Citation

Ganesh S, Guernon A, Chalcraft L, Harton B, Smith B, Pape TL. Arch. Phys. Med. Rehabil. 2013; 94(10): 1899-1907.e3.

Affiliation

The Department of Veterans Affairs (VA), Research Service and the Center for Management of Complex Chronic Care Center of Excellence, Edward Hines Jr. VA Hospital, PO Box 5000 (M/C 151H), Hines, IL 60141; Edward Hines JR. VA Hospital, Physical Medicine and Rehabilitation Service (MC 116), Hines, IL 60141.

Copyright

(Copyright © 2013, Elsevier Publishing)

DOI

10.1016/j.apmr.2012.12.026

PMID

23735521

Abstract

OBJECTIVE: To identify, for patients in states of seriously impaired consciousness, co-morbid conditions present during inpatient rehabilitation and their association with function at one year. DESIGN: Abstracted data from a prospective cross sectional observational study SETTINGS: Four inpatient rehabilitation facilities in metropolitan areas PARTICIPANTS: 68 of 157 patients remaining in states of seriously impaired consciousness for at least twenty-eight days. Data collection occurred from January 1996 through December 2007. INTERVENTIONS: Not Applicable MAIN OUTCOME MEASURES: 1 year cognitive, motor, and total Functional Independence Measure (TM) (FIM) score RESULTS: The most common medical complications during inpatient rehabilitation for the study sample are active seizures (46%), spasticity (57%), urinary tract infections (47%) and hydrocephalus with and without shunt (38%). Presence of three or more medical complications during inpatient rehabilitation, controlling for injury severity, is significantly (p < 0.05) associated with poorer Total FIM and FIM motor scores one year after injury. The presence of hydrocephalus with and without shunt (r = -0.20, -0.21, -0.18, (p here 0.15)), active seizures (r = -0.31, -0.22, -0.42), spasticity (r =-0.38, -0.28, -0.40) and urinary tract infections (UTI) (r =-0.25, -0.24,-0.26) were significantly (p < 0.1 or lower) associated with Total FIM, FIM Cognitive and FIM motor scores, respectively. CONCLUSIONS: Reported findings indicate that persons in states of seriously impaired consciousness with higher numbers of medical complications during inpatient rehabilitation are more likely to have lower functional levels one-year post injury. The findings indicate that persons with three or more medical complications during inpatient rehabilitation are at higher risk for poorer functional outcomes at one year. It is, therefore, prudent to evaluate these patients for indications of these complications during inpatient rehabilitation.

Language: en