Archives of rehabilitation research and clinical translation · 2025
Effective and Efficient Rehabilitation. What Works Best for Persons With SCI During (Sub)Acute Phase of Rehabilitation?
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Metzger Stefan, Polanco Boris, Eriks-Hoogland Inge, Gemperli Armin, Pacheco Barzallo Diana
Аннотация
OBJECTIVE: To estimate the effectiveness and efficiency of comprehensive rehabilitation in improving the score of the spinal cord independence measure III (SCIM) for individuals with spinal cord injury/disease (SCI/D).
DESIGN: Observational cohort study.
SETTING: A specialized spinal cord injury (SCI) rehabilitation clinic in Switzerland that admits patients from across the country and provides (sub)acute rehabilitation following SCI/D.
PARTICIPANTS: This study analyzes the clinical data of 383 patients (N=383) who received rehabilitation from a specialized spinal cord injury hospital and rehabilitation center in Switzerland from 2017 to 2020.
INTERVENTIONS: Not applicable. This study used routinely collected clinical and administrative data from the clinic.
MAIN OUTCOME MEASURES: We estimated the average effectiveness by computing how the SCIM changed from admission to discharge during the (sub)acute phase of rehabilitation. To compute the efficiency of rehabilitation, we used 2 measures: 1. length of hospital stay and 2. severity of the services a person received. The results were adjusted by patients' characteristics, using a generalized additive model.
RESULTS: Comprehensive (sub)acute rehabilitation for persons with SCI/D is effective, with an average improvement of 35.7 SCIM points. Key factors influencing rehabilitation effectiveness included sex, age, etiology, number of comorbidities, and injury group. Rehabilitation efficiency increases by an average of 0.34 SCIM points per day, or 0.30 SCIM points per Swiss francs (CHF) 1,000.
CONCLUSIONS: Rehabilitation for persons with SCI/D is shown to be effective. However, there is variability in clinical outcomes and severity across injury groups, emphasizing the need for tailored clinical management strategies. Further research is needed to deepen the understanding of clinical outcome variability and efficiency factors by considering the severity of services.
DESIGN: Observational cohort study.
SETTING: A specialized spinal cord injury (SCI) rehabilitation clinic in Switzerland that admits patients from across the country and provides (sub)acute rehabilitation following SCI/D.
PARTICIPANTS: This study analyzes the clinical data of 383 patients (N=383) who received rehabilitation from a specialized spinal cord injury hospital and rehabilitation center in Switzerland from 2017 to 2020.
INTERVENTIONS: Not applicable. This study used routinely collected clinical and administrative data from the clinic.
MAIN OUTCOME MEASURES: We estimated the average effectiveness by computing how the SCIM changed from admission to discharge during the (sub)acute phase of rehabilitation. To compute the efficiency of rehabilitation, we used 2 measures: 1. length of hospital stay and 2. severity of the services a person received. The results were adjusted by patients' characteristics, using a generalized additive model.
RESULTS: Comprehensive (sub)acute rehabilitation for persons with SCI/D is effective, with an average improvement of 35.7 SCIM points. Key factors influencing rehabilitation effectiveness included sex, age, etiology, number of comorbidities, and injury group. Rehabilitation efficiency increases by an average of 0.34 SCIM points per day, or 0.30 SCIM points per Swiss francs (CHF) 1,000.
CONCLUSIONS: Rehabilitation for persons with SCI/D is shown to be effective. However, there is variability in clinical outcomes and severity across injury groups, emphasizing the need for tailored clinical management strategies. Further research is needed to deepen the understanding of clinical outcome variability and efficiency factors by considering the severity of services.