Seniz AKCAY, İLKER ŞENGÜL, Altinay GOKSEL KARATEPE, Hatice Merve GOKMEN, Taciser KAYA

WHAT ARE THE FACTORS EFFECT ON LENGTH OF STAY IN REHABILITATION UNIT IN SPINAL CORD INJURY PATIENTS?

Introduction: The objective of this study is to evaluate the main clinical and functional factors influencing the length of stay (LOS) in rehabilitation unit and to explore the effect of complications on the LOS in patients with Spinal Cord Injury (SCI). Material and Methods: The sample, who were admitted for inpatient rehabilitation unit consisted of 59 patients with SCI. Demographic, clinical, and functional characteristics, LOS, number and types of medical complications were determined. To find out the factors related to the LOS, correlation analysis was performed. Regression analysis was also carried out to determine the independent factors affecting the LOS and the extent to which these factors explain the change in LOS. Results: Although, the urinary tract infection, neuropathic pain and pressure ulcer were the complications related to the LOS, in regression analysis, the number of complications and the FIM efficiency were determined as independent predictive factors of the rehabilitation LOS. None of the complications alone was found to be the independent predictor for the LOS. However, the regression model was able to explain only 37.8% of the variation in the LOS. Conclusion: The number of complications is the main determinant of the LOS. The daily functional gain decreases as the LOS increases. Thus, future studies are necessary to determine the role of the number of complications and possible other factors that may have an impact on the LOS.

SPİNAL KORD YARALANMASI HASTALARINDA REHABİLİTASYON ÜNİTESİNDE KALMA SÜRESİNE ETKİSİ OLAN FAKTÖRLER NELERDİR?

Giriş: Bu çalışmanın amacı, Omurilik yaralanması (OY) olan hastalarda rehabilitasyon ünitesinde kalış süresini (KS) etkileyen ana klinik ve fonksiyonel faktörleri değerlendirmek ve komplikasyonların KS üzerindeki etkisini araştırmaktır. Gereç ve Yöntem: Örneklem, yatarak rehabilitasyon ünitesine başvuran 59 OY hastasından oluşuyordu. Demografik, klinik ve fonksiyonel özellikler, KS, tıbbi komplikasyon sayısı ve tipleri belirlendi. LOS ile ilgili faktörleri bulmak için korelasyon analizi yapıldı. KS'yi etkileyen bağımsız faktörleri ve bu faktörlerin KS değişimini ne ölçüde açıkladığını belirlemek için regresyon analizi yapıldı. Bulgular: İdrar yolu enfeksiyonu, nöropatik ağrı ve basınç ülseri, KS ile ilgili komplikasyonlar olsa da, regresyon analizinde komplikasyon sayısı ve FIM etkinliği, KS’nin bağımsız prediktif faktörleri olarak belirlenmiştir. Tek başına komplikasyonların hiçbiri, KS için bağımsız belirleyici olarak bulunmadı. Ancak, regresyon modeli LOS'taki varyasyonun sadece% 37.8' ini açıklayabildi. Sonuç: Komplikasyon sayısı, KS'nin ana belirleyicisidir. KS arttıkça günlük fonksiyonel kazanç azalır. Bu nedenle, gelecekteki çalışmalar, komplikasyon sayısının rolünü ve KS'yi etkileyebilecek diğer olası faktörleri belirlemek için gereklidir.

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1. DeVivo MJ, Kartus PL, Rutt RD, Stover SL, Fine PR. The influence of age at time of spinal cord injury on rehabilitation outcome. Arch Neurol 1999; 47(6): 687-91.

2. Eastwood EA, Hagglund KJ, Ragnarsson KT, Gordon WA, Marino RJ. Medical rehabilitation length of stay and outcomes for persons with traumatic spinal cord injury-1990-1997. Arch Phys Med Rehabil 1999; 80(11): 1457- 63.

3. Pagliacci MC, Celani MG, Zampolini M, Spizzichino L, Franceschini M, Baratta S et al. An Italian survey of traumatic spinal cord injury. The Gruppo Italiano Studio Epidemiologico Mielolesioni study. Arch Phys Med Rehabil 2003; 84(9): 1266-75.

4. Ditunno JF, Young W, Donovan WH, Creasey G.. The international standards booklet for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Paraplegia 1994; 32(2): 70-80.

5. Küçükdeveci AA, Yavuzer G, Elhan AH, Sonel B, Tennant A. Adaptation of the functional independence measure for use in Turkey. Clin Rehabil 2001; 15(3): 311-9.

6. Stineman MG, Goin JE, Hamilton BB, Granger CV. Efficiency pattern analysis for medical rehabilitation. Am J Med Qual 1995; 10(4): 190- 8.

7. Sumida M, Fujimoto M, Tokuhiro A, Tominaga T, Magara A, Uchida R. Early rehabilitation effect for traumatic spinal cord injury. Arch Phys Med Rehabil 2001; 82(3): 391-5.

8. Post MWM, Dallmeijer AJ, Angenot EL, Van Asbeck FWA, Van der Woude LHV. Duration and functional outcome of spinal cord injury rehabilitation in the Netherlands. J Rehabil 2005; Res Dev 42(3 Suppl 1): 75-85.

9. Tasoglu O, Koyuncu E, Daylak R, Karacif DY, Ince Z, Yenigün D, Ozgirgin N. Demographic and clinical characteristics of persons with spinal cord injury in Turkey: One-year experience of a primary referral rehabilitation center. J Spinal Cord Med 2018; 41(2):157-64.

10. Güneş S, Kurtaiş Aytür Y, Gök H, Kutlay Ş, Güneş N, Sonel Tur B, et al. Demographic and clinical profile and functional outcomes of patients with spinal cord injury after rehabilitation. Türk Fiz Tıp Rehab Derg 2017; 63(1): 066-71.

11. Milicevic S. Bukumiric Z, Nikolic AK, Sekulic A, Trajkovic G, Corac A, et al. Predictors of length of stay in patients with spinal cord injury. Pyhs Med Rehabb Kurur 2015; 25(3):136-40.

12. Hall KM, Cohen ME, Wright J, Call M, Werner P. Characteristics of the Functional Independence Measure in traumatic spinal cord injury. Arch Phys Med Rehabil 1999; 80(11): 1471-6.

13. Stineman MG, Hamilton BB, Goin JE, Granger CV, Fiedler RC. Functional gain and length of stay for major rehabilitation impairment categories. Patterns revealed by function related groups. Am J Phys Med Rehabil 1996; 75(1): 68-78.

14. Bode RK, Heinemann AW. Course of functional improvement after stroke, spinal cord injury, and traumatic brain injury. Arch Phys Med Rehabil 2002; 83(1): 100-6.

15. Osterthun R, Post MWM, van Asbeck FWA; Dutch-Flemish Spinal Cord Society. Characteristics, length of stay and functional outcome of patients with spinal cord injury in Dutch and Flemish rehabilitation centres. Spinal Cord 2009; 47(4): 339-44.

16. Sattar AB. Predictors of functional outcome in patients with traumatic spinal cord injury after inpatient rehabilitation: in Saudi Arabia. NeuroRehabilitation 2014; 35(2): 341-7.

17. Mahmoud H, Qannam H, Mortenson B. Spinal cord injury rehabilitation in Riyadh, Saudi Arabia: Time to rehabilitation admission, length of stay and functional independence. Spinal Cord 2017; 55(5): 509–14.

18. Whiteneck G, Gassaway J, Dijkers M, Backus D, Charlifue S, Chen D et al.Inpatient treatment time across disciplines in spinal cord injury rehabilitation. J Spinal Cord Med. 2011; 34(2): 133–48.

19. Stampas A, Dominick E, Zhu L. Evaluation of functional outcomes in traumatic spinal cord injury with rehabilitationacquired urinary tract infections: a retrospective study. Journal Spinal Cord Med 2018; doi:10,1080/10790268. 2018,1452389. [Epub ahead of print]

20. Riegger T, Conrad S, Schluesener HJ, Kaps HP, Badke A, Baron C et al. Immune depression syndrome following human spinal cord injury (SCI): a pilot study. Neuroscience. 2009; 158(3): 1194-9.