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. 2016 Oct;97(10):1620-1627.e4.
doi: 10.1016/j.apmr.2016.05.009. Epub 2016 Jun 5.

Association Between Time to Rehabilitation and Outcomes After Traumatic Spinal Cord Injury

Kurt R Herzer  1 , Yuying Chen  2 , Allen W Heinemann  3 , Marlis González-Fernández  4
Affiliations

Association Between Time to Rehabilitation and Outcomes After Traumatic Spinal Cord Injury

Kurt R Herzer et al. Arch Phys Med Rehabil. 2016 Oct.

Abstract

Objective: To examine the relations between time to rehabilitation after spinal cord injury (SCI) and rehabilitation outcomes at discharge and 1-year postinjury.

Design: Retrospective cohort study.

Setting: Facilities designated as Spinal Cord Injury Model Systems.

Participants: Patients (N=3937) experiencing traumatic SCI between 2000 and 2014, who were 18 years or older, and who were admitted to a model system within 24 hours of injury.

Interventions: Not applicable.

Main outcome measures: Rasch-transformed FIM motor score at discharge and 1-year postinjury, discharge to a private residence, and the Craig Handicap Assessment and Reporting Technique (CHART) Physical Independence and Mobility scores at 1-year postinjury.

Results: After accounting for health status, a 10% increase in time to rehabilitation was associated with a 1.50 lower FIM motor score at discharge (95% confidence interval [CI], -2.43 to -0.58; P=.001) and a 3.92 lower CHART Physical Independence score at 1-year postinjury (95% CI, -7.66 to -0.19; P=.04). Compared to the mean FIM motor score (37.5) and mean CHART Physical Independence score (74.7), the above-mentioned values represent relative declines of 4.0% and 5.3%, respectively. There was no association between time to rehabilitation and discharge to a private residence, 1-year FIM motor score, or the CHART mobility score.

Conclusions: Earlier rehabilitation after traumatic SCI may improve patients' functional status at discharge.

Keywords: Models, econometric; Outcome assessment (health care); Rehabilitation; Spinal cord injuries.

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Conflict of interest statement

The authors have no conflicts of interest to report.

Figures

Figure 1
Figure 1. Time-to-Rehabilitation Following Spinal Cord Injury
Regional intensity of hospital days at end-of-life is based on data reported in The Dartmouth Atlas of Health Care and is measured at the hospital referral region (HRR) level as the average number of inpatient days among Medicare beneficiaries in their terminal hospitalizations. “Low” refers to HRRs in the first tercile of regional end-of-life hospital days (median, 1.4 days; range, 0.9 to 1.6), “intermediate” refers to HRRs in the second tercile (median, 1.9 days; range, 1.6 to 2.4), and “high” refers to HRRs in the third tercile (median, 3.0 days; range, 2.4 to 7.0).
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