Comparing content of therapy for people with a spinal cord injury in postacute inpatient rehabilitation in Australia, Norway, and The Netherlands

Abstract

Background: Research reports have described the contents of therapy in spinal cord injury (SCI) rehabilitation only as the total number of therapy hours. We developed the Spinal Cord Injury-Interventions Classification System (SCI-ICS) as a tool to classify therapy to improve mobility and self-care into 3 levels (body functions, basic activities, and complex activities) and 25 categories.

Objective: The purposes of this study were: (1) to compare specific contents and amount of therapy provided, with the aim of improving mobility and self-care for people with SCI in Australia, Norway, and the Netherlands and (2) to evaluate the use of the SCI-ICS outside the Netherlands.

Design: This was a prospective, descriptive study.

Methods: Physical therapists, occupational therapists, and sports therapists in 6 centers recorded all therapy provided to all people with a recent SCI in inpatient rehabilitation during 4 designated weeks. Each treatment session was classified using 1 or more SCI-ICS codes. Duration of each intervention was specified.

Results: Seventy-three therapists recorded 2,526 treatments of 79 people with SCI (Netherlands, 48; Australia, 20; Norway, 11). Most therapy time was spent on exercises (overall mean=84%) and on categories at body function and basic activity level of the SCI-ICS. Therapy time significantly differed among countries for 13 of 25 categories. Mean time in minutes per treatment (Netherlands, 28; Australia, 43; Norway, 39) and in hours per patient per week (Netherlands, 4.3; Australia, 5.8; Norway, 6.2) differed significantly.

Limitations: The short period and small number of patients may have influenced the results.

Conclusions: Therapy in inpatient SCI rehabilitation in all 3 countries focused on mobility and self-care exercises at body function and basic activity level, but differences were present in focus on the various categories and therapy time. The SCI-ICS can be used reliably to describe therapy in different countries.