Inpatient Rehabilitation Care Research Articles

Health care utilization in multiple sclerosis: a population-based study in Olmsted County, MN.

The authors sought to determine acute ambulatory- and hospital-billed charges for the Olmsted County, Minnesota Multiple Sclerosis (MS) Disability Prevalence Cohort and compare them to those incurred by the general population. Billed charges for 155 people with clinically definite or laboratory-supported MS were compared with those of age- and gender-matched non-MS controls. Billing data, including all inpatient and outpatient acute and rehabilitative medical care charges over a 5-year period surrounding a December 1, 1991 prevalence date, were analyzed. Data were correlated with level of disability using the Minimal Record of Disability for MS. Median total annual billed charges for most individuals with MS, including those with less severe ($1,277) and relapsing-remitting illness ($1,348), did not differ from those for controls ($1,327, p=0.075). Only those with severe MS (22.6%) had median annual medical charges higher than controls ($5,440, p < 0.001). Male patients with MS had higher median annual total charges ($2,353) than male controls ($762, p=0.003). Total charges for female patients with MS ($1,440) were not different from those for female controls ($1469). Median annual outpatient charges were 15% more for the MS group ($1,418) than for controls ($1,231). Patients with MS had a mean of 0.2 hospital admissions annually compared with 0.1 annual admissions per control patient. Among variables collected on persons with MS, the Expanded Disability Status Scale was the strongest predictor of level of charges (p < 0.001). Acute ambulatory- and hospital-billed charges for most patients with MS do not differ from those of the general population.

Neuromuscular disease: Rehabilitation and electrodiagnosis. 2. Nerve disease

The purpose of this section of the Self-Directed Physiatric Education Program Study Guide on rehabilitation in diseases affecting nerve and muscle is to assist practitioners and trainees in physical medicine and rehabilitation by providing an overview of the evaluation, treatment, and rehabilitative care of patients with inherited and acquired neuropathies. Both diffuse and focal processes are discussed. Current research is briefly reviewed, and the utility and limitations of electrodiagnostic studies are discussed.

Evaluation of and controversies in stroke rehabilitation

The decline in stroke mortality, increased longevi­ ty, and modest increases in the incidence of stroke result in more individuals living with physical dis­ ability caused by cerebrovascular disease. This is creating an increasing burden on the facilities and expertise of individuals who are concerned with the rehabilitation of the patient after stroke. The costs of rehabilitation services are considerable, and there is concern about the cost-effectiveness of rehabilitative care for pat ients with stroke. Not every individual following a stroke is a candi­ date for rehabilitative therapy. A number of investi­ gations have been conducted as to who is most likely to benefit from stroke rehabilitation. Third-party reimbursers in the United States have made determi­ nations on this issue and have set guidehnes for ad­ missioncriteria for inpatient rehabihtation. Admission criteria include that the patient must (a) be medically stable, (b) be responsive to verbal or visual stimuli, (c) have sufficient mental alertness to participate in a program, and (d) have a condition that indicates a potential for rehabilitation with a reasonable expecta­ tion of improvement. The patient must be able to enter a program that requires at least 3 h of active participation per day in physical therapy, occupa­ tional therapy, speech therapy, or rehabilitation nursing. A number of attempts have been made to deter­ mine from the large population of patientswithstroke which ones might be the best candidates for rehabil­ itation. Assuming a population of 100 patients follow­ ing an ischemic cerebral infarction 14 days after the ons et of stroke, approximately 14% of the patients will be dead, 13% will be normal, 20% will have hemi­ plegia, 49% will have hemiparesis, and 4% will have monoparesis. Thus, 73% of the total are potential candidates for inpatient rehabilitation. Analyzing this group of 73 patients, approximately 18-24 will be too well to need inpatient rehabilitation and 18-24 will be too neurologically impaired or medically unstable to be able to enter a rehabilitation program, leaving approximately one-quarter to one-third of the total group as good candidates for rehabilitation.

Rehabilitation Care for Patients

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Rehabilitation Care for Patients

Rehabilitation Care for Patients