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

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• 作者：Kurt R. Herzer ; PhD ; MSc^a ; ^{kherzer@jhmi.edu" class="auth_mail" title="E-mail the corresponding author} ; Yuying Chen ; MD ; PhD^b ; Allen W. Heinemann ; PhD^c ; ^d ; Marlis Gonzá ; lez-Ferná ; ndez ; MD ; PhD^e
• 关键词：Models ; econometric ; Outcome assessment (health care) ; Rehabilitation ; Spinal cord injuries
• 刊名：Archives of Physical Medicine and Rehabilitation
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：97
• 期：10
• 页码：1620-1627.e4
• 全文大小：329 K

文摘

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.