Loganathan, V (2011) Predictors of the length of stay of inpatients in Rehabilitation setting after Traumatic Spinal Cord Injury. Masters thesis, Christian Medical College, Vellore.
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Abstract
INTRODUCTION: Spinal cord injury (SCI) caused by either traumatic or non traumatic ( T SCI or NT SCI) is a major clinical and social problem and lead to permanent disability. SCI is a devastating condition that requires intensive and specialized clinical rehabilitation. Traumatic SCI occurs often at a young age, and life expectancy of persons with SCI has increased in recent decades, although it is still lower than the life expectancy of the general population. Evidence of the benefits of medical rehabilitation is documented typically by the reduction in disability of persons receiving inpatient rehabilitation and by length of stay (LOS). Functional outcome, or gain in functional ability during rehabilitation, reflects the effectiveness of clinical rehabilitation, and LOS is often used as a measure of its efficiency. Patients with low motor Functional Independence Measure (FIMTM) scores on discharge are more dependent and are therefore more likely to be discharged to a long-term care facility. Those with high motor FIM scores on discharge are likely to return to community living on discharge, even though there may be a need for modification to the living environment to support independent living. Traumatic spinal cord lesion occurs primarily in young adults with more than half being between 16 to 30 years of age. Men account for about 80% of cases. Managed care and improvements in medical and rehabilitative expertise are believed to account for declines in rehabilitation LOS. The Walking Index for Spinal Cord Injury (WISCI) scale will show more incremental change than current scales, and therefore demonstrate criterion validation for use in future clinical trials. The Functional Independence Measure (FIM) is the most widely used valid and reliable measure of the severity of disability and rehabilitation outcome, including SCI. Keeping in view of all the above cited variables for LOS and importance of the topic, this study of LOS in inpatient rehabilitation after SCI in Qatar is conducted, where there was no pioneer study. My study supports the hypothesis of an association between length of stay in rehabilitation, functional independence measure motor, and length of stay in acute care, American spinal cord injury association impairment scale and walking index for spinal cord injury. METHODS: A total of 54 patients with traumatic spinal cord injury, discharged from the inpatient rehabilitation unit (IPRU), Rumaillah Hospital of Hamad Medical Corporation, Doha, Qatar, during the period from January 2008 to July 2010, were included in this prospective study. All descriptive data were collected from demographic data files maintained by Medical Records Department, Rumaillah Hospital of the Hamad Medical Corporation. The demographic information on age, sex, marital status, nationality, and type of SCI has been included in the study. The functional independence measure (FIM) was used for measuring the functional status on admission and discharge. It analyzed 18 items and seven levels of performance in eating, grooming, bathing, upper and lower body dressing, toileting, bladder and bowel management, bed transfer, toilet transfer, shower transfer, locomotion, stairs, comprehension, expression, social interaction, problem solving, and memory. By summing the points for each item, the possible total score ranges from 18 (lowest) to 126 (highest level of independence). RESULTS: The study included 54 SCI patients with an age range of 20-60 years. The distribution of qualitative characteristics is shown in Table 3. Most of the patients (98%) were expatriates, and the type of lesion was paraplegia in 59% and tetraplgia in 41%. The majority of SCI patients on discharge were in the disability range of disabled but independence in self-care (32%), followed by minor symptoms not affecting life style (24%) and moderate assistance for daily living (22%). The rest were in two other groups of disability (14%), with up to maximal assistance, total assistance (4%) and well (4%) in daily living. Regarding the mobility category, most of the patients were in wheelchair propelled by themselves (37%), group of walks with aid (22%), and in the group of slow gait speed (19%). The others were in wheelchair propelled by others (9%) and walks with another person to help (2%). No walking deficit was in only 11% of the SCI patients. This study showed SCI patients admitted in IPRU were in complete paraplegia (ASIA A) group as 56% (10) and complete tetraplegia 44% (8). CONCLUSION: In relation to other findings, overall, our study showed that FIM admission was the best predictor of functional outcome in SCI inpatients, and also SCI patients of lower admission and discharge FIMs were related to extended LOS in both acute and IPRU However, we found that some higher FIMd and ASIA impairment group C were also with extended LOSr (Fig. 6, 7), but only 14% of the total SCI patients. The reason for this extended LOSr might be dependent upon socioeconomic factors. Our study identified the need for further prospective studies in large SCI populations in order to evaluate other predictors influencing LOS in rehabilitation units.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Predictors ; length of stay of inpatients ; Rehabilitation setting ; Traumatic Spinal Cord Injury. |
| Subjects: | MEDICAL > Physical Medicine and Rehabilitation |
| Depositing User: | Kambaraman B |
| Date Deposited: | 09 May 2018 02:13 |
| Last Modified: | 09 May 2018 02:13 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/7668 |
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