Non-traumatic spinal cord injury: what is the ideal setting for rehabilitation?

Abstract

OBJECTIVE: To survey rehabilitation physicians about management of patients with non-traumatic spinal cord injury (NTSCI). METHODS: Postal and email survey of Australian physicians treating adult inpatients in neurological rehabilitation or Spinal Injury Units (SIUs). 59/69 returned surveys met inclusion criteria. 75% (44) of respondents were from neurological rehabilitation units (response rate 72%) and 25% (15) were from SIUs (response rate 94%). Outcomes were: incidence of NTSCI, opinion regarding ideal setting for NTSCI inpatient rehabilitation, and availability of key services for NTSCI patients in neurological rehabilitation units. RESULTS: Estimated incidence of NTSCI was 26/million adults/year. 60% of NTSCI patients were managed in general neurological rehabilitation units. The majority of respondents (85% (50/59); 95% CI, 73%-92%) believed that the most appropriate setting for NTSCI rehabilitation was either an SIU or a neurological team that specialises in NTSCI patients. Neurological rehabilitation units offered NTSCI patients the following services: education regarding coping with NTSCI and preventing complications (55% [18/33]); specialised wheelchair and seating prescription (85% [28/33]); Environmental Control Unit training (36% [12/33]); and bladder training (97% [32/33]). CONCLUSIONS: The most appropriate setting for rehabilitation of NTSCI patients is either a dedicated SIU or a neurological rehabilitation team that specialises in NTSCI. The organisation of inpatient rehabilitation services for NTSCI patients in Australia should be improved.