Factors influencing the outcomes of specialized institution-based rehabilitation in spinal cord injury

English Keywords:Spinal cord injury individuals  Specialized institution-based rehab training  Influencing factor  Factor analysis

English Abstract:

  【Abstract】 Objectives: To evaluate the factors influencing the effects of rehabilitation training in spinal cord injury(SCI) individuals. Methods: Training documents of SCI individuals who had fulfilled rehabilitation training from 2013 to 2016 in Shanghai Yangzhi Rehabilitation Hospital(Shanghai Sunshine Rehabilitation Center, SSRC) were reviewed, and general characteristics such as sex, date of birth, marital status, injury time, lesion level and etiology of injury were collected. Fifteen indicators of basic life skills(eating, grooming, bathing, upper limb dressing, lower limb dressing, toileting, bed/chair/wheelchair transfer, toilet transfer, bath transfer, walk, stairs, wheelchair, interpersonal communication, problem solving and emotion handling), 3 indicators of family life skills(personal hygiene, housework, entertainment), and 5 indicators of social life skills(wheelchair use, transportation use, destination arrival, task completion and communication skills) were compared between before and after the rehabilitation training. A total of 383 SCI individuals was included in this study, and the median age on admission was 45 years with a range of 9-71 years. They got injury at a median of 31 years old, and the oldest patient was 69 years old. There were 0-61 years(mean time, 11 years; median time, 5 years) from injury onset to rehab training. The SCI individuals with traumatic cause counted 303(79.3%). Factor analysis was used to explore the inner structure of the variables and resulted in 5 common factors(basic life skills, application in social life, cognition and emotion, application in family life, walk and stairs). Multivariate linear regression was conducted to explore the factors influencing the 5 common factors, and the independent variables included the time span from injury onset to rehab training, sex, education background, marital status, injury level and etiology. Results: The study found that the score of each indicator significantly increased, the lowest was eating(2.2%) and the highest was wheelchair use(78.8%); in the 5 factors, the application in family life improved highest(54.3%, P<0.01), and walk and stairs(locomotion) improved lowest(10.5%, P<0.01). The multivariate linear regression showed that the earlier to take part in rehab training, the greater improvement(P<0.1) in basic life skills obtained; the cases with cervical(P<0.1) and thoracic(P<0.1) cord injury had better rehabilitation outcomes in basic life skills than the cases with lumbosacral cord injury; the SCI individuals with junior or regular college education background showed more improvement in cognition and emotion than those with junior high school or below education background(P<0.1). Married SCI individuals had a positive influence on the application in family life(P<0.1), while the time span from injury onset to rehab training(P<0.1) and traumatic injury(P<0.1) had a negative influence. Married SCI individuals and earlier start of rehab training had a positive influence on applications in social life. Conclusions: The rehabilitation training outcomes are encouraging in SSRC, and the influencing factors may include the time span from injury onset to rehab training, education background, marital status, injury level and etiology. More attention should be paid on earlier rehab training and education et al, which are beneficial for rehab training outcomes.