TY - JOUR
T1 - Effects of Etiology on Inpatient Rehabilitation Outcomes in 65- to 74-Year-Old Patients With Incomplete Paraplegia From a Nontraumatic Spinal Cord Injury
AU - Kay, Elizabeth
AU - Deutsch, Anne
AU - Chen, David
AU - Manheim, Larry
AU - Rowles, Diane
N1 - Copyright:
Copyright 2010 Elsevier B.V., All rights reserved.
PY - 2010/6
Y1 - 2010/6
N2 - Objective: To examine differences in rehabilitation outcomes for older patients with a nontraumatic spinal cord injury (NT-SCI) for 5 etiologic diagnoses: degenerative spinal disease (DSD), malignant spinal tumor, benign spinal tumor, vascular ischemia, and spinal abscess. Design: Retrospective cohort study that used Medicare claims and assessment data. Setting: A total of 479 inpatient rehabilitation hospitals and units. Patients: A total of 1780 Medicare beneficiaries (65-74 years old) with incomplete paraplegia attributable to NT-SCI who were discharged from inpatient rehabilitation facilities from 2002 through 2005. Interventions: Not applicable. Main Outcome Measures: Length of stay, discharge Functional Independence Measure (FIM) instrument motor item and subscale scores, and discharge destination. Results: Demographic characteristics varied by etiology group. Mean ± SD rehabilitation stays ranged from 13.3 ± 7.7 days for DSD to 26.4 ± 13.4 days for vascular ischemia. Adjusted data showed stays differed (P < .001) across etiology groups. Adjusted discharge mean self-care and mobility subscores revealed that patients with DSD and benign tumor were more independent (P < .001) than patients with a malignant tumor or spinal abscess. Patients with vascular ischemia were more dependent (P < .01) in mobility than the DSD and benign tumor groups. Etiologic differences (P < .01) in independence in discharge FIM modifiers for walking (FIM ≥ 4), bladder (FIM ≥ 6) and bowel management (FIM ≥ 6) and bowel accidents/continence (FIM ≥ 6), but not bladder accidents (FIM ≥ 6), were present. The percent of patients discharged to a community residence ranged from 59.3% to 92.6%. Adjusted data showed that significantly larger percentages (P < .01) of patients in the DSD and malignant tumor groups than in the spinal abscess group were discharged to a community residence (versus nursing home). Conclusion: There are etiologic differences in demographics, rehabilitation length of stay, functional outcomes, and discharge destination in elderly patients with NT-SCI.
AB - Objective: To examine differences in rehabilitation outcomes for older patients with a nontraumatic spinal cord injury (NT-SCI) for 5 etiologic diagnoses: degenerative spinal disease (DSD), malignant spinal tumor, benign spinal tumor, vascular ischemia, and spinal abscess. Design: Retrospective cohort study that used Medicare claims and assessment data. Setting: A total of 479 inpatient rehabilitation hospitals and units. Patients: A total of 1780 Medicare beneficiaries (65-74 years old) with incomplete paraplegia attributable to NT-SCI who were discharged from inpatient rehabilitation facilities from 2002 through 2005. Interventions: Not applicable. Main Outcome Measures: Length of stay, discharge Functional Independence Measure (FIM) instrument motor item and subscale scores, and discharge destination. Results: Demographic characteristics varied by etiology group. Mean ± SD rehabilitation stays ranged from 13.3 ± 7.7 days for DSD to 26.4 ± 13.4 days for vascular ischemia. Adjusted data showed stays differed (P < .001) across etiology groups. Adjusted discharge mean self-care and mobility subscores revealed that patients with DSD and benign tumor were more independent (P < .001) than patients with a malignant tumor or spinal abscess. Patients with vascular ischemia were more dependent (P < .01) in mobility than the DSD and benign tumor groups. Etiologic differences (P < .01) in independence in discharge FIM modifiers for walking (FIM ≥ 4), bladder (FIM ≥ 6) and bowel management (FIM ≥ 6) and bowel accidents/continence (FIM ≥ 6), but not bladder accidents (FIM ≥ 6), were present. The percent of patients discharged to a community residence ranged from 59.3% to 92.6%. Adjusted data showed that significantly larger percentages (P < .01) of patients in the DSD and malignant tumor groups than in the spinal abscess group were discharged to a community residence (versus nursing home). Conclusion: There are etiologic differences in demographics, rehabilitation length of stay, functional outcomes, and discharge destination in elderly patients with NT-SCI.
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U2 - 10.1016/j.pmrj.2010.03.010
DO - 10.1016/j.pmrj.2010.03.010
M3 - Article
C2 - 20630437
AN - SCOPUS:77954593723
VL - 2
SP - 504
EP - 513
JO - PM and R
JF - PM and R
SN - 1934-1482
IS - 6
ER -