Spinal Cord Injury Inpatient Recovery: Sequence Modeling with Emphasis on Physical and Occupational Therapy

Research Objectives: To identify patterns of patient care that are associated with independence at discharge from inpatient care for SCI patients, with a focus on factors that can be controlled by rehabilitation professionals (e.g., PT, medication) while also accounting for external factors (e.g., age). Frequent sequences are those that occur above a predefined support threshold, indicating their significance in the dataset.

Design: This comprehensive analysis employed a multidimensional approach, encompassing data collection, sequence mining, and advanced statistical techniques to uncover insights into patient care and independence at Shephard Health. The methodology was structured as follows:
● Data Collection and Preparation: The study began with the aggregation of patient records. Data were meticulously cleaned and anonymized to ensure privacy while maintaining integrity for analysis.
● Classification of Independence: Patients were classified as independent or dependent based on a set of predefined criteria. The criteria included various health indicators such as mobility, bowel and bladder function, and specific rehabilitation outcomes.
● Sequence Mining Techniques: To analyze the vast array of treatment sequences, we utilized advanced sequence mining techniques. Specific algorithms, including PrefixSpan and Generalized Sequential Pattern (GSP), were employed to identify recurring patterns that signify crucial steps towards patient independence.

Setting: Shepherd Center, a non-for-profit rehabilitation hospital in Atlanta Georgia, specializing in treatment of SCI, ABI, and other neurological disorders.

Participants: All inpatient SCI patients from April 2019 through December of 2023.

Interventions: None, this is a natural experiment.

Main Outcome Measures: SCI patient independence at the end of their inpatient rehabilitation journey.

Results: Independence vs. Dependence: The sequences showed that 93 independent patients frequently underwent similar procedures, differing slightly from the 86 dependent patients, suggesting potential pathways to recovery and independence.

Patterns: Patterns of a chronological arrangement of appointments that reconstruct individual patient care journeys. This process has yielded 1,182 unique sequences, indicating varied treatments. These sequences were juxtaposed with demographic data to elucidate any underlying patterns or correlations.

Conclusions: Three salient conclusions emerge:
1. Treatment Sequences and Independence: Specific treatment sequences have been linked to patient independence, revealing a potential pathway to recovery to enhance patient outcomes.
2. Central Role of PT and OT: Physical Therapy and Occupational Therapy have been identified as pivotal in the rehabilitation protocols for SCI patients.
3. Influence of Demographic Factors: The analysis underscored the influence of demographic factors on treatment pathways. Variations in sequences by age, gender, and race point to the need for personalized care plans.

Author(s) Disclosures: Authors have no disclosures.