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Eur J Phys Rehabil Med
Eur J Phys Rehabil Med
EJPRM
European Journal of Physical and Rehabilitation Medicine
1973-9087
1973-9095
Edizioni Minerva Medica

38922316
8391
10.23736/S1973-9087.24.08391-6
Article
Utilization and features of rehabilitation and health services for persons with spinal cord injury
METZGER Stefan 1 2 3
POLANCO Boris 1 2
ERIKS-HOOGLAND Inge 1 2 3
SCHEEL-SAILER Anke 1 3
PACHECO BARZALLO Diana 1 2 4 *
1Faculty of Health Science and Medicine, University of Lucerne, Lucerne, Switzerland; 2Swiss Paraplegic Research, Nottwil, Switzerland; 3Swiss Paraplegic Center, Nottwil, Switzerland; 4Center for Rehabilitation in Global Health Systems, WHO Collaborating Center, Lucerne, Switzerland
* Corresponding author: Diana Pacheco Barzallo, Faculty of Health Science and Medicine, University of Lucerne, Frohburgstrasse 3, 6002 Lucerne, Switzerland. E-mail: diana.pachecobarzallo@paraplegie.ch
Authors’ contributions: Stefan Metzger, Boris Polanco, and Diana Pacheco Barzallo were involved in the conceptualization and formal analysis of the study. The study data were collected by SM. Stefan Metzger and Boris Polanco, performed the statistical analysis, and Stefan Metzger wrote the original draft, reviewed, and approved the methodology. Diana Pacheco Barzallo, Inge Eriks-Hoogland, and Anke Scheel-Sailer critically reviewed and interpreted the results and were involved in the revision of the manuscript. All the authors read and approved the final draft of the manuscript before submission.

26 6 2024
8 2024
60 4 634642
07 6 2024
12 4 2024
27 12 2023
2024 THE AUTHORS
https://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives (CC BY-NC-ND) 4.0 License.
BACKGROUND

The increasing prevalence of individuals experiencing disabilities underscores the importance of rehabilitation. Nevertheless, healthcare systems are already facing financial constraints, which makes it imperative to strive for a more efficient delivery of services. The first step, however, is to understand how the provision of services behaves for patients with different characteristics.

AIM

To determine the most frequently used healthcare services in the (sub)acute phase of rehabilitation of patients with spinal cord injury/disease (SCI/D) and the link with patient characteristics.

DESIGN

Observational cohort study.

POPULATION

This study analyzes the clinical data of patients discharged from a specialized SCI hospital and rehabilitation center in Switzerland.

METHODS

We implemented a compound risk model to estimate the total amount of healthcare services used, defined by length of stay (LOS) and the units per day of health services (sub)acute phase of rehabilitation.

RESULTS

The study included 403 individuals with SCI/D. The analysis of the intensity and severity of healthcare services across different patient and injury characteristics revealed differences in the intensity of healthcare use and variations in the length of stay (LOS). Male patients with a low SCIM upon admission tended to use healthcare services more extensively than female patients. In terms of etiology, therapies were employed more intensively for patients with traumatic SCI (TSCI). In addition, the analysis revealed that variations in the intensity of healthcare services used were more significant than those adjusted for LOS. Ultimately, similar patient groups received comparable quantities of healthcare services at the end of treatment.

CONCLUSIONS

This population-based study provides information for a better understanding of the determinants of health service use during the (sub)acute rehabilitation phase of individuals with SCI/D. When analyzing LOS, intensity, and severity of services, it shows that the use of healthcare services significantly differs for the level of SCIM at admission, age groups, sex, and etiology. However, the variation among individual patients also suggests the presence of other influential modifiers that were not considered in this analysis.

CLINICAL REHABILITATION IMPACT

The approach outlined enables a systematic follow-up of this data analysis by enriching the computed data with additional details about the patient, the patient’s treatment, and outcomes.

Key words:

Spinal cord injuries
Rehabilitation
Length of stay
Delivery of healthcare
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pmcThe increasing prevalence of individuals experiencing disabilities underscores the importance of rehabilitation. Nevertheless, healthcare systems are already facing financial constraints, which makes it imperative to strive for a more efficient delivery of services. This entails maximizing health outcomes while optimizing the utilization of rehabilitation and other healthcare services. To this end, it is crucial to gain a better understanding of the existing allocation of services to patients and their effects on enhancing functionality and reducing disability.1 Currently, there is limited evidence for SCI/D patients on the optimal healthcare services based on patients’ characteristics, which may result in suboptimal care provision.2

Routine clinical data, which are currently underutilized, can be helpful in supporting clinical decisions by providing health professionals with information about their past decisions.3 Routine data are generated during the treatment processes of persons due to internal or external requirements. These data provide an overview of what services a patient received, the timing of different treatments, the observed effects, and follow-up. Over the past few years, the analysis of routine data has become a more common approach among healthcare providers due to its reliability when accessible.3, 4 In addition, the increasing availability of new methods for analyzing large and complex datasets has further facilitated this trend.3, 5 In particular for SCI/D, with routine assessments of healthcare service utilization and outcomes relevant to rehabilitation, like independence measure score III (SCIM) or length of stay (LOS), we now have the opportunity to assess some aspects of service use and rehabilitation needs.6

In recent years, related literature has made efforts to develop a system to classify spinal cord injury/disease (SCI/D) rehabilitation interventions so that the specific components of rehabilitation programs can be described and studied in detail.7-10 A better understanding of the services delivered in inpatient rehabilitation is crucial to assess how certain interventions relate to rehabilitation outcomes.11-14 However, to gain insight into what constitutes optimal rehabilitation, it is crucial to first describe the current state within a healthcare service provision that features openness and lacks strict resource limitations. Switzerland has universal healthcare coverage, where anyone in need of rehabilitation care can access it. However, rehabilitation content and LOS are generally determined by healthcare professionals. This approach is needed to define “optimal” rehabilitation in terms of achieving optimal health and functioning outcomes by containing healthcare costs.

The objective of this paper is to provide an account of healthcare service utilization and LOS for persons with SCI/D during their (sub)acute phase of rehabilitation. The (sub)acute phase of rehabilitation spans from the immediate occurrence of the lesion to a few days post-incident until the patient’s discharge from the hospital and may also include a stay in an intensive care unit.15

Materials and methods

Study population and study variables

This research is a retrospective study using routinely collected clinical and administrative data obtained during the (sub)acute phase of rehabilitation for individuals with SCI/D at an acute and rehabilitation clinic in Switzerland. Notably, this clinic is the largest among four specialized SCI clinics in the country, providing treatment to more than 150 (sub)acute rehabilitation patients on average each year.16 Annually, it admits about 1000 SCI/D patients and employs 820 full-time employees in various medical, therapeutic, and nursing disciplines.

Data for this study were collected from individuals admitted for their (sub)acute phase of rehabilitation and discharged between January 2017 and December 2020. Despite the World Health Organization (WHO) declaring the coronavirus pandemic on 11th March 2020, treating patients with SCI/D at the clinic remained uninterrupted, without resource constraints. Consequently, the data from 2020 can be utilized for this analysis without bias or restrictions. The dataset includes administrative and medical information generated from routine data collections. Specifically, the data encompass the clinic specific medical statistics of the Federal Statistical Office, standard cost data from the data delivery about the Swiss diagnosis-related groups (DRGs), and information from the electronic medical records, the administrative planning system, and the business intelligence (BI) tool utilized by the clinic. We adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement guidelines for reporting the results of this study.

Study outcomes and variables

In total, we included records of 403 persons with SCI/D who underwent their (sub)acute phase of rehabilitation, ranging in age from 10 to 85 years. Individuals without SCI/D and those who did not sign a general consent form were excluded from the sample. The demographic and lesion characteristics included in our analysis were age at admission, sex, etiology of SCI/D, and international standard neurological classification for spinal cord injury (ISNCSCI) score at admission.17, 18 We also included in our analysis the SCIM obtained immediately at admission, which evaluates the ability to perform basic everyday tasks such as mobility, self-care, breathing and bladder and bowl management and assesses the impact of disability on the patient’s overall medical condition.19, 20 Total SCIM score is measured from 0 to 100, with lower scores corresponding to higher disability.

The duration of stay at hospital, also called LOS, was also considered in the analysis. For healthcare service provision, we included information about the type and quantity of services a patient received during the (sub)acute phase of rehabilitation. The term “services” refers to medical and rehabilitative treatments performed directly with or for the patient, as well as supporting services such as laboratory and imaging. These services are registered by the responsible health professionals in the respective service catalog units (minutes, Swiss francs, tax points) in the administrative or therapy planning system that reflects the effort per person during the treatment and cover disciplines such as physiotherapy, occupational therapy, speech therapy, psychology, other therapies (social counseling, nutritional, and vocational therapy), (intensive care) nursing, imaging, and laboratory. The recorded healthcare service quantities correspond to the documented service quantities for each patient and represent the service use over the stay or per day in the respective unit minutes, Swiss francs, or tax points.

Rehabilitation is a collaborative and interprofessional process in which work is often carried out together on a patient.2 The recorded services show the effective contribution made by the health professionals in the treatment of patients. Our evaluation framework adopts an effort-oriented perspective, whereby the cumulative time expended by multiple therapists is considered. For instance, if two therapists participate in a half-hour treatment session, the combined effort is accounted for as one hour. Similarly, in group therapy facilitated by a single group therapist, the total time spent is equitably distributed among the participants. No further distinction was made between the different treatment activities in a service discipline. Since the services provided by rehabilitation physicians are based on a standardized survey, a corresponding analysis would not be conclusive.

The included services for the analysis were categorized and described for four injury groups based on the definition used by ISNCSCI as Teeter et al. showed that the impact of physiotherapy treatment increases when patient groupings become more homogeneous.21 The injury groups are patients with high tetraplegia (C1-C4 AIS A, B, C), patients with low tetraplegia (C5-C8 AIS A, B, C), patients with paraplegia (TH1-S5 AIS A, B, C), and patients with AIS grade D, grouped irrespective of injury level.5 The values C1-S5 indicate the lesion level of the spinal cord. If the spinal cord is injured in the cervical spine (C1-C8), there is tetraplegia; if it is injured in the areas below (from Th1), there is paraplegia.22 The American Spinal Injury Association Impairment Scale (ASIA) is a standardized examination that describes the grade of motor and sensory function of a patient from A (= complete; no motor or sensory function preserved in the sacral segments S4-S5) to E (= normal; motor and sensory function are normal).23

The clinic follows the international classification of functioning (ICF) for collecting information relevant to rehabilitation and adheres to a health service-specific standard for outcome measures, the Nottwil standard.24 Rehabilitation in the clinic is coordinated by the rehabilitation physician in an interprofessional team with specialized health professionals in close cooperation with the patient.

Modeling framework

There are a number of theoretical models to explain health service utilization in the literature.25 We implemented a compound risk model that quantifies the healthcare services most frequently provided to individuals, categorized by discipline, considering both patient and injury characteristics. Providing the same “type” and “amount” of healthcare services to people of different characteristics is not optimal, even when they suffer from the same health conditions.

The compound Poisson risk model calculates the total “amount” of a service, also known as the “severity” Si of a service, adjusted by the LOS with the intensity of a service.26 The degree of severity aligns with the level of care, which, within the context of this study, pertains to service utilization. Specifically, the total number of minutes, Swiss francs, or tax points that an individual is provided during (sub)acute rehabilitation. In formal terms:

[Si] = LOS × I [Ii]

where LOS stands for the length of stay during the inpatient period of hospitalization. LOS was calculated from the date of admission until the date of discharge. To model LOS, we first assessed its distribution by fitting the observed durations with distributions commonly established in the literature.27 We considered a zero-truncated negative binomial distribution conditional on taking positive values.28, 29 In formal terms:

The intensity measures the healthcare service (I) in units (minutes, Swiss francs, tax points) provided to patient i during (sub)acute phase of rehabilitation. To model the intensity of each service, we considered generalized linear models with a family distribution of Gamma and logarithm link functions. In formal terms:

To understand how Si changes by patients’ characteristics, our results will be presented by SCIM across the various services included in the analysis. The same analysis was also performed for other patient and injury characteristics. All statistical analyses were performed using the statistical software R (version 4.2.3). The computations were performed with the Vector Generalized Linear and Additive Models (VGAM) library, which facilitates vector generalized and additive models.30

Ethics statement

The study was formally approved by the regional medical ethics committee of northwest and central Switzerland (Project-ID 2023-04). All participants involved in the study provided consent for the anonymized use of their data for research purposes and were given the option to opt out.

Results

Descriptive statistics

Description of person and lesion characteristics and their relation to LOS

Table I provides an overview of the study sample. In total, 30.8% were female, with a median age of 57 (IQR 37-70). Persons over the age of 46 represent 65.3% of the population, 40% of the patients suffered from a high lesion level (tetraplegia), and the cause of SCI was traumatic in 55.1% of the cases. SCIM at admission was lowest in the injury group C1-C4 AIS A, B, C, with a mean of 16.9.

Table I —Description of population characteristics by LOS.

Indicator parameter [missing]	N.	(%)	Length of stay
Mean±SD; median (IQR)	P value a	
Overall	403	100%	150±72.1; 151 (102–196)		
Sex [0]				0.21	
Male	279	69.2%	152±72.4; 153 (101–202)		
Female	124	30.8%	144±71.3; 142 (104–183)		
Age class [0]				0.01	
10-30	80	19.9%	143 (70.4); 148 (89–194)		
31-45	60	14.9%	157 (66.9); 154 (108–210)		
46-60	87	21.6%	168 (75.9); 161 (134–210)		
61-75	128	31.8%	148 (73.0); 147 (100–195)		
76	48	11.9%	122 (63.4); 130 (88–162)		
Level of injury [0]				<0.0001	
C1-C4	68	16.9%	186 (85.1); 202 (135–234)		
C5-T1	98	24.3%	169 (79.6); 188 (109–229)		
T2-L2	225	55.8%	133 (57.3); 141 (97–163)		
L3-S5	12	3.0%	102 (53.0); 129 (53–142)		
Lesion level [0]				<0.0001	
Paraplegia	242	60.0%	131 (57.0); 140 (96–162)		
Tetraplegia	161	40.0%	178 (82.7); 196 (118–232)		
Injury group [1]				<0.0001	
C1-C4 AIS A, B, C	44	10.9%	193 (93.5); 207 (145–237)		
C5-C8 AIS A, B, C	58	14.4%	195 (77.9); 217 (173–239)		
Paraplegia AIS A, B, C	176	43.7%	143 (54.0); 150 (118–170)		
AIS D	124	30.8%	121 (65.8); 118 (72–162)		
Etiology [0]				<0.0001	
NTSCI	181	44.9%	135 (76.6); 137 (86–169)		
TSCI	222	55.1%	162 (65.9); 161 (125–208)		
	Mean±SD		Median (IQR)		
SCIM at admission by injury group [0]				<0.0001	
C1-C4 AIS A, B, C	16.9±16.0		12 (8-24)		
C5-C8 AIS A, B, C	19.9±12.9		17 (11-24)		
Paraplegia AIS A, B, C	34.9±16.7		32 (24-46)		
AIS D	44.6±25.9		40 (22-66)		
a P value from Kruskal-Wallis Rank Sum Test. For indicator parameters, person numbers (N) are given with percentages of total population (%), and corresponding estimates of LOS (days) as mean with standard deviation and median with interquartile range (IQR) in days (except SCIM at admission).

The mean rehabilitation LOS in the sample was 150±72.1 days (median 151, 25th percentile 102, 75th percentile 196). Significant differences in LOS were observed across injury characteristics, including level of injury, lesion level, and injury group, as well as by etiology and SCIM at admission. However, patient characteristics such as sex and age class did not exhibit a significant discriminatory difference on LOS (Table I).

Healthcare service use: description of services

Table II presents the mean time spent by total and by day on each service type by injury group allocated to patients during their (sub)acute phase of rehabilitation.

Table II —Description of the frequency of healthcare services within the (sub)acute phase of rehabilitation care by injury group.

Service [unit]	Total
N.=402	C1-C4
AIS A, B, C
N.=44	C5-C8
AIS A, B, C
N.=58	Paraplegia
AIS A, B, C
N.=176	AIS D
N.=124	P value a	
Occupational therapy [min] b							
Total hours [mean]	161.4	265.4	257.8	126.77	126.56		
Minutes per day [mean]	64.8	82.5	79.2	53.22	62.60	<0.0001	
Speech therapy [min] b							
Total hours [mean]	10.8	39.5	14.2	2.97	10.31		
Minutes per day [mean]	4.4	12.3	4.4	1.25	5.10	<0.0001	
Physiotherapy [min] b							
Total hours [mean]	288.7	363.2	371.3	269.13	248.98		
Minutes per day [mean]	115.8	112.9	114.1	112.97	123.16	0.35	
Nursing [min] b							
Total hours [mean]	783.3	1503.0	1226.5	657.20	491.44		
Minutes per day [mean]	314.3	467.2	376.8	275.88	243.09	<0.0001	
Other therapies [tax points] c							
Total tax points [mean]	6913.8	11,864.2	8603.0	6163.17	5361.32		
Tax points per day [mean]	46.2	61.5	44.1	43.12	44.20	<0.0001	
Psychology [tax points] c							
Total tax points [mean]	1722.7	2341.0	2050.6	1683.34	1336.54		
Tax points per day [mean]	11.5	12.1	10.5	11.78	11.02	0.13	
Imaging [CHF] d							
Total CHF [mean]	3849.2	5515.3	4460.5	3915.59	2899.88		
CHF per day [mean]	25.7	28.6	22.8	27.39	23.91	0.08	
Laboratory [CHF] d							
Total CHF [mean]	3498.0	5479.1	3943.7	3719.02	2266.09		
CHF per day [mean]	23.4	28.4	20.2	26.02	18.68	<0.0001	
a P value from Kruskal-Wallis Rank Sum Test; b service is registered in minutes; c service is registered in tax points; d service is registered in Swiss francs.

By comparing the allocated healthcare service intensity to the patients that are measured in minutes, most of the service time was provided by nursing, followed by physiotherapy and occupational therapy. The frequency of other therapies exceeded that of psychology services, with a ratio of more than four to one. Both service types are quantified using tax points. Additionally, the use of the two technical service types, imaging, and laboratory services, measured in Swiss francs, is comparable.

Significant differences in service intensity between injury groups were observed within the service disciplines of occupational therapy, speech therapy, nursing, other therapies, and laboratory (Table II).

Modeling framework

Figure 1 presents the results of the compound Poisson risk model. The results display the relation between the estimated service intensity, service severity, and SCIM at admission for different service types. The figures also present the intensity to describe the services utilized per day. The same analysis was performed for the estimated service intensity and service severity along age group, injury group, and etiology (Figure 1).

Figure 1 —Service’s intensity (services utilized per day) and severity (services utilization during (sub)acute rehabilitation) across independence measure (SCIM).

Analysis of service intensity

Utilization of occupational therapy is significantly influenced by injury group, particularly for C1-C4, ASIA A, B, C, and C5-C8, ASIA A, B, C groups. The age group significantly affects the use of speech therapy services, with 31-45 and 45-60 age groups showing significant impacts. The utilization of physiotherapy services increases with higher SCIM scores at admission. The 31-45 age group and the paraplegia, A, B, C injury group significantly impact the use of nursing services. Sex is a significant factor in explaining differences in the use of other therapies, with females using these therapies less intensively. The age group influences the utilization of psychology services, with the 60-75 age group using them less. Sex affects imaging service utilization, with females being associated with lower use. The C5-C8, A, B, C injury group is associated with lower service utilization. Patients with higher SCIM scores at admission receive significantly fewer healthcare services (P<0.001), emphasizing their role in determining the intensity of healthcare services use.

Analysis of service severity

In most healthcare services, we observe a significant difference in service severity as SCIM improves, i.e., persons with higher functional dependence receive, in total, more healthcare services. Similar behavior can be seen in the different injury groups; the lower the lesion level, the lower the severity of healthcare services used. Furthermore, it is noticeable that there exists a significant sex difference for certain services across injury and patient characteristics. Male patients in the 46-60 age group receive more services than any other group. In terms of etiology, all therapies are used more intensively for patients with TSCI, except for speech therapy, where patients with NTSCI show higher severity.

The analysis shows that the variations in the intensity of healthcare services used are notably more significant than the differences in severity, which takes LOS into account. This suggests that therapy program intensities and lengths of stay are individually adjusted but follow a linear pattern. At the end of treatment, similar patient groups receive similar healthcare service quantities.

However, the diagrams also show that the spread of individual patients is relatively large. In addition to the variables considered, other modifiers as comorbidities, secondary health conditions during the rehabilitation phase or the living situation also have a relevant influence on the use of healthcare services.

Discussion

Using clinical data of patients from 2017 to 2020, we determined the use of healthcare services for persons with SCI/D in one clinic. The results regarding the frequency of healthcare services correspond with the data from earlier studies.12, 27 Nursing, physiotherapy, and occupational therapy are the most provided healthcare services during (sub)acute phase of rehabilitation. Furthermore, we have developed a model framework based on the LOS and the intensity of services, which measures the daily service provision, to identify the determinants of service intensity and severity during (sub)acute phase of rehabilitation.26 We found differences in the use of services by patient and injury characteristics. There are significant differences between age groups, an increase in the severity of services for patients with a higher level of lesion, a higher severity of services for patients with TSCI, and some sex differences. These results are also consistent with the findings of Taylor-Schroeder et al., who showed a significant difference in time spent in physiotherapy among injury groups.12

The results indicate that notable disparities in healthcare service utilization intensity are greater than in service severity, after adjusting for LOS. This implies that therapy programs and lengths of stay are individually and linearly adjusted, resulting in similar patient groups receiving comparable quantities of healthcare services by the end of their treatment. This effect is also concluded in the paper of Whiteneck et al. and is not surprising, as certain therapy programs are prescribed according the level of the lesion.5 Through the described statistical methods, we demonstrated that a profound examination of routine data can provide interesting insights into the allocation of healthcare services in the context of (sub)acute phase of rehabilitation to support health professionals in their daily decision-making.12, 21

Our findings about patient and injury characteristics determining service severity show that certain differences based on these factors cannot be sufficiently explained in an interconnected manner and warrant further examination in subsequent studies. Additionally, the wide variation among individual patients suggests the presence of other influential modifiers that were not accounted for in this analysis. Gliedt et al. also expounded upon the intricate and multidimensional nature of healthcare service utilization.25 Individuals with SCI/D are at risk of complications such as pressure injuries, cardiopulmonary arrest, thromboembolism, cardiopulmonary arrest, cardiovascular, and pulmonary, and renal conditions during the sub(acute) phase of rehabilitation.31 Depression during rehabilitation also influences the outcome of treatment.32 In addition, (sub)acute rehabilitation is influenced by injury-related and sociodemographic factors.33 Despite this, the concept of overuse/underuse of care, described in detail in a publication by Ooi, clearly shows that it is worthwhile to look at the allocation of services in terms of optimal use and outcomes for the benefit of patients.34

The main contribution of this paper is to show how the (sub)acute phase of rehabilitation happens for persons with SCI/D in Switzerland. To date, there is no literature that analyses this data. (Sub)acute phase of rehabilitation for persons with SCI/D seems to be quite effective, considering the high level of activity and participation of people with SCI/D living in the community compared to other similar countries.35, 36 This finding is supported by the results of the study conducted by Pacheco et al., which demonstrates that the living situation of people with SCI/D is significantly influenced by the performance of the health system. Notably, Switzerland ranks prominently among the 22 countries included in the study in terms of quality of life.37

Limitations of the study

Due to the challenges in rehabilitation research, including the lack of standardization of interventions, treatment intensities, and outcome measures, as well as spontaneous recovery and other contextual factors, it is difficult to define the optimal treatment strategies for patients with SCI/D, so no quantitative comparisons with existing guidelines are feasible.38 This is problematic because understanding the similarities and differences between rehabilitation units and within a rehabilitation center by using guidelines is essential to interpreting patient outcomes.27

This study focused on a selection of relevant patient and injury characteristics to elucidate their impact on the utilization of healthcare services and LOS. It is important to note that numerous variables, such as comorbidities, were not incorporated in the analysis, yet they may exert an additional influence on the utilization of healthcare services and LOS.

Conclusions

The results of this study describe the characteristics that influence the utilization of healthcare services during the (sub)acute phase of rehabilitation of patients with SCI/D. Upon analyzing service intensity, it becomes evident that injury group, age, sex, and functional independence significantly impact the utilization of various services.

Turning to the analysis of service severity, it is apparent that, on average, service severity diminishes as SCIM scores improve, signifying that individuals with higher functional dependence receive more extensive healthcare services. This observation aligns with the fact that therapy programs are prescribed based on the level and completeness of the lesion. Furthermore, sex differences in service utilization are notable across injury and patient characteristics. Etiology also plays a role, with all therapies being used more intensively for patients with TSCI, where patients with NTSCI exhibit higher service severity.

This study illustrates variations in the utilization of healthcare services among different age groups, sexes, and etiologies, as well as LOS within these patient and injury characteristics. This description not only enhances our comprehension but also serves as a historical cohort for potential future changes. The approach outlined enables a systematic follow-up of this data analysis by enriching the computed data with additional details pertaining to the patient, the patient’s treatment, and its outcomes.

Conflicts of interest: The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.
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