Objective: Most studies on the effectiveness of rehabilitation consider only particular rehabilitation treatments for particular conditions, and do not give a global vision of the issue. This study evaluated the effectiveness of various types of post acute rehabilitative care in patients with different diagnoses by investigating the association between treatments and functional gain by type of impairment and severity on admission.
Design, setting and participants: Information on the characteristics of patients and the rehabilitative treatments was collected using an Italian version of the Minimum Data Set-Post Acute Care. The questionnaire was created and validated by the Centers for Medicare and Medicaid Services, it is divided in various section and was filled in at regular intervals throughout the hospital stay. Patients included in the study were 1918.
Main outcome measures: We used factor analysis to summarize each section in a single continuous variable. The observed functional gain was calculated as the difference between functional status at the beginning and at the end of the admission. A multiple linear regression analysis was performed to evaluate the association between rehabilitation treatments and functional gain, adjusting for patient characteristics and severity at admission. The effectiveness of the treatments were obtained by calculating the difference between the overall functional gain of the hospital stay and the predicted functional gain of the stay in the absence of rehabilitation treatments.
Results and conclusion: The effectiveness of treatments differs across diagnostic class and it is associated directly with severity of functional status at admission. In most cases, the positive effect of treatments combines with the spontaneous functional gain; in other cases the positive effect of treatments opposes the spontaneous deterioration of patient functional status.