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概要

Factors Affecting Functional Outcomes among Trauma Patients Admitted to an Acute Inpatient Rehabilitation Unit

Anup H. Patel, Edward Coffield, Trishla R. Kanthala, Arpit A. Patel, Jamal Khan and Lyn Weiss

Background: There is limited information regarding changes in functional outcome among trauma patients during acute inpatient rehabilitation and the factors associated with such changes. Examining the factors associated with functional outcome changes can provide a meaningful way to predict and prognosticate the needs of trauma patients during post-acute care rehabilitation.

Objective: The objective of this study was to evaluate the association between changes in functional mobility and factors such as age and gender among trauma patients admitted to an acute Inpatient rehabilitation facility.

Design: The retrospective study consisted of a 330 patients treated in a Level I academic trauma center who were discharged to an acute inpatient rehabilitation facility. Admission- and discharge-acute inpatient rehabilitation functionality was measured using Functional Independence Measure (FIM) scores.

Methods: Information from the hospital’s trauma database on patients admitted to the level 1 trauma center and subsequently discharged to the hospital’s inpatient acute rehabilitation was retrospectively extracted and analyzed.

Main outcome Measure: FIM scores. Mean/proportion comparison tests were used to investigate whether admission- and discharge-FIM scores statistically differed by age and gender. Multivariate regression analyses were estimated to examine whether age and gender were associated with differences between patients admission- and discharge-acute inpatient rehabilitation FIM scores while controlling for confounding factors.

Results: Improvements in patients’ FIM scores during acute inpatient rehabilitation (FIM-gains) were statistically higher (p ≤ 0.05) among patients under 65 years old (FIM-gains: 21.3) relative to patients aged 65 years and older (FIM-gains: 18.13) despite the younger age group’s higher injury severity scores and longer hospital length of stays. Increased age and admission-acute inpatient rehabilitation FIM scores were both associated with lower FIM score improvements during acute inpatient rehabilitation admissions. FIM-gains score was estimated to be 6.34 points (p=0.00) lower in patients aged 65 years and older relative to patients under the age of 65; while a one-unit increase in patients’ admission-acute inpatient rehabilitation FIM score was associated with a 0.36 decrease (p=0.00) in their FIM-gains score. No gender based differences in patients’ FIM-gains scores were found.

Conclusion: Patients under 65 years of age had a greater improvement in FIM-gains scores relative to patients aged 65 years and older. Besides age, we also found that patients with a higher admission-acute inpatient rehabilitation FIM score had a lower improvement in their FIM-gains score. No gender differences were noted.