International comparison of the organisation of rehabilitation services and systems of care for patients with spinal cord injury

New, Peter W; Townson, Andrea; Scivoletto, Giorgio; Post, Marcel W.M.; Eriks‐Hoogland, Inge; Gupta, Anupam; Smith, Éimear; Reeves, Ronald K.; Gill, Zaheerahmad

doi:10.1038/sc.2012.82

Cited by 41 publications

(32 citation statements)

References 25 publications

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“…This is because of the variability in hospital reimbursements systems and the organisation of care for patients with SCD that can influence length of stay. 22 It is important to emphasise, however, that SRUs from many different countries have also reported problems with barriers to discharge. 14 Furthermore, unless discharge barriers are measured, they cannot be improved.…”

Section: Discussionmentioning

confidence: 99%

Prospective study of barriers to discharge from a spinal cord injury rehabilitation unit

New

2014

Spinal Cord

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Prospective study of barriers to discharge from a spinal cord injury rehabilitation unit PW New 1,2Study design: Prospective open cohort case series of consecutive patients admitted with spinal cord damage to a spinal rehabilitation unit (SRU) between 1 January 2008 and 31 July 2013. Objectives: Measure the prevalence of barriers to discharge, their reasons and resulting additional unnecessary days in hospital. Setting: SRU, Victoria, Australia. Methods: Consecutive SRU admissions had prospective documentation of key clinical and demographic characteristics, the occurrence of any discharge barrier, the cause(s) and duration of unnecessary hospitalisation. Results: There were 235 patients in the study; 138 (58.7%) were male and the median age was 63 years. Eighty-six (36.6%) patients had a discharge barrier. The most common reasons for a discharge barrier were: waiting for approval for long-term and supported care or services, residential care, home modifications, family deliberations regarding discharge planning and the provision of equipment necessary for discharge. The reasons accounting for the greatest number of additional hospital days were: home modifications, residential care, equipment necessary for discharge, waiting for approval for long-term and supported care or services and accommodation for people unable to return to their previous residence without readily available alternatives. Over the study period 17.5% (3176/18 184) of all bed-days were occupied by patients deemed to be clinically ready for discharge from the SRU but who had a discharge barrier. Conclusions: Barriers to discharge from rehabilitation for patients with spinal cord damage are common, substantial, and represent an important opportunity for health systems improvement.

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Section: Discussionmentioning

confidence: 99%

Prospective study of barriers to discharge from a spinal cord injury rehabilitation unit

New

2014

Spinal Cord

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“…[19][20][21] It has been stated that 'patients not cared for in specialised units may have worse outcomes, such as greater disability at discharge, longer hospital admission, higher rates of discharge to nursing homes and more preventable complications (p. 34)' . 29 Furthermore, a survey of physicians found that 85% believed NT-SCI patients should be rehabilitated in an SIC or a neurological rehabilitation unit specialising in NT-SCI. 19 An editorial in Spinal Cord stated that NT-SCI patients should have equal access to the care provided by SICs and made the valid point that a matched-case-control study to demonstrate this would not be ethical.…”

Section: Discussionmentioning

confidence: 99%

Traumatic versus non-traumatic spinal cord injuries: are there differential rehabilitation outcomes?

Kennedy

Chessell

2013

Spinal Cord

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Study design: Retrospective case review. Objectives: To compare the rehabilitation outcomes between patients with traumatic spinal cord injuries and patients with nontraumatic spinal cord injuries, using The Needs Assessment Checklist (NAC), to observe if both the groups benefit from the same rehabilitation programme. Setting: Tertiary care, spinal cord injury rehabilitation unit (National Spinal Injuries Centre), Stoke Mandeville Hospital, UK. Methods: Information obtained with the NAC at two time points during patients' rehabilitation was examined. Statistical analysis investigated the rehabilitation outcomes both between and within groups. Results: Initial differences were observed on admission between patients with traumatic and non-traumatic spinal cord injuries in five of the ten rehabilitation domains measured, with patients with non-traumatic injuries presenting with better outcomes. At a later stage in patients' rehabilitation, however, differences between the groups had lessened. Furthermore, the results demonstrated that the whole cohort made significant improvements in all the ten rehabilitation domains, with the same finding evident for both patients with traumatic and patients with non-traumatic spinal cord injuries. Conclusion: Patients with traumatic spinal cord injuries and patients with non-traumatic spinal cord injuries benefitted from the same rehabilitation programme in a spinal injury centre, making significant improvements in all ten rehabilitation domains measured, suggesting that it is effective to admit and rehabilitate patients with injuries resulting from both traumatic and non-traumatic aetiologies in the same specialised setting.

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“…5,6 Despite the known importance of employment for individuals with SCI, there is a lack of research into the effectiveness of interventions Internationally, including in Australia, VR is traditionally not provided until after the completion of inpatient rehabilitation in spinal units where services are primarily focused on physical rehabilitation. 9,10 Where vocational services are available, they are typically delivered after the patient is discharged from the hospital with referral to a community provider. 10 At the time of discharge, many individuals have preconceived notions of their work ability as employment decisions are often made early during the inpatient stay and are influenced by factors such as self-confidence, perceptions of physical capacity to resume work, uncertainty about job options, and employer expectations.…”

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confidence: 99%

Early Access to Vocational Rehabilitation for Inpatients with Spinal Cord Injury: A Qualitative Study of Patients' Perceptions

Ramakrishnan

Johnston

Garth

et al. 2016

Topics in Spinal Cord Injury Rehabilitation

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Background: A pilot early-intervention vocational rehabilitation program was conducted in Sydney, Australia, over a 2-year period. It was postulated that the early provision of integrated vocational rehabilitation services in the hospital settings for newly injured individuals would be well received and result in better employment and psychosocial health outcomes. Objective: The objective of this qualitative inquiry was to examine the perspectives of program participants who had completed the intervention about the timeliness, perceived value, and critical elements of the early intervention. Methods: A convenience sample of participants was selected by accessibility; participants were interviewed individually after discharge using a semi-structured approach. Transcripts of the interviews were created via audio recordings; interviews were transcribed verbatim, and the contents were analyzed thematically. Results: Thirteen participants aged from 19 to 60 years with varying levels of impairment and vocational backgrounds were interviewed from 7 to 21 months post injury. Overall, the early introduction of vocational rehabilitation services was well received and viewed positively. Emerging themes include sense of direction and distraction, advocacy, and support, with "hope" (early after injury) emerging as the overarching theme. Criticisms voiced about the program were that it was offered too early in the intensive care unit and there were competing interests and information overload in the early recovery phase. Conclusions: Vocational rehabilitation provided during inpatient rehabilitation appears appropriate, important, and valuable from patients' perspective. Early engagement results in feelings of hope and encourages patients to see the possibility of returning to work or education very early after injury, and it allows rehabilitation to be directed accordingly.

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International comparison of the organisation of rehabilitation services and systems of care for patients with spinal cord injury

Cited by 41 publications

References 25 publications

Prospective study of barriers to discharge from a spinal cord injury rehabilitation unit

Prospective study of barriers to discharge from a spinal cord injury rehabilitation unit

Traumatic versus non-traumatic spinal cord injuries: are there differential rehabilitation outcomes?

Early Access to Vocational Rehabilitation for Inpatients with Spinal Cord Injury: A Qualitative Study of Patients' Perceptions

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