Archives of Physical Medicine and Rehabilitation
Original articleRelation Between Inpatient and Postdischarge Services and Outcomes 1 Year Postinjury in People With Traumatic Spinal Cord Injury
Section snippets
Methods
Data were collected under the aegis of the 5-year, prospective, observational cohort, multicenter SCIRehab study. SCIRehab collected detailed information regarding patient characteristics, interventions, and services during inpatient rehabilitation and after discharge, as well as outcomes 1 year after SCI. Study details are reported elsewhere.10, 18
Participant and injury characteristics
The analysis sample consisted of 1032 individuals with traumatic SCI (see table 1). The validation dataset of 344 participants was essentially the same for all key participant characteristics. The majority of participants were men, white, had a high school diploma, were covered by private health plans, and were not obese (ie, body mass index <30). Only about one third were married. Nearly half were injured as a result of motor vehicle events. The average admission mFIM scores were low,
Discussion
Type and intensity of inpatient rehabilitation services have been reported to be associated with a variety of outcomes at 1 year postinjury.10 This analysis expands on these findings and demonstrates that some discipline-specific postdischarge services are associated with life satisfaction, participation, and function 1 year after SCI. In some cases, these associations are positive and in other cases negative. The direction of associations may indicate service benefits, patient need, or a
Conclusions
Rehabilitation services during and after inpatient rehabilitation are weakly associated with 1-year, postdischarge SCI outcomes, such as functional status, as well as distal outcomes, such as life satisfaction and societal participation. Although relatively few patients received postdischarge TR and VOC services, both appeared to have a positive relation to outcomes at 1 year postdischarge from SCI rehabilitation. Further, a high proportion of PT and OT services were received after inpatient
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Cited by (16)
Predicting Duration of Outpatient Physical Therapy Episodes for Individuals with Spinal Cord Injury Based on Locomotor Training Strategy
2022, Archives of Physical Medicine and RehabilitationCitation Excerpt :Over the past half century, inpatient rehabilitation for spinal cord injury (SCI) has been characterized by an increase in medical and rehabilitation sophistication coupled with a decrease in length of stay while aiming to maximize function, mobility, and independence.1,2 Outpatient services and wellness programs have helped to fill the gap in rehabilitation resulting from decreasing inpatient length of stay and the need to enhance function in the community.3,4 Whiteneck et al5,6 investigated outpatient rehabilitation characteristics using a practice-based evidence framework and reported that 44% of all rehabilitation services provided in the first year after SCI occur after inpatient discharge.
Physical Function Recovery Trajectories After Spinal Cord Injury
2022, Archives of Physical Medicine and RehabilitationUsing individual growth curve models to predict recovery and activities of daily living after spinal cord injury: An SCIRehab project study
2013, Archives of Physical Medicine and RehabilitationCitation Excerpt :While IGC models can accommodate time-varying characteristics, our models are not sufficiently sophisticated to examine such variations in treatment characteristics because of the lack of time points between admission and discharge and the lack of specificity of the variation of treatment hours by discipline across the intervention. Our results were consistent with associations reported in other SCIRehab studies for PT and OT total treatment hours and discharge motor FIM scores2 and with admission motor FIM scores and hours of OT therapeutic activities per week.5 Although our results appear contrary to the association between admission motor FIM scores and hours of PT transfer training per week,4 our models included PT hours per week for all activities, which may be distributed according to patient need and ability.
CER, PBE, SCIRehab, NIDRR, and other important abbreviations
2013, Archives of Physical Medicine and RehabilitationCitation Excerpt :They report that white non-Hispanic patients who were admitted promptly after injury and received fewer PT hours per week have slower functional recovery rates. Backus et al21 note that rehabilitation services during and after inpatient rehabilitation are associated with life satisfaction, societal participation, and functional outcomes in the first year after SCI, but explain only a small part of the variance in these outcomes. They suggest that further study of the type and intensity of postdischarge services is needed to ascertain the most effective and economically sound use of therapy services after SCI.
Supported in part by the National Institute on Disability and Rehabilitation Research, U.S. Department of Education (grant nos. H133A060103, H133N060005, H133N060009, H133N060028, and H133N060014).
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.