POSTREHABILITATION OUTCOMES AFTER SPINAL-CORD INJURY CAUSED BY FIREARMS AND MOTOR-VEHICLE CRASH AMONG ETHNICALLY DIVERSE GROUPS

Objectives: To determine the differential effects of impairment, disab ility, etiology, and selected preinjury and social factors on medical complications, medical resources use, and handicap after rehabilitatio n for spinal cord injury (SCI). Design: Survey including interview and medical record review. Setting: Model SCI Care System centered at an urban, public medical center. Participants: A volunteer convenience sa mple of 164 men, ages 18 to 35 yrs at injury, with SCI caused by firea rms or motor vehicle crash. Main Outcome Measures: Mean numbers of doc umented complications, pressure sore episodes, nonroutine clinic visit s, postrehabilitation hospitalization days per year, assessment by Fun ctional Independence Measure (FIM), and total score on the Craig Handi cap Assessment and Reporting Technique (CHART). Results: Significant f actors for postrehabilitation complications were discharge FIM (p <.00 1) and injury duration (p =.046); for pressure ulcer episodes, they we re injury completeness (p <.001), drug abuse following injury (p =.005 ), and ethnicity (p =.043); for average annual nonroutine clinic visit s, they were complications (p <.001), pressure ulcer episodes (p <.001 ), duration of injury (p =.001), and pain (p =.052); for hospitalizati on, they were pressure ulcer episodes (p <.001) and complications (p = .043); for CHART scores, they were discharge FIM (p <.001), preinjury education (p <.001), hospitalization (p =.007), chronic pain (p =.01), longest time at one job (p =.02), completeness of injury (p =.042), a nd preinjury employment (p =.049). Conclusions: Disability is the most important factor in postrehabilitation outcomes for SCI, followed by injury completeness, which is also associated with multiple outcomes. Postinjury but not preinjury drug abuse is adversely associated with o utcomes. Etiology and ethnicity are not important determinates of outc ome. (C) 1998 by the American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation.