Acute Rehabilitation after Trauma: Does it Really Matter?

Abstract

The impact of post-discharge rehabilitation care for the trauma patient remains poorly investigated. Here we describe the functional outcomes of trauma patients discharged to an inpatient rehabilitation facility (IRF), and compare the likelihood of discharge home, 1-year rehospitalization, and 1-year mortality between patients discharged to an IRF and a propensity score-matched cohort of patients not discharged to an IRF. The Washington State Rehabilitation Registry was used to collect data for all trauma patients discharged to an IRF between 2011 and 2012. These charts were linked to the Washington State Trauma Registry and the Comprehensive Hospital Abstract Reporting System database to obtain detailed patient, injury, and mortality data. Propensity score matching was used to identify a control group of patients who were not discharged to an IRF. Primary outcomes measures were improvement in Functional Independence Measure score with inpatient rehabilitation and the likelihood of discharge home, 1-year rehospitalization, and 1-year mortality. Nine hundred and thirty-three trauma patients were discharged to an IRF between 2011 and 2012. Total functional independence measure scores improved from 63.7 (SD 20.3) to 92.2 (SD 20.9) (p < 0.001) with care at an IRF. When patients discharged to an IRF were compared with the propensity score-matched control patients, rehabilitation was found to significantly increase the likelihood of discharge to home (odds ratio= 9.41; 95% CI, 6.80-13.01) and to decrease 1-year mortality (odds ratio= 0.60; 95% CI, 0.39-0.92). Acute trauma patients should be recognized as an underserved population that would benefit considerably from inpatient rehabilitation services after discharge from the hospital.