Psychology treatment time during inpatient spinal cord injury rehabilitation

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Background/objective: Length of stay (LOS) for rehabilitation treatment after spinal cord injury (SCI) has been documented extensively. However, there is almost no published research on the nature, extent, or intensity of the various treatments patients receive during their stay. This study aims at providing such information on a large sample of patients treated by specialty rehabilitation inpatient programs. Methods: Six hundred patients with traumatic SCI admitted to six rehabilitation centers were enrolled. Time spent on various therapeutic activities was documented by each rehabilitation clinician after each patient encounter. Patients were grouped by neurologic level and completeness of injury. Total time spent by each rehabilitation discipline over a patient's stay and total minutes of treatment per week were calculated. Ordinary least squares stepwise regression models were used to identify patient and injury characteristics associated with time spent in rehabilitation treatment overall and within each discipline. Results: Average LOS was 55 days (standard deviation 37), during which 180 (106) hours of treatment were received, or 24 (5) hours per week. Extensive variation was found in the amount of treatment received, between and within neurologic groups. Total hours of treatment provided throughout a patient's stay were primarily determined by LOS, which in turn was primarily predicted by medical acuity. Variation in minutes per week of treatment delivered by individual disciplines was predicted poorly by patient and injury characteristics. Conclusions: Variations between and within SCI rehabilitation patient groups in LOS, minutes of treatment per week overall, and for each rehabilitation discipline are large. Variation in treatment intensity was not well explained by patient and injury characteristics. In accordance with practice-based evidence methodology, the next step in the SCIRehab study will be to determine which treatment interventions are related with positive outcomes (at 1 year post injury), after controlling for patient and injury differences.

Section: Discussionmentioning

confidence: 99%

Inpatient treatment time across disciplines in spinal cord injury rehabilitation

Whiteneck

Gassaway²,

Dijkers

et al. 2011

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“…They used handheld personal digital assistants to record service details after each patient encounter. 34,35 As described in…”

Section: Service Characteristicsmentioning

confidence: 99%

Relationship of psychology inpatient rehabilitation services and patient characteristics to outcomes following spinal cord injury: The SCIRehab Project

Heinemann

Wilson

Huston

et al. 2012

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Context and objective:To evaluate the effects of psychological interventions on rehabilitation outcomes, including residence and functional status at discharge, and residence, school attendance, or employment, and physical, social, occupational, and mobility aspects of participation 1 year after spinal cord injury (SCI). Design: Prospective observational cohort study. Setting: Six inpatient rehabilitation facilities in the United States. Participants: Inpatients with SCI 12 years of age and older. Interventions: Usual rehabilitation care. Outcome measures: Functional Independence Measure at rehabilitation discharge and 1-year injury anniversary; discharge destination and residence at 1-year anniversary; Craig Handicap Assessment and Reporting Technique, Diener Satisfaction with Life Scale, Patient Health Questionnaire, employment or school attendance, rehospitalization, and occurrence of a pressure ulcer at 1-year anniversary. Results: More time in psycho-educational interventions was associated with better function, discharge to home, home residence at 1 year, and the absence of pressure ulcers at 1 year. More psychotherapeutic sessions focusing on processing emotions and/or locus of control were associated with poorer function at discharge and 1 year, less physical independence and community mobility, lower satisfaction with life, and the presence of pressure sores at 1 year. Conclusions: Psychological services are an important component of comprehensive medical rehabilitation and tailored to patient needs and readiness to benefit from rehabilitation. Services focused on remediating deficits tend to be associated with negative outcomes, while services intended to foster adjustment and growth tend to be associated with favorable outcomes. Further research is needed to determine the optimal type and timing of psychological services during inpatient rehabilitation based on individuals' strengths and vulnerabilities. Note: This is the sixth in this third series of SCIRehab articles.

“…An earlier set of papers in this journal reported on the predictors of therapy hours by discipline 6 and hours of major therapy type within each discipline. [18][19][20][21][22][23][24] Rehabilitation outcomes are multi-determined, and the nature and quantity of therapies may have a limited role in shaping outcomes. An extensive literature has explored the relationship of various outcomes, especially functional status, to level and completeness of injury, 25 gender, 26 age, 27,28 race/ethnic group, 29 and co-morbidities.…”

Section: Introductionmentioning

confidence: 99%

Relationship of patient characteristics and rehabilitation services to outcomes following spinal cord injury: The SCIRehab Project

Whiteneck

Gassaway²,

Dijkers

et al. 2012

Self Cite

Patient characteristics explain a large proportion of variation in multiple outcomes after inpatient rehabilitation. The total amount of treatment received during rehabilitation from each of seven disciplines explains little additional variance. Reasons for this and the phenomenon that sometimes more hours of service predict poorer outcome, need additional study. Note: This is the first of nine articles in the SCIRehab series.