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Open Access Research article

Additional Saturday rehabilitation improves functional independence and quality of life and reduces length of stay: a randomized controlled trial

Casey L Peiris12*, Nora Shields13, Natasha K Brusco14, Jennifer J Watts5 and Nicholas F Taylor12

Author Affiliations

1 Department of Physiotherapy, La Trobe University, Melbourne, Victoria, Australia

2 Allied Health Clinical Research Office, Eastern Health, Box Hill, Victoria 3128, Australia

3 Allied Health Learning and Research Unit, Northern Health, Bundoora, Victoria, Australia

4 Physiotherapy Services, Cabrini Health, Malvern, Victoria, Australia

5 School of Health and Social Development, Faculty of Health, Deakin University, Burwood, Victoria, Australia

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BMC Medicine 2013, 11:198  doi:10.1186/1741-7015-11-198

Published: 10 September 2013

Abstract

Background

Many inpatients receive little or no rehabilitation on weekends. Our aim was to determine what effect providing additional Saturday rehabilitation during inpatient rehabilitation had on functional independence, quality of life and length of stay compared to 5 days per week of rehabilitation.

Methods

This was a multicenter, single-blind (assessors) randomized controlled trial with concealed allocation and 12-month follow-up conducted in two publically funded metropolitan inpatient rehabilitation facilities in Melbourne, Australia. Patients were eligible if they were adults (aged ≥18 years) admitted for rehabilitation for any orthopedic, neurological or other disabling conditions excluding those admitted for slow stream rehabilitation/geriatric evaluation and management. Participants were randomly allocated to usual care Monday to Friday rehabilitation (control) or to Monday to Saturday rehabilitation (intervention). The additional Saturday rehabilitation comprised physiotherapy and occupational therapy. The primary outcomes were functional independence (functional independence measure (FIM); measured on an 18 to 126 point scale), health-related quality of life (EQ-5D utility index; measured on a 0 to 1 scale, and EQ-5D visual analog scale; measured on a 0 to 100 scale), and patient length of stay. Outcome measures were assessed on admission, discharge (primary endpoint), and at 6 and 12 months post discharge.

Results

We randomly assigned 996 adults (mean (SD) age 74 (13) years) to Monday to Saturday rehabilitation (n = 496) or usual care Monday to Friday rehabilitation (n = 500). Relative to admission scores, intervention group participants had higher functional independence (mean difference (MD) 2.3, 95% confidence interval (CI) 0.5 to 4.1, P = 0.01) and health-related quality of life (MD 0.04, 95% CI 0.01 to 0.07, P = 0.009) on discharge and may have had a shorter length of stay by 2 days (95% CI 0 to 4, P = 0.1) when compared to control group participants. Intervention group participants were 17% more likely to have achieved a clinically significant change in functional independence of 22 FIM points or more (risk ratio (RR) 1.17, 95% CI 1.03 to 1.34) and 18% more likely to have achieved a clinically significant change in health-related quality of life (RR 1.18, 95% CI 1.04 to 1.34) on discharge compared to the control group. There was some maintenance of effect for functional independence and health-related quality of life at 6-month follow-up but not at 12-month follow-up. There was no difference in the number of adverse events between the groups (incidence rate ratio = 0.81, 95% CI 0.61 to 1.08).

Conclusions

Providing an additional day of rehabilitation improved functional independence and health-related quality of life at discharge and may have reduced length of stay for patients receiving inpatient rehabilitation.

Trial registration

Australian and New Zealand Clinical Trials Registry ACTRN12609000973213

Please see related commentary: http://www.biomedcentral.com/10.1186/1741-7015-11-199 webcite.

Keywords:
Occupational therapy; Physiotherapy; Rehabilitation; Quality of life