Authors (including presenting author) :
Cheung PCL
Affiliation :
Department of Orthopaedics and Traumatology, Queen Elizabeth Hospital
Introduction :
Spinal cord injury (SCI) is a significant health condition, leading to varying daily living needs upon discharge. Returning home is one of the most important aims for patients after rehabilitation.
Objectives :
The purpose of this study is to examine the factors independently associated with increased likelihood of institutionalization after discharge.
Methodology :
We recruited 433 patients admitted to Kowloon Hospital Spinal Cord Rehabilitation Centre after spinal cord injury between the periods of 2002 to 2018. The following baseline parameters were ascertained: sex, age, level of neurological impairment, functional independent measures (FIM) in self-care and continence care before discharge, ambulatory status before discharge, and carer readiness. Logistic regression analyses were used to create predictive models on patient discharge destination.
Result & Outcome :
Amongst 433 patients (male = 65.6%, median age = 62.0 years, ranged from 12-91), 343 (79.2%) returned home. Binary logistic regression with backward method using likelihood estimation method was used to assess the risk factors for institutional care with p=value set at 0.1. The equation of the final model of binary logistic regression was: Logit (institutional care) = 0.023 (age) - 0.160 (dependent in mobility) - 0.229 (deficit in communication) + 2.807 (lack of carer) + 0.965 (failure to transfer from bed to chair) + 0.616 (failure in self voiding) - 1.809 The area under the curve (AUC) of this model was 0.876 (95% confidence interval (CI) 0.842– 0.911). The consequence of SCI is that patients suffer from a series of disabilities. Hence from our results it was shown that increased dependence in mobility, failure in transfer from bed to chair and urological dysfunction led to a higher likelihood of institutional care. In addition, it was likely that advanced age and impaired communication further increased the dependency of the patient. All these factors pointed to the need of a constant experienced carer and if this was not available, these patients were more likely to be institutionalized. The discharge destination for SCI patients can be predicted by several parameters. Level of mobilization, urological function, age, cognitive function and availability of carer were the most important factors affecting discharge destination. These social and clinical characteristics need to be addressed during discharge planning with family members to facilitate feasibility and sustainability.
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