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Effect of Functional Gain on Satisfaction with Medical Rehabilitation After Stroke

Tooth, Leigh R. PhD; Ottenbacher, Kenneth J. PhD; Smith, Pamela M. DNS, RN; Illig, Sandra B. MS, RN; Linn, Richard T. PhD; Gonzales, Vera A. PhD; Granger, Carl V. MD

American Journal of Physical Medicine & Rehabilitation: September 2003 - Volume 82 - Issue 9 - p 692-699
doi: 10.1097/01.PHM.0000083672.01300.47
CME Article: CME Article •: 2003 Series • Number 9: Outcomes
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Tooth LR, Ottenbacher KJ, Smith PM, Illig SB, Linn RT, Gonzales VA, Granger CV: Effect of functional gain on satisfaction with medical rehabilitation after stroke. Am J Phys Med Rehabil 2003;82:692–699.

Objective To examine the association between gain in motor and cognitive functional status with patient satisfaction 3–6 mo after rehabilitation discharge.

Design Patient satisfaction and changes in functional status were examined in 18,375 patients with stroke who received inpatient medical rehabilitation. Information was obtained from 144 hospitals and rehabilitation facilities contributing records to the Uniform Data System for Medical Rehabilitation and the National Follow-up Services.

Results Data analysis revealed significant (P < 0.05) differences in satisfaction responses based on whether information was collected from patient self-report or from a family member proxy, and the two subsets were analyzed separately. Logistic regression revealed the following significant predictors of satisfaction for data collected from stroke patients: cognitive and motor gain, rehospitalization, who the patient was living with at follow-up, age, and follow-up therapy. In the patient-reported data subset, compared with patients who showed improved cognitive or motor functional status, those with no change, respectively, had a 31% and 33% reduced risk of dissatisfaction. In addition, rehospitalized patients had a higher risk of dissatisfaction. For the proxy reported data subset, significant influences on satisfaction were health maintenance, rehospitalization, stroke type, ethnicity, cognitive FIM™ gain, length of stay, and follow-up therapy.

Conclusions Ratings of satisfaction with rehabilitation services were affected by change in functional status and whether the information was collected from patient rating or proxy response.

From the School of Population Health, University of Queensland, Brisbane, Australia (LRT); the Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston, Texas (KJO, VAG); National Follow-Up Services, Buffalo, New York (PMS, SBI); and the Uniform Data System for Medical Rehabilitation, State University of New York at Buffalo, Buffalo, New York (RTL, CVG).

Supported by a National Health and Medical Research Council of Australia Public Health Fellowship (997032) and Traveling Award for Research Training (252818) (L. R. Tooth); and by a National Institute on Aging grant (R01-17638), American Heart Association grant (027045N), and National Institutes of Health Independent Scientist Award (K02-AG19736) (K. J. Ottenbacher).

FIM™ is a trademark of the Uniform Data System for Medical Rehabilitation, a division of UB Foundation Activities, Inc.

All correspondence and requests for reprints should be addressed to Kenneth J. Ottenbacher, PhD, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-1137.

Objectives: Upon completion of this article, the reader should be able to: 1) identify the variables that predict dissatisfaction with medical rehabilitation in patients after stroke, 2) describe how ratings of satisfaction differ for patients and proxies, in terms of confounding factors, and 3) interpret these differences with respect to implications for clinical practice.

Level: Comprehensive

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to sponsor continuing medical education for physicians.

The Association of Academic Physiatrists designates this continuing medical education activity for a maximum of 1.5 credit hours in Category 1 of Physician’s Recognition Award of the American Medical Association. Each physician should claim only those hours of credit that he or she actually spent in the education activity.

Disclosure: Disclosure statements have been obtained regarding the authors’ relationships with financial supporters of this activity. There is no apparent conflict of interests related to the context of participation of the authors of this article.

How to Obtain CME Category 1 Credits

To obtain CME Category 1 credit, this educational activity must be completed and postmarked by December 31, 2004. Participants may read the articles and take the exams issue by issue or wait to study several issues together. After reading the CME Article in this issue, participants may complete the Self-Assessment Exam by answering the questions on the CME Answering Sheet and the Evaluation pages, which appear later in this section. Send the completed forms to: Bradley R. Johns, Managing Editor, CME Department-AAP, American Journal of Physical Medicine & Rehabilitation, 7240 Fishback Hill Lane, Indianapolis, IN 46278. Documentation can be received at the AAP National Office at any time throughout the year, and accurate records will be maintained for each participant. CME certificates are issued only once a year in January for the total number of credits earned during the prior year.

© 2003 Lippincott Williams & Wilkins, Inc.