AA

Summary

There is level 3 evidence (with predominately US data) that rehabilitation LOS has become progressively shorter up to the mid-1990s. Only investigators from Israel have published data that supports this contention.

There is level 3 evidence that those with higher level and more severe injuries have longer rehabilitation LOS.

There is level 4 evidence that a significant proportion of people (~50%) initially assessed as AIS B and C will improve by at least 1 AIS grade in the first few months post-injury concomitant with inpatient rehabilitation. Fewer individuals (~10%) initially assessed as AIS A and D will improve by 1 AIS grade.

There is level 4 evidence that individuals make significant functional gains during inpatient rehabilitation, more so for those with complete and incomplete paraplegia and incomplete tetraplegia.

There is level 4 evidence based on a single case series that increased therapeutic intensity may not be associated with any functional benefit as measured by the FIM.

There is level 3 evidence that significantly shorter rehabilitation LOS is associated with younger vs older individuals with paraplegia. The same may not be true for those with tetraplegia or for mixed cohorts involving traumatic and nontraumatic SCI.

There is level 3 evidence that age is inversely related to patients independence level.

There is level 3 evidence that younger as compared to older individuals are more likely to obtain greater functional benefits during rehabilitation.

There is level 3 evidence that significant increases in neurological status during rehabilitation are more likely with younger than older individuals with tetraplegia or for mixed cohorts involving traumatic and nontraumatic SCI. The same may not be true for those with paraplegia.

There is level 4 evidence that those with nontraumatic SCI are more likely to be older, female, have paraplegia and have an incomplete injury as compared to those with traumatic SCI.

There is level 3 evidence that those with nontraumatic SCI have generally reduced rehabilitation LOS, reduced hospital charges but similar discharge destinations as compared to those with traumatic SCI.

There is conflicting level 3 evidence that individuals with nontraumatic SCI have lower FIM efficiencies than those with traumatic SCI, although many studies are comparing persons with different etiologies of nontraumatic SCI.

There is level 3 evidence that individuals with traumatic SCI with or without concomitant TBI have similar LoS and achieve similar FIM motor scores, but associated costs were higher in those with dual diagnosis.

There is level 3 evidence from a single study that there is no difference with respect to gender on discharge destination, rehabilitation LOS and neurological or functional outcomes associated with rehabilitation, although there is conflicting level 4 evidence from individual studies that indicate gender differences for some of these outcomes.

There is level 3 evidence that there is no difference with respect to race (Caucasians vs African-American) on rehabilitation LOS and neurological or functional outcomes associated with rehabilitation that are not otherwise explained by socio-demographic or etiological differences.

Based on several retrospective, case-control studies there is level 3 evidence that individuals cared for in interdisciplinary, specialist SCI acute care units soon after injury (most being admitted within 48 hours) begin their rehabilitation program earlier.

There is level 3 evidence that individuals cared for in interdisciplinary, specialist acute care SCI units have fewer complications upon entering and during their rehabilitation programs.

There is level 4 evidence that individuals initially cared for in interdisciplinary, specialist acute care SCI units make more efficient functional gains during rehabilitation (i.e., more or faster improvement).

There is level 4 evidence that individuals cared for in interdisciplinary, specialist SCI units have reduced mortality.

Based on several retrospective, case-control studies there is level 3 evidence that individuals admitted earlier to interdisciplinary, integrated specialist SCI units have a shorter total hospitalization length of stay than those admitted later.

There is level 3 evidence that individuals admitted earlier to interdisciplinary, integrated specialist SCI units make greater functional gains in a shorter period of time (i.e., greater efficiency) than those admitted later.

There is level 3 evidence that individuals admitted earlier to interdisciplinary, integrated specialist SCI units have fewer secondary medical complications (especially pressure sores) than those admitted later.

There is level 4 evidence for positive utility of admission to rehabilitation even at delays 90 days post injury.

Because of the variability between studies as to what constitutes early admission to interdisciplinary, specialist integrated SCI units; it is not possible to determine a specific period for optimal admission. At least one study has demonstrated benefits with an early admission described as 30 days post-injury. The majority of studies defined early admissions as 1-2 weeks post-injury, while studies focused on acute care describe early admission as within 24 hours post-injury.

There is level 4 evidence that provision of routine, comprehensive, specialist follow-up services may result in perceived improvements of health, independence and less feelings of depression.

There is limited level 4 evidence that coordination of care through a community-based transmural nurse has no effect on reducing secondary complications and associated health utilization as compared to routine outpatient care consisting of periodic visits to a specialized rehabilitation doctor or centre.

There is level 4 evidence that regular and accessible interdisciplinary follow-up can result in achieving functional goals where protocolized SCI care is unavailable.

There is limited Level 1 evidence  from a single study that telemedicine videoconferencing as an adjunct to routine follow-up care improves patient satisfaction and may lead to enhanced functional outcomes.

There is level 4 evidence that at least 25% of persons with SCI (moreso in some jurisdictions including the US) may expect a hospital readmission in the first year following discharge from SCI rehabilitation.

There is level 4 evidence from three studies that hospital re-admission rates are highest in the first year post injury and then stabilize at a still significantly high rate.

There is level 4 evidence from eight studies that urinary problems (UTIs), pressure ulcers, respiratory infections and musculoskeletal problems are consistently among the most frequent causes of hospital readmission among persons with SCI.

There is level 4 evidence from three studies that factors such as increased age, lower function / greater severity of injury, prior contact with the health system, funding, rural habitation and being unmarried are associated with a greater chance of a hospital readmisssion.

There is level 3 evidence from 1 study and supported by two level 4 studies that persons with SCI have an increased number of physician contacts as compared to matched controls from the general population, especially moreso in the first year post-injury.