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

Abstract

Context and objective

To evaluate the effects of psychological interventions on rehabilitation outcomes, including residence and functional status at discharge, and residence, school attendance, or employment, and physical, social, occupational, and mobility aspects of participation 1 year after spinal cord injury (SCI).

Design

Prospective observational cohort study.

Setting

Six inpatient rehabilitation facilities in the United States.

Participants

Inpatients with SCI 12 years of age and older.

Interventions

Usual rehabilitation care.

Outcome measures

Functional Independence Measure at rehabilitation discharge and 1-year injury anniversary; discharge destination and residence at 1-year anniversary; Craig Handicap Assessment and Reporting Technique, Diener Satisfaction with Life Scale, Patient Health Questionnaire, employment or school attendance, rehospitalization, and occurrence of a pressure ulcer at 1-year anniversary.

Results

More time in psycho-educational interventions was associated with better function, discharge to home, home residence at 1 year, and the absence of pressure ulcers at 1 year. More psychotherapeutic sessions focusing on processing emotions and/or locus of control were associated with poorer function at discharge and 1 year, less physical independence and community mobility, lower satisfaction with life, and the presence of pressure sores at 1 year.

Conclusions

Psychological services are an important component of comprehensive medical rehabilitation and tailored to patient needs and readiness to benefit from rehabilitation. Services focused on remediating deficits tend to be associated with negative outcomes, while services intended to foster adjustment and growth tend to be associated with favorable outcomes. Further research is needed to determine the optimal type and timing of psychological services during inpatient rehabilitation based on individuals' strengths and vulnerabilities.

Note

This is the sixth in this third series of SCIRehab articles.

Keywords:

• Spinal cord injuries
• Rehabilitation
• Rehabilitation psychology
• Paraplegia
• Tetraplegia
• Participation
• Quality of life
• Employment
• Functional outcome
• Practice-based evidence
• SCI model systems
• Interventions
• Psychological
• Depression

Acknowledgements

This work was supported in part by grants from the National Institute on Disability and Rehabilitation Research (NIDRR), Office of Special Education Services, US Department of Education to: Craig Hospital (grants H133A060103 and H133N060005), Rehabilitation Institute of Chicago (grant H133N060014), Carolinas Rehabilitation, Shepherd Center (grant H133N060009), and MedStar National Rehabilitation Hospital (grant H133N060028).