Original article
Pain and Its Impact on Inpatient Rehabilitation for Acute Traumatic Spinal Cord Injury: Analysis of Observational Data Collected in the SCIRehab Study

https://doi.org/10.1016/j.apmr.2012.10.035Get rights and content

Abstract

Objective

To describe pain during inpatient rehabilitation and its impact on delivery of inpatient rehabilitation services for persons with spinal cord injury (SCI).

Design

Prospective observational study and retrospective chart review.

Setting

Six inpatient rehabilitation facilities participating in the SCIRehab Study.

Participants

Patients (N=1357) receiving initial rehabilitation after traumatic SCI, for whom pain data were available.

Interventions

Not applicable.

Main Outcome Measures

Self-reported rating of pain intensity (0–10), pain locations, and treatment time by various rehabilitation disciplines.

Results

The vast majority of patients (97%) reported pain at least once during the rehabilitation stay, with an average pain intensity ± SD of 4.9±2.4. Average pain intensity over the stay was severe (rated 7–10) for 30% of patients, moderate (4–6) for 42%, and mild (1–3) for 25%. Pain prevalence at admission was greater than at discharge (87% vs 74%), as was pain intensity (6.0 vs 4.6). Most (79%) of the 177 participants who did not have pain at admission reported pain at least once later in the rehabilitation stay, but their average high pain intensity over the stay was lower than that of the full sample (1.9 vs 4.9). Nearly half (47%) of patients reported pain at ≥3 locations during the stay, with the back, neck, and shoulder commonly reported. Patients with severe pain spent fewer days in rehabilitation, received less rehabilitation treatment time (hours per week and total hours), and had more treatment sessions altered in objective or content because of pain than those with lower pain levels.

Conclusions

Pain is a common problem for persons receiving inpatient rehabilitation for traumatic SCI and adversely impacts delivery of therapy services.

Section snippets

Study design and participating organizations

Data analyzed herein were collected as part of the SCIRehab Study18, 19—a multicenter study that uses practice-based evidence research methodology, an observational approach in which detailed data are collected on rehabilitation interventions, patient characteristics, and medical, functional, and psychosocial outcomes.20, 21, 22 Six clinical centers participated in the study: The Rocky Mountain Regional Spinal Injury System at Craig Hospital (lead center), Rehabilitation Institute of Chicago,

Sample characteristics

The sample was predominantly men, white, spoke English as a primary language, worked at the time of injury, and had private insurance coverage (table 1). More than one third of the patients had paraplegia (36%). Average age at injury was 41 years, and average LOS was 57 days.

Presence, intensity, and locations of pain

High and low pain intensity at admission, discharge, and over the entire stay are presented in table 2. The majority of patients (97.2%) reported pain at some point during the rehabilitation stay, with an average high pain

Discussion

The SCIRehab Study is one of the largest prospective studies of SCI inpatient rehabilitation ever undertaken and provides a unique opportunity to examine the prevalence and intensity of pain reported by persons with acute traumatic SCI during inpatient rehabilitation and to assess the impact of pain on delivery of inpatient rehabilitation services. This investigation supports the assertion that pain is highly prevalent in persons with SCI, with the vast majority (97%) of patients reporting pain

Conclusions

Pain is highly prevalent among persons with SCI receiving acute inpatient rehabilitation. Persons with SCI report multiple locations of pain, and a substantial percentage experience severe pain. Persons with severe pain receive less treatment time, but this does not appear to be because of missing scheduled therapies. PT, OT, and NU pain management activities took up relatively little of their discipline's total treatment time, but this may not be true for PSY. Further studies are needed to

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    Supported in part by the National Institute on Disability and Rehabilitation Research, Office of Special Education and Rehabilitative Services, U.S. Department of Education (grant nos. H133N060027 and H133A060103).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

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