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Rehabilitation Practices

SCI Rehabilitation Outcomes

Much research has been directed at describing outcomes following SCI rehabilitation and examining various factors that might be associated with favourable or unfavourable 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-center 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 endeavor to determine optimal rehabilitation practice. Given the inherent breadth of findings present in individual studies, it is difficult to follow the same pattern of brevity and topic-focus found in other SCIRE chapters. In the present section, we have taken a slightly different approach.

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 the functional, neurological and general health status of patients.

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.

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