Do all patients with functional motor-incomplete (AIS-D) traumatic spinal cord injury need specialized inpatient functional rehabilitation? A prospective observational cohort study proposing clinical criteria for home-based rehabilitation after acute care

The Journal of Spinal Cord Medicine, 2024 · DOI: 10.1080/10790268.2023.2200354 · Published: May 1, 2024

Spinal Cord Injury Trauma Rehabilitation

Simple Explanation

This study addresses the growing population of individuals with functional motor-incomplete AIS-D traumatic spinal cord injuries (tSCI) and the need to optimize rehabilitation resources. The research proposes eligibility criteria to identify individuals with AIS-D tSCI who could be discharged home for home-based rehabilitation after acute care, comparing their long-term outcomes to those transferred to inpatient functional rehabilitation (IFR). The study aims to assess the impact of home-based rehabilitation on functional status and quality of life (QOL) compared to inpatient rehabilitation, focusing on optimizing rehabilitation resources.

Study Duration

May 1st 2010 and August 31st 2018

Participants

213 individuals sustaining an AIS-D tSCI

Evidence Level

Observational prospective cohort study

Key Findings

1
A significant proportion (37.9%) of individuals with AIS-D tSCI met the criteria for home-based rehabilitation after acute care.
2
Home-based rehabilitation was associated with higher long-term functional status, physical, and psychological QOL compared to IFR, after accounting for confounding factors.
3
Absence of acute medical complications, absence of comorbidities, and higher pinprick score at admission were significantly associated with a higher likelihood of being selected for home-based rehabilitation.

Research Summary

This study investigates the feasibility and impact of home-based rehabilitation for individuals with functional motor-incomplete (AIS-D) traumatic spinal cord injuries (tSCI). It proposes clinical criteria for selecting patients suitable for home-based rehabilitation after acute care, comparing their outcomes to those receiving inpatient functional rehabilitation (IFR). The research found that a significant proportion of AIS-D tSCI patients could be successfully discharged home for rehabilitation, achieving comparable or better long-term functional status and quality of life compared to those in IFR. The study identifies factors such as absence of complications and comorbidities that are associated with successful home-based rehabilitation. The findings suggest that home-based rehabilitation is a safe and effective strategy for optimizing rehabilitation resources in selected AIS-D tSCI patients, potentially improving functional recovery, physical and psychological QOL, and reducing the burden on inpatient rehabilitation facilities.

Practical Implications

Optimizing Rehabilitation Resources

Home-based rehabilitation can be a viable alternative to inpatient rehabilitation for selected AIS-D tSCI patients, freeing up resources in specialized IFR centers.

Personalized Rehabilitation Plans

Clinical criteria can be used to identify patients who are most likely to benefit from home-based rehabilitation, allowing for more personalized and effective rehabilitation plans.

Improved Patient Outcomes

Home-based rehabilitation may lead to improved long-term functional status and quality of life for suitable patients, particularly in terms of physical and psychological well-being.

Study Limitations

1
Single trauma center setting limits external validity.
2
High rate (38%) of loss to follow-up.
3
Lack of continuous assessment of functional status and quality of life from discharge to acute care.

Your Feedback

Was this summary helpful?

Back to Spinal Cord Injury