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IIR 94-125 – HSR&D Study

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IIR 94-125
Evaluation of Subacute Rehabilitative Care
Ronald L. Evans MSW
VA Puget Sound Health Care System Seattle Division, Seattle, WA
Seattle, WA
Funding Period: January 1997 - June 2000

BACKGROUND/RATIONALE:
Prior rehabilitation outcome studies had many weaknesses. They had: a) evaluated rehabilitation effects only in isolated subgroups, b) focused on functional ability rather than on quality of life, c) not used randomized control groups, and d) had inadequate sample sizes. Differences in methodological approaches have resulted in inconsistent findings. The lack of long-term benefits suggests that services may need to be continued at home or in subacute care settings to optimize their effectiveness. Unfortunately, prior research did not include behavioral outcomes. The potential benefits of rehabilitative care could thus not be evaluated by these studies in more meaningful detail, and they did not accurately reflect the psychosocial objectives of rehabilitation.

OBJECTIVE(S):
The goal of this study was to measure the additive effect of outpatient, subacute rehabilitation as follow-up services to acute, inpatient rehabilitation on adults diagnosed with a disabling disorder in four major diagnostic groups (nervous, circulatory, musculoskeletal, and injury).

METHODS:
A randomized clinical trial was conducted to determine the effects of subacute rehabilitative care on: 1) physical function, 2) health and mental health, 3) mortality, 4) family function, 5) personal adjustment, and 6) use of health care resources. Patients hospitalized for the first time with a disabling condition [n=180] were provided inpatient rehabilitation and then randomly assigned to either subacute rehabilitation at home [n=90] or to usual outpatient follow-up [n=90] in which only medical services were provided but no scheduled rehabilitative therapies were offered. To compare the two groups, analysis of covariance was conducted for the outcome variables. The between subjects factor was subacute rehabilitative care versus usual medical services as an outpatient.

FINDINGS/RESULTS:
The major finding of the study was that there was no significant effect of the study intervention on any study outcome.

IMPACT:
Some prior clinical trials had noted a short term treatment effect on functional ability but not on mortality, need for skilled care, or for health or mental health status. Any long term benefit, however, may not be detectable across disability categories and may required closer evaluation in studies with a more homogeneous population than in the current study. Providing follow-up services to all clients is apparently not beneficial. Future studies should determine if services are more effective when provided to those with the most unmet rehabilitative needs.

PUBLICATIONS:

Journal Articles

  1. Evans RL. Perceived functional health of disabled elderly persons in a follow-up program for primary care. Psychological reports. 1999 Apr 1; 84(2):553-7.
  2. Evans RL, Connis RT, Haselkorn JK. Hospital-based rehabilitative care versus outpatient services: effect on functioning and health status. Disability and rehabilitation. 1998 Aug 1; 20(8):298-307.
Books

  1. Evans RL, Technical Advisory. Case Management Outcomes & Measures: A Source Book. Washington, DC: National Center for Cost Containment: US Department of Veteran Affairs; 1998.
Conference Presentations

  1. Evans RL. Research Agenda and Grant Authorization. Paper presented at: American Association of Spinal Cord Injury Psychologists and Social Workers Annual Conference; 1998 Sep 15; New York, NY.
  2. Evans RL. Educational Goals in Spinal Cord Injury Care. Paper presented at: Eastern Paralyzed Veterans Association Annual Meeting; 1998 Sep 15; Las Vegas, NV.


DRA: Health Systems, Acute and Combat-Related Injury
DRE: none
Keywords: Disability, Organizational issues
MeSH Terms: Disabled Persons, Rehabilitation, Subacute Care

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