Association Between Time-to-Rehabilitation and Outcomes Following Traumatic Spinal Cord Injury

Arch Phys Med Rehabil, 2016 · DOI: 10.1016/j.apmr.2016.05.009 · Published: October 1, 2016

Spinal Cord Injury Rehabilitation Research Methodology & Design

Simple Explanation

This study looks at how quickly people with spinal cord injuries (SCI) start rehabilitation and how it affects their recovery. Researchers analyzed data from many patients to see if starting rehab sooner leads to better results, like being able to move better and live more independently, one year after their injury. The study found that starting rehab earlier might help people with SCI improve their physical abilities and independence.

Study Duration

2000-2014

Participants

3,937 patients experiencing traumatic SCI

Evidence Level

Retrospective cohort study

Key Findings

1
A longer time-to-rehabilitation (TTR) was associated with a lower FIM motor score at discharge, indicating worse functional status.
2
Increased TTR was linked to a lower CHART Physical Independence score at 1-year post injury, suggesting reduced independence.
3
No significant association was found between TTR and discharge to a private residence, 1-year FIM motor score, or CHART mobility score.

Research Summary

This study investigated the relationship between time-to-rehabilitation (TTR) following traumatic spinal cord injury (SCI) and rehabilitation outcomes at discharge and 1-year post injury, hypothesizing that a longer TTR interval would be negatively associated with outcomes. The study found that a longer TTR was associated with a lower FIM motor score at discharge and a lower CHART Physical Independence score 1-year post injury, even after adjusting for patients’ health status. The authors conclude that efforts to promote earlier rehabilitation following traumatic SCI may improve patients’ functional status at discharge.

Practical Implications

Improved Communication

Enhance communication between acute care and rehabilitation providers to expedite rehabilitation.

Education for Acute Care Providers

Educate acute care providers about the benefits of early rehabilitation for SCI patients.

New Payment Models

Implement bundled payment models to incentivize integrated acute and post-acute care services, reducing delays to rehabilitation.

Study Limitations

1
Limited region-year variation in the instrumental variable leading to moderate imbalances in race/ethnicity and education.
2
Unclear generalizability to patients with SCI treated in non-Model Systems facilities.
3
The SCIMS data do not report whether rehabilitation interventions were initiated during acute care.

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