Comparative analysis of goal achievement during rehabilitation for older and younger adults with spinal cord injury

Abstract

Objective: To evaluate rehabilitation outcome in a representative sample of older and younger SCI patients. Design: Case series, consecutive sample, survey. Setting: Tertiary care, spinal cord injury unit (National Spinal Injuries Centre), Stoke Mandeville Hospital. Participants: One hundred and forty-seven male and 45 female newly injured in-patients (consisting of 152 younger adults, age range=16 to 54, and 40 older adults, age range=55 to 85) admitted between 1995 and 1999. Intervention: All patients were actively participating in a comprehensive, multidisciplinary Goal Planning and Needs Assessment rehabilitation programme. Main outcome measure: The Needs Assessment Checklist. Specifically designed and developed for the spinal cord injured population, this clinical assessment tool provides a way of assessing and ensuring that rehabilitation programmes are geared toward each patient's individual needs, providing the patient with the skills appropriate to their level of lesion. As part of ongoing psychometric analyses of the Needs Assessment Checklist, internal consistency reliability coefficients are reported for this measure. Results: The type and cause of injury for the older adult group in this study was comparable with previous research. Older adults' rehabilitation gains were comparable to those of the younger age group. Younger adults were more mobile initially after their injury. However, when the two groups were matched for injury characteristics etc. the only differences in final outcome between older and younger adults were in skin management ability. Both groups showed significant improvements in all areas of need in the period between mobilisation and entering the pre-discharge ward. Conclusion: These results highlight important considerations for the rehabilitation of older adults and emphasise the need for active, individually tailored rehabilitation programmes. There are specific areas of need (i.e. skin management) where older adults do not achieve comparable levels of independence. Special attention needs to be paid to the problems presented by SCI older adults and efforts should be made to better prepare rehabilitation professionals to adapt to age specific differences.