Effectiveness and Efficiency of tele‐rehabilitation on functionality after spinal cord injury: A Matched Case‐Control Study

Abstract

AbstractIntroductionTele‐rehabilitation in spinal cord injury (teleSCI) is a growing field that can improve access to care and health outcomes in patients with spinal cord injury (SCI). The clinical effectiveness of teleSCI is not known.ObjectivesTo compare independence in activities of daily living and mobility capacity in patients following teleSCI and matched controls undergoing traditional rehabilitation.DesignMatched case‐control study.SettingTeleSCI occurring in home setting (cases) versus traditional rehabilitation on inpatient unit (controls).ParticipantsA total of 42 consecutive patients with SCI followed with teleSCI were compared to 42 historical rehabilitation inpatients (controls) matched for age, time since injury to rehabilitation admission, level of injury (paraplegia/tetraplegia), complete or incomplete injury and etiology (traumatic/non‐traumatic). The teleSCI group (n=42) was also compared to the complete cohort of historical controls (n=613).InterventionsThe teleSCI group followed home‐based tele‐rehabilitation (3.5h/day, 5 days/week, 67 days average duration) and historical controls followed in‐person rehabilitation.Main Outcome Measure(s)The Functional Independence Measure (FIM), the Spinal Cord Independence Measure (SCIM) and the Walking Index for Spinal Cord Injury (WISCI). We formally compared gains, efficiency and effectiveness. International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) and the American Spinal Injury Association Impairment Scale (AIS) were used.ResultsThe teleSCI group (57.1% non‐traumatic, 71.4% paraplegia, 73.8% incomplete, 52.4% AIS D) showed no significant differences with historical controls in AIS grades, neurological levels, duration, gains, efficiency and effectiveness in FIM, SCIM nor WISCI, although the teleSCI cohort had significantly higher admission FIM scores compared to the complete cohort of historical controls.ConclusionsTeleSCI may provide similar improvements in mobility and functional outcomes as traditional rehabilitation in medically stable patients (predominantly with paraplegia and motor incomplete SCI) when provided with appropriate support and equipment.This article is protected by copyright. All rights reserved.