McKechnie Duncan, Pryor Julie, Fisher Murray J, Alexander Tara
Royal Rehab, Sydney, Australia.
Sydney Nursing School, The University of Sydney, Sydney, Australia.
Disabil Rehabil. 2020 Sep;42(19):2718-2725. doi: 10.1080/09638288.2019.1568592. Epub 2019 Feb 14.
To compare the rehabilitation of patients with brain and spinal cord injury in specialist rehabilitation units and non-specialist rehabilitation units in Australia over a 10-year period. A retrospective cohort study design was used. Epidemiological descriptive analysis was used to examine inpatient rehabilitation data held in the Australasian Rehabilitation Outcomes Centre Registry Database at four discrete time points: 2007, 2010, 2013 and 2016. Data sets included patient demographics, length of stay and the Functional Independence Measure. Data sets were examined for differences between specialist and non-specialist rehabilitation units. Over the 10-year study period, compared to patients admitted to non-specialist rehabilitation units patients admitted to specialist rehabilitation units: (1) were younger and more likely to be male; (2) had a longer time between onset of illness/injury and rehabilitation admission; (3) had a longer median rehabilitation length of stay; (4) had a higher burden of care on admission to rehabilitation; however (5) had a greater functional gain. Patients in specialist rehabilitation units had a lower relative functional efficiency per day of rehabilitation, but higher percentage of Functional Independence Measure gain. In 2016, 66% of brain injury and 51% of spinal cord injury patients were not rehabilitated in specialist rehabilitation units. There are differences in the characteristics of patients admitted to specialist versus non-specialist rehabilitation units. Patients admitted to specialist rehabilitation units have greater functional gain. A noteworthy proportion of brain and spinal cord injury patients are not being rehabilitated in specialist rehabilitation units, particularly patients with non-traumatic injuries.Implications for rehabilitationPatients with a brain or spinal cord injury rehabilitated in specialist rehabilitation units achieve a greater functional gain than those in non-specialist units.Development of best practice admission guidelines would better enable the right care for the right patient in the right setting at the right time.There is a need for longitudinal examination of patient outcomes to better understand the long-term benefits of being rehabilitated in specialist rehabilitation units compared to non-specialist rehabilitation units.
比较澳大利亚专业康复机构和非专业康复机构中脑损伤和脊髓损伤患者在10年期间的康复情况。采用回顾性队列研究设计。运用流行病学描述性分析方法，在四个离散时间点（2007年、2010年、2013年和2016年）检查澳大利亚康复结局中心注册数据库中保存的住院康复数据。数据集包括患者人口统计学信息、住院时间和功能独立性测量。检查数据集以分析专业康复机构和非专业康复机构之间的差异。在10年研究期间，与入住非专业康复机构的患者相比，入住专业康复机构的患者：（1）更年轻，男性比例更高；（2）疾病/损伤发作与康复入院之间的时间更长；（3）康复住院时间中位数更长；（4）康复入院时护理负担更重；然而（5）功能改善更大。专业康复机构的患者每天康复的相对功能效率较低，但功能独立性测量的改善百分比更高。2016年，66%的脑损伤患者和51%的脊髓损伤患者未在专业康复机构接受康复治疗。入住专业康复机构与非专业康复机构的患者特征存在差异。入住专业康复机构的患者功能改善更大。值得注意的是，相当一部分脑损伤和脊髓损伤患者未在专业康复机构接受康复治疗，尤其是非创伤性损伤患者。康复启示在专业康复机构接受康复治疗的脑损伤或脊髓损伤患者比在非专业机构的患者功能改善更大。制定最佳实践入院指南将更好地在合适的时间、合适的环境为合适的患者提供合适的护理。需要对患者结局进行纵向检查，以更好地了解与非专业康复机构相比，在专业康复机构接受康复治疗的长期益处。
