Effectiveness of Multidisciplinary Rehabilitation Services in Postacute Care: State-of-the-Science. A Review

Abstract

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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“…[2][3][4] Although trials of rehabilitation in the home environment indicate cost effectiveness for many conditions, there is lack of robust evidence toward comparability of the effect of the hospital versus alternative environments. 2,5,6 The evidence is strongest for stroke 7 followed by elective joint surgery 1,8,9 and several other conditions. 1,[8][9][10][11] Rehabilitation in the home (RITH) schemes generally aim to provide short-term, person-centred care in selected cases.…”

Exploring work-related spinal cord injuries in Gauteng province, South Africa

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