Rehabilitation outcomes in traumatic spinal cord injury in Australia: Functional status, length of stay and discharge setting

Abstract

Study design: Retrospective, descriptive study. Objectives: To describe patients' length of stay (LOS), functional status and discharge setting after rehabilitation and how degree of impairment (complete/incomplete paraplegia/tetraplegia) impacts on these outcomes. To compare actual LOS with estimated LOS. Estimated LOS was based on an Australian model, the Australian National Sub-acute and Non-acute Patient Classification System (AN-SNAP), which classifies patients using admission Functional Independence Measure (FIM™) scores. To further describe outcomes for each AN-SNAP class by degree of impairment. Setting: Spinal Injuries Unit of major Metropolitan hospital in Brisbane, Australia. Methods: Retrospective chart review of 167 patients with traumatic spinal cord injury (SCI). Main outcome measures were rehabilitation LOS, discharge FIM™ scores and discharge setting. Injury measures were degree of impairment, acute LOS and rehabilitation admission FIM™ scores. Standard demographic measures were also collected. Results: The median rehabilitation LOS was 83 days and mean discharge FIM™ scores 102 for all patients. These differed by impairment (incomplete paraplegia LOS 43, FIM 117; complete paraplegia LOS 96, FIM 109; incomplete tetraplegia LOS 64, FIM 100; complete tetraplegia LOS 206, FIM 78). Patients discharged to the community (noncare facility) ranged from 93% with incomplete paraplegia to 73% with complete tetraplegia. For patients in the three AN-SNAP classes with the lowest FIM scores, the actual LOS was up to twice the estimated LOS. A large variability in discharge outcomes was found within individual AN-SNAP classes, despite similar FIM™ scores on admission. Conclusions: Rehabilitation outcomes differed substantially by impairment. The variability in outcomes for patients within the same AN-SNAP class questions the ability of this system to accurately predict LOS, and therefore cost of rehabilitation services, for patients with traumatic SCI in Australia. Sponsorship: Some of this research was supported by a grant from Queensland Health. Leigh Tooth was supported by a National Health and Medical Research Council of Australia Public Health Fellowship (#997032) while some of this research was undertaken.