Inpatient treatment time across disciplines in spinal cord injury rehabilitation

Abstract

Background/objective

Length of stay (LOS) for rehabilitation treatment after spinal cord injury (SCI) has been documented extensively. However, there is almost no published research on the nature, extent, or intensity of the various treatments patients receive during their stay. This study aims at providing such information on a large sample of patients treated by specialty rehabilitation inpatient programs.

Methods

Six hundred patients with traumatic SCI admitted to six rehabilitation centers were enrolled. Time spent on various therapeutic activities was documented by each rehabilitation clinician after each patient encounter. Patients were grouped by neurologic level and completeness of injury. Total time spent by each rehabilitation discipline over a patient's stay and total minutes of treatment per week were calculated. Ordinary least squares stepwise regression models were used to identify patient and injury characteristics associated with time spent in rehabilitation treatment overall and within each discipline.

Results

Average LOS was 55 days (standard deviation 37), during which 180 (106) hours of treatment were received, or 24 (5) hours per week. Extensive variation was found in the amount of treatment received, between and within neurologic groups. Total hours of treatment provided throughout a patient's stay were primarily determined by LOS, which in turn was primarily predicted by medical acuity. Variation in minutes per week of treatment delivered by individual disciplines was predicted poorly by patient and injury characteristics.

Conclusions

Variations between and within SCI rehabilitation patient groups in LOS, minutes of treatment per week overall, and for each rehabilitation discipline are large. Variation in treatment intensity was not well explained by patient and injury characteristics. In accordance with practice-based evidence methodology, the next step in the SCIRehab study will be to determine which treatment interventions are related with positive outcomes (at 1 year post injury), after controlling for patient and injury differences.

Keywords:

• Spinal cord injuries
• Rehabilitation
• Health services research
• Occupational therapy
• Physical therapy
• Rehabilitation nursing
• Psychology
• Speech–language pathology
• Social work
• Case management
• Recreation therapy
• Practice-based evidence
• Paraplegia
• Tetraplegia

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 # H133A060103 and # H133N060005), Carolinas Rehabilitation, Mount Sinai School of Medicine (grant # H133N060027), National Rehabilitation Hospital (grant # H133N060028), Rehabilitation Institute of Chicago (grant # H133N060014), and Shepherd Center (grant # H133N060009). The opinions contained in this publication are those of the grantees and do not necessarily reflect those of the US Department of Education.