Relationship of patient characteristics and rehabilitation services to outcomes following spinal cord injury: The SCIRehab Project

Abstract

Background/objective

To examine associations of patient characteristics along with treatment quantity delivered by seven clinical disciplines during inpatient spinal cord injury (SCI) rehabilitation with outcomes at rehabilitation discharge and 1-year post-injury.

Methods

Six inpatient SCI rehabilitation centers enrolled 1376 patients during the 5-year SCIRehab study. Clinicians delivering standard care documented details of treatment. Outcome data were derived from SCI Model Systems Form I and II and a project-specific interview conducted at approximately 1-year post-injury. Regression modeling was used to predict outcomes; models were cross-validated by examining relative shrinkage of the original model R² using 75% of the dataset to the R² for the same outcome using a validation subsample.

Results

Patient characteristics are strong predictors of outcome; treatment duration adds slightly more predictive power. More time in physical therapy was associated positively with motor Functional Independence Measure at discharge and the 1-year anniversary, CHART Physical Independence, Social Integration, and Mobility dimensions, and smaller likelihood of rehospitalization after discharge and reporting of pressure ulcer at the interview. More time in therapeutic recreation also had multiple similar positive associations. Time spent in other disciplines had fewer and mixed relationships. Seven models validated well, two validated moderately well, and four validated poorly.

Conclusion

Patient characteristics explain a large proportion of variation in multiple outcomes after inpatient rehabilitation. The total amount of treatment received during rehabilitation from each of seven disciplines explains little additional variance. Reasons for this and the phenomenon that sometimes more hours of service predict poorer outcome, need additional study.

Note

This is the first of nine articles in the SCIRehab series.

Keywords:

• Spinal cord injuries
• Tetraplegia
• Paraplegia
• Rehabilitation
• Physical
• Social participation
• Quality of life
• Activities of daily living
• Spinal cord injury model system
• Practice-based evidence

Acknowledgements

The contents of this paper were developed under grants from the National Institute on Disability and Rehabilitation Research, Office of Rehabilitative Services, US Department of Education, to Craig Hospital (grant numbers H133A060103 and H133N060005) and to The Mount Sinai School of Medicine (grant number H133N060027), and Rehabilitation Institute of Chicago (grant number H133N060014). The opinions contained in this publication are those of the grantees and do not necessarily reflect those of the US Department of Education.

Special thanks to Craig Hospital: Daniel P. Lammertse, MD, Susan Charlifue, PhD, William Scelza, MD; Mount Sinai Medical Center: Jeanne Zanca, PhD; MedStar National Rehabilitation Center: Gerben DeJong, PhD, Ching-Hui Hsieh, PhD, Pamela Ballard, MD; Shepherd Center: David Apple, MD, Deborah Backus PhD; Rehabilitation Institute of Chicago: David Chen, MD; Indiana University, Flora Hammond, MD.