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Critical Reviews™ in Physical and Rehabilitation Medicine

ISSN Print: 0896-2960
ISSN Online: 2162-6553

Critical Reviews™ in Physical and Rehabilitation Medicine

DOI: 10.1615/CritRevPhysRehabilMed.2018024333
pages 45-66

Service Interruptions and Their Impact on Rehabilitation Length of Stay among Ontarians with Traumatic, Subacute Spinal Cord Injury

Rohit Bhide
Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
Carly Rivers
Rick Hansen Institute, Vancouver, British Columbia
Dilnur Kurban
Rick Hansen Institute, Vancouver, British Columbia
Jason Chen
Rick Hansen Institute, Vancouver, British Columbia
Vanessa Noonan
Rick Hansen Institute, Vancouver, British Columbia
Farnoosh Farahani
Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
Heather Flett
Toronto Rehabilitation Institute, University Health Network, Toronto, Canada
Cathy Craven
Toronto Rehabilitation Institute, University Health Network, Toronto, Canada

ABSTRACT

Objectives: To describe the frequency, type, and duration of service interruptions(SI) among Ontarians with subacute, traumatic spinal cord injury (SCI) and to describe the impact of SI on rehabilitation length of stay(LOS). Design, setting, and participants: Retrospective cross-sectional cohort study of individuals admitted for inpatient rehabilitation(IPR) in Ontario between April 1, 2002, and March 31,2010. Outcome measures: Relevant patient-related demographic, socio-vocational, and injury severity variables were included. Individual SIs were grouped by categories of secondary health conditions following SCI. Descriptive statistics were used to describe SI characteristics. Multivariate regression analyses were conducted to identify which factors predict SIs and how SIs impact rehabilitation LOS. Results: Among a cohort of 1,918 patients, 143 individuals had 180 SIs. The mean SI duration was 9.2 days; GI issues were most common. Average SI duration was shorter for patients managed in a rehabilitation facility compared to acute facility transfer (p = 0.77). Significant differences were observed between the any SI and no SI groups for gender, neurological impairment, referral source, LOS, admission functional independence measure (FIM) scores, and FIM efficiency. Multiple logistic regression demonstrated that gender, ASIA impairment scale (AIS) ranking, vocational status, and referral source are significant predictors of having any SI. Multiple linear regression to explore the impact of SI on rehabilitation LOS indicated that SI along with rehabilitation onset days ≥18, neurological level C1–C8, injury severity(AIS A or B), and referral source (inpatient, acute unit, other facility) contributed to increases in LOS. Conclusions: Reported SIs are infrequent, but they may be underreported. SIs resulted in a mean 9 day disruption in IPR and reduced FIM efficiency by half. After consideration of other variables, SI extends rehabilitation LOS by 1.5 days(p <.0001). The health impact for individuals and economic impact on a universal health system warrant a future comprehensive inquiry of SI.