Postrehabilitation outcomes after spinal cord injury caused by firearms and motor vehicle crash among ethnically diverse groups
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R L Waters1, R H Adkins, I Sie
1Regional Spinal Injury Care System of Southern California, Injury Prevention Research Center, University of California, Los Angeles, USA.
Objectives:
To determine the differential effects of impairment, disability, etiology, and selected preinjury and social factors on medical complications, medical resources use, and handicap after rehabilitation for spinal cord injury (SCI).
Design:
Survey including interview and medical record review.
Setting:
Model SCI Care System centered at an urban, public medical center.
Participants:
A volunteer convenience sample of 164 men, ages 18 to 35yrs at injury, with SCI caused by firearms or motor vehicle crash.
Main Outcome Measures:
Mean numbers of documented complications, pressure sore episodes, nonroutine clinic visits, postrehabilitation hospitalization days per year, assessment by Functional Independence Measure (FIM), and total score on the Craig Handicap Assessment and Reporting Technique (CHART).
Results:
Significant factors for postrehabilitation complications were discharge FIM (p < .001) and injury duration (p = .046); for pressure ulcer episodes, they were injury completeness (p < .001), drug abuse following injury (p = .005), and ethnicity (p = .043); for average annual nonroutine clinic visits, they were complications (p < .001), pressure ulcer episodes (p < .001), duration of injury (p = .001), and pain (p = .052); for hospitalization, they were pressure ulcer episodes (p < .001) and complications (p = .043); for CHART scores, they were discharge FIM (p < .001), preinjury education (p < .001), hospitalization (p = .007), chronic pain (p = .01), longest time at one job (p = .02), completeness of injury (p = .042), and preinjury employment (p = .049).
Conclusions:
Disability is the most important factor in postrehabilitation outcomes for SCI, followed by injury completeness, which is also associated with multiple outcomes. Postinjury but not preinjury drug abuse is adversely associated with outcomes. Etiology and ethnicity are not important determinates of outcome.