Team size in spinal cord injury inpatient rehabilitation and patient participation in therapy sessions: The SCIRehab Project

Abstract

Context/objective

Rehabilitation teams generally are described as consisting of a single representative of 6–8 disciplines, but research suggests that the number of individuals involved may be much larger. This study aimed to determine the size of teams in spinal cord injury (SCI) rehabilitation, and the effect of team size on patients' active participation in their treatment sessions.

Design

Prospective observational study.

Setting

Six SCI rehabilitation centers.

Participants

A total of 1376 patients with traumatic SCI admitted for first rehabilitation.

Interventions

Not applicable.

Outcome measures

Number of treatment sessions, by discipline and overall clinician rating of active participation of the patient; Treatment Concentration Index (TCI) calculated as Σp_k² (where p refers to the proportion of treatment sessions delivered by team member k).

Results

The average patient was treated by 39.3 different clinicians. The numbers were especially high for physical therapy (mean: 8.8), occupational therapy (7.2), and nursing (16.1). TCI was 0.08 overall; it varied by discipline. TCI was negatively correlated with length of stay, except for psychology. Participation ratings were minimally affected by the number of sessions the patient and the therapist had worked together.

Conclusions

In SCI rehabilitation, teams are at least as large as suggested by previous research. However, this may not mean lack of familiarity of patient and therapist with one another, or alternatively, the possibly weak therapeutic alliance does not affect the patients' active participation in their sessions. Further research is needed to determine whether there are negative effects on rehabilitation outcomes.

Keywords:

• Continuity of patient care
• Health services
• Patient participation
• Rehabilitation
• Spinal cord injuries
• Outcomes

Acknowledgements

Thanks are due to the participating clinicians and researchers at Craig Hospital (Denver, CO, USA), Shepherd Center (Atlanta, GA, USA), Rehabilitation Institute of Chicago (Chicago, IL, USA), Carolinas Rehabilitation (Charlotte, NC, USA), the Mount Sinai Medical Center (New York, NY, USA), and National Rehabilitation Hospital (Washington, DC, USA), as well as researchers at the Institute for Clinical Outcomes Research (Salt Lake City, UT, USA). This research was funded by grants from the National Institute on Disability and Rehabilitation Research (NIDRR), Office of Special Education and Rehabilitative Services, U.S. Department of Education, numbers H133A060103 to Craig Hospital and H133N060027 to Mount Sinai School of Medicine.