Health care and rehabilitation services utilization, benefits and satisfaction: a community survey of individuals with spinal cord injury in Thailand.

STUDY DESIGN: Cross-sectional study. OBJECTIVES: This study aimed to explore and report on health care and rehabilitation service utilization, rehabilitation service benefits, and levels of satisfaction of individuals with spinal cord injury (SCI) living in communities in Thailand. SETTING: Four rehabilitation facilities in Thailand, two university hospitals (Maharaj Nakorn Chiang Mai Hospital in Chiang Mai Province and Siriraj Hospital in Bangkok), one large provincial hospital (Ratchaburi Hospital in Ratchaburi Province), and one national rehabilitation institute (Sirindhorn National Medical Rehabilitation Institute in Nonthaburi Province). METHODS: This study was part of the International Spinal Cord Injury Community Survey (InSCI). Individuals with SCI completed a set of questionnaires, then data related to their health care and rehabilitation services were extracted and analyzed. RESULTS: Of the 320 participants, most were male (71%), and the majority were living with paraplegia (73%). In cases of mild illnesses where hospitalization was not required, 46% went to a nearby health service hospital. In cases of serious illnesses where hospitalization was required, 39% went to a higher-level hospital. The majority (80%) were satisfied with their experience with health care services. The three top preferred products and services in descending order were wheelchairs and cushions, increased disability pension, medication and medical equipment including bladder relaxants, urinary catheters and urine bags. CONCLUSIONS: Individuals with SCI living in communities in Thailand preferred treatment at a nearby district hospital for mild illnesses with one-third transferring to a higher-level hospital for serious illnesses. The majority were satisfied with the health care services and rehabilitation services.

Is admission to an SCI specialized rehabilitation facility associated with better functional outcomes? Analysis of data from the Thai Spinal Cord Injury Registry.

STUDY DESIGN: Prospective cohort study of the Thai Spinal Cord Injury Registry. OBJECTIVE: To determine whether being admitted to a spinal cord injury (SCI) specialized rehabilitation facility (SSRF) is associated with better functional outcomes. SETTING: Four rehabilitation facilities in Thailand; one a SSRF and the others non-SSRFs. METHODS: Data from the one SSRF and three non-SSRFs were extracted from the Thai Spinal Cord Injury Registry. Multivariate regression analysis was used to exclude the effect of confounding factors and prove the independent association of SSRF admission with respect to Spinal Cord Independence Measurement (SCIM) at discharge. RESULTS: Among the 234 new SCI inpatients enrolled, 167 persons (71%) had been admitted to the SSRF. The SSRF had a greater proportion of persons with AIS A, B, C tetraplegia and people with AIS D, whereas the non-SSRFs had a higher proportion of patients with AIS A, B or C paraplegia. Patients discharged from the SSRF demonstrated a greater SCIM score improvement than those from the non-SSRFs (24.1 vs 17.0; p = 0.003). By using multivariate regression analysis controlling for age, time from injury to rehabilitation, severity of injury and SCIM score on admission, SSRF admission was found to be an independent predictive factor of SCIM score improvement at discharge (p = 0.008). CONCLUSION: Admission to an SSRF is associated with better rehabilitation outcomes. This finding supports the importance of SSRF access to improve the functional outcome of patients with SCI.