SCIRehab: How clinicians spend their time with patients and how it can it be documented efficiently

Disability and rehabilitation research has been hampered by the lack of systematic classification and quantification of the many therapeutic interventions occurring during the multi-disciplinary rehabilitation process. The SCIRehab Project is a five-year investigation involving 1,500 patients with traumatic spinal cord injury (SCI) at six rehabilitation centers. The Practice-Based Evidence research methodology requires detailed documentation of each treatment session.

Seven discipline-specific taxonomies, programmed into custom PDA applications, provide information about approximately 100,000 sessions per year. Costs of this system compared to traditional approaches, research advantages, and clinical implications will be discussed. Details of the electronic documentation system provide a model that could be used in other rehabilitation research to increase data collection efficiency and accuracy while reducing clinician burden.

We found considerable variability in the amount and type of treatments provided during the rehabilitation for the 560 patients enrolled in the first year of the SCIRehab project. The mean total hours of treatment per patient documented by all disciplines was 140 hours. However, the interquartile range was 70 to 189 hours. After considering differences in length of stay, the interquartile range per week was 15 to 21 hours with almost no difference between patients with paraplegia and tetraplegia. Discipline-specific variation examples will be presented. The wide variations demonstrate the absence of a common standard of care in SCI rehabilitation and the need for better understanding of these variations and their relationship to outcomes.