Rehabilitation outcomes in traumatic spinal cord injury in Australia: functional status, length of stay and discharge setting

Tooth, L., McKenna, K. and Geraghty, T. (2003) Rehabilitation outcomes in traumatic spinal cord injury in Australia: functional status, length of stay and discharge setting. Spinal Cord, 41 4: 220-230. doi:10.1038/sj.sc.3101433


Author Tooth, L.
McKenna, K.
Geraghty, T.
Title Rehabilitation outcomes in traumatic spinal cord injury in Australia: functional status, length of stay and discharge setting
Journal name Spinal Cord   Check publisher's open access policy
ISSN 1362-4393
1476-5624
Publication date 2003-04-01
Year available 2003
Sub-type Article (original research)
DOI 10.1038/sj.sc.3101433
Open Access Status Not yet assessed
Volume 41
Issue 4
Start page 220
End page 230
Total pages 11
Editor L. S. Illis
Place of publication London, U.K.
Publisher Nature Publishing Group
Language eng
Subject C1
321024 Rehabilitation and Therapy - Occupational and Physical
730306 Evaluation of health outcomes
730303 Occupational, speech and physiotherapy
Abstract Study design: Retrospective, descriptive study.
Formatted abstract
Study design:
Retrospective, descriptive study.

Objectives:

To describe patients' length of stay (LOS), functional status and discharge setting after rehabilitation and how degree of impairment (complete/incomplete paraplegia/tetraplegia) impacts on these outcomes. To compare actual LOS with estimated LOS. Estimated LOS was based on an Australian model, the Australian National Sub-acute and Non-acute Patient Classification System (AN-SNAP), which classifies patients using admission Functional Independence Measure (FIM™) scores. To further describe outcomes for each AN-SNAP class by degree of impairment.

Setting:
Spinal Injuries Unit of major Metropolitan hospital in Brisbane, Australia.

Methods:

Retrospective chart review of 167 patients with traumatic spinal cord injury (SCI). Main outcome measures were rehabilitation LOS, discharge FIM™ scores and discharge setting. Injury measures were degree of impairment, acute LOS and rehabilitation admission FIM™ scores. Standard demographic measures were also collected.

Results:

The median rehabilitation LOS was 83 days and mean discharge FIM™ scores 102 for all patients. These differed by impairment (incomplete paraplegia LOS 43, FIM 117; complete paraplegia LOS 96, FIM 109; incomplete tetraplegia LOS 64, FIM 100; complete tetraplegia LOS 206, FIM 78). Patients discharged to the community (noncare facility) ranged from 93% with incomplete paraplegia to 73% with complete tetraplegia. For patients in the three AN-SNAP classes with the lowest FIM scores, the actual LOS was up to twice the estimated LOS. A large variability in discharge outcomes was found within individual AN-SNAP classes, despite similar FIM™ scores on admission.

Conclusions:

Rehabilitation outcomes differed substantially by impairment. The variability in outcomes for patients within the same AN-SNAP class questions the ability of this system to accurately predict LOS, and therefore cost of rehabilitation services, for patients with traumatic SCI in Australia.

Sponsorship:
Some of this research was supported by a grant from Queensland Health. Leigh Tooth was supported by a National Health and Medical Research Council of Australia Public Health Fellowship (#997032) while some of this research was undertaken.
Keyword Clinical neurology
Traumatic spinal cord injury
Length of stay
Discharge setting
Functional satus
Outcomes
Medical rehabilitation
Independence measure
Motor
Recovery
System
Q-Index Code C1
Institutional Status UQ

 
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Created: Wed, 15 Aug 2007, 11:34:56 EST