Objectives-To summarize the efficacy of postacute rehabilitation and to outline future research strategies for increasing knowledge of its effectiveness.Data Sources-English-language systematic reviews that examined multidisciplinary therapybased rehabilitation services for adults, published in the last 25 years and available through Cochrane, Medline, or CINAHL databases. We excluded multidisciplinary biopsychosocial rehabilitation programs and mental health services.Study Selection-Using the search term rehabilitation, 167 records were identified in the Cochrane database, 1163 meta-analyses and reviews were identified in Medline, and 226 in CINAHL. The Medline and CINAHL search was further refined with 3 additional search terms: therapy, multidisciplinary, and interdisciplinary. In summary, we used 12 reviews to summarize the efficacy of multidisciplinary, therapy-based postacute rehabilitation; the 12 covered only 5 populations.Data Extraction-Two reviewers extracted information about study populations, sample sizes, study designs, the settings and timing of rehabilitation, interventions, and findings.Data Synthesis-Based on systematic reviews, the evidence for efficacy of postacute rehabilitation services across the continuum was strongest for stroke. There was also strong evidence supporting multidisciplinary inpatient rehabilitation for patients with rheumatoid arthritis, moderate to severe acquired brain injury, including traumatic etiologies, and for older adults. Heterogeneity limited our ability to conclude a benefit or a lack of a benefit for rehabilitation in other postacute settings for the other conditions in which systematic reviews had been completed. The efficacy of multidisciplinary rehabilitation services has not been systematically reviewed for many of the diagnostic conditions treated in rehabilitation. We did not complete a summary of findings from individual studies.Conclusions-Given the limitations and paucity of systematic reviews, information from carefully designed nonrandomized studies could be used to complement randomized controlled No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit upon the author(s) or upon any organization with which the author(s) is/are associated. The pressure on providers of postacute rehabilitation to deliver clinically effective care will only intensify as cost-containment efforts and requirements for documenting the quality of care increase. Systematically acquired evidence can guide rehabilitation services toward higher quality, effective and cost-efficient care; however, the evidence for certain conditions and rehabilitation settings is better developed than for others. More clearly delineating the evidence of effectiveness will help determine whether certain postacute rehabilitation services produce better outcomes than alternatives. Subsequently, policy-makers, health care administrators, and clinicians might be better informed for making decisions about prov...

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Background. Everything known about the roles, relationships, and repercussions of comorbidity in cardiovascular disease is shaped by how comorbidity is currently measured. Objectives. To critically examine how comorbidity is measured in randomized controlled trials or clinical trials and prospective observational studies in acute myocardial infarction (AMI), heart failure (HF), or stroke. Design. Systematic review of studies of hospitalized adults from MEDLINE CINAHL, PsychINFO, and ISI Web of Science Social Science databases. At least two reviewers screened and extracted all data. Results. From 1432 reviewed abstracts, 26 studies were included (AMI n = 8, HF n = 11, stroke n = 7). Five studies used an instrument to measure comorbidity while the remaining used the presence or absence of an unsubstantiated list of individual diseases. Comorbidity data were obtained from 1–4 different sources with 35% of studies not reporting the source. A year-by-year analysis showed no changes in measurement. Conclusions. The measurement of comorbidity remains limited to a list of conditions without stated rationale or standards increasing the likelihood that the true impact is underestimated.

Objective To examine trajectories of recovery and change in patterns of personal care and instrumental functional activity performance to determine whether different assessment interval designs within a 12-month period yield different estimates of improvement and decline following acute hospitalization and inpatient rehabilitation. Design Secondary analysis of a 12-month prospective cohort study. Setting Transition to the community. Participants Adults (N=419) admitted to acute care and receiving inpatient rehabilitation for a neurological, lower-extremity musculoskeletal, or medically complex condition. Interventions Not applicable Main Outcome Measures Improvement, no change, and decline as measured by the personal care and instrumental scale of the Activity Measure for Post-Acute Care. Results Assessment at the end of a single 12-month follow-up assessment interval showed that over 60% of the participants improved. In contrast, analysis of 2 fixed-length 6-month assessment intervals revealed an almost 40% decrease in the proportion who improved from 6 to 12 months. Fewer participants continued to improve in the time periods further from the acute hospitalization and the proportion of subjects who declined increased from 21.4% to 31.2% to 38.0% over the 3 consecutive assessment intervals (baseline to 1mo, 1–6mo, 6–12mo). Only 58 (19.7%) participants continued on the same path of recovery from baseline to 12 months (9.9% improved over all 3 consecutive time periods, 3.1% made no change, 6.8% declined). Conclusions Examination of change over shorter compared with longer assessment intervals revealed considerable variability in the trajectories of recovery. Research is needed to determine the appropriate frequency and timing for measuring and monitoring function and recovery following an acute hospitalization.