Article

OBJECTIVE: To investigate the amount of variation in short- and medium-term
spinal cord injury (SCI) rehabilitation outcomes explained by various comorbidity
measures, over and above patient preinjury characteristics and neurologic and
functional status. DESIGN: Prospective observational cohort study of traumatic
SCI patients receiving inpatient rehabilitation and followed up at 1 year
postinjury. SETTING: Inpatient rehabilitation and community follow-up at 6 SCI
treatment centers. PARTICIPANTS: Participants (N=1376) included 1032 patients
randomly selected for model development and 344 patients selected for
cross-validation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES:
Rehabilitation length of stay (LOS), return to acute care during rehabilitation,
discharge motor FIM, discharge home, rehospitalization after discharge, 1-year
return to work/school and 1-year depression symptomatology, motor FIM, and
residence. Comorbidity measures used were case-mix groups tier weights, Charlson
Comorbidity Index (CCI), and the Comprehensive Severity Index (CSI). RESULTS:
Multivariable regression analyses, controlling for patient preinjury and injury
characteristics, found that the maximum Comprehensive Severity Index (MCSI) was a
significant and stronger predictor of LOS, return to acute care during
rehabilitation, and 1-year motor FIM compared with the case-mix groups tier
weight or the CCI. The admission CSI was a strong predictor of LOS. For
rehospitalization after discharge, only the case-mix groups tier weight was
significant. No comorbidity measure was significant beyond patient preinjury and
injury characteristics for discharge home, discharge motor FIM, living at home,
depression symptomatology, major depressive syndrome, and return to work/school.
CONCLUSIONS: Patient preinjury and injury characteristics are sufficient to
predict most SCI outcomes. For rehabilitation LOS and return to acute care during
rehabilitation, one achieves substantially better explanation when taking
clinical comorbidity based on the MCSI into account.
CI - Copyright (c) 2013 American Congress of Rehabilitation Medicine. Published by
Elsevier Inc. All rights reserved.

Langue : ANGLAIS