Functional Outcomes Among American Indian and Alaska Native Children in Inpatient Rehabilitation

Abstract

Disclosures: M. Fuentes, No Disclosures: I Have Nothing To Disclose. Objective: To compare the functional changes during inpatient rehabilitation of American Indian and Alaska Native (AI/AN) children to non-Hispanic White (NHW) children. Design: Retrospective cohort study. Setting: Tertiary pediatric hospital inpatient rehabilitation unit. Participants: 65 AI/AN and 699 NHW children age 0-21 who participated in inpatient rehabilitation from January 1996 through December 2011. Interventions: Not applicable. Main Outcome Measures: Age, gender, percentage of traumatic etiology, length of time from traumatic injuries to rehabilitation admission, length of stay, WeeFIM total and subscale scores at admission and discharge, change in WeeFIM scores from admission to discharge and WeeFIM efficiency (change in WeeFIM divided by length of rehabilitation stay). Results or Clinical Course: AI/AN children were significantly younger (10.3 4.9 years versus 12.1 4.9 for NHWs; p1⁄4.004). No differences found in gender (AI/AN 59% male versus NHW 62%, p1⁄4.581), percentage of traumatic impairments (AI/AN 52% versus NHW 43%, p1⁄4.150), time to rehabilitation from traumatic injury (31.6 days 38.0 versus 27.5 40.7, p1⁄4.561) or length of stay (20.8 days 11.7 versus 21.4 16.7; p1⁄4.561). On admission, no significant differences found in total WeeFIM (56.8 27.9 versus 61.6 27.8, p1⁄4.194) or subscale scores. At discharge, AI/AN children had significantly lower total WeeFIM (79.9 30.2 versus 88.4 27.6, p1⁄4.032) and mobility (21.4 9.1 versus 24.6 8.3, p1⁄4.008) scores. The change in WeeFIM score from admission to discharge was significantly different between groups only for the mobility subscale (8.2 5.8 versus 9.8 6.2, p1⁄4.047). No significant difference found in WeeFIM efficiency (1.5 1.6 versus 1.8 1.4, p1⁄4.227). Conclusions: In this cohort of children admitted to inpatient rehabilitation, AI/AN children had similar functional status to NHW children on admission to rehabilitation but at discharge had lower mobility and total WeeFIM scores with smaller functional change from admission to discharge in the WeeFIM mobility subscale. Further work is needed to identify factors influencing these outcomes and to characterize the post-hospital experience of AI/AN children who received inpatient rehabilitation.