Significance of self-evaluation of patients with spinal cord injury for occupational therapy in early rehabilitation

The aim of this study – to evaluate influence of self assessment for occupational therapy in early rehabilitation period, of patients with spinal cord injury. Goals of this study: to evaluate functional outcomes and occupational performance issues, using traditional assessment methods; to evaluate occupational performance issues, of patients with spinal cord injury, using client – centred methods; to determine the relation between traditional and client – centred assessment methods, dependantly on spinal cord injury level and patients` age. The research took place at a Vilnius University hospital Santariškių klinikos, Centre of Rehabilitation, Physical and Sports Medicine inpatient departmens in 2007 02 – 2008 04. The research contingent consisted of 29 patients with spinal cord injury: 25 (86,2%) were men and 4 (13,8%) women, average of age 35,03 (SD ± 14,2) years. According to the level of spinal cord injury, 16 (55,2%) patients suffered from cervical spinal cord injury, 11 (37,9%) patients suffered from thoracic spinal cord injury and 2 (6,9%) patients had lumbar spinal cord injury. For 13 (81,3%) patients with cervical spinal cord injury was identified complete (American Spinal Injury Association (ASIA-A)) injury, for 5 (45,5%) patients with thoracic spinal cord injury was identified complete (ASIA – A) injury and both patients with lumbar spinal cord injury were identified to have incomplete (ASIA – C) injury. The data were obtained from medical history records and by questionnaire filling. Functional state and activity were evaluated by Functional Independence Measure (FIM), occupational performance issues were identified using client – centred approach (COPM). Patients after spinal cord injury in the begining of the rehabilitation has disorders in all areas of independency. At the begining of rehabilitation the average of patients’ independence was 48,69 (SD ±14,4) poinst out of 126 possible points according to the FIM. Independence of patients with cervical spinal cord injury was 39,19 (SD ± 3,4) points out of 126 possible points. After rehabilitation it has increased to 63,69 (SD ± 17,9) points, according to the FIM. The best changes of independence for persons with cervical spinal cord injury were in personal hygiene (an average 3,31 points), according to FIM. Independence of patients with thoracic - lumbar spinal cord injury was 60,38 (SD ± 14,2) points out of 126 possible points, according to the FIM. After the rehabilitation it has increased to 98,46 ± 13,9 points. The best changes were in locomotion with weelchair (an average 4,69 points). For the client – centred approach, the COPM was used. At the primary evaluation patients had emphasized eating, grooming, dressing, walking, locomotion with weelchair, transfers, using mobile phone and job keeping as the most important occupational performance issues for them. At the second evaluation, in the rehabilitation ending, patients had metioned more occupational performance issues related to getting back to the job or finding the new one, they have more cared about social relationships and leisure activities. Also self – care and mobility problems, but it were not so emphasized as in primary evaluation. The main attention through the rehabilitation time was payed to the patient`s needs and expectations and it had determined patient`s occupational performance and satisfaction with this performance increasing. Occupational performance had increased from 2,81 (SD ±2,2) points to 4,86 (SD ± 2,5) points. Satisfaction with occupational performane had increased from 2,8 (SD ± 2,2) points to 4,99 (SD ± 2,7) points. It was determined that FIM and COPM correlates . Independence changes depends on the spinal cord injury level. Occupational performance rating at the rehabilitation begining depends on spinal cord injury level. In the end of rehabilitation no factors influence occupational performance rating. Satisfaction with occupational performance in the rehablitation begining depends on occupational performance rating. In the rehabilitation ending it depends on occupational prformance rating, functional independance and spinal cord injury level. The age of patients does not influence any results