Factors complicating treatment sessions in spinal cord injury rehabilitation: Nature, frequency, and consequences

Marcel P. Dijkers, Jeanne M. Zanca

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


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.

Original languageEnglish
Pages (from-to)S115-S124
JournalArchives of Physical Medicine and Rehabilitation
Issue number4 SUPPL.
StatePublished - Apr 2013


  • Allied health personnel
  • Comorbidity
  • Health services
  • Health services research
  • Hospitals
  • Patient participation
  • Rehabilitation
  • Spinal cord injuries


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