Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: The SCIRehab project

Abstract

Background/objective

Examine associations of type and quantity of physical therapy (PT) interventions delivered during inpatient spinal cord injury (SCI) rehabilitation and patient characteristics with outcomes at the time of discharge and at 1 year post-injury.

Methods

Physical therapists delivering routine care documented details of PT interventions provided. Regression modeling was used to predict outcomes at discharge and 1 year post-injury for a 75% subset; models were validated with the remaining 25%. Injury subgroups also were examined: motor complete low tetraplegia, motor complete paraplegia, and American Spinal Injury Association (ASIA) Impairment Scale (AIS) D motor incomplete tetra-/paraplegia.

Results

PT treatment variables explain more variation in three functionally homogeneous subgroups than in the total sample. Among patients with motor complete low tetraplegia, higher scores for the transfer component of the discharge motor Functional Independence Measure () are strongly associated with more time spent working on manual wheelchair skills. Being male is the most predictive variable for the motor FIM score at discharge for patients with motor complete paraplegia. Admission ASIA lower extremity motor score (LEMS) and change in LEMS were the factors most predictive for having the primary locomotion mode of “walk” or “both (walk and wheelchair)” on the discharge motor FIM for patients with AIS D injuries.

Conclusion

Injury classification influences type and quantity of PT interventions during inpatient SCI rehabilitation and is a strong predictor of outcomes at discharge and 1 year post-injury. The impact of PT treatment increases when patient groupings become more homogeneous and outcomes become specific to the groupings.

Note

This is the second of nine articles in the SCIRehab series.

Keywords:

• Spinal cord injuries
• Rehabilitation
• Physical therapy
• Paraplegia
• Tetraplegia
• Participation
• Quality of life
• Employment
• Functional outcome practice-based evidence
• SCI model systems

Acknowledgements

The contents of this paper were developed under grants from the National Institute on Disability and Rehabilitation Research, Office of Rehabilitative Services, U.S. Department of Education, to Craig Hospital (grant numbers H133A060103 and H133N060005), the MedStar National Rehabilitation Hospital (grant number H133N060028), Rehabilitation Institute of Chicago (grant number H133N060014), the Mount Sinai School of Medicine (grant number H133N060027), and to Shepherd Center (grant number H133N060009). The opinions contained in this publication are those of the grantees and do not necessarily reflect those of the US Department of Education.