National Rehabilitation Hospital

An Investigation into the Functional Independence of Individuals with Spinal Cord Injury following Discharge

An Investigation into the Functional Outcomes of Individuals with Paraplegia, Resulting from Spinal Cord Injury, Following Discharge from a Rehabilitation Setting

Lisa Held

The purpose of this study was to investigate if changes occurred in the functional independence of spinal cord injured (SCI) patients, following discharge from a rehabilitation setting. The research was carried out on patients with a paraplegic injury, who underwent rehabilitation in the spinal injury unit of a Dublin based rehabilitation hospital. Eight male subjects residing in the Republic of Ireland were recruited to the study between October 2004 and May 2005.

Two measures of functional independence, a mood outcome measure and semi-structured interviews were carried out at two separate stages. The first, in the hospital one to five days prior to discharge. The second in the home of the subject six to eight weeks following discharge.

Studies investigating the experience of spinal injured patients soon after discharge are very limited. Research to date indicates that the functional independence of those with spinal cord injury improves after a period of one year and longer at home.

Results in this study showed that functional independence as measured using the Functional Independence Measure (FIM), decreased following discharge and the change was statistically significant (p=0.041). A decrease was also noted on the Spinal Cord Independence Measure (SCIM), but this was not shown to be statistically significant (p=0.075). Mood was measured using the Centre for Epidemiological Studies Depression Scale (CES-D) and an overall improvement in mood following discharge was observed. The qualitative data obtained through the semi-structured interviews, yielded rich information on the subjects views of the pre and post discharge phase. Six factors which could be associated with changes in functional independence were identified; environmental, lack of appropriate equipment, social support, lack of services, pre-discharge preparation and pain.

Exploring the experiences and functional changes of individuals with spinal cord injury following discharge has implications for pre discharge rehabilitation and follow-up. Changes in line with other models of rehabilitation in Australia and America may provide a more transitional period to allow persons with SCI to be well prepared for the physical and emotional challenges presented to them in the community.

Final Report presented to the NRH Ethics Committee –  May 2006