Neoplastic versus traumatic spinal cord injury: an outcome comparison after inpatient rehabilitation.

OBJECTIVE: To compare outcomes of patients with neoplastic spinal cord compression (SCC) to outcomes of patients with traumatic spinal cord injury (SCI) after inpatient rehabilitation. DESIGN: A comparison between patients with a diagnosis of neoplastic SCC admitted to an SCI rehabilitation unit and patients with a diagnosis of traumatic SCI admitted to the regional Model Spinal Cord Injury Centers over a 5-year period, controlling for age, neurologic level of injury, and American Spinal Injury Association impairment classification. SETTING: Tertiary university medical centers. PATIENTS: Twenty-nine patients with neoplastic SCC and 29 patients with SCI of traumatic etiology who met standard rehabilitation admission criteria. MAIN OUTCOME MEASURES: Acute and rehabilitation hospital length of stay (LOS), Functional Independence Measure (FIM) scores, FIM change, FIM efficiency, and discharge rates to home. RESULTS: Patients with neoplastic SCC had a significantly (p < .01) shorter rehabilitation LOS than those with traumatic SCI (25.17 vs 57.46 days). No statistical significance was found in acute care LOS. Motor FIM scores on admission were higher in the neoplastic group, but discharge FIM scores and FIM change were significantly lower. Both groups had similar FIM efficiencies and community discharges. CONCLUSIONS: Patients with neoplastic SCC can achieve rates of functional gain comparable to those of their counterparts with traumatic SCI. While patients with traumatic SCI achieve greater functional improvement, patients with neoplastic SCC have a shorter rehabilitation LOS and can achieve comparable success with discharge to the community.     

Neoplastic vs. traumatic spinal cord injury: an inpatient rehabilitation comparison

OBJECTIVE: To compare demographics, injury characteristics, and functional outcomes of patients with neoplastic spinal cord compression with those with traumatic spinal cord injuries. DESIGN: A prospective 5-yr comparison was undertaken comparing 34 patients with neoplastic spinal cord compression with 159 patients with traumatic spinal cord injury. RESULTS: Patients with neoplastic spinal cord compression were significantly older, more often female, and unemployed than patients with traumatic spinal cord injury. Neoplastic spinal cord compression presented more often with paraplegia involving the thoracic spine, and injuries were more often incomplete compared with traumatic spinal cord injury. Patients with neoplastic spinal cord compression had a significantly shorter rehabilitation length of stay compared with those with traumatic spinal cord injury. The neoplastic group had significantly lower FIM change scores. Both groups had similar FIM efficiencies and discharge to home rates. CONCLUSIONS: Patients with neoplastic spinal cord compression have different demographic and injury characteristics but can achieve comparable rates of functional gains as their traumatic spinal cord injury counterparts. Although patients with traumatic injuries achieve greater functional improvement, patients with neoplasms have a shorter rehabilitation length of stay and comparable FIM efficiencies and home discharge rates.     

Nontraumatic vs. traumatic spinal cord injury: a rehabilitation outcome comparison

OBJECTIVE: Nontraumatic spinal cord injury (SCI) represents a significant proportion of individuals admitted for SCI rehabilitation; however, there is limited literature regarding their outcomes. As our society continues to age and nontraumatic injuries present with greater frequency, further studies in this area will become increasingly relevant. The objective of this study was to compare outcomes of patients with nontraumatic SCI with those with traumatic SCI after inpatient rehabilitation. DESIGN: A longitudinal study with matched block design was used comparing 86 patients with nontraumatic SCI admitted to a SCI rehabilitation unit and 86 patients with traumatic SCI admitted to regional model SCI centers, controlling for age, neurologic level of injury, and American Spinal Injury Association impairment classification. Main outcome measures included acute and rehabilitation hospital length of stay, FIM scores, FIM change, FIM efficiency, rehabilitation charges, and discharge-to-home rates. RESULTS: Results indicate that when compared with traumatic SCI, patients with nontraumatic SCI had a significantly (P < 0.01) shorter rehabilitation length of stay (22.38 vs. 41.35 days) and lower discharge FIM scores (57.3 vs. 65.6), FIM change (18.6 vs. 31.0), and rehabilitation charges ($25,050 vs. $64,570). No statistical differences were found in acute care length of stay, admission FIM scores, FIM efficiency, and community discharge rates. CONCLUSIONS: The findings indicate that patients with nontraumatic SCI can achieve rates of functional gains and community discharge comparable with traumatic SCI. Whereas patients with traumatic SCI achieved greater overall functional improvement, patients with nontraumatic SCI had shorter rehabilitation length of stay and lower rehabilitation charges. These findings have important implications for the interdisciplinary rehabilitation process in the overall management and outcome of individuals with nontraumatic SCI.     

Poster 7: Impact of balance deficits after traumatic brain injury on inpatient rehabilitation functional outcome: a multicenter study

Objective: To evaluate how sitting and standing balance ratings of patients with traumatic brain injury (TBI) on admission to rehabilitation impacts functional outcome, rehabilitation charges, and rehabilitation length of stay (LOS). Design: Multicenter analysis of consecutive admissions to designated Traumatic Brain Injury Model Systems (TBIMS). Setting: TBIMS centers. Participants: 908 adults with TBI were included in the study. Interventions: Not applicable. Main Outcome Measure: FIM™ instrument admission and discharge scores, FIM change and efficiency; rehabilitation LOS and charges; and discharge disposition. Results: Persons with grossly impaired sitting balance on admission to rehabilitation had lower discharge FIM scores and greater rehabilitation charges than those with normal or mildly impaired sitting balance. Persons with mildly impaired sitting balance had lower discharge FIM scores and greater rehabilitation charges than those with normal sitting balance. Subjects with grossly impaired standing balance compared with normal or mildly impaired standing balance had greater rehabilitation charges and LOS and lower discharge FIM scores and FIM efficiency. Subjects with grossly impaired balance on admission to rehabilitation had significantly lower motor FIM items compared with those who had normal or mildly impaired balance. Subjects with grossly impaired sitting balance were discharged from rehabilitation to someplace other than their home more than twice as often as those with normal sitting balance (11.7% vs 23.3%). Subjects with grossly impaired standing balance were discharged from rehabilitation to someplace other than their home more than 3 times as often as subjects with normal standing balance (6.7% vs 21.5%). Conclusion: In patients with TBI, sitting and standing balance ratings on admission to rehabilitation are useful indicators of functional impairment and not returning home at discharge from rehabilitation.     

An Italian survey of traumatic spinal cord injury. The Gruppo Italiano Studio Epidemiologico Mielolesioni study

OBJECTIVE: To describe the etiology, clinical presentation, complications, outcome indicators, and links between emergency and acute intervention and rehabilitation of patients with traumatic spinal cord injury (SCI). DESIGN: Multicenter prospective study involving patients with SCI discharged, after rehabilitative care, between February 1, 1997, and January 31, 1999. SETTING: Thirty-two Italian hospitals involved in SCI rehabilitation. PARTICIPANTS: Six hundred eighty-four patients with traumatic SCI on their first admission to a rehabilitation center. INTERVENTIONS: Not applicable. Main Outcome Measures: Neurologic improvement (NI), bladder autonomy, feelings of dependency, and destination were evaluated on discharge. Pressure ulcers on admission, time from injury to admission, and length of stay (LOS) were considered as indirect measures of the effectiveness of the health system. RESULTS: Traumatic etiology had a male-to-female ratio of 4:1 (548:136). Collision on the road was the main cause of traumatic injury (53.8%). Mean time from injury to admission was 36.8 days; 126 patients (18%) were admitted within the first week after injury. Mean LOS was 135.5 days. In 184 patients (26.9%), a pressure ulcer was present on admission. On discharge, NI was recorded in 179 patients (26.2%), whereas 446 (65%) and 418 (61%) had bladder and bowel autonomy, respectively, and 560 (81.9%) returned home. In the multivariate analysis, independent variables predicting poor outcome (NI, feelings of dependency, sphincter autonomy, discharge to home, LOS) were related both to the lesion (completeness, cervical involvement) and to the indicators of health service organization (time from injury to admission, complications on admission and during stay). CONCLUSIONS: Our focus on the etiology of traumatic SCI showed that efforts should be made to prevent collisions on the road. Our study also highlights problems in the comprehensive management of patients with SCI in Italy. Better organization could help reduce the time from injury to admission, the number of complications on admission, and LOS, and it could help improve rehabilitation outcome.     

Medical rehabilitation length of stay and outcomes for persons with traumatic spinal cord injury--1990-1997

OBJECTIVES: To describe changes in acute and rehabilitation length of stay (LOS) for persons with traumatic spinal cord injury (SCI), describe predictors of LOS, and explore year-1 anniversary medical and social outcomes. DESIGN: Longitudinal, exploratory study of patients with SCI. SETTING: Eighteen Model Spinal Cord Injury Centers across the United States. SAMPLE: A total of 3,904 persons discharged from the Model Systems between 1990 and 1997 who had follow-up interviews at 1 year postinjury. MAIN OUTCOME MEASURES: Rehabilitation LOS; injury anniversary year-1 presence of pressure ulcers; incidence of rehospitalization; community or institutional residence; and days per week out of residence. RESULTS: Acute rehabilitation LOS declined from 74 days to 60 days. Discharges to nursing homes and rehospitalizations increased between 1990 and 1997. Linear regression showed that lower admission motor Functional Independence Measure (FIM) scores, year of discharge from the Model System, method of bladder management, tetraplegia, race, education, marital status, discharge disposition, and age were related to longer LOS. At first anniversary, logistic regressions revealed that lower discharge motor FIM, injury level, and age were related to the presence of pressure ulcers, rehospitalization, residence, and time spent out of residence. Of those discharged to nursing homes, 44% returned to home by year 1, and these individuals had higher functional status and were younger. DISCUSSION: High functional status is associated with shorter LOS, discharge to the community, and time spent out of residence, indicating efficiency in the system. For 44.4% of individuals one or more of the following outcomes were observed by first year anniversary: rehospitalization; residing in a skilled nursing facility; having pressure ulcers; or infrequently leaving one's residence.     

Sex and age effects on outcomes of total hip arthroplasty after inpatient rehabilitation

OBJECTIVE: To retrospectively examine the effects of sex and age on the inpatient rehabilitation outcomes of patients after total hip arthroplasty (THA). DESIGN: Exploratory, retrospective study. SETTING: A university-affiliated rehabilitation hospital. PARTICIPANTS: Male and female THA patients (N=332) were stratified into age brackets (<65y, 65-84y, >or=85y). All patients completed interdisciplinary inpatient rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Length of stay (LOS), FIM instrument scores, FIM efficiency (FIM/LOS), hospital costs, and discharge disposition location were collected by chart review. RESULTS: Regardless of age, women had lower FIM scores at admission and discharge than men (P<.05). FIM efficiency was 22% to 53% lower for women in primary THA and 16% to 85% lower in revision THA than men (P=.001). Women accrued higher total hospital charges than men (13,099 dollars vs 11,141 dollars; P<.05), and were discharged home less frequently than men (84.4% vs 90.9%; P<.05). Admission FIM scores were 10.6% and 8.9% lower and discharge FIM scores were 7.3% and 9.2% lower in patients 85 years or older than those less than 65 or 65 to 84 years (P<.01). FIM efficiency was 25% to 38% higher in patients less than 85 years than those 85 years and older (P=.015), and 37% higher in men than women (P=.001). Patients 85 years and older were discharged less frequently to home than patients less than 85 years (P<.05). CONCLUSIONS: All patients made functional improvement after inpatient rehabilitation, but women and patients 85 years and older had longer LOS and lower FIM efficiency, incurred greater hospital charges, and were less likely to be discharged to home than men and younger counterparts.     

Do preinjury alcohol problems predict poorer rehabilitation progress in persons with spinal cord injury?

OBJECTIVE: To determine whether a history of alcohol-related problems is associated with inpatient rehabilitation progress. DESIGN: Cross-sectional cohort survey. SETTING: Acute inpatient rehabilitation program in a level I trauma center. PARTICIPANTS: Seventy-six of 104 consecutive patients with spinal cord injury (SCI) who met inclusion criteria and had completed interviews and functional outcome data. Participants were on average 38 years old; 84% were white, and 86% were men. Forty-two percent had tetraplegia and 39% had a history of problem drinking. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: FIM instrument admission, discharge, and efficiency scores as well as rehabilitation length of stay (LOS). RESULTS: The group with a history of problem drinking had significantly lower FIM admission, discharge, and efficiency scores and longer rehabilitation LOS. After controlling for potential confounding factors, a history of problem drinking accounted for a significant proportion of the variance in FIM efficiency scores. CONCLUSIONS: A history of problem drinking may be a risk factor for poorer rehabilitation progress among patients with SCI. They may be more costly to rehabilitate and may be discharged before attaining an adequate level of independence. Despite this, the current rehabilitation prospective payment system does not recognize this common comorbid condition.     

Nontraumatic spinal cord injury: demographic characteristics and complications

OBJECTIVES: To investigate the demographic characteristics and complications of nontraumatic spinal cord injury (NT/SCI), to compare patients who were admitted for initial rehabilitation with readmission rehabilitation patients, to compare our findings with those of other studies, and to develop a model to predict the length of stay (LOS). DESIGN: Retrospective, 3-year, case series. SETTING: Tertiary medical unit specializing in SCI rehabilitation in Australia. PARTICIPANTS: Consecutive sample of 134 adult referred inpatients with NT/SCI (58% women; median age, 61y). Patients requiring initial rehabilitation or readmission were included. INTERVENTION: Chart review. Main Outcomes Measures: Demographic characteristics, neurologic injury, etiology, comorbidities, and complications of NT/SCI. RESULTS: The most common cause of NT/SCI was tumor (20.1%), but there were many different etiologies. Tetraplegia occurred in 32.8% of patients, and 56% had motor incomplete injuries. Most patients (63%) had at least 1 complication, including urinary tract infection (32.8%), pressure ulcer (31.5%), and pain (18.7%). Initial rehabilitation patients were significantly older (initial median, 69y vs readmission median, 54y; P=.0001). A multivariate model for LOS was able to predict 52% of the variance. CONCLUSIONS: NT/SCI rehabilitation patients have a different demographic profile compared with traumatic SCI (T/SCI) patients and a lower prevalence of many of the complications that affect T/SCI patients. There are differences between initial and readmission patients.     

Nontraumatic spinal cord injury: incidence, epidemiology, and functional outcome.

OBJECTIVES: To identify and compare the incidence, demographics, neurologic presentation, and functional outcome of individuals with nontraumatic spinal cord injury (SCI) to individuals with traumatic SCI. DESIGN: A 5-year prospective study. SETTING: Level I trauma center of a Regional SCI Model System. PATIENTS: Two hundred twenty adult SCI admissions. MAIN OUTCOME MEASURES: Demographics, etiology, level and completeness of injury, Functional Independent Measure (FIM) scores. RESULTS: Of SCI admissions, 39% were nontraumatic in etiology (spinal stenosis, 54%; tumor, 26%). Compared to subjects with traumatic SCI, those individuals with nontraumatic SCI were significantly (p < .01) older and were more likely married, female, and retired. Injury characteristics revealed significantly more paraplegia and incomplete SCI within the nontraumatic SCI group (p < .01). Both nontraumatic and traumatic SCI individuals had significant FIM changes from rehabilitation admission to discharge (p < .01). Those with tetraplegia-incomplete nontraumatic SCI had significantly higher admission motor FIM scores and shorter rehabilitation length of stay than in the traumatic group (p < .05). Paraplegic-complete and paraplegic-incomplete nontraumatic SCI subjects had lower discharge motor FIM scores, FIM change, and FIM efficiency than those with traumatic SCI. Similar discharge-to-home rates were noted in both nontraumatic and traumatic SCI groups. CONCLUSIONS: These data suggest that individuals with nontraumatic SCI represent a significant proportion of SCI rehabilitation admissions and, although differing from those with traumatic SCI in demographic and injury patterns, can achieve similar functional outcomes.     

Paraplegia after aortic aneurysm repair versus traumatic spinal cord injury: functional outcome, complications, and therapy intensity of inpatient rehabilitation

Yokoyama O, Sakuma F, Itoh R, Sashika H. Paraplegia after aortic aneurysm repair versus traumatic spinal cord injury: functional outcome, complications, and therapy intensity of inpatient rehabilitation.

Objective

To compare outcomes, complications, and therapy intensity of inpatient rehabilitation in patients with paraplegia caused by spinal cord injury associated with aortic aneurysm repair (SCI-AA) versus patients with traumatic spinal cord injury (SCI).

Design

Case-controlled study.

Setting

SCI unit in a rehabilitation center.

Participants

Seventeen patients with SCI-AA and 17 patients with traumatic SCI.

Intervention

Standard rehabilitation therapy for SCI.

Main Outcome Measures

Length of stay (LOS) in acute and rehabilitation hospitals; FIM instrument scores; FIM change; FIM efficiency; complications; therapy intensity; and ambulatory state and return to community at discharge.

Results

No significant differences were noted in acute and rehabilitation LOS and admission FIM scores. Discharge FIM scores, FIM change, and FIM efficiencies were significantly lower in the SCI-AA group, which had many complications related to AA and SCI. Intensity of rehabilitation sports therapy in the SCI-AA group was significantly lower than that of the traumatic SCI group, but total therapy intensity did not differ significantly. Both had similar rates of return to ambulatory state and discharge to the community.

Conclusions

SCI-AA patients had many complications that interfered with rehabilitation therapy, and could not achieve functional gains comparable to those with traumatic SCI. However, both groups achieved comparable success with return to ambulatory state and discharge to the community.     

Rehabilitation outcomes of terror victims with multiple traumas

OBJECTIVES: To describe the rehabilitation outcomes of terror victims with multiple traumas, and to compare those outcomes with those of patients with nonterror-related multiple traumas treated in the same rehabilitation facility over the same time period. DESIGN: Retrospective chart reviews. SETTING: Rehabilitation department in a university hospital in Jerusalem, Israel. PARTICIPANTS: Between September 2000 and September 2004, we treated 72 victims of terrorist attacks who had multiple traumas. Among them, 47 (65%) had multiple traumas without central nervous system involvement (MT subgroup), 19 (26%) had multiple traumas with traumatic brain injury (TBI subgroup), and 6 (8%) had multiple traumas with spinal cord injury (SCI subgroup). We matched, according to their types of injury and demographic data, each terror victim with a control patient treated in the same period in our rehabilitation department. INTERVENTION: Interdisciplinary inpatient and outpatient rehabilitation. MAIN OUTCOME MEASURES: Hospital length of stay (LOS) in acute care departments, inpatient and outpatient rehabilitation departments, functional outcome (FIM instrument score), occupational outcome (returning to previous occupation), and psychologic outcome (Solomon PTSD [post-traumatic stress disorder] Inventory). RESULTS: The mean LOS of terror victims was 218+/-131 days; for the nonterror group it was 152+/-114 days (P<.01). In comparison with the control subgroups, the MT subgroup of terrorist victims had significantly longer LOS in the acute care and outpatient rehabilitation departments (P=.06) and the terror TBI subgroup had a longer LOS in outpatient department only (P<.05). The LOS of the SCI patients, both terror victims and control patients, was significantly longer than that of the other 2 subgroups. The difference between FIM value at entry and discharge (DeltaFIM) was significantly higher for terror victims than for the controls (41.1+/-21.6 vs 30.8+/-21.8, P=.002). This difference was mainly the result of the significantly higher DeltaFIM achieved by the terror MT subgroup than by the MT controls. The rate of PTSD was higher among terror victims than among controls (40.9% vs 24.2%, P=.04). The rate of return to previous occupations was similar between terror victims and nonterror patients (53% vs 46.9%, respectively). CONCLUSIONS: Victims of terror spent longer periods in rehabilitation than the nonterror group; however, they regained most activity of daily living functions similar to the nonterror group. Despite the higher rate of PTSD, terror victims succeeded in returning to their previous occupations at a similar rate to that of the nonterror group.     

Time to rehabilitation admission and associated outcomes for patients with traumatic brain injury

OBJECTIVE: To examine the association between time from injury to rehabilitation admission and outcomes for patients with traumatic brain injuries (TBIs). DESIGN: Retrospective chart review. SETTING: One hundred-bed inpatient rehabilitation facility with a 20-bed brain injury unit. PARTICIPANTS: Patients with TBIs discharged from initial inpatient rehabilitation between 2003 and 2004 (N=158). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Outcomes examined were functional independence at discharge (motor, cognitive, total FIM scores), rehabilitation length of stay (LOS), and rehabilitation cost. RESULTS: Significant linear trends were observed for time to admission and motor FIM scores, total FIM scores, rehabilitation LOS, and cost. All linear regression models contained time to admission as a significant predictor of rehabilitation outcomes. Over half of the variability in outcomes was explained by predictors including time to admission and case-mix group or individual FIM scores with the exception of discharge motor FIM score, for which only 45% of the variability was explained. CONCLUSIONS: Patients who progress to rehabilitation earlier do better functionally and have lower costs and shorter LOSs. Furthermore, the time to rehabilitation admission is easily calculated and could be used by rehabilitation providers in adjunct with admission FIM scores to estimate resource utilization.     

Impact of Medicare prospective payment system on acute rehabilitation outcomes of patients with spinal cord injury

Qu H, Shewchuk RM, Chen Y, Deutsch A. Impact of Medicare prospective payment system on acute rehabilitation outcomes of patients with spinal cord injury.

Objective

To examine the impact of Medicare's inpatient rehabilitation facility (IRF) prospective payment system (PPS) on inpatient rehabilitation outcomes for patients with traumatic spinal cord injury (SCI).

Design

Retrospective study.

Setting

Twelve SCI Model Systems.

Participants

A sample of Medicare (n=296) and non-Medicare (n=3110) patients was selected from the National SCI Statistical Center Database from 1996 to 2006.

Interventions

Not applicable.

Main Outcome Measures

Motor FIM score change and length of stay (LOS).

Results

LOS decreased by about 5.8 days a year (P<.001) for Medicare patients and about 1.3 days a year (P=.031) for non-Medicare patients after PPS implementation. However, for both groups, FIM score gains were not significantly different in the pre-PPS and PPS periods.

Conclusions

Although significant decreases in LOS were observed for Medicare patients after IRF PPS implementation, Medicare patients' improvements in motor function did not decrease. Non-Medicare patients with SCI also experienced shortened stays after Medicare IRF PPS implementation, but had equivalent FIM score gains compared with their counterparts who received inpatient rehabilitation care before PPS implementation. IRF PPS implementation was associated with shorter stays, but was not associated with lower functional improvement.     

Gender-related differences in acute rehabilitation lengths of stay, charges, and functional outcomes for a matched sample with spinal cord injury: a multicenter investigation

OBJECTIVE: To examine the effects of gender on length of stay (LOS), treatment costs, and outcomes by using a matched sample of patients with spinal cord injury (SCI). DESIGN: A 2 x (15 x 3) mixed, block design was used retrospectively to analyze the impact of gender on subjects matched for age, American Spinal Injury Association (ASIA) motor impairment classification, and level of neurologic injury. SETTING: Twenty medical centers in the federally sponsored Spinal Cord Injury Model Systems project. PARTICIPANTS: One thousand seventy-four adult patients with SCI admitted between 1988 and 1998 were assessed at acute-care admission, inpatient rehabilitation admission, and inpatient rehabilitation discharge. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: ASIA motor index and FIM instrument admission, discharge, and efficiency scores; rehabilitation LOS and medical care charges; and discharge disposition. RESULTS: Analysis revealed no gender-related differences in FIM motor scores on admission and discharge. No differences in FIM motor efficiencies or daily change were observed. No significant differences were found for ASIA motor scores on acute-care admission and rehabilitation discharge. No differences in acute rehabilitation LOS and charges were observed. No gender-related differences were seen in the likelihood of discharge to an institutional setting. CONCLUSION: Gender was not a significant factor in functional outcome of SCI patients after acute rehabilitation.     

Poster 17: Is length of stay associated with spinal cord injury functional outcome at discharge from acute rehabilitation?

Objective: To determine whether rehabilitation length of stay (LOS) is associated with discharge motor function for persons with spinal cord injury (SCI). Design: Longitudinal. Setting: Spinal Cord Injury Model Systems center. Participants: 920 persons with traumatic, complete SCI enrolled in the Spinal Cord Injury National Database, with levels of injury (LOI) at C5, C6, C7, and T1-5; and inpatient rehabilitation discharge dates between 1989 and 1992 (“early”) and 1999 and 2002 (“late”). Interventions: Not applicable. Main Outcome Measures: FIM™ instrument at rehabilitation discharge. Results: For all LOI groups, the late group had a LOS shorter than the early group, with the largest difference in the C7 group: 107 days (early) versus 59 days (late). FIM motor scores at rehabilitation discharge also differed significantly for the C5, C7, and T1-5 LOI groups. For each of these LOIs, the late group was discharged with lower FIM motor scores; the largest difference was again noted for the C7 group, which had FIM motor scores of 51.9 (early) versus 40.7 (late). Conclusions: Decreased inpatient rehabilitation LOS was associated with decreased function at rehabilitation discharge. Persons with C7-level SCI were the most affected group; this group had the largest decrease in LOS and motor FIM score.     

Functional outcomes and disability after nontraumatic spinal cord injury rehabilitation: Results from a retrospective study

OBJECTIVE: To describe, in a group of patients undergoing initial inpatient rehabilitation after nontraumatic spinal cord injury (SCI), the demographic characteristics, clinical features, and outcomes, with a focus on the functional status and disability. DESIGN: Retrospective data analysis, 3-year case series. SETTING: Tertiary medical unit specializing in nontraumatic SCI rehabilitation. PARTICIPANTS: Consecutive sample of 70 adult inpatient referrals with nontraumatic SCI undergoing initial inpatient rehabilitation. INTERVENTION: Chart review. MAIN OUTCOME MEASURES: Primary outcomes were demographic characteristics, clinical features, mortality, length of stay (LOS), neurologic classification, accommodation setting, support services, mobility, bladder and bowel continence, and FIM instrument scores. RESULTS: Forty-one patients (58.6%) were paraplegic incomplete, 23 (32.9%) were tetraplegic incomplete, and 6 (8.6%) were paraplegic complete. Eight patients (11.4%) died before hospital discharge. Of those who survived, 47 (75.8%) were discharged home, 11 (17.7%) were transferred to a nursing home, and 4 (6.4%) went elsewhere in the community. The geometric mean LOS was 55.8 days. Nine patients (14.5%) were discharged walking unaided, 27 (43.5%) were walking at least 10 m with a gait aid, and 26 (41.9%) were wheelchair dependent for mobility. Thirty patients (48.4%) were voiding on sensation, 7 (11.1%) used intermittent catheterization, 23 (37.2%) had an indwelling catheter, and 2 (2.8%) used reflex voiding. Eleven patients (17.7%) were fecally continent on sensation and 47 (75.8%) were fecally continent with a bowel program, 1 patient (1.6%) had a colostomy, and 3 patients (4.8%) were discharged fecally incontinent. The mean Rasch FIM motor score was 39.6 on admission and 58.7 at discharge (paired t test, t=-11.2; P<.000). CONCLUSIONS: Most nontraumatic SCI patients returned home with a good level of functioning regarding mobility, bladder, and bowel status, in comparison to other studies of patients with SCI. Patients' disability was usually significantly reduced during rehabilitation.     

Course of functional improvement after stroke, spinal cord injury, and traumatic brain injury.

OBJECTIVE: To examine functional improvement patterns of persons with stroke, traumatic brain injury (TBI), and spinal cord injury (SCI). DESIGN: Statistical analysis of data from a multisite study evaluating rehabilitation outcomes. SETTING: Eight inpatient rehabilitation facilities. PARTICIPANTS: A total of 314 consecutive admissions of persons with stroke, SCI, and TBI who received acute medical rehabilitation between 1994 and 1998. INTERVENTION: Calibration of motor and cognitive items from the FIM instrument, grouping of cases by number of weeks of rehabilitation (length of stay [LOS] groups), and plotting of weekly averages across time. MAIN OUTCOME MEASURES: Weekly motor and cognitive functional status. RESULTS: With the exception of cognitive functioning for persons with SCI, LOS was related to initial functional status, with patients with greater disability having longer LOS (eg, initial motor status for persons with stroke was 48.3 for those with a 2-week stay, 36.8 for a 6-week stay, with the averages between decreasing monotonically). With the exception of cognitive gains for person with TBIs, the amount of functional gain during rehabilitation was essentially the same for all LOS groups (eg, the overall average total motor gain for persons with SCI is 22.3, with no patterns of increase or decrease across LOS groups); however, the rate of improvement in motor (but not cognitive) functioning differed across LOS groups, with patients with shorter stays having the greater rates of improvement (eg, the overall average weekly motor gain for persons with SCI was 3.6, with the averages by LOS group monotonically decreasing from 6.4 for those with 4-week stays to 2.7 for those with 9-week stays). CONCLUSIONS: When examined separately for persons grouped by LOS, functional status improved linearly during the rehabilitation stay, with differences in rate of improvement depending on initial functional status.     

A follow-up study of older adults with traumatic brain injury: taking into account decreasing length of stay

OBJECTIVE: To examine age-related differences in rehabilitation outcomes following traumatic brain injury (TBI). DESIGN: Retrospective collaborative study. SETTING: Patients received acute neurotrauma and inpatient rehabilitation services at 1 of the 17 National Institute on Disability and Rehabilitation Research-designated Traumatic Brain Injury Model Systems (TBIMS) centers. PARTICIPANTS: A sample of 273 older patients (> or =55y) admitted for TBI were taken from the TBIMS National Database. Older patients were matched with subjects 44 years of age or younger, based on severity of injury (Glasgow Coma Scale score, length of coma, intracranial pressure elevations). Due to decreasing length of stay (LOS), only patients admitted from 1996 through 2002 were included. INTERVENTION: Inpatient interdisciplinary brain injury rehabilitation. MAIN OUTCOME MEASURES: Acute care LOS, inpatient rehabilitation LOS, admission and discharge FIM instrument and Disability Rating Scale (DRS) scores, FIM and DRS efficiency, acute and rehabilitative charges, and discharge disposition. RESULTS: One-way analyses of variance demonstrated a statistically significant difference between older and younger patients with respect to LOS in rehabilitation but not for acute care. Total rehabilitative charges, and admission and discharge DRS and FIM scores also showed statistically significant differences between groups. Older patients progressed with significantly less efficiency on both the DRS and FIM scales. Significantly more charges were generated per unit for older patients to improve on the DRS scale, but not the FIM scale. Using chi-square analysis, a statistically significant difference in rate of discharge to home was identified between older (80.5%) and younger (94.4%) patients. CONCLUSIONS: Results in this study are similar to those in earlier studies with smaller sample sizes. Major differences observed include significantly slower and more costly progress in inpatient rehabilitation for older patients with TBI, as well as a significantly lower rate of discharge to community for older patients. However, even with decreasing LOS in both settings, community discharge rate is still encouraging for older patients with TBI.