AA

Key Points

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Description of SCI Rehabilitation Outcomes

Rehabilitation Length of Stay

  • Those with higher level and more severe injuries have longer rehabilitation LOS.
  • Rehabilitation LOS in the US and Israel has become progressively shorter over the last few decades.

Neurological and Functional Status

  • Most individuals make significant functional gains during inpatient rehabilitation.
  • A significant proportion of people improve 1 AIS (ASIA Impairment Scale) grade in the first few months post-injury particularly those initially assessed AIS B and C.

Factors for Optimal Outcomes

Effect of Intensity on Rehabilitation Outcomes

  • Increased therapeutic intensity may not necessarily lead to functional benefits, but data is scarce.

Effect of Age on Rehabilitation Outcomes

  • Younger individuals with paraplegia are more likely to have shorter rehabilitation LOS than older individuals.
  • Younger individuals are more likely to make greater functional gains during rehabilitation than older individuals.
  • Younger individuals with tetraplegia (or in a mixed traumatic, nontraumatic sample) are more likely to make gains in neurological status during rehabilitation than older individuals.

Differences in Traumatic vs Non-Traumatic SCI Rehabilitation Outcomes

  • Individuals with nontraumatic SCI have reduced LOS and less functional improvement with rehabilitation as compared to those with traumatic SCI, although additional studies that better control for nontraumatic subtypes are required.

Effect of Gender and Race on Rehabilitation Outcomes

  • Neither gender nor race effects have been demonstrated for discharge destination, rehabilitation LOS and neurological or functional status in US Model Systems data.

Specialized vs General SCI Units (Acute Care)

  • More specialized, interdisciplinary acute SCI care is associated with faster transfers to rehabilitation and may result in fewer medical secondary complications, more efficient functional gains and reductions in overall mortality.

Early vs Delayed Admission to Specialized SCI Units

  • Earlier admission to specialized, interdisciplinary SCI care is associated with reduced length of total hospital stay and greater and faster rehabilitation gains with fewer medical secondary complications.
  • Prospective studies with stronger designs are needed to strengthen the evidence and provide more direction as to the optimal model of care.

Health Care After SCI Inpatient Rehabilitation

Outpatient and Follow-up Care

  • Routine, comprehensive, specialist follow-up services may result in improved health
  • In the absence of protocolized SCI care, regular and accessible interdisciplinary follow-up and outpatient care can result in functional goal attainment.
  • Telehealth applications such as telemedicine may enhance patient satisfaction with follow-up services and also may improve functional outcomes.

Rehospitalization and Healthcare Utilization after Initial Rehabilitation in SCI

  • Hospital readmission occurs frequently for persons with SCI (especially within the first year post-injury), with UTIs, pressure ulcers, respiratory infections and musculoskeletal problems among the most frequent causes.
  • Persons with SCI have more physician contacts than the general population, especially more so in the first year post-injury.