Shirley Ryan AbilityLab to Lead International Investigation of Length of Rehabilitation Stay After Spinal Cord Injury and Associated Outcomes

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Shirley Ryan AbilityLab has received a $4.2 million, 5-year grant from the National Institute on Disability, Independent Living and Rehabilitation Research (NIDILRR) to lead an international study exploring how differences in inpatient rehabilitation length of stay (LOS) after spinal cord injury (SCI) affect the experiences and long-term outcomes of people with SCI.

The project includes collaborators in the United States, Australia, Canada, The Netherlands, Norway and the United Kingdom.

"While we know length of inpatient rehabilitation stay is an important factor in predicting outcomes, patients’ experiences of rehabilitation are also important,” says Allen Heinemann, PhD, Director of the Center for Rehabilitation Outcomes Research at Shirley Ryan AbilityLab and co-project director on the grant. “This grant offers a unique opportunity for us to answer questions about experience such as, ‘Did patients learn the skills needed to live in their communities? Do countries with longer rehabilitation stays prepare their patients better for community living than countries with shorter LOS?’”  

In addition to conducting a review of international literature on rehabilitation LOS after SCI, the researchers will analyze inpatient rehabilitation data from the United States, Australia, New Zealand, Canada and England to compare how LOS, intensity of rehabilitation therapy and other patient-level, facility-level and country-level factors affect outcomes. They will also conduct an international survey of people with SCI with different inpatient rehabilitation LOS about their experiences in rehabilitation and after discharge. An advisory committee of people with SCI, representatives of SCI organizations, SCI clinicians and policymakers will provide input on study design. Research findings will be shared with a variety of scientific and lay audiences through published papers, presentations, social media posts, newsletters and podcasts.

SCI can significantly affect a person’s physical, mental and social well-being and has a substantial financial impact on care partners and healthcare systems. The World Health Organization estimates that between 250,000 and 500,000 people worldwide are affected by traumatic and non-traumatic SCI annually.

People who experience SCI usually receive inpatient rehabilitation after discharge from an acute-care hospital. The goal is to help preserve or restore mobility and function, learn how to compensate for lost physical abilities due to injury and prepare for returning home. 

LOS in inpatient rehabilitation varies widely from country to country. In the U.S., the median rehabilitation LOS is 32 days, whereas in Australia it is 83 days and in Canada it is 81 days.

“Studies have yielded mixed results on whether longer or shorter rehabilitation LOS after SCI is better or worse,” says Alex Wong, PhD, DPhil, OT, CRC, a Research Scientist in the Center for Rehabilitation Outcomes Research at Shirley Ryan AbilityLab and a project leader on the grant. “Recent research suggests that factors outside of rehabilitation time, such as injury type and severity, and having more psychological services during rehabilitation may be better predictors of outcomes. Our goal is to uncover the complex associations between LOS and these other factors so we can ultimately design more effective rehabilitation plans.”

How rehabilitation services are paid for plays a major role in rehabilitation LOS. The United Kingdom, Canada, Australia, New Zealand, The Netherlands and Norway have variations of universal healthcare, while in the United States, health insurance coverage is either private or through various federal and state programs like Medicare and Medicaid. 

“Our study is unique because it includes countries with different models of healthcare payment that will allow us to take a close look at how these models affect LOS and outcomes for people with SCI,” says Anne Deutsch, PhD, a Research Scientist in the Center for Rehabilitation Outcomes Research at Shirley Ryan AbilityLab and co-project director on the grant. Dr. Deutsch is an expert on Medicare post-acute care payment.

Ultimately, the goal of the study is to contribute new, research-based knowledge about rehabilitation LOS and intensity to improve rehabilitation outcomes for people with SCI, explains Jane Duff, clinical psychologist in the National Spinal Injuries Centre at Stoke Mandeville Hospital in England and an investigator on the grant.

“I have worked with people with spinal cord injury for more than 25 years and unfortunately in that time have seen a decline in outcomes and preparedness to return home after discharge. We’re not sure exactly how LOS plays into this,” says Dr. Duff. “Do we need longer or shorter rehabilitation LOS, or are there other things we can do that will have a bigger impact on improving outcomes? At the end of the day, what is most important is that we do everything possible during this crucial window of time in inpatient rehabilitation to set patients up for success as best we can, no matter how long or short they may be with us.”  

Investigators on the grant are:

Shirley Ryan AbilityLab:

• Allen Heinemann, PhD, ABPP, FACRM (Project Director)
• Anne Deutsch, PhD, RN (Co-Project Director)
• Alex Wong, PhD, DPhil, OT, CRC (Co-I)
• Linda Ehrlich-Jones, PhD, RN (Co-I)
• Allison Kessler, MD (Co-I)
• Manasi Sheth, PhD (Biostatistician)
• Deborah Crown, MS, CRC (Research Manager)
• Jennifer Burns (Project Manager)
• Nicholas Formanski, (Project Coordinator)
   

Collaborators:

• Sherri LaVela, PhD, MPH, MBA, Research Associate Professor of Physical Medicine and Rehabilitation, Northwestern University; Senior Research Health Scientist at the Department of Veterans, Health Services Research and Development
• Orit Almagor, Senior Statistical Analyst, Division of Rheumatology, Northwestern University Feinberg School of Medicine
• Ashley Craig, PhD, Professor of Rehabilitation Studies, University of Sydney, Australia
• Sara Ahmed, PhD, Associate Professor, School of Physical and Occupational Therapy, McGill University Faculty of Medicine and Health Sciences, Canada
• Marcel Post, PhD, Professor, University of Groningen and Hoogstraat Rehabilitation, Center of Excellence in Rehabilitation Medicine, Utrecht, The Netherlands
• Jane Duff, PhD, Consultant Clinical Psychologist, National Spinal Injuries Centre, Stoke Mandeville Hospital, Buckinghamshire Healthcare NHS Trust, United Kingdom
• Tara Alexander,  Research Fellow, Australian Health Services Research Institute

Advisory Committee Members:

• Xinsheng “Cindy” Cai, PhD, Principal Investigator and Project Director, Model Systems Knowledge Translation Center, American Institutes for Research
• Terrence Carolan, MS, Managing Director, Medical Rehabilitation, CARF International
• Yuying Chen, MD, PhD, Professor and Director of Research, Department of Physical Medicine and Rehabilitation, University of Alabama at Birmingham and Director, National Spinal Cord Injury Statistical Center
• Wouter De Groote, MD, Technical Advisor, World Health Organization Rehabilitation Programme
• Janice Eng, PhD, PT, FCAHS, Professor and Canada Research Chair in Neurological Rehabilitation, Department of Physical Therapy, University of British Columbia and GF Strong Rehab Centre, Co-Director, Centre for Aging SMART at Vancouver Costal Health
• Thea K. Flaum, PMP, President, Facing Disability, Hill Foundation for Families Living with Disabilities
• Matthew Ginsberg-Jaeckle, MA, Director, Global Patient Services, Shirley Ryan AbilityLab
• Suzanne L. Groah, MD, MSPH, Director, MedStar National Rehabilitation Hospital Spinal Cord Injury Research Center; Chief, MedStar National Rehabilitation Hospital SCI Rehabilitation & Recovery Program; President, American Spinal Cord Injury Association
• Carlotte Kiekens, MD, Co-Director, Cochrane Rehabilitation; ISPRM-WHO Liaison Committee Chair
• Ruth Marshall, MBBS, DPRM, President, International Spinal Cord Injury Society (ISCoS)
• Jan Egil Nordvik, PhD, Project Manager, The Norwegian Directorate of Health
• Vincenzo Piscopo, MS, MBA, President and CEO, United Spinal Association
• Cheryl L. Vines, MS, Director, Research and Education, Paralyzed Veterans of America
• Michael P. Whelan, person with a spinal cord injury