脊髓损伤后患者特征及康复服务与预后的关系：脊髓损伤康复（SCIRehab）项目
Relationship of patient characteristics and rehabilitation services to outcomes following spinal cord injury: the SCIRehab project.
作者信息
Whiteneck Gale, Gassaway Julie, Dijkers Marcel P, Heinemann Allen W, Kreider Scott E D
机构信息
Department of Research, Craig Hospital, Englewood, CO, USA.
出版信息
J Spinal Cord Med. 2012 Nov;35(6):484-502. doi: 10.1179/2045772312Y.0000000057.
BACKGROUND/OBJECTIVE: To examine associations of patient characteristics along with treatment quantity delivered by seven clinical disciplines during inpatient spinal cord injury (SCI) rehabilitation with outcomes at rehabilitation discharge and 1-year post-injury.
METHODS
Six inpatient SCI rehabilitation centers enrolled 1376 patients during the 5-year SCIRehab study. Clinicians delivering standard care documented details of treatment. Outcome data were derived from SCI Model Systems Form I and II and a project-specific interview conducted at approximately 1-year post-injury. Regression modeling was used to predict outcomes; models were cross-validated by examining relative shrinkage of the original model R(2) using 75% of the dataset to the R(2) for the same outcome using a validation subsample.
RESULTS
Patient characteristics are strong predictors of outcome; treatment duration adds slightly more predictive power. More time in physical therapy was associated positively with motor Functional Independence Measure at discharge and the 1-year anniversary, CHART Physical Independence, Social Integration, and Mobility dimensions, and smaller likelihood of rehospitalization after discharge and reporting of pressure ulcer at the interview. More time in therapeutic recreation also had multiple similar positive associations. Time spent in other disciplines had fewer and mixed relationships. Seven models validated well, two validated moderately well, and four validated poorly.
CONCLUSION
Patient characteristics explain a large proportion of variation in multiple outcomes after inpatient rehabilitation. The total amount of treatment received during rehabilitation from each of seven disciplines explains little additional variance. Reasons for this and the phenomenon that sometimes more hours of service predict poorer outcome, need additional study. Note: This is the first of nine articles in the SCIRehab series.
背景/目的：研究住院脊髓损伤（SCI）康复期间患者特征以及七个临床学科提供的治疗量与康复出院时和受伤后1年的结局之间的关联。
方法
在为期5年的SCIRehab研究中，六个住院SCI康复中心招募了1376名患者。提供标准护理的临床医生记录了治疗细节。结局数据来自SCI模型系统表格I和II以及在受伤后约1年进行的特定项目访谈。使用回归模型预测结局；通过检查原始模型R²的相对收缩率来对模型进行交叉验证，使用75%的数据集计算原始模型R²，使用验证子样本计算相同结局的R²。
结果
患者特征是结局的有力预测因素；治疗持续时间增加了稍多的预测能力。物理治疗时间越长，与出院时和1周年时的运动功能独立性测量、CHART身体独立性、社会融合和活动维度呈正相关，出院后再住院的可能性较小，且在访谈中报告有压疮的可能性较小。治疗性娱乐时间越长也有多个类似的积极关联。在其他学科花费的时间关系较少且好坏参半。七个模型验证良好，两个模型验证中等良好，四个模型验证较差。
结论
患者特征解释了住院康复后多种结局的大部分变异。七个学科中每个学科在康复期间接受的治疗总量几乎没有额外解释变异。对此的原因以及有时服务时间越长结局越差的现象，需要进一步研究。注：这是SCIRehab系列九篇文章中的第一篇。
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