Predicting Duration of Outpatient Physical Therapy Episodes for Individuals with Spinal Cord Injury Based on Locomotor Training Strategy

Mauricio Garnier-Villarreal, Daniel Pinto*, Chaithanya K. Mummidisetty, Arun Jayaraman, Candy Tefertiller, Susan Charlifue, Heather B. Taylor, Shuo Hsiu Chang, Nicholas McCombs, Catherine L. Furbish, Edelle C. Field-Fote, Allen W. Heinemann

*Corresponding author for this work

Research output: Contribution to JournalArticleAcademicpeer-review

Abstract

Objective: To characterize individuals with spinal cord injuries (SCI) who use outpatient physical therapy or community wellness services for locomotor training and predict the duration of services, controlling for demographic, injury, quality of life, and service and financial characteristics. We explore how the duration of services is related to locomotor strategy. Design: Observational study of participants at 4 SCI Model Systems centers with survival. Weibull regression model to predict the duration of services. Setting: Rehabilitation and community wellness facilities at 4 SCI Model Systems centers. Participants: Eligibility criteria were SCI or dysfunction resulting in motor impairment and the use of physical therapy or community wellness programs for locomotor/gait training. We excluded those who did not complete training or who experienced a disruption in training greater than 45 days. Our sample included 62 participants in conventional therapy and 37 participants in robotic exoskeleton training. Interventions: Outpatient physical therapy or community wellness services for locomotor/gait training. Main Outcome Measures: SCI characteristics (level and completeness of injury) and the duration of services from medical records. Self-reported perceptions of SCI consequences using the SCI-Functional Index for basic mobility and SCI-Quality of Life measurement system for bowel difficulties, bladder difficulties, and pain interference. Results: After controlling for predictors, the duration of services for the conventional therapy group was an average of 63% longer than for the robotic exoskeleton group, however each visit was 50% shorter in total time. Men had an 11% longer duration of services than women had. Participants with complete injuries had a duration of services that was approximately 1.72 times longer than participants with incomplete injuries. Perceived improvement was larger in the conventional group. Conclusions: Locomotor/gait training strategies are distinctive for individuals with SCI using a robotic exoskeleton in a community wellness facility as episodes are shorter but individual sessions are longer. Participants’ preferences and the ability to pay for ongoing services may be critical factors associated with the duration of outpatient services.

Original languageEnglish
Pages (from-to)665-675
Number of pages11
JournalArchives of Physical Medicine and Rehabilitation
Volume103
Issue number4
Early online date11 Oct 2021
DOIs
Publication statusPublished - Apr 2022

Bibliographical note

Funding Information:
Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research provided funding through the Midwest Regional SCI Model System (90SI5009), the Rocky Mountain Regional Spinal Injury System (90SI5015), the Southeastern Regional Spinal Cord Injury Model System at Shepherd Center (90SI5016), and the Texas Model Spinal Cord Injury System at TIRR Memorial Hermann (90SI5027).

Funding Information:
We thank Q. Eileen Wafford, of the Galter Health Sciences Library and Learning Center, Northwestern University Feinberg School of Medicine, for help identifying background literature. Supported by the National Institute on Disability, Independent Living, and Rehabilitation Research provided funding through the Midwest Regional SCI Model System (90SI5009), the Rocky Mountain Regional Spinal Injury System (90SI5015), the Southeastern Regional Spinal Cord Injury Model System at Shepherd Center (90SI5016), and the Texas Model Spinal Cord Injury System at TIRR Memorial Hermann (90SI5027).

Publisher Copyright:
© 2021 The American Congress of Rehabilitation Medicine

Keywords

  • Episode of care
  • Exoskeleton device
  • Gait
  • Health services
  • Physical therapy modalities
  • Rehabilitation
  • Spinal cord injury

Fingerprint

Dive into the research topics of 'Predicting Duration of Outpatient Physical Therapy Episodes for Individuals with Spinal Cord Injury Based on Locomotor Training Strategy'. Together they form a unique fingerprint.

Cite this