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Richard-Denis A, Dionne A, Mputu PM, Mac-Thiong JM. Do all patients with functional motor-incomplete (AIS-D) traumatic spinal cord injury need specialized inpatient functional rehabilitation? A prospective observational cohort study proposing clinical criteria for home-based rehabilitation after acute care. J Spinal Cord Med 2023:1-12. [PMID: 37083554 DOI: 10.1080/10790268.2023.2200354] [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: 04/22/2023] Open
Abstract
CONTEXT/OBJECTIVE Functional motor-incomplete AIS-D traumatic spinal cord injury (tSCI) represents an important growing population in neuro-traumatology. There is thus an important need for establishing strategies to optimize SCI rehabilitation resources. This study aims at proposing eligibility criteria to select individuals who could be discharged home (home-based rehabilitation) after acute care following an AIS-D tSCI and investigate its impact on the long-term functional status and quality of life (QOL), as compared to transfer to inpatient functional rehabilitation (IFR) resources. DESIGN An observational prospective cohort study. SETTING A single Level-1 specialized trauma center. PARTICIPANTS 213 individuals sustaining an AIS-D tSCI. INTERVENTIONS Home-based rehabilitation based on clinical specific criteria to be assessed by the acute care team. OUTCOME MEASURES Functional status and QOL as assessed by the Spinal Cord Independence Measure version 3 and WHOQOL-BREF questionnaire one year following the injury, respectively. RESULTS A total 37.9% of individuals fulfilled proposed criteria for home-based rehabilitation after acute care. As expected, this group was significantly younger, experienced lesser comorbidities and acute complications, and showed higher motor and sensory function compared to the IFR group. Home-rehabilitation was associated with a higher long-term functional status, physical and psychological QOL, when accounting for relevant confounding factors after an acute AIS-D tSCI. There was no readmission due to failure of home-based rehabilitation. CONCLUSION Home-based rehabilitation in selected individuals sustaining an acute AIS-D tSCI is a safe and interesting strategy to optimize the long-term outcome in terms of functional recovery, physical and psychological QOL, as well as to optimize inpatient rehabilitation resources. The proposed eligibility criteria can be used by the acute care team to select the optimal discharge orientation in this important subpopulation.
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Affiliation(s)
- Andréane Richard-Denis
- Department of medicine, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche du CIUSSS Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Institut universitaire sur la réadaptation en déficience physique de Montreal, Montreal, Québec, Canada
| | - Antoine Dionne
- Department of medicine, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche du CIUSSS Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Pascal Mputu Mputu
- Department of medicine, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
- Centre de recherche du CIUSSS Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
| | - Jean-Marc Mac-Thiong
- Centre de recherche du CIUSSS Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada
- Department of orthopaedic surgery, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada
- Sainte-Justine University Hospital Research Center, Montreal, Quebec, Canada
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Does Wait Time During Acute Care for Transfer to Rehabilitation Admission Impact the Outcomes After a Traumatic Spinal Cord Injury?: A Retrospective Cohort Study. Am J Phys Med Rehabil 2022; 101:1122-1128. [PMID: 35213398 DOI: 10.1097/phm.0000000000001992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND The objective of this study was to determine the impact of wait time in acute care for inpatient functional rehabilitation admission on the inpatient functional rehabilitation length of stay and functional outcome after a traumatic spinal cord injury. METHODS A retrospective cohort including 277 patients admitted to a single level 1 spinal cord injury acute care center was completed. Partial correlations were used between wait time (in days) for transfer to inpatient functional rehabilitation, the inpatient functional rehabilitation length of stay, and the Spinal Cord Independence Measure total score in the chronic period, adjusting for confounding variables. Stratified analyses were carried out based on the age group and severity of the injury. RESULTS Patients had to wait a mean of 7.3 ± 6.4 days (median = 6 days, interquartile range = 2-10 days, max = 29 days) for inpatient functional rehabilitation admission after rehabilitation readiness, which was not associated with the outcomes when adjusted ( P > 0.05). However, individuals 65 yrs or older with a motor-complete injury showed a lower functional status when exposed to wait time for transfer ( r = -0.87, P = 0.02). CONCLUSIONS Wait time up to 29 days may have no impact on the inpatient functional rehabilitation length of stay nor functional outcome after traumatic spinal cord injury. However, additional resources and/or prioritization should be considered for vulnerable subgroups.
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Warren N, Walford K, Susilo A, New PW. Emotional Consequences of Delays in Spinal Rehabilitation Unit Admission or Discharge: A Qualitative Study on the Importance of Communication. Top Spinal Cord Inj Rehabil 2018; 24:54-62. [PMID: 29434461 DOI: 10.1310/sci17-00026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Objective: To explore the influence of health communications on the emotional consequences of delays in transfer from acute hospital into a spinal rehabilitation unit (SRU) or delays in discharge from SRU. Methods: Semi-structured interviews were conducted in this exploratory, thematic qualitative research design in an SRU, Melbourne, Australia. Results: Six patients experienced delay in admission to (n = 4) or discharge from (n = 3) the SRU, with one person experiencing both an admission and discharge delay. Median admission delay was 41.5 days, primarily related to bed availability and staffing issues. Participants experiencing a delay in transfer from the acute hospital reported feelings of uncertainty, frustration, disappointment, and concern due to a perception that their functional recovery was compromised because of delayed access to specialist rehabilitation. Psychological issues were less common than emotional responses. One participant spent some of the delay period waiting for admission to the SRU in a non-spinal rehabilitation unit and reported no concerns about his recovery. Median discharge delay was 27 days, largely due to a wait in obtaining funding for equipment. Emotional and psychological responses to delayed discharge, particularly frustration, appeared to be influenced by having a sense of control over the discharge process. Conclusion: Patients' experiences during the delay periods partially mitigated the emotional and psychological consequences of a delayed admission or discharge on their psychological well-being. Locus of control, where participants reported being able to effect some influence on their situation, appeared to moderate their emotional state. The findings suggest that clinicians can draw on the concept of control to better support patients through periods of delay.
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Affiliation(s)
- Narelle Warren
- School of Social Sciences and Psychology Department, Alfred Hospital, Monash University, Victoria, Australia
| | - Karin Walford
- School of Psychological Science, Monash University, Victoria, Australia
| | - Annisha Susilo
- School of Psychological Science, Monash University, Victoria, Australia
| | - Peter Wayne New
- Spinal Rehabilitation Service, Caulfield Hospital, Alfred Health, Caulfield, Victoria, Australia.,Epworth-Monash Rehabilitation Medicine Unit, Southern Medical School, Monash University, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Victoria, Australia
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Burns AS, Santos A, Cheng CL, Chan E, Fallah N, Atkins D, Dvorak MF, Ho C, Ahn H, Paquet J, Kwon BK, Noonan VK. Understanding Length of Stay after Spinal Cord Injury: Insights and Limitations from the Access to Care and Timing Project. J Neurotrauma 2017; 34:2910-2916. [PMID: 28245734 PMCID: PMC5653133 DOI: 10.1089/neu.2016.4935] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Costs associated with initial hospitalization following spinal cord injury (SCI) are substantial, and a major driver of costs is the length of stay (LOS); that is, the time that the injured individual remains hospitalized prior to community reintegration. Our aim was to study the factors and variables that contribute to LOS following traumatic SCI. Modeling (process mapping of the SCI healthcare delivery system in Canada and discrete event simulation) and regression analysis using a national registry of individuals with acute traumatic SCI in Canada, existing databases, and peer-reviewed literature were used to examine the driver of LOS following traumatic SCI. In different jurisdictions, there is considerable variation in the definitions and methods used to determine LOS following SCI. System LOS can be subdivided into subcomponents, and progression through these is not unidirectional. Modeling reveals that healthcare organization and processes are important contributors to differences in LOS independent of patient demographics and injury characteristics. Future research is required to identify and improve understanding of contributors to LOS following traumatic SCI. This will help enhance system performance. Work in this area will be facilitated by the adoption of common terminology and definitions, as well as by the use of simulations and modeling.
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Affiliation(s)
- Anthony S Burns
- 1 Division of Physiatry, Department of Medicine, University of Toronto , Toronto Ontario, Canada
| | - Argelio Santos
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | | | - Elaine Chan
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | - Nader Fallah
- 2 Rick Hansen Institute , Vancouver, British Columbia, Canada
| | - Derek Atkins
- 3 Operations and Logistics Division, Sauder School of Business, University of British Columbia , Vancouver, British Columbia, Canada
| | - Marcel F Dvorak
- 4 Department of Orthopaedics, University of British Columbia , Vancouver, British Columbia, Canada
| | - Chester Ho
- 5 Division of Physical Medicine & Rehabilitation, Department of Clinical Neurosciences, University of Calgary , Calgary, Alberta, Canada
| | - Henry Ahn
- 6 University of Toronto Spine Program , Toronto, Ontario, Canada
| | | | - Brian K Kwon
- 4 Department of Orthopaedics, University of British Columbia , Vancouver, British Columbia, Canada
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Donovan L, Francis L, Muter P, Nevin S, Warren R. Spinal cord injuries: overcoming barriers to seamless care for patients. ACTA ACUST UNITED AC 2017; 26:324-330. [PMID: 28345977 DOI: 10.12968/bjon.2017.26.6.324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
| | - Lee Francis
- Spinal Specialist Nurse, North West Regional Spinal Injuries Centre, Southport
| | - Paula Muter
- Clinical Nurse Specialist, Princes Royal Spinal Cord Injuries Centre, Sheffield Teaching Hospitals
| | - Sheila Nevin
- Ward Manager, Musgrave Park Hospital, Belfast Health and Social Care Trust, NI
| | - Rebecca Warren
- Nurse, Ward Manager, Midland Centre for Spinal Injuries, Oswestry
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Time-series analysis of the barriers for admission into a spinal rehabilitation unit. Spinal Cord 2015; 54:126-31. [PMID: 26099216 DOI: 10.1038/sc.2015.108] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 04/17/2015] [Accepted: 05/25/2015] [Indexed: 11/09/2022]
Abstract
STUDY DESIGN This is a prospective open-cohort case series. OBJECTIVES The objective of this study was to assess changes over time in the duration of key acute hospital process barriers for patients with spinal cord damage (SCD) from admission until transfer into spinal rehabilitation unit (SRU) or other destinations. SETTING The study was conducted in Acute hospitals, Victoria, Australia (2006-2013). METHODS Duration of the following discrete sequential processes was measured: acute hospital admission until referral to SRU, referral until SRU assessment, SRU assessment until ready for SRU transfer and ready for transfer until SRU admission. Time-series analysis was performed using a generalised additive model (GAM). Seasonality of non-traumatic spinal cord dysfunction (SCDys) was examined. RESULTS GAM analysis shows that the waiting time for admission into SRU was significantly (P<0.001) longer for patients who were female, who had tetraplegia, who were motor complete, had a pelvic pressure ulcer and who were referred from another health network. Age had a non-linear effect on the duration of waiting for transfer from acute hospital to SRU and both the acute hospital and SRU length of stay (LOS). The duration patients spent waiting for SRU admission increased over the study period. There was an increase in the number of referrals over the study period and an increase in the number of patients accepted but not admitted into the SRU. There was no notable seasonal influence on the referral of patients with SCDys. CONCLUSIONS Time-series analysis provides additional insights into changes in the waiting times for SRU admission and the LOS in hospital for patients with SCD.
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Prospective study of barriers to discharge from a spinal cord injury rehabilitation unit. Spinal Cord 2014; 53:358-62. [DOI: 10.1038/sc.2014.166] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2014] [Revised: 08/20/2014] [Accepted: 08/27/2014] [Indexed: 11/08/2022]
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