilitation of the patient with spinal cord injury. TOTBID Dergisi. 2018;17:581-91. doi: 10.14292/totbid.dergisi.2018.77.
Roth E, Davidoff G, Haughton J, Ardner M. Functional assessment in spinal cord injury: a comparison of the Modified Barthel Index and the ‘adapted’ Functional Independence Measure. Clin Rehabil. 1990;4:277-85.
Küçükdeveci AA, G. Y, Elhan AH, Sonel B, Tennant A. Adaptation of the Functional Independence Measure for use in Turkey. Clin Rehabil. 2001;15(3):311-9.
Güzelküçük Ü, Duman İ, Yılmaz B, Tan AK. Midodrine Treatment of Orthostatic Hypotension in Patients with Acute Tetraplegia. Turk J Phys Med Rehab. 2012;58(Suppl 1):56-7.
Ordu Gökkaya NK. Pulmonary Dysfunction As a Member of Autonomic Dysfunction Family: From a Different Window. Turk J Phys Med Rehab. 2012;58(Suppl 1):16-20.
Malas FU, Koseoglu F, Kara M, Ece H, Aytekin M, Ozturk GT, et al. Diaphragm ultrasonography and pulmonary function tests in patients with spinal cord injury. Spinal Cord. 2019;57(8):679-83. doi: 10.1038/s41393-019-0275-3.
Flueck JL, Schlaepfer MW, Perret C. Effect of 12-Week Vitamin D Supplementation on 25(OH)D Status and Performance in Athletes with a Spinal Cord Injury. Nutrients. 2016;8(10). doi:10.3390/nu8100586.
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