Format

Send to

Choose Destination
J Spinal Cord Med. 2017 Nov;40(6):676-686. doi: 10.1080/10790268.2017.1368962. Epub 2017 Sep 12.

Predicting rehabilitation length of stay in Canada: It's not just about impairment.

Author information

1
a Brain and Spinal Cord Rehabilitation Program , Toronto , ON , Canada.
2
b Neural Engineering & Therapeutics Team, Toronto Rehabilitation Institute , University Health Network , Toronto , ON , Canada.
3
c Dept. of Medicine, Division of PM&R , University of Toronto , Toronto , ON , Canada.
4
d University Health Network Toronto Rehab Lyndhurst Centre , Toronto , ON , Canada.
5
e Rick Hansen Institute , Vancouver , BC , Canada.
6
f Toronto Rehabilitation Institute , University Health Network , Toronto , ON , Canada.
7
g Allied Health, AHS Calgary Zone , Calgary , AB , Canada.
8
h Division of Physical Medicine & Rehabilitation, Dept of Clinical Neurosciences , University of Calgary , Calgary , AB , Canada.
9
i Department of Physical Medicine and Rehabilitation , University of Saskatchewan , Saskatoon , SK , Canada.
10
j Spinal Cord Injury and Amputation Programs , Saskatoon Health Region , Saskatoon , SK , Canada.
11
k École de réadaptation, Faculté de médecine , Université de Montréal , Montréal , QC , Canada.
12
l Physical Medicine & Rehabilitation , Dalhousie University, Faculty of Medicine , Fredericton , NB , Canada.
13
m Department of Medicine , University of Manitoba , Winnipeg , MB , Canada.
14
n Department of Rehabilitation , Université Laval & Centre for Interdisciplinary Research in Rehabilitation and Social Integration , Québec City , QC , Canada.
15
o University of British Columbia , Vancouver , BC , Canada.

Abstract

INTRODUCTION:

Current tertiary Spinal Cord Injury (SCI) rehabilitation funding and rehabilitation length of stay (R-LOS) in most North American jurisdictions are linked to an individual's impairment. Our objectives were to: 1) describe the impact of relevant demographic, impairment and medical complexity variables at rehabilitation admission on R-LOS among adult Canadians with traumatic SCI; and 2) identify factors which extend R-LOS.

METHODS:

Data from 1,376 adults with traumatic SCI were obtained via chart abstraction and administrative data linkage from 15 Rick Hansen SCI Registry sites (2004-2014). Variables included age, sex, neurological impairment (level, severity), rehabilitation onset days, R-LOS, Glasgow Coma Score (GCS) at admission, prior ventilation or endotracheal tube (Vent/ETT), or indwelling bladder catheter at acute discharge, pain interference score, intensive care unit (ICU) length of stay (LOS), and lower extremity motor scores (LEMS) at rehabilitation admission. Variables related to R-LOS in bivariate analysis were included in multivariate analysis to determine their impact on R-LOS.

RESULTS:

Prior Vent/ETT tube, indwelling bladder catheter, GCS, LEMS, and neurological impairment were related to R-LOS in bivariate analysis. Multivariate linear regression analyses identified five variables as significant predictors: age, Vent/ETT for >24 hours in acute care, indwelling bladder catheter at acute discharge, LEMS, and NLI/AIS subgroup at rehabilitation admission explained 32% of the variation in R-LOS (p<0.001).

CONCLUSIONS:

Based on the enclosed formula, and knowledge of an individual's age at injury, spinal cord impairment (level and severity), prior Vent/ETT, presence of an indwelling bladder catheter, and LEMS at admission, administrators and clinicians may readily identify patients for whom an extended R-LOS beyond conventional LOS targets is likely.

KEYWORDS:

Health system; Length of stay; Outcome measures; Rehabilitation; Spinal cord injury

PMID:
28899285
PMCID:
PMC5778931
DOI:
10.1080/10790268.2017.1368962
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Taylor & Francis Icon for PubMed Central
Loading ...
Support Center