Achieving a minimally important difference in physical function during pediatric inpatient rehabilitation

Abstract

Our objectives were to examine the proportion of children who achieved a minimally important difference (MID) in physical function during inpatient rehabilitation and to identify factors related to achievement of MID. For a consecutive series of 452 inpatient admissions to a pediatric rehabilitation hospital in the northeastern United States, change scores were calculated by subtracting Pediatric Evaluation of Disability Inventory (PEDI) self-care and mobility functional skills and caregiver assistance admission scores from discharge scores and then evaluated for MID. Logistic regression analyses were used to determine the contributions of demographic and clinical variables as predictors of MID for each PEDI scale. More than 55% of the children achieved MID. The highest proportion of children achieving MID was in mobility functional skills (78%) and caregiver assistance (67%). Children who were older at admission (>10 years) had a greater chance of achieving MID on all scales. In addition, associated with achieving MID were longer length of stay, lower admission PEDI score, and a diagnosis of brain injury. More than half of all children admitted achieved MID in physical function. In this pediatric inpatient rehabilitation center, older children with brain injury who have low functional abilities at admission, and are able to extend their length of stay for a safe, planned discharge are most likely to achieve MID. Identifying children who are most likely to make functional progress can help program administrators and clinicians set realistic functional goals and expectations for an episode of inpatient care.