Get 20M+ Full-Text Papers For Less Than $1.50/day. Start a 14-Day Trial for You or Your Team.

Learn More →

Development of Complications During Rehabilitation

Development of Complications During Rehabilitation Abstract Background and Methods: Although studies have demonstrated that medical rehabilitation patients have many complications that warrant attention, none has attempted to categorize complications by severity. This retrospective cohort study examined the incidence, types, and severity of problems that interrupt rehabilitation and the major risk factors for these events. Results: Of 1075 patients, 359 (33.4%) had acute medical complications on rehabilitation considered severe enough to interrupt treatment. Of the 359 patients, 158 (44%) required an unexpected transfer off rehabilitation. The most common reasons for unexpected transfer were surgical causes (22.8%), followed by infection or fever (17.1%) and by thromboembolic events (16.5%). Logistic regression revealed that major risk factors for complications requiring transfer were a primary diagnosis of deconditioning or nontraumatic spinal cord injury (adjusted odds ratio, 2.7; confidence interval, 1.8 to 4.2), severity of initial disability (adjusted odds ratio, 1.2; confidence interval, 1.1 to 1.3 for every 10-point drop in a Modified Barthel Index), and number of comorbid conditions (adjusted odds ratio, 1.1; confidence interval, 1.0 to 1.2). Risk factors for any complication were similar, but there was an interaction between comorbidity and the degree of functional impairment; in patients who were severely functionally impaired, the number of comorbidities was not as strongly associated with the risk of complications as it was in patients who were less functionally impaired. Conclusion: There is a complex relationship among the type of underlying medical impairment, severity of functional limitation, comorbidity, and unanticipated medical or surgical complications that interrupt rehabilitation. The interruptions vary both in type and in severity.(Arch Intern Med. 1994;154:2185-2190) References 1. Feigenson JS, McCarthy ML, Greenberg SD, Feigenson WD. Factors influencing outcome and length of stay in a stroke rehabilitation unit, II . Stroke . 1977; 8:657-662.Crossref 2. Felsenthal G, Cohen BS, Hilton EB, Panagos AV, Aiken BM. The physiatrist as primary physician for patients on an inpatient rehabilitation unit . Arch Phys Med Rehabil. 1984;65:375-378. 3. Parry F. Physical rehabilitation of the old patient . J Am Geriatr Soc. 1983;31: 482-484. 4. Stineman MG, Shelton BA, Brody SJ, Shin G. Severe medical complications during rehabilitation pre- and post-introduction of acute care prospective payment . Arch Phys Med Rehabil. 1986;67:650. 5. Stineman MG, Williams SV. Predicting inpatient rehabilitation length of stay . Arch Phys Med Rehabil. 1990;71:881-887. 6. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index . Md Med J. 1965;14:61-65. 7. Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research . Belmont, Calif: Lifetime Learning; 1982. 8. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation . J Chronic Dis. 1987;40:373-383.Crossref 9. Kaplan MH, Feinstein AR. The importance of classifying initial comorbidity in evaluating the outcome of diabetes mellitus . J Chronic Dis. 1974;27:387-404.Crossref 10. Horn SD, Sharkey PD, Buckle JM, Backofen JE, Averill RF, Horn RA. The relationship between severity of illness and hospital length of stay and mortality . Med Care. 1991;29:305-317.Crossref 11. Narain P, Rubenstein LZ, Wieland GD, et al. Predictors of immediate and 6-month outcomes in hospitalized elderly patients . J Am Geriatr Soc. 1988; 36:775-783. 12. Pompei P, Charlson ME, Douglas RG Jr. Clinical assessments as predictors of 1-year survival after hospitalization: implications for prognostic stratification . J Clin Epidemiol. 1988;41:275-284.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Internal Medicine American Medical Association

Development of Complications During Rehabilitation

Loading next page...
 
/lp/american-medical-association/development-of-complications-during-rehabilitation-rboxVB0VVs
Publisher
American Medical Association
Copyright
Copyright © 1994 American Medical Association. All Rights Reserved.
ISSN
0003-9926
eISSN
1538-3679
DOI
10.1001/archinte.1994.00420190085010
Publisher site
See Article on Publisher Site

Abstract

Abstract Background and Methods: Although studies have demonstrated that medical rehabilitation patients have many complications that warrant attention, none has attempted to categorize complications by severity. This retrospective cohort study examined the incidence, types, and severity of problems that interrupt rehabilitation and the major risk factors for these events. Results: Of 1075 patients, 359 (33.4%) had acute medical complications on rehabilitation considered severe enough to interrupt treatment. Of the 359 patients, 158 (44%) required an unexpected transfer off rehabilitation. The most common reasons for unexpected transfer were surgical causes (22.8%), followed by infection or fever (17.1%) and by thromboembolic events (16.5%). Logistic regression revealed that major risk factors for complications requiring transfer were a primary diagnosis of deconditioning or nontraumatic spinal cord injury (adjusted odds ratio, 2.7; confidence interval, 1.8 to 4.2), severity of initial disability (adjusted odds ratio, 1.2; confidence interval, 1.1 to 1.3 for every 10-point drop in a Modified Barthel Index), and number of comorbid conditions (adjusted odds ratio, 1.1; confidence interval, 1.0 to 1.2). Risk factors for any complication were similar, but there was an interaction between comorbidity and the degree of functional impairment; in patients who were severely functionally impaired, the number of comorbidities was not as strongly associated with the risk of complications as it was in patients who were less functionally impaired. Conclusion: There is a complex relationship among the type of underlying medical impairment, severity of functional limitation, comorbidity, and unanticipated medical or surgical complications that interrupt rehabilitation. The interruptions vary both in type and in severity.(Arch Intern Med. 1994;154:2185-2190) References 1. Feigenson JS, McCarthy ML, Greenberg SD, Feigenson WD. Factors influencing outcome and length of stay in a stroke rehabilitation unit, II . Stroke . 1977; 8:657-662.Crossref 2. Felsenthal G, Cohen BS, Hilton EB, Panagos AV, Aiken BM. The physiatrist as primary physician for patients on an inpatient rehabilitation unit . Arch Phys Med Rehabil. 1984;65:375-378. 3. Parry F. Physical rehabilitation of the old patient . J Am Geriatr Soc. 1983;31: 482-484. 4. Stineman MG, Shelton BA, Brody SJ, Shin G. Severe medical complications during rehabilitation pre- and post-introduction of acute care prospective payment . Arch Phys Med Rehabil. 1986;67:650. 5. Stineman MG, Williams SV. Predicting inpatient rehabilitation length of stay . Arch Phys Med Rehabil. 1990;71:881-887. 6. Mahoney FI, Barthel DW. Functional evaluation: the Barthel Index . Md Med J. 1965;14:61-65. 7. Kleinbaum DG, Kupper LL, Morgenstern H. Epidemiologic Research . Belmont, Calif: Lifetime Learning; 1982. 8. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation . J Chronic Dis. 1987;40:373-383.Crossref 9. Kaplan MH, Feinstein AR. The importance of classifying initial comorbidity in evaluating the outcome of diabetes mellitus . J Chronic Dis. 1974;27:387-404.Crossref 10. Horn SD, Sharkey PD, Buckle JM, Backofen JE, Averill RF, Horn RA. The relationship between severity of illness and hospital length of stay and mortality . Med Care. 1991;29:305-317.Crossref 11. Narain P, Rubenstein LZ, Wieland GD, et al. Predictors of immediate and 6-month outcomes in hospitalized elderly patients . J Am Geriatr Soc. 1988; 36:775-783. 12. Pompei P, Charlson ME, Douglas RG Jr. Clinical assessments as predictors of 1-year survival after hospitalization: implications for prognostic stratification . J Clin Epidemiol. 1988;41:275-284.Crossref

Journal

Archives of Internal MedicineAmerican Medical Association

Published: Oct 10, 1994

References