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PubMed2004

Impact of transfer delays to rehabilitation in patients with severe trauma.

OBJECTIVE: To measure the effect on rehabilitation outcomes of administrative delays in transferring patients from a level I trauma center to inpatient rehabilitation. DESIGN: Retrospective cohort study. SETTINGS: Level I trauma center and an inpatient rehabilitation center in Quebec, Canada. PARTICIPANTS: A total of 289 patients with severe trauma admitted to inpatient rehabilitation from a level I trauma center between 1994 and 1999. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Length of stay (LOS) in rehabilitation, motor and cognitive function at discharge from rehabilitation, interruptions in rehabilitation, and disposition at discharge. RESULTS: Shorter administrative delays were associated with shorter rehabilitation LOS (P<.01) improved cognitive function (P=.02) and had a negative but statistically nonsignificant association with motor function at discharge. No effect was observed for rehabilitation interruptions or dispositions at discharge. CONCLUSIONS: Transferring trauma patients more quickly to inpatient rehabilitation can affect rehabilitation outcomes positively. It can also lead to an economy of resource use in both acute and rehabilitation settings.

Adolescent↗

PubMed2000

Functional recovery in cancer rehabilitation.

OBJECTIVE: To assess the impact of inpatient rehabilitation on the motor and cognitive functional status of cancer patients, and to determine whether cancer diagnosis, rehabilitation impairment, physician-determined rehabilitation goals, and active cytotoxic treatment affect the magnitude of functional improvement. DESIGN AND SETTING: A retrospective, case series of patients with an oncology diagnosis undergoing inpatient rehabilitation at a rehabilitation hospital. PARTICIPANTS: A sample of 200 patients admitted for rehabilitation services due to disability resulting from impairments caused by cancer or its treatment. INTERVENTION: Comprehensive multidisciplinary inpatient rehabilitation. OUTCOME MEASURES: Function status was measured using the motor and cognitive measures of the Functional Independence Measure. RESULTS: All patients made significant gains in motor function regardless of diagnostic group, rehabilitation impairment group, rehabilitation goal group, and cytotoxic treatment status. The magnitude of motor function gain was not equivalent across all impairments and rehabilitation goals. Significant gains in cognitive function were made by all patients except those with intracranial neoplasms, central nervous system dysfunction, and palliative rehabilitation goals. CONCLUSION: Inpatient rehabilitation can improve both motor and cognitive function in patients with disability resulting from impairments caused by cancer or its treatment.

Activities of Daily Living↗

PubMed2006

Cost-benefits associated with social outcome from neurobehavioural rehabilitation.

PRIMARY OBJECTIVE: To carry out a clinical and cost-outcome evaluation of a neurobehavioural post-acute rehabilitation programme in the UK. RESEARCH DESIGN: The study was a multi-centre prospective cohort study of adults with acquired brain injury admitted for residential rehabilitation. Comprehensive data were collected on type of residence, amount and type of care, functional independence, engagement in constructive occupation and participation in social roles. PROCEDURES: Data were gathered on admission relating to individuals' levels of care and functioning, both pre-morbidly and at the time of admission (pre-rehabilitation). Additional information about functioning was collected upon discharge (post-rehabilitation). Follow-up data was collated in person, by telephone or by post after an average of 18 months by a researcher who was blind to the rehabilitation outcomes. The data were analysed in terms of clinical outcomes and support costs. Savings in costs of care or support were calculated on the basis of difference between pre-rehabilitation and follow-up support costs minus the costs of rehabilitation. RESULTS: Significant gains were evident at discharge and follow-up in virtually all indices of social outcome. Improvements were recorded in type of accommodation, levels of care, functional ability, productive occupation and performance of social roles. Patients admitted within 1 year of injury made the most progress, but improvements were made regardless of time since injury. Patients continued to benefit from rehabilitation well beyond the period when most natural recovery would take place. Economic calculations suggested that the initial costs of rehabilitation are generally offset by savings in care costs within 2 years. Sensitivity analysis on estimated savings in care costs yielded projected lifetime savings of between Pounds 1.1-0.8 M for persons admitted for rehabilitation within 12 months of injury, Pounds 0.7- Pounds 0.5 M within 2 years of injury and Pounds 0.5-0.36 M for admissions after 2 years. CONCLUSIONS: Specialist rehabilitation for neurobehavioural disability produces comprehensive and sustainable improvements in the life of individuals with brain injury. The initial costs associated with neurobehavioural rehabilitation are offset by savings in costs of support in the medium and longer term.

Activities of Daily Living↗

PubMed2002

Rehabilitation after hamstring anterior cruciate ligament reconstruction.

A prospective comparative study was conducted involving 62 patients to determine the effects and limits of accelerated rehabilitation on clinical outcome. The study focused on whether aggressive rehabilitation after anterior cruciate ligament reconstruction with the doubled semitendinosus and gracilis tendon autograft results in stretching the graft. Thirty patients had postoperative rehabilitation according to the current conservative protocol, and 32 patients had rehabilitation using an accelerated regime. Each patient was evaluated subjectively and objectively 36 months or more after surgery. Concerning the side-to-side difference in the anterior laxity, 87% of the patients in the conservative rehabilitation group had 3 mm or less and 80% of the patients in the accelerated rehabilitation group had the same acceptable laxity. There was no significant difference between the two groups. Muscle torque was restored significantly earlier in the patients in the accelerated rehabilitation group than in the patients in the conservative rehabilitation group. Nine months after surgery, however, there were no significant differences in the torque between the two groups. Accelerated rehabilitation significantly increased the incidence of knee effusion during rehabilitation. This study showed that acceleration of postoperative rehabilitation could rapidly restore muscle strength without significantly compromising graft stability in anterior cruciate ligament reconstruction with the doubled hamstring tendon autograft. However, this study also showed that acceleration significantly increases the incidence of synovitis. Acceleration of postoperative rehabilitation has advantages and disadvantages for clinical outcome after anterior cruciate ligament reconstruction.

Adolescent↗

PubMedDate not supplied

Number needed to treat in cardiac rehabilitation.

Clinicians, patients, and health policy-makers must judge whether healthcare interventions are worth the side effects, inconvenience, and costs. The number needed to treat (NNT) provides an estimate of the number of patients who need to be treated to attain an additional favorable outcome, or to prevent an additional adverse outcome, and is the reciprocal of the absolute risk reduction. The closer the NNT is to 1.0-meaning that every patient who is treated achieves a benefit-the more effective the treatment. Traditionally, mortality has been considered a primary outcome measure of the effectiveness of cardiac rehabilitation and, if the event rates in two groups (ie, rehabilitation and usual care) are known, the absolute risk reduction can be calculated and the NNT estimated. Mortality data were derived from three meta-analyses of cardiac rehabilitation trials: one published in 1988 (n = 3614), one in 1989 (n = 4247), and one in 2001 (n = 7683). The respective estimated NNT for mortality in the meta-analyses were 32, 46, and 72 (95% confidence intervals [95% CI] 19, 1403). Improved exercise tolerance and patient-perceived health-related quality of life (HRQL) are also considered important and attainable outcomes of cardiac rehabilitation but are continuous, not dichotomous, variables. If the minimal important difference for a continuous outcome is known, then the proportions of patients who improve, remain the same, or deteriorate can be determined and the NNT estimated. Exercise tolerance and HRQL data from two randomized controlled trials of 8 weeks of rehabilitation after myocardial infarction, the Cardiac Rehabilitation in Advanced Age trial (CR-AGE; n = 270) and the McMaster Early Rehabilitation Study (MERS; n = 201) were used to estimate the NNT. In CR-AGE, the improvement in exercise tolerance was significantly greater in the rehabilitation than usual care group and the estimated NNT was 5 (95% CI 3, 13). The generic global HRQL score increased significantly in CR-AGE with rehabilitation with an estimated NNT of 12 (95% CI 5, 26) but, as the subscale group differences were not significant, the NNT was not estimated. The NNT for exercise tolerance was not estimated in MERS, as the group difference was not significant. On the other hand, specific HRQL scores in MERS increased significantly with rehabilitation giving an estimated NNT for global HRQL of 6 (95% CI 3, 21) and 6 to 10 for the HRQL sub-scales. The data and the estimated NNT from the meta-analyses of cardiac rehabilitation in large numbers of patients suggest a limited mortality effect, probably reflecting current cardiology practice. The estimated NNT from the two trials with relatively small numbers of patients suggest inconsistent exercise tolerance effects and a relatively short duration for improved HRQL. Along with the classic reporting scales, information about clinical and laboratory variables, and patient preferences, the NNT is a useful additional measure of effectiveness that provides both clinicians and patients with information about the impact of cardiac rehabilitation as secondary prevention therapy.

Exercise Tolerance↗

PubMed2006

Effect of rehabilitation facility location on outcomes in head and neck surgical patients.

The objective of this study was to determine the significance of in-hospital rehabilitation facility vs. distant rehabilitation facilities in the outcomes and complications of post-operative head and neck surgical patients. Retrospective review of head and neck surgical patients was conducted over a 5-year period at a tertiary care medical centre. Fifty patients met criteria for this study (35 males, 15 females). Forty-two patients had a primary squamous cell carcinoma and eight patients had other primary malignancies of the head and neck. Thirty-two patients were placed in an in-hospital rehabilitation facility and 18 patients were placed in distant rehabilitation facilities (average distance 40.9 miles). Seventeen patients (34%) had complications including infection/drainage (seven patients), fistula (six patients), pneumonia (two patients), wound dehiscence (two patients) and other minor complications. The difference complication rate among the two groups was not statistically significant (37.5% in-hospital rehabilitation, 27.8% distant rehabilitation; P=0.496). The rate of hospital re-admission was not statistically significant (25% in-hospital rehabilitation patients, 16.7% distant rehabilitation patients; P=0.505). The average length of stay of patients without complications was 18.5 days (SD=5.8) for in-hospital rehabilitation and 12.9 days (SD=17) for distant rehabilitation. This difference was not statistically significant (P=0.346). In summary, one-third of post-operative head and neck surgical patients developed complications while in a rehabilitation facility. The length of stay, hospital re-admission rate and frequency of complications does not correlate with the proximity of the rehabilitation facility to the hospital where the patients received their surgery.

Aged↗

PubMed2001

"It was really nice to have someone"--lay people with musculoskeletal disorders request supportive relationships in rehabilitation.

AIMS: To explore the lay person's perspective on the rehabilitation process. METHODS: A total of 20 interviews were conducted with women and men who had recent or more distant experience of sickness absence with musculoskeletal diagnoses. Grounded theory was used, which includes an inductive approach and theoretical sampling. The interviews focused on the individuals' own stories and experiences of factors that promoted or hindered the rehabilitation process. RESULTS: The interviewees emphasized how and by whom they had been treated rather than what type of rehabilitation programmes they had attended. They focused on the importance of supportive relationships from the private. occupational, and health care arenas. The relationship with rehabilitation agents (professionals who implemented rehabilitation) was described as having either supportive or non-supportive qualities. Based on the interviewees' descriptions, a model was developed on the socioemotional qualities of the rehabilitation agent. The most promoting factor in the rehabilitation process was to have a professional mentor that is a rehabilitation agent who combines a supportive approach with individually chosen rehabilitation measures and goals. CONCLUSIONS: The lay person's perspective gave additional knowledge regarding rehabilitation and recovery from musculoskeletal disorders. The socioemotional qualities of the rehabilitation agents were emphasized by the interviewees and a model regarding these qualities was developed. This model needs to be tested further. A clinical implication of the present study is the need for rehabilitation agents to develop their communication skills further.

Adult↗

PubMed2005

The effects of pulmonary rehabilitation in the national emphysema treatment trial.

STUDY OBJECTIVES: Pulmonary rehabilitation is an established treatment in patients with chronic lung disease but is not widely utilized. Most trials have been conducted in single centers. The National Emphysema Treatment Trial (NETT) provided an opportunity to evaluate pulmonary rehabilitation in a large cohort of patients who were treated in centers throughout the United States. DESIGN: Prospective observational study of cohort prior to randomization in a multicenter clinical trial. SETTING: University-based clinical centers and community-based satellite pulmonary rehabilitation programs. PATIENTS AND INTERVENTION: A total of 1,218 patients with severe emphysema underwent pulmonary rehabilitation before and after randomization to lung volume reduction surgery (LVRS) or continued medical management. Rehabilitation was conducted at 17 NETT centers supplemented by 539 satellite centers. MEASUREMENTS AND RESULTS: Lung function, exercise tolerance, dyspnea, and quality of life were evaluated at regular intervals. Significant (p < 0.001) improvements were observed consistently in exercise (cycle ergometry, 3.1 W; 6-min walk test distance, 76 feet), dyspnea (University of California, San Diego Shortness of Breath Questionnaire score, -3.2; Borg breathlessness score: breathing cycle, -0.8; 6-min walk, -0.5) and quality of life (St. George Respiratory Questionnaire score, -3.5; Quality of Well-Being Scale score, +0.035; Medical Outcomes Study 36-item short form score: physical health summary, +1.3; mental health summary, + 2.0). Patients who had not undergone prior rehabilitation improved more than those who had. In multivariate models, only prior rehabilitation status predicted changes after rehabilitation. In 20% of patients, exercise level changed sufficiently after rehabilitation to alter the NETT subgroup predictive of outcome. Overall, changes after rehabilitation did not predict differential mortality or improvement in exercise (primary outcomes) by treatment group. CONCLUSIONS: The NETT experience demonstrates the effectiveness of pulmonary rehabilitation in patients with severe emphysema who were treated in a national cross-section of programs. Pulmonary rehabilitation plays an important role in preparing and selecting patients for surgical interventions such as LVRS.

Aged↗

PubMed2006

Sustained effects of cardiac rehabilitation in children with serious congenital heart disease.

OBJECTIVE: Past studies have documented the acute benefits of cardiac rehabilitation in children with congenital heart disease. It is not known whether these benefits persist. PATIENTS AND METHODS: Fifteen patients, ages 8 to 17 years, with complex congenital heart disease, whose exercise function immediately after a 12-week cardiac rehabilitation program was superior to that present on a precardiac rehabilitation exercise test, were restudied 6.9 +/- 1.6 months after completion of the cardiac rehabilitation program (approximately 1 year after the precardiac rehabilitation study). Changes in exercise function relative to baseline, precardiac rehabilitation exercise tests were also compared with changes observed in a group of 18 control subjects, with similar diagnoses, who also had 2 exercise tests separated by a year but did not undergo cardiac rehabilitation. RESULTS: The cardiac rehabilitation patients' exercise function did not change significantly over the 6.9-month period after the completion of the cardiac rehabilitation program; percentage of predicted peak oxygen consumption and peak work rate remained significantly superior to baseline, precardiac rehabilitation values. These changes were also associated with improvements in self-esteem, behavior, and emotional state. In contrast, among the control subjects, small, but statistically insignificant declines in peak oxygen consumption and peak work rate were observed on the final exercise test compared with values obtained at baseline, 1 year earlier. The improvements realized by the cardiac rehabilitation patients differed significantly from the concurrent changes observed among the control subjects and appeared to be a result of an increase in the oxygen pulse at peak exercise; significant changes in peak heart rate were not observed. CONCLUSIONS: In patients with congenital heart disease, cardiac rehabilitation produces significant, sustained improvements in exercise function, behavior, self-esteem, and emotional state.

Adolescent↗

PubMed2000

Home-based rehabilitation for patients with COPD: organization, effects and financial implications.

Rehabilitation in patients with chronic obstructive pulmonary disease (COPD) has been shown to be an effective treatment and can be carried out in different settings, i.e. inpatient, outpatient or home-based. This review focuses on home-based rehabilitation and four important issues are discussed. 1) Which patients should received home-based rehabilitation? 2) How should home-based rehabilitation be organized? 3) What are the effects of home-based rehabilitation? 4) What are the financial implications. Home-based rehabilitation is an attractive approach for most patients with COPD. However, there is some evidence that patients who are severely disabled due to dyspnoea do not gain benefit from home-based rehabilitation. This might not be the appropriate setting for this group, and these patients are probably better candidates for an inpatient or outpatient multidisciplinary approach. After initial evaluation of the patient by a pulmonary physician, home-based rehabilitation can be set up in two different ways. Firstly, the patients can receive their instructions at the hospital: a detailed exercise programme can be developed that the patients can perform unsupervised at home with regular follow-up at the outpatient clinic. Second, home rehabilitation can be fully addressed at home with instruction and regular supervision by a local team. At this moment, it is not clear which disciplines, i.e. what kinds of intervention, are needed in a home rehabilitation team. Nevertheless, the key element of home-based rehabilitation is exercise training, which is the same for the other settings. Short-term studies with a maximum duration of 12 weeks showed increased exercise tolerance, decreased dyspnoea and improved quality of life. Conversely, the effects of long-term home-based rehabilitation are not clearly established. The need for long-term supervision is still open to debate: contradictory results have been shown regarding dyspnoea and exercise tolerance. Cost/benefit analysis showed positive trends in reduction in hospitalization rate and reduction of total costs; however, these results came from uncontrolled studies.

Cost-Benefit Analysis↗

PubMed2002

Rehabilitation of the Ankle After Acute Sprain or Chronic Instability.

OBJECTIVE: To outline rehabilitation concepts that are applicable to acute and chronic injury of the ankle, to provide evidence for current techniques used in the rehabilitation of the ankle, and to describe a functional rehabilitation program that progresses from basic to advanced, while taking into consideration empirical data from the literature and clinical practice. BACKGROUND: Important considerations in the rehabilitation of ankle injuries include controlling the acute inflammatory process, regaining full ankle range of motion, increasing muscle strength and power, and improving proprioceptive abilities. These goals can be achieved through various modalities, flexibility exercises, and progressive strength- and balance-training exercises. In this article, we discuss the deleterious effects of ankle injury on ankle-joint proprioception and muscular strength and how these variables can be quantifiably measured to follow progress through a rehabilitation program. Evidence to support the effectiveness of applying orthotics and ankle braces during the acute and subacute phases of ankle rehabilitation is provided, along with recommendations for functional rehabilitation of ankle injuries, including a structured progression of exercises. RECOMMENDATIONS: Early functional rehabilitation of the ankle should include range-of-motion exercises and isometric and isotonic strength-training exercises. In the intermediate stage of rehabilitation, a progression of proprioception-training exercises should be incorporated. Advanced rehabilitation should focus on sport-specific activities to prepare the athlete for return to competition. Although it is important to individualize each rehabilitation program, this well-structured template for ankle rehabilitation can be adapted as needed.

Journal Article↗

PubMed2005

Occupational therapy for patients with spinal cord injury in early rehabilitation.

OBJECTIVE: To determine factors influencing the effectiveness of occupational therapy of patients with spinal cord injury in early rehabilitation. MATERIAL AND METHODS: Data were obtained on 136 patients with spinal cord injury admitted to the Department of Rehabilitation, Kaunas University of Medicine Hospital in 1999-2005. The study population consisted of 97 (71.3%) males and 39 (28.7%) females. Complex rehabilitation was started after the stabilization of functional state in the Department of Neurosurgery and transfer to Department of Rehabilitation. The average duration of early rehabilitation in the Department of Rehabilitation was 68.3+/-22.5 days. According to the level of spinal cord injury patients were divided into two groups: patients with cervical lesions (C1-Th1 segments) and with thoracic-lumbar lesions (Th2-S1 segments). According to the level of spinal cord injury patients also were divided into two groups: complete (American Spinal Injury Association (ASIA-A)) and incomplete injury (ASIA-B, ASIA-C). The evaluation of the level of patients' independence was dependent on the level of injury: C4; C5; C6; C7-C8; Th1-Th9; Th10-L1; L2-S5 segments. Functional state and activity were evaluated by Functional Independence Measure (FIM). Effectiveness of occupational therapy was supposed to be good, if predicted independence level of final rehabilitation was achieved by a patient and it was supposed to be unsatisfactory if the same level of independence was not achieved. RESULTS: The examination of patients has shown that 21 (15.4%) patients had complete injury (ASIA-A) in cervical level and 41 (30.2%) patients had complete injury in thoracic-lumbar level. Thirty-five (25.7%) patients had incomplete injury in cervical area and 39 (28.7%) patients in thoracic-lumbar level. At the end of early rehabilitation period in the case of complete spinal cord injury in cervical level (C4-C8) the expected level was achieved by 33.3-100% of patients. In the case of incomplete injury the expected level was achieved by 87.5-100% of patients. No patient with spinal cord injury in thoracic-lumbar (Th1-S5) level achieved the expected level of independence of final rehabilitation in early rehabilitation period. CONCLUSIONS: Patients with spinal cord injury had disturbances of all activities according to FIM in early rehabilitation. The level of spinal cord injury had greater influence on the level of independence of patients with injury in cervical level rather than in thoracic-lumbar level. The level of independence in early rehabilitation period was achieved in 17.7% of complete spinal cord injury cases and in 45.9% of incomplete spinal cord injury cases.

Activities of Daily Living↗

PubMed1977

Stroke rehabilitation: maintenance of achieved gains.

Gains made during rehabilitation following stroke were maintained or improved by the majority of rehabilitants when assessed 2 to 12 years later. Five measures of rehabilitative activity studied were self care, mobility, amount of time spent at the rehabilitant's major daily activity, vocational status, and over-all rehabilitative status. Independent variables that correlated positively with these rehabilitative functions were living at home, rather than in a nursing home, and the rehabilitant's having an accepting, rather than non-accepting, attitude about his present status. The functional levels of rehabilitation are maintained as well through education of the rehabilitant and his family as through the use of public health nursing and community resources. The interviewed rehabilitants in this study maintained the gains in function achieved during stroke rehabilitation throughout the long survival time, averaging seven to eight years; and functional loss, when it did occur, was usually secondary to a superimposed health problem. This study shows that the gains in the level of functioning achieved during stroke rehabilitation presist in long-surviving stroke patients and that the quality of life is enhanced from the perspectives of the patient and his family.

Activities of Daily Living↗

PubMed2026

Effects of Adding Incentive Spirometry to Hospital-Based Cardiovascular Rehabilitation on Pulmonary Complications, Hospital Length of Stay, and Clinical-Functional Recovery After Cardiac Surgery: A Randomized Controlled Trial.

BACKGROUND AND PURPOSE: This study investigated the effects of combining incentive spirometry with cardiac rehabilitation compared with cardiac rehabilitation alone on postoperative pulmonary complications, clinical-functional recovery, and hospital length of stay in patients undergoing cardiac surgery. METHODS: Randomized controlled trial was conducted from May 2019 to October 2023 in two hospitals, including 46 inpatients undergoing cardiac surgery. Participants were assigned to incentive spirometry plus cardiac rehabilitation or cardiac rehabilitation alone. Both interventions were performed twice daily; spirometry used a volume-oriented device, and rehabilitation followed a seven-step protocol (2-4 METs). Outcomes included postoperative pulmonary complications, functional capacity (6-min walk test), handgrip strength, respiratory muscle function, and length of hospital stay. RESULTS: The incentive spirometry associated with cardiac rehabilitation group had a longer extracorporeal circulation time (98 ± 26 min) than the cardiac rehabilitation group (76 ± 1; p = 0.008). Both groups showed a postoperative decline in respiratory muscle strength, and walking distance (MD: -64.37 m; 95% CI: [-24.1; -104.6]; d = 0.71), with no difference in postoperative pulmonary complications and handgrip strength. The incentive spirometry associated with cardiac rehabilitation group did not significantly differ on postoperative hospital stay compared with the cardiac rehabilitation group (MD: -1 day; 95% CI: [-4.71; 2.71]; d = -0.19). CONCLUSIONS: In this study, no additional benefit was observed with the addition of incentive spirometry to cardiac rehabilitation compared with cardiac rehabilitation alone. No significant differences were detected between groups in postoperative pulmonary complications, hospital length of stay, or clinical-functional recovery among individuals undergoing cardiac surgery. TRIAL REGISTRATION: Brazilian Registry of Clinical Trials (REBEC) under the number RBR-8tsjf97.

Aged↗

PubMed2004

[New forms of remuneration and care delivery: their impact on rehabilitation].

Current health policy reform efforts in Germany include introduction of a DRG (Diagnosis Related Group) based funding system in the hospital sector as well as integrated delivery of health care and disease management programs, developments that will directly affect the medical rehabilitation sector. Decreasing lengths of hospital stay induced by the DRG system will inter alia entail a shifting of cases and costs to subsequent sectors. Moreover, hospitals might not least seek compensation for shorter hospital stays by extending their scope to include rehabilitation and long-term care services. Introduction of the DRG system in acute-hospital care has resulted in major changes in respect of early rehabilitation. Existing specialized early rehabilitation facilities providing high-quality care face serious funding problems on account of the newly introduced early rehabilitation DRGs. For hospitals previously not involved in early rehabilitation on the other hand, incentives arise to set up new early rehabilitation structures although the need for these additional capacities obviously is questionable. Introduction of the DRG-based funding system has reinforced the discussion about applying a flat-rate system also in the rehabilitation sector. This form of remuneration however is inappropriate to medical rehabilitation concepts. On the other hand, a remuneration system incorporating cross-institutional per-diem fees and "treatment time" budgets might enable using essential advantages of flat-rate payment without having to expect repercussions for the quality of care. In the context of integrated care and disease management programs the issue at stake for rehabilitation primarily is to be able to contribute its specific competencies appropriately. Also, integrated health care is bound to result in stronger competition among the various health care sectors. If rehabilitation is set to face this competition, further research efforts will urgently have to be made along with ongoing development of clinical practice guidelines.

Budgets↗

PubMed1993

Functional status outcomes in rehabilitation. Implications for prospective payment.

Previous studies have demonstrated that functional status is a significant predictor of resource utilization for rehabilitation patients. Before implementing a prospective payment system (PPS) for rehabilitation, it is important to first: 1) develop an underlying conceptual framework of rehabilitation resource use; and 2) understand how the role of functional status may vary by rehabilitation condition. In this study, a theoretical model of rehabilitation is presented that proposes relationships between patient and provider characteristics, rehabilitation treatment, costs, and clinical outcomes of rehabilitation. Also presented are regression analyses based on this model for a key outcome of rehabilitation, change in functional status, for nine rehabilitation conditions using variables that minimize adverse incentives by providers in selecting patients for admission to rehabilitation. The change-in-functional-status model explained the most variance for back injury, cardiopulmonary, and arthritis, and less variance for stroke, spinal cord injury, and neurologic impairment. The significant predictors of change in functional status varied by condition. Results support the use of functional status measurements in a PPS for rehabilitation services, the need to refine the measurement of functional status, and the use of condition-specific activities of daily living (ADL) items to include in summary indices.

Activities of Daily Living↗

PubMed2001

Medical rehabilitation in Croatia impact of the 1991-1995 war: past problems, present state, future concerns.

AIM: To assess whether the 1991-1995 war has stimulated development of the medical rehabilitation system in Croatia. METHODS: Review of documents pertaining to the system, study of clinical reports describing rehabilitation activities as published in the Croatian medical literature, study of data obtained and their consideration in terms of effectiveness and quality of rehabilitation care, and comparison of data from 1991 with those from 1995. RESULTS: There has been no significant change in the number of rehabilitation facilities, beds, and rehabilitation professionals. However, elements of structure and process of rehabilitation care have improved in respect of 1) education and composition of rehabilitation professionals, 2) availability of specialized facilities for rehabilitation of patients with complex impairments (traumatic brain and spinal cord injuries), 3) interdisciplinary team approach, 4) use of functional status measurements, and 5) laying the foundations for community-based rehabilitation in the country. CONCLUSION: The 1991-1995 war has stimulated the development of medical rehabilitation system in Croatia. Other factors may have played a complementary role, too. This proves that medical rehabilitation is a field that develops in association with war.

Croatia↗

PubMed1983

[The need for presenting rehabilitation legislation in teaching and research].

In the four phases of rehabilitation (the medical, educational, vocational, and social phase) it is the function of the law to set the frame of objectives for, and the procedures to be followed in, rehabilitation. In this connexion, legal science has a threefold function: It is an auxiliary and reference science of educational and medical rehabilitation; it is the basic science for transferring social policies into substantive legislation; and alongside the social sciences, it is the special branch of science relevant to social-vocational rehabilitation. An overview of the lectures and courses offered in the field of rehabilitation demonstrates that the legal discipline is markedly under-represented when compared to the medical and social sciences. Six postulates are put forward for the legal science's role of basic science, followed by a demonstration of its capacity of special branch of science by means of the "Rehabilitation Guidelines for the Future in the Medical, Vocational, Educational and Social Fields" issued by Rehabilitation International. Finally, the legal science's function of auxiliary and reference science is set forth, allocating to it a general function of reference science. For accomplishing these tasks, an Institute of Rehabilitation Law is called for, and the central tasks of such an institution are described, e.g. linking rehabilitation practice and legal science, uniform curricular orientation of the professional schools, international comparisons of rehabilitation legislation, or the importance of the law for the development of rehabilitation models as well as for the pertaining operational requirements.

Academies and Institutes↗