Nav: Home

Rehabilitation services for trauma patients improve outcomes after hospital discharge

November 01, 2016

As more trauma patients survive their initial hospital stays, new study results show that acute inpatient rehabilitation facilities are the best places for some of these patients to go once they leave the hospital. Yet, the percentage of trauma patients sent to these facilities is in decline, according to a new study published online as an "article in press" on the Journal of the American College of Surgeons in advance of print.

Little research exists on survival of trauma patients a year after they leave the hospital. However, study researchers at the University of Washington, Seattle, report that trauma patients who have intensive physical, occupational, and cognitive therapy at an acute care inpatient rehabilitation facility (IRF) are more likely to eventually go home and survive a year after discharge than a matched group of trauma patients who were not discharged to an IRF.

"We believe this study is the first to investigate long-term outcomes in trauma patients discharged to IRFs," lead investigator Saman Arbabi, MD, MPH, FACS, said. "We analyzed data for 993 trauma patients in the Washington State Rehabilitation Registry discharged to an IRF in 2011 and 2012 and compared them with a matched group of 26,127 trauma patients who were not discharged to an IRF." The Washington State Rehabilitation Registry collects demographic and outcomes data on trauma patients discharged to any of the 14 IRFs in the state.

"Advances in in-hospital care have benefited the most severely injured patients who now survive to discharge," Dr. Arbabi said. "Many of these patients require post-hospital care. Over the last several years, there has been an increase in the number of trauma patients being discharged to skilled nursing facilities and a decrease in the number being discharged to inpatient rehabilitation. The data from the current study make this trend particularly concerning."

IRFs and skilled nursing facilities (SNFs) differ in many ways. A patient in an IRF must be able to follow physical therapy for three hours. IRFs have services that are focused on physical, occupational, cognitive, and social therapy with a goal of getting the patient to independently perform activities of daily living. In SNFs, the availability of therapy services can vary and are generally significantly less than IRFs. "There's huge variability among skilled nursing facilities," Dr. Arbabi said.

The researchers rated recovery by improvements in functional independence measure (FIM) scores, noting that those who went to an IRF improved on average from an FIM score of 63.7 to 92.2. These patients also had a nine times greater chance of going home after their post-hospital care and a 40 percent lower risk of death after a year than the control group of trauma patients who did not receive care at an IRF.

"We found that injured patients who received post-discharge rehabilitation care at IRFs in Washington State experienced a significant improvement in functional outcome over the course of their rehabilitation and that 78 percent of these patients were successfully discharged home from the IRF," Dr. Arbabi said. "This finding is particularly striking when one considers the fact that these are generally older and severely injured patients."

In the study, the authors noted a host of trends that do not bode well for post-trauma care. For example, the numbers of IRFs have decreased in the past decade, according to Medicare data. The number of trauma patients discharged to rehabilitation centers has decreased nearly 50 percent in Washington State over the past 20 years, according to a previous study by Dr. Arbabi and co-authors.1 Today only 6 percent of all hospitalized trauma patients in Washington State get discharged to an IRF. That same study showed that patients discharged to an IRF had a mortality rate of 5.5 percent after a year and 12 percent after three years, while patients discharged to an SNF had mortality rates of 18.7 percent and 34 percent at the same intervals.

Dr. Arbabi and coauthors also cited a 2015 multicenter study that showed a significant increase in the number of trauma patients discharged to SNFs compared with IRFs.2

"Rehabilitation for trauma patients is a scarce resource and our study results show that this scarce resource may be important for some trauma patients," Dr. Arbabi said.

"Post-hospital care is as important, if not more important, than hospital care for trauma patients, and in that post-hospital care there should be a plan for physical therapy, cognitive therapy, and educational activities of daily living," he said. "What we call it, per se, is not important. But if we are going to send people to skilled nursing facilities, we need to ensure that these places include these important rehabilitation services as a core part of their care."
The study was awarded first prize in the clinical research category at the American College of Surgeons Committee on Trauma 2015 Resident Trauma Paper Competition.

Study coauthors include Deepika Nehra, MD; Eileen M. Bulger, MD, FACS; Joseph Cuschieri, MD, FACS; and Ronald V. Maier, MD, FACS; of the Department of Surgery, Harborview Medical Center of the University of Washington, along with Zeynep A. Nixon, PhD, MPH, and Claudia Lengenfeld, MN, RN, CRRN, of the Washington State Department of Health.

"FACS" designates that a surgeon is a Fellow of the American College of Surgeons.

The study authors have no conflicts of interest to disclose.

Citation: Acute Rehabilitation after Trauma: Does it Really Matter? Journal of the American College of Surgeons. DOI:

1 Davidson GH, Hamlat CA, Rivara FP, Koepsell TD, Jurkovich GR, Arbabi S. Long-term survival of adult trauma patients. JAMA. 2011;305:1001-1007.
2Ayoung-Chee PR, Rivara FP, Weiser T, Maier RV, Arbabi S. Beyond the hospital doors: Improving long-term outcomes for elderly trauma patients. J Trauma Acute Care Surg. 2015 Apr;78(4):837-43.

About the American College of Surgeons

The American College of Surgeons is a scientific and educational organization of surgeons that was founded in 1913 to raise the standards of surgical practice and improve the quality of care for surgical patients. The College is dedicated to the ethical and competent practice of surgery. Its achievements have significantly influenced the course of scientific surgery in America and have established it as an important advocate for all surgical patients. The College has more than 80,000 members and is the largest organization of surgeons in the world. For more information, visit

American College of Surgeons

Related Rehabilitation Articles:

Study examines the benefits of virtual stroke rehabilitation programs
While virtual medical and rehabilitation appointments seemed novel when COVID-19 first appeared, they now seem to be part of the new norm and might be paving the way to the future.
How rehabilitation impacts research and care of patients with cerebral palsy
Cerebral palsy (CP) is one of the most common developmental movement disorders in children.
Smartphone accelerometers could help in resistance workouts and rehabilitation protocols
Smartphone accelerometers are effective tools to measure key time-under-tension indicators of muscle training -- and could help in resistance-based workouts and rehabilitation protocols.
Many children in intensive care may not be getting rehabilitation therapy, study shows
Adult patients in hospital intensive care units (ICUs) are often given rehabilitation therapy and urged to keep mobile from an early point in their hospital stays.
Movement study could be significant in helping understand brain rehabilitation
Researchers from the University of Plymouth (UK) and Technical University of Munich (Germany) say their study could be particularly important for those working in rehabilitation and helping people to recover after neurological conditions.
Only 1 in 4 Medicare patients participate in cardiac rehabilitation
Only about 24% of Medicare patients who could receive outpatient cardiac rehabilitation participate in the program.
A conversation could be the answer to successful rehabilitation of prisoners
Researchers have found people on the brink of release from a prison sentence have lost any sense of being connected to the outside world and, as a result, become prejudiced towards wider society.
An artificial skin that can help rehabilitation and enhance virtual reality
EPFL scientists have developed a soft artificial skin that provides haptic feedback and -- thanks to a sophisticated self-sensing mechanism -- has the potential to instantaneously adapt to a wearer's movements.
Dynamic reorganization of brain circuit with post-stroke rehabilitation
Nagoya City University researchers have revealed an interaction between cortico-brainstem pathways during training-induced recovery in stroke model rats.
Cardiac rehabilitation: Preliminary results
In the current issue of Cardiovascular Innovations and Applications volume 4, issue 2, pp.
More Rehabilitation News and Rehabilitation Current Events

Trending Science News

Current Coronavirus (COVID-19) News

Top Science Podcasts

We have hand picked the top science podcasts of 2020.
Now Playing: TED Radio Hour

Warped Reality
False information on the internet makes it harder and harder to know what's true, and the consequences have been devastating. This hour, TED speakers explore ideas around technology and deception. Guests include law professor Danielle Citron, journalist Andrew Marantz, and computer scientist Joy Buolamwini.
Now Playing: Science for the People

#576 Science Communication in Creative Places
When you think of science communication, you might think of TED talks or museum talks or video talks, or... people giving lectures. It's a lot of people talking. But there's more to sci comm than that. This week host Bethany Brookshire talks to three people who have looked at science communication in places you might not expect it. We'll speak with Mauna Dasari, a graduate student at Notre Dame, about making mammals into a March Madness match. We'll talk with Sarah Garner, director of the Pathologists Assistant Program at Tulane University School of Medicine, who takes pathology instruction out of...
Now Playing: Radiolab

What If?
There's plenty of speculation about what Donald Trump might do in the wake of the election. Would he dispute the results if he loses? Would he simply refuse to leave office, or even try to use the military to maintain control? Last summer, Rosa Brooks got together a team of experts and political operatives from both sides of the aisle to ask a slightly different question. Rather than arguing about whether he'd do those things, they dug into what exactly would happen if he did. Part war game part choose your own adventure, Rosa's Transition Integrity Project doesn't give us any predictions, and it isn't a referendum on Trump. Instead, it's a deeply illuminating stress test on our laws, our institutions, and on the commitment to democracy written into the constitution. This episode was reported by Bethel Habte, with help from Tracie Hunte, and produced by Bethel Habte. Jeremy Bloom provided original music. Support Radiolab by becoming a member today at     You can read The Transition Integrity Project's report here.