Inpatient and Post-Discharge Rehabilitation Services Provided in the First Year after Spinal Cord Injury: Findings from the SCIRehab Study

Introduction: The pressures of managed care as well as improvements in medical and rehabilitative expertise are said to have driven declines in rehabilitation lengths of stay (LOS). However, some treatment hours that disappeared with LOS reductions may have been replaced with new or expanded services that occur after rehabilitation discharge. The SCIRehab study examines the amount and type of therapy services received in the inpatient and post discharge settings during the first year after SCI. Methods: Rehabilitation services received by 434 individuals with traumatic SCI admitted to six SCI rehabilitation centers participating in the SCIRehab study were assessed. Inpatient data were collected prospectively by the treating clinicians; while post-discharge service data were collected retrospectively by self-report during follow-up interviews. Results: Of the total time spent on rehabilitation interventions during the first year after injury, 46% occurred in the period after discharge from inpatient rehabilitation. Participants received 57% of their total Physical Therapy after discharge and 53% of their total Occupational Therapy after discharge, but only a minority received any post-discharge services from the other rehabilitation disciplines. Discussion: This practice-based evidence study demonstrates that SCI rehabilitation care, at least for many individuals, is given in a continuum with inpatient rehabilitation being only the beginning. This points to the need to study the availability and impact of post-discharge care in greater detail and for better methods to optimize the accuracy and logistics of capturing the wide array of post-discharge services.