Department of medicine, Faculty of medicine, Université de Montréal, Montreal, Quebec, Canada.
Centre de recherche du CIUSSS Nord-de-l'Île-de-Montréal, Montreal, Quebec, Canada.
J Spinal Cord Med. 2024 Sep;47(5):753-764. doi: 10.1080/10790268.2023.2200354. Epub 2023 Apr 21.
CONTEXT/OBJECTIVE: Functional motor-incomplete AIS-D traumatic spinal cord injury (tSCI) represents an important growing population in neuro-traumatology. There is thus an important need for establishing strategies to optimize SCI rehabilitation resources. This study aims at proposing eligibility criteria to select individuals who could be discharged home (home-based rehabilitation) after acute care following an AIS-D tSCI and investigate its impact on the long-term functional status and quality of life (QOL), as compared to transfer to inpatient functional rehabilitation (IFR) resources.
An observational prospective cohort study.
A single Level-1 specialized trauma center.
213 individuals sustaining an AIS-D tSCI.
Home-based rehabilitation based on clinical specific criteria to be assessed by the acute care team.
Functional status and QOL as assessed by the Spinal Cord Independence Measure version 3 and WHOQOL-BREF questionnaire one year following the injury, respectively.
A total 37.9% of individuals fulfilled proposed criteria for home-based rehabilitation after acute care. As expected, this group was significantly younger, experienced lesser comorbidities and acute complications, and showed higher motor and sensory function compared to the IFR group. Home-rehabilitation was associated with a higher long-term functional status, physical and psychological QOL, when accounting for relevant confounding factors after an acute AIS-D tSCI There was no readmission due to failure of home-based rehabilitation.
Home-based rehabilitation in selected individuals sustaining an acute AIS-D tSCI is a safe and interesting strategy to optimize the long-term outcome in terms of functional recovery, physical and psychological QOL, as well as to optimize inpatient rehabilitation resources. The proposed eligibility criteria can be used by the acute care team to select the optimal discharge orientation in this important subpopulation.
背景/目的：运动功能不完全的 AIS-D 型创伤性脊髓损伤（tSCI）是神经创伤学中一个重要的增长人群。因此，需要制定策略来优化 SCI 康复资源。本研究旨在提出选择标准，以选择那些在 AIS-D tSCI 后急性治疗后可以出院（家庭康复）的个体，并研究其对长期功能状态和生活质量（QOL）的影响，与转入住院功能康复（IFR）资源相比。
一项观察性前瞻性队列研究。
一家单一的 1 级专业创伤中心。
213 名患有 AIS-D tSCI 的个体。
基于急性护理团队评估的临床特定标准进行家庭康复。
急性护理后，符合家庭康复标准的个体占总人数的 37.9%。不出所料，与 IFR 组相比，这组患者年龄明显更小，合并症和急性并发症更少，运动和感觉功能更高。在考虑急性 AIS-D tSCI 后的相关混杂因素后，家庭康复与长期功能状态、身体和心理 QOL 的提高相关。由于家庭康复失败而再次入院的情况并未发生。
在选定的急性 AIS-D tSCI 个体中进行家庭康复是一种安全且有趣的策略，可以优化长期功能恢复、身体和心理 QOL 的预后，并优化住院康复资源。急性护理团队可以使用这些标准来为这一重要亚群选择最佳的出院方向。
