A retrospective study of 251 patients admitted to a multidisciplinary, neurorehabilitation unit with intensive care unit capabilities

Abstract

Introduction: In Denmark, specialised neurorehabilitation is centralised in two centres; one is Hammel Neurocentre. The neurointensive stepdown unit at Silkeborg Regional Hospital offers intensive care in addition to specialised neurorehabilitation of patients transferring to Hammel. Knowledge on patient’s characteristics and course of rehabilitation in this kind of setting is sparse.

Objective: To characterise the patients, their change in function and to identify variables associated with referral time to Hammel.

Methods: Functional scores and available covariates were extracted from hospital records on 251 patients admitted from 01 November 2011 to 31 July 2016. Statistical methods included logistic regression and paired tests.

Results: Mean (standard deviation) time from injury to admission at the neurointensive stepdown unit was 30 (22) d, medians (interquartile range) of Functional Independence Measure and Early Functional Abilities increased significantly from 18 (18, 19) to 24 (18, 44) and 37 (30, 46) to 52 (43, 70), respectively, during admission (p < 0.01). Spontaneous ventilation and Early Functional Abilities score on admission were positively associated with early referral. Obesity and anoxic brain injury were negatively associated with early referral.

Conclusions: This study demonstrated functional improvement in patients in a neurointensive stepdown unit and identified variables associated with early referral. The study indicated higher sensitivity of the Early Functional Abilities score as compared to the Functional Independence Measure.

Implications for rehabilitation

• Patients requiring prolonged intensive care services after severe acquired brain injury may require the fusion of neurorehabilitation and intensive care services to benefit maximally.

• There is a need for a consensus on which functional scores to use when documenting functional level and functional changes in patients with severe acquired brain injury and very low functional levels.

• The Early Functional Abilities score is an example of a valuable tool when assessing functional levels of patients with severe acquired brain injury and very low functional levels.

Keywords:

• Intensive care unit
• acquired brain injury
• rehabilitation
• mechanical ventilation
• early functional abilities
• functional independence measure

Acknowledgements

The authors would like to thank the project nurses, Maria Haarh Uhd and Anne-Louise Degn Wivelsted for their efforts in collecting the data from the hospital records.

Disclosure statement

The authors declare that they have no conflict of interests to report.