Functional outcomes and cost-efficiency of specialist in-patient rehabilitation following spinal cord injury: a multi-centre national cohort analysis from the UK Rehabilitation Outcomes Collaborative (UKROC).

Abstract

<b>Purpose:</b> To evaluate functional outcomes, care needs and cost-efficiency of specialist rehabilitation for a multi-centre cohort of inpatients with spinal cord injury (SCI)-comparison based on age and aetiology.<b>Methods and materials:</b> Retrospective analysis of prospectively collected data from the UK Rehabilitation Outcomes Collaborative (UKROC) national clinical database from 2012-2019. Adults with SCI admitted for a rehabilitation programme in levels 1 and 2 specialist rehabilitation Units in England, were included if they had valid UK Functional Assessment Measure (UK FIM + FAM) and Northwick Park Dependency Scale (NPDS) scores recorded on admission and discharge (<i>n</i> = 2506 of 3321 admissions).<b>Results:</b> Approximately 425 patients were admitted yearly. 1344(56%) patients were under 65. 736(29%) had traumatic aetiology. Older and Traumatic SCI patients were more likely to have cervical cord damage (<i>X</i>², <i>p</i> < 0.001). There was a significant improvement in all parameters of functional independence (UK FIM + FAM) (<i>p</i> < 0.001), with the reduction in dependency and care costs (NPDS/NPCNA) (<i>p</i> < 0.001). 1817(72.5%) patients were discharged home. Mean care-costs savings were £25 500/year per patient. Year-on-year trends showed admissions with increasing age, higher complexity and dependency with corresponding increasing episode costs (ANOVA <i>p</i> < 0.001). However, the time taken to offset the cost of rehabilitation did not change significantly (ANOVA <i>p</i> = 0.57).<b>Conclusions:</b> Specialist rehabilitation services provide effective and cost-efficient rehabilitation for patients with spinal cord injury.Implications for RehabilitationApproximately a third of patients who access specialist inpatient rehabilitation following spinal cord injury (SCI) in England are managed in the Specialist Level 1 and 2 neuro-rehabilitation units, rather than in the eight designated national SCI Centres.Despite admitting progressively more complex and dependent patients over eight years, these specialist rehabilitation units continue to provide highly cost-efficient care.The mean annual savings amount to £25,500 per patient. With a mean admission rate of 425 patients, this would generate total savings in excess of £10 million per year for the cohort.Specialist rehabilitation services play an important, but under-recognised, role in the spinal cord injury care pathway.