Factors Complicating Treatment Sessions in Spinal Cord Injury Rehabilitation: Nature, Frequency, and Consequences

Objective: To describe therapist-reported factors affecting therapy sessions in spinal cord injury (SCI) inpatient rehabilitation and explore their impact on the patient's rehabilitation program. Design: Prospective observational longitudinal cohort design. Data were obtained from systematic recordings of interventions by clinicians and from medical record abstraction. Setting: Six inpatient rehabilitation programs. Participants: Patients (N=1376) with traumatic SCI admitted for initial rehabilitation. Interventions: Not applicable. Main Outcome Measures: Factors recorded as impacting the objective or content of treatment sessions by physical therapy, occupational therapy, speech therapy, and therapeutic recreation, patients' participation in treatment as rated using a modified Pittsburgh Rehabilitation Participation Scale (PRPS), length of stay (LOS), medical morbidity measured using the Comprehensive Severity Index, hours of therapy per week, and missed therapy minutes. Results: Patients received 151,172 treatment sessions from 483 therapists. Pain, fatigue, and spasticity were commonly reported factors; other medical, behavioral, and logistical factors were also frequent, with 30% of sessions being affected by at least 1 factor. The number of factors was correlated with missed therapy minutes and with the PRPS score. Patients with more reported factors, overall or per average session, had a longer LOS and fewer hours of treatment per week. Conclusions: Medical and other factors complicating therapy are common. Those who need a longer stay because of their injury level or for other reasons have more opportunity to have sessions affected, but having many treatment sessions impacted by 1 or more factors also is likely to increase LOS. The nature of these factors and their impact on rehabilitation processes and outcomes deserve further study. Archives of Physical Medicine and Rehabilitation 2013;94(4 Suppl 2):S115-24 (C) 2013 by the American Congress of Rehabilitation Medicine