Article

OBJECTIVES: To investigate the frequency of and reasons for missed therapy
sessions during inpatient rehabilitation after traumatic spinal cord injury
(SCI), and to assess the influence of demographic, medical, and injury factors on
the missing of therapy sessions. DESIGN: Prospective cohort study. SETTING: Six
inpatient rehabilitation centers. PARTICIPANTS: Individuals with SCI (N=1376)
consecutively admitted for inpatient rehabilitation at participating sites; 1032
participants were randomly selected for model development, and 344 participants
were selected for model cross-validation. INTERVENTIONS: Not applicable. MAIN
OUTCOME MEASURES: Total hours of missed therapy; total minutes missed per week;
and reason for missed therapy. RESULTS: Patients missed an average of 153 minutes
of therapies per week, or a total of 20 hours over their rehabilitation stay.
Common reasons for missing physical, occupational, and speech therapy were lack
of patient readiness and medical reasons. Therapeutic recreation sessions were
commonly missed because of patient refusal. More missed therapy (for any reason)
was predicted by having C5-8 tetraplegia, paraplegia, greater morbidity, higher
motor and cognitive functional independence, higher percent of sessions limited
by fatigue, violent SCI etiology, longer rehabilitation length of stay, and
treatment center. Older age, ventilator use, and percent of sessions limited by
spasticity were predictive of less therapy time missed. CONCLUSIONS: On average,
patients missed about 2.5 hours of therapy weekly. In view of the potential
impact on rehabilitation outcomes and given the potential cost of lost resources,
missed therapy deserves further study and administrative attention. In addressing
this issue, there may be potential for the rehabilitation facility to intervene
to reduce such lost time, including addressing equipment/therapist availability,
patient readiness, patient engagement, and center-specific approaches.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS