Differences in physical and psychological outcomes among patients who were and were not admitted to an inpatient physical rehabilitation facility 3 months after acute traumatic injury

Purpose: After experiencing a traumatic injury, many patients are recommended to receive inpatient physical rehabilitation to continue their recovery. Even with recommendations from the acute care therapy team to continue care at an inpatient rehabilitation facility, some patients are unable to be admitted for a variety of reasons. The objective of the current analysis was to examine differences in perceived functional and psychological outcomes between (1) individuals who were admitted to an inpatient physical rehabilitation hospital after an acute traumatic injury, and (2) patients who were recommended and but not admitted to inpatient rehabilitation. Methods: After obtaining hospital IRB approval, patients admitted to a Level I trauma center for acute injury were approached to participate in this prospective, longitudinal study. After meeting inclusion criteria, 505 patients completed informed consent and were enrolled into the study during hospitalization. Of these, 60 (8.4%) patients were identified with recommendations by the therapy team to continue care in inpatient rehabilitation; 50 patients subsequently were admitted to an inpatient rehabilitation facility and 10 were not. Eight of ten subjects that did not admit to an inpatient rehabilitation facility as recommended completed a three month follow up. Patient-perceived physical and emotional function was evaluated three months after initial injury using the Veterans RAND 12 Item Health Survey (VR12); all individuals were also screened for depression, posttraumatic stress disorder (PTSD), pain, and return to work. Wilcoxon and Fisher’s tests were conducted to identify differences between the two groups. Results: There were no differences in functional and psychological outcomes between the two groups during initial hospitalization. However, at three month follow up, a significant difference was found between groups for both emotional health and depression. No significant differences between groups were found for PTSD, pain, and physical function at three month follow up. Though not significant, patients who were admitted to an inpatient rehabilitation facility reported greater pain improvement at three month follow up when compared to patients who did not go to inpatient rehabilitation. Conclusion: Patients receiving inpatient physical rehabilitation appear to fare better emotionally and psychologically three months after initial injury. These results suggest that admission to inpatient rehabilitation is an important factor in optimizing psychological health after injury. As such, recommendations across disciplines should be strongly considered when making discharge decisions from the acute care setting. Future research to provide evidence regarding the importance of inpatient rehabilitation in later outcomes post injury should be conducted to maximize later quality of life.