Impact of participation on rehabilitation results: a multivariate study.

Background. Participation in inpatients is commonly considered as a relevant factor influencing rehabilitation results, but its effects are still not exhaustively investigated. Aim. To clarify and quantify the impact of level of participation in rehabilitation on functional outcome in inpatients. Design. Prospective, observational multivariate study. Settings. Rehabilitation hospital. Population. Three hundred and sixty-two patients (mean age 59.41 +/- 12.85 years) with stroke or orthopedic diseases consecutively admitted to rehabilitation hospital. Methods. Rehabilitation program participation was assessed by means of Pittsburgh Rehabilitation Participation Scale (PRPS). Patients who scored below 4 in 25% of the physical and occupational therapy treatment were classified as "low" participants. Multiple and logistic regressions were performed to identify variables associated not only with participation but also with rehabilitation results. Results. Nearly one third of patients (33.88%, primarily stroke) showed low participation. Low early participation (within the first two weeks) was associated with disability and depressive symptoms at admission, and late participation with early participation, age and years of schooling. Both early and late participation were associated with effectiveness of treatment on both ADL and mobility, even if there was much unexplained variance in both models. Patients with low early participation had a greater risk (OR=2.45, 95% CI 1.27-4.71) of a low response to treatment on mobility than the patients who had participated more. Among other prognostic factors, early start of rehabilitation treatment and the presence of cognitive and neuropsychological impairments have significant roles. Conclusions. Our results confirm the importance of participation in rehabilitation programs, which should be encouraged. Further studies are needed to improve knowledge about the overall effects of participation. Clinical Rehabilitation Impact. Early participation should be considered a treatment target as well as a prognostic factor.