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Evidence of Improved Efficiency in Functional Gains During Subacute Inpatient Rehabilitation

Kuys, Suzanne S. PhD; Burgess, Kara B Phty; Fleming, Jennifer PhD; Varghese, Paul MBBS; McPhail, Steven M. PhD

American Journal of Physical Medicine & Rehabilitation: November 2016 - Volume 95 - Issue 11 - p 800–808
doi: 10.1097/PHM.0000000000000491
Original Research Articles

ABSTRACT This comparative study investigated differences in functional capacity and functional gains of patients admitted for hospital rehabilitation between 2005 and 2011. Patients were grouped according to broad diagnostic categories: neurological, orthopedic, and deconditioned. Functional capacity (Functional Independence Measure (FIM), gait speed) and functional gains were compared between two 1-year patient cohorts (2005 and 2011) for diagnostic groups. In 2011, more patients were admitted (n = 626 vs. n = 474) with a shorter length of stay (mean difference 9.72 days, 95% confidence interval (CI) 5.26 to 14.18) compared to 2005. Functional capacity of patients at admission was worse in 2011 for all measures (P < 0.05). By hospital rehabilitation discharge, no differences were found between the two cohorts (P > 0.497) except for discharge gait speed; in 2011, patients walked faster (mean difference 0.58 m/s, 95% CI 0.05 to 0.11). Higher FIM gain and FIM efficiency was demonstrated in 2011, but differences between diagnostic groups were evident. Deconditioned patients overall demonstrated less gain and efficiency (F > 3.623, P < 0.028). In summary, improved service efficiencies were demonstrated with improved throughput of patients without compromising functional capacity at hospital rehabilitation discharge. These efficiencies seem to be gained through neurological and orthopedic admissions compared to deconditioned admissions.

From the School of Physiotherapy, Australian Catholic University, Banyo, Australia (SSK); Princess Alexandra Hospital, Brisbane, Australia (KB, PV); School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia (JF); Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia (JF, SMM); Occupational Therapy Department, Princess Alexandra Hospital, Brisbane, Australia (JF); The University of Queensland and Centre for Research in Geriatric Medicine, Brisbane, Australia (PV); and Institute of Health & Biomedical Innovation and School of Public Health & Social Work, Queensland University of Technology, Brisbane, Australia (SMM).

This work was supported by a Queensland Health Health Practitioner research grant 2011–12. Parts of this work were presented at Australasian Association of Gerontology conference 2012.

Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article.

All correspondence and requests for reprints should be addressed to: Suzanne S. Kuys, PhD, School of Physiotherapy, Australian Catholic University, 1100 Nudgee Road, Banyo, Queensland 4014, Australia.

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