HOSPITAL-BASED REHABILITATIVE CARE VERSUS OUTPATIENT SERVICES - EFFECTS ON FUNCTIONING AND HEALTH-STATUS

Purpose: The goal of this clinical trial was to examine the long-term impact of rehabilitative care on the health status of patients diagnos ed with a disabling disorder. Method: Study patients consisted of firs t-time hospitalizations from diagnostic groups commonly admitted for i npatient rehabilitation, including nervous, circulatory, and musculosk eletal disorders or injury. Patients were randomly assigned to inpatie nt rehabilitation (n = 43) or to outpatient follow-up (n = 42) in whic h the usual medical services were provided but no scheduled rehabilita tive therapies were offered. Specific objectives of the study were to determine the effects of inpatient rehabilitation on: (1) functional a bility, (2) health and mental health status, (3) personal adjustment, and (4) family function. Cost and use of health-care resources were de scriptively assessed. Results: Analysis of covariance found no signifi cant treatment effects, either at 6 months or at 1 year, for any of th e variables under study. In addition, there were no differences betwee n groups in their use of nursing homes, length of hospital stay, morta lity, or in the number of hospital readmissions or clinic visits durin g the first year after hospital discharge. Use of rehabilitation servi ces and cost of care was significantly higher than outpatient services . The findings were consistent with previous studies for most outcomes , with the major exception being functional improvements. Contrary to earlier studies, rehabilitation was not found to effectively produce l asting functional outcomes. However, study conditions may not have ful ly corresponded to those of previous studies, and further research is needed. The patient sample was representative of a full inpatient serv ice and therefore more heterogeneous than samples reported in prior st udies, but the small sample size (due to reductions in the number of a dmitted patients to the rehabilitation unit during the course of the s tudy) precluded subgroup analysis of diagnostic groupings. Conclusions : The findings suggest that hospital-based rehabilitative care does no t have lasting benefits, and that alternative care or supportive follo w-up by a subacute-care facility may be needed to assist patients in m aintaining functional gains and health benefits.