(Research Hub Theater) Lower Admission Key IRF-PAI Functional Scores Correspond to Higher Rate of Non-home Discharge Among Lower Extremity Amputees

Background and/or Objectives: The objective of this study was to determine key admission functional factors associated with non-home discharge in lower extremity amputees.

Design: Retrospective comparative study.

Setting: Inpatient rehabilitation hospital affiliated with a tertiary care facility.

Participants: National data from the Select Rehabilitation Hospital System were queried for patients with lower extremity amputation (N=951). Patients were stratified by discharge-to-home (n=680) or not (n=271).

Interventions: n/a

Main Outcome Measures: Inpatient Rehabilitation Facility Patient Assessment Instrument functional scores (IRF-PAI; GG section 6-point independence ratings for self-care activities, body transfers, mobility), length of stay (LOS), and therapy time (per day and total) were compared between groups.

Results: Patients discharged home were younger (62.4±13.1 vs 65.7±12.8, p<.001) and tended to have fewer comorbidities. There were no differences in body mass index values. Higher preadmission manual wheelchair use (42.1% vs 23.6%, p< 0.001) and lower pre-admission use of prosthetics (4.3% vs 12.7%) were noted in patients who were not discharged-to-home. In general, admission IRF-PAI GG scores were lower for all measures in patients who did not go home. However, patients who scored less than “3” (substantial/max assist or functionally dependent) on admission scores for toilet hygiene, transferring from bed-to-chair or sit-to-stand had 10%-33% lower prevalence of discharge-to-home than patients who scored ≥3 (Chi Square tests all p<.001) despite similar LOS. LOS did not differ between the two groups (13.7d-14.0d). Daily and total PT and OT times were 7%-25% lower among patients who were not discharged home (all p<.001).

Conclusions: Requiring substantial/max assist or full dependence on admission for toilet hygiene, transferring from bed to chair or sitting to standing were associated with a lower prevalence of discharge-to-home. Potentially screening for these factors prior to admission to inpatient rehabilitation units could help optimize the value of intensive rehabilitation and ensure patients maximize their therapy needs.