MULTIDISCIPLINARY REHABILITATION VERSUS MEDICAL-CARE - A METAANALYSIS

Research studies in physical medicine have not demonstrated the effect iveness of inpatient rehabilitation services, primarily due to differe nces in methodological approaches which have led to inconsistent findi ngs. Because of differing inclusion and outcome criteria, even meta-an alyses have been inconclusive. To address this problem, research liter ature comparing the clinical effectiveness of rehabilitation programs with medical care was evaluated for three uniformly available outcome criteria: survival; functional ability; and discharge location. Publis hed trials were obtained from citations in Index Medicus (Medline) and Nursing and Allied Health Abstracts covering the recent 20 year perio d from 1974 to 1994. We used meta-analyses to test the hypotheses that specialized rehabilitative care (vs conventional medical care) improv es health outcomes. Results of our meta-analyses indicated that rehabi litation services were significantly associated with better rates of s urvival and improved function during hospital stay (P<0.01), but signi ficance was not observed at follow-up. Also, rehabilitation patients r eturned to their homes and remained there more frequently than control s (P<0.001). We concluded that patients who participate in inpatient r ehabilitation programs function better at hospital discharge, have a b etter chance of short term survival, and return home more frequently t han non-participants. However, long term survival and function were th e same for experimental and control subjects. The sustaining benefit o f returning home may suffice to justify the provision of inpatient reh abilitation. However, the lack of other long term benefits suggests th at services may need to be continued at home or in subacute care setti ngs to optimize their effectiveness. Future research should include be havioral outcomes so that the benefits of rehabilitative care can be e valuated in more meaningful detail and can accurately reflect the psyc hosocial objectives of rehabilitation programs.