Prediction of functional outcome after spinal cord injury: a task for the rehabilitation team and the patient

Study design: Descriptive analysis of data gathered in an information syste m. Objectives: To explore the predictions of professionals and patients regard ing functional outcome after spinal cord injury related to the final result s after inpatient rehabilitation, in order to make prognostics of rehabilit ation outcome more successful and enlarge the role of the patient in select ing realistic rehabilitation goals. Methods: Data from 55 patients with spinal cord injury admitted to the reha bilitation centre. Expectations of the rehabilitation team and the patients regarding future independence in performing six daily activities were comp ared to the functional results at discharge. The results of patients with d ifferent level and extent of lesion were analyzed. Results: In 52% of all performed skills, independence was achieved at disch arge. Professionals and patients made similar predictions. If they both exp ected independence after rehabilitation, 90% of the skills were performed i ndependently at discharge. If they both did not expect independence only 3% of the functional results were positive. Of all combined predictions 64% w as correct. Correct predictions were most often found regarding self-care s kills of patients with paraplegia and regarding mobility of patients with c omplete lesions. Prediction of self-care outcome of patients with tetrapleg ia is far more complicated. There was a considerable variation in predictio ns of mobility potential, especially regarding patients with incomplete les ions. If the team and patients agreed upon expected independence in mobilit y skills of these patients, the final results were mostly positive. Conclusions: Prediction of functional outcome after spinal cord injury was most successful if the expectations of the team and patients were combined. Prognosis of self-care outcome of patients with paraplegia and mobility po tential of patients with complete spinal cord lesions was usually clear at admission. However, selection of realistic goals concerning self-care skill s of patients with tetraplegia and mobility skills of patients with incompl ete lesions is far more complicated. Gradual adjustment of objectives is ne eded during the rehabilitation process in close collaboration between the p rofessionals and the patients.