Challenge or opportunity: Rehabilitation outcomes in patients with metastatic spinal cord compression - a UK single center experience.

CONTEXT /OBJECTIVE: Metastatic Spinal Cord Compression (MSCC) is a devastating complication of cancer, affecting approximately 3000 patients per annum in England. However, access to rehabilitation services for MSCC patients is limited. The London Spinal Cord Injury Centre has set up a bespoke MSCC rehabilitation pathway from May 2013. This article aims to describe the clinical features and functional outcomes of patients with MSCC admitted to a Specialist Spinal Cord Injury Rehabilitation Centre between May 2013 and December 2021. DESIGN: Retrospective analysis of medical records from a single specialist rehabilitation centre database. SETTING: London Spinal Cord Injury Centre (LSCIC), Stanmore, United Kingdom. PARTICIPANTS: Adult patients diagnosed with MSCC who were admitted to and discharged from LSCIC from May 2013 to December 2021. INTERVENTIONS: Specialist Inpatient Spinal Cord Injury Rehabilitation Program. OUTCOME MEASURES: Spinal Cord Independence Measure 19 (SCIM version III), Discharge Destination. RESULTS: A total of 40 patients with MSCC were admitted - 32 male and 8 female patients. The average length of stay was 6 weeks. 17(42.5%) patients had primary prostate cancer. Most patients (34(85%)) had thoracic MSCC. There was an improvement in the Spinal Cord Independence Measure in all patients with an average significant improvement from 43.8 to 64.5 (P < 0.001). There was no significant difference in SCIM scores between patients under 65 and over 65. 28 (70%) patients required psychological input. 33(82.5%) patients were discharged home. CONCLUSION: Patients with MSCC show improvement in SCIM outcome measures after a six-week inpatient Specialist Spinal Rehabilitation program.

"Can We Vaccinate Everybody?" A Rehabilitation Ward's Experience of an Inpatient COVID-19 Vaccination Program.

Gwynne Holford Ward (GHW) is an inpatient rehabilitation Unit at Queen Mary's Hospital in London, UK, which provides care for patients with amputation rehabilitation needs (10 beds) as well as Level 1 and 2 specialist neurorehabilitation needs (26 beds). The ward MDT has encouraged all inpatients to be vaccinated either during or prior to admission. We have conducted a weekly snapshot audit over a 3-week period in March 2021, which has shown an increase of the percentage of inpatients vaccinated, progressively from 68.75% to 80%, and 73% of vaccinated inpatients received the vaccine whilst on the ward. We also conducted inpatient interviews, which highlighted that: (1) opening dialogue about vaccines increased uptake of COVID-19 vaccine; (2) patients felt that all vaccination sites provided quick, efficient service; and (3) all patients who received the first COVID-19 vaccine were willing to have the second COVID-19 vaccine. Finally, although there were many hurdles faced whilst organizing the inpatient vaccination process, we have been able to cumulatively vaccinate 80% of rehabilitation inpatients making our ward a safer place to work and rehabilitate.

Functional outcomes and cost-efficiency of specialist in-patient rehabilitation following spinal cord injury: a multi-centre national cohort analysis from the UK Rehabilitation Outcomes Collaborative (UKROC).

Purpose: To evaluate functional outcomes, care needs and cost-efficiency of specialist rehabilitation for a multi-centre cohort of inpatients with spinal cord injury (SCI)-comparison based on age and aetiology.Methods and materials: Retrospective analysis of prospectively collected data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database from 2012-2019. Adults with SCI admitted for a rehabilitation programme in levels 1 and 2 specialist rehabilitation Units in England, were included if they had valid UK Functional Assessment Measure (UK FIM + FAM) and Northwick Park Dependency Scale (NPDS) scores recorded on admission and discharge (n = 2506 of 3321 admissions).Results: Approximately 425 patients were admitted yearly. 1344(56%) patients were under 65. 736(29%) had traumatic aetiology. Older and Traumatic SCI patients were more likely to have cervical cord damage (X2, p < 0.001). There was a significant improvement in all parameters of functional independence (UK FIM + FAM) (p < 0.001), with the reduction in dependency and care costs (NPDS/NPCNA) (p < 0.001). 1817(72.5%) patients were discharged home. Mean care-costs savings were £25 500/year per patient. Year-on-year trends showed admissions with increasing age, higher complexity and dependency with corresponding increasing episode costs (ANOVA p < 0.001). However, the time taken to offset the cost of rehabilitation did not change significantly (ANOVA p = 0.57).Conclusions: Specialist rehabilitation services provide effective and cost-efficient rehabilitation for patients with spinal cord injury.Implications for RehabilitationApproximately a third of patients who access specialist inpatient rehabilitation following spinal cord injury (SCI) in England are managed in the Specialist Level 1 and 2 neuro-rehabilitation units, rather than in the eight designated national SCI Centres.Despite admitting progressively more complex and dependent patients over eight years, these specialist rehabilitation units continue to provide highly cost-efficient care.The mean annual savings amount to £25,500 per patient. With a mean admission rate of 425 patients, this would generate total savings in excess of £10 million per year for the cohort.Specialist rehabilitation services play an important, but under-recognised, role in the spinal cord injury care pathway.