Effects of Etiology on Inpatient Rehabilitation Outcomes in 65- to 74-Year-Old Patients With Incomplete Paraplegia From a Nontraumatic Spinal Cord Injury

Kay, Elizabeth; Deutsch, Anne; Chen, David; Manheim, Larry; Rowles, Diane

doi:10.1016/j.pmrj.2010.03.010

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Volume 2, Issue 6 , Pages 504-513, June 2010

Effects of Etiology on Inpatient Rehabilitation Outcomes in 65- to 74-Year-Old Patients With Incomplete Paraplegia From a Nontraumatic Spinal Cord Injury

Elizabeth Kay, PT, PhD
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago, 345 East Superior Street, O-964, Chicago, IL 60611; and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL^†
- Address correspondence to E.K.
Anne Deutsch, RN, PhD, CRRN
- Center for Rehabilitation Outcomes Research, Rehabilitation Institute of Chicago; Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, and Institute for Health Care Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL^‡
David Chen, MD
- Spinal Cord Injury Program, Rehabilitation Institute of Chicago; Spinal Cord Injury Program, Northwestern Memorial Hospital; and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL^§
Larry Manheim, PhD
- Institute for Health Care Studies, Feinberg School of Medicine, Northwestern University, Chicago, IL^¶
Diane Rowles, MS, ACNP-BC, CRRN
- Spinal Cord Injury Program, Rehabilitation Institute of Chicago; and Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL^∥

Received 1 October 2009; accepted 5 March 2010.

Objective

To examine differences in rehabilitation outcomes for older patients with a nontraumatic spinal cord injury (NT-SCI) for 5 etiologic diagnoses: degenerative spinal disease (DSD), malignant spinal tumor, benign spinal tumor, vascular ischemia, and spinal abscess.

Design

Retrospective cohort study that used Medicare claims and assessment data.

Setting

A total of 479 inpatient rehabilitation hospitals and units.

Patients

A total of 1780 Medicare beneficiaries (65-74 years old) with incomplete paraplegia attributable to NT-SCI who were discharged from inpatient rehabilitation facilities from 2002 through 2005.

Interventions

Not applicable.

Main Outcome Measures

Length of stay, discharge Functional Independence Measure (FIM) instrument motor item and subscale scores, and discharge destination.

Results

Demographic characteristics varied by etiology group. Mean ± SD rehabilitation stays ranged from 13.3 ± 7.7 days for DSD to 26.4 ± 13.4 days for vascular ischemia. Adjusted data showed stays differed (P < .001) across etiology groups. Adjusted discharge mean self-care and mobility subscores revealed that patients with DSD and benign tumor were more independent (P < .001) than patients with a malignant tumor or spinal abscess. Patients with vascular ischemia were more dependent (P < .01) in mobility than the DSD and benign tumor groups. Etiologic differences (P < .01) in independence in discharge FIM modifiers for walking (FIM ≥ 4), bladder (FIM ≥ 6) and bowel management (FIM ≥ 6) and bowel accidents/continence (FIM ≥ 6), but not bladder accidents (FIM ≥ 6), were present. The percent of patients discharged to a community residence ranged from 59.3% to 92.6%. Adjusted data showed that significantly larger percentages (P < .01) of patients in the DSD and malignant tumor groups than in the spinal abscess group were discharged to a community residence (versus nursing home).

Conclusion

There are etiologic differences in demographics, rehabilitation length of stay, functional outcomes, and discharge destination in elderly patients with NT-SCI.