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Description of SCI Rehabilitation Outcomes

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Much research has been directed at describing outcomes following SCI rehabilitation and examining various factors that might be associated with good (or poor) outcomes. Ethical and practical considerations limit the application of randomized controlled designs or other experimental designs in investigating methods for enhancing patient outcomes. Typically, investigators employ case series, case control or pre-post trial designs and often utilize correlational or predictive analyses (e.g., univariate or multivariate regression) of large single or multi-centre patient databases to determine specific associations or factors that are associated with optimal rehabilitation outcomes. Often these studies are quite large in scope as investigators explore relationships among a variety of socio-demographic and injury-related variables as they endeavour to determine optimal rehabilitation practice. Given the inherent breadth of findings present in individual studies in this area in which large databases are mined for relationships among large arrays of variables, it is difficult to follow the same pattern of brevity and topic focus found in most chapters of the present review. In the present section we have taken a slightly different approach. First, a comprehensive table can be found in Section 9.0 Appendix 1 that lists specific studies in more detail and which outlines various findings directed at describing outcomes associated with comprehensive inpatient SCI rehabilitation. This is intended as an overall resource for those interested in the specific findings relating to outcomes associated with rehabilitation practice. In the text are more focused tables summarizing specific data culled from the more comprehensive table (contained in the appendix), thereby permitting an assessment of similar types of rehabilitation outcomes. The subsequent section then describes more focused investigations that examine the effect of the various factors in producing optimal outcomes. These include studies that assess the effect of the intensity of rehabilitation, age, gender and race on rehabilitation outcomes.

 

There are many types of outcomes that have been associated with SCI rehabilitation. In the present review, we will focus on the most commonly employed measures and have outlined these along with a few typical examples in Table 1. In particular, these include measures that examine the effectiveness of health delivery as well as measures that assess functional, neurological and general health status of patients. Each of these measurement types comprise the topic areas of separate summary tables assembled from the more comprehensive table in Appendix 1. It should be noted that other measures of obvious importance to SCI rehabilitation care providers and people with SCI such as measures of health-related quality of life and those that assess different facets of community integration (e.g., employment status, Reintegration to Normal Living Index) have not been included in the present chapter as they are considered in the chapter entitled “Community Reintegration Issues Post Spinal Cord Injury”. In addition, studies examining health status have not been fully addressed in the present chapter as these typically report the incidence of specific secondary conditions (most notably, pressure sores and UTIs) and these will be described more fully in the specific chapters devoted to these issues.

Table: Outcome Measure Types and Examples Relevant to SCI Rehabilitation

Outcome Measure Type

Specific Outcome Measures

Health Delivery Indicators

LOS, Hospital Charges, Discharge Destination

Functional Status

FIM, MBI

Neurological Status

AIS, ASIA motor scores, Frankel Index

Health Status

Incidence of secondary complications

It should also be noted that specific outcome measures can combine 2 of these outcomes such as in measures of efficiency. Most commonly, change scores for functional (e.g., FIM) or neurological (e.g., ASIA motor scores) measures are divided by LOS to get an average change for that particular measure, thereby providing an indication of the efficiency of the rehabilitation process in effecting change. Measures of this nature will be profiled in the sub-section for which the numerator is related. For example, ASIA motor score efficiency would be addressed under findings associated with neurological status.