title: Impact of participation on rehabilitation results: a multivariate study.
abstract: BACKGROUND
  Participation in inpatients is commonly considered as a relevant factor influencing rehabilitation results, but its effects are still not exhaustively investigated.
  
  
  OBJECTIVE
  To clarify and quantify the impact of level of participation in rehabilitation on functional outcome in inpatients.
  
  
  METHODS
  Prospective, observational multivariate study.
  
  
  METHODS
  Rehabilitation hospital.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  Early participation should be considered a treatment target as well as a prognostic factor.
authors.affiliation: I.R.C.C.S. Santa Lucia Foundation, Rome, Italy. s.paolucci@hsantalucia.it
authors.forename: S
authors.initials: S
authors.lastname: Paolucci
authors.forename: A
authors.initials: A
authors.lastname: Di Vita
authors.forename: R
authors.initials: R
authors.lastname: Massicci
authors.forename: M
authors.initials: M
authors.lastname: Traballesi
authors.forename: I
authors.initials: I
authors.lastname: Bureca
authors.forename: A
authors.initials: A
authors.lastname: Matano
authors.forename: M
authors.initials: M
authors.lastname: Iosa
authors.forename: C
authors.initials: C
authors.lastname: Guariglia
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D006233:Persons with Disabilities / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009788:Occupational Therapy / Q000379:methods*; D010358:Patient Participation / Q000706:statistics & numerical data*; D026741:Physical Therapy Modalities; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012047:Rehabilitation Centers; D015203:Reproducibility of Results; D000071939:Stroke Rehabilitation; D016896:Treatment Outcome; D055815:Young Adult