Beyond Function: Predicting Participation in a Rehabilitation Cohort

doi:10.1016/j.apmr.2005.08.001

Archives of Physical Medicine and Rehabilitation

Volume 86, Issue 11, November 2005, Pages 2087-2094

https://doi.org/10.1016/j.apmr.2005.08.001 Get rights and content

Abstract

Jette AM, Keysor J, Coster W, Ni P, Haley S. Beyond function: predicting participation in a rehabilitation cohort.

Objectives

To monitor participation in a rehabilitation cohort and to identify determinants of change during a 12-month period posthospitalization following the onset of one of several major disabling conditions.

Design

Cohort study.

Setting

Postacute care rehabilitation settings.

Participants

Adults (N=435) aged 18 years and older with complex medical, lower-extremity orthopedic, and major neurologic impairments.

Interventions

Not applicable.

Main Outcome Measures

At 1-, 6-, and 12-month follow-ups, community participation and social and home participation were assessed by personal interviews using the Participation Measure for Post-Acute Care. Information on potential determinants was abstracted from the medical chart and by personal interview using standardized instruments.

Results

On average, rehabilitation patients achieved modest improvements in their levels of community participation during the first 6 months after acute hospitalization. In contrast, these same patients displayed a modest loss in social and home participation levels during the follow-up period. Activity limitations were the dominant factors that explained much of the variance in the extent of community participation achieved by patients. Personal and social environmental factors played a major role in predicting levels of social and home participation.

Conclusions

The focus of rehabilitation interventions aimed at achieving posthospital participation requires careful consideration of the specific domain of participation that is being targeted.

Section snippets

Participants

Participants were 435 adults aged 18 years and older from the Rehabilitation Outcomes Study who were recruited at discharge from a large acute care hospital or on admission to 1 of 2 rehabilitation hospitals in the greater Boston, MA, region. All subjects had a primary diagnosis of neurologic disorder, lower-extremity orthopedic trauma, or medically complex conditions. Specific inclusion criteria were that the person was currently receiving and/or about to be referred to skilled rehabilitation

Results

Table 1 displays the characteristics of the study sample. The mean age of the sample was 67.4 years, 50.8% of the patients were women, and 90.5% were white. The most prevalent impairment group was patients with complex medical conditions (42.3%) followed by lower-extremity orthopedic (33.6%), and, finally, major neurologic (24.1%). Of the 435 patients enrolled in this study, 417 (81%) completed the 1-month follow-up, 370 (72%) completed the 6-month follow-up, and 336 (65%) completed the

Discussion

This study revealed a distinct pattern of change in participation after hospitalization in the cohort of patients who received rehabilitation care. On average, patients with complex medical, lower-extremity orthopedic, and major neurologic impairments who received rehabilitation care achieved modest improvements in their levels of community participation during the first 6 months after their hospitalization. In contrast, on average, these same patients displayed a modest loss in social and home

Conclusions

The clinical implications of our findings are clear and significant. The focus of rehabilitation intervention to improve long-term participation requires careful consideration of the domain of participation of specific clinical interest. A rehabilitation intervention aimed at improving activity performance is more likely to have an effect on improving a patient’s subsequent performance of community participation roles, but not on social and home participation as measured by the PM-PAC. If the

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Community, the Netherlands.
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Supported by the National Institute of Disability and Rehabilitation Research, U.S. Department of Education (grant no. H133B990005).

No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated.

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Original articleBeyond Function: Predicting Participation in a Rehabilitation Cohort

Abstract

Objectives

Design

Setting

Participants

Interventions

Main Outcome Measures

Results

Conclusions

Section snippets

Participants

Results

Discussion

Conclusions

Soc Sci Med

Osteoarthritis Cartilage

Arch Phys Med Rehabil

Arch Phys Med Rehabil

J Clin Epidemiol

Soc Sci Med

Arch Phys Med Rehabil

Some conceptual issues in disability and rehabilitation

International classification of impairments, disabilities and handicapsa manual of classification relating to the consequences of disease

Trends in length of stay, living setting, functional outcome, and mortality following medical rehabilitation

JAMA

On autonomy and participation in rehabilitation

Disabil Rehabil

Social consequences of long term impairments and disabilitiesconceptual approach and assessment of handicap

Int J Rehabil Res

Community integrationa useful construct, but what does it really mean?

Brain Inj

International classification of functioning, disability and health

Value and application of the ICF in rehabilitation medicine

Disabil Rehabil

Determinants of handicap 1 and 3 years after a stroke

Disabil Rehabil

Associations between diagnoses, impairments, disability and handicap in a population of elderly people

Int J Epidemiol

Original article
Beyond Function: Predicting Participation in a Rehabilitation Cohort