Abstract
DiSotto-Monastero M, Chen X, Fisch S, Donaghy S, Gomez M. Efficacy of 7 days per week inpatient admissions and rehabilitation therapy.
Objective
To evaluate the efficacy of 7d/wk of inpatient admissions and rehabilitation therapy (7DART) in a rehabilitation hospital.
Design
Cross-sectional, retrospective electronic data review.
Setting
Rehabilitation hospital.
Participants
Adult patients who participated in the 7DART program and were admitted and discharged between February 2009 and January 2010 (n=1808), and adult patients who received 5d/wk of inpatient admissions and rehabilitation therapy (5DART), and were admitted and discharged between February 2008 and January 2009 (n=1692).
Interventions
Occupational therapy and physiotherapy during the weekends (7DART only).
Main Outcome Measures
FIM rating change from admission to discharge, length of hospital stay, rehabilitation workload per patient, and discharge destination.
Results
There were 3500 patients admitted with a mean age ± SD of 72.1±13.3 years and a male-to-female ratio of 1:1.9. Under 7DART conditions, there was a 6.9% increase in admissions (7DART=1808 vs 5DART=1692, P=.006), an 86% increase in weekend admissions (255 vs 137, P<.001), a 13.2% increase in rehabilitation workload per patient (40.7h vs 36h, P<.001), and a 5.4% decrease in rehabilitation hospital stay (19.3d vs 20.3d, P=.043). Similar FIM rating changes were obtained from admission to discharge under both conditions (18.2 for 7DART vs 18.7 for 5DART, P=.099). Both groups resulted in 94% of patients achieving their rehabilitation goals (7DART=94.1%, 5DART=94.5%; P=.967), and 88.6% of patients returning to their homes (7DART=88.1%, 5DART=89.2%; P=.334).
Conclusions
Despite the fact that patients in both groups had similar functional outcomes and discharge destination, the 7DART rehabilitation model reduced length of hospital stay and increased rehabilitation workload, demonstrating increased efficiency and access to care by admitting more patients from acute care, rehabilitating them, and discharging them to the community in less time than the 5DART model.
Key Words
List of Abbreviations:
THA (total hip arthroplasty), TKA (total knee arthroplasty)REHABILITATION THERAPY IS of paramount importance to help individuals recovering from life-changing illnesses, injuries, or complex medical conditions and procedures to rebuild their lives and return to their community and work activities. Increased rehabilitation intensity (including weekend therapy) has produced improved outcomes in different patient populations.
1
, 2
, 3
, 4
, 5
, 6
, 7
However, some studies8
, 9
, 10
present different results. Johnston and Miller8
studied 934 patients in acute medical rehabilitation units who received a minimum of 3h/d of physical and occupational therapy combined, and despite the average intensity of physical and occupational therapy having increased to .55 hours per patient per day, they could not find detectable benefit to patients in functional status, living arrangement, or other outcomes. Ruff et al9
studied 113 patients who sustained a cerebrovascular accident and were hospitalized at a rehabilitation inpatient unit. They did not find a difference in length of stay or functional outcomes between those patients who received 6d/wk of inpatient rehabilitation compared with those who received 7d/wk of rehabilitation. Lang10
studied 140 subjects with hip or knee arthroplasty and found no significant difference in postoperative length of stay, discharge destination, or discharge disposition between those individuals who received 6-day or 7-day physical therapy.The purpose of this study was to evaluate the efficacy of 7d/wk of inpatient admissions and rehabilitation therapy (7DART) in a rehabilitation hospital.
Methods
After approval by our institution's Research Ethics Board, we conducted a cross-sectional retrospective review of electronic data collected at our institution for the National Rehabilitation Reporting System from consecutive patients who met the inclusion criteria: adult patients who received 7d/wk of inpatient admissions and rehabilitation therapy (7DART) and were admitted and discharged between February 2009 and January 2010, and adult patients who received 5d/wk of inpatient admissions and rehabilitation therapy (5DART) and were admitted and discharged between February 2008 and January 2009. Patients who did not meet these criteria were excluded from the study. Patient demographics (age, sex) and the preadmission status are presented in table 1.
χ2 test or Student t test between 7DART and 5DART values.
Table 1Demographics
| Variable | 7DART | 5DART | All Patients | P |
|---|---|---|---|---|
| Patients | 1808 (51.7) | 1692 (48.3) | 3500 (100.0) | .006 |
| Sex | ||||
| Men | 642 (35.5) | 572 (33.8) | 1214 (34.7) | .290 |
| Women | 1166 (64.5) | 1120 (66.2) | 2286 (65.3) | .290 |
| Age (y) | 72.2±13.6 | 71.9±13.0 | 72.1±13.3 | .505 |
| Pre-adm home | 1724 (95.5) | 1625 (96.0) | 3349 (95.7) | .318 |
| Private house/apartment | ||||
| without paid health services | 1472 (85.4) | 1384 (85.2) | 2856 (85.3) | .862 |
| Private house/apartment | ||||
| with paid health services | 252 (14.6) | 241 (14.8) | 493 (14.1) | .862 |
| Pre-adm assistive living setting | 68 (3.8) | 51 (3.0) | 119 (3.4) | .223 |
| Pre-adm residential care | 8 (0.4) | 8 (0.5) | 16 (0.5) | .894 |
| Other or unknown | 8 (0.4) | 8 (0.5) | 16 (0.5) | .894 |
NOTE. Values are n (%), mean ± SD, or as otherwise indicated.
Abbreviation: Pre-adm, preadmission.
† Other or unknown refers to patient records without documented preadmission living conditions.
Functional Outcomes
The FIM rating on admission, FIM rating at discharge, and percent FIM rating change (100% × [FIM discharge − FIM admission/FIM admission]) were compared between 7DART and 5DART patients.
Resource Utilization
The total number of admissions and discharges (specifically those that happened during the weekend), rehabilitation length of stay, and rehabilitation workload per patient provided by physiotherapy and occupational therapy staff were compared between 7DART and 5DART patients.
Results
Functional and resource utilization outcomes were compared between 7DART and 5DART groups using the Student t test and chi-square analysis, with P<.05 considered significant.
Patient Demographics, Living Situation, and Waiting Time to Treatment
There were 3500 patients (7DART, 1808; 5DART, 1692) admitted during the study period, with a mean age ± SD of 72.1±13.3 years and a male-to-female ratio of 1:1.9 (see table 1); most (60%) were admitted for rehabilitation after musculoskeletal conditions (table 2). A group of subspecialty patients had a significant increase in admissions after the implementation of the 7DART program (ie, cardiac, neurologic, complex care, trauma, and oncology), but other groups of subspecialty patients had a significant decrease in admissions after the implementation of the 7DART program (ie, musculoskeletal, amputees, transplants, and burn) (see table 2). More patients in the group with increased admissions were men (45.2% vs 29.4%, P<.001), younger (71.0±16.1y vs 73.0±11.7y, P=.002), living at home preadmission (96.7% vs 94.5%, P=.027), fewer were living at an assistive living setting (2.6% vs 4.5%, P.033), more waited longer before rehabilitation admission (2.2±2.2d vs 1.5±2.1d, P<.001), had a greater admission total FIM rating (92.9±11.1 vs 91.6±11.3, P=.016), had a greater admission motor FIM rating (60.5±9.9 vs 58.3±10.0, P<.001), and more were discharged home without paid health services (47.8% vs 37.2%, P<.001) (table 3).
χ2 test between 7DART and 5DART values.
χ2 test or Student t test between increased and reduced values.
Table 2Rehabilitation Specialties
| Specialty | 7DART | 5DART | All Patients | P |
|---|---|---|---|---|
| (n=1808) | (n=1692) | (n=3500) | ||
| Musculoskeletal | 1014 (56.1) | 1087 (64.2) | 2101 (60.0) | <.001 |
| Cardiac | 243 (13.4) | 175 (10.3) | 418 (11.9) | .005 |
| Neurology | 148 (8.2) | 121 (7.2) | 269 (7.7) | .251 |
| Complex care | 138 (7.6) | 73 (4.3) | 211 (6.0) | <.001 |
| Trauma | 99 (5.5) | 74 (4.4) | 173 (4.9) | .133 |
| Oncology | 74 (4.1) | 36 (2.1) | 110 (3.1) | <.001 |
| Amputees | 50 (2.8) | 58 (3.4) | 108 (3.1) | .257 |
| Transplants | 23 (1.3) | 44 (2.6) | 67 (1.9) | .004 |
| Burns | 19 (1.1) | 24 (1.4) | 43 (1.2) | .324 |
NOTE. Values are n (%) or as otherwise indicated.
Table 3Subspecialty Patient Groups With Increased or Reduced Admissions After 7DART
| Variable | Increased | Reduced | P |
|---|---|---|---|
| (n=702) | (n=1106) | ||
| Sex | |||
| Men | 317 (45.2) | 325 (29.4) | <.001 |
| Women | 385 (54.8) | 781 (70.6) | <.001 |
| Age (y) | 71.0±16.1 | 73.0±11.7 | .002 |
| Living arrangements | |||
| Pre-adm home | 679 (96.7) | 1045 (94.5) | .027 |
| Pre-adm assistive living setting | 18 (2.6) | 50 (4.5) | .033 |
| Pre-adm residential care | 3 (0.4) | 5 (0.4) | .938 |
| Pre-adm other or unknown | 2 (0.3) | 6 (0.5) | .421 |
| Waiting time for rehab (d) | 2.2±2.2 | 1.5±2.1 | <.001 |
| Admission total FIM (rating) | 92.9±11.1 | 91.6±11.3 | .016 |
| Admission motor FIM (rating) | 60.5±9.9 | 58.3±10.0 | <.001 |
| Admission cognitive FIM (rating) | 32.4±4.2 | 33.3±2.9 | <.001 |
| Rehab LOS (d) | 19.4±11.8 | 19.2±14.9 | .764 |
| Rehab workload (d) | 44.28 | 38.56 | <.001 |
| Discharge total FIM (rating) | 110.2±8.0 | 110.3±8.2 | .799 |
| Discharge motor FIM (rating) | 77.3±6.4 | 76.9±6.7 | .208 |
| Discharge cognitive FIM rating | 32.8±3.6 | 33.4±2.6 | <.001 |
| Percentage FIM rating change | 19.9±13.9 | 21.7±13.0 | .005 |
| Percentage rehab goals met | 88.6 | 97.5 | <.001 |
| Total discharges | 634 (90.3) | 1034 (93.5) | .013 |
| Weekend discharges | 81 (12.8) | 222 (21.5) | <.001 |
| Discharge destination | |||
| Discharged home total | 529 (83.4) | 940 (90.9) | <.001 |
| Discharged home without paid health services | 253 (47.8) | 350 (37.2) | <.001 |
| Discharged home with paid health services | 276 (52.2) | 590 (62.8) | <.001 |
| Discharged to an assistive living setting | 27 (4.3) | 59 (5.7) | .147 |
| Discharged to a residential care | 2 (0.3) | 8 (0.8) | .221 |
| Discharged to other or unknown | 9 (1.4) | 3 (0.3) | .010 |
| Transfer to acute care | 67 (10.6) | 24 (2.3) | <.001 |
NOTE. Values are n (%), mean ± SD, or as otherwise indicated.
Abbreviations: Pre-adm, preadmission; Rehab, rehabilitation; Rehab LOS, rehabilitation length of stay.
† Other or unknown refers to patient records without documented preadmission living conditions.
‡ Percentage FIM rating change: 100% × ([Discharge total FIM rating − Admission total FIM rating]/Admission total FIM rating).
Subspecialty Patient Groups
Even though fewer patients with musculoskeletal disorders were admitted under the 7DART rehabilitation model (48.3% vs 51.7%, P<.001), a greater number of them were admitted during the weekend (20.9% vs 12.6%, P<.001), and more of them were discharged during the weekend (22.3% vs 10.5%, P<.001), than patients with musculoskeletal disorders admitted under the 5DART rehabilitation model (table 4).
χ2 test or Student t test between 7DART and 5DART values.
Table 4Subspecialty Patient Groups
| Subspecialty | 7DART | 5DART | P |
|---|---|---|---|
| Musculoskeletal | |||
| Total admissions | 1014 (48.3) | 1087 (51.7) | <.001 |
| Weekend admissions | 212 (20.9) | 137 (12.6) | <.001 |
| Rehab LOS (d) | 18.4±14.4 | 18.9±14.8 | .471 |
| FIM rating change (%) | 21.4±12.4 | 21.8±13.7 | .451 |
| Rehab goals met (%) | 98.4 | 97.1 | .888 |
| Total discharges | 959 (94.6) | 1017 (93.6) | .325 |
| Weekend discharges | 214 (22.3) | 107 (10.5) | <.001 |
| Discharged home | 885 (92.3) | 934 (91.8) | .715 |
| TKA | |||
| Total admissions | 455 (44.5) | 523 (53.5) | <.001 |
| Weekend admissions | 126 (27.7) | 97 (18.5) | <.001 |
| Rehab LOS (d) | 13.3±7.8 | 13.5±7.2 | .707 |
| FIM rating change (%) | 19.3±11.8 | 19.9±10.9 | .378 |
| Rehab goals met (%) | 99.5 | 98.8 | .942 |
| Total discharges | 435 (95.6) | 503 (96.2) | .653 |
| Weekend discharges | 109 (25.1) | 51 (10.1) | <.001 |
| Discharged home | 423 (97.2) | 480 (95.4) | .144 |
| THA | |||
| Total admissions | 298 (51.0) | 286 (49.0) | .739 |
| Weekend admissions | 72 (24.2) | 40 (14.0) | .002 |
| Rehab LOS (d) | 15.3±11.0 | 16.8±12.8 | .126 |
| FIM rating change (%) | 21.7±11.2 | 21.5±10.6 | .868 |
| Rehab goals met (%) | 98.6 | 98.5 | .995 |
| Total discharges | 285 (95.6) | 274 (95.8) | .921 |
| Weekend discharges | 63 (22.1) | 27 (9.9) | <.001 |
| Discharged home | 265 (93.0) | 262 (95.6) | .180 |
| Cardiac | |||
| Total admissions | 243 (58.1) | 175 (41.9) | .005 |
| Weekend admissions | 19 (7.8) | 0 (0.0) | <.001 |
| Rehab LOS (d) | 12.5±4.9 | 13.5±4.3 | .028 |
| FIM rating change (%) | 16.5±7.9 | 16.9±6.9 | .585 |
| Rehab goals met (%) | 90.7 | 95.7 | .600 |
| Total discharges | 225 (95.6) | 164 (93.7) | .656 |
| Weekend discharges | 34 (15.1) | 8 (4.9) | .001 |
| Discharged home | 195 (86.7) | 151 (92.1) | .093 |
NOTE. Values are n (%), mean ± SD, or as otherwise indicated.
Abbreviations: Rehab, rehabilitation; Rehab LOS, rehabilitation length of stay.
† FIM rating change (%) = 100% × ([Discharge total FIM rating − Admission total FIM rating]/Admission total FIM rating).
Similar improved outcomes were obtained among patients admitted under the 7DART rehabilitation model for rehabilitation after total knee arthroplasty (TKA), total hip arthroplasty (THA), or after cardiac interventions (eg, myocardial infarct, coronary artery bypass, or angioplasty) (see table 4).
Resource Utilization
There was a 6.9% increase in total admissions (1808 vs 1692, P=.006), an 86% increase in weekend admissions (255 vs 137, P<.001), and an 8.3% increase in total discharges (1668 vs 1540, P=.185), including especially a 111.9% increase in discharges during the weekends (303 vs 143, P<.001), in the 7DART group compared with the 5DART group (table 5). The total number of admissions to the rehabilitation hospital has increased during the last 4 years, specifically after the introduction of the 7DART rehabilitation model in February 2009 (Feb 2007 through Jan 2008=2438 admissions; Feb 2008 through Jan 2009=2335 admissions; Feb 2009 through Jan 2010=2470 admissions; Feb 2010 through Jan 2011=2596 admissions).
χ2 test or Student t test between 7DART and 5DART values.
Table 5Resource Utilization
| Resource | 7DART | 5DART | Total | P |
|---|---|---|---|---|
| Total admissions | 1808 (51.7) | 1692 (48.3) | 3500 (100.0) | .006 |
| Weekend admissions | 255 (14.1) | 137 (8.1) | 392 (11.2) | <.001 |
| Total discharges | 1668 (52.0) | 1540 (48.0) | 3208 (100.0) | .185 |
| Weekend discharges | 303 (18.2) | 143 (9.3) | 446 (13.9) | <.001 |
| Rehab LOS (d) | 19.3±13.8 | 20.3±15.4 | 19.8±14.6 | .043 |
| Rehab workload (h) | 40.7 | 36.0 | 76.7 | <.001 |
| Waiting time for rehab (d) | 1.8±2.1 | 1.6±2.2 | 1.7±2.2 | .007 |
NOTE. Values are n (%), mean ± SD, or as otherwise indicated.
Abbreviations: Rehab, rehabilitation; Rehab LOS, rehabilitation length of stay.
Also, there was a 13.2% increase in rehabilitation workload per patient (40.7h vs 36h, P<.001) and a 5.4% decrease in rehabilitation hospital length of stay (19.3d vs 20.3d, P=.43) among 7DART patients compared with 5DART patients. The waiting time for rehabilitation admission was similar in both groups (see table 5).
Functional Outcomes
The mean total FIM rating and the mean motor FIM and cognitive FIM ratings were similar in both rehabilitation groups on admission and at discharge. The percentage FIM rating change from admission to discharge, as well as the percentage of rehabilitation goals met, were similar between 7DART and 5DART patients (table 6).
χ2 test or Student t test between 7DART and 5DART values.
Table 6Functional Outcomes
| Outcome | 7DART | 5DART | Total | P |
|---|---|---|---|---|
| Admission total FIM | 92.0±11.2 | 91.7±11.5 | 91.9±11.4 | .434 |
| Admission motor FIM | 59.1±10.0 | 58.7±10.2 | 58.9±10.1 | .242 |
| Admission cognitive FIM | 33.0±3.4 | 33.0±3.4 | 33.0±3.4 | 1.000 |
| Discharge total FIM | 110.2±8.2 | 110.4±8.5 | 110.3±8.3 | .479 |
| Discharge FIM motor | 77.0±6.6 | 77.2±7.2 | 77.1±6.9 | .391 |
| Discharge FIM cognitive | 33.2±3.0 | 33.2±3.0 | 33.2±3.0 | 1.000 |
| FIM rating change (points) | 18.2±8.9 | 18.7±9.0 | 18.4±9.0 | .099 |
| Percentage FIM rating change | 21.1±13.4 | 21.9±15.7 | 21.5±14.5 | .104 |
| Rehabilitation goals met (%) | 94.1 | 94.5 | 94.3 | .967 |
NOTE. Values are mean ± SD or as otherwise indicated.
† FIM rating change: (Discharge total FIM rating − Admission total FIM rating)/Admission total FIM rating.
‡ Percentage FIM rating change: 100% × ([Discharge total FIM rating − Admission total FIM rating]/Admission total FIM rating).
Discharge Destination
Even though percentage-wise more patients were discharged home in the 5DART group than in the 7DART group (89.2% vs 88.1%, P=.334), there were percentage-wise more patients discharged home without paid health services in the 7DART group than in the 5DART group (59% vs 57.8%, P=.544) (table 7).
χ2 test between 7DART and 5DART values.
Table 7Discharge Destination
| Destination | 7DART | 5DART | Total | P |
|---|---|---|---|---|
| (n=1668) | (n=1540) | (n=3208) | ||
| Home | 1469 (88.1) | 1373 (89.2) | 2842 (88.6) | .334 |
| Private house/apartment without paid health services | 866 (59.0) | 794 (57.8) | 1660 (58.4) | .544 |
| Private house/apartment with paid health services | 603 (41.0) | 579 (42.2) | 1182 (41.6) | .544 |
| Assistive living setting | 86 (5.2) | 70 (4.5) | 156 (4.9) | .422 |
| Residential care | 10 (0.6) | 12 (0.8) | 22 (0.7) | .538 |
| Other or unknown | 12 (0.7) | 11 (0.7) | 23 (0.7) | .986 |
| Transfer to acute care | 91 (5.5) | 74 (4.8) | 165 (5.1) | .405 |
NOTE. Values are n (%) or as otherwise indicated.
Discussion
The main results in this study were a 1-day reduction in length of inpatient rehabilitation stay, better resource utilization, and more patients discharged home without paid health services in the 7DART group compared with the 5DART group. Similar results were reported by Hooper and Dijkers
11
who surveyed 149 rehabilitation facilities that offered some weekend therapy (82%), and many of them for 5 or more years before the survey in the state of Michigan. These authors found that the benefits of offering weekend coverage outranked the costs by improved patient care and treatment consistency (26%), improved revenue and profitability (21%), higher patient and family satisfaction (16%), decreased length of stay (15%), and better integration of the family into the treatment program (11%).11
They identified the following challenges on initial implementation of the weekend therapy program: staffing (76%), interference with patient leaves of absence (21%), recruiting personnel (18%), and interference with visiting hours (16%). Nevertheless, 11% of the respondents reported “little or no problems.” The initial staffing challenges (76%) decreased after the weekend program was fully established (22% staff costs + 14% staff coverage).A similar reduction in length of rehabilitation hospital stay (5.1%) was reported in a randomized controlled trial
2
among patients who received physiotherapy intervention from Monday to Saturday compared with patients who received physiotherapy intervention only from Monday to Friday among 262 inpatients in an Austrian metropolitan hospital.Hughes et al
4
also reported a reduction in length of postoperative length of stay (1.44±.12d) among 84 patients who received physical therapy over the weekend after a THA or a TKA, compared with a retrospective control group of 53 patients who received a THA or a TKA before the implementation of the weekend physical therapy program.4
The reduction in the postoperative length of stay was greater in the THA group than in the TKA group (1.91±.23d vs .93±.12d, P<.001). Their reduction in postoperative length of stay for the THA study group was slightly greater than the reduction obtained with the 7DART group in our present study (1.91±.23d vs 1.5±1.8d, P=.126). Their reduction in postoperative length of stay for the TKA study group was significantly greater than the reduction obtained with the 7DART group in the present study (.93±.12d vs 0.2±0.6d, P<.001). A possible explanation for the better results in their study is that those patients received rehabilitation therapy immediately after THA or TKA in the acute care hospital. In our study, patients were transferred from the acute care hospital to our rehabilitation hospital after THA or TKA, because their cases were complex (eg, diabetes, hypertension, obesity) and they could not be discharged home after surgery. Instead they required a specialized rehabilitation institution like ours.Other authors did not find improved rehabilitation outcomes with increased rehabilitation intensity,
8
, 9
, 10
which differs with the results of our study. In 1 study8
of 934 patients who received a minimum of 3h/d of physical and occupational therapy combined, and despite an increase of physical and occupational therapy of .55 hours per patient per day, the authors could not find a detectable benefit to patients in functional status, living arrangement, or other outcomes, probably because the intensity of the physical and occupational therapy was not graded according to the varying needs of patients. In another study9
of 113 patients who sustained a cerebrovascular accident, the study group received 7d/wk of rehabilitation therapy compared with the control group who received only 6d/wk of rehabilitation therapy. The authors found no significant differences in length of stay or in patients' functional recovery, but there was a treatment selection bias because the treatment selection was based on the funding source, and the study group was funded by Medi-Cal. Another study10
did not find a significant difference in postoperative length of stay, discharge destination, or discharge disposition between those individuals who received 6-day or 7-day physical therapy, among 140 subjects with hip or knee arthroplasty. These results differ from those of our present study (see table 4), probably because this author only added 1 day of rehabilitation therapy in the 7-day physical therapy group and did not control for confounding factors that could affect length of stay (ie, age, living situation, comorbid conditions, type of institution, and physician feedback on resource utilization).Study Limitations
The main limitation of this study is that it is a retrospective study based on electronic data collected at our institution for the National Rehabilitation Reporting System, and it could have errors in data entry or errors in the coding of clinical diagnoses, complications, or discharge destination. Another limitation is that this study did not evaluate the work-related quality of life and satisfaction of the affected clinical staff (ie, medical, nursing, physiotherapy, occupational therapy, and pharmacy), or the quality-of-life ratings and satisfaction of study participants and their families, after the implementation of the 7DART model of rehabilitation. It is too early to evaluate the cost-effectiveness of the 7DART model implementation. Another limitation might be that we only looked at the difference between 5DART and 7DART, and did not specifically look at 6-day rehabilitation therapy, which some other studies did. However, these limitations do not reduce the importance of the study findings in support of the 7DART model of rehabilitation, and they could be the purpose of future research studies.
Conclusions
Despite the fact that patients in both groups had similar functional outcomes and discharge destinations, the 7DART rehabilitation model reduced length of hospital stay and increased rehabilitation workload, demonstrating increased efficiency and access to care by admitting more patients from acute care, rehabilitating them, and discharging them to the community in less time than the 5DART model.
Acknowledgments
We thank all members of the Clinical Informatics Department at St. John's Rehab Hospital for providing the electronic data used in this study; the clinical, management, and professional practice staff at St. John's Rehab Hospital for planning and implementing the 7DART program; and Olesya Falenchuk, PhD, for her review of the statistical analysis.
References
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- A Saturday physiotherapy service may decrease length of stay in patients undergoing rehabilitation in hospital: a randomised controlled trial.Aust J Physiother. 2007; 53: 75-81
- The relationship between therapy intensity and rehabilitation outcomes after traumatic brain injury: a multicenter analysis.Arch Phys Med Rehabil. 2003; 84: 1441-1448
- Effect of weekend physical therapy treatment on postoperative length of stay following total hip and total knee arthroplasty.Physiother Can. 1993; 45: 245-249
- The effect of extra walking on the mobility, independence and exercise self-efficacy of elderly hospital in-patients: a pilot study.Contemp Nurse. 2006; 22: 120-133
- Rehabilitation effectiveness with severe brain injury: translating research into policy.J Head Trauma Rehabil. 1987; 2: 24-36
- Full-time integrated treatment program, a new system for stroke rehabilitation in Japan: comparison with conventional rehabilitation.Am J Phys Med Rehabil. 2004; 83: 88-93
- Cost-effectiveness of the Medicare three-hour regulation.Arch Phys Med Rehabil. 1986; 67: 581-585
- Are stroke patients discharged sooner if in-patient rehabilitation services are provided seven v six days per week?.Am J Phys Med Rehabil. 1999; 78: 143-146
- Comparison of 6- and 7-day physical therapy coverage on length of stay and discharge outcome for individuals with total hip and knee arthroplasty.J Orthop Sports Phys Ther. 1998; 28: 15-22
- Weekend therapy in rehab hospitals: a survey of costs and benefits.Clin Manage. 1987; 7: 16-21
Article Info
Publication History
Published online: July 23, 2012
Footnotes
Reprints are not available from the author.
Supported by the Department of Clinical Research, St. John's Rehab Hospital, Toronto, Ontario, Canada.
No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.
In-press corrected proof published online on Aug 30, 2012, at www.archives-pmr.org.
Identification
Copyright
© 2012 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
