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The concept of positive deviance applied to spinal cord injury recovery: An exploratory analysis

Authors: Lucie Bourguignon, Louis P. Lukas, Sarah C. Brüningk, Fred H. Geisler, EMSCI study group, Catherine R. Jutzeler, John L. K. Kramer

Short summary: The concept of positive deviance studies individuals achieving better outcomes than expected. Applied to spinal cord injury (SCI), it allows for an exploration and characterization of individuals that recover beyond what is clinically explainable. In this study, we defined positive deviance as phenomenal recovery (PR) following SCI in two cohorts, namely the Sygen clinical trial and the EMSCI cohort. The definitions of PR followed two strategies: based on clinical knowledge, and on statistical characterization. After defining PR and comparator groups, we reported on demographics, patterns in motor scores recovery - with a specific focus on the comparison between scores in the upper and lower extremities -, and prescriptions of antibiotics. We observe that phenomenal recoveries tend to occur more in individuals with cervical injuries (from 45.8% to 100% of the PR groups defined). They exhibit a higher prevalence of central cord patterns in motor scores at recovery, especially when using more refined definition of central cord syndrome, based on the level of injury. However, we could not identify consistent patterns in antibiotics prescription across the different PR groups or in comparing PR groups to their respective comparator group. Further explorations in additional cohorts are warranted to confirm or infirm the trends observe and thus better characterize patients with a potential for PR. This characterization would be crucial in the context of clinical trials, where such PRs should not be mistaken for a treatment effect.

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This project is supported by the Swiss National Science Foundation (Ambizione Grant, #PZ00P3_186101). LB was supported by an ICORD student exchange award provided by the Praxis Spinal Cord Injury Foundation. SB was supported by the Botnar Research Centre for Child Health Postdoctoral Excellence Programme (#PEP-2021-1008). The funding sources of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. The corresponding authors had full access to all the data in the study and had final responsibility for the decision to submit for publication.

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