Outcomes of the rehabilitation process – spinal cord injury


The outcomes of patients with a spinal cord injury who completed their neurorehabilitation process at the Institut Guttmann in 2022 and who are over 16 years of age are presented below. On the other hand, data from patients who come for regular comprehensive check-ups are provided.

In 2022, 221 adult patients with spinal cord injury completed their neurorehabilitation process, 58% of whom had paraplegia and 42% of whom had quadriplegia; in 73% of cases the injury was incomplete.

Type of injury
Complete paraplegia3817%
Incomplete paraplegia9041%
Complete quadriplegia2210%
Incomplete quadriplegia7132%

Their mean age was 51 and the majority were men (64%). The most frequent level of studies among the population attended this year is primary, followed by secondary and higher education. The demographic details are listed below.

Population by gender

In 60% of cases the origin of the injury is medical, compared to 40% of traumatic origin.

Among patients discharged in 2022, 4.7% were readmissions for complications (prior to 2 years after discharge). The main complications treated deriving from a disability were urological and traumatological.

Psychosocial situation

This section contains the results on where patients with spinal cord injury go once they have been discharged from the hospital and also who they live with and their level of interrelation with other people and their environment.

Once the rehabilitation process had been completed, 89% of patients with a spinal cord injury returned to their usual residence or a new residence, whilst 11% required an institutional alternative on a temporary or permanent basis. Over the past years, this percentage has remained steady with minimal variations (a mean of 90%).

If we analyse the situation of living with others on admission and on discharge, some variations are observed compared to previous years. Cases of people with a spinal cord injury who return to live with their parents or other close relatives after discharge are increasing, and cases that must be admitted to an institution are increasing in particular. On the other hand, cases of people living with a partner, as well as living alone, decreased.

At the Institut Guttmann we also assess the domestic and social situation of the patient, which helps us detect situations of social risk in order to make an appropriate intervention based on the social needs of each person. According to data from 2022, the social and domestic situation of the patient on discharge has improved in 53% of cases, is maintained in 29% and is worse in 18%.

The results have been calculated with the EVSF-IG, which is an adaptation of the Gijón Socio-Family Assessment Scale. This scale allows us to classify patients according to 4 categories (No social difficulties ≤ 5 points; Mild social difficulties from 6 to 9 points; Important social difficulties from 10 to 14 points and Severe social difficulties ≥ 15 points).

Quality of life

According to the World Health Organization (WHO), Quality of Life (QoL)  is “an individual’s perception of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns”.

This is a broad concept that includes the physical health of the person, their psychological state, their level of independence, their social relationships, personal beliefs and their relationship with the context. At the Institut Guttmann, we work with a cross-cutting and interdisciplinary approach to improve the quality of life of our patients.

To obtain information on the perception of the QoL of our patients, we use item 1 of the WHOQOL-BREF scale, the WHO’s quality of life questionnaire. Starting with the question “How would you rate your quality of life?”, subjects respond using a five-point Likert-type response format.

The data analysed show that the perception of quality of life (QoL) after neurorehabilitation treatment improves in 47% of cases.

Comparison of the perception of quality of life on admission and discharge:

These results are obtained from the Global Quality of Life facet of the WHOQOL-BREF scale. It has a range of values from 1 to 5 on a Likert-type scale – the higher the score, the higher the perception of the person’s quality of life.

On the other hand, one of the indicators that can condition the rehabilitation process and its results is the presence of reactive emotional distress. The Hospital Anxiety and Depression Scale (HADS) is a self-assessment scale that is used as an instrument to detect states of depression and anxiety within the framework of hospital admission or outpatient consultations. The depression and anxiety subscales are also valid measures of the severity of emotional disturbances. The items that make up the depression subscale are largely based on the core symptoms of the psychopathology of depression and the items that make up the anxiety subscale are based on psychological manifestations of situational anxiety.

Based on a predictive analysis of data from the Institut Guttmann, we can conclude that the presence of symptoms of depression on admission has a statistically significant influence on the perception of quality of life on discharge. In accordance with this premise, we work intensely and in a personalised way on the psychological care of our patients, focusing on improving symptoms of depression and anxiety.

Mean on AdmissionMean on Discharge

The state of depression is measured using the Hospital Anxiety and Depression Scale (HADS). The questionnaire consists of 14 items divided into two subscales of Anxiety (HAD-A) and Depression (HAD-D), each consisting of 7 items that are rated on a Likert-type scale with scores from 0 to 3, with a score of 0 corresponding to the most favourable response and 3 to the least favourable. The scores in each subscale range from 0 to 21. The higher the score, the greater the risk of symptoms and emotional distress.

Improved functional autonomy

The functionality achieved by our patients is measured with the international Functional Independence Measure (FIM) scale. Patients with spinal cord injury present an improvement in functional independence of 15.75 points on discharge in their total score. Regarding the improvement of motor functionality, patients discharged in 2022 improve an average of 15.08 points.

The FIM scale measures the patient’s capacity for independence in performing activities of daily living (ADLs). The FIM-Total is the sum of the two areas (cognitive and motor) and the score ranges from 18 to 126 points – the higher the score, the better the patient’s level of functionality.

We also use the Spinal Cord Injury Measure (SCIM III), the functional assessment scale used by the EMSCI Group (European Multicenter Study about Spinal Cord Injury), an association featuring the best European rehabilitation hospitals, including ours. As the following figure shows, patients at the Institut Guttmann experience an improvement in their functionality of 14.95 points.

The SCIM III scale specifically measures functional independence in spinal cord injuries. It has a range of values from 0 to 100 points – the higher the score, the more independent the person (where 0 is complete dependence and 100 is complete independence).

Finally, another indicator related to improvement in functionality is the fact that 41.67% of the patients who were admitted with a tracheostomy cannula during 2022 were discharged without a cannula.