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Factors associated with discharge destination following inpatient functional rehabilitation in patients with traumatic spinal cord injury

Spinal Cord (2020)Cite this article

Subjects

Abstract

Study design

Retrospective review of data from a prospective database of a Level 1 trauma center.

Objectives

This project aims to identify factors collected during the acute and rehabilitative care following a traumatic spinal cord injury (TSCI) associated with success and failure to return home after inpatient intensive functional rehabilitation (IFR).

Setting

Level 1 trauma center specialized in TSCI care in Montreal, Canada.

Methods

All eligible patients from our prospective database were separated into two groups according to discharge destination following IFR. Clinical variables collected during the acute and rehabilitative care as well as demographic variables were compared between patients who managed to return home (Group 1) and those who were discharged elsewhere (Group 2). Multivariable regression analyses were conducted with variables that were significant at the univariate level.

Results

Out of the 193 patients included, 22 (11%) failed to return home following IFR. Six variables were associated with failure to return home at the univariate level: longer acute length of stay (LOS), longer rehabilitation LOS, living alone, higher neurological level of injury, having comorbidities, and having a pressure injury (PI) during acute care. Three variables remained significant at the multivariate level: living alone, increasing acute LOS and presenting a high cervical (C1-C4) neurological level of injury.

Conclusions

It is important that acute care clinicians recognize the aforementioned factors early after TSCI in order to optimize patients for community reintegration.

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Data archiving

The datasets generated during and/or analyzed during the current study are not publicly available due to the regulations defined by the ethics committee of the CIUSS Nord-de-l’Île-de-Montréal but are available from the corresponding author on reasonable request.

References

  1. 1.

    DeVivo MJ, Richards JS. Community reintegration and quality of life following spinal cord injury. Paraplegia. 1992;30:108–12.

    CAS  PubMed  Google Scholar 

  2. 2.

    Putzke JD, Richards JS. Nursing home residence: quality of life among individuals with spinal cord injury. Am J Phys Med Rehabil. 2001;80:404–9.

    CAS  Article  Google Scholar 

  3. 3.

    Silver J, Ljungberg I, Libin A, Groah S. Barriers for individuals with spinal cord injury returning to the community: a preliminary classification. Disabil Health J. 2012;5:190–6.

    Article  Google Scholar 

  4. 4.

    Smith B, Caddick N. The impact of living in a care home on the health and wellbeing of spinal cord injured people. Int J Environ Res Public Health. 2015;12:4185–202.

    Article  Google Scholar 

  5. 5.

    Cheng CL, Plashkes T, Shen T, Fallah N, Humphreys S, O’Connell C, et al. Does specialized inpatient rehabilitation affect whether or not people with traumatic spinal cord injury return home? J Neurotrauma. 2017;34:2867–76.

    Article  Google Scholar 

  6. 6.

    Munce SE, Wodchis WP, Guilcher SJ, Couris CM, Verrier M, Fung K, et al. Direct costs of adult traumatic spinal cord injury in Ontario. Spinal Cord. 2013;51:64–9.

    CAS  Article  Google Scholar 

  7. 7.

    Whiteneck G, Gassaway J, Dijkers MP, Heinemann AW, Kreider SE. Relationship of patient characteristics and rehabilitation services to outcomes following spinal cord injury: the SCIRehab project. J Spinal Cord Med. 2012;35:484–502.

    Article  Google Scholar 

  8. 8.

    DeVivo MJ. Discharge disposition from model spinal cord injury care system rehabilitation programs. Arch Phys Med Rehabil. 1999;80:785–90.

    CAS  Article  Google Scholar 

  9. 9.

    Anzai K, Young J, McCallum J, Miller B, Jongbloed L. Factors influencing discharge location following high lesion spinal cord injury rehabilitation in British Columbia, Canada. Spinal Cord. 2006;44:11–8.

    CAS  Article  Google Scholar 

  10. 10.

    Gour-Provencal G, Mac-Thiong JM, Feldman DE, Begin J, Richard-Denis A. Decreasing pressure injuries and acute care length of stay in patients with acute traumatic spinal cord injury. J Spinal Cord Med. 2020 [Published online ahead of print].

  11. 11.

    Membres de la Table de réadaptation fonctionnelle intensive de Montréal et du sous-comité sur les soins postaigus de la Table SAPA de Montréal. Programme de soins postaigus et services de rédaptation fonctionnelle intensive pour la clientèle montréalaise. 2017. p. 40.

  12. 12.

    Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14:187–96.

    CAS  Article  Google Scholar 

  13. 13.

    Quan H, Li B, Couris CM, Fushimi K, Graham P, Hider P, et al. Updating and validating the Charlson comorbidity index and score for risk adjustment in hospital discharge abstracts using data from 6 countries. Am J Epidemiol. 2011;173:676–82.

    Article  Google Scholar 

  14. 14.

    WHO. US National Institute of Aging. Global health and aging. 2011.

  15. 15.

    Kirshblum S, Waring W 3rd. Updates for the International Standards for Neurological Classification of Spinal Cord Injury. Phys Med Rehabil Clin N Am. 2014;25:505–17.

    Article  Google Scholar 

  16. 16.

    Kang MG, Kim CH, Park E, Huh JW, Yang WJ, Nam TW, et al. Effect of family caregiving on depression in the first 3 months after spinal cord injury. Ann Rehabil Med. 2018;42:130–6.

    Article  Google Scholar 

  17. 17.

    Richard-Denis A, Beausejour M, Thompson C, Nguyen BH, Mac-Thiong JM. Early predictors of global functional outcome after traumatic spinal cord injury: a systematic review. J Neurotrauma. 2018;35:1705–25.

    Article  Google Scholar 

  18. 18.

    Gulati A, Yeo CJ, Cooney AD, McLean AN, Fraser MH, Allan DB. Functional outcome and discharge destination in elderly patients with spinal cord injuries. Spinal Cord. 2011;49:215–8.

    CAS  Article  Google Scholar 

  19. 19.

    Jain NB, Ayers GD, Peterson EN, Harris MB, Morse L, O’Connor KC, et al. Traumatic spinal cord injury in the United States, 1993-2012. JAMA. 2015;313:2236–43.

    CAS  Article  Google Scholar 

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Acknowledgements

We acknowledge the contribution of all team members at the Orthopedics—Spine Research Unit of the Hôpital du Sacré-Coeur de Montréal. We thank Louis-Félix Gravel (medical student at the University of Montreal) and Ms. Geneviève Leblanc who both assisted in the task of data extraction. We also recognize the important guidance of Dr. Jean Bégin, who provided us with crucial insight for the design of all statistical analyses. Finally, we thank the patients for their essential participation in all our research initiatives.

Funding

This research was funded by the Programme d’Excellence en Médecine pour l’Initiation En Recherche, the Fonds de recherche du Québec – Santé, the Praxis Spinal Cord Institute and the Medtronic Research Chair in Spinal Trauma at Université de Montréal.

Author information

Affiliations

  1. Faculty of Medicine, University of Montreal, Pavillon Roger-Gaudry, S-749, C.P. 6128, succ. Centre-ville, Montreal, QC, H3C 3J7, Canada

    Antoine Dionne, Andréane Richard-Denis, Victor Lim & Jean-Marc Mac-Thiong

  2. Hôpital du Sacré-Cœur de Montréal, 5400 Gouin Boul. West, Montreal, QC, H4J 1C5, Canada

    Andréane Richard-Denis & Jean-Marc Mac-Thiong

  3. Sainte-Justine University Hospital Research Center, 3175 Chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 1C5, Canada

    Jean-Marc Mac-Thiong

Authors
  1. Antoine Dionne
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  2. Andréane Richard-Denis
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  3. Victor Lim
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  4. Jean-Marc Mac-Thiong
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Contributions

AD was responsible for designing the protocol, conducting the search, screening for potentially eligible patients, extracting and analyzing data, interpreting results, creating findings tables and figures, and writing the report. AR-D was responsible for designing the protocol and reviewing the manuscript. VL was responsible for extracting and analyzing data. J-MM-T was the senior author for this study. As such, he was responsible for designing the research protocol, interpreting the results, reviewing the manuscript and securing funding.

Corresponding author

Correspondence to Jean-Marc Mac-Thiong.

Ethics declarations

Conflict of interest

AR-D has received a scholarship and research grants from the Fonds de recherche du Québec – Santé, an investigator-initiated research grant from Medline Industries, and a research grant from Praxis Spinal Cord Institute. J-MM-T is chairholder of the Medtronic research chair in spinal trauma at Université de Montréal, owns stocks and is a board member in Spinologics, and has received a scholarship and research grants from the Fonds de recherche du Québec – Santé, an investigator-initiated research grant from Medline Industries, educational grants from Medtronic and Depuy-Synthes, as well as research grants from the U.S. Department of Defense—Congressionally directed medical research programs, Craig H. Neilsen Foundation, from Social Sciences and Humanities Research Council, Canadian Institutes of Health Research, Natural Sciences and Engineering Research Council, Praxis Spinal Cord Institute, and Vertex Pharmaceutical. AD and VL have nothing to disclose.

Ethical approval

This study was approved by the “Comité d’éthique de la recherche du CIUSSS du Nord-de-l’Île-de-Montréal” at Hôpital Sacré-Cœur de Montréal. We certify that all applicable institutional and governmental regulations concerning the ethical use of human volunteers were followed during the course of this research.

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Dionne, A., Richard-Denis, A., Lim, V. et al. Factors associated with discharge destination following inpatient functional rehabilitation in patients with traumatic spinal cord injury. Spinal Cord (2020). https://doi.org/10.1038/s41393-020-00542-z

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