Rehabilitation of patients with spinal cord lesions in the Netherlands: an epidemiological study

Abstract

Very little is known about the occurrence of spinal cord lesions and results of the rehabilitation of patients with such lesions in the Netherlands. This study was conducted to describe the process of rehabilitation in the Dutch situation, to assess the incidence of spinal cord lesions in a regional rehabilitation centre and to characterise differences between traumatic and non-traumatic spinal cord lesions regarding age, level and extent of lesion. In this study 293 patients were included who were admitted to the rehabilitation centre between 1982 and 1993. Sixty-six per cent of this group came from the university hospital. The mean length of stay in the rehabilitation centre was 154 days. After completing the rehabilitation programme 94% of patients went home. Sixteen new SCI patients per million per year were admitted to the rehabilitation centre. Of our group 52% had a non-traumatic lesion, which concerned older patients with more incomplete lesions. In our opinion close collaboration between the university hospital and the rehabilitation centre is needed for optimal rehabilitation. Attention to independent living programmes and appropriate housing facilities can shorten the length of stay and increase the number of discharges of patients to their own environment. For patients with non-traumatic spinal cord lesions special programmes should be made available.

Characteristics, length of stay and functional outcome of patients with spinal cord injury in Dutch and Flemish rehabilitation centres

“…The male/ female ratio was slightly lower than that described in previous Dutch studies, 3,7 but lies within the range of 2.5:1 to 5.8:1 reported in international studies. 1,10 Mean age in this study was relatively high, but also within the range reported in the literature (31-50 years).…”

“…Lesions of vascular origin accounted for a smaller proportion in a study from Turkey (8%), 2 but for about a quarter of non-traumatic lesions in other publications. 7,12,13 An inflammatory cause was found in 17.2% of the patients with SCI in our study, compared to 19.5% reported elsewhere. 12 Not all studies described the same categories of aetiologies, making it difficult to draw comparisons between different studies.…”

“…LOS in this study was longer than those reported in studies from the United States (mean 60.8 days), 14 Australia (median 83 days), 15 Italy (mean 143.1 for traumatic and 91.7 days for non-traumatic injuries) 8 and a previous retrospective Dutch Characteristics of Dutch and Flemish patients with SCI R Osterthun et al study. 7 It was more or less comparable to LOS in Israel 16 and shorter than that reported in Japan. 17 Another Dutch study reported much longer mean and median LOS, viz.…”

“…7 Lower percentages were found in studies from Turkey (32.5%), 2 Italy (25%) 8 and the United States (39%). 9 This difference might be attributed to the low incidence of traumatic SCI in the Netherlands 3 or to a greater readiness of specialized Dutch rehabilitation centres to admit patients with non-traumatic SCI compared to rehabilitation centres elsewhere.…”

“…2,7-9,12,13 Percentages of women reported in the literature (36.6-58%) also resembled our findings, as did those for paraplegia (63.6-82.5%) and incomplete lesions (68.6-91%). 2,[7][8][9]12,13 The most common non-traumatic aetiologies in this study were vascular diseases, spinal degeneration and tumours (benign and malignant), which all accounted for over a quarter of non-traumatic lesions. Tumours and spinal degeneration were also a substantial category of nontraumatic SCI in other studies (20.1-36.4% 2,8,9,12,13 and 18-29%, 2,7,12,13 respectively).…”