Article

Literature supporting the benefits of inpatient rehabilitation for
cancer patients is increasing. Many cancer patients, however, do not qualify for
inclusion in the Centers for Medicare and Medicaid 60% rule and consequently may
not receive services. The benefit of inpatient rehabilitation in this specific
cancer group has not been investigated and is the focus of this study. OBJECTIVE:
To investigate functional gains made during inpatient rehabilitation by patients
impaired by cancer, and to compare the functional gains made during inpatient
rehabilitation for patients impaired by cancer in relation to the presence or
absence of metastatic disease and compliance or noncompliance with the Medicare
60% rule. SETTING: Freestanding university-affiliated rehabilitation hospital.
PARTICIPANTS: A total of 176 adult patients admitted for inpatient rehabilitation
due to cancer. METHODS: Retrospective chart review of patients admitted for
inpatient rehabilitation with deficits identified related to cancer. MAIN OUTCOME
MEASURES: Demographic data including cancer type, presence of metastasis, age,
gender, marital status, ethnicity, length of stay (LOS), discharge destination,
and transfer to acute care. Functional status including admission and discharge
Functional Independence Measure Score (FIM), total, motor, and cognitive FIM
gains, total, motor, and cognitive FIM efficiency for the study sample, for
patients with and without a diagnosis compliant with the 60% rule and for
patients with and without metastatic disease. RESULTS: In all, 176 cases met
inclusion criteria. An admission coded diagnosis that was compliant with the 60%
rule was present in 97 cases (55.1%). In 153 cases, the presence or absence of
metastatic disease was known. Metastatic disease was present in 69 cases (45%).
All groups (total sample, metastatic versus nonmetastatic, compliant versus
noncompliant) made significant functional gains. Patients with a diagnosis
noncompliant with the 60% rule had higher admission total FIM (P = .001),
discharge total FIM (P = .014), admission motor FIM (P = .005), admission
cognitive FIM (P = .008), and discharge cognitive FIM (P < .001) scores than
those with a compliant diagnosis. Patients with metastatic disease had higher
admission total FIM (P = .026) and admission (P = .001) and discharge (P = .02)
cognitive FIM scores than patients with nonmetastatic disease. There were no
significant differences between groups regarding total, motor, or cognitive FIM
gains or total motor or cognitive FIM efficiencies. Differences in age, length of
stay, and admission motor and discharge FIM scores between groups were related to
cancer types and source of impairment. CONCLUSION: Patients with functional
limitations resulting from cancer or its treatment made significant functional
gains in inpatient rehabilitation. There were no significant differences in
functional gains made by those with or without metastatic disease or those
compliant versus noncompliant with the 60% rule. The presence of metastatic
disease or a diagnosis not compliant with the 60% rule does not preclude cancer
patients from making significant functional gains.
CI - Copyright (c) 2016 American Academy of Physical Medicine and Rehabilitation.
Published by Elsevier Inc. All rights reserved.

Langue : ANGLAIS