WHAT HAPPENS TO PATIENTS WITH SPINAL CORD INJURY AFTER DISCHARGE: A LONG TERM REALITY CHECK

J. Dsa^1,2, Z.L. Dsouza^1,3, R. Krishnamurthy⁴

Background: Spinal cord injury is a devastating and debilitating condition that has a long term effect on function and quality of life. Patients with spinal cord injury further develop secondary  complications like pressure ulcers, urinary tract infections, deep vein thrombosis, cardiopulmonary problems and depressive disorders, consequently increasing the rate of mortality and morbidity. Role of physiotherapy not only concerns with physical rehabilitation in inpatients service but also more importantly in preventing complications and achieving maximum functional recovery after discharge from the hospital. Also, clinical set up physiotherapy should have a carry over effect when the patient goes back to his/ her community. This can be achieved by providing a patient specific home exercise program at discharge and analyzing long term complications, functional independence and community re-integration status post- discharge.

Purpose: To assess complications, functional ability and community re integration of patients with spinal cord injury at 3, 6, and 12 months after physiotherapy and providing a home exercise program booklet at discharge.

Methods: The study was carried out at the physiotherapy department of a tertiary care hospital. We conducted a cross sectional study with purposive sampling technique. Inclusion criteria were patients with traumatic spinal cord injury both male and female. Post surgical intervention patients stayed in the hospItal until hemodynamically stable and for physiotherapy rehabilitation. At the time of discharge, each patient received a home exercise program sheet specific to their need. Secondary complications, functional level of independence and community re integration were measured using Spinal cord injury secondary conditions scale (SCI- SCS), Spinal cord injury measure (SCIM) and Re-integration to normal living index (RNL) respectively.Primary patient outcomes were measured at discharge, and repeated at 3, 6 and 12 months. Post discharge each patient were telephonically assessed in their own language for the outcome measures. Data was analyzed using SPSS software.

Results: Repeated measures ANOVA was used to find within group differences for complications and functional ability. We found statistically significant within group difference of p > .05 using repeated measure ANOVA for all the three outcome measures. 

Conclusion(s): This study signifies that patients with spinal cord injury show better levels of improvement in community re-integration and functional independence and reduction in complications post physical rehabilitation and a formulated exercise program not only post discharge but even after a year.

Implications: The finding of this study can be used to adapt an exercise program at discharge for all patients with spinal cord injury. Uniformity in practice will allow to achieve the main goal of rehabilitation which is in restoring optimal level of function and community re-integration. The implementation of patient centric exercise program at the time of discharge can bring about better health promotion for persons with spinal cord injury. However, since there was no control group, further research is required to confirm the need for supported exercise program at discharge.

Funding, acknowledgements: None

Keywords: Spinal cord injury, Rehabiltation, Post discharge

Topic: Neurology: spinal cord injury

Did this work require ethics approval? Yes

Institution: Father Muller Medical College Hospital, Mangalore, India

Committee: Father Muller Institutional Ethics Committee

Ethics number: FMMC/ FMIEC/ 2326/ 2015