Acute Inpatient Rehabilitation Improves Function Independent of Comorbidities in Medically Complex Patients

Shangming Zhang; Dan Lin; Megan E Wright; Nicole Swallow

doi:10.1016/j.arrct.2022.100178

Acute Inpatient Rehabilitation Improves Function Independent of Comorbidities in Medically Complex Patients

Arch Rehabil Res Clin Transl. 2022 Jan 12;4(2):100178. doi: 10.1016/j.arrct.2022.100178. eCollection 2022 Jun.

Authors

Shangming Zhang¹, Dan Lin², Megan E Wright³, Nicole Swallow⁴

Affiliations

¹ Department of Physical Medicine and Rehabilitation, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania.
² Department of Public Health Sciences, Penn State University College of Medicine, Hershey, Pennsylvania.
³ Department of Neurology, Division of Rehabilitation Medicine, University of Maryland Medical Center, Baltimore, Maryland.
⁴ Department of Internal Medicine, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania, United States.

Abstract

Objectives: (1) To evaluate the benefits of acute inpatient rehabilitation for a medically complex patient population and (2) to assess the effect of comorbid conditions on rehabilitation outcomes.

Design: Retrospective cohort study.

Setting: Freestanding inpatient rehabilitation facility.

Participants: A total of 270 medically complex adult patients including those with cardiac, pulmonary, and orthopedic conditions, with mean age of 73.6 years; 52.6% were female and 47.4% were male (N=270).

Interventions: Not applicable.

Main outcome measures: Functional Independence Measure (FIM) gain, FIM efficiency, rehabilitation length of stay (RLOS), home discharge rate, and readmission to acute care (RTAC).

Results: Among 270 medically complex patients, mean total FIM gain, mean RLOS, and mean FIM efficiency with SD were 26.0±13.6 points, 12.6±5.9 days, and 2.3±1.6, respectively. A total of 71.9% of patients were discharged to home, 12.2% for RTAC, and 15.9% to a skilled nursing facility (SNF). Hypertension (HTN) was the only comorbidity significantly associated with FIM gain (53.7% [total FIM gain ≥27] vs 67.2% [total FIM gain <27]; P=.024) and FIM efficiency (53.3% [FIM efficiency ≥2.12] vs 67.4% [FIM efficiency <2.12]; P=.025), independent of age, body mass index, sex, race, ethnicity, insurance type, and Charlson Comorbidity Index. The 5 most common reasons for RTAC were cardiac, pulmonary, acute blood loss anemia, infection, and neurologic conditions.

Conclusions: Among 270 medically complex patients, 71.9% were discharged to home, 15.9% to an SNF, and 12.2% for RTAC with a mean RLOS 12.6 days, mean total FIM gain of 26 points, and mean FIM efficiency of 2.3, which were all better than those of all admissions at our facility in 2018. Furthermore, RLOS, total FIM gain and FIM efficiency in this study were all better than their corresponding eRehabData weighted national benchmarks (RLOS, 15.82 days; FIM gain, 25.57; FIM efficiency, 2.13) for a total of 202,520 discharges in 2018. These findings support acute inpatient rehabilitation for this patient population. With the exception of HTN, no medical comorbidities or demographic variables were associated with rehabilitation outcomes.

Keywords: Centers for Medicare and Medicaid Services; Comorbidity; Rehabilitation.