Influence of different rehabilitation therapy models on patient outcomes: Hand function therapy in individuals with incomplete SCI

Abstract

Objectives

The primary objective was to compare the benefits of single (COT1) versus double (COT2) dose of conventional occupational therapy (COT) in improving voluntary hand function in individuals with incomplete, sub-acute C3–C7 spinal cord injury (SCI). The secondary objective was to compare these two interventions versus functional electrical stimulation therapy plus COT (FES + COT).

Design

Retrospective analysis.

Setting

Inpatient spinal cord rehabilitation center, Toronto.

Participants

Individuals with traumatic incomplete sub-acute SCI.

Interventions

Data from Phases I and II (ClinicalTrials.gov ID NCT00221117) randomized control trials were pooled together for the purpose of this study. Participants in the COT1 group received 45 hours of therapy, the COT2 group received 80 hours of therapy, and the FES + COT group received 40 hours of COT therapy +40 hours of FES therapy.

Outcome measures

We analyzed the functional independence measure (FIM) and the spinal cord independence measure (SCIM) self-care sub-scores.

Results

The mean change scores on the FIM self-care sub-score for the COT1, COT2, and FES + COT groups were 12.8, 10, and 20.1 points, respectively. Similarly, the mean change scores on the SCIM self-care sub-score for the COT1, COT2, and FES + COT groups were, 2.6, 3.16, and 10.2 points, respectively.

Conclusion

Increased rehabilitation intensity alone may not always be beneficial. The type of intervention plays a significant role in determining functional changes. In this instance, receiving one (COT1) or two (COT2) doses of COT resulted in similar outcomes, however, FES + COT therapy yielded much better outcomes compared to COT1 and COT2 interventions.

Keywords:

• Conventional occupational therapy
• Functional electrical stimulation
• Hand function
• Therapy
• Intensity
• FIM
• SCIM

Acknowledgments

The authors acknowledge Dr Vera Zivanovic, Jennifer Holmes, Marlene Adams, and Sylvia Haycock for providing assistance with participant recruitment and with delivery of research therapy to the study participants.