Relationship of patient characteristics and rehabilitation services to outcomes following spinal cord injury: The SCIRehab Project

Gale Whiteneck*, Julie Gassaway, Marcel P. Dijkers, Allen W. Heinemann, Scott E.D. Kreider

*Corresponding author for this work

Research output: Contribution to journalArticle

34 Scopus citations

Abstract

Background/objective: To examine associations of patient characteristics along with treatment quantity delivered by seven clinical disciplines during inpatient spinal cord injury (SCI) rehabilitation with outcomes at rehabilitation discharge and 1-year post-injury. Methods: Six inpatient SCI rehabilitation centers enrolled 1376 patients during the 5-year SCIRehab study. Clinicians delivering standard care documented details of treatment. Outcome data were derived from SCI Model Systems Form I and II and a project-specific interview conducted at approximately 1-year post-injury. Regression modeling was used to predict outcomes; models were cross-validated by examining relative shrinkage of the original model R2 using 75% of the dataset to the R2 for the same outcome using a validation subsample. Results: Patient characteristics are strong predictors of outcome; treatment duration adds slightly more predictive power. More time in physical therapy was associated positively with motor Functional Independence Measure at discharge and the 1-year anniversary, CHART Physical Independence, Social Integration, and Mobility dimensions, and smaller likelihood of rehospitalization after discharge and reporting of pressure ulcer at the interview. More time in therapeutic recreation also had multiple similar positive associations. Time spent in other disciplines had fewer and mixed relationships. Seven models validated well, two validated moderately well, and four validated poorly. Conclusion: Patient characteristics explain a large proportion of variation in multiple outcomes after inpatient rehabilitation. The total amount of treatment received during rehabilitation from each of seven disciplines explains little additional variance. Reasons for this and the phenomenon that sometimes more hours of service predict poorer outcome, need additional study. Note: This is the first of nine articles in the SCIRehab series.

Original languageEnglish (US)
Pages (from-to)484-502
Number of pages19
JournalJournal of Spinal Cord Medicine
Volume35
Issue number6
DOIs
StatePublished - Nov 1 2012

Keywords

  • Activities of daily living
  • Paraplegia
  • Physical
  • Practice-based evidence
  • Quality of life
  • Rehabilitation
  • Social participation
  • Spinal cord injuries
  • Spinal cord injury model system
  • Tetraplegia

ASJC Scopus subject areas

  • Clinical Neurology

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