Predicting rehabilitation length of stay in Canada: It’s not just about impairment

Figures & data

Table 1 Median/mean R-LOS by country for the traumatic SCI population

Country	Centre	Period	Trauma (N)	Median R-LOS (IQR)	Mean R-LOS ± SD (days)
USA^Citation3	Multi	2010–2015	1446	35	–
Australia^Citation25	Single	1993–1998	167	83 (IQR: 35–139)	–
Israel^Citation26	Single	1996–2002	25		T= 102 ± 59
Italy^Citation27	Multi	1997–1999	684	122	135.5
Japan^Citation28	Single	2000–2004	17		115.6 ± 35.8
Netherlands^Citation29	Multi	2000–2003	157	240 (IQR:164–322)	272.9 ± 148.7
Netherlands & Flanders^Citation30	Multi	2002–2007	207	IQR: 116.0–307.0	227.6 ± 105.2
Qatar^Citation31	Single	2008–2010	54		138.4 ± 114.1
Russia^Citation32	Single	N/A	50		46.9 ± 20.5
Saudi Arabia^Citation33	Single	2005–2008	495		58.8 ± 1.68

Note: SD=standard deviation; IQR=interquartile range.

Figure 1 R-LOS (days) for A) initially identified cohort (n=1455) and B) the cohort with outliers removed (n=1376) as used for analysis.

Figure 2 Box plot of R-LOS (days) among adults with traumatic SCI (2004–2014).

Figure 3 R-LOS (days) distribution based on the individual's neurological Level of injury and ASIA Impairment Scale category.

Table 2 Patient, injury, and management details for patients with incomplete paraplegia (T2-S4/5, AIS C/D; n=218), incomplete tetraplegia (C1-T1, AIS C/D; n=540), complete paraplegia (T2-S4/5, AIS A/B; n=311), complete tetraplegia (C1-T1, AIS A/B; n=227), and the total analysis cohort (n=1376)

Variable	Incomplete paraplegic n = 218	Incomplete tetraplegia n = 540	Complete paraplegic n = 311	Complete tetraplegia n = 227	Analysis cohort n = 1376
Age at injury (years); mean (SD)	42.7 (18.3)	54.2 (17.2)	36.7 (15.7)	39.0 (16.5)	45.2 (18.5)
Male; n (%)	162 (74.3%)	443 (82.0%)	258 (83.0%)	183 (80.6%)	1107 (80.5%)
Marital status; n (%)
Married/common law	72 (45.9%)	226 (55.9%)	113 (44.5%)	80 (48.8%)	491 (50.2%)
Widowed	7 (4.5%)	25 (6.2%)	2 (0.8%)	3 (1.8%)	37 (2.6%)
Divorced/separated	9 (5.7%)	48 (11.9%)	14 (5.5%)	10 (6.1%)	81 (8.3%)
Single	69 (44.0%)	105 (26.0%)	125 (49.2%)	71 (43.3%)	370 (37.8%)
Education; n (%)
Less than high school	41 (27.0%)	118 (30.7%)	69 (27.6%)	35 (22.2%)	263 (27.8%)
High school	56 (36.8%)	130 (33.8%)	103 (41.2%)	84 (53.2%)	373 (13.8%)
Higher education	55 (36.2%)	137 (35.6%)	78 (31.2%)	39 (24.7%)	309 (32.7%)
Employed at injury; n (%)	103 (66.5%)	212 (52.5%)	185 (72.3%)	116 (71.2%)	616 (63.0%)
Pre-injury smoking status; n (%)
Current	36 (24.8%)	87 (24.3%)	62 (27.1%)	33 (22.8%)	218 (24.9%)
Former	50 (34.5%)	139 (38.8%)	61 (26.6%)	39 (26.9%)	289 (32.9%)
Never	59 (40.7%)	132 (36.9%)	106 (46.3%)	73 (50.3%)	370 (42.2%)
Pre-injury living setting; n (%)
Own home/rent	141 (95.9%)	388 (97.2%)	240 (98.4%)	153 (98.1%)	922 (97.5%)
Other	6 (4.1%)	11 (2.8%)	4 (1.6%)	3 (1.9%)	24 (2.5%)
Pre-injury living situation; n (%)
Alone	36 (23.2%)	91 (22.3%)	45 (17.6%)	24 (14.6%)	196 (19.9%)
Not alone	119 (76.8%)	318 (77.8%)	211 (82.4%)	140 (85.4%)	788 (80.1%)
Pre-injury BMI ≥ 22; n (%)	112 (79.4%)	309 (82.2%)	198 (84.3%)	122 (80.3%)	741 (82.0%)
Mechanism of injury; n (%)
Sports	25 (11.8%)	70 (13.2%)	49 (15.9%)	44 (19.4%)	188 (14.7%)
Transport	65 (30.7%)	119 (22.4%)	120 (38.8%)	107 (47.1%)	411 (32.1%)
Falls	92 (43.3%)	290 (54.5%)	104 (34.7%)	50 (22.0%)	536 (41.9%)
Other	30 (14.2%)	53 (10.0%)	36 (11.7%)	26 (11.5%)	145 (11.3%)
Rehabilitation onset (days);
Mean (SD)	34.3 (36.4)	39.0 (41.2)	35.0 (27.7)	67.4 (49.3)	42.3 (41.5)
Median (IQR)	24.0 (26.0)	27.0 (31.0)	27.0 (24.0)	55.0 (57.0)	30.0 (34.0)
Rehabilitation Admission FIM; mean (SD)	82.4 (15.1)	66.4 (21.4)	66.9 (10.5)	50.5 (7.7)	66.4 (18.6)

Note: BMI = Body Mass Index, FIM = Functional Independence Measure.

Table 3 Participant, injury, and management details for the analysis cohort (n = 1376) and their relationship to R-LOS. Neurological data was assessed within 7 days of admission to rehabilitation care. *Ventilation in acute care is defined as an ETT for > 24 hours or tracheostomy. AIS = ASIA Impairment Scale; ICU = intensive care unit; IQR = interquartile range; SD = standard deviation

Variable	Analysis cohort n = 1376	p-value
Age at injury (years); mean (SD)	45.2 (18.5)	0.7648
Male; n (%)	1107 (80.5%)	0.5911
Pre-injury living situation; n (%)
Alone	201 (20.4%)	0.2893
Not alone	829 (79.6%)	0.0040
Glasgow Coma Scale (GCS, n = 844) ≤ 12; n (%)	60 (7.1%)	<0.0001
Impairment (NLI and AIS subgroups)
High cervical (C1-C4) A/B	104 (8.0%)
High cervical (C1-C4) C/D	308 (23.8%)
Low cervical (C5-T1) A/B	123 (9.5%)
Low cervical (C5-T1) C/D	232 (17.9%)
Thoracic (T2-T10) A/B	205 (15.8%)
Thoracic (T2-T10) C/D	56 (4.3%)
Thoracolumbar (T11-S4/5) A/B	106 (8.2%)
Thoracolumbar (T11-S4/5) C/D	162 (12.5%)
Lower Extremity Motor Score ≤ 10; n (%)	572 (45.0%)	<0.0001
Ventilation in acute care*; n (%)	316 (31.1%)	<0.0001
PEG tube; n (%)	22 (2.0%)	0.7633
Acute ICU length of stay (R-LOS, days, n = 321); mean (SD)	82.8 (274.2)	0.7993
Pain interference score > 15; n (%)	185 (21.3%)	0.9410
Rehabilitation R-LOS (days)		–
Mean (SD)	84.1 (46.0)
Median (IQR)	78 (64)
Indwelling Catheter at Discharge; n (%)	95 (10.0%)	<0.0001

Table 4 Results of multivariate analysis on the effect of participant, injury, and management data on rehabilitation R-LOS (n = 861). CI = confidence interval. AIS = ASIA Impairment Scale

Independent variable	Parameter	Standard error	95% CI lower	95% CI upper	p-value
Intercept	50.0774	5.0942	40.0779	60.0769	<.0001
Age	0.1785	0.0822	0.0173	0.3398	0.0301
Injury neurology (level, AIS); n (%)
High cervical (C1-C4) A/B	33.2040	7.6553	18.1772	48.2308	<0.0001
High cervical (C1-C4) C/D	11.9570	4.97701	2.2010	21.7129	0.0164
Low cervical (C5-T1) A/B	24.3632	7.1986	10.2330	38.4933	<0.0007
Low cervical (C5-T1) C/D	3.5217	5.1223	−6.5330	13.5764	0.4920
Thoracic (T2-T10) A/B	−5.1770	6.5500	−18.0342	7.6801	0.4295
Thoracic (T2-T10) C/D	11.6766	7.6545	−3.3486	26.7017	0.1275
Thoracolumbar (T11-S4/5) A/B	−3.8998	6.6225	−16.8992	9.0997	0.5561
Thoracolumbar (T11-S4/5) C/D	Baseline	–	–	–	–
Ventilation
Yes	10.6047	3.1180	4.4843	16.7250	0.0007
No
Indwelling catheter
Yes	12.0451	4.8327	2.5589	21.5314	0.0129
No
LEMS
≤10	36.2156	4.7964	26.8008	45.6305	<.0001
>10	Baseline	–	–	–	–

National Spinal Cord Injury Statistical Center. Annual Report for the Spinal Cord Injury Model Systems. Birmingham; 2008. https://www.nscisc.uab.edu/PublicDocuments/reports/pdf/2008NSCISCAnnualStatisticalReport-CompletePublicVersion.pdf. Accessed January 13, 2017.

 Google Scholar

Tooth L, McKenna K, Geraghty T. Rehabilitation outcomes in traumatic spinal cord injury in Australia: functional status, length of stay and discharge setting. Spinal Cord 2003;41(4):220–30. doi: https://doi.org/10.1038/sj.sc.3101433

 PubMed Web of Science ®Google Scholar

Ronen J, Itzkovich M, Bluvshtein V, Thaleisnik M, Goldin D, Gelernter I, et al. Length of stay in hospital following spinal cord lesions in Israel. Spinal Cord 2004;42(6):353–8. doi: https://doi.org/10.1038/sj.sc.3101590

 PubMed Web of Science ®Google Scholar

Pagliacci MC, Celani MG, Zampolini M, Spizzichino L, Franceschini M, Baratta S, et al. An Italian survey of traumatic spinal cord injury. The Gruppo Italiano Studio Epidemiologico Mielolesioni study. Arch Phys Med Rehabil 2003;84(9):1266–75. doi: https://doi.org/10.1016/S0003-9993(03)00234-X

 PubMed Web of Science ®Google Scholar

Yokoyama O, Sakuma F, Itoh R, Sashika H. Paraplegia after aortic aneurysm repair versus traumatic spinal cord injury: functional outcome, complications, and therapy intensity of inpatient rehabilitation. Arch Phys Med Rehabil 2006;87(9):1189–94. doi: https://doi.org/10.1016/j.apmr.2006.05.017

 PubMed Web of Science ®Google Scholar

Post MWM, Dallmeijer AJ, Angenot ELD, van Asbeck FW, van der Woude LH V. Duration and functional outcome of spinal cord injury rehabilitation in the Netherlands. J Rehabil Res Dev 2004;42(3sup1):75. doi: https://doi.org/10.1682/JRRD.2004.10.0133

 Google Scholar

Osterthun R, Post M, van Asbeck F, Society D-FSC. Characteristics, length of stay and functional outcome of patients with spinal cord injury in Dutch and Flemish rehabilitation centres. Spinal Cord 2009;47(4):339–44. doi: https://doi.org/10.1038/sc.2008.127

 PubMed Web of Science ®Google Scholar

Venkatachalam L, Yazeedi W Al, George LA. Predictors of the length of stay of inpatients in rehabilitation setting after traumatic spinal cord injury. Open Access Scientific Reports 2012;1(2). 2012.

 Google Scholar

Fromovich-Amit Y, Biering-Sørensen F, Baskov V, Juocevicius A, Hansen HV, Gelernter I, et al. Properties and outcomes of spinal rehabilitation units in four countries. Spinal Cord 2009;47(8):597–603. doi: https://doi.org/10.1038/sc.2008.178

 PubMed Web of Science ®Google Scholar

Al-jadid MS, Robert AA. An analysis of the length of stay in traumatic and non- traumatic spinal cord injured patients. Saudi Med J. 2010;31(5):555–9.

 PubMed Web of Science ®Google Scholar