Rehabilitation outcomes in people with pre-morbid mental health disorders following spinal cord injury

Abstract

All patients were involved in a multidisciplinary Goal Planning and Needs Assessment Rehabilitation Programme. Rehabilitation outcomes were measured using the Needs Assessment Checklist (NAC), which has been specifically designed for use with people with SCI. It is a reliable and valid clinical assessment tool, which provides a means to assess and facilitate the delivery of an individually tailored rehabilitation programme. Results: No significant difference was found between the MHD and non-MHD groups for rehabilitation outcomes. The MHD group showed higher achieved independence scores in psychology for the first needs assessment. Overall, both groups were found to make significant improvements in their level of independence for all nine areas of need between the first and second NAC administration. Conclusion: Results suggest that rehabilitation can be tailored to meet the individual needs of patients with SCI having MHD; however, further research comparing these outcomes with other rehabilitation approaches is required. The function of timely psychological support for MHD patients on admission to the NSIC has been suggested as a potential explanation for rehabilitation performance. Most importantly, rehabilitation outcomes of patients with MHD have not been found to differ significantly compared with those without MHD.

Spinal cord injury rehabilitation and mental health, SCReaM

“…Overall, there was no significant difference for the discharge SCIM between the cases and controls, which answers our second question-do people with MHD have poorer outcomes from SCI rehabilitation than those without MHD? This supports the research by Kennedy et al 5 in 2009 who demonstrated improving scores of the Needs Assessment Checklist in patients with MHD.…”

“…The prevalence of pre-existing MHD among patients in this sample was substantially larger than previous research has indicated. 5 This may be related to the population coming from the London area, given previous evidence of a link between urbanicity and MHD rates and morbidity. 14,15 Alternatively, it may be in other settings, MHD is underrecognised or people with MHD are not being admitted for rehabilitation.…”

“…3 Previous research looking specifically at MHD and spinal cord injury outcomes is limited but has, in general, found that outcomes do not greatly differ between those with pre-existing MHD and those without. 5 These studies have been significantly limited for a number of reasons. First, they have had small sample sizes.…”

“…Third, they have not used matched controls or compared outcomes with those empirically expected. [5][6][7][8] We investigated rehabilitation outcomes of those discharged from the London SCI Centre (LSCIC) from April 2007 to April 2013 with a pre-existing MHD and compared outcomes with matched controls. A retrospective matched case-control study design was used to compare the Spinal Cord Independence Measure III (SCIM III) between those with an SCI and pre-existing MHD and those without, and compared with published expected outcomes; the multicentre study by Aidinoff et al 1 found that there is a negative correlation between the SCI level and 'discharge functional-score'.…”

Building and Sustaining Inpatient-Clinician Collaboration in Spinal Cord Injury Rehabilitation: A Case Example Using the Stoke Mandeville Spinal Needs Assessment Checklist (SMS-NAC) and Goal Planning Programme

“…This research enabled subsequent mapping to develop [41] and international audits [42] based on the findings. Outcome data from the NAC (now SMS-NAC) has also been used to evidence the impact of the programme, examining whether goal achievement varies for a range of potentially marginalised groups, including older adults [43] and people with pre-injury mental health needs [44], comparing outcome with respect to ethnicity [45], injury aetiology [46][47][48] and psychological need [49]. The breadth of the domains and items on the NAC (now SMS-NAC) has enabled self-management concerns such as skin knowledge skills development through rehabilitation to be examined [19,50,51] and issues such as pain [52] and return-towork intentions to be tracked [53], with recent reporting of the mediating relationship that appraisals provide for mood and self-management on the skin and bladder domains [54].…”