OJTR  Vol.1 No.2 , November 2013
Inpatient rehabilitation outcomes in solid organ transplantation: Results of a unique partnership between the rehabilitation hospital and the multi-organ transplant unit in an acute hospital
ABSTRACT
Objective: To determine the outcomes in solid organ transplant recipients following inpatient rehabilitation, as a result of a unique partnership between the rehabilitation hospital and the multi-organ transplant program in an acute hospital. Design: Retrospective observational study. Setting: Community rehabilitation hospital affiliated with a university. Participants: A cohort of 173 organ transplant patients admitted consecutively over a four-year period (2004-2008) was compared to a cohort of all rehabilitation patients (n = 9762) admitted to the same inpatient rehab facility during the same period. Interventions: Inpatient rehab program to all participants. Main Outcome Measures: Length of hospital stay, Functional Independence Measure (FIMTM) change (admission-discharge), and rate of discharges to home. Results: Outcomes were measured using components of the FIMTM instrument, admission and discharge data. Chi-square and independent two-sample t-tests were used for statistical analysis. Compared to a general rehabilitation inpatient population, transplant rehabilitation inpatients had: more immediate (<3 days) transfers to an acute hospital (5.2% vs. 1.9%, p < 0.001); a higher rate of readmission to an acute hospital after the first 3 days (19.1% vs. 1.9%, p < 0.001); a longer mean length of stay (27 ± 19 vs. 20 ± 18 days, p < 0.001); a lower total FIMTM change (8.9 vs. 20.9, p < 0.001); a lower FIMTM efficiency (1.1 vs. 1.4, p < 0.001); and a higher rate of discharges to home in patients not readmitted to acute care (98.5% vs. 94.5% p < 0.001). Conclusion: Outcomes of rehabilitation in solid organ transplant patients are comparable but not identical to those in other patient groups. Inpatient rehabilitation for transplant patients is therefore fully justifiable and necessary. The ten times higher rate of transplant patient readmission to acute hospital must be communicated, facilitated, accepted and managed within a partnership strategy.

Cite this paper
Patcai, J. , Disotto-Monastero, M. , Gomez, M. and Adcock, L. (2013) Inpatient rehabilitation outcomes in solid organ transplantation: Results of a unique partnership between the rehabilitation hospital and the multi-organ transplant unit in an acute hospital. Open Journal of Therapy and Rehabilitation, 1, 52-61. doi: 10.4236/ojtr.2013.12009.
References
[1]   Bravata, D.M., Olkin, I., Barnato, A.E., Keeffe, E.B. and Owens, D.K. (1999) Health-related quality of life after liver transplantation: A meta-analysis. Liver Transplantation and Surgery, 5, 318-331. http://dx.doi.org/10.1002/lt.500050404

[2]   Hathaway, D.K., Winsett, R.P., Johnson, C., Tolley, E.A., Hartwig, M., Milstead, J., et al. (1998) Post kidney transplant quality of life prediction models. Clinical Transplantation, 12, 168-174.

[3]   Liem, Y.S., Bosch, J.L., Arends, L.R., Heijenbrok Kal, M.H. and Hunink, M. (2007) Quality of life assessed with the medical outcomes study short form 36 item health survey of patients on renal replacement therapy: A systematic review and meta analysis. Value in Health, 10, 390-397. http://dx.doi.org/10.1111/j.1524-4733.2007.00193.x

[4]   Smith, G.C., Trauer, T., Kerr, P.G. and Chadban, S.J. (2010) Prospective quality-of-life monitoring of simultaneous pancreas and kidney transplant recipients using the 36-item short form health survey. American Journal of Kidney Diseases, 55, 698-707. http://dx.doi.org/10.1053/j.ajkd.2009.12.025

[5]   Isla Pera, P., Moncho Vasallo, J., Torras Rabasa, A., Oppenheimer Salinas, F., Fernandez Cruz Perez, L. and Ricart Brulles, M.J. (2009) Quality of life in simultaneous pancreas-kidney transplant recipients. Clinical Transplantation, 23, 600-605. http://dx.doi.org/10.1111/j.1399-0012.2009.01054.x

[6]   Hummel, M., Michauk, I., Hetzer, R. and Fuhrmann, B. (2001) Quality of life after heart and heart-lung transplantation. Transplantation Proceedings, 33, 3546-3548. http://dx.doi.org/10.1016/S0041-1345(01)02427-7

[7]   Littlefield, C., Abbey, S., Fiducia, D., Cardella, C., Greig, P., Levy, G., et al. (1996) Quality of life following transplantation of the heart, liver, and lungs. General Hospital Psychiatry, 18, 36S-47S. http://dx.doi.org/10.1016/S0163-8343(96)00082-5

[8]   Pinson, C.W., Feurer, I.D., Payne, J.L., Wise, P.E., Shockley, S. and Speroff, T. (2000) Health-related quality of life after different types of solid organ transplantation. Annals of Surgery, 232, 597-607. http://dx.doi.org/10.1097/00000658-200010000-00015

[9]   Beyer, N., Aadahl, M., Strange, B., Kirkegaard, P., Hansen, B.A., Mohr, T., et al. (1999) Improved physical performance after orthotopic liver transplantation. Liver Transplantation and Surgery, 5, 301-309. http://dx.doi.org/10.1002/lt.500050406

[10]   Wickerson, L., Mathur, S. and Brooks, D. (2010) Exercise training after lung transplantation: A systematic review. The Journal of Heart and Lung Transplantation, 29, 497-503. http://dx.doi.org/10.1016/j.healun.2009.12.008

[11]   Gordon, E.J., Prohaska, T., Siminoff, L.A., Minich, P.J. and Sehgal, A.R. (2005) Needed: Tailored exercise regimens for kidney transplant recipients. American Journal of Kidney Diseases, 45, 769-774. http://dx.doi.org/10.1053/j.ajkd.2005.01.002

[12]   Painter, P.L., Hector, L., Ray, K., Lynes, L., Dibble, S., Paul, S.M., et al. (2002) A randomized trial of exercise training after renal transplantation. Transplantation, 74, 42-48. http://dx.doi.org/10.1097/00007890-200207150-00008

[13]   Di Landro, D., Koenigsrainer, A., Oefner, D., Aichberger, C., Romagnoli, G.F. and Margreiter, R. (1996) Experience with 100 combined pancreatic renal transplantations in a single center. Nephron, 72, 547-551. http://dx.doi.org/10.1159/000188937

[14]   Haykowsky, M., Taylor, D., Kim, D. and Tymchak, W. (2009) Exercise training improves aerobic capacity and skeletal muscle function in heart transplant recipients. American Journal of Transplantation, 9, 734-739. http://dx.doi.org/10.1111/j.1600-6143.2008.02531.x

[15]   Kobashigawa, J.A., Leaf, D.A., Lee, N., Gleeson, M.P., Liu, H., Hamilton, M.A., et al. (1999) A controlled trial of exercise rehabilitation after heart transplantation. New England Journal of Medicine, 340, 272-277. http://dx.doi.org/10.1056/NEJM199901283400404

[16]   Stewart, K.J., Badenhop, D., Brubaker, P.H., Keteyian, S.J. and King, M. (2003) Cardiac rehabilitation following percutaneous revascularization, heart transplant, heart valve surgery, and for chronic heart failure. Chest, 123, 2104-2111. http://dx.doi.org/10.1378/chest.123.6.2104

[17]   Stewart, K.J., Badenhop, D., Brubaker, P.H., Keteyian, S.J. and King, M. (2003) Cardiac rehabilitation following percutaneous revascularization, heart transplant, heart valve surgery, and for chronic heart failure. Chest, 123, 2104. http://dx.doi.org/10.1378/chest.123.6.2104

[18]   Taylor, R.S., Brown, A., Ebrahim, S., Jolliffe, J., Noorani, H., Rees, K., et al. (2004) Exercise-based rehabilitation for patients with coronary heart disease: Systematic review and meta-analysis of randomized controlled trials. The American Journal of Medicine, 116, 682-692. http://dx.doi.org/10.1016/j.amjmed.2004.01.009

[19]   Tuel, S.M., Meythaler, J.M. and Cross, L.L. (1991) Inpatient comprehensive rehabilitation after liver transplantation. American Journal of Physical Medicine & Rehabilitation, 70, 242-245. http://dx.doi.org/10.1097/00002060-199110000-00003

[20]   Hastings, J., Gowans, S. and Watson, D.E. (2004) Effectiveness of occupational therapy following organ transplantation. Canadian Journal of Occupational Therapy, 71, 238-242. http://dx.doi.org/10.1177/000841740407100409

[21]   Cortazzo, M.H., Helkowski, W., Pippin, B., Boninger, M.L. and Zafonte, R. (2005) Acute inpatient rehabilitation of 55 patients after liver transplantation. American Journal of Physical Medicine & Rehabilitation, 84, 880-884. http://dx.doi.org/10.1097/01.phm.0000184093.53032.ed

[22]   Joshi, A. and Kevorkian, C.G. (1997) Rehabilitation after cardiac transplantation: Case series and literature review. American Journal of Physical Medicine & Rehabilitation, 76, 249. http://dx.doi.org/10.1097/00002060-199705000-00019

[23]   Cowen, T.D., Huang, C.T., Lebow, J., Devivo, M.J. and Hawkins, L.V.N. (1995) Functional outcomes after inpatient rehabilitation of patients with end-stage renal disease. Archives of Physical Medicine and Rehabilitation, 76, 355-359. http://dx.doi.org/10.1016/S0003-9993(95)80661-X

[24]   Stephenson, A.L., Yoshida, E.M., Abboud, R.T., Fradet, G. and Levy, R.D. (2001) Impaired exercise performance after successful liver transplantation. Transplantation, 72, 1161-1164. http://dx.doi.org/10.1097/00007890-200109270-00032

[25]   Hasse, J.M. (2001) Nutrition assessment and support of organ transplant recipients. Journal of Parenteral and Enteral Nutrition, 25, 120-131. http://dx.doi.org/10.1177/0148607101025003120

[26]   Dittmer, D.K. and Teasell, R. (1993) Complications of immobilization and bed rest. Part 1: Musculoskeletal and cardiovascular complications. Canadian Family Physician, 39, 1428-1432, 1435-1437.

[27]   Teasell, R. and Dittmer, D.K. (1993) Complications of immobilization and bed rest. Part 2: Other complications. Canadian Family Physician, 39, 1440-1442, 1445-1446.

[28]   Koch, S., Spuler, S., Deja, M., Bierbrauer, J., Dimroth, A., Behse, F., et al. (2011) Critical illness myopathy is frequent: Accompanying neuropathy protracts ICU discharge. Journal of Neurology, Neurosurgery & Psychiatry, 82, 287-293. http://dx.doi.org/10.1136/jnnp.2009.192997

[29]   Hudson, L.D. and Lee, C.M. (2003) Neuromuscular sequelae of critical illness. New England Journal of Medicine, 348, 745-747. http://dx.doi.org/10.1056/NEJMe020180

[30]   Herridge, M.S., Cheung, A.M., Tansey, C.M., Matte-Martyn, A., Diaz-Granados, N., Al-Saidi, F., et al. (2003) One-year outcomes in survivors of the acute respiratory distress syndrome. New England Journal of Medicine, 348, 683-693. http://dx.doi.org/10.1056/NEJMoa022450

[31]   Latronico, N. and Guarneri, B. (2008) Critical illness myopathy and neuropathy. Minerva Anestesiologica, 74, 319-323.

[32]   Campellone, J.V., Lacomis, D., Giuliani, M.J. and Kramer, D.J. (1998) Mononeuropathies associated with liver transplantation. Muscle & Nerve, 21, 896-901. http://dx.doi.org/10.1002/(SICI)1097-4598(199807)21:7<896::AID-MUS7>3.0.CO;2-1

[33]   Campellone, J.V., Lacomis, D., Kramer, D.J., Van Cott, A.C. and Giuliani, M.J. (1998) Acute myopathy after liver transplantation. Neurology, 50, 46-53. http://dx.doi.org/10.1212/WNL.50.1.46

[34]   Hockerstedt, K., Kajaste, S., Muuronen, A., Raininko, R., Seppalainen, A.M. and Hillbom, M. (1992) Encephalopathy and neuropathy in end-stage liver disease before and after liver transplantation. Journal of Hepatology, 16, 31-37. http://dx.doi.org/10.1016/S0168-8278(05)80091-1

[35]   Ahonen, R.E. (1981) Peripheral neuropathy in uremic patients and in renal transplant recipients. Acta Neuropathologica, 54, 43-53. http://dx.doi.org/10.1007/BF00691331

[36]   Ducloux, D., Schuller, V., Bresson-Vautrin, C. and Chalopin, J.M. (1997) Colchicine myopathy in renal transplant recipients on cyclosporin. Nephrology Dialysis Transplantation, 12, 2389-2392. http://dx.doi.org/10.1093/ndt/12.11.2389

[37]   Pantiga, C., Rodrigo, L.R., Cuesta, M., Lopez, L. and Arias, J.L. (2003) Cognitive deficits in patients with hepatic cirrhosis and in liver transplant recipients. The Journal of Neuropsychiatry and Clinical Neurosciences, 15, 84-89. http://dx.doi.org/10.1176/appi.neuropsych.15.1.84

[38]   Cupples, S.A. and Stilley, C.S. (2005) Cognitive function in adult cardiothoracic transplant candidates and recipents. Journal of Cardiovascular Nursing, 20, S74-S87. http://dx.doi.org/10.1097/00005082-200509001-00009

[39]   Brown, E.S. (2003) Management of psychiatric side effects associated with corticosteroids. Expert Review of Neurotherapeutics, 3, 69-75. http://dx.doi.org/10.1586/14737175.3.1.69

[40]   Newman, M.F., Kirchner, J.L., Phillips-Bute, B., Gaver, V., Grocott, H., Jones, R.H., et al. (2001) Longitudinal assessment of neurocognitive function after coronary-artery bypass surgery. The New England Journal of Medicine, 344, 395-402. http://dx.doi.org/10.1056/NEJM200102083440601

[41]   Granger, C.V. and Hamilton, B.B. (1992) The uniform data system for medical rehabilitation report of first admissions for 1990. American Journal of Physical Medicine & Rehabilitation, 71, 108-113. http://dx.doi.org/10.1097/00002060-199204000-00009

[42]   Heinemann, A.W., Kirk, P., Hastie, B.A., Semik, P., Hamilton, B.B., Linacre, J.M., Wright, B.D. and Granger, C. (1997) Relationships between disability measures and nursing effort during medical rehabilitation for patients with traumatic brain and spinal cord injury. Archives of Physical Medicine and Rehabilitation, 78, 143-149. http://dx.doi.org/10.1016/S0003-9993(97)90255-0

[43]   Oczkowski, W.J. and Barreca, S. (1993) The functional independence measure: Its use to identify rehabilitation needs in stroke survivors. Archives of Physical Medicine and Rehabilitation, 74, 1291-1294. http://dx.doi.org/10.1016/0003-9993(93)90081-K

[44]   Pollack, N., Rheault, W. and Stoecker, J.L. (1996) Reliability and validity of the FIM for persons aged 80 years band above from a multilevel continuing care retirement community. Archives of Physical Medicine and Rehabilitation, 77, 1056-1061. http://dx.doi.org/10.1016/S0003-9993(96)90068-4

[45]   Segal, M.E., Gillard, M. and Schall, R.R. (1996) Telephone and in-person agreement between stroke patients and caregivers for the functional independence measure. American Journal of Physical Medicine & Rehabilitation, 75, 208-212. http://dx.doi.org/10.1097/00002060-199605000-00013

[46]   Whitlock, J.A. and Hamilton, B.B. (1995) Functional outcome after rehabilitation for severe traumatic brain injury. Archives of Physical Medicine and Rehabilitation, 76, 1103-1112. http://dx.doi.org/10.1016/S0003-9993(95)80117-0

[47]   Heinemann, A.W., Linacre, J.M., Wright, B.D., Hamilton, B.B. and Granger, C.V. (1993) Relationships between impairment and physical disability as measured by the functional independence measure. Archives of Physical Medicine and Rehabilitation, 74, 566-573.

[48]   Mokler, P.J., Sandstrom, R., Griffin, M., Farris, L. and Jones, C. (2000) Predicting discharge destination for patients with severe motor stroke: Important functional tasks. Neurorehabilitation and Neural Repair, 14, 181-185.

[49]   D’Aquila, M.A., Smith, T., Organ, D., Lichtman, S. and Reding, M. (2004) Validation of a lateropulsion scale for patients recovering from stroke. Clinical Rehabilitation, 18, 102-109. http://dx.doi.org/10.1191/0269215504cr709oa

[50]   Ring, H., Bar, L. and Abboud, S. (1999) Functional correlates with left-right asymmetry of visual evoked potentials in stroke patients: Modeling and experimental results. Archives of Physical Medicine and Rehabilitation, 80, 166-172. http://dx.doi.org/10.1016/S0003-9993(99)90115-6

[51]   Saboe, L.A., Darrah, J.M., Pains, K.S. and Guthrie, J. (1997) Early predictors of functional independence 2 years after spinal cord injury. Archives of Physical Medicine and Rehabilitation, 78, 644-650. http://dx.doi.org/10.1016/S0003-9993(97)90431-7

[52]   Mylotte, J.M., Graham, R., Kahler, L., Young, L. and Goodnough, S. (2001) Impact of nosocomial infection on length of stay and functional improvement among patients admitted to an acute rehabilitation unit. Infection Control and Hospital Epidemiology, 22, 83-87. http://dx.doi.org/10.1086/501868

[53]   Nakamura, D.Y., Esselman, P.C., Mann, R. and Engrav, L.H. (1997) The inadequacy of the FIM (Functional independence measure) for burns. Journal of Burn Care & Rehabilitation, 18, S140.

[54]   Esselman, P.C., Engrav, L.H., Ptacek, J.T., Kowalske, K. and Krabak, B. (2000) Outcome of burn injuries in older adults. Journal of Burn Care & Rehabilitation, 21, S192. http://dx.doi.org/10.1097/00004630-200001001-00116

[55]   Costa, B.A., Engrav, L.H., Holavanahalli, R., Lezotte, D.C., Patterson, D.R., Kowalske, K.J. and Esselman, P.C. (2003) Impairment after burns: A two-center, prospective report. Burns, 29, 671-675. http://dx.doi.org/10.1016/S0305-4179(03)00153-0

[56]   Dodds, T.A., Martin, D.P., Stolov, W.C. and Deyo, R.A. (1993) A validation of the functional independence measurement and its performance among rehabilitation inpatients. Archives of Physical Medicine and Rehabilitation, 74, 531-536. http://dx.doi.org/10.1016/0003-9993(93)90119-U

[57]   Ottenbacher, K.J., Smith, P.M., Illig, S.B., Linn, R.T., Ostir, G.V. and Granger, C.V. (2004) Trends in length of stay, living setting, functional outcome, and mortality following medical rehabilitation. JAMA, 292, 1687-1695. http://dx.doi.org/10.1001/jama.292.14.1687

[58]   Alam, E., Wilson, R.D. and Vargo, M.M. (2008) Inpatient cancer rehabilitation: A retrospective comparison of transfer back to acute care between patients with neoplasm and other rehabilitation patients. Archives of Physical Medicine and Rehabilitation, 89, 1284-1289. http://dx.doi.org/10.1016/j.apmr.2008.01.014

[59]   Guo, Y., Persyn, L., Palmer, J.L. and Bruera, E. (2008) Incidence of and risk factors for transferring cancer patients from rehabilitation to acute care units. American Journal of Physical Medicine & Rehabilitation, 87, 647-653. http://dx.doi.org/10.1097/PHM.0b013e31817fb94e

[60]   Herridge, M.S. (2009) Building consensus on ICU-acquired weakness. Intensive Care Medicine, 35, 1-3. http://dx.doi.org/10.1007/s00134-008-1305-3

 
 
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