Do all patients with functional motor-incomplete (AIS-D) traumatic spinal cord injury need specialized inpatient functional rehabilitation? A prospective observational cohort study proposing clinical criteria for home-based rehabilitation after acute care

Abstract

Context/Objective

Functional motor-incomplete AIS-D traumatic spinal cord injury (tSCI) represents an important growing population in neuro-traumatology. There is thus an important need for establishing strategies to optimize SCI rehabilitation resources. This study aims at proposing eligibility criteria to select individuals who could be discharged home (home-based rehabilitation) after acute care following an AIS-D tSCI and investigate its impact on the long-term functional status and quality of life (QOL), as compared to transfer to inpatient functional rehabilitation (IFR) resources.

Design

An observational prospective cohort study.

Setting

A single Level-1 specialized trauma center.

Participants

213 individuals sustaining an AIS-D tSCI.

Interventions

Home-based rehabilitation based on clinical specific criteria to be assessed by the acute care team.

Outcome measures

Functional status and QOL as assessed by the Spinal Cord Independence Measure version 3 and WHOQOL-BREF questionnaire one year following the injury, respectively.

Results

A total 37.9% of individuals fulfilled proposed criteria for home-based rehabilitation after acute care. As expected, this group was significantly younger, experienced lesser comorbidities and acute complications, and showed higher motor and sensory function compared to the IFR group. Home-rehabilitation was associated with a higher long-term functional status, physical and psychological QOL, when accounting for relevant confounding factors after an acute AIS-D tSCI. There was no readmission due to failure of home-based rehabilitation.

Conclusion

Home-based rehabilitation in selected individuals sustaining an acute AIS-D tSCI is a safe and interesting strategy to optimize the long-term outcome in terms of functional recovery, physical and psychological QOL, as well as to optimize inpatient rehabilitation resources. The proposed eligibility criteria can be used by the acute care team to select the optimal discharge orientation in this important subpopulation.

Keywords:

• Traumatic spinal cord injury
• Motor-incomplete injury
• Acute care
• Home-based rehabilitation
• Functional outcome
• Quality of life

Acknowledgements

The authors thank Mrs. Erika Rinaldi, Mrs. Nesrine Amireche and Mr. Pascal Mputu for their assistance in collecting the data.

Disclaimer statements

Contributors None.

Funding This study was supported by the [Fonds de Recherche Québec-Santé] under Grant [Consortium in traumatology, 35370]; the Chaire Medtronic de traumatologie spinale de l'Université de Montréal, and part of the data was collected through the Praxis National SCI Registry (RHSCIR).

Conflicts of interest No potential conflict of interest was reported by the author(s).

Data availability statement The data that support the findings of this study are available from the corresponding author [ARD], upon reasonable request and approval of the local Ethics Board committee.