Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3083 — Efficacy of Rehabilitation Interventions on OEF/OIF Veterans with Combat Related Injuries

Siddharthan K (Tampa VAMC) , Bass E (Tampa VAMC), Scott S (Tampa VAMC), Foulis P (Tampa VAMC)

Objectives:
We analyzed initial inpatient rehabilitation healthcare use and associated health outcomes among 38 veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) wounded in combat and referred to the Polytrauma Rehabilitation Center (PRC) at the Tampa VAMC from September 2003 to June 2006 to determine VA resource utilization and its effectiveness in rehabilitation. Health outcomes were measured as improvements in Functional Independence Measure (FIM) scores; which are widely used to determine disability and rehabilitation outcomes in the domains of Self Care, Sphincter control, Mobility, Locomotion, Communication, and Social Cognition.

Methods:
We used the Tampa VA Decision Support System (DSS) to obtain data on health care utilization and associated costs of all 38 veterans included in the study. FIM scores were recorded initially at admission to the PRC and at discharge. Due to the small sample size and diversity in scale and scope in treatment we used the Tampa DSS total cost estimate for hospitalization as a proxy for length of stay and rehabilitation interventions. Improvements in FIM scores in each domain were computed. Regression analysis was conducted to analyze the effect of resource utilization on improvement in aggregate FIM scores.

Results:
The average age of combat returnees was 26 (standard deviation: 7.8). The predominant diagnosis was Traumatic Brain Injury. Mean length of stay was 36 (26) days at an average cost of $48,500 ($34k). Rehabilitation resulted in a marked decrease in disability with an average improvement in aggregate FIM scores of 89 percent (112 percent) corresponding to a change in absolute scores at 36 (25.6) points. Total cost of rehabilitation interventions significantly (p<.01, R squared: .20) influenced change in FIM scores with average improvement of 2 percent for every $1,000 in hospitalization utilization. Scores showed significant increase (p<.01) in all domains except Social Cognition.

Implications:
Our limited analysis clearly indicates that intensive therapy decreases disability and increases functional ability. Future studies using more extensive data from all four Level 1 PRCs in the nation need to research the efficacy of specific interventions on appropriate outcomes especially as they pertain to mental health issues such as Post Traumatic Stress Disorders.

Impacts:
This study represents one of the first VA research efforts on rehabilitating wounded veterans from combat theatres in Iraq and Afghanistan. With increasing numbers of wounded arrivals in VA facilities, this effort is a first step in understanding cost effective rehabilitation pathways for servicemen/women wounded in combat.