Impact of Therapy on Recovery during Rehabilitation in Patients with Traumatic Spinal Cord Injury

JOURNAL OF NEUROTRAUMA, 2017 · DOI: 10.1089/neu.2016.4932 · Published: October 15, 2017

Spinal Cord Injury Healthcare Rehabilitation

Simple Explanation

This study examines how rehabilitation therapy affects recovery, hospital stay, and costs for people with traumatic spinal cord injuries (tSCI). By looking back at the records of 262 patients, the researchers analyzed the link between therapy hours, improvement in function, and the resources used during their rehabilitation. The study found that more therapy hours were linked to better functional outcomes, but only up to a certain point. The researchers also used computer models to predict how increasing therapy intensity could lead to shorter hospital stays and cost savings. The main goal was to better understand how to optimize therapy to improve patient outcomes while also being mindful of the costs and resources involved.

Study Duration

2005-2012

Participants

262 persons with tSCI

Evidence Level

Retrospective review

Key Findings

1
Motor FIM change was positively associated with total hours of therapy (b = 0.40, p < 0.0001) up to a certain time point, adjusted for age, gender, injury, complications, and rehabilitation onset.
2
Hypothetically increasing therapy intensity by 50% and 100% resulted in average motor FIM efﬁciency gain ranging between 0.04–0.07 and 0.1–0.17, respectively, across injury groups.
3
The hypothetical changes resulted in reductions in the average LOS and bed utilization rate, translating to cost savings of $20,000 and $50,000 (2011 CAD) for the +50% and +100% scenarios, respectively.

Research Summary

This retrospective study investigated the impact of rehabilitation therapy on functional outcomes, bed utilization, and care costs for 262 patients with traumatic spinal cord injury (tSCI). The study found a positive association between total therapy hours and motor FIM change, but only up to a certain point, after adjusting for various factors. Simulation modeling suggested that increasing therapy intensity could reduce LOS and bed utilization, leading to potential cost savings. The findings emphasize the importance of monitoring functional change during rehabilitation and tailoring therapeutic strategies to optimize resource allocation and patient outcomes.

Practical Implications

Customized Therapeutic Strategies

The results highlight the importance of monitoring functional change throughout rehabilitation after tSCI and the need for customized therapeutic strategies.

Potential Cost Savings

Increasing therapy intensity could reduce resource utilization and cost savings.

Nonlinear Relationship

The nonlinear aspect of the relationship between hours of therapy and motor FIM change found in our study illustrates that therapy hours are positively associated with motor FIM change up to a certain time point, after which this relationship becomes negative.

Study Limitations

1
Data collected from a single site with limited representation of patients with C1–3 necessitating ventilation support.
2
The study cohort may not be representative of the entire patient population from the study site, because those with incomplete data were signiﬁcantly different from the study cohort as shown by the sensitivity analysis.
3
The clinical application of our results remains to be tested, because the minimal clinical signiﬁcant improvement in motor FIM has not been determined.

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