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OBJECTIVE: To provide benchmarking information for a large national sample of patients receiving inpatient rehabilitation after a stroke. DESIGN: Analysis of secondary data from 893 medical rehabilitation facilities located in the United States and contributing information to the Uniform Data System for Medical Rehabilitation from 2000 to 2007. RESULTS: Variables analyzed included demographic information (age, sex, marital status, race/ethnicity, prehospital living setting, and discharge setting), hospitalization information (length of stay, program interruptions, payer, event onset date, rehabilitation impairment group, International Classification of Diseases-9 codes for the admitting diagnosis, and comorbidities), and functional status information (FIM(R) instrument ['FIM'] ratings at admission and discharge, FIM efficiency, and FIM gain). Descriptive statistics revealed that the length of stay decreased from a mean of 19.6 (+/-12.8) days to 16.5 (+/-9.8) days during the 8-yr study period. FIM instrument admission and discharge ratings also decreased. Mean admission ratings decreased from 62.5 (+/-20.1) to 55.1 (+/-19.3), and mean discharge ratings decreased from 86.4 (+/-23.6) to 79.8 (+/-24.0). FIM change remained relatively stable; the mean for the entire sample was 23.9 (+/-14.8). The percent of persons discharged to the community ranged from 75.8% in 2000 to 69.3% in 2007. All results are likely affected by changes in the definition for program interruption and procedures for FIM data collection. CONCLUSION: Uniform Data System for Medical Rehabilitation data from persons with stroke receiving rehabilitation from 2000 to 2007 indicate patients are showing improvement in functional independence during their rehabilitation stay, and a large percentage are discharged to community settings. [ABSTRACT FROM AUTHOR]

Medical necessity is a legal, not medical, term. Depending on the stakeholder's point of view, it may seem less about human need and dispensing medical care and more about a web of rules, rulings, regulations, and manuals, especially for Medicare patients, who use the lion's share of rehabilitation services. In other words, the term medical necessity seems, to some stakeholders, to refer more to what determines payment by Medicare instead of what should be done to determine optimal patient health. Such a perspective on medical necessity has major implications, considering that Medicare pays for most of the rehabilitation treatment in some 1200 inpatient rehabilitation facilities and that its policies determine which patients qualify for admission to an inpatient rehabilitation facility. Medicare's medical necessity policies are often described by inpatient rehabilitation facility administrators and physiatrists as complicated and unfair, as well as being demeaning to the standing of physicians. Ask some physiatrists about their patients meeting Medicare guidelines for medical necessity, and they might bark, 'Medical necessity?! That's what I was taught to know!' [ABSTRACT FROM AUTHOR]

OBJECTIVE: This study is a secondary analysis of results from the Multiple Sclerosis Collaborative Research Group multicenter trial. We investigated the effect of interferon beta-1a on disability in patients with relapsing-remitting multiple sclerosis (MS), using the FIM instrument to assess levels of decline in total, motor, and cognitive items. DESIGN: Of the 301 patients enrolled in the trial, 274 subjects with relapsing-remitting multiple sclerosis with baseline FIM and Kurtzke Expanded Disability Status Scale scores were studied in this secondary analysis. Mildly disabled patients were chosen, as indicated by a Kurtzke Expanded Disability Status Scale score of 1.0-3.5. Matched subjects were assigned to receive either interferon beta-1a or placebo. Kurtzke Expanded Disability Status Scale and FIM scores were measured serially every 6 mo. Failure was defined as a 4-point reduction in total FIM score sustained for 6 mo. Analysis was by Kaplan-Meier methodology. The Mann-Whitney test (log rank) compared mean change and Spearman's rank-correlation test determined correlation. RESULT: A significant difference in treatment groups was seen, with a FIM score decline of > or = 4 points, with placebo subjects demonstrating greater loss of function than subjects treated with interferon beta-1a. There was no statistically significant difference in total, cognitive, or motor activities, with a decline of < or = 3 points. CONCLUSION: Disability, as measured by the FIM instrument, was slowed by treatment with interferon beta-1a compared with placebo. The treatment effect determined using the FIM instrument, with its motor and cognitive components, indicates an additional level of response to therapy for mild to moderate multiple sclerosis. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To determine, only for those who improved, the rate per day of improvement expected for outpatients with low back pain and to identify factors influencing pain improvement: pain duration before assessment, pain and physical functioning levels before assessment, age, sex, and affective factors. It was presupposed that affective factors would have an appreciable effect. DESIGN: The LIFEware System database was used. Analysis was performed on 1292 records for the Painfree measure and 1562 records for the LIFEware System Visual Analog Scale. Measures for pain, physical functioning, and affective well-being were analyzed for 0-30 days vs. >30 days of pain duration before assessment using classification and regression trees analysis. RESULTS: In both Painfree and LIFEware System Visual Analog Scale, 73% improved and 27% did not improve. Of those who improved, outpatients with 0-30 days of pain duration before assessment had higher per day rates of improvement than the >30 days group. Factors affecting improvement were, in descending order, more initial pain, younger age, and positive affective well-being; physical functioning did not affect rate of improvement. Factors affecting improvement for outpatients with >30 days since onset were, in descending order, more initial pain and better initial physical functioning; age and affective well-being were not factors. For all, neither sex nor the 'satisfaction with life in general' question affected low back pain rate of improvement. CONCLUSION: Findings may be useful for clinical application because the actual rate of improvement may be compared with the expected rate. There was only a weak relationship shown between affective factors and pain improvement. [ABSTRACT FROM AUTHOR]