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Rehabilitation Practices

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Wolfe DL, Hsieh JTC, Mehta S (2012). Rehabilitation Practices and Associated Outcomes Following Spinal Cord Injury. In Eng JJ, Teasell RW, Miller WC, Wolfe DL, Townson AF, Hsieh JTC, Connolly SJ, Noonan V, Mehta S, Sakakibara BM, Boily K, editors. Spinal Cord Injury Rehabilitation Evidence. Version 4.0.


Introduction

The SCI rehabilitation practices of today were influenced greatly by the pioneering efforts of Sir Ludwig Guttman who was instrumental in the creation of specialized spinal units to care for injured soldiers returning to England during and after WWII (Guttmann 1967). Eventual adoption of this more specialized and integrated approach followed in many additional jurisdictions (Bors 1967; Bedbrook 1979), bolstered by reports of reduced mortality and enhanced long-term survival which was attributed in part to more effective management of secondary conditions associated with SCI (e.g., UTI’s, pressure sores, respiratory conditions) (Richardson & Meyer Jr. 1981; Le & Price 1982; Geisler et al.1983).

At present, the “ideal” scenario for modern SCI care is purported to be treatment in specialized, integrated centres with an interdisciplinary team of health care professionals providing care as early as possible following injury and throughout the rehabilitation process with appropriate discharge to the community characterized by ongoing outpatient care and follow-up (Donovan et al. 1984; Tator et al. 1995). This is best facilitated under one roof or within an organized “system” which is distinguished by seamless transitions as patients proceed from acute care through rehabilitation to outpatient care. While it is generally accepted that this “ideal” more specialized, integrated approach should result in better outcomes, there is very little robust evidence that supports this directly. This is understandable, given the relatively low incidence of SCI, limitations in designing trials with adequate controls and the inherent difficulty in ascribing potential outcomes to such a multi-faceted process as rehabilitation. For these reasons, we have adopted an alternative approach within the present chapter with respect to the reviewed articles as compared to most other chapters in SCIRE. Many of the articles presented in the current chapter do not investigate a specific intervention although they do describe rehabilitation outcomes and the various factors that are associated with producing optimal outcomes. Accordingly, when no specific intervention is assessed experimentally, a PEDro or Downs and Black (Downs & Black 1998) score is not provided. These articles were separated into five categories: Description of Rehabilitation Outcomes, Factors for Optimal Outcomes, Specialized vs. General SCI Units, Early vs. Delayed Admission to Specialized Units and Health Care After SCI Inpatient Rehabilitation.

In addition, in some studies the distinction between acute vs. rehabilitative care is somewhat blurred as studies may have been conducted in centers or systems where these services are more integrated. The present chapter is focused on issues associated with rehabilitation care and we have attempted to clearly identify when acute care practice may have been merged within the reporting of rehabilitation research results.