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PubMed1981

[Problems of assessment and occupational rehabilitation of patients with malignant urogenital neoplasm].

The expert opinion and the rehabilitation of patients with urogenital tumours often render great problems and tasks for the urologist. A schematic invalidisation of these patients is to be refused. The leading idea of an expert opinion should be the rehabilitation. This demands from the expert a judgment of the function with evaluation of the oncological prognosis quoad vitam and a judgment of the remaining functions of the treated organism as well as a recommendation for the further professional activity based on this judgment. A close cooperation with industrial institutions, the factory public health, the medical advisory commissions and the rehabilitation commissions is necessary for rehabilitation. The notion of rehabilitation--professional as well as social--is to be extended to the not unconsiderable number of patients at pensioner's age. The resumption of a suitable work effects in a patient sith successfully treated tumour disease the improvement of the general physico-psychic resistance, increases the will to recovery and activity and furthers the acclimatization and adaptation to remaining disturbances. Thus expert opinion in the sense of rehabilitation is also a therapy. The results of modern tumour therapy should not be measured only at the survival rates, but also at the degree of the social and professional rehabilitation of the patients.

Disability Evaluation↗

PubMed1981

[The tasks of a rehabilitation psychology in teaching, services, and research (author's transl)].

The first Chair of rehabilitation psychology established in the Federal Republic of Germany was started at the Institute of Psychology of Freiburg University in the 1979/1980 winter semester. On the basis of the conviction that interdisciplinarity constitutes a fundamental requirement for work and research in the rehabilitation field, the author discusses the tasks of rehabilitation psychology, and its relationship with medical and vocational rehabilitation. The working conditions faced by psychologists in the rehabilitation facilities as well as the preparation they hitherto used to receive during their studies for work in the rehabilitation field, are criticised. The curriculum developed in Freiburg for "rehabilitation psychology", as one of the fields of applied psychology included the studies for a university degree in psychology, is explained. Further, the new department's service delivery functions and intended research are presented.

Germany, West↗

PubMed1993

Psychiatric rehabilitation.

The financial, personal, and societal costs of severe mental illness are extraordinarily high. Individuals suffering from schizophrenia occupy 25 percent of all hospital beds and account for 40 percent of all long-term care days. The rate of Supplemental Security income (SSI) and Social Security disability insurance (SSDI) beneficiaries who are disabled because of a mental disorder has increased more than 50 percent since 1986, and a total of more than 1.1 million individuals received benefits in 1991 because of their mental disorders. All of these costs have continued to rise despite the nearly ubiquitous administration of antipsychotic medication with its well-documented benefits. The most promising treatment to complement medication and produce better outcomes is psychiatric rehabilitation. It is based on the same rationale as rehabilitation for physically challenged individuals--illness produces impairments that make individuals less able to perform basic life skills that handicap them when they try to be students, workers, spouses, parents, etc. Rehabilitation teaches individuals to perform the basic skills using methods that compensate for the impairments, and modifying the environment so the new methods are successful or the skills are not required. Rehabilitation with severely mentally ill individuals is particularly challenging because of the extent of their impairments and disabilities. The impairments--flagrant symptoms that unpredictably wax, wane, and persist even with medication; reduced motivation to participate in community life; residual deficits in the most elemental cognitive processes of attention, memory, and abstraction--clearly limit individuals' abilities to perform life skills and function in major societal roles. Moreover, the challenge of successful rehabilitation is magnified by the individual-to-individual, time-to-time, and disorder-to-disorder variations in these impairments and disabilities. Given this challenge, how well does psychiatric rehabilitation work in practice? Two types of studies provide answers to this question; those that have focused exclusively on teaching skills to severely mentally ill individuals, and those that have focused on larger units of care, case management, and vocational rehabilitation, that typically include skills training as one of their services. The first type of study provides "pure" information but sacrifices, to some extent, clinical utility and immediate generality. The second provides information that can be transferred to clinical practice but sacrifices clarity about what is the effective ingredient in a set of intermingled services. The results of the first type have generally indicated, with some qualifications, that severely mentally ill individuals learn skills, use them in their own environments, and may receive other clinically meaningful benefits.(ABSTRACT TRUNCATED AT 400 WORDS)

Humans↗

PubMed1993

[Rehabilitation for the elderly, why?].

Within human culture the attitude towards the aged has been very different up to now, ranking from ritual slaughter to worshipping of the wise old persons. Ambivalence persists till now. We have introduced the terminus "rehabilitation of the old" to indicate a principal which is adequate in the medical sense as it is adequate to humanity. Our slogan runs: nursing alone (meaning isolated care for vegetative necessities) is inhuman in old people. Rehabilitative view points and activities must come into the care for the aged on all levels there are: from readaptation to profession, "over independence and being socially adequate" up to the resting last possibility of having fun. Rehabilitation of the old can only succeed if there is an integrative set up which means (again as a slogan): We want rehabilitation of old to invade all hospitals and all human groupements instead of bringing the old out of these groupings and separate them in senior ghettos. This must go hand in hand with specialization and scientific identification of geriatrics and rehabilitation; specially neuro-rehabilitation and rehabilitation of the old, which are in close connex. Quite a number of administrative barriers have to be removed, new possibilities must be created. There must be a complete new viewing of the matter and new goals in medical education, as well pregraduate as postgraduate. A new generation of doctors can find here a big good chance. However, it can only be successful in close collaboration with a progressive politic administration.

Aged↗

PubMed1995

[Characteristics of participants in community-based rehabilitation programs and their levels of independence in activities of daily living].

To clarify characteristics of participants in community-based rehabilitation programs provided by local municipalities (cities, towns, and villages) and effect of the program on their levels of independence in activities of daily living (ADL), a cross-sectional study was performed on 422 participants in 49 municipalities in Kochi Prefecture. 1. Mean age of participants was 68.3 +/- 9.0, and 77.7% of them were stroke patients. 2. The mean interval between disease onset and program participation was 40.4 months, and the mean duration of program participation was 54.5 months. 3. At the start of rehabilitation programs and at the time of the investigation (December 1993), about 90% of the participants had good levels of independence in ADL (Rank A and over according to the standard of the Ministry of Health and Welfare). 4. The frequency of rehabilitation programs and the presence of occupational therapists were positively associated with the improvement of levels of independence in ADL. In particular, the frequency of rehabilitation programs was associated with improvement of quality of life in self-supporting participants (Rank J2), and the presence of occupational therapists was associated with the improvement of ADL in semi-bed-ridden participants (Rank A). 5. After adjusting for age and sex, using multiple logistic regression analysis, type of diseases (non-stroke), hospital rehabilitation immediately after onset, higher levels of independence in ADL at the start of rehabilitation programs, and higher frequency of rehabilitation programs were significantly associated with improvements in levels of independence in ADL. Shorter interval between disease onset and program participation, and the presence of occupational therapists were also associated with improvements in levels of independence in ADL, although the relation did not reach statistical significance.

Activities of Daily Living↗

PubMed1995

[Ambulatory rehabilitation of cardiac patients in Switzerland].

In 1989, there were 21 rehabilitation clinics and 21 ambulatory cardiac rehabilitation programs in Switzerland. Approximately 3/4 of the cardiac rehabilitation programs are offered within rehabilitation clinics, which cater for 6000 patients. The first ambulatory cardiac rehabilitation program in Switzerland was instituted in 1972. Since then a continuous rise in the number and importance of such programs has been observed. There is a wide variety of program selection and intensity. All programs include physical activity, risk factor interventions and psychosocial support. The mean duration of the programs is 3 months, the range being from 6 weeks to a year. Evaluation after 8 years' existence of the ambulatory cardiac rehabilitation program at the Kantonspital Olten indicates that such a program in an out-patient setting in conjunction with a community hospital is feasible; it can be conducted with a high degree of safety and is followed by similar lifestyle changes to those observed after in patient rehabilitation at specialist clinics. The results with regard to cardiovascular risk factors and ability to return to work are comparable.

Ambulatory Care↗

PubMed1995

Cardiac rehabilitation as secondary prevention. Agency for Health Care Policy and Research and National Heart, Lung, and Blood Institute.

This Quick Reference Guide for Clinicians highlights the conclusions and recommendations from Cardiac Rehabilitation, Clinical Practice Guideline No. 17, which was formulated by a panel representing the major health care disciplines involved in cardiac rehabilitation. The conclusions and recommendations were derived from an extensive and critical review of the scientific literature pertaining to cardiac rehabilitation, as well as from the expert opinion of the panel. This guide addresses the role of cardiac rehabilitation and the potential benefits to be derived in the comprehensive care of the 13.5 million patients with heart disease in the United States, as well as the 4.7 million patients with heart failure and the several thousand patients undergoing heart transplantation. This Quick Reference Guide for Clinicians highlights the major effects of multifactorial cardiac rehabilitation services: medical evaluation; prescribed exercise; cardiac risk factor modification; and education, counseling, and behavioral interventions. The outcomes of and recommendations for cardiac rehabilitation services are categorized as to their effects on exercise tolerance, strength training, exercise habits, symptoms, smoking, lipids, body weight, blood pressure, psychological well-being, social adjustment and functioning, return to work, morbidity and safety issues, mortality and safety issues, and pathophysiologic measures. Patients with heart failure and after cardiac transplantation, as well as elderly patients, are specifically addressed. Alternate approaches to the delivery of cardiac rehabilitation services are presented.

Aged↗

PubMed1996

Women's compliance with cardiac rehabilitation programs.

As the incidence of cardiovascular disease in women increases, the process of cardiac rehabilitation in women is becoming increasingly important to nurses. Specifically, the issue of women's compliance with cardiac rehabilitation needs to be addressed by nurses. Most past and current research on cardiac rehabilitation and compliance with rehabilitation programs has been conducted on male subjects and cannot be accurately generalized to the female population. This article reviews current literature which addresses the issues of heart disease in women, cardiac rehabilitation and compliance in the general population, gender differences in cardiac rehabilitation, and compliance of women in cardiac rehabilitation.

Aged↗

PubMed1997

[Harmonization of the assessment of outcomes, predictors and costs as well as testing for gender-specific differences in rehabilitation research].

The scientific program "Rehabilitation Research in Germany" includes as a priority topic the evaluation of the effectiveness of rehabilitation regarding return to work. Controlled intervention studies with randomized allocation to treatment and a minimum follow-up of six to twelve months after rehabilitation are of primary importance. It is also recommended that the studies should include economic aspects and consider gender differences. Another request is harmonization of studies with respect to methods, assessment tools, and implementation to improve the relevance of the studies and to allow for combining the results. The authors respond to this request. They make proposals for harmonizing the assessment of outcomes, predictors, and costs as well as for testing gender differences in intervention studies. The proposals address the rehabilitation research networks and aim to provide a basis of discussion and to initiate the necessary consensus finding between the networks. Proposals include (1) a taxonomy of outcomes and predictors for rehabilitation and recommendations for generic assessment tools which allow for data-pooling of studies; (2) a concept for the pre-post and follow-up measurement and recommendations concerning the time interval on which evaluation of the effectiveness and efficiency of rehabilitation or treatment modalities should be based; (3) descriptions of the content and interpretation of the self assessment instruments which are recommended for cross study comparisons; (4) a procedure to assess the direct and indirect costs, i.e. costs of treatments and costs of disease consequences, which considers especially the assessment of rehabilitative services and their monetary evaluation; (5) provisions for ensuring representativeness of women in intervention studies and procedures for testing differences in treatment outcomes between women and men; (6) a procedure to reach harmonization by establishing a coordination committee including representatives of the research networks, and by using well-established methods such as consensus conferences.

Cost-Benefit Analysis↗

PubMed1998

Effectiveness and cost analysis of community-based rehabilitation service in Bangkok.

This paper aimed to clarify the effectiveness and the cost of the community-based rehabilitation service in Klong Toey slum after a three year study period. One hundred and seventy eight patients used community-based rehabilitation during the three year period. One hundred and fifty-seven patients (86.5%) reported that their problems/conditions were cured or improved. Only nine patients (5.1%) reported that they stopped using community-based rehabilitation because their problems/conditions did not improve. A statistically significant improvement in pain level and walking velocity assessment, in 105 and 78 patients respectively, was demonstrated. Total cost and cost per patient-day of the community-based rehabilitation were Bt 559,920 and Bt 111.1 respectively. Cost per-patient-day of this community-based rehabilitation service was compared with an estimated cost per patient-day of using rehabilitation services at Chulalongkorn University Hospital and was found to be cheaper. This study supported the role of community-based rehabilitation in Thailand. The need for a health service study in rural areas was also noted.

Cost-Benefit Analysis↗

PubMed2002

Success and predictability of provox prosthesis voice rehabilitation.

OBJECTIVES: To determine the success rate and relating clinical factors of voice prosthesis rehabilitation and to analyze the discrimination ability of the multidimensional Harrison-Robillard-Shultz Tracheoesophageal Puncture Rating Scale (HRS Rating Scale). DESIGN: Prospective clinical study. SETTING: University Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Inselspital, Bern, Switzerland. SUBJECTS AND METHODS: From 1992 through 1998, 87 patients with advanced squamous cell carcinoma of the larynx and/or hypopharynx underwent primary tracheoesophageal puncture after total laryngectomy. Clinician otolaryngologists and speech/language pathologists independently used the HRS Rating Scale for success assessment of voice prosthesis rehabilitation. RESULTS: Age, sex, tumor localization, tumor stage, and radiation therapy had no influence on the success of voice prosthesis rehabilitation. Overall, voice rehabilitation success rates between 40% and 62% were achieved. Speech/language pathologists and clinician otolaryngologists evaluated the same patient group without significant statistical differences. The HRS Rating Scale analysis showed an equal distribution of the subscale parameter care in functional and nonfunctional speakers and a strong correlation between the subscale parameters quality and use. CONCLUSIONS: Because of its safety and simplicity, tracheoesophageal puncture has become a state of the art method for voice rehabilitation after total laryngectomy. The short-term superiority of voice prosthesis in voice rehabilitation over esophageal speech rehabilitation must be seen in light of comparable long-term success rates of the 2 methods.

Adult↗

PubMed1998

Early inpatient rehabilitation after elective hip and knee arthroplasty.

CONTEXT: Inpatient rehabilitation after elective hip and knee arthroplasty is often necessary for patients who cannot function at home soon after surgery, but how soon after surgery inpatient rehabilitation can be initiated has not been studied. OBJECTIVE: To test the hypothesis that high-risk patients undergoing elective hip and knee arthroplasty would incur less total cost and experience more rapid functional improvement if inpatient rehabilitation began on postoperative day 3 rather than day 7, without adverse consequences to the patients. DESIGN: Randomized controlled trial conducted from 1994 to 1996. SETTING: Tertiary care center. PARTICIPANTS: A total of 86 patients undergoing elective hip or knee arthroplasty and who met the following criteria for being high risk: 70 years of age or older and living alone, 70 years of age or older with 2 or more comorbid conditions, or any age with 3 or more comorbid conditions. Of the 86 patients, 71 completed the study. INTERVENTIONS: Random assignment to begin inpatient rehabilitation on postoperative day 3 vs postoperative day 7. MAIN OUTCOME MEASURES: Total length of stay and cost from orthopedic and rehabilitation hospital admissions, functional performance in hospitals using a subset of the functional independence measure, and 4-month follow-up assessment using the RAND 36-item health survey I and the functional status index. RESULTS: Patients who completed the study and began inpatient rehabilitation on postoperative day 3 exhibited shorter mean (+/-SD) total length of stay (11.7+/-2.3 days vs 14.5+/-1.9, P<.001), lower mean (+/-SD) total cost ($25891+/-$3648 vs $27762+/-$3626, P<.03), more rapid attainment of short-term functional milestones between days 6 and 10 (36.2+/-14.4 m ambulated vs 21.4+/-13.3 m, P<.001; 4.8+/-0.8 mean transfer functional independence measure score vs 4.3+/-0.7, P<.01), and equivalent functional outcome at 4-month follow-up. CONCLUSION: These data showed that high-risk individuals were able to tolerate early intensive rehabilitation, and this intervention yielded faster attainment of short-term functional milestones in fewer days using less total cost.

Aged↗

PubMed1987

Rehabilitation needs of the patient with cancer.

As the success rate of earlier diagnosis and more effective cancer therapy increases, more individuals are finding that they are living with a cancer diagnosis. Cancer, as a chronic illness, requires that all health care professionals view the patient from a perspective of functional abilities rather than from a disease process. Rehabilitation is a dynamic process and is generally goal-directed. The goal of rehabilitation is to help the individual to function at his maximum level within the limitations and constraints of the disease and treatment protocols (Dudas, 1984). The physical, mental, emotional, social, sexual, and economic potential of the individual are the broad areas involved in the assessment, plan, implementation, and evaluation of rehabilitation programs. The rehabilitation team consists of the oncologist, surgeon, nurse, social worker, physical therapist, occupational therapist, nutritionist, and others depending on the special needs of the individual. The most important members of the team are the patient and family. The patient involved on the team can help to identify specific needs throughout the trajectory of the cancer diagnosis and treatment. The spouse and friends of the patient with cancer are important support systems and assist the patient in exploring feelings and needs (Frank-Stomborg and Wright, 1984). Dietz (1980) described four rehabilitation stages for cancer programs: preventive, restorative, supportive, and palliative. During each phase of rehabilitation the physical, mental, emotional, social, sexual, and economic needs of the patient must be considered. This report identifies specific areas of concern for the patient and family during the four stages of rehabilitation and to identify potential action plans for individual patients.

Counseling↗

PubMed1990

Current issues in cancer rehabilitation.

Many patients with cancer enjoy long-term survival and are cured; others may live for extended periods while receiving specific treatment for cancer. This has been accomplished with increasingly complex and multimodal therapy, along with heightened toxicity and longer treatment. Cancer has become a chronic disease for many patients. Contemporary cancer rehabilitation provides a coordinated approach that addresses the physical, psychosocial, vocational, and economic concerns of the patient. Key components of a cancer rehabilitation program should include initial needs assessment with periodic reassessments, direct provision of specific interventions, and referrals to appropriate community resources. Almost all patients with cancer can benefit from a rehabilitation assessment and intervention. Important rehabilitation issues include the physical toxicity of treatment, psychosocial concerns, sexual dysfunction, diet and nutritional concerns, pain management, and vocational and economic problems. Patient groups with unique rehabilitation problems include patients with head and neck cancer or breast cancer, and patients who have undergone osteotomies or amputations. Long-term cancer survivors also have special rehabilitation needs that relate to the delayed effects of treatment on normal tissues, gonadal dysfunction, second neoplasms, employment discrimination, and difficulties obtaining health and life insurance coverage. Rehabilitation assessment and intervention should be incorporated into the routine health care of patients with cancer.

Chronic Disease↗

PubMed2001

Bone metastasis and rehabilitation.

Patients with cancer that has metastasized to bone will frequently develop functional problems that may respond to rehabilitative treatment. Many rehabilitation professionals, however, are concerned about the possibility of producing pathologic fracture with their treatment. Several methods have been proposed for identifying which malignant lesions in bone are at risk of fracture. In this article, these methods are reviewed and statistical analyses of them are presented. The risk of rehabilitating patients with bony metastases is also reviewed, as are the reported outcomes of these rehabilitation efforts. Standard approaches to the rehabilitation of these patients have evolved, although most of them have not been rigorously validated, and these are discussed. None of the methods for identifying lesions at risk of pathologic fracture are useful in other than long bones, and they are limited even there. The risk of producing pathologic fractures in cancer patients by increasing mobility and function, however, is low. Satisfactory outcomes have been demonstrated in attempting to rehabilitate patients who have had recent surgical repair of pathologic or impending fractures. Rehabilitation of cancer patients with bony metastases can be safely and effectively accomplished using standard approaches to the treatment of these patients.

Bone Neoplasms↗

PubMed2000

Multidisciplinary rehabilitation for fibromyalgia and musculoskeletal pain in working age adults.

BACKGROUND: Non-malignant musculoskeletal pain is an increasing problem in western countries. Fibromyalgia syndrome is an increasing recognised chronic musculoskeletal disorder. OBJECTIVES: The objective of this systematic review was to determine the effectiveness of multidisciplinary rehabilitation for fibromyalgia and widespread musculoskeletal pain among working age adults. SEARCH STRATEGY: An electronic search was conducted and included Medline from 1966, PsycLIT from 1967 and EMBASE from 1980 to April 1998. The Cochrane Musculoskeletal Group Trials Register was searched as well as, the Cochrane Controlled Trials Register (CCTR). The references of identified articles and reviews were checked, studies published in the Finnish medical database Medic from 1978 to 1998 screened and the Science Citation Index searched. Content experts were also contacted for additional or unpublished studies. SELECTION CRITERIA: From all references found in our original search, we selected all randomized controlled trials (RCTs) and clinical controlled trials (CCTs). Trials had to assess the effectiveness of multidisciplinary rehabilitation for patients suffering from fibromyalgia and widespread musculoskeletal pain among working age adults. The rehabilitation program was required to be multidisciplinary; that is, it had to consist of a physician's consultation, plus a psychological, social or vocational intervention, or a combination of both. DATA COLLECTION AND ANALYSIS: Four reviewers independently selected the RCTs and CCTs that met the specified inclusion criteria. Two experts in the field of rehabilitation evaluated the relevance and applicability of the findings of the selected studies to actual clinical use. Two other reviewers extracted the data and assessed the main results and the methodological quality of the studies using standardized forms. Finally, a qualitative analysis was performed to evaluate the level of scientific evidence for the effectiveness of multidisciplinary rehabilitation. MAIN RESULTS: After screening 1808 abstracts, and the references of 65 reviews, we found only seven relevant studies (1050 patients) that met our inclusion criteria. None of these were considered, methodologically, a high quality randomized controlled trial. Four of the included RCTs on fibromyalgia were graded low quality and suggest no quantifiable benefits. The three included RCTs on widespread musculoskeletal pain showed that based on limited evidence, overall, no evidence of efficacy was observed. However, behavioral treatment and stress management appear to be important components. Education combined with physical training showed some positive effects in long term follow up. REVIEWER'S CONCLUSIONS: We conclude that there appears to be little scientific evidence for the effectiveness of multidisciplinary rehabilitation for these musculoskeletal disorders. However, multidisciplinary rehabilitation is a commonly used intervention for chronic musculoskeletal disorders, which cause much personal suffering and substantial economic loss to the society. There is a need for high quality trials in this field.

Adult↗

PubMed2006

Pulmonary rehabilitation for chronic obstructive pulmonary disease.

BACKGROUND: The widespread application of pulmonary rehabilitation in chronic obstructive pulmonary disease (COPD) should be preceded by demonstrable improvements in function attributable to the programs. This review updates that reported in 2001. OBJECTIVES: To determine the impact of rehabilitation on health-related quality of life (QoL) and exercise capacity in patients with COPD. SEARCH STRATEGY: We identified additional RCTs from the Cochrane Airways Group Specialised Register. Searches were current as of July 2004. SELECTION CRITERIA: We selected RCTs of rehabilitation in patients with COPD in which quality of life (QoL) and/or functional (FEC) or maximal (MEC) exercise capacity were measured. Rehabilitation was defined as exercise training for at least four weeks with or without education and/or psychological support. Control groups received conventional community care without rehabilitation. DATA COLLECTION AND ANALYSIS: We calculated weighted mean differences (WMD) using a random-effects model. We requested missing data from the authors of the primary study. MAIN RESULTS: We included the 23 randomized controlled trials (RCTs) in the 2001 Cochrane review. Eight additional RCTs (for a total of 31) met the inclusion criteria. We found statistically significant improvements for all the outcomes. In four important domains of QoL (Chronic Respiratory Questionnaire scores for Dyspnea, Fatigue, Emotional function and Mastery), the effect was larger than the minimal clinically important difference of 0.5 units (for example: Dyspnoea score: WMD 1.0 units; 95% confidence interval: 0.8 to 1.3 units; n = 12 trials). Statistically significant improvements were noted in two of the three domains of the St. Georges Respiratory Questionnaire. For FEC and MEC, the effect was small and slightly below the threshold of clinical significance for the six-minute walking distance (WMD: 48 meters; 95% CI: 32 to 65; n = 16 trials). AUTHORS' CONCLUSIONS: Rehabilitation relieves dyspnea and fatigue, improves emotional function and enhances patients' sense of control over their condition. These improvements are moderately large and clinically significant. Rehabilitation forms an important component of the management of COPD.

Dyspnea↗

PubMed2006

Impact of osteoarthritis on rehabilitation for persons with hip fracture.

OBJECTIVE: To determine the impact of osteoarthritis (OA) on length of rehabilitation stay, Functional Independence Measure (FIM Instrument) ratings at discharge and followup, functional gain, and percentage of patients discharged home. METHODS: We conducted a retrospective cohort analysis using a national registry of US medical rehabilitation inpatients. We obtained standardized data for all patients admitted after a hip fracture between 1994 and 2001. Our primary analytical method was multiple regression analysis. Outcome variables were length of stay, FIM Instrument ratings at discharge and followup, functional gain, and percentage of patients discharged home. The predictor variable was the presence of OA. Covariates were age, sex, race/ethnicity, other comorbidity, admission FIM ratings, total hip replacement, and time to followup. RESULTS: We studied 1,953 patients with OA and 11,441 patients without OA admitted to inpatient rehabilitation facilities after hip fracture. Mean +/- SD length of stay for patients with OA was 18.1 +/- 10.0 days versus 16.5 +/- 8.9 days for those without OA (P < 0.01). After adjusting for age, sex, race/ethnicity, comorbidity, admission FIM ratings, and total hip replacement, OA was associated with a longer rehabilitation stay (1.4 days; P < 0.01) and slightly higher discharge FIM ratings; however, OA was not associated with lower weekly rehabilitation gain, followup FIM ratings, and percentage discharged home. CONCLUSION: Persons with hip fracture and OA had longer inpatient rehabilitation length of stay than persons without OA, but there were similarities in weekly rehabilitation gain and percentage discharged home.

Aged↗