Missed therapy time during inpatient rehabilitation for spinal cord injury.

OBJECTIVES

To investigate the frequency of and reasons for missed therapy sessions during inpatient rehabilitation after traumatic spinal cord injury (SCI), and to assess the influence of demographic, medical, and injury factors on the missing of therapy sessions.

DESIGN

Prospective cohort study.

SETTING

Six inpatient rehabilitation centers.

PARTICIPANTS

Individuals with SCI (N=1376) consecutively admitted for inpatient rehabilitation at participating sites; 1032 participants were randomly selected for model development, and 344 participants were selected for model cross-validation.

INTERVENTIONS: Not applicable.

MAIN OUTCOME MEASURES: Total hours of missed therapy; total minutes missed per week; and reason for missed therapy.

RESULTS

Patients missed an average of 153 minutes of therapies per week, or a total of 20 hours over their rehabilitation stay. Common reasons for missing physical, occupational, and speech therapy were lack of patient readiness and medical reasons. Therapeutic recreation sessions were commonly missed because of patient refusal. More missed therapy (for any reason) was predicted by having C5-8 tetraplegia, paraplegia, greater morbidity, higher motor and cognitive functional independence, higher percent of sessions limited by fatigue, violent SCI etiology, longer rehabilitation length of stay, and treatment center. Older age, ventilator use, and percent of sessions limited by spasticity were predictive of less therapy time missed.

CONCLUSIONS

On average, patients missed about 2.5 hours of therapy weekly. In view of the potential impact on rehabilitation outcomes and given the potential cost of lost resources, missed therapy deserves further study and administrative attention. In addressing this issue, there may be potential for the rehabilitation facility to intervene to reduce such lost time, including addressing equipment/therapist availability, patient readiness, patient engagement, and center-specific approaches.