Predicting rehabilitation length of stay in Canada: It’s not just about impairment

The Journal of Spinal Cord Medicine, 2017 · DOI: 10.1080/10790268.2017.1368962 · Published: January 1, 2017

Spinal Cord Injury Healthcare Rehabilitation

Simple Explanation

This study aimed to identify factors that influence the length of stay in rehabilitation facilities for adults with traumatic spinal cord injuries in Canada. Researchers analyzed data from 1,376 adults with traumatic SCI from 15 sites across Canada between 2004 and 2014, looking at demographic, impairment, and medical complexity variables. The study found that age, severity of spinal cord injury, prior ventilation, presence of an indwelling bladder catheter, and lower extremity motor scores were significant predictors of rehabilitation length of stay.

Study Duration

2004-2014

Participants

1,376 adults with traumatic SCI

Evidence Level

Not specified

Key Findings

1
Age, prior Vent/ETT tube for >24 hours in acute care, indwelling catheter, LEMS within 7 days of rehabilitation admission, and NLI/AIS subgroups at rehabilitation admission, explain 32% of the variation in R-LOS.
2
Patients with more severe impairment had a longer R-LOS than those with less severe injuries.
3
Prior ventilation in acute care and having an indwelling catheter increased R-LOS by 11 days (p = 0.0007) and 12 days (p = 0.0129) respectively.

Research Summary

The objectives of this manuscript are to: 1) identify and describe the relevant demographic, impairment and medical complexity variables evident at/before tertiary SCI rehabilitation admission and their association with R-LOS among adult Canadians with traumatic SCI; and, 2) to identify the factors which predict an extended R-LOS using a predictive equation. Multivariate linear regression analyses identified five variables as significant predictors: age, Vent/ETT for >24 hours in acute care, indwelling bladder catheter at acute discharge, LEMS, and NLI/AIS subgroup at rehabilitation admission explained 32% of the variation in R-LOS (p<0.001). This enclosed predictive equation may be used to identify patients with SCI at risk for an extended R-LOS, well beyond the mean NRS R-LOS by RCG at rehabilitation admission.

Practical Implications

Clinical Prediction Tool

Clinicians and administrators can use the predictive equation to identify patients likely to require extended rehabilitation, facilitating resource allocation.

Health Policy

The study highlights the need to move beyond impairment-only funding models to incorporate factors like medical complexity and prognosis for functional recovery.

Future Research

The data elements including the NLI-AIS subgroups may be used to help inform the design of future predictive models identifying individuals at risk for an extended R-LOS.

Study Limitations

1
Direct measures of relevant health system variables and medical complexity may yield a more potent multivariate model.
2
The time frame upon which the enclosed results are based, covers a period of rapid health system transformation and advances in SCI Care and reductions in R-LOS which are not reflected in our model.
3
There are health system variables that also influence R-LOS that we did not account for nor include in our multivariable model.

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