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Nontraumatic vs. Traumatic Spinal Cord Injury: A Rehabilitation Outcome Comparison

McKinley, William O. MD; Seel, Ronald T. PhD; Gadi, Ramakrishna K. MD; Tewksbury, Michael A. MBA

American Journal of Physical Medicine and Rehabilitation: September 2001 - Volume 80 - Issue 9 - p 693-699
CME Article 2001 Series Number

McKinley WO, Seel RT, Gadi RK, Tewksbury MA: Nontraumatic vs. traumatic spinal cord injury: a rehabilitation outcome comparison. Am J Phys Med Rehabil 2001;80:693–699.

Objective: Nontraumatic spinal cord injury (SCI) represents a significant proportion of individuals admitted for SCI rehabilitation; however, there is limited literature regarding their outcomes. As our society continues to age and nontraumatic injuries present with greater frequency, further studies in this area will become increasingly relevant. The objective of this study was to compare outcomes of patients with nontraumatic SCI with those with traumatic SCI after inpatient rehabilitation.

Design: A longitudinal study with matched block design was used comparing 86 patients with nontraumatic SCI admitted to a SCI rehabilitation unit and 86 patients with traumatic SCI admitted to regional model SCI centers, controlling for age, neurologic level of injury, and American Spinal Injury Association impairment classification. Main outcome measures included acute and rehabilitation hospital length of stay, FIMTM scores, FIM change, FIM efficiency, rehabilitation charges, and discharge-to-home rates.

Results: Results indicate that when compared with traumatic SCI, patients with nontraumatic SCI had a significantly (P < 0.01) shorter rehabilitation length of stay (22.38 vs. 41.35 days) and lower discharge FIM scores (57.3 vs. 65.6), FIM change (18.6 vs. 31.0), and rehabilitation charges ($25,050 vs. $64,570). No statistical differences were found in acute care length of stay, admission FIM scores, FIM efficiency, and community discharge rates.

Conclusions: The findings indicate that patients with nontraumatic SCI can achieve rates of functional gains and community discharge comparable with traumatic SCI. Whereas patients with traumatic SCI achieved greater overall functional improvement, patients with nontraumatic SCI had shorter rehabilitation length of stay and lower rehabilitation charges. These findings have important implications for the interdisciplinary rehabilitation process in the overall management and outcome of individuals with nontraumatic SCI.

From the Medical College of Virginia, Virginia Commonwealth University, Richmond, Virginia.

Objectives: On completion of this article, the reader should be able to: (1) identify the common etiologies of nontraumatic spinal cord injury; (2) recognize differing demographic and clinical presentations between nontraumatic and traumatic spinal cord injury patients admitted for rehabilitation; and (3) discuss the rehabilitation outcomes of patients with nontraumatic spinal cord injury.

Level: Comprehensive.

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians. The Association of Academic Physiatrists designates this continuing medical education activity for a maximum of 1.5 credit hours in Category 1 of Physician’s Recognition Award of the American Medical Association. Each physician should claim only those hours of credit that he/she actually spent in the education activity.

Disclosure: Disclosure statements have been obtained regarding the authors’ relationships with financial supporters of this activity. There is no apparent conflict of interest related to the context of participation of the authors of this article.

Supported by Grant H133N50015, the National Institute on Disability and Rehabilitation Research, from the Office of Special Education and Rehabilitative Services, U.S. Department of Education.

FIMTM is a trademark of the Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

All correspondence should be addressed to William O. McKinley, MD, Medical College of Virginia, Virginia Commonwealth University, Richmond, VA 23298.

© 2001 Lippincott Williams & Wilkins, Inc.