Journal:Journal of Spinal Cord Medicine
Year, Volume, Issue, Page(s):12, 35, 6, 503-526
Study examined the effects of the type and quantity of physical therapy (PT) interventions delivered during inpatient spinal cord injury (SCI) rehabilitation and patient characteristics on outcomes at the time of discharge and at 1 year post-injury. Physical therapists delivering routine care documented details of PT interventions provided. Regression modeling was used to predict outcomes for 75 percent of participants; models were validated with the remaining 25 percent. Injury subgroups were also examined: motor complete low tetraplegia, motor complete paraplegia, and American Spinal Injury Association (ASIA) Impairment Scale (AIS) D motor incomplete tetra-/paraplegia. PT treatment variables explained more variation in three functionally homogeneous subgroups than in the total sample. Among patients with motor complete low tetraplegia, higher scores for the transfer component of the discharge motor Functional Independence Measure (FIM) were strongly associated with more time spent working on manual wheelchair skills. Being male was the most predictive variable for the motor FIM score at discharge for patients with motor complete paraplegia. Admission ASIA lower-extremity motor score (LEMS) and change in LEMS were the factors most predictive for having the primary locomotion mode of "walk" or "both” (walk and wheelchair) on the discharge motor FIM for patients with AIS D injuries. Results indicate that injury classification influences type and quantity of PT interventions during inpatient SCI rehabilitation and is a strong predictor of outcomes at discharge and 1 year post-injury. The impact of PT treatment increases when patient groupings become more homogeneous and outcomes become specific to the groupings.