This study identified the explanatory power of the Korean rehabilitation patient group (KRPG) v1.1 for acquired brain injury (ABI) on medical expenses in the rehabilitation hospitals and the correlation of functional outcomes with the expenses. Here, the design is a retrospective analysis from the claim data of the designated rehabilitation hospitals. Data including KRPG information with functional status and medical expenses were collected from 1 January and 31 August 2018. Reduction of variance (R2) was statistically analyzed for the explanation power of the KRPG. Association between functional status and the medical expenses was carried out using the Spearman's rank order correlation (rho). From the claim data of 365 patients with ABI, the KRPG v1.1 explained 8.6% of variance for the total medical expenses and also explained 9.8% of variance for the rehabilitation therapy costs. Cognitive function and spasticity showed very weak correlation with the total medical expenses (rho = −0.17 and −0.14, respectively). Motor power and performance of activities of daily living were associated weakly (rho = −0.27 and −0.30, respectively). The KRPG and related functional status in ABI reflects the total medical expenses and rehabilitation therapy costs insufficiently in the designated rehabilitation hospitals. Thus, the current KRPG algorithm and variables for ABI may need to be ameliorated in the future.
Activities of Daily Living ; Brain Diseases ; Brain Injuries ; Brain ; Cognition ; Diagnosis-Related Groups ; Fee-for-Service Plans ; Humans ; Muscle Spasticity ; Neurological Rehabilitation ; Rehabilitation ; Retrospective Studies

BACKGROUND: Rehabilitations in subacute phase are different from acute treatments regarding the characteristics and required resource consumption of the treatments. Lack of accuracy and validity of the Korean Diagnosis Related Group and Korean Out-Patient Group for the acute patients as the case-mix and payment tool for rehabilitation inpatients have been problematic issues. The objective of the study was to develop the Korean Rehabilitation Patient Group (KRPG) reflecting the characteristics of rehabilitation inpatients. METHODS: As a retrospective medical record survey regarding rehabilitation inpatients, 4,207 episodes were collected through 42 hospitals. Considering the opinions of clinical experts and the decision-tree analysis, the variables for the KRPG system demonstrating the characteristics of rehabilitation inpatients were derived, and the splitting standards of the relevant variables were also set. Using the derived variables, we have drawn the rehabilitation inpatient classification model reflecting the clinical situation of Korea. The performance evaluation was conducted on the KRPG system. RESULTS: The KRPG was targeted at the inpatients with brain or spinal cord injury. The etiologic disease, functional status (cognitive function, activity of daily living, muscle strength, spasticity, level and grade of spinal cord injury), and the patient's age were the variables in the rehabilitation patients. The algorithm of KRPG system after applying the derived variables and total 204 rehabilitation patient groups were developed. The KRPG explained 11.8% of variance in charge for rehabilitation inpatients. It also explained 13.8% of variance in length of stay for them. CONCLUSION: The KRPG version 1.0 reflecting the clinical characteristics of rehabilitation inpatients was classified as 204 groups.
Brain ; Classification ; Diagnosis ; Humans ; Inpatients ; Korea ; Length of Stay ; Medical Records ; Muscle Spasticity ; Muscle Strength ; Outpatients ; Rehabilitation* ; Retrospective Studies ; Spinal Cord ; Spinal Cord Injuries

OBJECTIVE: To assess the risk factors for delirium in patients admitted to a rehabilitation unit for acute or subacute neurological or musculoskeletal disorders. METHODS: We reviewed the medical records of 537 patients admitted to a rehabilitation unit and selected 398 patients in the acute or subacute stage of various neurological or musculoskeletal disorders. Among them, patients who had suffered from delirium were categorized into the delirium group (n=65), and the other patients were categorized into the non-delirium group (n=333). As potential risk factors for delirium, the patients' diagnosis, underlying disease, demographic data, hospital stay duration, surgery, and laboratory findings were reviewed, and the differences between the two groups with respect to independent risk factors were analyzed. RESULTS: The average age in the delirium group was higher; the hospital stay and pre-transfer periods were longer. A large proportion of the patients were admitted for musculoskeletal disorders, and many patients had diabetes mellitus, dementia, and depression as underlying diseases. Laboratory tests revealed increases in the white blood cells (WBC), glucose, blood urea nitrogen (BUN), total bilirubin, aspartate transaminase (AST), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels in the delirium group, while the hemoglobin, calcium, phosphorus, protein, albumin, and potassium levels were decreased. Depression, musculoskeletal disorders, traumatic brain injury, elevated WBC, BUN, AST, and CRP levels, and decreased potassium and phosphorus levels were identified as independent risk factors for delirium. CONCLUSION: Risk factors treatable before delirium onset were identified in rehabilitation patients in acute and subacute stages of various disorders. Early diagnosis and prevention of these risk factors could decrease delirium occurrence and increase rehabilitation effectiveness.
Aspartate Aminotransferases ; Bilirubin ; Blood Glucose ; Blood Sedimentation ; Brain Injuries ; C-Reactive Protein ; Calcium ; Delirium* ; Dementia ; Depression ; Diabetes Mellitus ; Diagnosis ; Early Diagnosis ; Humans ; Length of Stay ; Leukocytes ; Medical Records ; Nitrogen ; Phosphorus ; Potassium ; Rehabilitation* ; Risk Factors* ; Urea

PURPOSE: The purpose of this study was to identify the clinical variables that predict functional and cognitive recovery at 1- and 6-month in both severe and moderate/mild traumatic brain injury patients. METHODS: The subjects of this study were 82 traumatically brain-injured patients who were admitted to a Neurological Intensive Care Unit at a university hospital. Potential prognostic factors included were age, motor and pupillary response, systolic blood pressure, heart rate, and the presence of intracranial hematoma at admission. RESULTS: The significant predictors of functional disability in severe traumatic brain injury subjects were, age, systolic blood pressure, the presence of intracranial hematoma, motor response, and heart rate at admission. In moderate/mild traumatic brain injury patients, motor response, abnormal pupil reflex, and heart rate at admission were identified as significant predictors of functional disability. On the other hand, the significant predictors of cognitive ability for severe traumatic brain injury patients were motor response and the presence of intracranial hematoma at admission, whereas those for moderate/mild patients were motor response, pupil reflex, systolic blood pressure at admission, and age. CONCLUSIONS: The results of the present study indicate that the significant predictors of TBI differ according to TBI severity on admission, outcome type, and outcome measurement time. This can be meaningful to critical care nurses for a better understanding on the prediction of brain injury patients. On the other hand, the model used in the present study appeared to produce relatively low explicabilities for functional and cognitive recovery although a direct comparison of our results with those of others is difficult due to differences in outcome definition and validation METHODS: This implies that other clinical variables should be added to the model used in the present study to increase its predicting power for determining functional and cognitive outcomes.
Adolescent ; Adult ; Aged ; Aged, 80 and over ; Brain Injuries/*diagnosis/*rehabilitation ; Disability Evaluation ; Female ; *Glasgow Coma Scale ; *Health Status Indicators ; Humans ; Korea ; Male ; Middle Aged ; Multivariate Analysis ; Neuropsychological Tests ; Prognosis ; Prospective Studies ; *Recovery of Function

OBJECTIVES: This study was designed to investigate the long-term psychosocial outcome of the patients with traumatic brain injury (TBI) about five years after initial assessment of disability. The psychosocial outcome was evaluated in the areas of cognitive function, neurobehavioral symptoms, socio-occupational function, purpose of life, and quality of life. METHODS: Twenty seven patients with TBI (TBI-S) were selected, who had admitted to the department of Neuropsychiatry of the Wonkwang University Hospital with a primary diagnosis of TBI for the initial assessment of disability during the period 1994-1998. At first, the author assessed their functions with the Neurobehavioral Rating Scale, Social Occupational Functioning Assessment Scale, and Quality of Life Index. And the patients completed the Korean Wechsler Adult Intelligence Scale, Rey-Kim Memory Test and Kims Executive Function Test, the Head Injury Symptom Checklist, Korean version of SmithKline Beecham Quality of Life Scale and Purpose-in-Life Test. The data from the TBI-S were compared between those from the TBI patients (TBI-C) who had received brain injury at the similar time and the TBI-S and admitted for the assessment of disability. RESULTS: Although there was no significant difference between the two TBI groups in the areas of cognitive function, such as general intelligence, verbal comprehension, visuo-spatial function, attention, memory, and executive function, the TBI-S showed significantly lower neurobehavioral symptoms, higher socio-occupational functioning, and higher purpose in life and quality of life levels than the TBI-C. Though 5 years had passed since injury the TBI-S still had various emotional and somatic symptoms and remained at the relatively lower levels in psychosocial functioning. CONCLUSION: The overall long-term psychosocial outcome of the TBI patients depends significantly on the status at the initial assessment of disability about 5 years ago. The improvement was seen in the areas of neurobehavioral symptoms and socio-occupational functioning but not in cognitive function. In spite of the improvement in some areas they still remained at relatively low levels in purpose-in-life and quality of life. This findings suggest that the specialized medical and social support is needed for their rehabilitation.
Adult ; Brain Injuries* ; Checklist ; Comprehension ; Craniocerebral Trauma ; Diagnosis ; Executive Function ; Humans ; Intelligence ; Memory ; Neuropsychiatry ; Quality of Life ; Rehabilitation

OBJECTIVES: This study was designed to investigate the long-term psychosocial outcome of the patients with traumatic brain injury (TBI) about five years after initial assessment of disability. The psychosocial outcome was evaluated in the areas of cognitive function, neurobehavioral symptoms, socio-occupational function, purpose of life, and quality of life. METHODS: Twenty seven patients with TBI (TBI-S) were selected, who had admitted to the department of Neuropsychiatry of the Wonkwang University Hospital with a primary diagnosis of TBI for the initial assessment of disability during the period 1994-1998. At first, the author assessed their functions with the Neurobehavioral Rating Scale, Social Occupational Functioning Assessment Scale, and Quality of Life Index. And the patients completed the Korean Wechsler Adult Intelligence Scale, Rey-Kim Memory Test and Kims Executive Function Test, the Head Injury Symptom Checklist, Korean version of SmithKline Beecham Quality of Life Scale and Purpose-in-Life Test. The data from the TBI-S were compared between those from the TBI patients (TBI-C) who had received brain injury at the similar time and the TBI-S and admitted for the assessment of disability. RESULTS: Although there was no significant difference between the two TBI groups in the areas of cognitive function, such as general intelligence, verbal comprehension, visuo-spatial function, attention, memory, and executive function, the TBI-S showed significantly lower neurobehavioral symptoms, higher socio-occupational functioning, and higher purpose in life and quality of life levels than the TBI-C. Though 5 years had passed since injury the TBI-S still had various emotional and somatic symptoms and remained at the relatively lower levels in psychosocial functioning. CONCLUSION: The overall long-term psychosocial outcome of the TBI patients depends significantly on the status at the initial assessment of disability about 5 years ago. The improvement was seen in the areas of neurobehavioral symptoms and socio-occupational functioning but not in cognitive function. In spite of the improvement in some areas they still remained at relatively low levels in purpose-in-life and quality of life. This findings suggest that the specialized medical and social support is needed for their rehabilitation.
Adult ; Brain Injuries* ; Checklist ; Comprehension ; Craniocerebral Trauma ; Diagnosis ; Executive Function ; Humans ; Intelligence ; Memory ; Neuropsychiatry ; Quality of Life ; Rehabilitation

OBJECTIVE: To identify the factors which can delay home discharges or transfers to other hospitals of rehabilitation inpatients in a tertiary hospital and the change of discharge destination during past 6 years. METHOD: This was a retrospective study of patients with a diagnosis of stroke, traumatic brain injury or spinal cord injury who were admitted to our hospital in 1996, 1999, 2001 and 2003. Demographic data, length of stay, discharge destination and functional status by the FIM(TM) instrument were studied by a medical record review. RESULT: Patients who were transferred to other hospitals or discharged with delay showed significantly lower admission and discharge FIM scores, lower FIM efficiencies, longer length of stays and longer intervals between the onset and admission to a rehabilitation ward. CONCLUSION: Lower functional outcome was associated with a longer length of stay and discharge to another hospital. It would be necessary to establish the long term rehabilitation care facilities with extended rehabilitation program for the patients with lower functional gains in a rehabilitation unit of the tertiary hospitals.
Brain Injuries ; Diagnosis ; Humans ; Inpatients* ; Length of Stay ; Medical Records ; Rehabilitation* ; Retrospective Studies ; Spinal Cord Injuries ; Stroke ; Tertiary Care Centers*

OBJECTIVE: To investigate the influencing factors on the discharge destinations of the patients who were treated in the rehabilitation department of acute hospital for the major disabilities. METHOD: Medical records of the 108 patients with stroke, spinal cord injury and traumatic brain injury were reviewed after the discharge from acute rehabilitation care. The demographic factors, socioeconomic status, disease characteristics and functional status of the patients were evaluated to investigate the affecting factors to the discharge destinations. RESULT: Discharge destinations were subdivided into homes 67 (62%), transfer to other hospitals 31 (29%) and transfer to oriental medicine hospitals 10 (9%). The Functional independence measure (FIM) score, length of rehabilitation care, type of payment, operation and diagnosis significantly influenced discharge destinations (p<0.05). The patients who were transferred to other hospital showed significantly lower FIM score and longer length of rehabilitation care compared with patients who were discharged to home or transferred to oriental medicine hospital (p<0.05). CONCLUSION: The FIM score, length of rehabilitation care, type of payment, operation, and diagnosis significantly influenced the discharge destinations of patients after rehabilitation. It is necessary to increase the subacute or chronic rehabilitation facilities for the case of patients with severe physical disabilities.
Brain Injuries ; Demography ; Diagnosis ; Humans ; Medical Records ; Medicine, East Asian Traditional ; Rehabilitation* ; Social Class ; Spinal Cord Injuries ; Stroke

OBJECTIVE: The purposes of this study are to find out the characteristics of patients with pain in outpatient practice of rehabilitation medicine and to provide basic data for outpatient management. METHOD: We surveyed a hundred one outpatient practices with questionnaire including the distribution of diagnosis, pain site, disease related with pain, pain treatment method, etc. RESULTS: 1) Distribution of diagnosis was traumatic brain injury (TBI) 10.5%, stroke 14.8%, spinal cord injury (SCI) 10.8%, musculoskeletal disorder (MSD) 55.8% and others 8.1% in training hospital, and TBI 6.7%, stroke 10.6%, SCI 14.0%, MSD 58.7% and others 10.0% in non-training general hospital, and TBI 2.6%, stroke 4.9%, SCI 2.9%, MSD 78.3% and others 11.3% in private clinic. 2) The most common site of pain was low back area. 3) The most common disease related with pain was myofascial pain syndrome. 4) Trigger point injection and physical therapy were performed for pain treatment in most of outpatient practice, whereas local injection and nerve block were less used. CONCLUSION: We believe that this study's results will provide helpful basic-data for management of outpatient with pain.
Brain Injuries ; Diagnosis ; Hospitals, General ; Humans ; Myofascial Pain Syndromes ; Nerve Block ; Outpatients* ; Surveys and Questionnaires ; Rehabilitation* ; Spinal Cord Injuries ; Stroke ; Trigger Points

OBJECTIVE: The purpose of this study is to investigate the incidence and types of skin lesions occurring in the patients with a spinal cord injury(SCI), traumatic brain injury(TBI), cerebrovascular accident(CVA), and an amputation. METHOD: Five hundred and eighty-nine charts from 1991 to 1997 were retrospectively reviewed. During the hospitalization, the skin lesions were examined by the dermatologists upon consultations. The patients were divided by their diagnosis of the SCI, TBI, CVA, and amputation. The incidence of the skin lesions were analysed. RESULTS: The number of patients was as follows; SCI 228, TBI 181, CVA 143, and amputation 37. The skin lesions occurred in 72 cases(12.9%) of which 30 cases(13.2%) occured in SCI, 21 cases(11.6%) in TBI, 15 cases(9.8%) in CVA and 7 cases(18.9%) in amputation. These include dermatophytosis 23 cases(23.9%), seborrheic dermatitis 21 cases(21.8%), pilosebaceous disorder 17 cases(17.7%) such as folliculitis, acne, and acneiform eruption, eczema 11 cases(11.4%), drug eruption 9 cases(9.4%), candidiasis 6 cases(6.3%), and others 9 cases(9.4%) such as steatocytoma multiplex, epidermal cyst, intertrigo, alopecia areata, and etc. The incidence of ANS related skin lesion such as seborrheic dermatitis and pilosebaceous disorder in SCI was significantly higher than in TBI and stoke, which the defect is in the brain(p<0.05). However, the incidence in other lesions such as dermatophytosis, eczema, and candidiasis was not significantly different between these two groups(p>0.05). The number of cases of ANS related skin lesions was 21(52.5%) and 3(42.9%) in SCI patients whose level of injury was from C1 to T6(in 40) and at or below T7(in 7) respectively. In contrast, the number of cases of other skin lesions such as dermatophytosis, eczema, and candidiasis was 15(37.5%) of C1 to T6 level and 4(57.1%) of at or below T7 level in the same SCI patients groups. CONCLUSION: This study illustrates that the incidence of skin lesion in rehabilitation unit is 72 cases of 589 patients(12.9%). The incidence of ANS related skin lesion is higher in the patients with spinal cord injury than brain lesion. And the level of injury is higher in SCI, the more skin lesions occur.
Acne Vulgaris ; Acneiform Eruptions ; Alopecia Areata ; Amputation ; Autonomic Nervous System ; Brain ; Candidiasis ; Dermatitis, Seborrheic ; Diagnosis ; Drug Eruptions ; Eczema ; Epidermal Cyst ; Folliculitis ; Hospitalization ; Humans ; Incidence ; Intertrigo ; Pressure Ulcer* ; Referral and Consultation ; Rehabilitation* ; Retrospective Studies ; Skin* ; Spinal Cord ; Spinal Cord Injuries ; Tinea