The functional outcome and length of stay of Aboriginal patients in Saskatchewan inpatient rehabilitation programs

Abstract

The purpose of this study was to investigate the relationship between ethnicity, functional outcome and length of stay in Saskatchewan inpatient rehabilitation programs. The study identified and described the differences in theses rehabilitation outcome measures of Aboriginal and non-Aboriginal patients with disabilities resulting from the following causes (impairment groups): stroke, traumatic brain injury, spinal cord injury, amputation, and 'other' impairments. Using the Functional Independence Measure (FIM), the most commonly used measure of functional outcome in rehabilitation and indicator of the change in severity of disability during rehabilitation, the study identified the difference in the change in the Total, Motor, and Cognitive FIM scores at admission and discharge between Aboriginal and non-Aboriginal patients. The study also identified the differences in the length of stay for Aboriginal and non-Aboriginal patients within similar impairment groups, with similar disability and confounders. The final purpose of the study was to identify possible general strategies described in the literature that could potentially be implemented within Saskatchewan inpatient rehabilitation programs to improve the rehabilitation experience for Aboriginal patients. The settings of the study were a university based tertiary rehabilitation centre in Saskatoon City Hospital, and the Wascana Rehabilitation Centre in Regina, Saskatchewan. Each of the programs under study provided comprehensive, multidisciplinary rehabilitation services. The independent and outcome variables used in this study had been collected in the FIM databases at each rehabilitation centre by the rehabilitation teams. The study population consisted of 1652 individuals admitted to the two rehabilitation programs between 1994 and 1999. The primary independent variable used in the study was ethnicity. The independent co variables were gender, age, marital status, vocational category and effort, impairment group, comorbidities, admit from, pre-admission living with, discharge to living with, and Admission Total, Cognitive, and Motor FIM scores. The outcome variables used were Total FIM Change, Motor FIM Change, Cognitive FIM Change, and Length of Stay. The methods used to analyse the data were descriptive univariate, bivariate, and multivariate. The multivariate analysis consisted of the use of General Linear Models. The data was also analysed for the internal reliability of the FIM instrument with Aboriginal patients. The results of the study indicated that significant differences existed between Aboriginal and non-Aboriginal patients in functional outcome and Length of Stay. Aboriginal patients had significantly lower Total FIM Change, Cognitive FIM Change and shorter lengths of stay than non-Aboriginal patients. These findings add to a very sparse evidence base regarding the rehabilitation experience of Aboriginal peoples in Saskatchewan. This study suggests that further research is required to gain a better understanding of the many factors involved in the differences between Aboriginal and non-Aboriginal functional outcome and length of stay. Further research is also needed to gain some understanding of the holistic experience of Aboriginal peoples in inpatient rehabilitation programs, which should result in opportunities for Aboriginal peoples to participate in the determination of culturally appropriate and relevant rehabilitation program planning. Based on the literature, this study concludes that rehabilitation administrators and staff, in general, should attempt to increase their cultural awareness and understanding to ensure the delivery of culturally sensitive and relevant services.