Functional Outcome of Patients with Post-acute Traumatic Spinal Cord Injury after a 6-month Home-based Rehabilitation Program and its Related Factors
Keywords:
functional independence, spinal cord injury, home care, rehabilitationAbstract
Objectives: The study aimed to evaluate the effectiveness of home-based rehabilitation programs on the functional outcomes of patients with traumatic spinal cord injuries in the post-acute phase and analyze factors associated with improved functional outcomes.
Study design: Prospective cohort study
Setting: Phatthalung Hospital, Thailand.
Subjects: Patients with traumatic spinal cord injuries had a home-based rehabilitation program and 6-month follow-up at a rehabilitation outpatient clinic from April 2022 to January 2023.
Methods: The demographic and medical information was retrieved from the medical record. The Spinal Cord Independence Measure version III was used to evaluate patients’ functional outcomes at the program’s start and the end of the 6-month follow-up period. The Thai-HADs questionnaire was assessed at the 6-month follow-up period. The chi-square and Fisher’s exact tests were used to evaluate the factors related to improved functional outcomes.
Results: A total of 76 patients participated in this study, with 76.3% of patients being men and mean (SD) age of 47.49 (14.85) years. The SCIM scores of 63.16% of patients increased throughout the follow-up period. Age, body mass index, neurological level of injury, level of paralysis, complications related to spinal cord injuries, frequency of encounter with therapists, frequency of self-exercise, and depressive symptoms were statistically significant factors associated with improved functional outcomes.
Conclusions: Home-based rehabilitation has benefits for patients with traumatic spinal cord injuries. Many factors are associated with improved functional outcomes. Healthcare workers and community support can help patients reach the highest level of independence and better reintegrate into their families and communities.
References
Bickenbach J, Officer A, Shakespeare T, von Groote P, World Health Organization. International perspectives on spinal cord injury. World Health Organization; 2013.
Kang Y, Ding H, Zhou HX, Wei ZJ, Liu L, Pan DY, Feng SQ. Epidemiology of worldwide spinal cord injury: a literature review. Journal of Neurorestoratology[Internet]. 2018 [cited 2023 Mar 31]; 6:1-9. Available from: https://www.dovepress.com/epidemiology-of-worldwide-spinal-cord-injury-a-literature-review-peer-reviewed-fulltext-article-JN doi:10.2147/JN.S143236
Fekete C, Brach M, Ehrmann C, Post MWM; InSCI; Stucki G. Cohort Profile of the International Spinal Cord Injury Community Survey Implemented in 22 Countries. Arch Phys Med Rehabil [Internet]. 2020 Dec[cited 2023 Mar 31];101(12):2103-11. Available from: https://pubmed.ncbi.nlm.nih.gov/32533933/ doi:10.1016/j.apmr.2020.01.022
Waters RL, Adkins RH, Yakura JS, Sie I. Motor and sensory recovery following complete tetraplegia. Arch Phys Med Rehabil [Internet]. 1993 Mar [cited 2023 Mar 25];74(3):242-7. Available from: https://pubmed.ncbi.nlm.nih.gov/8439249/
Yarkony GM, Roth EJ, Heinemann AW, Wu YC, Katz RT, Lovell L. Benefits of rehabilitation for traumatic spinal cord injury. Multivariate analysis in 711 patients. Arch Neurol [Internet]. 1987 Jan [cited 2023 Mar 25];44(1):93-6. Available from: https://pubmed.ncbi.nlm.nih.gov/3800727/ doi: 10.1001/archneur.1987.00520130071020
Thomas B, Kristjan R, Adam S, Fin B. Spinal cord injury. In: Braddom RL, Chan L, Harrast MA, Kowalske KJ, Matthews DJ, Ragnarsson KT et al., editors. Braddom’s Physical Medicine and Rehabilitation. 4th ed. Philadephia: Saunders; 2011. p. 1293-346.
Guideline for Intermediate Care for Intermediate Rehabilitation for Medical Personnel under the Service Plan: Health Ministration Division, Ministry of Public Health; 2018. p. 72.
Wolfe DL, Hsieh JT, Mehta S. Rehabilitation practices and associated outcomes following spinal cord injury. Spinal cord injury rehabilitation evidence [Internet]. 2010[cited 2021 Aug 25]; 23:44-90. Available from: https://scireproject.com/evidence/rehabilitation-evidence/rehabilitation-practices
Schönherr MC, Groothoff JW, Mulder GA, Eisma WH. Functional outcome of patients with spinal cord injury: rehabilitation outcome study. Clin Rehabil [Internet]. 1999 Dec [cited 2023 Apr 1];13(6):457-63. Available from: https://pubmed.ncbi.nlm.nih.gov/10588531/ doi:10.1191/026921599666105472
Welage N, Liu KP. Review of a home and community integration programme for people with spinal cord injuries in Hong Kong and its relevance to Sri Lanka. Hong Kong J Occup Ther [Internet]. 2008 Jan [cited 2023 Apr 1];18(1):34-9. Available from: https://www.researchgate.net/publication/248597383 doi: 10.1016/S1569-1861(08)70011-1
Hughes R. The management of patients with spinal cord injury. Nurs Times [Internet]. 2003 Dec 16-2004 Jan 5[cited 2023 Apr 1];99(50):38-41. Available from: https://pubmed.ncbi.nlm.nih.gov/14705423/
Kendall MB, Ungerer G, Dorsett P. Bridging the gap: transitional rehabilitation services for people with spinal cord injury. Disabil Rehabil [Internet]. 2003 Sep 2[cited 2023 Apr 1];25(17):1008-15. Available from: https://pubmed.ncbi.nlm.nih.gov/12851090/ doi:10.1080/0963828031000122285
Whiteneck G, Meade MA, Dijkers M, Tate DG, Bushnik T, Forchheimer MB. Environmental factors and their role in participation and life satisfaction after spinal cord injury. Arch Phys Med Rehabil [Internet]. 2004 Nov [cited 2023 Apr 1];85(11):1793-803. Available from: https://pubmed.ncbi.nlm.nih.gov/15520974/ doi:10.1016/j.apmr.2004.04.024
Cruise CM, Lee MH. Delivery of rehabilitation services to people aging with a disability. Phys Med Rehabil Clin N Am [Internet]. 2005 Feb [cited 2023 Feb 28];16(1):267-84. Available from: https://pubmed.ncbi.nlm.nih.gov/15561555/ doi:10.1016/j.pmr.2004.06.007
Kinnersly D, Grundy D, Russell J. ABC of spinal cord injury. Transfer of care from hospital to community. Br Med J (Clin Res Ed) [Internet]. 1986 Mar 1 [cited 2023 Apr 1];292(6520):607-9. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1339580/ doi:10.1136/bmj.292.6520.607
Michael, M., Roth, K. Against all odds: a qualitative study of rehabilitation of persons with spinal cord injury in Afghanistan.Spinal Cord [Internet]. 2012 [cited 2023 Apr 1]; 50:864-8. Available from: https://www.nature.com/articles/sc2012113#citeas doi:10.1038/sc.2012.113
Barclay L, McDonald R, Lentin P. Social and community participation following spinal cord injury: a critical review. Int J Rehabil Res [Internet]. 2015 Mar [cited 2023 Apr 1];38(1):1-19. Available from: https://pubmed.ncbi.nlm.nih.gov/25305008/ doi:10.1097/MRR.0000000000000085.
Muangdan C, Pattanakuhar S, Ratanapinunchai J. Functional Independence of Patients with Spinal Cord Injury and Related Factors after Inpatient Rehabilitation. ASEAN J Rehabil Med [Internet]. 2019 May [cited 2023 Feb 20];29(2): 63-70. Available from:https://he01.tci-thaijo.org/index.php/aseanjrm/article/view/170159
Stata Corp. Stata Statistical Software: Release 14 [Internet]. College Station, TX: Stata Corp LP; 2015[cited 2022 Dec 23]. Available from: https://www.stata.com/stata14/
Itzkovich M, Gelernter I, Biering-Sorensen F, Weeks C, Laramee MT, Craven BC, et al. The Spinal Cord Independence Measure (SCIM) version III: reliability and validity in a multicenter international study. Disabil Rehabil [Internet]. 2007 Dec 30 [cited 2022 Nov 22];29(24):1926-33. Available from: https://pubmed.ncbi.nlm.nih.gov/17852230/ doi:10.1080/09638280601046302
Ackerman P, Morrison SA, McDowell S, Vazquez L. Using the Spinal Cord Independence Measure III to measure functional recovery in a post-acute spinal cord injury program. Spinal Cord [Internet]. 2010 May [cited 2022 Nov 22];48(5):380-7. Available from: https://pubmed.ncbi.nlm.nih.gov/19884897/ doi:10.1038/sc.2009.140
Nilchaikovit T, Lotrakul M, Phisansuthideth U. Development of Thai version of Hospital anxiety and depression scale in cancer patients. J Psychiatr Assoc Thai [Internet]. 1996 Jan [cited 2022 Nov 20]; 41:18-30. Available from: https://www.psychiatry.or.th/JOURNAL/v4111.html
Lindberg J, Kreuter M, Taft C, Person LO. Patient participation in care and rehabilitation from the perspective of patients with spinal cord injury. Spinal Cord [Internet]. 2013 Nov [cited 2022 Nov 24];51(11):834-7. Available from: https://pubmed.ncbi.nlm.nih.gov/23999110/ doi:10.1038/sc.2013.97
Jannings W, Pryor J. The experiences and needs of persons with spinal cord injury who can walk. Disabil Rehabil [Internet]. 2012 [cited 2022 Dec 12];34(21):1820-6. Available from: https://pubmed.ncbi.nlm.nih.gov/22423597/ doi:10.3109/09638288.2012.665126
Haisma JA, van der Woude LH, Stam HJ, Bergen MP, Sluis TA, Post MW, Bussmann JB. Complications following spinal cord injury: occurrence and risk factors in a longitudinal study during and after inpatient rehabilitation. J Rehabil Med [Internet]. 2007 May [cited 2022 Nov 29];39(5):393-8. Available from: https://pubmed.ncbi.nlm.nih.gov/17549331/ doi:10.2340/16501977-0067
Ronen J, Itzkovich M, Bluvshtein V, Thaleisnik M, Goldin D, Gelernter I, et al. Length of stay in hospital following spinal cord lesions in Israel. Spinal Cord Internet]. 2004 [cited 2022 Dec 12];42, 353-8. Available from: https://pubmed.ncbi.nlm.nih.gov/14968104/ doi:10.1038/sj.sc.3101590
David C, Ronald S, Jeffrey K, Jennifer M, Douglas W. Age, outcome, and rehabilitation costs after tetraplegia spinal cord injury. Neuro Rehabilitation [Internet]. 1999 [cited 2022 Dec 12];12(3):177-85. Available from: https://msktc.org/sci/publications/age-outcome-and-rehabilitation-costs-after-tetraplegia-spinal-cord-injury
Putzke JD, Barrett JJ, Richards JS, DeVivo MJ. Age and spinal cord injury: an emphasis on outcomes among the elderly. J Spinal Cord Med [Internet]. 2003 Spring [cited 2022 Dec 15];26(1):37-44. Available from: https://pubmed.ncbi.nlm.nih.gov/12830968/ doi:10.1080/10790268.2003.11753659
AlHuthaifi F, Krzak J, Hanke T, Vogel LC. Predictors of functional outcomes in adults with traumatic spinal cord injury following in-patient rehabilitation: A systematic review. J Spinal Cord Med [Internet]. 2017 May [cited 2022 Dec 23];40(3):282-94. Available from: https://pubmed.ncbi.nlm.nih.gov/27852160/ doi:10.1080/10790268.2016.1238184
Furlan JC, Hitzig SL, Craven BC. The influence of age on functional recovery of adults with spinal cord injury or disease after inpatient rehabilitative care: a pilot study. Aging Clin Exp Res [Internet]. 2013 Aug [cited 2022 Dec 14];25(4):463-71. Available from: https://pubmed.ncbi.nlm.nih.gov/23784728/ doi:10.1007/s40520-013-0066-1
Whiteneck GG, Harrison-Felix CL, Mellick DC, Brooks CA, Charlifue SB, Gerhart KA. Quantifying environmental factors: a measure of physical, attitudinal, service, productivity, and policy barriers. Arch Phys Med Rehabil [Internet]. 2004 Aug [cited 2022 Dec 17];85(8):1324-35. Available from: https://pubmed.ncbi.nlm.nih.gov/15295760/ doi:10.1016/j.apmr.2003.09.027
Wilson JR, Cadotte DW, Fehlings MG. Clinical predictors of neurological outcome, functional status, and survival after traumatic spinal cord injury: a systematic review. J Neurosurg Spine [Internet]. 2012 Sep [cited 2022 Dec 16];17(1 Suppl):11-26. Available from: https://pubmed.ncbi.nlm.nih.gov/22985366/ doi:10.3171/2012.4.AOSPINE1245
Milicevic S, Piscevic V, Bukumiric Z, Nikolic AK, Sekulic A, Corac A, Babovic R, Jankovic S. Analysis of the factors influencing functional outcomes in patients with spinal cord injury. J Phys Ther Sci [Internet]. 2014 Jan [cited 2022 Dec 19];26(1):67-71. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3927044/ doi:10.1589/jpts.26.67
Williams TL, Smith B, Papathomas A. The barriers, benefits and facilitators of leisure time physical activity among people with spinal cord injury: a meta-synthesis of qualitative findings. Health Psychol Rev [Internet]. 2014[cited 2023 Jan 4];8(4):404-25. Available from: https://pubmed.ncbi.nlm.nih.gov/25211208/ doi:10.1080/17437199.2014.898406
Arsh A, Darain H, Muhammad D, Khan MN, Ilyas SM, Zeb A, et al. Factors responsible for readmissions to rehabilitation center following spinal cord injury. JKCD [Internet]. 2017 [cited 2022 Dec 12]; 7: 60-5. Available from: https://www.academia.edu/38708250/
Levins SM, Redenbach DM, Dyck I. Individual and societal influences on participation in physical activity following spinal cord injury: a qualitative study. Phys Ther [Internet]. 2004 June [cited 2022 Dec 17];84(6):496-509. Available from: https://pubmed.ncbi.nlm.nih.gov/15161416/
Kilic SA, Dorstyn DS, Guiver NG. Examining factors that contribute to the process of resilience following spinal cord injury. Spinal Cord [Internet]. 2013 Jul [cited 2023 Jan 2];51(7):553-7. Available from: https://pubmed.ncbi.nlm.nih.gov/23689391/ doi:10.1038/sc.2013.25
Jensen MP, Truitt AR, Schomer KG, Yorkston KM, Baylor C, Molton IR. Frequency and age effects of secondary health conditions in individuals with spinal cord injury: a scoping review. Spinal Cord [Internet]. 2013 Dec [cited 2022 Dec 17];51(12):882-92. Available from: https://pubmed.ncbi.nlm.nih.gov/24126851/ doi:10.1038/sc.2013.112
Teeter L, Gassaway J, Taylor S, LaBarbera J, McDowell S, Backus D, et al. Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project. J Spinal Cord Med [Internet]. 2012 Nov [cited 2022 Dec 11];35(6):503-26. Available from: https://pubmed.ncbi.nlm.nih.gov/23318034/ doi:10.1179/2045772312Y.0000000058
Richard-Denis A, Chatta R, Thompson C, Mac-Thiong JM. Patterns and predictors of functional recovery from the subacute to the chronic phase following a traumatic spinal cord injury: a prospective study. Spinal Cord [Internet]. 2020 Jan [cited 2023 Dec 4];58(1):43-52. Available from: https://pubmed.ncbi.nlm.nih.gov/31462758/ doi:10.1038/s41393-019-0341-x
Sabata D, Bruce C, Sanford J. Preparing home health clients for work opportunities with workplace accommodation. Home Healthc Manag Pract [Internet]. 2006 [cited 2022 Dec 21]; 19:12-8. Available from: https://www.researchgate.net/publication/244917114 doi:10.1177/1084822306292532
Galea M, Tumminia J, Garback LM. Telerehabilitation in spinal cord injury persons: a novel approach. Telemed J E Health [Internet]. 2006 Apr [cited 2023 Jan 3];12(2):160-2. Available from: https://pubmed.ncbi.nlm.nih.gov/16620171/ doi:10.1089/tmj.2006.12.160
Kowalczewski J, Chong SL, Galea M, Prochazka A. Inhome tele-rehabilitation improves tetraplegic hand function. Neurorehabil Neural Repair [Internet]. 2011 Jun [cited 2022 Dec 25];25(5):412-22. Available from: https://pubmed.ncbi.nlm.nih.gov/21372246/ doi:10.1177/1545968310394869
Global recommendations on physical activity for health: World Health Organization; 2010. 60 p. Available from: http://www.who.int/dietphysicalactivity/factsheet_recommendations/en/
Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, Barrow A, Bourne C, Carruthers P, et al. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord [Internet]. 2018 Apr [cited 2022 Dec 22];56:308-21. Available from: https://pubmed.ncbi.nlm.nih.gov/29070812/ doi:10.1038/s41393-017-0017-3
Phillips VL, Vesmarovich S, Hauber R, Wiggers E, Egner A. Telehealth: reaching out to newly injured spinal cord patients. Public Health Rep [Internet]. 2001[cited 2022 Dec 7];116 Suppl 1:94-102. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1913671/ doi:10.1093/phr/116.S1.94
Vissers M, van den Berg-Emons R, Sluis T, Bergen M, Stam H, Bussmann H. Barriers to and facilitators of everyday physical activity in persons with a spinal cord injury after discharge from the rehabilitation centre. J Rehabil Med [Internet]. 2008 Jun [cited 2023 Apr 17];40(6):461-7. Available from: https://pubmed.ncbi.nlm.nih.gov/18509562/ doi:10.2340/16501977-0191
Cowan RE, Nash MS, Anderson KD. Exercise participation barrier prevalence and association with exercise participation status in individuals with spinal cord injury. Spinal Cord [Internet]. 2013 Jan [cited Apr 9];51(1):27-32. Available from: https://pubmed.ncbi.nlm.nih.gov/22584283/ doi:10.1038/sc.2012.53
Bauman WA, Spungen AM. Carbohydrate and lipid metabolism in chronic spinal cord injury. J Spinal Cord Med [Internet]. 2001 Winter [cited 2023 Jan 5];24(4):266-77. Available from: https://pubmed.ncbi.nlm.nih.gov/11944785/ doi:10.1080/10790268.2001.11753584
Janssen TW, van Oers CA, van Kamp GJ, TenVoorde BJ, van der Woude LH, Hollander AP. Coronary heart disease risk indicators, aerobic power, and physical activity in men with spinal cord injuries. Arch Phys Med Rehabil [Internet]. 1997 Jul [cited 2022 Dec 7];78(7):697-705. Available from: https://pubmed.ncbi.nlm.nih.gov/9228871/ doi:10.1016/s0003-9993(97)90076-9
Post MW, van Leeuwen CM. Psychosocial issues in spinal cord injury: a review. Spinal Cord [Internet]. 2012 May [cited 2022 Dec 8];50(5):382-9. Available from: https://pubmed.ncbi.nlm.nih.gov/22270190/ doi:10.1038/sc.2011.182
Krause JS, Saunders LL. Health, secondary conditions, and life expectancy after spinal cord injury. Arch Phys Med Rehabil [Internet]. 2011 Nov [cited 2022 Dec 5];92(11):1770-5. Available from: https://pubmed.ncbi.nlm.nih.gov/22032212/ doi:10.1016/j.apmr.2011.05.024
Qasheesh M, Shaphe MA, Iqbal A, Alghadir AH. Association of psychological variants with functional outcomes among people with spinal cord injury. Sci Rep [Internet]. 2021 Oct 13[cited 2022 Dec 8];11(1):20325. Available from: https://pubmed.ncbi.nlm.nih.gov/34645884/ doi:10.1038/s41598-021-98808-w
Mulroy SJ, Hatchett PE, Eberly VJ, Haubert LL, Conners S, Gronley J et al. Objective and Self-Reported Physical Activity Measures and Their Association With Depression and Satisfaction With Life in Persons With Spinal Cord Injury. Arch Phys Med Rehabil [Internet]. 2016 Oct [cited Mar 1];97(10):1714-20. Available from: https://pubmed.ncbi.nlm.nih.gov/27109328/ doi:10.1016/j.apmr.2016.03.018
Downloads
Published
Issue
Section
License
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
