Efficacy of specialist versus non-specialist management of spinal cord injury within the UK.

Abstract

Retrospective outcome measurement study. Spinal cord injury (SCI) represents a life changing multi-factorial event for persons sustaining this condition. There has been anecdotal evidence that some persons sustaining this condition in the UK have not been managed within one of the 11 national specialist spinal injury units (SIU) but rather are managed in non-specialist rehabilitation areas. This study aimed to ascertain if differences in outcome from health, functional and social perspectives exists between the two cohorts. All participants had received rehabilitation within the UK National Health Service. A sample of 800 participants were recruited from the database of the Spinal Injury Association (UK) to complete a postal, self reporting questionnaire ascertaining perceived outcome across all of these perspectives. Despite having more severe injuries, the SIU cohort demonstrated statistically significant improved outcomes in 10 out of 18 health outcomes, 16 out of 18 functional outcomes and five out of 10 social outcomes in comparison with the non-SIU cohort. This study provides the evidence that people with SCI are better managed through a specialist system. Should a like for like comparison have been made as regards severity (completeness) of injury, the likelihood is that the results would have been even more in favour of the SIU cohort. These results should encourage commissioners of health care and those working in trauma settings to ensure people with SCI are managed in a specialist spinal injury unit setting both nationally and internationally.