Effectiveness and efficiency of telerehabilitation on functionality after spinal cord injury: A matched case-control study

Alejandro García-Rudolph; Mark Andrew Wright; Carlos Yepes; Narda Murillo; Lucas Conesa; Ignasi Soriano; Raquel Bautista; Eloy Opisso; Josep Maria Tormos; Josep Medina

doi:10.1002/pmrj.13125

Effectiveness and efficiency of telerehabilitation on functionality after spinal cord injury: A matched case-control study

PM R. 2023 Dec 29. doi: 10.1002/pmrj.13125. Online ahead of print.

Authors

Alejandro García-Rudolph^{1

2

3}, Mark Andrew Wright^{1

2

3}, Carlos Yepes^{1

2

3}, Narda Murillo^{1

2

3}, Lucas Conesa^{1

2

3}, Ignasi Soriano^{1

2

3}, Raquel Bautista^{1

2

3}, Eloy Opisso^{1

2

3}, Josep Maria Tormos^{1

2

3}, Josep Medina^{1

2

3}

Affiliations

¹ Department of Research and Innovation, Institut Guttmann, Institut Universitari de Neurorehabilitació adscrit a la UAB, Barcelona, Spain.
² Universitat Autònoma de Barcelona, Bellaterra, Spain.
³ Fundació Institut d'Investigació en Ciències de la Salut Germans Trias i Pujol, Barcelona, Spain.

PMID: 38155582
DOI: 10.1002/pmrj.13125

Abstract

Background: Telerehabilitation in spinal cord injury (teleSCI) is a growing field that can improve access to care and health outcomes in patients with spinal cord injury (SCI). The clinical effectiveness of teleSCI is not known.

Objectives: To compare independence in activities of daily living and mobility capacity in patients following teleSCI and matched controls undergoing traditional rehabilitation.

Design: Matched case-control study.

Setting: TeleSCI occurring in home setting (cases) versus traditional rehabilitation on inpatient unit (controls).

Participants: Forty-two consecutive patients with SCI followed with teleSCI were compared to 42 historical rehabilitation inpatients (controls) matched for age, time since injury to rehabilitation admission, level of injury (paraplegia/tetraplegia), complete or incomplete injury, and etiology (traumatic/nontraumatic). The teleSCI group (n = 42) was also compared to the complete cohort of historical controls (n = 613).

Interventions: The teleSCI group followed home-based telerehabilitation (3.5 h/day, 5 days/week, 67 days average duration) and historical controls followed in-person rehabilitation.

Main outcome measure(s): The Functional Independence Measure (FIM), the Spinal Cord Independence Measure (SCIM) and the Walking Index for Spinal Cord Injury (WISCI). We formally compared gains, efficiency and effectiveness. International Standards for Neurological Classification of Spinal Cord Injury and the American Spinal Injury Association Impairment Scale (AIS) were used.

Results: The teleSCI group (57.1% nontraumatic, 71.4% paraplegia, 73.8% incomplete, 52.4% AIS grade D) showed no significant differences compared with historical controls in AIS grades, neurological levels, duration, gains, efficiency and effectiveness in FIM, SCIM, or WISCI, although the teleSCI cohort had significantly higher admission FIM scores compared with the complete cohort of historical controls.

Conclusions: TeleSCI may provide similar improvements in mobility and functional outcomes as traditional rehabilitation in medically stable patients (predominantly with paraplegia and motor incomplete SCI) when provided with appropriate support and equipment.