Effect of functional gain on satisfaction with medical rehabilitation after stroke

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.     

Perceived pain and satisfaction with medical rehabilitation after hospital discharge

OBJECTIVE: To examine the association between pain and satisfaction with medical rehabilitation in patients with hip or knee replacement approximately 90 days after discharge from inpatient medical rehabilitation. DESIGN: A cross-sectional design. PARTICIPANTS: The sample included 2507 patients with hip or knee replacement using information from the IT Health Track medical outcome database. MAIN OUTCOME MEASURE: Satisfaction with medical rehabilitation. RESULTS: The average age was 70.2 years, 66.5% were female, and 88.5% were non-Hispanic white. Pain scores were significantly and inversely associated with satisfaction with medical rehabilitation after adjustment for possible confounding factors. In patients with hip replacement each one-point increase in pain score was associated with a 10% decreased odds ratio (OR) of being satisfied with medical rehabilitation (OR 0.90, 95% confidence interval (CI) 0.84, 0.96). In patients with knee replacement, each one-point increase in pain score was associated with a 9% decreased odds ratio (OR 0.91, 95% CI 0.87, 0.96) of being satisfied with medical rehabilitation. CONCLUSION: Our data indicate that postoperative pain from hip or knee replacement is associated with reduced satisfaction with medical rehabilitation. Better postoperative pain control may improve a patient's level of satisfaction.     

The influence of perceived pain on satisfaction with community participation after hospital discharge

OBJECTIVE: To examine the association between pain and satisfaction with community participation for patients with stroke approximately 4 months after discharge from inpatient medical rehabilitation. DESIGN: A cross-sectional study from 2001 to 2002 using information from the IT HealthTrack database. SETTING: Community based. PARTICIPANTS: The study included 1673 patients with stroke aged 40 years or older discharged from inpatient medical rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Primary measures included pain ratings and satisfaction with community participation. RESULTS: The sample was 49.4% female and 81.1% non-Hispanic white. One third of the sample reported mild to severe pain. Pain ratings showed a significant and inverse association with satisfaction with community participation. The association remained significant with adjustment for possible confounding factors and with stratification by right and left body involvement. Each 1-level increase in pain rating score (range, 0-10) was associated with a 12% decreased odds ratio (OR=.88; 95% confidence interval, .84-.93) of being satisfied with community participation after adjustment for age, sex, marital status, ethnicity, and motor and cognitive functional status. CONCLUSIONS: In persons with stroke, high pain rating scores were significantly associated with lower satisfaction with community participation. Effective pain management may increase level of satisfaction with community participation in persons with stroke.     

Satisfaction with medical rehabilitation in patients with cerebrovascular impairment

OBJECTIVE: Overall satisfaction has important social and economic implications for patients who have received inpatient medical rehabilitation. We conducted this study to examine the overall satisfaction level at 3- to 6-mo follow-up for inpatients with cerebrovascular impairments discharged from medical rehabilitation. DESIGN: The study was retrospective using information from a national database representative of medical rehabilitation patients across the United States. Information submitted in 1997 and 1998 to the Uniform Data System for Medical Rehabilitation by 177 hospital and rehabilitation facilities from 40 states was examined. The final sample included 8,900 patient records. The main outcome measure was the level of satisfaction with medical rehabilitation at 80-180 days postdischarge follow-up. RESULTS: A logistic regression model including ten independent variables was used to predict satisfied vs. dissatisfied at follow-up. Three statistically significant variables were included in the final model and correctly classified 95.1% of the patients. Higher FIM instrument discharge scores were associated with increased satisfaction. Further analysis of the FIM instrument subscales indicated that higher ratings in transfers, social cognition, and locomotion were significantly associated with increased satisfaction. CONCLUSION: We identified several functional variables associated with increased satisfaction after medical rehabilitation in persons with stroke. The ability to objectively assess patient satisfaction is important as consumer-based outcome measures are integrated in accreditation and healthcare evaluation.     

Satisfaction with medical rehabilitation in patients with orthopedic impairment

OBJECTIVE: To examine patient satisfaction after orthopedic impairment at 80 to 180 days after inpatient rehabilitation. DESIGN: Retrospective design examining records from facilities subscribing to the Uniform Data System for Medical Rehabilitation (UDSmr). SETTING: Information submitted to UDSmr from 1997 to 1998 by 177 hospital and rehabilitation facilities from 40 states. PARTICIPANTS: The sample (N=7781) was 72.63% female and 88.60% non-Hispanic white, with a mean age +/- standard deviation of 73.07+/-11.81 years, and average length of stay (LOS) of 13.84+/-10.48 days. INTERVENTION: Usual rehabilitation care.Main outcome measures Level of satisfaction 80 to 180 days after discharge as well as motor, cognitive, and subscale ratings for the FIM trade mark instrument. Predictor variables included gender, age, English language, marital status, discharge setting, LOS, rehospitalization, FIM gain, and primary payer. RESULTS: A logistic regression model was used to predict patient satisfaction at follow-up. Five statistically significant (P<.05) variables were found and correctly classified 94.9% of the patients. Discharge motor FIM rating, rehospitalization, age, patient's primary language, and discharge setting were associated with increased satisfaction. Discharge motor FIM ratings were significantly associated with increased satisfaction in patients with joint replacements and lower-extremity fractures. CONCLUSION: unctional and demographic variables were identified as predictors of satisfaction in patients with orthopedic impairments.     

Correlates of satisfaction and dissatisfaction with medical care: a community perspective.

The attitude of the public toward physicians and medical services is an issue of current concern and debate. To address this problem, an instrument was developed using Thurstone scaling methods in conjunction with a Likert format and a modified scoring technique. Following pretesting of the instrument among both patient and population samples, a survey was conducted among the residents of a probability sample of households in a city of 200,000 people. The attitude questionnaire was completed by 1,713 adults in 1,112 households. Overall, attitudes were favorable toward the professional competency and the personal qualities of physicians. Accessibility, including costs and convenience, were less highly regarded. Men were less satisfied than women and blacks less satisfied than whites. Particularly negative attitudes were expressed toward the personal qualities of physicians by young blacks, whereas among blacks over 60 the negative effect was toward cost and convenience. Having a regular physician and long attendance with that physician were correlated with positive attitudes. The most negative sentiment was expressed by women without regular source of care. Medical services are being sought and obtained by a large segment of society, but problems of costs and acceptability for the elderly, low social class persons, members of large families, and for blacks still remain.     

Factors contributing to patient satisfaction with medical rehabilitation in German hospitals

The objective of this study was to quantify overall patient satisfaction, through the identification of the particular aspects of patient satisfaction that were most likely to cause patients to recommend the rehabilitation hospital to others. The research entailed analysing secondary data from a quality improvement programme for medical rehabilitation, conducted from 1997 until 2004, in seven rehabilitation hospitals in Germany. Overall patient satisfaction and several potential predictors were examined in relation to 120,825 patients who had received inpatient medical rehabilitation. Recommending the rehabilitation hospital to others is a measure of overall patient satisfaction with the rehabilitation. Logistic regression was used to identify the factors that predicted patient satisfaction or dissatisfaction at discharge from the rehabilitation hospital. Overall satisfaction was mainly determined by the general atmosphere in the hospital, successful rehabilitation and the medical care. The general atmosphere was strongly associated with admission procedures, accommodation, catering, service, organisation and nursing care. In conclusion, the results suggest that in order to increase the rate of recommendation, rehabilitation hospitals should aim for not only high quality in medical care, but also the creation of a pleasant atmosphere.     

The functional performance of elderly urban African-American women who return home to live alone after medical rehabilitation.

OBJECTIVE: Elderly women who live alone are at increased risk for loss of independence. Hospitalization, in particular, often marks the transition from independent living to institutional care. The purpose of this study was to examine the relationship of rehabilitation admission to the subsequent function of elderly women and their ability to return to live-alone status. METHOD: The women in the study (N = 138) were admitted to a geriatric rehabilitation unit at a large urban medical center between September 1997 and September 1998. The findings reported here pertain to the subset of African-American women (n = 122), the majority of the sample. Data were collected using several standardized assessments, including the Functional Independence Measure (FIM). RESULTS: The FIM motor scores improved significantly for the total sample between admission and discharge, and the mean FIM motor score for the group that subsequently attained live-alone status was significantly higher than the non-live-alone group at 3 months and 6 months postdischarge. The participants who returned to live alone also reported significantly greater independence than did their non-live-alone counterparts across a variety of activities of daily living and instrumental activities of daily living skills. CONCLUSION: These data suggest that rehabilitation is associated with improved functional outcomes, and higher functional performance is related to live-alone status.     

Evaluation of consultation-based rehabilitation for hospitalized cancer patients with functional impairment.

OBJECTIVE: To evaluate prospectively the effect of consultation-based interdisciplinary rehabilitation in hospitalized cancer patients. PATIENTS AND METHODS: Three hundred forty-one hospitalized patients with cancer were referred to the Cancer Adaptation Team (interdisciplinary rehabilitation services) over an 8-month period. Functional status at enrollment and dismissal was evaluated with a Barthel Mobility Index and Karnofsky Performance Status scale. Quality-of-life parameters were evaluated with specifically designed questionnaires. RESULTS: Two hundred ninety patients met the inclusion criteria. One hundred eighty-nine survived and completed the study. Significant functional improvement was observed between enrollment and dismissal on both functional indexes (P< or =.001). Quality-of-life questionnaires, while limited by low completion rate, showed significant improvement on multiple parameters. CONCLUSION: Significant functional gains were observed in hospitalized cancer patients who received interdisciplinary rehabilitation services on a consultation basis.     

Cardiac rehabilitation program participation and outcomes after myocardial infarction.

Rehabilitation programs for myocardial infarction (MI) survivors are designed to alter survivors' self-care patterns and to improve long-term physical and psychological outcomes. The purpose of this study was to examine the relationship between participation in cardiac rehabilitation and health state; days of reduced activity; anxiety; depression; self-esteem; quality of life; and performance of exercise, diet, medication, stress-modification, and smoking-reduction self-care behaviors after MI. Interviews were conducted with 197 women and men 1 to 2 years after their initial MI to measure health state, mood, self-esteem, quality of life, and relevant self-care behaviors. Rehabilitation center records were reviewed to determine participation in rehabilitation programs. Rehabilitation participation was significantly associated with health state; days of reduced activity; self-esteem; quality of life; and performance of exercise, diet, and medication self-care. These findings suggest that participation in cardiac rehabilitation is a worthwhile intervention that facilitates recovery from myocardial infarction.     

Association of environmental factors with levels of home and community participation in an adult rehabilitation cohort

OBJECTIVE: To examine whether home and community environmental barriers and facilitators are predictors of social and home participation and community participation at 1 and 6 months after discharge from an acute care or inpatient rehabilitation hospital. DESIGN: Cohort study. SETTING: Postacute care. PARTICIPANTS: Adults (N=342) age 18 years or older with a diagnosis of complex medical, orthopedic, or neurologic condition recruited from acute care and inpatient rehabilitation facilities. The mean age +/- standard deviation of participants was 68+/-14 years; 49% were women and 92% were white. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Participation in social, home and community affairs as assessed with the Participation Measure for Post-Acute Care. RESULTS: Adjusting for covariates, 1 month after discharge a greater presence of home mobility barriers (P<.01) was associated with less social and home participation; whereas greater community mobility barriers (P<.01) and more social support (P<.001) were associated with greater participation. At 6 months, social support was the only environmental factor associated with participation after adjusting for covariates. CONCLUSIONS: This study provides new empirical evidence that environmental barriers and facilitators do influence participation in a general rehabilitation cohort, at least in the short term.     

Muscle rehabilitation: its effect on muscular and functional performance of patients with knee osteoarthritis

Muscle function and functional performance are limited in patients with osteoarthritis (OA). Although aerobic exercise can increase aerobic power and reduce fatigue, it does not appear to improve muscle function. The purpose of this study was to demonstrate the effect of a muscle rehabilitation program on muscle strength, endurance, speed, and function for patients with OA of the knees. Fifteen men (67.6 +/- 6.1 years) with OA of the knees underwent a four-month exercise program, three times per week. Muscle strength, endurance, and speed were 50% less in OA patients than in controls. After rehabilitation, there was a significant increase in strength (35%), endurance (35%), and speed (50%). Deficiencies and improvements in the muscles were greater at longer muscle lengths. Increases in muscle function were associated with decreased dependency (10%), difficulty (30%), and pain (40%). The average increase in all measured parameters was 10% and 25% after two and four months of rehabilitation, respectively. Improvements were sustained for eight months after rehabilitation. The muscle rehabilitation program was designed specifically to improve function; the improved muscle function was translated into improved functional performance.     

Understanding pain after traumatic brain injury: impact on community participation

OBJECTIVE: To examine the prevalence of pain 1 yr after moderate to severe traumatic brain injury (TBI) and identify predictors from the time of injury. Additionally, factors related to pain at 1 yr after injury were examined along with the impact of pain on community participation. DESIGN: Prospective cohort study of 146 individuals enrolled during acute inpatient rehabilitation for TBI and community follow-up at 1 yr after injury. RESULTS: Higher reports of depressive symptoms during inpatient rehabilitation and at 1 yr after injury were significantly related to reports of pain at 1 yr when controlling for demographic and injury characteristics. Being female and nonwhite were also factors related to increased reports of pain. Pain and community participation were significantly related until depression was entered into the model. Depression is a significant factor in the relationship between pain and community participation. CONCLUSION: Whereas pain was frequently reported 1 yr after injury, injury-related factors were surprisingly unrelated. Further evaluation of the role that depression plays in the relationship between pain and community participation will be important to determine appropriate management of pain and depression and to optimize participation in individuals with TBI.     

The effect of poststroke cognitive impairment on rehabilitation process and functional outcome

OBJECTIVES: To determine whether cognitive impairment affects access to, or quality of, rehabilitation services, and to examine the effects of functional outcomes in stroke patients. DESIGN: Secondary analysis of prospective cohort of stroke patients followed for 6 months after stroke. SETTINGS: Eleven large-volume US Department of Veterans Affairs hospitals nationwide. PARTICIPANTS: Stroke patients (N=272) who were candidates for rehabilitation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Rehabilitation process variables were examined for patients assessed as cognitively impaired or unimpaired according to education-adjusted Mini-Mental State Examination score. Functional outcomes were performance of activities of daily living (ADLs), measured by the FonFIM, and instrumental activities of daily living (IADLs), measured by Lawton, at 6-month follow-up. RESULTS: Compliance with guidelines and receipt of and interval to postacute treatment initiation did not differ between cognitively impaired and unimpaired patients. Although most cognition-related treatment elements were similar for both groups, cognitive goals were more frequently charted in impaired patients. Controlling for baseline function and rehabilitation process, cognitively impaired patients had worse IADL performance at 6 months than did unimpaired patients; cognition did not significantly influence ADL performance. CONCLUSIONS: Quality of, and access to, rehabilitative care was equivalent for patients with and without cognitive impairment. Despite a similar rehabilitation process, cognitively impaired stroke patients experienced worse recovery of IADLs.     

Occupational orientation in medical rehabilitation and measures for participation in the professional life

Return-to-work and protection of work-related participation is stated as a primary objective of rehabilitation by the statutory pension insurance institutes. A general continuous management of work-related participation in rehabilitation is a prerequisite for optimal results in view of stay in work and return to work. This means an extended vocational orientation in medical rehabilitation, individualized occupational rehabilitation according to need and capacity in connection with closer linkages between medical and occupational rehabilitation. In the course of the "Rehabilitation Sciences" research funding programme and beyond it, quite a few research projects and scientific activities aimed at development, testing and evaluation of -new screenings and diagnostic instruments with better findings of vocational related needs in medical and occupational rehabilitation, -specific methods of therapy and models for treatment settings with immediate reference to the work related restriction and capacity, as well as -models of the organization and forms of cooperation between medical and occupational rehabilitation. This paper reviews the projects and findings in these research fields in relation to the requirements for an increase of general continuous vocational orientation in rehabilitation.