4.3 Admission to Rehabilitation

Case Study 4 (continued)

A request is put in place for admission to rehabilitation.  The patient is still agitated and  aggressive and the question arises as to whether he should wait until he is admitted to an inpatient rehabilitation unit.

4.3.1  Admission to an ABI Rehabilitation Unit

What is the evidence for admitting the patient immediately to an inpatient rehabilitation unit?

  1. There is no Level 1 evidence (from at least one RCT) as to the efficacy or lack thereof of ABI rehabilitation units.
     
  2. There is some (Level 4) evidence that inpatient rehabilitation improves self-care and mobility.
     
  3. There is Level 2 evidence that inpatient rehabilitation significantly improves functional outcome, as measured by the FIM.
  • Results of the study conducted by Sahgal and Heinemann 4 found improvements in the patients for self-care and mobility after discharge from the comprehensive multidisciplinary program. 
     
  • In 2 studies, functional outcome was assessed post discharge from rehab and in each study significant improvements for patients on FIM measurement 5;6.

4.3.2   The Benefits of Early Admission to Rehabilitation 

List some of the benefits of early admission of an ABI patient to rehabilitation.

1.    Better outcomes overall

2.    Improved functional outcomes

3.    Shorter overall lengths of stay

4.    Decreased overall costs

5.    Higher cognitive levels at home

6.    Greater likelihood of discharge home.

  • Early onset of therapeutic interventions for those who have sustained a traumatic head injury is beneficial.
     
  • One review, concluded thatthose who receive early intervention do in fact have better outcomes than those who do not 7.
     
  • When PM&R consultations occurred earlier (< 48 hours after hospital admission) patients experienced significantly better FIM scores with transfers and locomotion and significantly shorter lengths of stay (p = 0.001)8
     
  • Overall, starting rehabilitation early was associated with shorter comas and lengths of stay, higher cognitive levels at discharge, and a greater likelihood of being discharged to home 9
     
  • Those who began treatment within six months of their TBI scored higher on the disability rating scale indicating a decrease in their disability 10.
     
  • Those who received early rehabilitation not only showed gains throughout the intervention phase, but were able to maintain these gains after the intervention phases had come to an end 11.
     
  • Rehabilitation earlier in the recovery stage were discharged from hospital earlier than those who were not involved in the early rehabilitation program 12
     
  • There was a cost savings favoring those who were subjected to early interventions although there was no statistically significant differences on the individual outcomes 13.


For a more detailed discussion please see ERABI/Efficacy and Models of Care Following an Acquired Brain Injury.