Relationship of occupational therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: The SCIRehab Project

Abstract

Background/objective: Describe associations of occupational therapy (OT) interventions delivered during inpatient spinal cord injury (SCI) rehabilitation and patient characteristics with outcomes at the time of discharge and 1-year post-injury. Methods: Occupational therapists at six inpatient rehabilitation centers documented detailed information about treatment provided. Least squares regression modeling was used to predict outcomes at discharge and 1-year injury anniversary for a 75% subset; models were validated with the remaining 25%. Functional outcomes for injury subgroups (motor complete low tetraplegia and motor complete paraplegia) also were examined. Results: OT treatment variables explain a small amount of variation in Functional Independence Measure (FIM) outcomes for the full sample and significantly more in two functionally homogeneous subgroups. For patients with motor complete paraplegia, more time spent in clothing management and hygiene related to toileting was a strong predictor of higher scores on the lower body items of the self-care component of the discharge motor FIM. Among patients with motor complete low tetraplegia, higher scores for the FIM lower body selfcare items were associated with more time spent on lower body dressing, manual wheelchair mobility training, and bathing training. Active patient participation during OT treatment sessions also was predictive of FIM and other outcomes. Conclusion: OT treatments add to explained variance (in addition to patient characteristics) for multiple outcomes. The impact of OT treatment on functional outcomes is more evident when examining more homogeneous patient groupings and outcomes specific to the groupings. Note: This is the third of nine articles in the SCIRehab series.

Impact of Spatial Neglect on Stroke Rehabilitation: Evidence From the Setting of an Inpatient Rehabilitation Facility

“…1 At the rehabilitation facility where the current study took place, there was no protocol or procedure for assigning rehabilitative interventions to address spatial neglect specifically. Studies examining whether differences in the way usual and standard care is administered accounts for some of the variation in outcomes have been done in spinal cord injury, 43 and future studies of these differences in rehabilitation in stroke patients with spatial neglect may be appropriate.…”

Racial and Ethnic Disparities in Functioning at Discharge and Follow-Up Among Patients With Motor Complete Spinal Cord Injury

“…Functional outcomes are the key predictors of SCI health status, community integration/participation, and quality of life, as well as quality indicators of inpatient rehabilitation facilities. 22,23 Self-care and mobility are key domains of SCI rehabilitation used in the classification of therapeutic interventions 24–26 as well as constructs of commonly used rehabilitation outcome measures, such as the FIM. 27–29 …”

Comparative Effective, Covariates, Complex Treatment, and Complex Outcomes

“…Adding site identity for each of the 6 sites involved boosted this to 73% to 78% and 54% to 62%, respectively. [2][3][4][5] Thus, unexplained outcome variability in the article by Dahdah et al may be due to missing baseline covariates or poorly performing covariates rather than differences in treatments provided.…”