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Inpatient Rehabilitation Units: Age and Comorbidities Are Not Relevant if Admission Fits the Mission

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Rehabilitation Medicine for Elderly Patients

Part of the book series: Practical Issues in Geriatrics ((PIG))

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Abstract

The aging and disability epidemics are pressing the health-care system for the appropriate allocation of resources for the expensive inpatient rehabilitation. The key point is deciding whether old age and the associated comorbidities should determine the assignment to “geriatric” or “geriatric rehabilitation” units or to nursing homes provided with some rehabilitation services, rather than to specific hospital rehabilitation units. An extensive international epidemiologic research, based on sophisticated models of case-mix classification including demographic, biomedical, and disability indexes, showed that age and comorbidities are, themselves, not major determinants of the outcome in rehabilitation units. However, the core aspect is the admission policy. In the reality, admissions at rehabilitation units require a prognosis for (a) functional improvement in the short midterm (1–12 months) and (b) need and tolerance for specific motor, cognitive, and visceral-sphincteric exercise treatments. Units can be differentiated in order to fit the needs of long stay-low-tolerance cases of any age, yet retaining their rehabilitation identity. Downstream a correct admission, elderly/comorbid patients may benefit from specific rehabilitation units not less than younger patients.

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References

  1. Tesio L, Rota V (2005) Function-based case-mix in rehabilitation medicine: the Italian experience. In: CLADAG. Meeting of the Classification and data Analysis Group of the Italian Statistical Society, Università di Parma, June 6–8, 2005, free download at https://www.researchgate.net/profile/Luigi_Tesio/contributions

  2. Gresham GE, Granger CV, Linn RT, Kulas MA (1999) Status of functional outcomes for stroke survivors. Phys Med Rehabil Clin N Am 10(4):957–966

    CAS  PubMed  Google Scholar 

  3. Tesio L (2004) Bridging the gap between biology and clinical medicine. Some help from Rasch measurement theory. J Appl Meas 5(4):362–366

    PubMed  Google Scholar 

  4. Tesio L, Franchignoni F (2007) Don’t touch the physical in physical and rehabilitation medicine. J Rehabil Med 39:662–663

    Article  PubMed  Google Scholar 

  5. Stineman MG, Granger CV (1997) A modular case-mix classification system for medical rehabilitation illustrated. Health Care Financ Rev 19(1):87–103

    CAS  PubMed  PubMed Central  Google Scholar 

  6. Tesio L, Granger CV, Perucca L, Franchignoni FP, Battaglia MA, Russell C (2002) The FIMTM instrument in the United States and Italy: a comparative study. Am J Phys Med Rehabil 81:168–176

    Article  PubMed  Google Scholar 

  7. FIM is a trademark of the University of Buffalo Foundation, State University of New York at Buffalo-NY; http://www.udsmr.org

  8. Tesio L (2003) Case-mix classification systems. The specific case for rehabilitation. Eura Medicophys 39:201–204

    Google Scholar 

  9. Tesio L, Francescutti C, Genetti B (2009) Misure di disabilità nel percorso riabilitativo dopo ictus cerebrale. Studio epidemiologico e gestionale della Regione Autonoma Friuli-Venezia Giulia. (Disability measures along the rehabilitation path after stroke. An epidemiologic and managed-care study with Regione Autonoma Friuli-Venzia Giulia-Italy). Aracne Editrice

    Google Scholar 

  10. D’Alisa S, Miscio G, Baudo S, Simone A, Tesio L, Mauro A (2006) Depression is the main determinant of quality of life in multiple sclerosis: a classification-regression (CART) study. Disabil Rehabil 28(5):307–314

    Article  PubMed  Google Scholar 

  11. Stineman MG, Goin JE, Hamilton BB, Granger CV (1995) Efficiency pattern analysis for medical rehabilitation. Am J Med Qual 10(4):190–198

    Article  CAS  PubMed  Google Scholar 

  12. Granger CV, Karmarkar AM, Graham JE, Deutsch A, Niewczyk P, Divita MA, Ottenbacher KJ (2012) The uniform data system for medical rehabilitation: report of patients with traumatic spinal cord injury discharged from rehabilitation programs in 2002–2010. Am J Phys Med Rehabil 91(4):289–299. doi:10.1097/PHM.0b013e31824ad2fd

    Article  PubMed  PubMed Central  Google Scholar 

  13. Carpenter GI, Ikegami N, Ljunggren G, Carrillo E, Fries BE (1997) RUG-III and resource allocation: comparing the relationship of direct care time with patient characteristics in five countries. Age Ageing 26(Suppl 2):61–65

    Article  PubMed  Google Scholar 

  14. Franchignoni FP, Tesio L, Martino MT, Benevolo E, Castagna M (1998) Length of stay of stroke rehabilitation inpatients: prediction though the functional independence measure. Ann Ist Super Sanita 34(4):463–467

    CAS  PubMed  Google Scholar 

  15. Tesio L, Franchignoni FP, Perucca L, Porta GL (1996) The influence of age on length of stay, functional independence and discharge destination of rehabilitation inpatients in Italy. Disabil Rehabil 18(10):502–508

    Article  CAS  PubMed  Google Scholar 

  16. Crimaldi S, Porta GL, Vaccari A, Springhetti I, Tesio L (1999) Comparison between low- and high-intensity inpatient rehabilitation. FIM measures as an index of appropriateness and effectiveness. Eura Medicophys 35:177–183

    Google Scholar 

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Correspondence to Luigi Tesio MD .

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Tesio, L. (2018). Inpatient Rehabilitation Units: Age and Comorbidities Are Not Relevant if Admission Fits the Mission. In: Masiero, S., Carraro, U. (eds) Rehabilitation Medicine for Elderly Patients. Practical Issues in Geriatrics. Springer, Cham. https://doi.org/10.1007/978-3-319-57406-6_54

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  • DOI: https://doi.org/10.1007/978-3-319-57406-6_54

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-57405-9

  • Online ISBN: 978-3-319-57406-6

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