Citation

Truchon C, Fallah N, Santos A, Vachon J, Noonan VK, Cheng CL. J. Neurotrauma 2017; 34(20): 2901-2909.

Affiliation

Rick Hansen Institute, Vancouver, British Columbia, Canada ; ccheng@rickhanseninstitute.org.

Copyright

(Copyright © 2017, Mary Ann Liebert Publishers)

DOI

10.1089/neu.2016.4932

PMID

28493787

Abstract

Evidence-based planning of rehabilitation interventions is important to improving cost efficiency while maintaining patient and system outcomes. This paper aims to explore the relationship between rehabilitation therapy, functional outcome, bed utilization, and care costs after traumatic spinal cord injury (tSCI). A retrospective review of 262 persons with tSCI admitted to an inpatient rehabilitation facility from 2005-2011 was conducted. Treatment variables and outcome measures included length of stay (LOS), days to rehabilitation (onset), hours and intensity of therapy, and Functional Independence Measure (FIM). Polynomial regression models and generalized additive models were applied to explore relationship between therapy hours and motor FIM change. Simulation modeling was used to assess the impact of hypothetically increasing therapy intensity. Patients were grouped by injury as: C1-4 AIS ABC; C5-8 AIS ABC; T1-S5 AIS ABC; and AIS D. The sample was 85% male, mean age=45.9, median LOS=102 days and mean therapy intensity=5.7 hours/week. Motor FIM change was positively associated with total hours of therapy (β=0.40, p<0.0001) up to a certain time point, adjusted for age, gender, injury, complications and rehabilitation onset. Hypothetically increasing therapy intensity by 50% and 100% resulted in average motor FIM efficiency gain ranging between 0.04-0.07 and 0.1-0.17, respectively, across injury groups. The hypothetical changes resulted in reductions in the average LOS and bed utilization rate, translating to cost savings of $20,000 and $50,000 (2011 CDN) for the +50% and +100% scenarios, respectively. The results highlight the importance of monitoring functional change throughout rehabilitation after tSCI and the need for customized therapeutic strategies.

Language: en

Keywords

REHABILITATION; TRAUMATIC SPINAL CORD INJURY; spinal cord injury