Sir Ludwig Guttmann Lecture: Trends in spinal cord injury rehabilitation outcomes from model systems in the United States: 1973–2006

Abstract

Study design: Consecutive case series with 5-year follow-up. Objective: To evaluate the spinal cord injury (SCI) model systems program in the United States by documenting improvements in treatment outcomes over time. Setting: SCI model systems throughout the United States. Methods: Initial data were collected on 24 332 patients injured between 1973 and 2006. Follow-up data were collected on 9225 of these patients 5 years post-injury. All data were grouped by calendar year. Descriptive statistics included means and percentages. Multiple linear or logistic regression was used to assess outcome trends after adjusting for demographics and injury severity. Results: Acute care and rehabilitation lengths of stay declined dramatically over time (Po0.01). Mean functional independence measure motor score at discharge and gain during rehabilitation decreased, whereas gain per day increased (Po0.01). The probability of neurologic improvement from admission to discharge increased. Odds of medical complications decreased during in-patient treatment, but increased post-discharge (Po0.05). Rehospitalizations declined over time (Po0.01). Community integration improved. First year mortality rates improved, but longer term mortality rates showed no improvement since 1982. Conclusions: Steady improvements have occurred for many treatment outcomes. Newer and more effective methods of prevention and treatment need to be developed to target those outcomes that have not improved and remain suboptimal.

Colonoscopy after spinal cord injury: a case–control study

“…2,10 An ageing background population and an independent increase in age at the time of injury account for a proportional increase in older patients with SCI. 1,10 An expected increase in the incidence of agerelated conditions requires a focus on chronic and preventative healthcare.…”

Clinical Algorithm for Improved Prediction of Ambulation and Patient Stratification after Incomplete Spinal Cord Injury

“…Among all subjects with SCI, 40-50% are ''motor incomplete '' (DeVivo, 2007) and classified as C or D on the ASIA Impairment Scale (AIS), depending on the degree of preserved motor function below the level of injury (International Standards of Neurological Classification, American Spinal Injury Association [ASIA]) (Marino et al, 2003).…”

Impact of benchmarking and clinical decision making tools on rehabilitation length of stay following spinal cord injury

“…Although LOS has been decreasing in many settings, 12,13 there is still considerable variability globally. 7,[12][13][14][15] Despite the importance of this issue, there has been little published regarding approaches to improving the efficiency of inpatient rehabilitation for SCI. One approach to improving outcomes is to introduce more efficacious therapeutic interventions; the typical emphasis of clinicians.…”