Turner-Stokes Lynne, Lafeuillee Gisele, Francis Richard, Nayar Meenakshi, Nair Ajoy
Department of Palliative Care, Policy and Rehabilitation, Cicely Saunders Institute, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
UK Rehabilitation Outcomes Collaborative, Northwick Park Hospital, London, UK.
Disabil Rehabil. 2022 Sep;44(19):5603-5611. doi: 10.1080/09638288.2021.1946603. Epub 2021 Jul 20.
To evaluate functional outcomes, care needs and cost-efficiency of specialist rehabilitation for a multi-centre cohort of inpatients with spinal cord injury (SCI)-comparison based on age and aetiology. Retrospective analysis of prospectively collected data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database from 2012-2019. Adults with SCI admitted for a rehabilitation programme in levels 1 and 2 specialist rehabilitation Units in England, were included if they had valid UK Functional Assessment Measure (UK FIM + FAM) and Northwick Park Dependency Scale (NPDS) scores recorded on admission and discharge ( = 2506 of 3321 admissions). Approximately 425 patients were admitted yearly. 1344(56%) patients were under 65. 736(29%) had traumatic aetiology. Older and Traumatic SCI patients were more likely to have cervical cord damage (, < 0.001). There was a significant improvement in all parameters of functional independence (UK FIM + FAM) ( < 0.001), with the reduction in dependency and care costs (NPDS/NPCNA) ( < 0.001). 1817(72.5%) patients were discharged home. Mean care-costs savings were £25 500/year per patient. Year-on-year trends showed admissions with increasing age, higher complexity and dependency with corresponding increasing episode costs (ANOVA < 0.001). However, the time taken to offset the cost of rehabilitation did not change significantly (ANOVA = 0.57). Specialist rehabilitation services provide effective and cost-efficient rehabilitation for patients with spinal cord injury.Implications for RehabilitationApproximately a third of patients who access specialist inpatient rehabilitation following spinal cord injury (SCI) in England are managed in the Specialist Level 1 and 2 neuro-rehabilitation units, rather than in the eight designated national SCI Centres.Despite admitting progressively more complex and dependent patients over eight years, these specialist rehabilitation units continue to provide highly cost-efficient care.The mean annual savings amount to £25,500 per patient. With a mean admission rate of 425 patients, this would generate total savings in excess of £10 million per year for the cohort.Specialist rehabilitation services play an important, but under-recognised, role in the spinal cord injury care pathway.
为评估脊髓损伤（SCI）住院患者多中心队列专科康复的功能结局、护理需求和成本效益——基于年龄和病因进行比较。对2012 - 2019年英国康复结局协作组（UKROC）国家临床数据库中前瞻性收集的数据进行回顾性分析。纳入在英格兰1级和2级专科康复单元接受康复计划的成年SCI患者，前提是他们入院和出院时记录有有效的英国功能评估量表（UK FIM + FAM）和诺斯威克公园依赖量表（NPDS）评分（3321例入院患者中 = 2506例）。每年约有425名患者入院。1344名（56%）患者年龄在65岁以下。736名（29%）患者病因是创伤性的。老年和创伤性SCI患者更有可能发生颈髓损伤（， ＜0.001）。功能独立性的所有参数（UK FIM + FAM）均有显著改善（ ＜0.001），依赖性和护理成本降低（NPDS/NPCNA）（ ＜0.001）。1817名（72.5%）患者出院回家。每位患者平均每年节省护理成本25500英镑。逐年趋势显示，随着年龄增长、复杂性和依赖性增加，入院患者相应的单次费用增加（方差分析 ＜0.001）。然而，抵消康复成本所需的时间没有显著变化（方差分析 = 0.57）。专科康复服务为脊髓损伤患者提供了有效且具有成本效益的康复。康复启示在英格兰，脊髓损伤（SCI）后接受专科住院康复的患者中，约三分之一在1级和2级专科神经康复单元接受治疗，而非在八个指定的国家SCI中心。尽管八年来收治的患者越来越复杂且依赖性越来越强，但这些专科康复单元继续提供高成本效益的护理。每位患者平均每年节省25500英镑。平均入院率为425名患者，这将为该队列每年带来超过1000万英镑的总节省。专科康复服务在脊髓损伤护理路径中发挥着重要但未得到充分认识的作用。
