Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1059 — Predictors of Functional Improvement during Acute Inpatient Rehabilitation among Combat-Injured Service Members

Sayer NA (CCDOR, Minneapolis COE) , Chiros C (CCDOR, Minneapolis COE), Scott S (PM&R, James A. Haley VAMC), Sigford B (PM&R, Minneapolis VAMC), Prickett T (PRC, McGuire VAMC), Lew H (PM&R Palo Alto VAMC), Clothier B (CCDOR, Minneapolis COE)

Objectives:
To identify predictors of improvement among combat injured service members treated at the four Polytrauma Rehabilitation Centers (PRC) and to determine whether blast-related injuries are unique.

Methods:
Observational study based on chart abstraction and VA administrative data. Cognitive and Motor Functional Independence Measure (FIM) gain scores were the primary outcomes. Participants included all military personnel who received acute inpatient rehabilitation for war injuries sustained in OIF/OEF at a PRC between October 2001 and January 2005. Multiple regression analyses were used to identify predictors of change from admissions to discharge in Cognitive and Motor FIM scores, controlling for covariates.

Results:
Most of the 188 patients sustained injuries to more than one body system or organ. Head injury was the primary injury for all but two patients. Blasts impacted more body systems and/or organs than other mechanisms of injury (p < .0001), with the median and modal number of injuries associated with blasts being five (range 1 to 9). Soft tissue (wounds, burns), eye, oral/maxillofacial, otologic, and penetrating brain injuries were more common in blast injured patients than in those with war injuries secondary to other mechanisms. Admissions Cognitive FIM, days from injury to admissions (logged), education, and intervention for a mental health problem contributed to Cognitive FIM gain (R2 = .42). Admissions Motor FIM, days from injury to admissions (logged), and length of stay (logged) contributed to Motor FIM gain (R2 = .38). Greater independence at admissions was associated with less improvement whereas earlier acute rehabilitation intervention was associated with greater improvement in FIM scores. Greater education and intervention for a mental health problem were associated with greater gains in cognitive independence. Longer lengths of stay were associated with greater improvements in motor function.

Implications:
PRCs are serving the population of patients for whom they were designated. Although blasts produce a unique constellation of injuries, they do not have a differential impact on FIM gain.

Impacts:
Findings confirm a clinical complexity of PRC inpatients that warrants innovative approaches to acute rehabilitation. Analysis of FIM gain indicates that service members with blast-related injuries are as likely to benefit from inpatient rehabilitation as those with other combat-related injuries.