DEVELOPMENT OF COMPLICATIONS DURING REHABILITATION

Background and Methods: Although studies have demonstrated that medica l rehabilitation patients have many complications that warrant attenti on, none has attempted to categorize complications by severity. This r etrospective cohort study examined the incidence, types, and severity of problems that interrupt rehabilitation and the major risk factors f or these events. Results: Of 1075 patients, 359 (33.4%) had acute medi cal complications on rehabilitation considered severe enough to interr upt treatment. Of the 359 patients, 158 (44%) required an unexpected t ransfer off rehabilitation. The most common reasons for unexpected tra nsfer were surgical causes (22.8%), followed by infection or fever (17 .1%) and by thromboembolic events (16.5%). Logistic regression reveale d that major risk factors for complications requiring transfer were a primary diagnosis of deconditioning or nontraumatic spinal cord injury (adjusted odds ratio, 2.7; confidence interval, 1.8 to 4.2), severity of initial disability (adjusted odds ratio, 1.2; confidence interval, 1.1 to 1.3 for every 10-point drop in a Modified Barthel Index), and number of comorbid conditions (adjusted odds ratio, 1.1; confidence in terval, 1.0 to 1.2). Risk factors for any complication were similar, b ut there was an interaction between comorbidity and the degree of func tional impairment; in patients who were severely functionally impaired , the number of comorbidities was not as strongly associated with the risk of complications as it was in patients who were less functionally impaired. Conclusion: There is a complex relationship among the type of underlying medical impairment, severity of functional limitation, c omorbidity, and unanticipated medical or surgical complications that i nterrupt rehabilitation. The interruptions vary both in type and in se verity.