Impact of COVID-19 on General Medical Rehabilitation Efficiency in Designated Inpatient Facilities: A Comparative Analysis of Patient Outcomes and Care Processes
Bibliographic record
Abstract
Objective To evaluate how the COVID-19 pandemic affected rehabilitation outcomes and care delivery processes in Physical Medicine and Rehabilitation programs of COVID-19-designated rehabilitation facilities. Design Retrospective cohort study comparing care processes and outcomes between prepandemic and pandemic periods and identifying factors that influenced rehabilitation efficiency using the total score of the Functional Independence Measure (FIM) instrument. Setting Four designated subacute rehabilitation facilities. Participants Patients (N=507) from the Physical Medicine and Rehabilitation program (PMR), with a mean age of 78.3 years (range: 28-99y) and 60% women (ranging from 58% to 64% across groups). The cohort included prepandemic patients (33%), non-COVID-19 patients during the pandemic (33%), patients who were COVID-19-positive before admission (23%), and those who acquired COVID-19 during rehabilitation (11%). Interventions Not applicable. Main Outcome Measures Average daily gain in functional independence using the FIM total score (FIM efficiency), clinical and demographic profiles at admission, functional outcomes, and indicators of care delivery processes. Results While functional outcomes were mostly similar across groups (FIM total score at discharge, P ≥.05), patients who acquired COVID-19 during rehabilitation experienced longer stays (mean difference=32.2d, P <.001) and higher rehospitalization rates (48%, P <.001). In contrast, those infected before admission had shorter stays (mean difference=−9.5d, P <.001) and less multidisciplinary involvement (mean difference=1 discipline, P <.001). Linear mixed effects modeling, with rehabilitation site as random effects, demonstrated that COVID-19 acquisition during rehabilitation and increased multidisciplinary care were significant predictors of reduced FIM efficiency ( P <.001). Conclusions The COVID-19 pandemic affected rehabilitation care delivery processes more than functional outcomes. Patients who acquired COVID-19 during rehabilitation and those requiring more diverse multidisciplinary care showed reduced FIM efficiency, highlighting the importance of infection control measures in rehabilitation settings. These insights will help health care professionals and decision makers optimize future crisis preparedness plans for rehabilitation services.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.030 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.002 | 0.002 |
| Science and technology studies | 0.000 | 0.002 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".