TY - JOUR
T1 - Factors complicating treatment sessions in spinal cord injury rehabilitation
T2 - Nature, frequency, and consequences
AU - Dijkers, Marcel P.
AU - Zanca, Jeanne M.
N1 - Funding Information:
Supported in part by Craig Hospital (grant no. H133A060103 ) and the National Institute on Disability and Rehabilitation Research , Office of Special Education Services , Department of Education (grant no. H133N060027 ).
PY - 2013/4
Y1 - 2013/4
N2 - Objective: To describe therapist-reported factors affecting therapy sessions in spinal cord injury (SCI) inpatient rehabilitation and explore their impact on the patient's rehabilitation program. Design: Prospective observational longitudinal cohort design. Data were obtained from systematic recordings of interventions by clinicians and from medical record abstraction. Setting: Six inpatient rehabilitation programs. Participants: Patients (N=1376) with traumatic SCI admitted for initial rehabilitation. Interventions: Not applicable. Main Outcome Measures: Factors recorded as impacting the objective or content of treatment sessions by physical therapy, occupational therapy, speech therapy, and therapeutic recreation, patients' participation in treatment as rated using a modified Pittsburgh Rehabilitation Participation Scale (PRPS), length of stay (LOS), medical morbidity measured using the Comprehensive Severity Index, hours of therapy per week, and missed therapy minutes. Results: Patients received 151,172 treatment sessions from 483 therapists. Pain, fatigue, and spasticity were commonly reported factors; other medical, behavioral, and logistical factors were also frequent, with 30% of sessions being affected by at least 1 factor. The number of factors was correlated with missed therapy minutes and with the PRPS score. Patients with more reported factors, overall or per average session, had a longer LOS and fewer hours of treatment per week. Conclusions: Medical and other factors complicating therapy are common. Those who need a longer stay because of their injury level or for other reasons have more opportunity to have sessions affected, but having many treatment sessions impacted by 1 or more factors also is likely to increase LOS. The nature of these factors and their impact on rehabilitation processes and outcomes deserve further study.
AB - Objective: To describe therapist-reported factors affecting therapy sessions in spinal cord injury (SCI) inpatient rehabilitation and explore their impact on the patient's rehabilitation program. Design: Prospective observational longitudinal cohort design. Data were obtained from systematic recordings of interventions by clinicians and from medical record abstraction. Setting: Six inpatient rehabilitation programs. Participants: Patients (N=1376) with traumatic SCI admitted for initial rehabilitation. Interventions: Not applicable. Main Outcome Measures: Factors recorded as impacting the objective or content of treatment sessions by physical therapy, occupational therapy, speech therapy, and therapeutic recreation, patients' participation in treatment as rated using a modified Pittsburgh Rehabilitation Participation Scale (PRPS), length of stay (LOS), medical morbidity measured using the Comprehensive Severity Index, hours of therapy per week, and missed therapy minutes. Results: Patients received 151,172 treatment sessions from 483 therapists. Pain, fatigue, and spasticity were commonly reported factors; other medical, behavioral, and logistical factors were also frequent, with 30% of sessions being affected by at least 1 factor. The number of factors was correlated with missed therapy minutes and with the PRPS score. Patients with more reported factors, overall or per average session, had a longer LOS and fewer hours of treatment per week. Conclusions: Medical and other factors complicating therapy are common. Those who need a longer stay because of their injury level or for other reasons have more opportunity to have sessions affected, but having many treatment sessions impacted by 1 or more factors also is likely to increase LOS. The nature of these factors and their impact on rehabilitation processes and outcomes deserve further study.
KW - Allied health personnel
KW - Comorbidity
KW - Health services
KW - Health services research
KW - Hospitals
KW - Patient participation
KW - Rehabilitation
KW - Spinal cord injuries
UR - http://www.scopus.com/inward/record.url?scp=84875438368&partnerID=8YFLogxK
U2 - 10.1016/j.apmr.2012.11.047
DO - 10.1016/j.apmr.2012.11.047
M3 - Article
C2 - 23465468
AN - SCOPUS:84875438368
SN - 0003-9993
VL - 94
SP - S115-S124
JO - Archives of Physical Medicine and Rehabilitation
JF - Archives of Physical Medicine and Rehabilitation
IS - 4 SUPPL.
ER -