Acute Inpatient Rehabilitation Improves Function Independent of Comorbidities in Medically Complex Patients.
Shangming Zhang, Dan Lin, Megan E Wright and 1 others
PMID 35756989WHAT IT FOUND
Medically complex patients in acute inpatient rehabilitation improved function regardless of most comorbidities.
Patients with higher functional gains or efficiency were significantly more likely to go home and less likely to return to acute care, suggesting comorbidity burden alone should not exclude patients from this level of care.
Key findings
01Total Functional Independence Measure (FIM) scores improved significantly from admission to discharge, with a mean gain of 26 points on a 126-point scale.
02Patients with higher functional gains (≥27 points) or better efficiency (≥2.12) were significantly more likely to be discharged home and less likely to return to acute care or go to a skilled nursing facility.
03Hypertension was the only comorbidity significantly associated with lower functional gains and efficiency; age, BMI, and Charlson Comorbidity Index scores showed no significant association with these outcomes.
STILL TO COME
How it was doneWhat they foundWhat it means for PTsWhat it means for OTsWhat it means for SLPs
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What it does not show
Single-center retrospective design limits generalizability to other settings, particularly IRFs housed within acute care hospitals. All patients were admitted under one attending physician, introducing potential selection bias. The population was predominantly White and non-Hispanic, so racial or ethnic disparities in outcomes may not have been captured. The study dichotomized FIM outcomes at the median, which may obscure linear associations between variables. Key social determinants such as family support, socioeconomic status, and psychiatric diagnoses were not captured, yet these heavily influence discharge destination.
Declared interests
No specific funding sources or conflicts of interest were explicitly declared in the provided text, though the study was approved by an institutional review board.
The easy way to misread this
Do not interpret the lack of association between most comorbidities and outcomes as proof that medical complexity is irrelevant to rehab success. The study excluded patients with '60 Percent Rule' compliant diagnoses (like stroke or hip fracture), so these findings apply specifically to the medically complex/debility population, not the general rehab census.