Comparison of patients managed in specialised spinal rehabilitation units with those managed in non-specialised rehabilitation units.

STUDY DESIGN: Prospective open cohort study. OBJECTIVE: Compare the demographic characteristics and rehabilitation outcomes for both non-traumatic SCI (NT-SCI) and traumatic SCI (T-SCI) patients admitted into either specialist spinal cord injury rehabilitation units (SCIRUs) or non-specialist rehabilitation units (NSRUs). SETTING: Rehabilitation units in Australia. METHODS: The Australasian Rehabilitation Outcomes Centre maintains a national database on inpatients admitted to most (130/145) public and private rehabilitation units in Australia. Patients were included if they had a diagnosis of spinal cord injury (SCI) and were discharged between 1 January 2006 and 31 December 2006. Patients were excluded if admitted for <7 days, only for assessment, or were a readmission following a previous SCI. RESULTS: There were 668 patients with confirmed SCI admitted (NT-SCI n=361, 54.0%; T-SCI n=307, 46.0%). NT-SCI patients were much less likely to be admitted into a specialist SCIRU (30.5%) compared with T-SCI patients (70.4%). For both NT-SCI and T-SCI patients, those admitted to a specialist SCIRU tended to be younger (P=0.000), have a longer length of stay in rehabilitation (P=0.000), and lower Functional Independence Measure (FIM) motor subscale score on admission (P=0.000) than those admitted to a NSRU. For NT-SCI patients, after adjusting for covariates, those admitted into specialist SCIRU had greater improvement in their FIM motor score during rehabilitation. This finding was not demonstrated in T-SCI patients. CONCLUSIONS: There are differences in the characteristics of SCI patients admitted to SCIRU compared with NSRU. NT-SCI patients admitted to SCIRU have greater functional gain.

A population-based study comparing traumatic spinal cord injury and non-traumatic spinal cord injury using a national rehabilitation database.

STUDY DESIGN: A limitation of many studies of non-traumatic spinal cord injury (NT-SCI) and traumatic spinal cord injury (T-SCI) is potential lack of generalizability because of selection bias. An open cohort study using a national rehabilitation database was planned to address this. OBJECTIVE: To compare the demographic characteristics and outcomes between NT-SCI and T-SCI patients. SETTING: Rehabilitation hospitals in Australia. METHODS: The Australasian Rehabilitation Outcomes Centre maintains a national database of information on in-patients admitted to almost all (130/145 as at 2006) public and private rehabilitation hospitals in Australia. It collects a range of demographic and clinical outcomes. Patients were included if they were discharged between 1 January 2002 and 31 December 2006. Patients were excluded if they were admitted for <7 days, only for assessment or were a readmission. RESULTS: There were 3610 patients included (NT-SCI, n=2241, 62.1%; T-SCI, n=1361, 37.7%). There were numerous significant differences between NT-SCI and T-SCI patients. NT-SCI patients were generally older (median age NT-SCI 67 years vs T-SCI 46 years, P=0.000), less likely to be male (male NT-SCI 52.5% vs T-SCI 71.6%, P=0.000) and had a shorter length of stay (median NT-SCI 21 days vs T-SCI 44 days, P=0.000). NT-SCI patients were also less disabled than T-SCI patients, having higher Functional Independence Measure motor subscale score on admission (median NT-SCI 53 vs T-SCI 38, P=0.000) and discharge (median NT-SCI 76 vs T-SCI 74, P=0.000). CONCLUSION: Previous demographic studies of NT-SCI and T-SCI patients are similar to our population-based results. More population-based research in SCI is required.

Multiple sclerosis rehabilitation outcomes: analysis of a national casemix data set from Australia.

OBJECTIVE: To examine the outcomes of inpatient rehabilitation for persons with multiple sclerosis (pwMS), using the Australian Rehabilitation Outcomes Centre (AROC) database. METHOD: Deidentified data from the AROC database were analyzed for all rehabilitation admissions during 2003-2007, using four classes for functional level. The outcomes included Functional Independence Measure (FIM) scores and efficiency, hospital length of stay (LOS), and discharge destination. RESULTS: Of 1010 case episodes, 70% were women, admitted from home (n = 851) and discharged into the community (n = 890), and 97% (n = 986) were in the higher three classes for functional level (classes 216, 217, and 218). Majority of the more disabled pwMS were treated in the public hospital system, with a longer LOS compared with private facilities (P < 0.001). The FIM for classes 216-218 showed significant functional improvement during the admission (P < 0.001), and those in higher classes showed less change (likely due to higher FIM admission scores). FIM efficiency was significantly higher in class 217 than other classes (P < 0.001). The year-on-year trend was toward reducing hospital LOS and FIM efficiency, but these did not reach significance (P = 0.107, P = 0.634). CONCLUSION: The AROC data set is useful for describing rehabilitation outcomes for pwMS. However, additional information needs to be collected to evaluate nature of services provided and service implications.