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All Abstracts

Characteristics of the Best Rehabilitation Programs Appear Difficult to Measure

Categories: Rehabilitation and Recovery

The Question

What are the characteristics of effective and efficient rehabilitation treatment programs?

Past Studies

Past Studies have assumed that scales of functional gain and length of stay are adequate measures of the effectiveness, efficiency, and quality of rehabilitation treatment programs. Program effectiveness refers to the amount of functional improvements or measurable gains produced by the rehabilitation program. Program efficiency pertains to the hospital days and cost it takes to produce such gains; prior publications have measured it in terms of functional gain per day in the rehabilitation hospital. . Research associating rehabilitation programs with individual gains is severely limited. Research about administrative factors associated with efficiency, such as the number of staff per patient, is also lacking.

This Study

This study examined information from 77 rehabilitation programs regarding 37,692 inpatients with various diagnoses, including acquired brain injury. The rehabilitation programs were surveyed to assess characteristics commonly believed to be associated with efficiency and effectiveness. Program effectiveness was estimated by the amount of gains calculated from the physical ability and thinking skills scores of the Functional Independence Measure (FIM). The FIM is a general disability scale used to rate the amount of assistance an individual needs for physical movement; daily tasks, such as dressing; and thinking and social skills. The researchers investigated the possible associations between an individual’s length of stay (LOS) in the rehabilitation program with the costs. The LOS was adjusted for injury severity because it varies across patients and facilities. The researchers also considered the amount of staff for patients, how many patients were receiving treatment, facility size, facility accreditation status, and staff opinions about the programs.

The researchers found no relationship between functional gain and the amount of available staff or the intensity of therapies or facility size. Facilities with higher staffing intensity did not produce significantly more functional gain or shorter lengths of stay. . The researchers found no evidence to support the assumption that rehabilitation programs which report greater functional gains or gain per day were better programs or provided better quality of care. Patients with managed care clearly had shorter lengths of stay.

Who May Be Affected By These Findings

Individuals with traumatic brain injuries and families searching for a rehabilitation provider, health care administrators, health care providers, researchers, quality improvement staff.


The researchers found that highly staffed rehabilitation programs did not have shorter LOS. Authors suggest the possible relationships between LOS and financial incentives. Funding was provided as a base rate per patient costs, rather than depending on an individual’s clinical needs. The researchers state that the rehabilitation programs with the highest charged base rates received greater funding and could afford larger amounts of staff and longer LOS. This may explain why there was not an association between staffing levels, LOS, and functional gains.

Bottom Line

The characteristics of effective and efficient rehabilitation treatment programs could not be identified using the available data on functional gain and gross program characteristics. The researchers found no evidence to support the idea that rehabilitation programs, which reported greater functional gains, were better programs or provided more or better quality of care. Additionally, they found no relationship between the functional gain rates and program size, available staff or the intensity of therapy. The researchers state that future studies using more specific subgroups and sophisticated research methods may generate more answers.


Find This Study

Johnston, M. V., Wood, K. D., & Fiedler, R. (2003). Characteristics of effective and efficient rehabilitation programs. Archives of Physical Medicine Rehabilitation, 84, 410-411.

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