Acute Inpatient Rehabilitation Facility Research Articles

Predicting and Assessing Fall Risk in an Acute Inpatient Rehabilitation Facility

Unintentional falls account for 70% of all hospital accidents. The objective of this study was to identify risk factors for falls and develop an assessment tool specific for an inpatient rehabilitation facility setting. Diagnosis and Functional Independence Measure (FIM) scores were collected for 174 patients to assess predictors for fall risk. Independent t-tests, chi-square, and logistic regression analysis were conducted to examine differences between fallers and nonfallers. We identified several risk factors for falls including 4 FIM items: toileting, bed transfer, tub/shower transfer, and stairs; and three diagnoses: right stroke, traumatic brain injury, and amputation. From these findings, we completed initial development of a risk assessment tool. Evaluation of the tool suggests good specificity with 20%-30% of the patient population identified as high risk and good sensitivity by correctly predicting nearly 90% of patient falls. Continued evaluation of this assessment tool is needed to identify effectiveness in predicting patients who are at high risk for falling.

Functional Outcomes of Persons Who Underwent Dysvascular Lower Extremity Amputations

The aim of this study was to examine the effect of postacute rehabilitation setting on functional outcomes among patients who underwent major dysvascular lower extremity amputations. This is a population-based prospective cohort study conducted in Maryland and Wisconsin. Data collected from medical records and patient interviews conducted during acute hospitalization after amputation and at 6 mos after the acute care discharge were analyzed using multivariate models and instrumental variable techniques. A total of 297 patients were analyzed on the basis of postacute care rehabilitation setting: acute inpatient rehabilitation facility (IRF), skilled nursing facility (SNF), or home. The majority (43.4%) received care in an IRF; 32%, in an SNF; and 24.6%, at home. On the Short Form-36 subscales, significantly improved outcomes were observed for the patients receiving postacute care at an IRF relative to those cared for at an SNF in physical function, role physical, and physical component summary score. Patients receiving postacute care in IRFs also experienced better role physical and physical component summary score outcomes compared with those discharged directly home. In addition, patients receiving postacute care in an IRF were significantly more likely to score in the top quartile for general health in IRF compared with SNF or home and less likely to score in the lowest quartile for physical function, role physical, and physical component summary score in IRF compared with SNF. Lower activity of daily living impairment was observed in IRF compared with SNF. Among this large and diverse cohort of patients who underwent major dysvascular lower limb amputations, receipt of interdisciplinary rehabilitation services in an IRF yielded improved functional outcomes 6 mos after amputation relative to care received in SNFs or at home.

Gait Speed Improves During Physical Therapy in General Acute Care, Skilled Nursing, and Inpatient Rehabilitation - a Pilot Study

Objective: To describe gait speed and gait speed changes that occurred in patients who received physical therapy in general health care settings of acute care, skilled nursing, and inpatient rehabilitation settings. Design: Pre-post observational cross-sectional study of changes in gait speed. Setting: Acute care, skilled nursing, and inpatient rehabilitation facilities of a regional medical center in the United States. Participants: Individuals (n=110) admitted with physical therapy referrals with full weight bearing status who could ambulate 20 feet and consented to participate. Main Outcome Measure: Change in gait speed from initial visit to therapy discharge. Results: Two-way mixed ANOVA determined that mean gait speed improved significantly between initial and discharge time points (p<.001). An interaction effect between gait speed and health care settings (p<.001), indicated varying levels of speed achieved across different health care settings. Post hoc tests using Bonferroni adjustments showed acute care discharge gait speed was not significantly different from skilled nursing (p=0.352), but inpatient rehabilitation was significantly different from both acute care (p<.001) and skilled nursing (p=0.02) units. Paired t-tests of the individual health care settings revealed that gait speed was significantly improved in acute care [initial vs. discharge; 0.31(0.22) vs. 0.38 (0.21) m/s], skilled nursing [0.36 (0.19) vs. 0.61(0.39) m/s], and inpatient rehabilitation [0.60( 0.70) vs. 0.98 (0.72) m/s]. Minimal detectable change for gait speed was 0.16m/s in acute care, 0.14m/s in skilled nursing, and 0.51m/s inpatient rehabilitation. Conclusions: Self-selected gait speed is an informative measure. Gait speed improved from physical therapy initial evaluation to discharge in 3 different health care settings. In acute care, gait speeds improved over a short course of therapy, but these speeds would still be considered to be slow relative to community requirements. In skilled nursing and inpatient rehabilitation, patients achieve gait speeds required for limited community level ambulation.

The effect of a wearable visual cue on patient satisfaction survey scores in the acute inpatient rehabilitation setting

With a portion of healthcare reimbursement now dependent on the patient’s report of the hospital experience, healthcare systems are looking for ways to improve patient satisfaction scores. In this study, one inpatient physiatrist at an acute inpatient rehabilitation facility wore a button on the right lapel of his white coat at all times which read, “Ask ME about your TREATMENT and PROGRESS!!!” in order to determine if a wearable visual cue prompting the patient to discuss his or her treatment and progress alters Press Ganey Patient Satisfaction Survey (PGPSS) scores. Mean score on the physician-specific PGPSS question “How well the rehabilitation doctor kept you informed about your treatment and progress” was calculated retrospectively for five months before and after the physiatrist donned the button. Comparisons were made to two other inpatient physiatrists. For the button-wearing physiatrist, mean score for the physician-specific patient satisfaction survey question for the five months before donning the button was 88.1 ± 11.5; and, for the five months after donning the button, the mean score was 95.8 ± 5.9. These scores were marginally statistically different (p = 0.07). Conversely, the difference in mean scores over the same time periods for two other inpatient physiatrists who did not wear the button did not approach statistical significance. In conclusion, a wearable visual cue improved the PGPSS score specific to the question the visual cue addressed.

Extension of the Representativeness of the Traumatic Brain Injury Model Systems National Database

To extend the representativeness of the Traumatic Brain Injury Model Systems National Database (TBIMS-NDB) for individuals 16 years and older, admitted for acute, inpatient rehabilitation in the United States with a primary diagnosis of traumatic brain injury (TBI) analyses completed by Corrigan and colleagues by comparing this data set to national data for patients admitted to inpatient rehabilitation with identical inclusion criteria that included 3 additional years of data and 2 new demographic variables. Secondary analysis of existing data sets and extension of previously published analyses. Acute inpatient rehabilitation facilities. Patients 16 years and older with a primary rehabilitation diagnosis of TBI; the US TBI Rehabilitation population, n = 156 447; and the TBIMS-NDB population, n = 7373. None. Demographics, functional status, and length of stay in hospital. The TBIMS-NDB was largely representative of patients 16 years and older, admitted for rehabilitation in the United States with a primary diagnosis of TBI on or after October 1, 2001, and discharged as of December 31, 2010. The results of the extended analyses were similar to those reported by Corrigan and colleagues. Age accounted for the largest difference between the samples, with the TBIMS-NDB including a smaller proportion of patients 65 years and older than all those admitted for rehabilitation with a primary diagnosis of TBI in the United States. After partitioning each data set at age 65, most distributional differences found between samples were markedly reduced; however, differences in the preinjury vocational status of the employed and rehabilitation lengths of stay between 1 and 9 days remained robust. The subsamples of patients 64 years and younger were found to differ only slightly on all remaining variables, whereas those 65 years and older were found to have meaningful differences in insurance type and age distribution. These results reconfirm that the TBIMS-NDB is largely representative of patients with TBI receiving inpatient rehabilitation in the United States. Differences between the 2 data sets were found to be stable across the 3 additional years of data, and new differences were limited to those involving newly introduced variables. To use these data for population-based research, it is strongly recommended that statistical adjustment be conducted to account for the lower percentage of patients older than 65 years, inpatient rehabilitation stays less than 10 days, and preinjury vocational status in the TBIMS-NDB.

Representativeness of the Traumatic Brain Injury Model Systems National Database.

To determine whether the Traumatic Brain Injury Model Systems National Database (TBIMS-NDB) is representative of individuals aged 16 years and older admitted for acute, inpatient rehabilitation in the United States with a primary diagnosis of traumatic brain injury (TBI). Secondary analysis of existing data sets. Acute inpatient rehabilitation facilities. Patients aged 16 years and older with a primary rehabilitation diagnosis of TBI. Demographic characteristics, functional status, and hospital length of stay. Patients included in the TBIMS-NDB from October 2001 through December 2007 were largely representative of all individuals 16 years and older admitted for rehabilitation in the United States with a primary diagnosis of TBI. The major difference in distribution was age-the TBIMS-NDB cohort did not include as large a proportion of patients older than 65 years as were admitted for rehabilitation with a primary diagnosis of TBI in the United States. Distributional differences for age-related characteristics were observed; however, groups of patients partitioned at aged 65 years differed minimally, especially within the younger than 65 years subset. Regardless of age, the proportion of patients with a rehabilitation stay of 1 to 9 days was larger nationwide. Nationwide admissions showed an age distribution similar to patients discharged alive from acute care with moderate, severe or penetrating TBI. The proportion of patients aged 70 years and older admitted for TBI rehabilitation in the United States increased every year, a trend that was not evident in the general population, TBIMS-NDB or among TBI patients in acute care. These results provide substantial empirical evidence that the TBIMS-NDB is representative of patients receiving inpatient rehabilitation for TBI in the United States. Researchers utilizing the TBIMS-NDB may want to adjust statistically for the lower percentage of patients older than 65 years or those with stays less than 10 days.

Poster 519 Acute Cervical Myelopathy Caused By Chiropractic Manipulation in a Young Person With a Cervical Osteochondroma: A Case Report

diagnoses. Design: Prospective cohort study. Setting: Acute inpatient rehabilitation facility. Participants: 78 inpatients. Interventions: Weekly calorie and protein intake calculations by registered dieticians. Main Outcome Measures: Mean calorie and protein intake. Results: Mean calorie intake (kcal) for the SCI, traumatic brain injury (TBI), Stroke, and Parkinson’s groups was 1967.9 611.6, 1546.8 352.3, 1459.7 443.2, and 1459.4 434.6, respectively. ANOVA revealed a significant overall group difference [F(3,74) 4.74, P .004]. Pairwise comparisons showed significant differences between SCI and Stroke (P .003) and SCI and Parkinson’s (P .045). Mean calorie intake per body weight (kcal/kg) for the SCI, TBI, stroke, and Parkinson’s groups was 24.4 9.8, 20.4 5.3, 17.4 8.4, and 19.2 6.6, respectively. ANOVA again revealed a significant overall group difference [F(3,74) 2.84, P .044]; however, pairwise comparison only found a significant difference between SCI and Stroke (P .025). Mean protein intake (g) for the SCI, TBI, Stroke, and Parkinson’s groups was 71.5 25.0, 61.1 12.8, 57.6 16.6, and 55.1 19.1, respectively. ANOVA revealed a marginally significant overall group difference [F(3,74) 2.50, P .066]. Pairwise comparisons only found a marginally significant difference between SCI and Stroke (P .060). Mean protein intake per body weight (g/kg) for the SCI, TBI, Stroke, and Parkinson’s groups was 0.89 0.39, 0.81 0.18, 0.68 0.29, and 0.73 0.28, respectively. ANOVA did not reveal a significant difference between the groups [F(3,74) 1.97, P .126]. Conclusions: Given the diet-related comorbidities and decreased resting metabolic rate associated with SCI patients in combination with the intake levels demonstrated in this study, education with regard to appropriate calorie and protein intake in patients with SCI should be employed in the acute inpatient rehabilitation setting.

Poster 121 Predicting Fall Risk in Acute Inpatient Rehabilitation Facilities

Patient falls during a hospital admission can result in serious injury and considerable financial implications however; no falls assessment tool has been developed specifically for use in an acute inpatient rehabilitation facility (IRF). The objective for this study is to identify risk factors for falls and develop an assessment tool specific for an IRF setting. Prospective clinical study. Inpatient Rehabilitation Facility. Patients consecutively admitted to a 68-bed rehabilitation hospital. Diagnosis, FIM scores, and pre-morbid history were collected for all patients to assess predictors for fall risk. From these a risk assessment tool was created and tested for its effectiveness. Independent T-tests were conducted for FIM scores, and chi-square tests for diagnosis, pre-morbid history, and other symptoms to examine differences between fallers and non-fallers. Logistical regression and chi-square analysis were used to determine the relative risk score associated with each predictive factor and these scores were used to develop a risk assessment tool. Several risk factors for falls were identified including four FIM scores; toileting, bed transfer, tub/shower transfer, and stairs, and three diagnoses; right stroke, traumatic brain injury, and amputation. From these findings a risk assessment tool was created. In this study several risk factors for falls were identified and used to create an assessment tool specific for an IRF. Thus far this tool has correctly predicted nearly 90% of patient falls and dropped the fall rate by 25%.

Hospital to Home

This study describes a social-worker navigator transitional care model for at-risk seniors being discharged from hospital to home. The model is designed to prevent rehospitalizations so as to improve quality of life and patient outcomes. This model is different from others with its focus on the psychosocial aspects of care transitions, medical needs, and individualized needs with the provision of nonreimbursable services. Care begins in the acute care hospital or inpatient rehabilitation facility and continues in the postdischarge home environment. Participants are connected to community services to support their independent living at home. Case managers, physicians, or others refer potential participants to the navigator. Criteria for inclusion include the following: age 65 years or older, Medicare and/or Medicaid recipient, living in the same county as the hospital, and having at least 2 of a list of 11 criteria that predict readmission. After the participant agrees to enroll, the navigator recommends in-home services at discharge. Within the first 72 hr, the navigator makes a home visit to evaluate the home environment, assess medical management, and make referrals for other services. Follow-up phone calls and other home visits are made by the navigator during the participant's enrollment, which is from 30 days to 4 months. Hospital readmissions were decreased by 61% for this high-risk population. Cost savings by preventing readmissions correlated to a cost savings of $628,202 per year. The 36-Item Short-Form Health Survey showed statistically significant improvements in quality-of-life scores for both physical and mental health summary scales and for all 8 subscales (p < .004). Almost all (99%) of respondents were satisfied with the overall Hospital to Home program. The results of this study demonstrate the importance of extending social support and health education into the home after discharge from the hospital. Access to immediate in-home care services such as transportation, housekeeping, laundry, and light meal preparation allows patients not to experience gaps in care that could result in a readmission. The assigned navigator reinforces medical management and connects participants to appropriate community resources in order to remain safe at home.

New approach in acute spinal chord injury: out with traditional narcotics

Acute pain is a prevalent consequence in traumatic and nontraumatic spinal cord injury (SCI). Treatment often includes narcotics that can exacerbate neurogenic bladder and bowel, which in turn can be devastating to achieving independence. We hypothesized that an integrative approach including massage therapy, deep breathing, and tapentadol would treat acute pain, decrease narcotics, and have minimal impact on bowel and bladder function. We report an observation, ongoing case-series in an acute inpatient rehabilitation facility.

Changes in Functional Independence Measure Ratings Associated with a Safe Patient Handling and Movement Program

Safe patient handling and movement (SPHM) programs are effective in reducing healthcare worker injuries. However, the perception among rehabilitation personnel that SPHM equipment promotes patient dependence and adversely affects functional outcomes is one barrier to implementing successful programs. This barrier is particularly evident in acute inpatient rehabilitation facilities, where functional independence is the primary goal. The purpose of this retrospective cohort study was to evaluate this perception. Functional Independence Measure (FIM) ratings were collected from 94 patients with a diagnosis of stroke. Forty-seven patients were admitted 1 year prior to implementation of the SPHM program (Group 1), and 47 were admitted to the facility over a period of 1 year (Group 2) 18 months after program implementation. Group 2 obtained equal or better discharge mobility FIM ratings than Group 1, who received care without the SPHM equipment. This study suggests that SPHM programs do not impede functional outcomes in stroke patients.

*Poster 54: Rehabilitation Services Provided to Patients With Traumatic and Nontraumatic Spinal Cord Injury in Acute Care and Inpatient Rehabilitation Facility

*Poster 54: Rehabilitation Services Provided to Patients With Traumatic and Nontraumatic Spinal Cord Injury in Acute Care and Inpatient Rehabilitation Facility

The relation of body mass index, demographic and health-related variables to length of stay for patients at an acute rehabilitation hospital after total hip arthroplasty

The relation of body mass index, demographic and health-related variables to length of stay for patients at an acute rehabilitation hospital after total hip arthroplasty Karin Greenberg1, Thilo Kroll21Medical Rehabilitation, Inc, Pittsburgh, PA, USA; 2National Rehabilitation Hospital (NRH), Washington DC, WA, USAAbstract: Obesity is a growing public health concern world-wide. At the same time, knee and hip replacements are becoming an increasingly regular treatment for osteoarthritis. There are conflicting reports in the literature as to what extent body mass affects the length of stay (LOS) of patients undergoing total hip replacements. This chart review aims at examining the &shy;relationship between body mass index (BMI), demographic and health-related variables, and LOS. The retrospective chart review of one acute inpatient rehabilitation facility involved n = 119 patients. There was no significant association between LOS and body mass index (BMI), confirming earlier results. Insurance payer type (Medicare vs private) was statistically significant related to LOS. Moreover, there was a trend for the potential influence of race/ethnic patient background on LOS with Caucasians having shorter hospital stays.Keywords: total hip arthroplasty, obesity, rehabilitation, length of stay, body mass index

One City, Two Worlds

The scenario is becoming achingly familiar to me: a woman in her fifties with no health insurance suffers a stroke. With luck, it is a small stroke--a warning sign. But the patients I'm likely to see as a rehabilitation physician are usually not that lucky. The stroke is invariably large, causing significant disability. And the other familiar part of this scene? While treating her, I discover, unbeknownst to the patient, that her blood sugar and blood pressure are out of control. Undoubtedly, the undiagnosed hypertension and diabetes contributed to the stroke. So what's the back story? Perhaps she works a job that doesn't provide insurance, or she can't afford the premiums. She has mouths to feed, rent to pay, and bills. She's raising her children in a violent neighborhood where the schools are inferior, receiving a little over half of the tax dollars per student that the wealthier suburban schools do. She takes three buses to get to work. Her neighborhood has no grocery stores with healthy food, only fast food and liquor stores. Preventive health care is not an option. The acute care hospital where the uninsured person is admitted immediately starts the process of applying for aid. The process takes about three months--the initial months most critical for stroke rehabilitation--and in the meantime, finding an acute inpatient rehabilitation facility willing to accept a patient who is public aid pending is extremely difficult. Once the aid is in place, medical options will be a little easier to find--but only a little. Fewer doctors accept aid. An elective procedure--like a knee replacement for crippling arthritis--is almost unattainable for many aid patients. After working on Chicago's upscale Gold Coast for twenty-two years, I recently moved my clinical practice to the Lawndale community, one of Chicago's poorest. I joined Schwab Rehabilitation Hospital, part of the Sinai Health System. Though they are only five miles apart, the neighborhoods and the health care systems couldn't be more different. Since I first learned about George Engel's biopsychosocial model of medicine in medical school twenty-five years ago and throughout my following years practicing physiatry, I've been increasingly convinced that such a heuristic best captures the scope of the problems (and potential solutions) in health care. A core principle for rehabilitation physicians is that disability is a product of both the patient and the environment. An expanded notion of this principle is now being captured in the biopsychoecological model, which adds an environmental perspective to the social domain. I think about my young stroke patient from Lawndale in this context. She may be impaired from her stroke, but her mobility difficulties are exacerbated by lack of a wheelchair-accessible home, curb cuts, and safe transportation systems. The environment is absolutely critical to her health and well-being, as are her medications, an appropriate diet, personal assistant services, and health care professionals who accept aid. While these issues are not unique to Lawndale and can arise on the Gold Coast as well, the pervasiveness, scope, and severity of these issues are exponentially worse for those in the former community. So here I am--thinking more about these basic needs than whether the Lokomat or robotic therapy is the best treatment for my patient's hemiparesis. I'm lucky because my current hospital system is one of the few that provides rehabilitation services for patients who are public aid pending, but what about her medications, medical supplies, and needed equipment? What about transportation to and from appointments? And how to get her timely, adequate personal assistant services? This latter is particularly critical as her daughter--the first of her family to attend college--is considering dropping out of school to take care of her mom. The only other viable alternative--a urinesoaked, short-staffed nursing home--is simply too heartbreaking to consider. …

Implementing a Back-to-Rehab Day

This article discusses the process of planning and implementing an event during which former patients are invited to return to their acute inpatient rehabilitation facility to visit the treating team, provide information about their treatment satisfaction, participate in follow-up interviews, and measure the functional gains made since discharge. For staff members and former patients and their families, Back-to-Rehab Days are rewarding and educational experiences.

Rehabilitation of a Marathon Runner with Guillain-Barré Syndrome

Guillain-Barré syndrome (GBS) is an acute inflammatory demyelinating polyradiculoneuropathy that affects nerve roots and peripheral nerves leading to motor neuropathy and flaccid paralysis. This case report describes the physical therapy examination, intervention, and outcomes for a marathon runner with GBS. The patient was a 30-year-old male marathon runner who presented with acutely evolving motor and sensory deficits that initially stabilized and then worsened. Both GBS and chronic inflammatory demyelinating polyradiculoneuropathy were considered as diagnoses, and medical treatment included a combination of intravenous administration of immunoglobulins, plasmapheresis, and corticosteroids. During his stay in an acute inpatient rehabilitation facility, the intervention was focused on regaining functional independence and strength with care not to induce fatigue or relapse. After three weeks in an acute inpatient rehabilitation facility, the patient showed marked gains in Functional Independence Measure scores and muscle performance as measured by manual muscle testing.

Poster 56: Pneumonias in Tracheostomy Patients: Does Topical Oral Chlorhexidine Decrease Incidence During Inpatient Rehabilitation?

Objective: To evaluate the effects of chlorhexidine, demographic variables, dysphagia, and their interaction on pneumonia incidence and resultant discharge destination in patients admitted to inpatient rehabilitation with tracheostomies. Design: Retrospective case-control study. Setting: Freestanding acute inpatient rehabilitation facility. Participants: 226 subjects admitted with tracheostomies over a 1-year period (2006). Interventions: All medical records of patients admitted to inpatient rehabilitation with a tracheostomy and discharged in 2006 were reviewed.

The Medicare Post-Acute Care Payment Reform Initiative

The Deficit Reduction Act of 2005 mandated that a standardized patient assessment occurs for all Medicare recipients at hospital discharge (regardless of whether they are transferred to a post-acute care [PAC] setting) and during stays in PAC settings to support PAC payment reform. The purpose of this article is to describe the current progress on this initiative and the impact and opportunities it presents for case managers. The mandate applies to acute care hospitals, skilled nursing and inpatient rehabilitation facilities (IRFs), home health (HHA), and long-term care hospitals. The PAC payment reform demonstration project is under way. The same standardized assessment tool will be utilized to measure the patient's health and functional progress throughout the entire episode of care. A Web application for providers to submit the assessment data to Center for Medicare and Medicaid Services is also under development. A final report must be submitted in Congress in 2011. 1. An assessment of a patient's discharge health and functional status will be available to the healthcare team to determine appropriate placement into a PAC site. 2. A patient's health and functional progress will be monitored throughout an episode of care. 3. Case managers have long known that paying attention to patients' needs across the care continuum can impact the outcomes of the care provided. 4. You can impact this initiative by discussing the opportunity to participate in the effort with other members of your organization and/or providing information on patient characteristics important to the discharge/transfer decision to the study team.

Poster 303: Paraplegia After Implantation of Spinal Cord Stimulator and Resultant Hematoma Development in a Patient With Chronic Pain: A Case Report

Setting: Acute inpatient rehabilitation facility. Patient: A 59-year-old woman with postlaminectomy syndrome. Case Description: The patient’s history involved multilevel degenerative disk disease, knee derangement, neck fusion, and multiple failed back surgeries. She subsequently had a T8-9 spinal cord stimulator implanted for chronic pain control. 2 days after the procedure she returned to the emergency department for severe abdominal pain and computed tomography (CT) was performed. Just prior to the test the patient noted significant difficulty transferring onto the examination table, and by its end reported the inability to move either of her legs.

Association of Environmental Factors With Levels of Home and Community Participation in an Adult Rehabilitation Cohort

Keysor JJ, Jette AM, Coster W, Bettger JP, Haley SM. Association of environmental factors with levels of home and community participation in an adult rehabilitation cohort. Objective To examine whether home and community environmental barriers and facilitators are predictors of social and home participation and community participation at 1 and 6 months after discharge from an acute care or inpatient rehabilitation hospital. Design Cohort study. Setting Postacute care. Participants Adults (N=342) age 18 years or older with a diagnosis of complex medical, orthopedic, or neurologic condition recruited from acute care and inpatient rehabilitation facilities. The mean age ± standard deviation of participants was 68±14 years; 49% were women and 92% were white. Interventions Not applicable. Main Outcome Measures Participation in social, home and community affairs as assessed with the Participation Measure for Post-Acute Care. Results Adjusting for covariates, 1 month after discharge a greater presence of home mobility barriers ( P<.01) was associated with less social and home participation; whereas greater community mobility barriers ( P<.01) and more social support ( P<.001) were associated with greater participation. At 6 months, social support was the only environmental factor associated with participation after adjusting for covariates. Conclusions This study provides new empirical evidence that environmental barriers and facilitators do influence participation in a general rehabilitation cohort, at least in the short term.