Interaction effects of in-hospital rehabilitation and the use of community-based services after hospital discharge on patients' subsequent functional abilities.

BACKGROUND: Patients' functional abilities after hospital discharge are influenced by rehabilitation during their hospital stay and their use of community-based services after hospital discharge. This study examined the interaction between rehabilitation during hospital stay, the use of community-based rehabilitation and non-rehabilitation services and their influence on patients' subsequent functional abilities. METHODS: This cohort study included 509 inpatients who underwent rehabilitation between 2008 and 2011 in Japan. Participants were categorized into 2 groups based on their condition: stroke and other. Interaction effects between the change in Functional Independence Measure (FIM) and the use of community-based rehabilitation and non-rehabilitation services on patients' subsequent functional abilities were estimated by sequential linear regression analyses in which the dependent variable was the FIM score 3 months after hospital discharge. RESULTS: A significant interaction between the change in FIM and the use of community-based rehabilitation or non-rehabilitation services after hospital discharge was observed among stroke and other patients. CONCLUSION: Rehabilitation during hospital stay and the use of community-based rehabilitation or non-rehabilitation services interacted to influence the subsequent functional abilities of patients discharged home. These findings may be useful for maintaining patients' functional abilities after hospital discharge.

Interaction effects between rehabilitation and discharge destination on inpatients' functional abilities.

A patient's functional ability after hospital discharge may be influenced by in-hospital rehabilitation and discharge destination. However, we know very little about how in-hospital rehabilitation intervention interacts with the type of discharge destination or how this interaction influences patients' functional abilities. Thus, how an interaction between in-hospital rehabilitation and discharge destination influences a patient's subsequent functional ability was examined. This was a cross-sectional study whose participants were inpatients who underwent rehabilitation between February 2008 and December 2010 at a hospital in Japan (n = 835). Participants were categorized into three condition groups (i.e., stroke, orthopedic, disuse syndrome). Then, interaction effects between the rehabilitation therapy and the type of discharge destination on a patient's subsequent functional ability were estimated by hierarchical linear regression analysis in each of the three subgroups. In models where the dependent variable was Functional Independence Measure (FIM) score at 3 mo after hospital discharge, a significant interaction between rehabilitation potential (a measure based on the FIM effectiveness measure) and discharge destination (home or other) was observed in the stroke and orthopedic patients (both p < 0.001). These findings may be useful in deciding on discharge destinations for patients.

Predicting the discharge destination of rehabilitation patients using a signal detection approach.

OBJECTIVE: To predict the discharge destination of rehabilitation patients using signal detection analysis. DESIGN: Cross-sectional and follow-up studies. SUBJECT: The subjects were 324 patients discharged from a hospital in Fukuoka, Japan, between April 2005 and March 2006 and 313 patients discharged from the same hospital between 1 April and 31 October 2006. METHODS: The discharge destinations of the 324 patients were predicted using signal detection analysis. As a validation study, 7 variables identified in the first analysis were used to categorize 313 patients, organized retrospectively into 8 groups, and to calculate the home discharge rate in each group. RESULTS: A patient's activities with respect to daily living, key person preference, dementia, age, route taken to hospitalization, residence before hospitalization, and gender were significant predictors of his or her discharge destination. Signal detection analysis established 8 subgroups, with 17.9-99.1% of the patients returning home after discharge. As a validation study, the actual and expected rates in the 8 subgroups were compared, and no significant difference was observed between the rates in any subgroup. CONCLUSION: Signal detection analysis is a useful technique for predicting the discharge destination of rehabilitation patients.

[Present status of patients in a rehabilitation unit at a geriatric hospital--analysis of cases with cerebrovascular disease and disuse syndrome].

AIM: To analyze the present status of patients in a rehabilitation unit at a geriatric hospital. METHODS: Subjects were 232 patients (74 male and 158 female; mean age, 78.6+/-12.9 years) and they were divided into two groups (group A had 83 with cerebrovascular disease; group B had 149 with disuse syndrome). In these groups, we retrospectively examined such items as; age, ADL, length of stay, underlying disease and complications, and outcome. RESULTS: Mean ages of groups A and B were 75.9+/-14.0, 80.0+/-12.0, respectively (p<0.05; group A vs. B). Mean value of length of stay was 140.9+/-9.4 in group A and 107.3+/-11.3 in group B (p<0.05). Cerebral infarction and pneumonia were the most frequently seen as the underlying diseases in group A (55 cases) and B (33 cases), respectively. During the hospital rehabilitation period, cases requiring medical care occurred in 30.1% of group A and in 26.8% of group B. The total number of patients who returned home or moved to facilities for the aged were 53 in group A and 109 in group B. In almost all of the cases who returned home, they were able to walk upon discharge. CONCLUSION: It was suggested that comprehensive geriatric medical care is necessary for the elderly during the rehabilitation period. The improvement of physical function up to the level of ambulation seems required for discharge.

[Factors related to the length of rehabilitation unit stay among elderly patients].

AIM: In order to suppress increases in medical costs in Japan, with regard to rehabilitation, it is extremely important to shorten the length of stay at rehabilitation units. Thus, factors related to the length of stay were analyzed in the study. METHODS: The subjects of the study were patients who stayed and left the rehabilitation unit at H hospital in Fukuoka, Japan during the period of May 1, 2003 and December 31, 2004. Of the 236 patients, 167 patients had no missing values with respect to 15 study variables. Thus, these 167 patients were used for analyses. In order to isolate factors related to the length of unit stay, a multiple regression analysis was performed with the length of stay as a dependent variable and other factors as independent variables. RESULTS: Of the 3 types of rehabilitation interventions (i.e., physical, occupational and speech therapies), the quantity of physical therapy was a significant predictor (p< 0.05). CONCLUSION: The findings imply the following. (1) The level of physical activity, which is a target of physical therapy, is used as a criterion for leaving the unit. (2) The three types of rehabilitation interventions highly correlated with one another, and the quantity of physical therapy is greatest. Thus, it is possible that only physical therapy could be isolated as a significant predictor. Since the present finding is based upon patients in a single rehabilitation unit, further studies using patients from multiple facilities is necessary.