Improving Spinal Cord Injury Rehabilitation Outcomes

PI: Gale Whiteneck, PhD, FACRM
Funded by: National Institute on Disability and Rehabilitation Research
Grant Number: H133A060103
Dates: 2006 - 2011
Contact: Susan Charlifue – Susie@craighospital.org 303 789 8306

This 5-year project will use Practice-Based Evidence (PBE) research methodology to isolate specific components of rehabilitation interventions, and to determine how, and to what degree, each component is associated with outcomes. PBE is an outcomes-directed, model-building process that has identified and established effective and efficient evidence-based treatment guidelines in stroke rehabilitation and other diagnostic groups and clinical settings.

CPI methodology will be used to identify specific SCI rehabilitation interventions that are most effective based on eight primary outcomes of acute rehabilitation: (1) neurologic recovery and (2) functional independence attained during initial rehabilitation and the first year after injury; (3) discharge to home; (4) medical complications and (5) rehospitalization in the first year after injury; (6) return to productive activity, (7) the extent of societal participation, and (8) perceived quality of life reported at the first anniversary of injury. Treatment effects will be examined controlling for differences in patient characteristics and for severity of injury and illness. CPI methodology allows a large number of intervention-by-impairment interactions to be examined, while patient individual differences are controlled for. The methodology is very efficient at identifying interventions that are associated with better outcomes.

Led by the Rocky Mountain Regional Spinal Injury System (RMRSIS) at Craig Hospital in Englewood, Colorado, this project is a collaborative research partnership among six SCI rehabilitation facilities. Also collaborating are the Institute for Clinical Outcomes Research (ICOR) at International Severity Information Systems (ISIS), which has extensive experience applying CPI methodology, and MobileDataforce, a software services provider for field data capture.

Specific aims of the project are to:

Aim 1: Identify individual patient characteristics, including demographic data, severity of spinal cord injury, and severity of illness (complications and comorbidities), that explain significant variation in the outcomes of acute rehabilitation for SCI.

Aim 2: Identify specific medical/nursing procedures and therapy interventions, or combinations of procedures and interventions that are associated with better outcomes, controlling for patient characteristics.

Aim 3: Determine whether specific impairment-by-treatment interactions are associated with better outcomes.