Analysis of Adherence to Acute Inpatient Rehabilitation in Patients with Cancer

Abstract

Importance:The need for cancer rehabilitation is expected to continue to dramatically increase with the aging population and increasing number of cancer survivors. These survivors experience a wide range of physical limitations and symptoms that negatively affect their health and quality of life. Research is needed to determine the rate of adherence, reasons for non-adherence, and interventions to improve adherence to acute inpatient rehabilitation among patients with cancer. Objective: To evaluate the rate of adherence and reasons for non-adherence to acute inpatient rehabilitation in patients with cancer. Design, Setting, and Participants: This was a secondary analysis of a retrospective study that assessed medical complications in 165 patients with cancer who had a median length of stay of 11 days (interquartile range of 8-14) in acute inpatient rehabilitation. We reviewed the records of all consecutive patients who underwent acute inpatient rehabilitation from September 1, 2017 through February 28, 2018 at a large academic, quaternary National Cancer Institute-designated Cancer Center. Main Outcomes and Measures: We calculated the rehabilitation session adherence rate and descriptively summarized the reasons for non-adherence. Results: There were 78/165 (47%) patients that had 1 or more incomplete rehabilitation sessions due to medical complications. These patients had a median of 2 (interquartile range of 1-4) incomplete rehabilitation sessions. We noted other reasons for incomplete rehabilitation sessions in 146/165 (89%) patients, who had a median of 3 (interquartile range of 2-4) incomplete rehabilitation sessions. The median total number of days with incomplete rehabilitation sessions in the entire cohort was 2 (interquartile range 1-3). Conclusion and Relevance: Among patients with cancer undergoing acute inpatient rehabilitation, the adherence rate to 1-hour long intensive rehabilitation sessions were low due to medical complications and other reasons. This in turn affected compliance with the 3 hours of rehabilitation a day requirement for acute inpatient rehabilitation. Patients with cancer undergoing acute inpatient rehabilitation are medically complex and further research at multiple institutions with larger cohorts may be beneficial in further assessing adherence rates and reasons for non-adherence to improve participation in acute inpatient rehabilitation.

Urinary Dysfunction: Frequency, Risk factors, and Interventions in patients with Cancer during Acute Inpatient Rehabilitation

“…To our knowledge, this is the first study to report the rate of acute urinary dysfunction among patients with cancer and undergoing acute inpatient rehabilitation. Identifying acute urinary dysfunction in these patients is essential because urinary symptoms can affect patients' participation in rehabilitation programs [25]. Improving patients' ability to independently manage their bladder (and bowel) function is a fundamental goal of acute inpatient rehabilitation, in addition to improving patients' physical functioning levels.…”

Palliative Rehabilitation in Acute Inpatient Rehabilitation: Prognostic Factors and Functional Outcomes in Patients with Cancer

“…Compared to typical patients in the acute inpatient rehabilitation settings, 7 patients with advanced cancer often have intense and dynamic symptoms, psychological distress, 3 ongoing various medical complications, 8 muscle loss, and poor baseline function. A high rate of symptom burdens and medical complications can decrease these patients’ tolerance and participation in intensive acute inpatient rehabilitation, 9 resulting in unplanned transfers back to acute care services. 8 Accordingly, among patients with advanced cancer receiving palliative rehabilitation in an acute inpatient rehabilitation setting, the rehabilitation goals may vary according to life expectancy, symptom burden, functional status, and goals.…”