Do preinjury alcohol problems predict poorer rehabilitation progress in persons with spinal cord injury?

Objective: To determine whether a history of alcohol-related problems is associated with inpatient rehabilitation progress. Design: Cross-sectional cohort survey. Setting: Acute inpatient rehabilitation program in a level I trauma center. Participants: Seventy-six of 104 consecutive patients with spinal cord injury (SCI) who met inclusion criteria and had completed interviews and functional outcome data. Participants were on average 38 years old; 84% were white, and 86% were men. Forty-two percent had tetraplegia and 39% had a history of problem drinking. Interventions: Not applicable. Main Outcome Measures: FIM instrument admission, discharge, and efficiency scores as well as rehabilitation length of stay (LOS). Results: The group with a history of problem drinking had significantly lower FIM admission, discharge, and efficiency scores and longer rehabilitation LOS. After controlling for potential confounding factors, a history of problem drinking accounted for a significant proportion of the variance in FIM efficiency scores. Conclusions: A history of problem drinking may be a risk factor for poorer rehabilitation progress among patients with SCI. They may be more costly to rehabilitate and may be discharged before attaining an adequate level of independence. Despite this, the current rehabilitation prospective payment system does not recognize this common comorbid condition.