Association Between Time to Rehabilitation and Outcomes After Traumatic Spinal Cord Injury.
Kurt R Herzer, Yuying Chen, Allen W Heinemann and 1 others
PMID 27269706WHAT IT FOUND
After traumatic spinal cord injury, a 10% longer wait for inpatient rehabilitation was associated with a 1.50-point lower FIM motor score at discharge.
This was an observational association, not proof that delay caused worse function.
Key findings
01In the instrumental variables analysis, a 10% greater time to rehabilitation was associated with a 1.50 lower FIM motor score at discharge.
02In the same instrumental variables analysis, a 10% greater time to rehabilitation was associated with a 3.92 lower CHART Physical Independence score at 1 year.
03Longer time to rehabilitation was not associated with discharge to a private residence, the 1-year FIM motor score, or the CHART mobility score.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTs
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What it does not show
This is an observational registry analysis, not a randomized trial, so it cannot prove that delaying rehabilitation caused worse outcomes. The data come from 21 Model Systems representing 23 rehabilitation facilities, so results may not apply to patients treated elsewhere. The study did not record whether rehabilitation was started during acute care, which could affect the timing relationship. Patients in regions with higher versus lower instrumental variable intensity differed by race and education, but the authors found no sign that patients with worse health status were more prevalent in high-intensity regions. Injury severity information was missing for 544 patients, and they were placed in an unknown category.
Declared interests
The authors reported no conflicts of interest. The article is tagged as having research support from the U.S. government, non-U.S. government, and NIH extramural funding.
The easy way to misread this
Do not read the association as proof that delaying rehabilitation caused worse outcomes. The study was observational, and the authors state the results should not be interpreted causally.