Impact of Cognition on Burn Inpatient Rehabilitation Outcomes

Abstract Background A significant proportion of burn injury patients are admitted to inpatient rehabilitation facilities (IRFs). There is increasing interest in the use of functional variables, such as cognition, in predicting IRF outcomes. Cognitive impairment is an important cause of disability in the burn injury population, yet its relationship to IRF outcomes has not been studied. Objective To assess how cognitive function affects rehabilitation outcomes in the burn injury population. Design Retrospective study Setting Inpatient rehabilitation facilities in the United States. Participants A total of 5347 adults admitted to an IRF with burn injury between 2002 and 2011. Methods or Interventions Multivariable regression was used to model rehabilitation outcome measures, using the cognitive domain of the Functional Independence Measure (FIM) instrument as the independent variable and controlling for demographic, medical, and facility covariates. Main Outcome Measurements FIM total gain, readmission to an acute care setting at any time during inpatient rehabilitation, readmission to an acute care setting in the first 3 days of IRF admission, rate of discharge to the community setting, and length of stay efficiency. Results Cognitive FIM total at admission was a significant predictor of FIM total gain, length of stay efficiency, and acute readmission at 3 days ( P < .05). Cognitive FIM total scores did not have an impact on acute care readmission rate or discharge to the community setting. Conclusions Cognitive status may be an important predictor of rehabilitation outcomes in the burn injury population. Future work is needed to further examine the impact of specific cognitive interventions on rehabilitation outcomes in this population. Level of Evidence To be determined.