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Deutsch A, Burns J, Potelle J, Kessler A. Trends in the characteristics and outcomes of older patients with non-traumatic spinal cord injury treated in inpatient rehabilitation facilities: 2013-2018. J Spinal Cord Med 2024:1-11. [PMID: 38588027 DOI: 10.1080/10790268.2024.2335414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
OBJECTIVE To describe the characteristics and outcomes of older (≥ 65 years of age) patients with a non-traumatic spinal cord injury (NTSCI) treated in inpatient rehabilitation facilities (IRFs) between 2013 and 2018. DESIGN Observational study. SETTING IRFs in the United States. PARTICIPANTS 93,631 IRF Medicare stays for patients with NTSCI. INTERVENTIONS Not Applicable. MAIN OUTCOME MEASURES Length of stay, self-care and mobility function, discharge destination. RESULTS Between 2013 and 2018, the number of older (≥ 65 years of age) Medicare patients with a NTSCI treated in IRFs increased about 22.1 percent, from 14,149 to 17,275. In addition to the increase, patients' sociodemographic characteristics shifted to have a slightly higher percentage of patients aged 65-74 years, a slightly higher percentage of males, and slightly fewer patients who identified as Hispanic. There was also a trend of more patients in the higher acuity case-mix groups and comorbidities tiers, but the median length of stay remained 12 days across all years. The percent of patients discharged home or to a community-based setting varied from 73.7 to 75.2 without a trend, although discharge self-care and mobility function increased slightly across the years. CONCLUSIONS Between 2013 and 2018, the number of Medicare patients with NTSCI treated in IRFs increased by more than 22 percent. While patient complexity increased, the median length of stay remained 12 days across the years. Discharge self-care and mobility function increased slightly, and the percent of patients discharged home ranged from 73.7 to 75.2 across the years.
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Affiliation(s)
- Anne Deutsch
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Health Practice, RTI International, Waltham, Massachusetts, USA
| | - Jennifer Burns
- Center for Rehabilitation Outcomes Research, Shirley Ryan AbilityLab, Chicago, Illinois, USA
| | - John Potelle
- Health Practice, RTI International, Waltham, Massachusetts, USA
| | - Allison Kessler
- Health Practice, RTI International, Waltham, Massachusetts, USA
- Renee Crown Center for Spinal Cord Innovation, Shirley Ryan AbilityLab, Chicago, Illinois, USA
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Ponfick M. Outcome after post-acute spinal cord specific rehabilitation: a German single center study. Spinal Cord Ser Cases 2017; 3:17055. [PMID: 28890805 PMCID: PMC5587790 DOI: 10.1038/scsandc.2017.55] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 07/24/2017] [Accepted: 07/26/2017] [Indexed: 11/08/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE The objective of this study was to analyze single center outcome measures of spinal cord injury (SCI)-specific rehabilitation (SCISR) in Germany. SETTING The study was conducted at an SCI specialized rehabilitation center. METHODS Nonparametric tests for outcome description such as SCIM and length of stay. Logistic regression for outcome prediction was used. RESULTS One hundred and sixty patients (113 men, 47 women) with a mean age of 64.4 years were included. Non-traumatic etiologies, such as vascular diseases, tumors, infections or degenerative diseases accounted for 55.6% of SCI (89/160). Men experienced significantly more cervical lesions (P=0.02) and presented with lower SCIMstart values (P=0.04). Patients with AIS D (incomplete SCI) had significantly higher SCIMstart and SCIMend (P<0.01, each). Age correlated negatively with SCIMstart and SCIMend (r=-0.21; P<0.05; r=-0.21; P<0.05; respectively). The chance to reach an SCIMend ⩾50 points (milestone for starting post-primary rehabilitation) increased with every SCIM point at the beginning of rehabilitation by 12.2% (95% CI 7.3-17.3%) and for every day in rehabilitation by 1.4% (95% CI 0.5-2.3%). Every additional day in acute medical care, however, decreased the chance for this by 2.2% (95% CI -3.6 to -0.8%). CONCLUSIONS This is the first study giving outcomes for post-acute SCISR in Germany. The obtained data support that even in an older cohort, early admission to SCISR after SCI and longer LOSreha increases the chance for higher independence at the end of the rehabilitation period.
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Kennedy P, Hasson L. An audit of demographics and rehabilitation outcomes in non-traumatic spinal cord injury. Spinal Cord 2016; 54:1020-1024. [PMID: 27001132 DOI: 10.1038/sc.2016.12] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/13/2015] [Accepted: 12/10/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN Repeated measures, retrospective cohort study. OBJECTIVES To classify specific causes of injury in a cohort of non-traumatic spinal cord injury (NTSCI) patients, with the aim of exploring whether there are differences in demographics or rehabilitation outcomes depending on the cause of NTSCI. SETTING Tertiary care, spinal cord injury rehabilitation unit. METHODS Patients admitted to the unit with a non-traumatic SCI between July 2008 and April 2015 were considered for this study. Demographic information and rehabilitation outcomes were obtained from the Needs Assessment Checklist (NAC). NAC1 is completed within 4 weeks post mobilisation and NAC2 upon the patient moving to the pre-discharge ward. Data were obtained for 265 patients. RESULTS The most common causes were vertebral column degenerative disorders, infection and vascular disorders, which together accounted for 80% of all NTSCI in this sample. Patients with vertebral column degenerative disorders were less likely to have a complete injury than patients with infections or vascular disorders. There were differences in rehabilitation outcomes on several domains of the NAC. Overall, patients with an SCI caused by an infection have the highest needs (more dependent), and patients with vertebral column degenerative disorders have the lowest needs (more independent). CONCLUSION The relationship between non-traumatic cause of injury and rehabilitation outcomes may be mediated by severity of injury. Individuals with infection-related NTSCI are more likely to be complete, therefore, present more significant rehab needs, and lower rehabilitation outcomes particularly in physical health, activities of daily living and bowel management domains. This supports previous findings of Kay et al. and provides a possible explanation for the differences. This further informs future interventions.
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Affiliation(s)
- P Kennedy
- Department of Clinical Psychology, The National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire, UK.,Oxford Institute of Clinical Psychology Training, University of Oxford, Oxford, UK
| | - L Hasson
- Department of Clinical Psychology, The National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire, UK
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Fortin CD, Voth J, Jaglal SB, Craven BC. Inpatient rehabilitation outcomes in patients with malignant spinal cord compression compared to other non-traumatic spinal cord injury: A population based study. J Spinal Cord Med 2015; 38:754-64. [PMID: 25615237 PMCID: PMC4725809 DOI: 10.1179/2045772314y.0000000278] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To compare and describe demographic characteristics, clinical, and survival outcomes in patients admitted for inpatient rehabilitation following malignant spinal cord compression (MSCC) or other causes of non-traumatic spinal cord injury (NT-SCI). DESIGN A retrospective cohort design was employed, using data retrieved from administrative databases. SETTING Rehabilitation facilities or designated rehabilitation beds in Ontario, Canada, from April 2007 to March 2011. PARTICIPANTS Patients with incident diagnoses of MSCC (N = 143) or NT-SCI (N = 1,274) admitted for inpatient rehabilitation. OUTCOME MEASURES Demographic, impairment, functional outcome (as defined by the Functional Independence Measure (FIM)), discharge, healthcare utilization, survival, and tumor characteristics. RESULTS There was a significant improvement in the FIM from admission to discharge (mean change 20.1 ± 14.3, <0.001) in the MSCC cohort. NT-SCI patients demonstrated a higher FIM efficiency (1.2 ± 1.7 vs. 0.8 ± 0.8, <0.001) and higher total (24.0 ± 14.4 vs. 20.1 ± 14.3, <0.001) FIM gains relative to MSCC cases. However, there were no differences between the MSCC and NT-SCI cohorts in length of stay (34.6 ± 30.3 vs. 37.5 ± 35.2, P = 0.8) or discharge FIM (100.7 ± 19.6 vs. 103.3 ± 18.1, P = 0.1). Three-month, 1-year, and 3-year survival rates in the MSCC and NT-SCI cohorts were 76.2% vs. 97.6%, 46.2% vs. 93.7%, and 27.3% vs. 86.7%, respectively. The majority (65.0%) of patients with MSCC was discharged home and met their rehabilitation goals (75.5%) at comparable rates to patients with NT-SCI (69.7 and 81.3%). CONCLUSION Despite compromised survival, patients with MSCC make clinically significant functional gains and exhibit favorable discharge outcomes following inpatient rehabilitation. Current administrative data suggests the design and scope of inpatient rehabilitation services should reflect the unique survival-related prognostic factors in patients with MSCC.
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Affiliation(s)
| | - Jennifer Voth
- Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | | | - B. Catharine Craven
- Correspondence to: B. Catharine Craven, Toronto Rehabilitation Institute, Lyndhurst Centre, 520 Sutherland Drive, Toronto, ON M4G 3V9, Canada.
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Datto JP, Bastidas JC, Miller NL, Shah AK, Arheart KL, Marcillo AE, Dietrich WD, Pearse DD. Female Rats Demonstrate Improved Locomotor Recovery and Greater Preservation of White and Gray Matter after Traumatic Spinal Cord Injury Compared to Males. J Neurotrauma 2015; 32:1146-57. [PMID: 25715192 DOI: 10.1089/neu.2014.3702] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
The possibility of a gender-related difference in recovery after spinal cord injury (SCI) remains a controversial subject. Current empirical animal research lacks sizable test groups to definitively determine whether significant differences exist. Evaluating locomotor recovery variances between sexes following a precise, clinically relevant spinal cord contusion model can provide valuable insight into a possible gender-related advantage in outcome post-SCI. In the current study, we hypothesized that by employing larger sample sizes in a reproducible contusive SCI paradigm, subtle distinctions in locomotor recovery between sexes, if they exist, would be elucidated through a broad range of behavioral tests. During 13 weeks of functional assessment after a thoracic (T8) contusive SCI in rat, significant differences owing to gender existed for the Basso, Beattie, and Bresnahan score and CatWalk hindlimb swing, support four, and single stance analyses. Significant differences in locomotor performance were noticeable as early as 4 weeks post-SCI. Stereological tissue-volume analysis determined that females, more so than males, also exhibited greater volumes of preserved gray and white matter within the injured cord segment as well as more spared ventral white matter area at the center of the lesion. The stereological tissue analysis differences favoring females directly correlated with the female rats' greater functional improvement observed at endpoint.
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Affiliation(s)
- Jeffrey P Datto
- 1 The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine , Miami, Florida
| | - Johana C Bastidas
- 1 The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine , Miami, Florida
| | - Nicole L Miller
- 1 The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine , Miami, Florida
| | - Anna K Shah
- 1 The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine , Miami, Florida
| | - Kristopher L Arheart
- 2 The Departments of Public Health Sciences, University of Miami Miller School of Medicine , Miami, Florida
| | - Alexander E Marcillo
- 1 The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine , Miami, Florida
| | - W Dalton Dietrich
- 1 The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine , Miami, Florida.,3 The Department of Neurological Surgery, University of Miami Miller School of Medicine , Miami, Florida.,4 The Department of Cell Biology, University of Miami Miller School of Medicine , Miami, Florida.,5 The Department of Neurology, University of Miami Miller School of Medicine , Miami, Florida.,6 The Neuroscience Program, University of Miami Miller School of Medicine , Miami, Florida
| | - Damien D Pearse
- 1 The Miami Project to Cure Paralysis, University of Miami Miller School of Medicine , Miami, Florida.,3 The Department of Neurological Surgery, University of Miami Miller School of Medicine , Miami, Florida.,6 The Neuroscience Program, University of Miami Miller School of Medicine , Miami, Florida.,7 The Interdisciplinary Stem Cell Institute, University of Miami Miller School of Medicine , Miami, Florida
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6
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Rinkaewkan P, Kuptniratsaikul V. The effectiveness of inpatients rehabilitation for spinal cord patients in Siriraj hospital. Spinal Cord 2015; 53:591-7. [DOI: 10.1038/sc.2015.8] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 12/06/2014] [Accepted: 01/08/2015] [Indexed: 11/09/2022]
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Abstract
PURPOSE OF REVIEW Both acute and chronic spinal cord disorders present multisystem management problems to the clinician. This article highlights key issues associated with chronic spinal cord dysfunction. RECENT FINDINGS Advances in symptomatic management for chronic spinal cord dysfunction include use of botulinum toxin to manage detrusor hyperreflexia, pregabalin for management of neuropathic pain, and intensive locomotor training for improved walking ability in incomplete spinal cord injuries. SUMMARY The care of spinal cord dysfunction has advanced significantly over the past 2 decades. Management and treatment of neurologic and non-neurologic complications of chronic myelopathies ensure that each patient will be able to maximize their functional independence and quality of life.
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Altersbezogene Aspekte in der Neurourologie. Urologe A 2013; 52:785-92. [DOI: 10.1007/s00120-013-3188-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Abstract
Walking is possible for many patients with a spinal cord injury. Avenues enabling walking include braces, robotics and FES. Among the benefits are improved musculoskeletal and mental health, however unrealistic expectations may lead to negative changes in quality of life. Use rigorous assessment standards to gauge the improvement of walking during the rehabilitation process, but also yearly. Continued walking after discharge may be limited by challenges, such as lack of accessibility in and outside the home, and complications, such as shoulder pain or injuries from falls. It is critical to determine the risks and benefits of walking for each patient.
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Affiliation(s)
- Elizabeth C Hardin
- Motion Study Laboratory, Louis Stokes Cleveland VA Medical Center, Cleveland, OH 44106, USA.
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Kay E, Deutsch A, Chen D, Semik P, Rowles D. Effects of gender on inpatient rehabilitation outcomes in the elderly with incomplete paraplegia from nontraumatic spinal cord injury. J Spinal Cord Med 2010; 33:379-86. [PMID: 21061897 PMCID: PMC2964026 DOI: 10.1080/10790268.2010.11689716] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To examine gender differences in rehabilitation outcomes for patients with nontraumatic spinal cord injury. RESEARCH DESIGN Secondary analysis was conducted on Medicare beneficiary data from 65 to 74 year olds with incomplete paraplegia discharged from inpatient rehabilitation facilities in 2002 through 2005. MAIN OUTCOME MEASURES Length of stay, Functional Independence Measure instrument motor item and subscale scores on discharge, and discharge destination. RESULTS Among patients with degenerative spinal disease, men had significantly longer rehabilitation stays than women (P < 0.001). Men with degenerative spinal disease had significantly lower discharge Functional Independence Measure scores than women, indicating more dependence in self-care (P < 0.001) and mobility (P < 0.001). Among patients with degenerative spinal disease, men were less likely to walk (odds ratio = 0.58; 95% CI = 0.38-0.87) and less likely to be independent with bladder management (odds ratio = 0.44; 95% CI = 0.31-0.62). Among patients with vascular ischemia, men were more independent (B = 2.59; 99% CI = 0.42-4.76) in mobility than women. There were no gender differences in the malignant spinal tumors group. There were no gender differences in being discharged to a community-based residence. CONCLUSIONS Gender distributions varied by etiology. Gender differences were found in demographics, length of stay, and functional outcomes but not discharge destination. Men were more dependent than women at discharge in the etiology group with the least overall disability (degenerative spinal disease) and more independent in mobility than women at discharge in the etiology group with the most overall disability (vascular ischemia).
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Affiliation(s)
- Elizabeth Kay
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, Chicago, Illinois 60611, USA.
| | - Anne Deutsch
- Center for Rehabilitation Outcomes Research
,Department of Physical Medicine and Rehabilitation
,Institute for Health Care Studies, Northwestern University, Feinberg School of Medicine, Chicago, Illinois
| | - David Chen
- Spinal Cord Injury Program, Rehabilitation Institute of Chicago, Chicago, Illinois
,Spinal Cord Injury Program, Northwestern Memorial Hospital, Chicago, Illinois
,Department of Physical Medicine and Rehabilitation
| | | | - Diane Rowles
- Spinal Cord Injury Program, Rehabilitation Institute of Chicago, Chicago, Illinois
,Department of Physical Medicine and Rehabilitation
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