Article

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.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS