Abstract
Objectives
To investigate the relation of gait training (GT) during inpatient rehabilitation
(IPR) to outcomes of people with traumatic spinal cord injury (SCI).
Design
Prospective observational study using the SCIRehab database.
Setting
Six IPR facilities.
Participants
Patients with new SCI (N=1376) receiving initial rehabilitation.
Interventions
Patients were divided into groups consisting of those who did and did not receive
GT. Patients were further subdivided based on their primary mode of mobility as measured
by the FIM.
Main Outcome Measures
Pain rating scales, Patient Health Questionnaire Mood Subscale, Satisfaction With
Life Scale, and Craig Handicap Assessment and Reporting Technique (CHART).
Results
Nearly 58% of all patients received GT, including 33.3% of patients who were primarily
using a wheelchair 1 year after discharge from IPR. Those who used a wheelchair and
received GT, received significantly less transfer and wheeled mobility training (P<.001). CHART physical independence (P=.002), mobility (P=.024), and occupation (P=.003) scores were significantly worse in patients who used a wheelchair at 1 year
and received GT, compared with those who used a wheelchair and did not receive GT
in IPR. Older age was also a significant predictor of worse participation as measured
by the CHART.
Conclusions
A significant percentage of individuals who are not likely to become functional ambulators
are spending portions of their IPR stays performing GT, which is associated with less
time allotted for other functional interventions. GT in IPR was also associated with
participation deficits at 1 year for those who used a wheelchair, implying the potential
consequences of opportunity costs, pain, and psychological difficulties of receiving
unsuccessful GT. Clinicians should consider these data when deciding to implement
GT during initial IPR.
Keywords
List of abbreviations:
AIS (American Spinal Injury Association Impairment Scale), CHART (Craig Handicap Assessment and Reporting Technique), GT (gait training), IPR (inpatient rehabilitation), PHQ-9 (Brief Patient Health Questionnaire Mood Subscale), PT (physical therapy), QOL (quality of life), SCI (spinal cord injury), SWLS (Satisfaction With Life Scale)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Rehabilitation goals of people with spinal cord injuries can be classified against the International Classification of Functioning, Disability and Health Core Set for spinal cord injuries.Spinal Cord. 2016; 54: 324-328
- Who wants to walk? Preferences for recovery after SCI: a longitudinal and cross-sectional study.Spinal Cord. 2009; 47: 268-269
- Spinal cord injury medicine. 3. Rehabilitation phase after acute spinal cord injury.Arch Phys Med Rehabil. 2007; 88: S62-S70
- Walking after spinal cord injury: evaluation, treatment, and functional recovery.Arch Phys Med Rehabil. 1999; 80: 225-235
- The relationship between quality of life and change in mobility 1 year postinjury in individuals with spinal cord injury.Arch Phys Med Rehabil. 2011; 92: 1027-1033
- Biomechanics and motor control of human gait: normal, elderly and pathological.University of Waterloo Press, Waterloo, Ontario, Canada1991
- Spinal cord injury (SCI) facts and figures at a glance.J Spinal Cord Med. 2016; 39: 243-244
- Manual wheelchair skills capacity predicts quality of life and community integration in persons with spinal cord injury.Arch Phys Med Rehabil. 2012; 93: 2237-2243
- Energy expenditure of the paraplegic gait: comparison between different walking aids and normal subjects.Int J Rehabil Res. 2003; 26: 213-217
- Evidence-based evaluation of physiological effects of standing and walking in individuals with spinal cord injury.Iran J Med Sci. 2011; 36: 242-253
- Ambulation and complications related to assistive devices after spinal cord injury.J Spinal Cord Med. 2013; 36: 652-659
- Factors related to obstacle crossing in independent ambulatory patients with spinal cord injury.J Spinal Cord Med. 2010; 33: 144-149
- Factors associated with risk for subsequent injuries after traumatic spinal cord injury.Arch Phys Med Rehabil. 2004; 85: 1503-1508
- A comparison of shoulder joint forces during ambulation with crutches versus a walker in persons with incomplete spinal cord injury.Arch Phys Med Rehabil. 2006; 87: 63-70
- Energy cost of paraplegic locomotion.J Bone Joint Surg Am. 1985; 67: 1245-1250
- Determinants of gait performance following spinal cord injury.Arch Phys Med Rehabil. 1989; 70: 811-818
- Assistive devices for balance and mobility: benefits, demands, and adverse consequences.Arch Phys Med Rehabil. 2005; 86: 134-145
- Relationship of physical therapy inpatient rehabilitation interventions and patient characteristics to outcomes following spinal cord injury: the SCIRehab project.J Spinal Cord Med. 2012; 35: 503-526
- New approach to study the contents and outcomes of spinal cord injury rehabilitation: the SCIRehab Project.J Spinal Cord Med. 2009; 32: 251-259
- The SCIRehab Project: classification and quantification of spinal cord injury rehabilitation treatments.Preface. J Spinal Cord Med. 2009; 32: 249-250
- SCIRehab Project series: the physical therapy taxonomy.J Spinal Cord Med. 2009; 32: 270-282
- Clinical taxonomy development and application in spinal cord injury research: the SCIRehab Project.J Spinal Cord Med. 2009; 32: 260-269
- The SCIRehab project: what rehabilitation interventions are most strongly associated with positive outcomes after spinal cord injury?.J Spinal Cord Med. 2012; 35: 482-483
- SCIRehab: a model for rehabilitation research using comprehensive person, process and outcome data.Disabil Rehabil. 2010; 32: 1035-1042
- International standards for neurological classification of spinal cord injury (revised 2011).J Spinal Cord Med. 2011; 34: 535-546
- The Functional Independence Measure: a measurement of disability and medical rehabilitation.in: Chino N. Melvin J.L. Functional evaluation of stroke patients. Springer, Tokyo1996: 75-92
- The SCIRehab project: treatment time spent in SCI rehabilitation. Physical therapy treatment time during inpatient spinal cord injury rehabilitation.J Spinal Cord Med. 2011; 34: 149-161
- Group physical therapy during inpatient rehabilitation for acute spinal cord injury: findings from the SCIRehab Study.Phys Ther. 2011; 91: 1877-1891
- Pain and its impact on inpatient rehabilitation for acute traumatic spinal cord injury: analysis of observational data collected in the SCIRehab study.Arch Phys Med Rehabil. 2013; 94: S137-S144
- The Craig Handicap Assessment and Reporting Technique (CHART): metric properties and scoring.Top Spinal Cord Inj Rehabil. 1998; 4: 16-30
- The Satisfaction With Life Scale.J Pers Assess. 1985; 49: 71-75
- Validity of the Brief Patient Health Questionnaire Mood Scale (PHQ-9) in the general population.Gen Hosp Psychiatry. 2006; 28: 71-77
- Establishing prognosis and maximizing functional outcomes after spinal cord injury: a review of current and future directions in rehabilitation management.Spine (Phila Pa 1976). 2001; 26: S137-S145
- Predicting neurologic recovery in traumatic cervical spinal cord injury.Arch Phys Med Rehabil. 1998; 79: 1456-1466
- Who is going to walk? A review of the factors influencing walking recovery after spinal cord injury.Front Hum Neurosci. 2014; 8: 141
- Participation and satisfaction after spinal cord injury: results of a vocational and leisure outcome study.Spinal Cord. 2005; 43: 241-248
- Health-related quality of life after spinal cord injury.Disabil Rehabil. 2002; 24: 196-202
- Age and spinal cord injury: an emphasis on outcomes among the elderly.J Spinal Cord Med. 2003; 26: 37-44
- Predicting quality of life 5 years after medical discharge for traumatic spinal cord injury.Br J Health Psychol. 2014; 19: 688-700
- Factors associated with health-related quality of life in chronic spinal cord injury.Am J Phys Med Rehabil. 2007; 86: 387-396
- Association of mode of locomotion and independence in locomotion with long-term outcomes after spinal cord injury.J Spinal Cord Med. 2009; 32: 237-248
- Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals.J Spinal Cord Med. 2005; 28: 434-470
- Wheelchair pushrim kinetics: body weight and median nerve function.Arch Phys Med Rehabil. 1999; 80: 910-915
- Shoulder pain and functional disability in spinal cord injury patients.Clin Orthop Relat Res. 1991; : 141-145
- Transfer technique is associated with shoulder pain and pathology in people with spinal cord injury: a cross-sectional investigation.Arch Phys Med Rehabil. 2016; 97: 1770-1776
- Longitudinal prediction of quality-of-life scores and locomotion in individuals with traumatic spinal cord injury.Arch Phys Med Rehabil. 2017; 98: 2385-2392
- Psychological adjustment to spinal cord injury: the contribution of coping, hope and cognitive appraisals.Psychol Health Med. 2009; 14: 17-33
- A clinical prediction rule for ambulation outcomes after traumatic spinal cord injury: a longitudinal cohort study.Lancet. 2011; 377: 1004-1010
- Walking Index for Spinal Cord Injury version II in acute spinal cord injury: reliability and reproducibility.Spinal Cord. 2014; 52: 65-69
- Interrater and intrarater reliability of the Wheelchair Skills Test version 4.2 for power wheelchair users.Disabil Rehabil. 2018; 40: 678-683
- Basic psychometric properties of the Transfer Assessment Instrument (version 3.0).Arch Phys Med Rehabil. 2013; 94: 2456-2464
- Predictors of life satisfaction: a spinal cord injury cohort study.Arch Phys Med Rehabil. 2002; 83: 555-561
Article info
Publication history
Published online: March 03, 2018
Footnotes
Supported by the Administration on Community Living, National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) (grant no. 90SI5014). NIDILRR is a Center within the Administration for Community Living (ACL) within the Department of Health and Human Services (HHS). The contents of this paper do not necessarily represent the policy of NIDILRR, ACL, or HHS, and you should not assume endorsement by the U.S. Government.
Disclosures: none.
Identification
Copyright
Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
