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Gait Training in Acute Spinal Cord Injury Rehabilitation—Utilization and Outcomes Among Nonambulatory Individuals: Findings From the SCIRehab Project

  • Stephanie Rigot
    Affiliations
    Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA
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  • Lynn Worobey
    Correspondence
    Corresponding author Lynn Worobey, PhD, DPT, ATP, 6425 Penn Ave, Suite 400, Pittsburgh, PA 15206.
    Affiliations
    Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA
    Search for articles by this author
  • Michael L. Boninger
    Affiliations
    Human Engineering Research Laboratories, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, PA

    Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA

    Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA

    Department of Rehabilitation Science and Technology, University of Pittsburgh, Pittsburgh, PA
    Search for articles by this author
Published:March 03, 2018DOI:https://doi.org/10.1016/j.apmr.2018.01.031

      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)
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